Arriving at the Root Issues with Product Adoption
A few months ago, I set out on a mission to talk with our users to get a better sense of where we could improve. The impetus for my mission was because we recognized certain implementations were stagnating. We wanted to find a way to better encourage and potentially even incentivize users for logging into the tool, but felt the need to explore where our adoption issues lied before simply throwing some features into the platform.
Our initial thought was that the interface was letting them down in some way, or that there was some barrier to entry, be it training or understanding of the product intention. After diving in though, we learned the waning success was much more about process than interface issues. Most challenges were not with the technology but with the agency’s buy-in and/or philosophy about the technology. And at the end of the day, that’s the technology company’s issue. After all, if a client isn’t successful with your technology, your technology can’t be a success.
Kathy Sierra (fist bump) talks about how no one wants to be awesome at your [technology’s] tool. People want to be awesome at solving the problem your tool facilitates. No photographer learns photoshop just to learn photoshop. She goes through the process of learning photoshop because it will improve her photography.
So, I’m going to let you in on what we learned about effective technology implementation and adoption process. Our lessons learned could help other home health agencies understand the most effective process for implementing and adopting, our, or any technology. This could also help other technology companies hoping to empower their users and facilitate long-term client success which translates into long-term clients.
Analyzing client agencies and users’ processes
Prior to interviewing our clients, I thought the process from purchase to implementation was simple: acknowledge the need for improvement, purchase the software, then train and start seeing the rewards.
What the process actually turned out to be was more like: c-suite management is sold our technology and wants to improve the company’s results in a given area, they sign then pass the project off on mid-management. That assignment gets shell-gamed around a few times before the right mid-management program sponsor is identified, at which point the ‘implementation’ process can truly begin. Medalogix and the agency then work through what the goals should be and what’s the best pathway is to get there. Then the branch/region is decided, then changed, then decided. Users are added, then trained, then trained some more, and then they’re off to the races. Woof.
To analyze our users’ processes and discover which processes work best, we started out with a graph. The y-axis measures the spectrum from novice to expert for the users and the x-axis novice to expert for the agency. We put two lines in the center of each axis to get four quadrants.
Q1 (novice/novice) “The New Adopters” : These are users and agencies that are either early in the learning process of the platform or are in the sales/marketing phase to initial implementation. It’s the kicking off point. Everyone has to come through this quadrant and there’s a time element to transitioning out of this phase.
Q2 (novice user/expert agency) “Heave Case-load Stage”: This is where we like our implementations to hang out for a while. Agencies are improving in their understanding of what the tool provides and how to quantify their results and users are growing in their knowledge of the product. Users are gaining knowledge and expertise in how best to utilize the tool and where it won’t help them. Knowing how the tool will NOT help you can be just as helpful in learning how it can help your process.
Q3 (expert user/novice agency) “The Danger Zone”: We tread into dark territory when talking about this quadrant. This is where the train can come off the rails. In this phase, we have an expert [or many expert] users and a novice agency. It’s a risky place because the users have improved greatly over time, but the agency can’t seem to transform in a way that supports having the new process. Generally this is filled with bureaucracy, fear, lack of communication between the agency and Medalogix, and a litany of other issues. Though it’s a not ideal place to be, just because you’re there doesn’t mean you can’t turn the ship around. This is a wonderful place to find opportunities to deploy additional or new resources to assist in clinical transformation and internal education.
Q4 (expert/expert) “The Gold Standard”: This is where we want all of our implementations to end up. The best path for our implementations is Q1 → Q2 → Q4. Following that trajectory would mean that the agency and the users are maturing in the product and process at roughly the same rate. Once an agency has firmly transitioned into “The Gold Standard” phase, we would likely look to their results and experience to extract marketing material, case studies, and best practices for their benefit and the benefit of our future implementations.
Plotting our customers
The practice of plotting each agency on the graph encouraged debate and discussion as to why an agency’s performance to date warranted its placement within the quadrant. We became very explicit in the criteria that determines why an agency lands where they do. We came up with 5 determinants.
Vision, Engagement, Culture, Knowledge and Infrastructure.
We’ve been calling these The Five Pillars. A low score on any one pillar prevents the “gold standard” quadrant distinction.
- Vision: This is the supportable reason, or mission statement, for implementing the technology. Maybe it’s rev-gen, patient care improvement, process improvement--it’s just something that the agency and its employees can rally around to support the implementation.
- Engagement: This is the agency’s c-suite’s commitment to be communicative with their technology partner, Medalogix. The program sponsor is also a pivotal player in the success of this pillar as he or she is generally held accountable for the program’s success. If engagement isn’t present at the c-suite and sponsor levels, we [the technology] company generally aren’t able to have systematic influence on how/why the program should be invested in both time and resources.
- Culture: This is the the harmony between the agency’s Home Health and Hospice representatives. Do both sides of the house work well together? Are you the type of agency where HH and HOS don’t ever communicate? Are HH and HOS contstantly in communication? (This is culture as it relates to our Bridge solution. Without the Bridge specificity, culture describes the team working toward a common goal to ensure the technology, and the technology’s mission succeeds.)
- Knowledge: This is the agency-wide education level of the challenge the technology is aiming to solve and why it’s important.
- Infrastructure: This is where we ask the questions: Does the agency have the processes and people needed to execute on the program’s vision and goals? Are they willing to explore different approaches in infrastructure to achieve those goals?
This exploration has been one of the best things for our company: separating the agency process and the user process. The pathway for a user to become an expert in using our tool is completely independent from the agency becoming an expert in providing and encouraging an environment where transformation is possible. But, for successful results the two need to work together.
Sifting through the minutiae of each implementation is an arduous and potentially tiresome process, but it is a fruitful exercise. Being equipped with the information learned here, we are able to better plan, triage and manage our implementations. We also have a dependable rubric in the Five Pillars to constantly reference as we evaluate the performance of each implementation and try to find the best way to help them on the ‘preferred trajectory’ in using our technology. The Five Pillars have become an integral part of how our company understands the health of any given implementation and what resources should be considered to promote better usage and outcomes in using Medalogix.
Sidenote: During this process we also defined the various organizational structures of our clients and learned what process approaches fit best for each.
- Grassroots: users at the local branches of an agency login to manage patients.
- Hub and spoke: one user sits at a regional level where a director of a region is the point person for all things involving the technology.
- Centralized: This is one, or a few full time employees, who reviews all branches for the company and is asked to be the primary user of the product 100% of the time.