Before implementation, think about prehabilitation

Craig-Joseph-1Most of us are familiar with the concept of rehabilitation. After a surgery or an injury, a patient typically works with a physical or occupational therapist to try to regain previous functionality or, at the very least, learn to minimize deficits. By definition, rehab occurs after some sort of insult has already happened to us. A lesser well-known concept is the up-and-coming idea of prehabilitation.

A 2022 review in the British Journal of Anesthesia notes that “[p]ostoperative morbidity and mortality are largely the product of the preoperative condition of the patient, the quality of surgical care provided, and the degree of surgical stress elicited.” While surgical quality and physiologic stress mitigation have long been areas of focus for clinicians, the preop condition of the patient has often been overlooked. Not anymore!

Prehabilitation involves trying to improve certain patient conditions before the operation occurs. Obviously, many surgeries or procedures must be done urgently or emergently, so there is no opportunity for such interventions. However, if time is not of the essence, prehabilitation can significantly reduce postoperative problems. Patients can be evaluated with respect to physical, nutritional, and psychosocial status. If issues are identified which can be improved upon, outcomes may be significantly improved.

The excitement about surgical prehabilitation got me thinking about healthcare technology implementations and optimizations. The parallels are surely there: Much like non-urgent surgery, a major tech implementation at a hospital or healthcare system is disruptive and can cause long-term problems. For decades, we’ve done what we can to maximize the quality of the surgery implementation, and then we dutifully send our patients clinicians to rehab optimization. Perhaps we should increase our focus on prehabilitation user readiness long before we kick off our project.

User readiness for large technology implementations (electronic health records [EHRs], I’m looking at you!) has been a standard, but somewhat underappreciated, step in the process for a while. Yet, I think many healthcare leaders still don’t understand how important this action is. Understandably, given the cost of a major technology install like an EHR, executives want to save money wherever possible. Hence, “soft” expenses such as a cultural assessment may see the chopping block early in the process. This is a mistake.

If an intricate organization like a hospital doesn’t have staff who are ready for a big change, it’s essential to ameliorate the situation before embarking on such a change. The bad news is that culture, while hard to define, can sink a project. The good news is that culture can be changed! If clinicians have been through failed implementations in the past, it’s understandable that they might expect the same outcome with those in the future. To change the narrative, senior leaders who are respected by the staff should acknowledge past problems and speak specifically about those that will be mitigated moving forward. Then they should repeat the message. And repeat it some more!

While I’ve long been a proponent of applying the principles of human-centered design to the implementation and optimization of big healthcare projects, these same ideas are relevant to all the pre-work that needs to be done. Paint a clear picture of the final outcomes (e.g., one source for all clinical data, improved communication among clinicians, etc.) to ensure that staff understand that you are starting with the end in mind. Explain how the organization has adopted a continuous improvement mindset, recognizing that despite the best planning, technology and organizational needs will always be in flux, so change will be omnipresent. Celebrate the fact that the healthcare system strives to use technology to make it easy to do the right thing.

Prehabilitation can significantly increase the chances of a successful operation. Similarly, user readiness assessments – and mitigation based on those findings – can ease the transformation that an organization faces when engaging in a substantial change. Doctors should take their own advice and prehab before jumping into a huge makeover of how they do their jobs.

Topics: Implementation, featured

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