I’ve recently been working on a mobile device management project for one of our clients, and we’ve just completed the pilot. The technology works great, but I couldn’t help but wonder how many users set “1234” as their passcode. This got me thinking about projects that implement new technologies or business processes and get stuck at the End User Acceptance stage without ever reaching Adoption. What are the implications to that department or organization? Specifically, what are the costs (financial and otherwise) of IT projects that are implemented and accepted by end users, but never truly adopted?

What Does “Acceptance” Look Like?

In our day-to-day lives, we all have had some experience with being the end user. Can you think of a time when software you use daily was “upgraded” or perhaps you got a new smartphone and you weren’t exactly thrilled with the results? Maybe you couldn’t find the feature you need (“I knew exactly where it was in Excel before.”). Maybe you find your old patterns and habits are harder to break than you thought they’d be. Depending on our personalities, level of frustration or disruption, and the availability/convenience of support options, we may or may not ask for help when a new technology presents challenges. We may or may not voice a complaint. And most of us have so many demands on our time that we aren’t able to devote a lot of time to searching for answers. As long as we can still accomplish what we need to, we usually accept (albeit sometimes begrudgingly) technology changes as inevitable. Although initial end user responses to changes are usually temporary and fade with time, as long as they can still accomplish the bare minimum (e.g., open the file, make a call, etc.), the responses below are more common than we’d like to admit in the days and first few weeks following a change:

  1. “Suck it up” and live with that bare minimum (e.g., they use the powerful new smartphone for phone calls only, managing emails from work and home computers); or
  2. Find a work-around to fully using the new technology (e.g., work on the file from their home computer which has the old software version).

Stepping out of the end user’s point of view, both of these post-implementation responses could look like “acceptance” to the organization. The user isn’t calling the Help Desk for assistance, the work seems to be getting done, and they “look” like they are using the new technology. A couple of weeks after go-live might be an appropriate place to evaluate the success or failure of the planning and implementation efforts, but clearly it is premature to gauge whether or not the new technology will achieve the business goals and deliver a positive returns on investment.

… vs. Adoption

Measuring true end user adoption requires more than just a couple of weeks of use of a new technology. In the article, “If Practices Don’t Change, EHRs Lose Money,” David Pittman reviews a recent 5-year study by Health Affairs of 80 physician practices that moved from paper-based charts to an electronic health record system (EHR). Compared to the paper charts, the EHRs were supposed to increase efficiency, streamline work flows, and make it easier to find and securely share information. But the study found that 5 years after implementing an EHR, only 10% noted improved efficiency and only 27% of practices achieved a positive return on the investment. Their findings also revealed that after 5 years on the new electronic health record system, only 55% of the practices noted reduced costs for paper medical records. Think about that for a minute – if the costs related to paper records didn’t drop at all for 65% of the practices, did they truly adopted the new tool? Probably not. The end users either found a way to live with the “bare minimum” in their EMR or found a work-around to bypass the electronic system, but this resulted a lack of return on investment. The researchers observed that, “Practices with a positive return on investment realized savings by eliminating paper medical records, as well as dictation and billing services and positions of, or hours worked by, staff members who were performing services no longer required after EHR adoption.” The researchers noted that ” “Practices may therefore need encouragement and assistance in changing the way they operate so they can benefit from EHR adoption.” In this example, the support calls related to the EHR implementation likely dissipated within the first several weeks of implementation, the project closure documentation was completed, and the project was deemed a success since staff were using the new EHR. Maybe the project even finished on-time and on-budget. It doesn’t necessarily mean that the related changes to the work flows, processes and culture took hold in a lasting, meaningful way – and that is precisely what is needed to realize the return on investment.