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A critical review of the constraints and barriers that an organization may encounter during the implementation of the intended changes is a necessary step in the project scope statement. In fact, examining the nature of the barriers not only makes it possible to identify any causes of errors and inaccuracies in a timely manner but also to develop preventive measures based on as many potential errors as possible. In this case, the Atrium Hospital’s project to migrate its electronic clinical information management system to EPIC, which allows for scalability, is being studied. One of the biggest concerns for the Atrium is the compatibility of the new EPIC with the automated operation of intravenous pumps, special devices that control the delivery of fluids, including medications, into the patient’s bloodstream. It is clear that errors in compatibility with such devices are critical. For this reason, it is necessary to describe the barriers and ways to solve them in as much detail as possible.
EPIC system failure, resulting in either functional failure of intravenous pumps or distorted results, is the most critical barrier to the Atrium. There have been reported cases where the EPIC system inadvertently skewed results or demonstrated incompatibility with intravenous pumps (FDA, 2021). In this case, the lack of control could lead to harm to the patient’s health, for example, through an uncontrolled dosage of the injected drug. The strategy to address this problem lies in conducting independent statistical tests during the implementation phase of EPIC to assess change management. For example, Pre/Post tests conducted by a third-party audit will help the Atrium determine whether their efforts to remove barriers have been practical, as well as quantify potentially undesirable outcomes. In addition, in the first phases of project implementation, manual controlled control of intravenous pumps should be provided to avoid error — in the event of a system failure, manual control would allow the clinical provider to adjust the pump device with the specified dosage manually.
A second potential limitation with the Atrium project is the lack of established communication between stakeholders. As reported, the current CERNER system is qualitatively different from the new EPIC system, so it is fair to expect that most hospital staff have no understanding of how EPIC works. Lack of this understanding with inadequate leadership will predictably lead to human error, during which management for a particular patient may be set up incorrectly or inaccurately (Alqatawenah, 2018). The solution to this problem lies in providing training to all employees, allowing them to understand how the new system works and to learn in advance about the basic procedures and found out the shortcomings of EPIC.
Another barrier to maximizing the effectiveness of the new system is the lack of communication during EPIC implementation between system administrators and clinical service providers themselves. The EPIC system must be set up in a way that is convenient for administrators, nurses, and physicians to use — without convenience, the speed and usefulness of EPIC are questionable. For this reason, the initial setup of EPIC must be coordinated with clinical stakeholders so that, on the one hand, the system is efficient in terms of uptime and IT architecture, and, on the other hand, the system is user-friendly and fast for its direct users.
Limitations may also apply to the emotional component of clinical providers’ work. Nursing work is known to be strongly associated with occupational stress, and about one in two nurses report moderate stress (Tsegaw et al., 2022). For this reason, it is not unlikely that the introduction of the new EPIC system could be a significant blow to them because it adds work and requires training. In this sense, the nurse receives a heavy workload in the short term, which can affect her productivity as well as lead to conflicts between stakeholders. This limitation is managed through effective transformational leadership to respond to any signs of anxiety in subordinate employees and take preventive measures to control it. For example, a face-to-face conversation with a staff psychologist, combined with finding out the needs of such a nurse, would be the right strategy to reduce stress levels and get the employee’s productivity back on track.
References
Alqatawenah, A. S. (2018). Transformational leadership style and its relationship with change management. Theory and Practice, 19, 17-24.
FDA. (2021). MAUDE adverse event report: CAREFUSION SD alaris system interoperability. Web.
Tsegaw, S., Getachew, Y., & Tegegne, B. (2022). Determinants of work-related stress among nurses working in private and public hospitals in Dessie City, 2021: Comparative cross-sectional study. Psychology Research and Behavior Management, 15, 1823-1835.
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