The importance of people has to remain clear while attending to each dimension of the digital house. Even if an information system is perfect, the process will fail if the people who have to use it reject it. In most fields, this rejection would mean a major loss of investment. In health systems, where people’s lives are at stake, the cost would be staggering.

Studies show that globally, 35% of public sector technology projects can be considered failures, 50% partial failures, and only 15% successful.¹ This is largely because transforming a system is not about swapping one thing for another; it is about evolving towards a new reality. This is where the human factor and cultural factor plays a decisive role. Ignoring this factor is one of the main reasons why enterprises fail in the digital age. In fact, a third of decision-makers consulted in a global survey said that culture is the main obstacle to digital effectiveness, followed by people’s lack of understanding of digital trends.²

A DT’s success depends on three ingredients, in equal measure: people, processes, and technology.³

Indispensable

When designing and implementing this dimension of DT processes, the aim is to get health personnel and citizens to accept and use the technology by empowering them and involving them in developing and the digital strategy and putting it into practice. This aspect encompasses communication, capacity building, and organizational change management actions.

Despite their importance, people and organizational culture are too often included in DT processes as an afterthought and are frequently the first target of budget cuts

Irresistible

New technology changes everyone’s processes and ways of doing things. Without an intentional change management strategy, there will be considerable resistance. Changes can make people feel insecure, like they are losing control, and afraid of the unknown. So, for a transition to be successful for individuals, groups, and organizations, it is essential to recognize resistance as a natural and inherently human reaction. This factor is even more important in the healthcare sector, with its broad and diverse network of stakeholders (each with their own interests) that cooperate or disagree to varying degrees⁴ and that are constantly dealing with highly sensitive matters like sickness, death, and even humanness itself.

Evidence shows that projects with a well-implemented change management strategy are six times more likely to meet their objectives than those without one.⁵ This means they are more likely to meet deadlines and stay within budget.

Fortunately, tools for implementing change management, especially in health care, have already been developed. For example, John P. Kotter’s change management model emphasizes how important it is for all stakeholders to understand:

• Why they need to leave the current state and move towards the desired one.
• Why the future state is better for patients and professional practice.
• What changes in workflows (daily routines) will be necessary.
• What technologies and new skills will be required.
• How staff will learn these new skills and incorporate the new technology into their work routines.

The model gives eight steps for achieving this:

• Create a sense of urgency based on the institution’s purpose.
• Build a coalition of professionals with different skills.
• Draw up an information systems master plan.
• Formalize the communication processes.
• Train stakeholders on new tools and skills.
• Rapidly obtain information on and an overview of the implementation’s success.
• Cement the change and set up a cycle of continuous improvement.
• Evaluate results, review processes, document new standards and procedures, and audit.

The Hospital Italiano de Buenos Aires estimates that up to 30% of a health information project’s budget should be allocated to change management.

The IDB publication: Irresistible: How to manage change in digital health details a variety of traditional resources and tools and delves deeper into this crucial topic.

Communication and adoption by citizens

What is the best way to get citizens to adopt change? Public comment processes have been an effective tool. For example, the government of Peru used this type of process to present its digital strategies to the general public and get their point of view.

These processes require identifying which stakeholder(s) the population trusts. A survey of 10 countries in the region measuring people’s level of trust in different institutions for adopting COVID-19 exposure notification apps found that people trust the WHO the most, followed by ministries of health. ⁶

In over 15 years of digital transformations, we have learned that underestimating the barriers linked to the human factor is a common error. Understanding people’s emotions and acting based on this understanding facilitates the change process and adoption of the technology, to the benefit of all involved. This dimension therefore deserves serious attention, funding, and planning from the outset.