Kubler-Ross Bereavement          System change e.g. IT

Denial                                                           Resistance

Anger                                                            Anger

Bargaining                                                    Bargaining

Depression                                                   Acceptance

Acceptance                                                  Frustration

As a practicing general practitioner, with a background in health IT, I have often thought about the way health care professionals and patients react to changes in the primary care environment.

I have made considerable observations on the way patients and colleagues particularly react to changes in business processes such as are enabled by information and communication technologies.  There has been an explosion in “clinical transformation” with the national program for IT and also ongoing local IT changes.

I have been pondering this whilst on train journeys (which I find as the only time I get to totally separate myself from the trade I have chosen…besides of course holidays) and could not help but see the similarities between the “five stages of bereavement” by Kubler-Ross, which are, denial, anger, bargaining, depression, acceptance, and those felt by colleagues and me when change is thrust upon us.

With Kubler-Ross as an inspiration, I started to think about the way one feels when confronted by new technology and or other changes in the Health IT environment.

Therefore I have come up with my adapted Kubler-Ross version of the different stages of “emotions” one feels when working business processes change.

(1)Resistance: I will not change the way I work…it works for me and I know how it works with all its supposed weaknesses…they did not ask me whether I want it change…I was not involved…

(2) Anger: Why are they making me change…I will have to learn to do something new…what happens if I make a mistake…work is already stressful enough…they are just making life more difficult for me…

(3)Bargaining: The old system is gone…I have no choice…I still do not like it…the old system had shortcuts I learnt over years…the old system was much better…what a waste of money and time…

(4)Acceptance: This new system works quite well…more useful then previous system…no choice but to get on with it…did not know I could do that so quickly now…

(5) Frustration: This new system is better than the old one…but it should be able to do more…why can it not also do this…they should have asked me when they were developing it and it would have been much better…they need to upgrade it to be more useful for me…

So maybe, just maybe, we should adjust project development processes to manage these emotional responses as people bereave their old ways of working, we should expect this, plan well for the training and support required, and manage expectations.

Sami Ansari initailly undertook a BSc(Hon) degree in Computer Science and Mathematics at the University of London, he then went to work for several financial corporations in the City of London and abroad. A few years later he had an “awakening” and decided to enter the field of medicine as he wanted be a student all his life. He went onto qualify from the Imperial College School of Medicine (St Mary’s Hospital Medical School) in 1999. He now works as a GP Partner in Harlesden as well as in the Health IT Industry as a Consultant.

Competing interests: SA has been previously employed as an Health IT Consultant by, Connecting For Health, iSoft Ltd and British Telecom Local Service Provider (LSP). He is also a Medical IT Director for Medical IT Consultancy Ltd, iHelpme Ltd and also a member of the British Computer Society.