Health Policy$ense

Organizational Change or Non-Change?

Lessons from Telemedicine

On August 3, 2020, The New York Times ran an article entitled “Is Telemedicine Here to Stay?” The article presented various reasons to answer "yes" to that question, and reasons to answer "no." The question, and its answers, offer a powerful and useful example of organizational change generally, as well as change in health care specifically. The uncertainty surrounding telemedicine’s future demonstrates the challenge of sustaining so many organizational changes, not just digital health care, and provides insight into why most organizational change initiatives fail. In this post, I suggest concrete actions that health care provider organizations can take to ensure successful and sustained telemedicine use.

Although many have heralded telemedicine as “the future of health care delivery,” it is not new. Many health systems have used it, at least to a limited extent. Digital technology offers the possibility of more frequent and convenient patient care, including chronic care management, acute symptom screening, and follow up to in-person visits. Use of telemedicine during the pandemic skyrocketed due to a strong patient (and clinician preference) to avoid potential COVID-19 transmission, as well as increased willingness by private and public insurers to cover telemedicine "visits."

But what will happen to telemedicine when the pandemic recedes? Well, like so many piloted or opportunistic moments for change, the answer is "it depends." This service seems beneficial to patient and provider alike, and may retain its enhanced place in medical care, generating about $4 billion nationally in March and April 2020. However, without sustained organizational change, telemedicine could snap back to its pre-pandemic usage (less than $60 million billed in March and April 2019). 

The revised edition of Wharton School Press’ Leading Successful Change: 8 Keys to Making Change Work offers the following perspective on how to secure and sustain desired change in clinician and patient behavior. In the case of telemedicine, first, health care provider organizations should focus their planning on the clinician-patient remote interface. Second, they should identify and embed the necessary organizational changes in as many as possible of the eight “subsystems” that comprise the work or operating environment, as discussed below.

1. Rewards: Organizations should ensure that telemedicine retains value (reward) for the clinician, health provider organization and the patient. Thus, securing adequate compensation to sufficiently skilled clinicians will be essential. This may require forming coalitions, identifying the stakeholder field (especially consumers), revisiting their business model, and lobbying insurers and regulators for the necessary policy changes.  

2. Task: In coordination with multiple stakeholders (including patients), organizations must develop protocols and pathways that support predictable, efficient, and effective telemedicine exchanges. These pathways should enable a) easy and accurate data capture, b) process measurements, and c) mechanisms for reviewing quality and safeguarding against fraud. 

3. People: For telemedicine exchanges to be useful, health care provider organizations should invest the time and resources in developing provider and patient adeptness with the technology. This could include providing guidance on how to download care instructions, access a care video, or view an x-ray or CT scan "alongside" the clinician.

4. Workplace: Organizations must create system compatibility for a visit, between patient and clinician as well as within the provider organization. Patients must also have access to adequate data plans or internet service to handle the call and view test results. While some organizations are working on solutions to improve access, this could present a significant hurdle for some patients. Organizations should ensure to secure privacy during the call, even if that entails providing a set of headphones to the patient.

5. Measurement: Organizations should measure call outcomes and processes in a way that will enable quality control and protect patient privacy. Otherwise, health care providers and their organizations will struggle to gauge the success of telemedicine and how best to improve it. Patient concerns about privacy will affect usage (hence the need for monitoring it), both in fact and as perceived by the patient.

6. Information Distribution: To maintain patient engagement, organizations should make scheduling easy and available during the call. They should also take steps to provide quick, real time access to patient records by both patient and clinician and safeguard all health information.

7. Decision Allocation: Similarly, organizations should enable real time patient and clinician decision-making during the call for actions such as issuing a script, scheduling a follow-up appointment, or contacting a specialist.

8. Organization: Finally, health care provider organizations must redesign themselves to dedicate and house the necessary resources for telemedicine to be successful (e.g., money and learning). To ensure continual process improvement, they should conduct cross-functional reviews of experiences and learnings, including best and worst practices.

Though these recommendations focus on telemedicine, they also apply to any significant change that alters the way the members of an organization interact with the task at hand, one another, and their customers. For change to be successful, organizations must determine their reason for using telemedicine: to implement a new technology (and risk “running faster trains over old track”), or reconfigure their care delivery? If organizations seek broader change, then they must align as many of the eight aspects of the work environment to support and drive that change. The more aligned the eight aspects, in turn, the more likely the sustained success of the attempted change, and the more likely that telemedicine is here to stay.

Gregory Shea is an Adjunct LDI Senior Fellow and Adjunct Professor of Management at the Wharton School and the Aresty Institute of Executive Education. For a more detailed presentation of this approach to change, consult Leading Successful Change: 8 Keys to Making Change Work by Gregory Shea and Cassie Solomon, Wharton School Press, 2020.