[MUSIC] I'd like to start off this segment by reading a paragraph from the end of one of the articles that we have posted on the course website. This is the 2000 JAMIA publication A Review, Managing Change by Nancy Lorenzi and Robert Reilly. Towards the end, you'll see the paragraph, quote, common wisdom suggests that technology drives change in the organizational environment. That common wisdom is wrong. Instead, information technology is a powerful enabling force that creates new options and opportunities in the environment for what organizations produce, whether goods or services, and how they produce it. The early response by innovative players drives change, end quote. In this segment, you'll hear me talk with one of the innovative players that's driving change in the emergency room here at Hopkins. He is a physician and the director of telemedicine in the emergency department. His clinical and research time is focused on the use of technology in improving access to emergency care. During the discussion, we'll touch on a litany of topics related to the course. Organizational readiness for change, generating short term wins, work flow, the issue of early adopters. But what I especially want you to listen to is the portion where he and I discuss some of the internal factors within the organization. As well as some external factors outside the health system. And the impact that they've had on some of his initiatives and innovative work. As you listen, think about what parts of a SWOT analysis you can glean information from based on our discussion. I do want you to think about it from the perspective of a SWOT analysis for the larger health system here at Hopkins. Think about it from the perspective of a telemedicine evangelist in the emergency room, okay. We end up covering, during the discussion, two parts of SWOT. So as a refresher, S for strength, W for weaknesses, O for opportunities, T for threats. Remember, a SWOT analysis is a study that can be taken on to examine internal factors within an organization and external opportunities and threats that impact an organization. So take a listen to the discussion as you learn about tele-emergency medicine here at Hopkins, and I'll follow up with you right after. I'm joined now by Dr. Junaid Razzak, who's the director of tele-emergency medicine here at Johns Hopkins. Dr. Razzak, thanks a lot for taking a few moments to chat with me. >> Thank you so much for the invitation. >> Yeah, now tell me a little bit about your role as an emergency physician here at Hopkins. >> So I play multiple roles, but within the telemedicine world, I am responsible for innovation in telemedicine in emergency medicine, especially focusing on the front door of the emergency department, when patients are coming in. And how do we match our capacity with the load we have. >> Yeah, yeah, okay. Now, you're a practicing provider as well. How did you get into this role in health IT? I think it's interesting for students to hear about the multiple different pathways. >> Right, the focus of emergency medicine is access to care. And there is, in most systems, I would say almost every system in the world there's a mismatch between the need and the capacity, so that hampers access to care. Prior to joining Hopkins, I was involved in a project on telemedicine, it was a more international project where we were trying to help patients get access to right kind of care using telemedicine. So when I first came here, I saw this need, and there was an interest by the leadership of the department. And so we started with the program and that it is also right time telemedicine's catching up in the rest of the world. Hopkins was already interested, my department was interested, so multiple things sort of pushed me in the direction. Right, I'm really glad that you brought that up about it being the right time. because one of the concepts we try to impress upon students is this concept of organizational readiness for change. So in some ways, do you feel like the timing of you joining faculty, taking all of this on. So much of everything is related to timing, right? Maybe ten years ago even if the technology was there. >> Yeah absolutely, I think there are multiple players and things that come into play when we talk about change. And one of them is, does the organization feel like it is the right opportunity and the players usually within the organization, but largely also outside the organization. So we had this whole big push outside Hopkins in other academic centers of using telemedicine. There are legislative changes, there are who are interested, so multiple things were happening. And within the small sort of world of emergency medicine, and Hopkins, we also had this opportunity where we were seeing a lot of patients who were unfortunately waiting for too long, or leaving without being seen. So there was an immediate need at the local, micro level and there's a larger macro level change that was happening in the world. >> Right. >> So both of those, I think, created this opportunity for us. >> Yeah, one of the concepts we talk about with strategic planning is there could be SWOT analysis, you can use Hambrick's strategic diamond. >> You can do scenario planning, and with scenario planning, you're really looking at all of these external factors. So I think it's a great point that you brought up that socio-technical landscape can have such a huge impact on making it the right time to take on this new type of change, like telehealth. >> Absolutely. >> Yeah, now we're in the hospital, there's all this hustle and bustle, folks are used to a particular type of structure each day, so there has to be some resistance that you face, right? Is there resistance to some of this change that you get from providers, or others? >> Yes there's always resistance, and if you understand resistance as part of the ,change then you're less frustrated with it, right. So yes, I mean, there are always people who are early accepters of change, and we focus on those people and we said, this is an opportunity, are you interested in working with us? And I will say about 15, 20% of our physicians, nurses, got excited about this. >> Right. >> And we have to show an early success. So we went in and we said that we're working with a small group of people, there were a lot of skeptics, they saw that it is actually a program which is working helping people. >> Right. >> And then we saw gradual change. I believe that there is a process of change, it's not a black and white, it's a little gray in between. So when you give that time for that gray to actually change colors to whatever color you want to take, to say a darker color, then you have much more patients, then. But if you try and push things you probably get a really feel-good sense. >> Mm-hm. >> But it's not sustainable. >> Right, I think that's a great tie in, we talked about John Carter's steps for successfully leading change. And I think you really hit it right there, talking about that importance of celebrating those short term wins, in order to make it sustainable. So, really great to see some of those principles really impacting your daily life and the work that you're doing. >> So I think we talk about keeping an eye on the goal, but as you said, every little step is a step in the right direction. Sometimes you take two steps forward and one step back. But it's all right, because you've got to get there. One can plan, or pull off best plan which never worked. So here we have my own learning laws, you come up with the plan, where you have flexibility enough that you understand that people are unpredictable that you're working with. But everybody wants to see the success. Some people want to see success, take a little more time to see success, others see right away, so you need to create this flexibility in your plan to take everybody along in this journey. >> Yeah, wonderful, well thank you so much for taking time to join me today, Dr. Razzak. >> Thank you so much. >> So based on our discussion, what two parts of a SWOT analysis did you glean the most information about from the discussion? That's right, strengths and opportunities. Strengths of the internal organization. Remember when we talked about timing? Dr. Razzak mentioned that there was interest from leadership in supporting the adoption of telemedicine in the emergency room. We also talked about the O, opportunities external to the organization, legislative changes, payers being interested, improvements in reimbursement. He also spoke about the timing of other academic centers outside of Hopkins making a push for tele-emergency medicine. And how each of these opportunities or external factors combined to create the right climate for change. Now, you may be thinking, didn't the discussion touch on the W in SWOT as well? A weakness, when we talked about the patients having lengthy wait times and limited access to care? That's a good observation, but remember what I said before the clip played, that some things might be a weakness of the health system overall. But from the perspective of teleemergency medicine proponents, that weakness of the health system is actually an opportunity for their work. So you're in an organization where there's a demonstrable need for improved access to care. That's not a weakness for the individuals trying to drive adoption of teleemergency medicine, that's actually an opportunity. Later in the course, when we discuss workflow reengineering, I want you to think back to this segment as well. You'll recall we kicked off the discussion talking about workflow. You heard Dr. Razzak refer to his role in managing, quote, the front door of the. When patients are coming in. And the key question he's tasked with is, how do we match capacity with the load we have? He went on to talk about the mismatch between need and capacity. These are really important concepts for informaticists to be familiar with when working in health IT. Capacity refers to the resources available to do work. Activity is what's actually being done. A bottleneck is any part of the system where the flow of surfaces is obstructed, leading to increased wait times or delays. A constraint is what restricts the capacity of the service at the bottleneck. And Dr. Razzak mentioned that there was this mismatch between capacity and need at the front door of the emergency room. He also referred to it as capacity and demand. Because of variation in demand, it can be difficult to predict exactly the number of patients that will need the On any given day. But with advanced analytics, there is the potential to gain insight from historical patterns of use. So when you do study work flow later on, think back to this example, where increased demand for Services and limited capacity led to a bottleneck, historically, at the front door of the. But innovations in tele-emergency medicine view this as an opportunity to expand their service, to expand their offerings, to expand adoption of their use. Innovations in tele-emergency medicine are one way in which the balance between supply and demand can be brought closer to equilibrium.
