Truly Transformative


Kennedy, M. (July, 2016). Truly Transformative. Online Journal of Nursing Informatics (OJNI), 20(2). Available at

It’s fascinating to observe growing prominence of the word “transformation” in our healthcare language, as it becomes a ubiquitous descriptor to represent a wide variety of health care initiatives. Indeed, transformation has become a mere buzz word, a trendy label to reflect desired, impending, or proceeding changes to an existing practice, level of knowledge, or philosophical position. Suddenly everything is seemingly intended to be a “transformation” or “transformational” regardless of scope, priority, potential value, or measurable outcome.

At its most basic level, transformation can be defined as a complete change in the characteristics or appearance of something to an improved state (Cambridge Online Dictionary).  Depending on one’s perspective, transformation can be further defined as outputs of change management, goals for strategic planning, a revised configuration of physical surroundings (such as intensive care units or personal living environments) or information systems, or even the result of a dramatic new hairstyle. 

On any given day, one can hear calls to transform the healthcare system, to transform the way the healthcare system is funded, to transform the manner in which health care is provided whether on an individual basis or a broader population-based approach, or to transform the clinical process through the use of digital technology. However, when we pause to consider the word transformation in the context of healthcare, and more specifically within the context of nursing informatics, the complexity of both the term’s meaning and the implications for its use become apparent.

Across Canada and many other countries, numerous projects entitled transformation (or some derivative thereof) are underway. Certainly, this creates tremendous expectations for stakeholders, and reflects the significance of the project among the project sponsors and teams. However, when the transformation projects are completed, project teams have been disbanded, and clinicians are practicing their respective professional disciplines supporting patient care using systems that suddenly appear less than truly transformative, it is time to reconsider how projects are conceptualized, socialized or marketed, and funded.

When health information systems are designed without the active engagement of clinicians – all clinicians, the results are often disastrous. Understanding existing workflows and having a clear future state are imperative for transformation to truly be achieved.  The ways in which clinicians provide care is a foundational element of every transformation, and that can only be improved with the active engagement of clinical experts. Too often, clinicians and other stakeholders are disappointed when the results of the latest and greatest transformation initiative, realizing that transformation is still far from reach.

Figure 1 Evolution toward Transformation

Figure 1 represents the stages of evolution from the commencement of a project to a position to a transformation. Replicating existing linear, paper-based processes, regardless of whether in a completely digital environment or a blended environment, will not and cannot drive the innovations required to develop a patient-centred, evidence-based, sustainable health care system. Worse still, the introduction of health information systems that merely replicate existing linear processes often introduce new errors into healthcare and patient care delivery processes. With new thinking about healthcare systems and delivery mechanisms, in collaboration with clinicians and other healthcare professionals, greater innovation supporting healthcare priorities can be embedded in health information systems, such as smart technology and mobile devices.  This however doesn’t take us all the way to transformation. In order to be truly transformative, information silos must be dissolved, information must be exchanged across transition of care to support patient needs, accurate, valid and timely data must be available at the hands of clinicians whenever and wherever needed to inform quality care, and data including financial, quality indicators, human resource  management, and materials management must be available to administrators to support program planning, current needs and trends, and future priorities. As well, consumers (or patients) must have access to their own data to become equal partners in creating a patient-centric, learning and sustainable healthcare system.
Not every project is actually designed to be transformative nor will all projects reach the level of transformation. Consequently, restraint is needed in positioning projects that contribute to incremental value to long-term transformation as “transformative” in the moment. There is greater value to having clear expectations of the proposed scope and outcome than suffering disillusionment when projects fall short of the marketing hype.


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