We’ve looked at three groups of clinicians, their attitudes and needs and potential motivation for moving to an EMR, but what about the managers?  They too are not a unitary group.  Top-level managers are presumably willing, as they have made the initial decision.  Hopefully they will have grounded their decision in an important strategic goal of the organization, rather than in response to external pressures or popular trends. They are probably eager for the greatly improved operational control managerial reports can provide.  Even better for them, they likely won’t be entering any of the data on which the managerial information is based.  They will, however, have to accept the scope of the task.  They will have to budget the funding, confront the resistances and allocate the resources for the implementation.  They will have to be open to the recommended changes which should result from the content design and workflow revision stage. They will have to be patient with stumbles and protests, but not too patient – more on this on this last later when I write about the crucial role of top leadership.

Mid and lower level managers may or may not be willing.  They too have to face the resistances while being closer to the resisters and to figure out how to accommodate the demands of the implementation on their local resources.  An effective EMR implementation involves clinical staff in content design and in training. In my experience the clinical program managers feel the most pressed regarding the time it takes to accomplish these tasks well.  They may want to reduce the time of the training sessions or suggest that staff be trained informally on the job. They must be engaged around the value of line clinician input and thorough preparation.  Also top managers must support line managers and clinicians by considering the necessary training time when reviewing productivity standards during the implementation.

Managers at all levels must work together to create an workable balance between the ongoing needs of the operation and the requirements of a well-executed implementation.  It calls for flexibility, discipline, imagination, fortitude and a sense of humor – the list could go on, but you get the idea. This all may sound rather dreary. It is certainly a challenge, but I found it to be energizing and with a good team it was even fun.