Each year the Emergency Care Research Institute (ECRI) produces a list of the Top 10 Technology Hazards, and they have just released their list for 2012. Not surprisingly, change management has made the list. Citing specifically, "A key reason problems arise is the failure to implement adequate change management policies and procedures that accommodate both IT and medical technology needs."
The ECRI does not take this list lightly. In fact, if an item appears on the list, there is a high likelihood that the hazard has resulted in death or injury to patients. In the example from the report, a bar code scanning system used for dispensing medication, and linked to a physiologic monitoring system, went down after a software upgrade to the monitoring system. The result at that facility was an increase in testing of all upgrades prior to implementation.
The guide offers a number of suggestions for overcoming this hazard. Many of which revolve around proper analysis and testing prior to any type of change (hardware, software, or otherwise). We've included a summary of their suggestions (as well as added a couple of our own) below.
- Analyze your exposure to change. While software and hardware upgrades will most likely stand out, also take a detailed look at everything that could change, and how that would impact a patient's safety.
- Develop change procedures. What do you do when something changes, and when should you make scheduled changes. There should be a hierarchy of decision for change implementation.
- Highlight change in your SLA(s). Software and technology partners (both internal and external) should understand that you need proper documentation and time to implement change. Use SLAs to make sure this is communicated clearly and concisely.
- Evaluate risk management principles applicable to change. The ECRI Institute offers specific guidance on this: "â‚¬Â¦as discussed in the IEC 0001-1 standard, Application of Risk Management for IT-Networks Incorporating Medical Devices-Part 1: Roles, Responsibilities and Activities. (Refer to our May 2010 Guidance Article "10 Questions about IEC 80001-1" for answers to some common questions about the standard.) "
- Communicate change internally. The SLA is a great start, but it takes active communication to build relationships between teams. Make sure communication is open and with regular frequency. Managing change is an effort that requires all teams working together.
- Manage (or Implement) your CMDB. Understanding the relationship between devices is essential. This means that change, and in turn configuration, must be managed with the proper tool(s). A CMDB will allow you to gauge the exposure, and the potential that change has to affect your Healthcare organization.
- Watch for change via your help desk. When issues arise, they are more than likely going to hit the help desk first. Staff there should be trained to identify potential issues that are the result of change, and have clear instructions for escalating issues.
- Consider updating your Change Management, or ITSM solution. In many cases taking all the steps above causes a bottle neck if software can't support the initiative(s). Your software solution can be the easiest, and often cheapest, component of a project dedicated to improving change management. Check out this webinar from Sonja Elder of King's Daughters Medical Center, and see what ChangeGear can do for your organization.