Having been involved in acute care medication management and the impact of a few disruptive technologies over the last 50 years, I have had a lot of time to think about what it takes for a disruptive technology to succeed within our practice. We are, after all, a cautious bunch. IV workflow was first presented at an ASHP Midyear Clinical Meeting in 2007; it took another 10 years to become commonplace.
I have come to the conclusion that it is not just our caution that stands in the way of disruptive innovation, but rather that the problems that really need be solved are so large, and have seemed to be insoluble for so long, that we just don't see them any more. They have become like wallpaper. We walk into the room, but just don't notice them.
We have worked around these problems, throwing people and process at them, for so long that we have now enshrined those workarounds as our normal practice. The people we have thrown at the problem have come to believe that what they do is the best and only solution to that problem. Indeed, those people would likely feel threatened by any solution that would replace them, no matter how much better that solution might be.
I have had the pleasure of working with organizations that were culturally built to handle (and, in fact, to enjoy) disruptive change. They have been few and far between.
- They had change management down pat.
- They asked themselves hard questions about why the current workflows were the way they were and explored alternatives, even imagining systems that did not yet exist.
- They spent time working on redesigning workflows to maximize the benefit of a new solution being implemented
- They new how to involve the end users of the solution while preserving the forward motion of a change.
- They were heavily data driven
- They new how to support the change process and set expectations. They took the time to ensure that everyone knew what success would look like and how long it would likely take to achieve it. They created a shared vision among the staff.
- Their staffs took pleasure and pride in making new systems work; they celebrated success
- They were always looking for ways to do things safer, better, faster. They didn't start the conversations with why something wouldn't work.
This was cultural. It was inherent in everything they did.
What if you could do away with missing meds? What would you do with all the people you currently have running stuff up to the floors? As noted in another blog, some research I have done indicates that the pharmacies studied seem to have people running something to an ADC very frequently and the majority of those trips involved taking one or two things to one or two ADCs.
What if you could prospectively deal with shortages before they became an emergency? I am not talking about predicting shortages; I am just imagining tools that would better notify you of shortages while you still had inventory on hand so that you had time to plan for the eventuality of running out of them. You would still have to make all the changes in the CPOE orders, and in the ADC contents, but those changes could be planned in advance and easier to implement. What would you do with the teams whose jobs are focused on the current urgent processes?
What if you could completely automate IV admixtures? What would you do with all the people who currently do sterile compounding?
I'll bet you can think of a number of things you could do with that headcount. I have yet to meet the pharmacy leader that didn't have a list of things they would like their staffs to do if only they could make the time.
Solving really big, enduring problems is achievable. We just have to be willing to believe our current solution may not be the best solution.
Dennis A. Tribble, PharmD, FASHP
Retired
Ormond Beach, FL