Reference no: EM133305706

Assignment: In the case study, the plan for training has been presented and run into opposition. What changes would you suggest to make the employees more willing and able to implement the change? In addition to training, what two "other resources" would be most helpful here?

SmartScope Case, part A

The big presentation

Carmen Rivera, VP in Charge of Strategy and Special Projects for the Tri-State Health hospital system, leaned forward and opened her notepad. Nkata Okolenga (MD Harvard Medical School, MBA Wharton, and now VP of Sales for SmartScope) stood slowly and nodded at the group of hospital executives sitting around a mahogany table.

"Now, before I start....a visual aid!" Slowly, dramatically, Nkata pulled from his briefcase a battered, four-inch-thick medical textbook. Delighted recognition swept through the room as Nkata held the book up, riffling through its yellow-highlighted pages. "You're right, Ferguson and Stroud, 12th edition, Atlas of Human Anatomy. An old friend to many of us here. I'll pass it around." Jerry, the CEO took the book, grinning, and nodded happily, memories of medical school tickling him from thirty years ago, then passed it to Edith, President of the Edgecott hospital site.

"So, a question ladies and gentlemen: is this book artificial intelligence? At SmartScope, some people call us the world's best at applying AI technology to medical diagnostic support. Personally, I think of what we do as an interactive version of Ferguson and Stroud....we gather information, quickly and well, from the best minds everywhere, including your own. And we scrunch it into a tool that suggests diagnostic routes. Most of which are confirmatory, some of which, well, are second opinions. Useful ones you can listen to, interact with, and may act upon. Which gets me to our logo."

A slide show started, showing SmartScope's logo of a brain with a hand holding a stethoscope reaching towards it. "We assemble information you can listen to in order to get a refined diagnosis and better, more consistent health outcomes. Clinical people at all levels, really, can access our database, enter symptoms on this" (here he held up what looked like a bulky iPad) "and get in real time a suggested diagnosis and a list of points to consider. We help you listen to the best medical knowledge and experience available. Very simple....." he beamed and nodded, his African accent encouraging the most analytical of scientists to sign a big check eagerly. "so please buy this. That's all I have to say."

Laughter followed, and of course the sales pitch had really just started. As Nkata and two others from SmartScope spoke, Carmen thought of what would have to happen for the product to be used. As the VP in Charge of Strategy and Special Projects, Carmen realized that adoption of SmartScope might not be as smooth and easy as was being suggested. The Tri-State Health System was big and complex, consisting of four hospitals, a medical group that had 34 physicians' offices, and a number of immediate care and specialty sites. Though up-to-date and clinically well-ranked, the system was financially strained and increasingly dependent of governmental reimbursements. Any innovative, image-enhancing change could help, which of course was why the discussion with SmartScope had started six months ago. Later today, the CEO and his leadership team would make a go or no-go decision, based on the presentation.

Carmen thought ahead: if the purchase was made, would Jerry the CEO drive the project....if not, would Edith and the other site heads become champions, or treat SmartScope as if it were just another corporate project? And would the doctors and other clinical people embrace the tool and all it offered, or see it as a challenge to their own diagnostic skills? Would Nurse Practitioners use the tool or push back on what they might see as another documentation requirement that mainly confirmed what they knew? And what, as a key member of Jerry's team, was Carmen's role here going to be?

Four months later

Marie-Claire, a psychiatrist from the Behavioral Health Institute, said it best in today's meeting: "We have made about six weeks' progress in four months." The SmartScope initiative seemed stalled. The people of Tri-State Health were all over in their adoption of the tool. Jerry the CEO had seemed eager to start with and had made visits to the hospitals and medical groups management meetings. His energy and excitement over the tool and what it could do were infectious and won a lot of people over to considering the tool and how it could work. But as with much else in Jerry's busy life, other challenges and opportunities became priorities, resulting in SmartScope becoming one more "top priority" project. It didn't help that the ultimate goal of the adoption-better clinical outcomes and improved image for the hospital in a very competitive market-had been a bit taken for granted in the communication surrounding SmartScope. In many cases hadn't been heard fully.

As expected, Carmen had gradually taken on the role of SmartScope champion, and had spent more and more of her time working to get the tool integrated into the hospital's life. This had involved a lot of work with the heads of the hospital sites and major practice areas. Edith from the Edgecott Hospital was enthusiastic and worked hard to get clinical people to use the tool fully. The Barton Heights hospital's leader, George, had taken a passive approach, and in some areas there was support and use/ In others, almost none. Medical Group offices were likewise mixed, and in some cases a fierce independence and resistance to "being managed" meant that SmartScope was being treated as a "nice to do." Medical Departments were likewise a patchwork of feelings. The Oncology Department had earlier adopted a cancer-specific database from the Mayo Clinic, and felt that SmartScope didn't really add much. The Cardiac Department was very positive and was encouraging its Nurses to make use of the tool for early-stage discussions with patients. All over there was a slight age factor going on, with younger and less experienced people being more open to use of SmartScope.

Nkata and others at SmartScope had some good ideas for increasing adoption. One of these was a "results group" that drew together experience and clinical outcomes from throughout TriState Health. A problem here was that it seemed to be mainly administrative rather than clinical people who were involved in the group. The clinical people, even those who supported technology innovations, were overworked and so not participating. The eager people, including some on Carmen's staff, were non-clinical and so had limited credibility. Still, the data prized by medical people was emerging, but slowly. It showed a measurable (though small at this point) increase in diagnostic accuracy. Also, it showed people at all levels were comfortable and generally unthreatened by the tool.

But still.....six weeks progress in four months. Carmen figured she had about two months to make real progress before SmartScope shrunk as a project and became just another "good idea" that didn't go far. What, she wondered, could be done differently?

SmartScope Case, part B

Howard Davidoff, the President of Tri-State's Surbiton hospital, clicked on the Zoom icon and pulled his thoughts together. It had been a month since Carmen and the CEO had visited Surbiton to enroll the site as their model for a relaunch of the SmartScope tool. What they said made sense: for the tool to work, it had to be adopted and used consistently throughout the system. But for that to happen, it would work best to have a single hospital serve as a model of how SmartScope could be used.

Howard had eagerly agreed. Surbiton was geographically far from Tri-State's headquarters and as an older facility could use any investment or attention it got. Howard was a physician as well as an executive, and spent Thursdays working as a thoracic surgeon. He saw the point of any artificial intelligence tool that could help and had been an active driver of the SmartTool process. Part of this had involved setting up a network of change agents in major parts of the Surbiton site. They met weekly. Today, Howard had asked everyone to check on progress and report on support / resistance.

Howard's meeting started, and after a few minutes of small talk and welcome, he had Jodi from Accounting share updates from the SmartScope team on how frequently the tool was being used. Jodi paused at the end of the data rundown, and said "Well, kind of what the SmartScope people predicted has happened....lots of initial use, then a drop-off as people experience challenges, then a gradual increase on use. In our case, the uptake is a little better than in most places."

"Well," said Howard, "OK. But let's spend our time this morning looking at where people are, what they feel about SmartScope, and of course what we can do about any push-back we're seeing. Tammi, what is going on in the Medical Groups offices?"

Tammi looked at her notes anxiously. "Bit of a disappointment here. As you know, we have eight separate sites, two labs and six doctors' offices. All the site Managers got the training and everything else they needed, and sounded pretty positive. No questions or issues, and reports indicated pretty good initial uptake and use of the tool. But, after a month, and despite no-one saying anything negative, it turns out that our physicians, with a few exceptions, are just using the tool when there's a really big question. As SmartScope says, it's most helpful when it's used frequently. But....despite our making that clear, it seems people don't want to do that." Heads nodded among the others on the call.

"Well....sounds like we're onto something. Moving on, John from HR....you have a not so quiet person to tell us about! "

John, the HR Director on Howard's staff, groaned and raised his hands in a "what are ya gonna do" gesture. "After my last visit from Dr. Mountjoy, I checked her files. She was never in the navy, but she can certainly swear as if she was. My Dad would have been impressed. In a sanitized nutshell, she feels the SmartScope tool is an insult to her brilliance, and that in fact she could help them improve it, being that she is one of the country's best pediatric cancer neurosurgeons. Or the best. She slammed her SmartScope on my desk as she left to go and complain to Howard. It still works, by the way!"

Howard nodded grimly. "At least she felt John listed to her. Me, not so much, as she said when she left my office! The point is she at least is saying what she doesn't like. And, well, could she be right? This is a lady who operates successfully on children with brain tumors several times a week. She is a superstar. How do we respond to that objection? How do we get more people to open up?"

Silence settled on the meeting....encourage resistance? Howard often surprised the group. "Now," he said, "any ideas from the work that you started with the staff in Obstetrics, Amy?"

Amy, a young and energetic doctor who managed the 13 staff physicians in Obstetrics, spoke next. "I don't get it.....we have a group of well-trained people who are tech savvy, but they just aren't seeing a lot of value so far from the tool. I am not sure how often they are using it. I have done it a lot, and it's confirming what I see, and occasionally making some useful suggestions. I try talking about this, and most people are seeing the same. I think the fact that the second opinion is needed seldom (so far anyway!) may make people feel this is a solution in search of a problem."

Howard nodded and took notes. "Are we that good? Or are we sort of seeing the tool the wrong way? Radiology....here and everywhere at Tri-State and in general, is still looking at the thing." He sighed. "Surah, what's going on?"

"Yes...here there's a real question about imaging assessment. As you know, for imaging-based diagnostics SmartScope has a function that is not on the hand-held. We have used a similar one for a while....the one from Mayo Clinic. Our team has set up a controlled study to compare the AI functionality and accuracy of the tools. This has been going on a long time. We pulled in a couple of research-based Interns, and the more we look at it, the more questions we find to look at and the more time it takes. It could be worth it, or....." Her voice trailed off.

"Hmmmh. OK, I'm sure SmartScope has some figures on this, but, well. We are data-drive people, aren't we? OK. Finally, Jan, Nurse Practitioners, on the front-line of diagnosis."

"Total mixed bag....it's mainly Nurse Practitioners who turn to SmartScope....even RN's don't do a great deal of diagnosis that would require SmartScope. Most people love it and use it a lot. But, there is a feeling, mainly among nurses and assistants who don't use the tool, that SmartScope could take away from peoples' jobs, dumb them down. And despite how hard it is to hire nurses and how much growth the field's going through, there's still that nagging fear of job loss or 'being replaced by a machine' ."

OK," said Howard. "We have good news and bad news. I'm not sure what to do with the resistance we have here. What are you all seeing? What are the priorities, and what can we do about them?"