Adopting new technology? Understand staff fears

Loss of job tops list of fears for all staff members

Increased efficiency, improved documentation, and faster reimbursement are all reasons to upgrade your agency's technology. Unfortunately, the challenges to upgrading technology in home health go beyond financial concerns and a desire to find the right vendor.

Even with the timesaving benefits that they will likely enjoy once you've upgraded the agency's technology, reluctant staff can negatively affect the success of new computer software and hardware, says Dale Reis, RN, BSN, senior implementation specialist at CareCentric in Atlanta. To improve your chance of a successful implementation, be sure to address staff fears early in the evaluation process of new technology, she says. "The biggest fear among home health employees is that they will be replaced by a computer," she explains.

Saving some money in salaries and benefits by reducing some full-time equivalents (FTE) within the agency is one benefit of upgrading any system, but you can reassure your employees that the new system doesn't guarantee that anyone loses their job, says Leslie Halchak, RN, director of professional services at Home Health Management in West Columbia, SC. "We did eliminate 2½ FTEs when we implemented our new system in 2005, but we knew well ahead of time that we would be cutting those staff positions once the system was up and running," she says.

Because she knew about the staff reduction, Halchak used a combination of attrition and redistribution of duties to make sure that no one was laid off. "When one employee in the area where the positions would be eliminated left the agency, I used a temporary employee to cover the job until we finished implementation and no longer needed that position," she explains.

Although the fear of losing a job is found mainly in the office areas of a home health agency, field clinicians' biggest fear is not being replaced, but the technology itself, Reis explains. "Agencies that introduce point-of-care technology, such as tablets, laptops, or personal digital assistants [PDAs], find resistance from their more experienced nurses, because many of these clinicians may not know how to type and may not use e-mail or even have a computer at home," she explains. "I've seen nurses react to a PDA placed in their hands the same way they would react to a hot potato in their hands. They want to drop it just as quickly."

Have staff evaluate hardware

The best time to address clinicians' fears of technology is as you begin selection of the hardware and design of the forms that will appear on the point-of-care technology, suggests Reis. "Agency management can narrow the selection to the three items that fit the needs of the agency but include a key group of field staff in the final evaluation of the three items and ask for their recommendations," she says. In addition to inviting staff members who are natural leaders among their peers, be sure to invite some staff members who have spoken against use of point-of-care technology, Reis recommends. "Of course, when you invite these staff members, be sure to ask them if they can participate with an open mind."

Once you've chosen the equipment that field staff will use, let them play with it, Halchak says. "Before we went live with the system, we gave all of our clinicians the tablet and let them play with it," she says. "We had software that allowed them to get use to the login process and we had games that they could play to become accustomed to the stylus," Halchak says. "Playtime" with the tablet meant that staff were comfortable with starting the computer, using the stylus, and maneuvering around the system before implementation occurred, she explains.

A survey of staff during the evaluation process asked them to describe their level of computer knowledge and enabled Halchak and her staff to find out what scared staff about the use of computers. "As a result of our survey, we chose a tablet that has a touch screen and a keyboard so clinicians can choose which way they want to enter information," she says.

Another approach that eased the implementation of the new system throughout the three-office agency was a gradual introduction, says Halchak. "We piloted the project at my location before we introduced it to the other two offices," she says. The entire system was not implemented at the same time, either. "We used the system in our back office for six months before we introduced it in the field," she says. "Then when we had our field staff using the point-of-care tablets; we implemented it in steps."

The first step for the field staff was the itinerary and activity log to get everyone accustomed to uploading and downloading information, says Halchak. "Then, we introduced the OASIS portion of the system for nurses and the last part of the system to be implemented was OASIS for therapists," she explains. Because it was introduced one step at a time, everyone had a chance to become accustomed to the system without being overwhelmed, she adds.

"It is important to run a pilot test of any new system," Reis says. If you are not a multi-office agency, you can choose a small group of clinicians to act as the pilot group, she says. "The pilot group needs to understand that their purpose is to use the system in order to identify the bugs that need to be fixed."

Your pilot group will be very helpful once the system is introduced to the whole agency, Reis points out. "The initial group of field staff members can serve as a resource for other staff members," she says. While you will need someone who can provide hardware and application support, nurses and therapists can help each other with questions about specific forms and entering information. Some of your pilot group members also might act as trainers as you introduce the system to other employees.

If you address employee concerns at the start of any technology upgrade, you can have a smooth transition, says Reis. "I'll always remember that in one of the agencies in which I worked, a nurse with 35 years of experience was the most vocal staff member in opposition to the use of PDAs. We included her on the evaluation and pilot teams. One month after full implementation of the system, she showed up in my office with a PDA that was not working properly and said that she was not going to admit one more patient until we gave her a working PDA."

She laughs and says, "That's when I knew we had done all the right things to introduce the new system."


For more information on introducing new technology, contact:

  • Leslie Halchak, RN, Director of Professional Services, Home Health Management, 2858 Sunset Blvd., West Columbia, SC 29171. Phone: (800) 252-7760 or (803) 939-0266, ext. 1001. E-mail:
  • Dale Reis, RN, BSN, Senior Implementation Specialist, CareCentric, 2625 Cumberland Parkway, Suite 310, Atlanta, GA 30339. Phone: (678) 264-4451 or (800) 441-2331, ext. 14451. Fax: (678) 264-4779.