Revised AUPHA presentation June25, 2009


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AUPHA conference Chicago 2009 - A Change Management Simulation

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  • Winston – Welcome and Introductions
  • Jake – Brief review of agendaRemind people that not an expert on simulations
  • JakeManaging health Information ServicesGeneral Management Course (Leadership, Teamwork, Decision Making, Strategy etc ) includes section on Innovation and Change ManagementFully On-Line using Blackboard Text Management – by Williams Kondra and Vibert
  • Too much readingLack of understanding of complexity of managing change and how the concepts discussed in the textbook fit into a real world context that they can understand.Some wrote their final paper on Change Management – clearly did not have a good appreciation for the complexity of Change process and failure rate and potential problems
  • JakeKevinValdarasFerris Bueller
  • Pay attention to last part
  • JakeGenerally Accepted to be ~ 60-70%Management Firm Bain and Company completed a recent survey of companies that had initiated large scale change project - 70% did not deliver expected results and this has remained unchanged from similar surveys in the 1980s and 1990sExample:In Toronto – in 1996 the Health services Restructuring commission initiated the changes that resulted in restructuring and some hospital mergers – due to the idea that it would reduce many redundancies and lead to greater efficiencies. In 1997 it released its plan for the city and called for the closing of eleven of forty-two hospital in this city and the amalgamation of others. Cost 123,000,000. Three years later the HSRC was disbanded. merger and demerger of Sunnybrook Health Sciences Centre and Women’s College Hospital-. Looked good on paper but in 2004/2005 the process to demerge the hospitals began. St. Michaels Hospital and Wellesley Hospital
  • All this talk about change and focus is often on the efficiencies and dollar saved – forgetting the complexity of people and different organizational cultures and how this impacts on theory and plays out in the real world.
  • Remember – I am not an expert on Simulations.
  • Clear objective – was to evaluate the studies currently in the literature and get a better sense on whether traditional instruction or games and interactive simulations were better teaching methods.Examined 248 studies – 32 met the requirements for inclusion That they had a hypothesis that identified cognitive gains or attitudinal changes That they reported statistics assessing traditional classroom versus computer gaming and interactive simulationsA computer game is defined as activity that has goals, is interactive and is rewarding (gives feedback)An interactive simulation must interact with the user by offering the options to choose or define parameters of the simulation then observe the newly created sequence rather than simply selecting a prerecorded simulation.Findings that overall significantly higher cognitive gains were observed in subjects utilizing interactive simulations or games versus traditional teaching methods (Z=6.051, p<.0001 (N=8549)
  • Objective was to inform policy What is the cumulative quantitative and qualitative evidence for using computer games for learning? What are the factors, if any that weigh in the effective application of instructional gamingGaming – a game is defined as being separate from a simulation in that a game involves competition and does not necessarily require two or more participants. If a Simulation enables a learner to compete against him or herself by comparing scores over successive attempts at the simulation or has a game structure imposed on the system, it is regarded as a game mode. If the focus of a simulation involves the completion of an event only (no score!), the simulation will not be considered a game.600 research reports or articles within the category of computer games in the literature. - content relevance – research focused on the design or applicaton of computer-based games for learning purpose - Year of publication was 1985-2007 - English language publicationsA total of 256 document on the design, use and evaluation of computer-based games were reviewed. - Of these, 167 could not be included in the analysis for a variety of reasons.Leaving - 89 research articles were included in the analysisAuthor conducted a qualitative meta analysis and found 5 major themes. Two of which are relevant to what we are looking at
  • 34 out of 65 game effectiveness studies reported significantly positive effects of computer-based games17 reported mixed results (instructional games facilitated certain learning outcomes but not others)12 reported no difference between computer games and conventional instruction1 reported conventional instruction as more effective than computer games.
  • Only 10 out of 89 studies looked at learner characteristics and gender was the most examinedThe studies that reported gender difference were qualitative in natureThe studies that reported no gender difference were experimental and comparative.
  • Many organizations use the simulations by experience point and they have more than healthcare.Decision Making simulations regarding recognizing decision making biasesChange management for a Global tech companyChange management where they implement lean practices in a hospital emergency roomChange management where they implement holistic corporate social responsibility strategies for a global company Custom simulations
  • Km to miles 1 kilometer = .62 milesSo 8 km is about 5 miles7km is about <4.5 miles4km is about 2.5 miles
  • In general the main distinguishing feature of an Urgent Care Centre is that ist is not designated as a receiving centre for ambulance bound patients. Thus any patients being transported by ambulance will automatically be routed to an Emergency DepartmentThat doesn’t mean that an urgent care centre can’t handle cases which may develop into an emergency or life threatening clinical problemUrgent care centres are also typically only operate 12 -16 hours per day.
  • Students must consider the positions, interests and advocacy efforts of a number of stakeholders who are affected by the Emergency restructuring. They will have the opportunity to interview some of these stakeholders in the simulation to learn more about their points of view. This is where they begin.
  • This is the 7 stageexperiencechange model. They need to use this to develop their change plan that maximizes commitment and minimizes resistance to change.
  • The first time I ran the simulation – I didn’t specify how many times they should run through the simulationHowever many ran through it more than once. What I noticed was a significant change in their scores if they ran through the simulation more than once.So in running the simulation this time I wanted to know how many times do they need to run through the simulation to score well on the simulation.
  • Revised AUPHA presentation June25, 2009

    1. 1. 2009 Annual Meeting<br />A CHANGE<br />MANAGEMENT<br />SIMULATION<br />SCHOOL OF HEALTH SERVICES MANAGEMENT<br />RYERSON UNIVERSITY<br />Winston Isaac PhD, CHE<br />Jake Pringle MBA, DC<br />PriaNippak PhD<br />
    2. 2. AGENDA<br />Background<br />1<br />2<br />Why a Simulation?<br />3<br />Pedagogical Evidence for Simulations<br />4<br />THE SIMULATION – EXPERIENCEPOINT<br />Central-Valleyview | ExperienceChange<br />Objective<br />5<br />6<br />Methodology<br />7<br />Results<br />8<br />Limitations<br />9<br />Discussion<br />Conclusion<br />10<br />Questions<br />11<br />
    3. 3. 1<br />BACKGROUND<br /><ul><li>Course
    4. 4. CHIM 300 (Managing Health Information Services)
    5. 5. Online Delivery through Blackboard
    6. 6. Section on Innovation and Change Management
    7. 7. Past
    8. 8. Williams, Kondra, Vibert (2008). Management,(2nd Canadian Ed.) . Toronto: Ontario. Thomson-Nelson
    9. 9. Supplemented with additional readings/case studies</li></li></ul><li>Student Feedback <br />Difficult conceptualizing what is “Change Management”<br />1<br />BACKGROUND<br />
    10. 10. 1<br />BACKGROUND<br />Change<br /><br />
    11. 11. 1<br />BACKGROUND<br />SIMULATION?<br />noun 1. imitation or enactment, as of something anticipated or in testing. 2. the act or process of pretending; feigning. 3. an assumption or imitation of a particular appearance or form; counterfeit; sham. 4. Psychiatry. a conscious attempt to feign some mental or physical disorder to escape punishment or to gain a desired objective. 5. the representation of the behavior or characteristics of one system through the use of another system, esp. a computer program designed for the purpose.<br />(simulation. (n.d.). Unabridged (v 1.1). Retrieved June 17, 2009, from website:<br />
    12. 12. 1<br />BACKGROUND<br />CHANGE MANAGEMENT<br />High Failure Rate (~60-70%)<br />Failure<br />Performance measures are not achieved<br />
    13. 13. 1<br />BACKGROUND<br />CHANGE MANAGEMENT<br />Why important?<br />The problem may not be a lack of knowledge but an inability to translate the knowledge into practice <br />Remember – definition of simulation<br />The representation of the behavior or characteristics of one system through the use of another system, esp. a computer program designed for the purpose.<br />(simulation. (n.d.). Unabridged (v 1.1). Retrieved June 17, 2009, from website:<br />
    14. 14. 2<br />WHY A SIMULATION?<br />A Simulation:<br />Provides a safe platform for practice<br />Provides an opportunity to test theory through application <br />Provides a powerful alternative approach to complement and extend traditional teaching approaches in change management.<br />
    15. 15. 3<br />PEDAGOGICAL EVIDENCE FOR SIMULATIONS AS AN EDUCATIONAL TOOL<br />Multiple studies have evaluated the efficacy of simulations as an educational tool<br />Two recent meta-analysis studies<br />Vogel, J.F., Vogel, D.S., Cannon-Bowes, J., Bowes, C.A., Muse, K., & Wright, M. (2006). Computer Gaming and interactive simulations for learning: A meta-analysis. Journal of Educational Computing Research, 34(3), 229-243<br />Ke, F. (2008). A qualitative meta-analysis of computer games as learning tools. In R. E. Ferdig (Ed.), Handbook of Research on Effective Electronic Gaming in Education (pp 1-32), New York: IGI Global.<br />
    16. 16. 3<br />PEDAGOGICAL EVIDENCE FOR SIMULATIONS AS AN EDUCATIONAL TOOL<br />Vogel et al. (2006)<br />Objective:<br />Evaluate which teaching method is better<br />games and interactive simulations or <br />traditional instruction<br /><ul><li>Findings:
    17. 17. Those using interactive simulations or games report higher cognitive gains and better attitudes toward learning compared to those using traditional teaching methods. </li></li></ul><li>Ke, Fengfeng (2008)<br />Objective:<br />To inform policy and practice based on existing studies.<br /><ul><li>Key Findings:
    18. 18. 5 major themes
    19. 19. Evaluating the effects of computer-based game on learning (65 out of 89 studies)
    20. 20. Exploring effective instructional game design (17 out of 89)
    21. 21. Exploring game-based learning activities or pedagogy (9 our of 89)
    22. 22. Evaluating the influence of learner characteristics on game based learning process (10 out of 89)
    23. 23. Investigating cognitive or motivational processes during game playing (4 out of 89)</li></ul>3<br />PEDAGOGICAL EVIDENCE FOR SIMULATIONS AS AN EDUCATIONAL TOOL<br />
    24. 24. <ul><li>Studies on the Effects of Instructional Gaming</li></ul>Ke, Fengfeng (2008)<br />3<br />PEDAGOGICAL EVIDENCE FOR SIMULATIONS AS AN EDUCATIONAL TOOL<br />
    25. 25. 3<br />PEDAGOGICAL EVIDENCE FOR SIMULATIONS AS AN EDUCATIONAL TOOL<br /><ul><li>Studies on Learner Characteristics:
    26. 26. Gender is the most examined and seems evenly split
    27. 27. Gender has an effect
    28. 28. Gender has no effect</li></ul>Ke, Fengfeng (2008)<br />
    29. 29. 4<br />THE SIMULATION – EXPERIENCEPOINTCentral-Valleyview | ExperienceChange<br />ExperiencePoint<br />Founded by James Chisholm and Greg Warman on August 6, 2006<br />“The best way to learn is through experience. We create experiences that enable people to practice decision-making in realistic situations, so they can perform in real situations”<br />
    30. 30. 4<br />THE SIMULATION – EXPERIENCEPOINTCentral-Valleyview | ExperienceChange<br />Leading Organizations<br />Leading Educators<br />
    31. 31. 4<br />THE SIMULATION – EXPERIENCEPOINTCentral-Valleyview | ExperienceChange<br />Explore Primer on Change<br />Player’s Guide<br />
    32. 32. 4<br />THE SIMULATION – EXPERIENCEPOINTCentral-Valleyview | ExperienceChange<br />Student<br />Assume role of Vice President Patient Care Programs (Operations)<br />Long term GOAL<br /><ul><li>To successfully oversee the merger of two hospitals, Central and Valleyview Hospital</li></li></ul><li>4<br />THE SIMULATION – EXPERIENCEPOINTCentral-Valleyview | ExperienceChange<br />
    33. 33. SIMULATION GOAL:<br />Spearhead the process of re-structuring the Emergency department of the two hospitals<br />Create an urgent care centre at the former Valleyview Emergency <br />Expand the 24/7 full service Emergency at Central Emergency<br />4<br />THE SIMULATION – EXPERIENCEPOINTCentral-Valleyview | ExperienceChange<br />
    34. 34. Essential Elements<br />Stakeholder Analysis<br />Planning<br />Organize and choose Tactics which are grouped into 4 categories: <br />Informational (Gather Tactics), <br />Educational (Share Tactics), <br />Social (Lead Tactics), and <br />Structural (Organize Tactics), <br />Resources<br />Cost and time allocated to each tactic.<br />Implement<br />4<br />THE SIMULATION – EXPERIENCEPOINTCentral-Valleyview | ExperienceChange<br />
    35. 35. 4<br />THE SIMULATION – EXPERIENCEPOINTCentral-Valleyview | ExperienceChange<br />
    36. 36. ExperiencePoint trailer (2 minutes)<br />4<br />THE SIMULATION – EXPERIENCEPOINTCentral-Valleyview | ExperienceChange<br />
    37. 37. 5<br />OBJECTIVE<br />STUDY: <br />What is the influence of repeat simulation testing on performance scores?<br />
    38. 38. 6<br />METHODOLOGY<br />Sample: <br />2 groups of students<br />Group 1: Basic Instructions (12 females, 4 males)<br />Group 2: Advanced Instructions (10 females, 4 males)<br />Instrument<br />EXPERIENCEPOINT simulation:Central-Valleyview | ExperienceChange Simulation<br />
    39. 39. 6<br />METHODOLOGY<br />Procedures: <br />Students performed the simulation twice within seven days<br />Group 1: were given standard instructions<br />Group 2: were given the same instructions a Group 1 plus additional instructions created by the instructor <br />
    40. 40. Standard Instructions (Group 1):<br /><ul><li>Before you play the simulation please read the case study and take the quickstart tour. The case study, quickstart tour, and simulation are all found within the 'Experience' section. The case study and tour should take you approximately 30 minutes. Plan on an additional 2 hours (or more) to play the simulation.
    41. 41. BIG HINT #1: You may benefit from reviewing the change management primer found within the 'Explore' section of ExperienceChange. Success in the simulation depends upon how well you apply the primer's 'staged approach to change'.
    42. 42. BIG HINT #2: The simulation is tough. Really tough (fewer than 20% of players succeed the first time through). If you find that you are struggling, think back to the staged model - maybe you've missed a step. Once you are done, check out the 'Reflect' section of ExperienceChange to see where you could improve and play again!</li></ul>  <br />6<br />METHODOLOGY<br />
    43. 43. 6<br />METHODOLOGY<br />Instructors Instructions (Group 2):<br />Same instructions as Group 1<br />PLUS<br />Complete Stakeholder analysis FIRST and review feedback before proceeding<br />Choose Tactics appropriately to fit Change Process outlined in Primer <br />Pay attention to available resources – cost and time<br />
    44. 44. Statistical Analysis<br />A repeated measures ANOVA examining the influence of Gender and Instruction on two dependent measures<br />Conversion Score<br />Session Score<br />No effect of Instruction was observed<br />Two groups were collapsed <br />6<br />METHODOLOGY<br />
    45. 45. 7<br />RESULTS: Conversion Score Effect<br />
    46. 46. 7<br />RESULTS: Session Score Effect<br />
    47. 47. 7<br />RESULTS<br />
    48. 48. 7<br />RESULTS<br />
    49. 49. 7<br />RESULTS: Conversion Score Effect for Group 2 <br />Note: Only Group 2 was required to complete 3 simulation trials.<br />
    50. 50. 7<br />RESULTS: Session Effect for Group 2<br />Note: Only Group 2 was required to complete 3 simulation trials.<br />
    51. 51. <ul><li>Small Sample size
    52. 52. Unequal Gender Distribution
    53. 53. Some subjects failed to complete the simulation twice (N = 2)
    54. 54. No verification that students read the additional instructions
    55. 55. No idea if knowledge was transferable beyond the simulation
    56. 56. Evaluate student knowledge using another measurement
    57. 57. Expose students to another simulation and assess for improved performance
    58. 58. Did not examine the influence of gaming capabilities as a tertiary factor</li></ul>8<br />LIMITATIONS<br />
    59. 59. 9<br />DISCUSSION<br />Change is Good:<br /><br />
    60. 60. To reiterate:<br /><ul><li>As indicated by Vogel et al (2006) – The overall result of the meta-analysis was that those using interactive simulations or games report higher cognitive gains and better attitudes toward learning compared to those using traditional methods.
    61. 61. Our study demonstrated that when delivering a simulation in an online environment, students should be required to run through the simulation at least twice to achieve targeted scores.
    62. 62. Practice, Practice</li></ul>9<br />DISCUSSION<br />
    63. 63. <ul><li>Additional instructions may be beneficial
    64. 64. Not significant in the current study, but scores were lower in the standard group
    65. 65. Variability may have accounted for the absence of an effect
    66. 66. Ensure that the delivery method can be verified
    67. 67. Provide another method of Change Management Evaluation
    68. 68. Ensures translation of Knowledge
    69. 69. Provide a forum to apply the Change Management Principles
    70. 70. Ensures generalized application of simulation learning objectives</li></ul>9<br />DISCUSSION<br />
    71. 71. 10<br />CONCLUSION<br />Simulations should be considered a valuable experiential tool for increasing motivation and learning outcomes when teaching change management.<br />
    72. 72. 11<br />ACKNOWLEDGEMENT?<br />
    73. 73. 11<br />QUESTIONS?<br />
    74. 74. 2009 Annual Meeting<br />A CHANGE<br />MANAGEMENT<br />SIMULATION<br />SCHOOL OF HEALTH SERVICES MANAGEMENT<br />RYERSON UNIVERSITY<br />Winston Isaac PhD, CHE:<br />Jake Pringle MBA, DC:<br />PriaNippak PhD:<br />