Eight “Ates” for Managing Change in Healthcare IT

Heraclitus said, “You cannot step into the same stream twice.” 

This metaphorical insight is frequently acknowledged but oft not appreciated. All things, both living and inanimate, are changing. We have no choice, as change is inevitable, but managing change is possible. Without planning and consideration, we may be swept away by the turbulence when we enter the stream of change.  With insight and consideration, we may leave our stream cleansed and refreshed.

What planning and considerations work for managing the implementation of new EHR? Consider the eight “ates.”


How would an IT implementation transform your health system and its operations?

To find out:

  • Secure a room with a whiteboard and dry-erase markers.
  • Select a diverse set of healthcare representatives from your organization.
  • Order pizza (a crucial step).
  • Let them describe all the interactions entailed by the new IT implementation.

These participants are the core group (the Planning Task Group, or PTG) for facilitating that change. Through this exercise, they should learn the organization’s processes for the proper care delivery.

In addition, the group should formulate an effective implementation plan, visualizing all potential outcomes after the IT change, and understand how they will support the values and mission of your organization.


Share the understanding of the why, where and what of the change. Why are we doing this implementation? If we can improve the care we provide from this implementation, the difference will sell itself. Where is this change taking us? Show the journey and the challenges along the way. 

When it’s complete, what will the care we provide look like? What will we be doing differently? What will our patients experience? This story must be told and retold across different venues and media like all good tales. Talk to employees one-on-one, hold department meetings, and host organization-wide town halls repeatedly. Include the C-suite and board members and the key medical staff. Amplify the feedback loop, too. Communication is best when it’s reciprocal.


Early in the planning phase, identify and include critical medical staff and organization members. These thought leaders should be part of the planning group (See “contemplate.”). Engage them in meaningful participation, and they will be the strongest champions of its implementation, assuring widespread adoption. More importantly, the end product will work for both patients and providers.


Everyone prefers to discover obstacles in ways other than by running into them. Therefore, the PTG should also be tasked with imagining significant roadblocks (vendor bankruptcy, union work stoppage, etc.) and have scripted responses that, at a minimum, outline initial steps to calm fears and solve the problem.

Some providers/physicians may need more support than others. So, first, have readily identifiable “coaches” skilled in the technology but more experienced in human interaction. Then, be ready to assign a uniquely selected coach to help grow those colleagues into IT champions.


The goal of a successful IT transformation should be more than its use and adoption. The real success of the implementation is in the improvement of the care we provide, not in reporting the medical staff adoption percentage. When the implementation works, it is the best motivator for adoption and use. However, never lose sight of the incredible passion of the providers for doing what is suitable for their patients.


Segment the implementation into manageable parts. The concept is a nod to the old “How do you eat an elephant?” adage. And the answer is, “One bite at a time.” Measure progress in parts that count toward the end goal, and share those successes and opportunities in a friendly, non-threatening manner.


When these components are completed, communicate and celebrate. For example, all physicians attend a required one-hour pre-implementation training session as part of your IT project. At department meetings, recognize those physicians who have completed this goal and mention them in organization newsletters. This is also an excellent time to remind participants of the “why” of the initiative and share information on upcoming milestones.


Remember, we started by understanding that change is inevitable for all things.  We know there is never any finish line for the implementation process. While we may successfully implement an EHR that reduces imaging studies, decreases readmissions within 30 days, and minimizes medication errors, there will always be opportunities to improve care delivery.

Over time, this means you’ll need to add new members to the PTG and rotate out other ones. In the “term-limiting” PTG service, you’ll expand the knowledge breadth and depth of the IT implementation throughout your organization.

Dr. Frank Speidel is a past Chief Medical Officer for Healthcare IT Leaders. Dr. Speidel's career spanned 25+ years of experience as a C-level hospital administrator and practicing emergency room physician.

Originally published 2013; Updated January 2022.