The ‘Us’ vs ‘Them’ Mentality is Toxic for EMR Adoption

Hind-sighting = blame. And blame solves no problems. –John G. Miller

Why can’t these nurses figure out these EMRs? It’s not that hard. What’s with these physicians? They have 12 years of education but can’t put in a simple CPOE for Tylenol. Why did our management team choose such a terrible charting system? What out-of-touch people designed this user-unfriendly EMR? Real clinicians don’t think like this.

Have you heard, or perhaps asked, some of these questions during an EMR implementation? I bet you have. I have too.  Most recently the question I heard was, “I’m technologically challenged so if I can learn it, they can learn it.”

“Why can’t you figure it out?” and “If I can learn it, you can learn it,” question the intelligence of the user. The first gives the if you can’t do it you must really be an idiot impression. The second is even worse. “If I can do it, you can do it,” translates to I’m a tech idiot and can figure this out so you must be an even bigger idiot. Oh, and also I’m better than you.

us_v_themThe problem with all these questions is they divide groups that are trying to reach the same goals – EMR adoption and use. During a time when we all need to work together, these questions actually split teams into “us” and “them.”

Recently, I learned about a technique to help turn these types of questions – which is really finger pointing disguised as question asking – into productive exercises of inquiry. It’s called The Question Behind the Question. QBQ was developed by John G. Miller who noticed a need for personal accountability while he was working as  a corporate trainer.

The philosophy behind QBQ is that questions that use “why, who or when,” are weak questions that leave the person asking them feeling powerless. These types of questions also blame others rather than finding true solutions.

Here are a few examples of what Miller calls “incorrect questions.”

  • Why are they making my job so hard?
  • When are they going to give us the resources we need to get the job done?
  • Who made these decisions?

Instead, Miller says we should formulate strong questions by doing the following:

  • Use “what” or “how”
  • Use “I”
  • Focus on action

Using these guidelines, questions like, “What can I do?” and “How can I support others?” would be considered strong questions. They help us find solutions and let us determine how we can best handle a situation. They recognize that we can’t control other people and we can only control ourselves and our response to the situation.

Let’s take a look at how the QBQ concept can apply to the questions we often hear during EMR implementation.

First let’s focus on the users. It’s not unusual for users to be a bit resistant to EMR. It’s something new and unfamiliar that has the potential to disrupt their well-established workflow. The incorrect questions often asked by users are: “Who designed these awful systems?” and “Why is management making us use these awful systems.”

Better questions to ask, according to QBQ, are, “How can I make learning these systems better,” or “What can I do to improve the situation?” Some actions that might arise from these questions are:

  • I can ask for extra help beyond the standard training that’s given to me.
  • I can talk to my manager about stumbling blocks the systems are causing in our workflow.

Some of you may balk at this and I understand. What if your manager is unwilling to help? Or chastises you for admitting your aren’t feeling up to par? If you get responses like that remember you have a choice. Do you really want to work for someone who won’t support his or her employees? If you get either of the above responses, then maybe it’s time to start looking elsewhere for an employer that shares your values.

Now for the designers, trainers and others implementing the systems. Are “Why can’t these doctors and nurses figure out these systems,” and “Why are these clinicians being stubborn and resisting EMR?” strong questions? No. They blame others for the situation.

Better questions would be, “How can I support these new users as they learn the system?” and “What can I do to make the transition easier?” Actions that may answer these questions:

I can attest to being a bit skeptical about the QBQ technique. But I used it and it did indeed work. Recently someone questioned some of my professional skills. In the past I would have panicked and thought I was doomed for failure. But instead I thought, “What can I do to be sure my skills are up to snuff?” I decided to talk to my manager and, if necessary, get extra training. The conversation was a success and I was reassured that my skills were just fine and that no extra training was necessary. After the situation was over, I felt empowered. I had solutions in my back pocket to make everything ok. And I didn’t even end up needing them.

I encourage anyone who is implementing an EMR to try out the QBQ technique. You may be pleasantly surprised!


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Jennifer Thew, RN, MSJ

Jennifer Thew, RN, MSJ, is a registered nurse and journalist who has covered healthcare issues and how they relate to the nursing profession. She began her nursing career as a neuroscience nurse at Rush University Medical Center in Chicago and then transitioned to journalism after receiving a degree from Roosevelt University in Chicago. She has edited and written numerous articles on a wide range of nursing and healthcare topics like Accountable Care Organizations, evidence-based practice and telehealth.

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