The number of mergers and acquisitions in healthcare has been increasing. M&A activities almost always involve changes in technology, EMRs, and/or workflows. Are there implications to clinical workflows and patient care as a result of technology changes? If so, what are they and how do you reduce the risk of patient safety issues? There is a lot to consider in regards to clinical operational readiness during this undertaking.
Plan for Clinical Operational Readiness
Clinical Operational Readiness (CORe) is something to plan for with each M&A event. Significant impacts and a large body of work for CORe includes updating policies, procedures, protocols, and order sets.
Even when healthcare institutions have similar policies, the language used and workflow for policies differ from institution to institution, system setting to system setting. It is important to take into consideration these differences and how they are impacted by the change.
- Don’t assume that the same groups of people handle the same tasks at every facility.
- Don’t assume that settings or policies are always going to be equal. A significant portion of policies, procedures, protocols and order sets can be impacted by this new arrangement. Supplies and formularies can change thus impacting order sets.
- Technology differences will affect the wording and structure of many of your policies.
- Different hospital groups handle protocols differently.
Bottom line: All must be reviewed and altered where needed.
Why Clinical Operational Readiness Matters
Recently we were working with a client on their clinical operational readiness plans and the clinical review group discovered this situation.
The policy for critical values was different for the new hospital from the acquiring hospital group. Alerts were embedded within the EMR based on the original hospital group’s settings. The laboratory machines at this new hospital had different parameters for their critical values and normal ranges. This then caused issues with order sets for certain types of medications where lab results helped to direct what settings should be made for medication administration. Changes had to be made in the EMR to help direct healthcare staff differently than the other institutions.
Bottom line: Had this not been discovered by the clinical review groups, the impact could have been detrimental to patient care.
How to Organize the Clinical Readiness Operations Work
Here are some approaches that help to organize this effort to review all these as you work towards your transition:
- Establish leadership champions
- Having a solid group of executive leaders (CMO, CNO, COO) who support this process will help the rest of the managers and directors understand the urgency of these reviews
- This leadership staff can also reduce roadblocks for approvals and expedite the process for your go-live.
- Create multi-disciplinary committees for review
- Many of the items changing will impact not just nursing or physicians, but may impact your respiratory therapists, laboratory personnel, and even your front desk staff.
- Have teams that can regularly meet to review the policies and potential impacts
- Involve the EMR build team in your clinical committee meetings
- While clinically you can make policy changes, the EMR staff will have awareness of downstream impact within the system.
- The EMR staff should be able to identify areas where policies, protocols or orders have embedded information that is critical to review.
- They can help to identify lists of items pertinent to review.
- Visualize the process
- Most of your staff are visual learners. If you can provide demonstrations on how these policies, protocols, orders, etc. would function within the EMR, then they will be able to identify issues and pain points.
- Workflow dress rehearsals are another great way to vet out any potential issues with these changes. “How will this work” is the ultimate end goal to validate the changes that you are making to the EMR and to your policies.
Of course, these are only a few items to help you through this transition. There are many moving parts to this process.
Build a strong team
The last word of advice is to stay flexible and to expect change. These situations are always stressful with so much going on. Having a strong team that works together will help your facility to get through all the changes.
At whatever stage your organization might be in the M&A process, you may find you need an advocate and advisor. We have a team of healthcare IT professionals with experience in patient care delivery and healthcare operations who have helped hospitals navigate and manage through the complexities of mergers and acquisitions and can help your organization, too.
