Five percent.
I stared at the report hoping I had misunderstood it.
A month earlier, I had confidently told our Board of Directors that within 90 days, our physicians would be successfully using our electronic medical record to meet a new set of federal healthcare objectives.
Now, only about 5% were doing it.
I had been wrong.
I was embarrassed to face my CEO and Board. But underneath the embarrassment was something heavier. Our regional hospital system was struggling financially. People were worried about their jobs and livelihoods, and I felt an enormous responsibility to help find a way forward.
I believed technology could be part of that answer.
Following the American Recovery and Reinvestment Act of 2009, healthcare organizations had an opportunity to receive significant federal incentives for demonstrating the “Meaningful Use” of electronic health records. For our organization, that meant the possibility of millions of dollars at a time when those dollars mattered tremendously.
Even better, this wasn’t simply about money. Better use of the electronic medical record could provide clinicians with better information, support better decisions and ultimately improve patient care.
It seemed like a win-win.
Our IT team worked incredibly hard. We invested in the technology, configured the system around the requirements, and trained our healthcare professionals. We believed we had built something great.
Then came 5%.
Looking back, I can see what I couldn’t see then.
I had confused technology readiness with organizational readiness.
We had prepared the technology, but we hadn’t adequately prepared ourselves to understand the people who would ultimately determine whether it succeeded.
Going Back to the Drawing Board
I told our leadership team we needed to change course.
Our clinical analysts, registered nurses who also had technology expertise, changed their schedules to match the physicians’. We arrived for early morning rounds and stayed for late evening rounds. Instead of asking physicians to come to us, we went to them.
And we listened.
We watched their workflows. We saw the pressures they were under. We began understanding why something that made perfect sense from our perspective could create frustration from theirs.
We also learned something humbling: our system wasn’t nearly as good as we thought it was.
So we changed it.
Physicians gave us feedback, and we worked to make adjustments quickly. Then we listened again. And changed again.
Gradually, the relationship changed too.
Physicians who once avoided us began seeking us out. They brought questions, ideas and frustrations. Our clinical analysts became more confident because they better understood not just the technology, but the people using it.
Trust was forming.
I would love to say we accomplished what I had promised the Board within 90 days, but we didn’t come close.
It took more than a year before nearly every physician was meeting the objectives.
Nearly every physician. One remained.
The Last Physician
He had been very clear about how he felt: I went to medical school to take care of patients, not type on a keyboard.
He believed the EMR slowed him down, cost too much money and contributed little to the care of his patients.
So I started joining his rounds.
Sometimes that meant 5:00 a.m. Sometimes it meant staying until 9:00 at night.
Initially, we didn’t talk much about technology. We just talked. Eventually, he agreed to start logging into the EMR, but not because I had convinced him it was valuable.
Quite the opposite. He wanted to show me how bad it was.
And honestly, I was thrilled, because now we had something we could talk about.
He showed me what frustrated him. I listened. We made changes. He showed me something else. We listened again.
One of those changes seemed almost insignificant.
I learned that his eyesight wasn’t as good as it once was and that reading the information on the screen was difficult. So we increased the text size for him.
The next time he logged in, he immediately noticed. He knew everyone else’s screen didn’t look like his.
It was a small change to the technology, but it communicated something much larger: we were listening.
From there, his engagement changed. He started offering more feedback. He became curious about what else could be improved and what the system might eventually be capable of doing.
He was still skeptical. Then one day, everything changed.
He was preparing to order a medication when the system generated an alert. Medication reconciliation indicated a potentially serious interaction with another medication the patient was already taking at home.
He looked at me,“Is this true?” I responded, “Let’s ask the patient.”
We did.
She confirmed she was taking the medication and he immediately understood the potential consequences of what he had almost prescribed.
We returned to the workstation. I didn’t say anything. I didn’t know what he was thinking, so I let the silence remain.
Finally, he looked at me, “I understand.”
So did I.
What Changed
That physician became an advocate. His colleagues respected him, and his advocacy helped us finally reach 100% participation.
We achieved our objectives and received millions of dollars in incentives. For a regional healthcare organization under significant financial pressure, those dollars helped us continue providing the services our communities had grown to depend upon and helped our healthcare professionals continue doing the work they had committed their lives to doing.
But the lesson I carried forward wasn’t about the money.
The technology had been capable of generating that medication alert long before that physician believed in it.
The technology hadn’t changed. We had.
That experience has stayed with me throughout my career, from healthcare, to military service, to global transportation and logistics, and now aviation.
I don’t carry it with me because I discovered some perfect formula for transformation. I carry it because it reminds me how confidently I can believe I have the answer and still miss something fundamental.
Over time, it has shaped a simple way I think about transformation: People → Foundation → Technology → Outcomes
- Start with people: Listen. Understand. Build trust.
- Build the foundation: the processes, skills, governance, data, architecture and organizational readiness necessary to support change.
- Apply technology: use in service of what we are trying to accomplish.
- Measure what matters: the outcome.
Why It Still Matters
Today, the technologies are different. Artificial intelligence, automation, computer vision and other emerging capabilities are creating possibilities I could scarcely have imagined during those early morning hospital rounds.
But that experience still causes me to ask the same question. Not simply, “Is the technology ready?” But, “Are we ready?”
Because the real promise of technology isn’t the technology itself. It is what people can accomplish with it.
It is a clinician using better information to provide safer care. A passenger using technology to navigate one of the world’s busiest and most complex airports more safely and seamlessly. A student gaining access to tools that help them learn in ways previously unavailable to them. A service member receiving the capabilities needed to accomplish the mission and return home safely after a long deployment.
And countless outcomes we have yet to imagine.
That’s why I believe our responsibility as technology leaders extends beyond selecting and implementing technology. We have to create the conditions in which people can understand it, trust it, shape it and ultimately use it to accomplish something meaningful.
Years ago, I thought my challenge was getting physicians to adopt an electronic medical record. I was wrong about that too. The greater challenge was learning to listen.
Technology can enable transformation. People make it happen.
