What is change management? What are the guiding principles?
Change management is defined as “the discipline that guides how we prepare, equip, and support individuals to successfully adopt change in order to drive organizational success and outcomes.” In order to keep up with competition, organizations continuously assess, reassess, and adjust their organizational strategies and operations. These constant changes, however, can put stress on employees if not implemented tactfully.
According to a number of organizational design and transformation specialists (here), there are 10 guiding principles of change management:
- Address the “human side” systematically
- Involves identifying and engaging stakeholders throughout the entire organization and involving them early on in the transformation process
- Start at the top
- The CEO and leadership team will need to set an example and practice the same principles they are encouraging all employees to adopt
- Involve every layer
- “Change efforts must include plans for identifying leaders throughout the company and pushing responsibility for design and implementation down, so that change “cascades” through the organization”
- Make the formal case
- This is a three step process that involves (1) articulating the need for change, (2) demonstrating faith in the organization, and (3) guiding employees in the right direction
- Create ownership
- Best done by involving people early on in both identifying problems and crafting potential solutions
- Communicate the message
- Regularly communicate with employees, reinforcing core messages and expressing confidence in their abilities
- Assess the cultural landscape
- “Thorough cultural diagnostics can assess organizational readiness to change, bring major problems to the surface, identify conflicts, and define factors that can recognize and influence sources of leadership and resistance”
- This will also help identify core values and beliefs among employees that will help determine the best approach to organizational change
- Address culture explicitly
- Leaders should know the culture necessary to support and sustain the transformation and then devise a plan as to how to promote that particular culture
- Prepare for the unexpected
- Continually reassess the organization and the impact of the transformation
- Speak to the individual
- “People will react to what they see and hear around them, and need to be involved in the change process”
But how does change management relate to health informatics? With advanced technology taking over the healthcare industry, hospitals, health plans, physician groups, and other healthcare facilities have had to either quickly adapt or risk being left behind. One of the biggest changes facing the healthcare industry has been the implementation of electronic health records, which will make up the remainder of this post.
What are some ways in which people are really resistant to EMR system? How can this resistance be mitigated?
What are some ways in which people are really resistant to EMR system? How can this resistance be mitigated?
The majority of people fear change and the greater that change is the more they will try to resist it. This is a natural human instinct but yet is often forgotten by those making leadership decisions. In the case of an EMR implementation there are many reasons for people to fear change. Such a dramatic shift affects every aspect of operations throughout the hospital. Everyone will have some aspect of their workflow changed because of the new EMR and for some people it alters nearly every single task they perform throughout the day. Knowing what type of concerns are likely to arise and how to mitigate those concerns are key for a successful implementation.
One major concern on the part of clinical staff is that they do not know how to use technology. Nurses or physicians who have been practicing medicine for decades may not be as technologically savvy as younger generations and therefore be concerned that they are not capable of learning the new system. In order to show that these concerns are unfounded it is necessary for part of the medical executive team who shares these demographic traits to sample and endorse the new EMR. If clinical staff see that the CMO has been willing to give the system a try and supports it they will be more willing to do the same. Additionally, offering extra training opportunities such as free typing lessons to help gain familiarity with computers can make the transition easier. This can have dual benefits as it will not only ease concerns over the implementation but also speed up the amount of time it takes for them to adjust to the new system
Another possible reason for staff displeasure is that they do not believe the benefits are worth the incredible disruption to the normal routine. A new EMR complete with a CPOE system will add significant time to the process of charting as well as placing orders which will take a minimum of months to begin seeing gains in efficiency compared to the baseline. At this stage it is important to stress the benefits that will be accrued by patients once the EMR is implemented. The convenience of having records available online as well as the increases in quality through automated checks for prescriptions or orders need to be emphasized. On top of the benefits to the patient there are also benefits for physicians despite several inconveniences. The ability to access imaging or lab results from anywhere is a key feature and will cancel out some amount of the hesitation on the part of physicians.
What are the specific roles your people play in a transition to EHR?
Transitioning to an EHR requires significant manpower and commitment to help make the change successful. Senior executive leadership should be sure to involve all stakeholders early in the process to foster a sense of ownership over their responsibilities to ensure successful EHR implementation. Additionally, defining clear roles and expectations is critical to the success of a transition to an EHR as well. Putting the organization’s human resources at the center of the change and including them in every step of the process will bring the organization closer to achieving its defined goals of the project.
Drivers of the EHR implementation project will usually include highly-visible clinical leadership, IT staff leaders, and administrative managers, all of which may sometimes form a steering committee with responsibility to lead and oversee the planning and implementation work. Implementers of transitions to EHR will make the actual changes occur within the IS network and infrastructure, create and lead the staff training, provide post-implementation support and ensure that the project is on-time and within budget. Many healthcare organizations will appoint project managers to ensure the project is on-track and goals are met. Vendors are often included in this phase of EHR implementation. This team of individuals further ensure the project succeeds through creation of “super-users” that lend a hand with change management and can communicate issues and challenges between different parties involved and impacted by the new changes. Champions of EHR implementation are influential and well-liked members of the team who are able to actively convey the benefits of the new changes to other staff members who will be impacted by the transition. Champions are often clinical leaders who are relatable and understand both the clinical workflow processes and the relationships between members of the care team. Though champions can also sometimes be supervising office managers, other staff members will look to these individuals for guidance.
The workflow of both clinicians and non-clinical office staff will undoubtedly change. Post-implementation, clinicians and office staff play a critical role in evaluating the EHR software’s usability and paying attention to opportunities for improvement as the front-line users of the new technology. The transition from paper to electronic data records will need to be carefully managed by administrative managers to ensure that all necessary patient and clinic information is being properly documented, stored, used, and accessed. IT staff will need to be continually involved with system upgrades and maintenance even after the EHR is implemented.
How important is change management to implementing an EHR?
The healthcare industry is changing rapidly. There is a transition in incentives from volume to value, the entry of non-traditional healthcare providers to the market, the introduction and utilization of telemedicine, as well as the changing dynamic of patients to a consumer focus mindset. All of these changes add additional stress to an already stressful industry for those frontline providers. All of this culminates in the truth that EHR systems are essential for healthcare organizations to remain competitive in their markets, yet is is arguably even more essential for healthcare organization to be adept at change management in order to implement said EHR systems.
A leader in change management, and someone who has developed tools and models for organizations to utilize when conducting change management is John Kotter. Kotter believes that there is an emotional component as well as a situational piece to every change, and that both have to be managed effectively for the change to be successful. The model below illustrates Kotter’s three phase approach to managing both components of change that are inherent with every change management project.
This model emphasizes the entire change management process, starting with laying the foundation for the change within the culture of the organization all the way through the importance of sustaining the change when the change has been implemented. Following this model, and tweaking it to fit specific organizational needs should provide the guidance necessary for successful change management relating to the implementation of an EHR system.
What are some change management must haves?
Staying with the insights shared from the model presented in the last section, here we will identify some of the must haves for a successful transition from paper charting to an EHR. The first of which is creating a climate for change.
- Creating a Climate for Change
The first step in creating a climate for change is to clearly define the future state or vision for the project. It is in this phase where stakeholders opinions are solicited and headed. Through the conversations and meetings you will be able to achieve buy-in and acknowledgement of the change that is to come in the future. In this step it is also critical to identify a champion for the change through the meetings and discussions. The identified champion should be staff who will be directly impacted by the change, has the respect of peers, and are supportive of the change. Additionally, it is critical in the creation of a climate for change to establish the project plan. This will be the road map for the EHR implementation and will allow the expectations of everyone involved in the project to be aligned.
2. Engaging and Enabling the Organization
Once the climate for change has been established. The next must have for successful change management regarding the implementation of an EHR system is to make sure that staff are engaged in all aspect of the system selection and workflow/processes redesign. This relates back to the importance of getting their buy-in and acceptance of the project. Additionally, it is critical in this phase of change management to conduct the trainings for users of the EHR system. Before the system goes live, users should be comfortable with it and able to navigate throughout the system. There will be strong resistance to the EHR if it slows down the workflow for clinicians after its’ launch. The training component will help to alleviate that. Lastly, this is the step where it is important to evaluate the usability of the new system. After training has been completed the project manager should have a good idea of what use of the system should look like. This is the final opportunity to cut losses and find a different system if the one selected will not improve patient care and is not a good fit for the organization.
3. Implementing and Sustaining the Changes
The last set of must haves for the change management surrounding the implementation of an EHR system pertain to the implementation and sustaining of the changes themselves. The first key component of that is by putting to use the feedback that engaged staff have provided throughout the entire process through system updates. This ensures to staff that their opinions are heard and will continue to garner their support of the new system. It is also a key must have for change management and sustaining the changes to reward the staff who have worked hard throughout the process to get the EHR system in place. Do not allow their hard work to go unnoticed and thank them to gather their continued support.
All of the information listed above in the three groupings of must-haves for change management are depicted visually in the table below:
Who should be in charge of the change management process? Who does the change management need to be tailored toward?
There are many moving parts of healthcare and determining who is accountable for what is challenging in a highly matrixed industry. For HIT, the change management process must involve all parts of a health system because everyone is a utilizer and customer to the HIT system.
Many organizations assemble a change review board or change advisory committee. This committee is represented by HIT personnel from various teams of the HIT department and also includes key users typically identified as “super users” from different business and clinical areas. Technical expertise is less of a predictor of success and those who participate in the committee are likely chosen for the respect and influence they have among their community. A typical makeup of this committee includes:
- Network engineer or network architect
- Server engineer or architect
- Key application analyst
- Support center manager
- Nurse manager
- Business office manager
- Physician
- Vendor representative
- Third-party consultant
- Other experts (as needed)
Change management does not necessarily tailor itself toward one group or one entity. It is organized through a formal process to allow managers to authorize change requests and to allow the advisory committee to review proposed changes to issues. Its purpose is to ensure changes coming from the business or clinical units are factual and the changes the advisory committee makes will amend and alleviate root causes to problems that arise. All change management processes are documented and are prioritized by urgency in order to quickly move requests to production. This is to ensure service disruption is minimized, but also to ensure that expectations such as competencies are properly tracked and demonstrated. One area that is tailored to specific groups is during training. To foster participation and to allow that all staff have adequate knowledge to carry out their responsibilities, members of the advisory committee will ensure under the direction of management that training materials are specific to the people doing the work and to ensure .
What are the common mistakes in change management?
Mistake #1: Not Defining Clear Leadership Roles-
Defining clear roles is the first step to avoiding mistakes in change management. Effective change management requires clear definition of change leadership roles: sponsor, change process leader, change leadership team, initiative leads, project teams, and change consultants. Without a common understanding of roles, the project cannot go forward in a coordinated fashion. All parties will need to align on their vision of decision making levels and authority, and the decision style and process that best supports the overall execution of the IT project.
Mistake #2: Making the change too quickly-
Change can sometime happen rapidly, and in a vacuum. With this occurrence, there will not be a collective effort because different departments within the organization are working on their own solutions to their own problems, and do not have time to come up with solutions to solve the bigger issues at hand.
Mistake #3: Failure to make a compelling case for change-
It takes time and energy to convince employees to work outside their comfort zones. It takes a strong emphasis from leadership to promote a sense of urgency surrounding a project. Creating a sense of urgency creates momentum within the project because it highlights how important the change is within the organization. Many times leadership will get resistance from employees while a project is underway. Leadership must circumvent this by messaging that a problem truly exists; the messaging should be a compelling change story that will become a motivator to their employees.
Mistake #4: Not having a clear vision-
After the case is made for change, many leaders feel that they have helped to create a clear goal for a project. However, this clear vision may not translate to the rest of the organization. According to Kotter’s 8-step process for change, communicating the vision and empowering others to act on the vision. Empowering others to act on the vision leads employees to take action sooner and more efficiently on efforts that will support the change.
Mistake #5: Not celebrating the small victories-
When a group goes through a project that deals with change there needs to be some early on success. This success will motivate the group and carry them forward onto the next set of tasks and goals for the project. It is crucial to choose targets that can easily be obtained to keep the momentum moving forward. It is no use to set high benchmarks that will only discourage the participants in the project. The benchmarks that are set should be completely analyzed to avoid potential failure.
Resources:
http://library.books24x7.com.offcampus.lib.washington.edu/assetviewer.aspx?bkid=74363&destid=479#479
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