En sjuksköterska håller en patients hand. Implementering av digitalisering i vården kan ta tid

A guide to support public healthcare on the path to digitization

Digitization: any people would probably agree that digitization is important. But how do you achieve the change in working methods that it often requires? To support organizations in public healthcare that want to work in a more digitized way, Swelife has started a project for implementation.

The project is called “Implementation tool for digital solutions” and will result in a practical tool to help organizations such as a hospital ward to become digital. It measures the propensity for change in the organization and supports management in implementing change.

Working digitally in public healthcare

“We are facing a digital revolution in public healthcare,” says associate professor Ylva Trolle Lagerros, one of the two researchers behind the project. Her regular job is as a physician and researcher at Karolinska Institutet.

The Swedish population is largely very used to computers, and there is every indication that this trend is on the rise. Half of all two-year-olds use the internet every day and, from the age of ten, nine out of ten children in Sweden have their own mobile phone.

“This drives a will to work digitally in public healthcare as well”, continues Ylva Trolle Lagerros. “When I started working on this, my question was: do patients want this? Will they use it? This has now been answered with a resounding: Yes, patients do want this, and the technology is available. But if we are to succeed in digitizing public healthcare, we must have the staff with us. Without them, we won’t get anywhere. Changing working methods requires a great deal from an organization which is already under constant time pressure.”

Introducing digitization takes time

The project includes implementation researcher Petra Dannapfel from Karolinska university hospital. She works with implementation and support in managing change. There is often a delay before new findings and methods start to be applied in practice, for example when new types of treatment are introduced within public healthcare. Often, there is no thorough preparation before the change is to be implemented, it is simply pushed through.

“Digitisation entails working in a new way, and now it goes faster than before”, says Petra Dannapfel. “There are completely new demands made on pushing development through. Yet it is not so simple to implement something new. Engagement wanes fairly quickly, you don’t consolidate the new behavior. But a good implementation gives better outcomes over time.”

Staff must be on board with the change

The research done on implementation shows that if you don’t have the staff on board for the change, nothing will happen. If you start working in new ways, you also have to remove other things – otherwise the digitisation only becomes an additional burden, not something that facilitates work.

Ylva Trolle Lagerros says:

“I understood it was the staff we needed to research – as well! Then this idea emerged: that we must measure how it is. If we are to introduce digital tools in a clinic, how open to change is the staff there? Can we gauge this in some way and perhaps put measures in place where people feel uncertain?”

Many people are online a lot in their private lives – for everything from booking travel to managing their banking errands on their phones – but it is another thing to believe in the possibility of working digitally as a group.

Questionnaire and guide provide support

There are instruments for measuring propensity for change, but none are in Swedish or adapted to Swedish public healthcare.

The tool includes a questionnaire to be completed by the organisation’s staff. The questionnaire reveals where the gaps are and what areas will require a little more work.

The tool also includes a guide. It functions as a support for managers, project managers or others assigned with responsibility for change management, so that they know what activities they can use to work in a good way with the various areas. The guide is practical and comprehensive.

“There is evidence in every part of this guide, and it is based on previous research”, says Petra Dannapfel. “All managers are to be able to work with and implement change, but I don’t think it is reasonable to expect all managers to be experts on change management. This isn’t your core area of expertise, because you have a different background. The guide offers you support in your leadership role.”

A tool for a smoother change process

The tool – comprising the questionnaire and the guide – is to be used before starting to introduce a new solution. This will enable the change to happen more smoothly, and the new procedures to settle in better.

“It has been a maturation process for healthcare staff also to want to work with digitization”, says Ylva Trolle Lagerros. “It is incredibly exciting and fun to start digging into this. The tool we are developing now would most probably be applicable in areas other than public healthcare. But I am a physician, after all, so my particular passion is digitization in public healthcare!”

A positive response from users

So, although Swedes have largely embraced digitisation, the challenge is to get public healthcare on board as well. A journey which could take some time:

“You have to remember that we physicians still walk around with pagers”, says Ylva Trolle Lagerros.
The response from the healthcare system has so far been very positive.

“I conducted cognitive interviews ahead of the questionnaire to be completed”, explains Petra Dannapfel. “I took the opportunity to ask afterward about how they would perceive receiving the questionnaire before a change process ‘in real life’ – would they be positive or negative? I had concerns. But all of them said: Oh, that would be great! It would be great because it feels as though they care. So I got a positive response. But what they go on to say is that feedback on the result must be given to the staff group. It is important for something to happen. If you then decide to follow this path, you must provide feedback and involve the staff.”

Read more about the project here (in Swedish).