TMHG 526CHANGENawanan Theera-Ampornpunt, M.D., Ph.D.Faculty of Medicine Ramathibodi HospitalMahidol UniversityApril 11, 20...
Outline• Change & IT• Theories on Change• Change Management• Change Management &  Sociotechnical Issues in Informatics• Ca...
Change Management References          Lorenzi & Riley (2004)
Change Management References      http://www.ncbi.nlm.nih.gov/pubmed/10730594
“The only constant is      change”                  Heraclitus
Change & IT
Class Exercise #1Discuss with your neighbor:• What changes does an  IT implementation bring about?• What are the risks of ...
Reasons for Change• Fix existing problems• Add more desirable features• Process improvement• Address a specific policy/str...
“To improve is to change...”                 Winston Churchill
IT Implementation FailuresLorenzi & Riley (2000)
IT Implementation FailuresLorenzi & Riley (2000)
IT Implementation FailuresLorenzi & Riley (2000)
Theories on Change
Theories on Change      • First-order change         • “A variation in the way processes and           procedures have bee...
Theories on Change      • Second-order change         • The system itself is changed         • Usually a result of a strat...
Theories on Change      • Middle-order change         • “Represents a compromise; the            magnitude of change is gr...
Theories on Change    • Lewin’s Field Theory: 3 fundamental types of      conflict situations in a person (“force fields”)...
Change Resistance
Change Resistance in the News                                                                    Washington Post (March 21...
Cost of Change in IT    • Time & effort to learn    • Sense of control / sense of belonging of      workers    • Sense of ...
“The changes we dread most may contain our       salvation”   Barbara Kingsolver, in Small Wonder
Change Management
Change Management      • “The process by which an organization        gets to its future state, its vision.”      • Starts...
Change Management Process      • Assessment      • Feedback and Options      • Strategy Development      • Implementation ...
Types of Change    • Operational changes      • Changes that affect the way the ongoing business        operations are con...
Types of Change    • Microchanges       • Differences in degree       • E.g., modifications, enhancements, improvements, &...
The Special PeopleAsh et al. (2003)
The Special People     • Administrative                     – CIO       Leadership Level                     •   Selects c...
The Special People     • Clinical Leadership                 – Curmudgeons       Level                                 • “...
The Special People     • Bridger/Support level                –Skills           –Trainers &                        • Posse...
Change Management and Sociotechnical Issues in       Informatics
Sociotechnical Systems       • Coined in 1960s by Eric Trist, Ken Bamforth &         Fred Emery       • “An approach to co...
People-Process-Technology          Technology      People      Process
“People & Organizational Issues” (POI)      • POI focuses on interactions between people         and technology, including...
“People & Organizational Issues” (POI)    • We bring varied perspectives, methods, and tools       from        •   Humanit...
Considerations for a successful CPOE      implementation                              Considerations         Motivation fo...
Minimizing MD’s Change Resistance     • Involve physician champions     • Create a sense of ownership through       commun...
User Involvement in Health IT:        A True Story
Reasons for User Involvement    • Better understanding of needs & requirements    • Leveraging user expertise about their ...
The Missing Piece in IT Adoption                                               Technological Sophistication               ...
Critical Success Factors in Health IT     Projects      Communications of plans & progresses      Physician & non-physicia...
Theory of Hospital Adoption of     Information Systems (THAIS)Theera-Ampornpunt (2011)
Gartner Hype Cycle                 Image source: Jeremy Kemp via http://en.wikipedia.org/wiki/Hype_cycle              http...
Rogers’ Diffusion of Innovations:Adoption Curve                                Rogers (2003)
Leading a Changehttp://www.ted.com/talks/lang/th/derek_sivers_how_to_start_a_movement.html
Summary• All IT implementations are change• Changes differ in nature, scale, and magnitude• Change resistance is common an...
Case Studies
Case Studies on Change Management     Leviss (Editor)   Leviss (Editor)         (2010)            (2013)
Upcoming SlideShare
Loading in …5
×

Change

551 views

Published on

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
551
On SlideShare
0
From Embeds
0
Number of Embeds
8
Actions
Shares
0
Downloads
17
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Change

  1. 1. TMHG 526CHANGENawanan Theera-Ampornpunt, M.D., Ph.D.Faculty of Medicine Ramathibodi HospitalMahidol UniversityApril 11, 2013http://www.slideshare.net/Nawanan
  2. 2. Outline• Change & IT• Theories on Change• Change Management• Change Management & Sociotechnical Issues in Informatics• Case Studies
  3. 3. Change Management References Lorenzi & Riley (2004)
  4. 4. Change Management References http://www.ncbi.nlm.nih.gov/pubmed/10730594
  5. 5. “The only constant is change” Heraclitus
  6. 6. Change & IT
  7. 7. Class Exercise #1Discuss with your neighbor:• What changes does an IT implementation bring about?• What are the risks of those changes?• What are the implications of those changes for implementers?
  8. 8. Reasons for Change• Fix existing problems• Add more desirable features• Process improvement• Address a specific policy/strategy• Business needs• Keep up with new technologies• Regulatory compliance• Could be internal or external
  9. 9. “To improve is to change...” Winston Churchill
  10. 10. IT Implementation FailuresLorenzi & Riley (2000)
  11. 11. IT Implementation FailuresLorenzi & Riley (2000)
  12. 12. IT Implementation FailuresLorenzi & Riley (2000)
  13. 13. Theories on Change
  14. 14. Theories on Change • First-order change • “A variation in the way processes and procedures have been done in a given system, leaving the system itself relatively unchanged.” • E.g. creating new reports, new ways to collect same data, refining existing processesWatzlawick, Weakland, & Fisch (1974), cited in Lorenzi & Riley (2000)
  15. 15. Theories on Change • Second-order change • The system itself is changed • Usually a result of a strategic change or a major crisis such as a threat against system survival • Involves redefinition or reconceptualization of the organization’s business and how it’s conducted • E.g. changing from paper to electronic medical records, automated teller machinesWatzlawick, Weakland, & Fisch (1974), cited in Lorenzi & Riley (2000)
  16. 16. Theories on Change • Middle-order change • “Represents a compromise; the magnitude of change is greater than first- order change, yet it neither affects the critical success factors nor is strategic in nature.”Golembiewski, Billingsley, & Yeager (1976), cited in Lorenzi & Riley (2000)
  17. 17. Theories on Change • Lewin’s Field Theory: 3 fundamental types of conflict situations in a person (“force fields”) • Standing midway between 2 positive goals of approximately equal strength • When there are 2 good systems to purchase • Standing between 2 approximately equal negative goals • Make a choice of a system that will not completely meet the needs • Opposing positive and negative forces • System users vs. IT peopleLorenzi & Riley (2000)
  18. 18. Change Resistance
  19. 19. Change Resistance in the News Washington Post (March 21, 2005)“One of the most important lessons learned to date is that the complexity of human change management may be easily underestimated” Langberg ML (2003) in “Challenges to implementing CPOE: a case study of a work in progress at Cedars-Sinai”
  20. 20. Cost of Change in IT • Time & effort to learn • Sense of control / sense of belonging of workers • Sense of control of middle managers (information systems increase ability of executives to know what’s going on and have more direct control) • Loss of position, power, networks “Power shift”Lorenzi & Riley (2000)
  21. 21. “The changes we dread most may contain our salvation” Barbara Kingsolver, in Small Wonder
  22. 22. Change Management
  23. 23. Change Management • “The process by which an organization gets to its future state, its vision.” • Starts with creating a vision for change and empowering people as change agents to achieve the vision. • “Change management encompasses the effective strategies and programs to enable those change agents to achieve the new vision.”Lorenzi & Riley (2000)
  24. 24. Change Management Process • Assessment • Feedback and Options • Strategy Development • Implementation • ReassessmentLorenzi & Riley (2004)
  25. 25. Types of Change • Operational changes • Changes that affect the way the ongoing business operations are conducted • Strategic changes • Changes in strategic business direction • Cultural changes • Affect basic organizational philosophies by which the business is conducted (e.g. implementing CQI) • Political changes • Staffing changes, primarily for political reasonsLorenzi & Riley (2000)
  26. 26. Types of Change • Microchanges • Differences in degree • E.g., modifications, enhancements, improvements, & upgrades of information systems • Megachanges • Differences in kind • E.g., a new system or a very major revisionLorenzi & Riley (2000)
  27. 27. The Special PeopleAsh et al. (2003)
  28. 28. The Special People • Administrative – CIO Leadership Level • Selects champions • Gains support –CEO • Possesses vision • Provides top • Maintains a thick skin level support and – CMIO vision • Interprets • Possesses vision • Holds steadfast • Maintains a thick skin • Connects with • Influences peers the staff • Supports the clinical support staff • Listens • Champions • ChampionsAsh et al. (2003)
  29. 29. The Special People • Clinical Leadership – Curmudgeons Level • “Skeptic who is usually quite vocal – Champions in his or her disdain • Necessary of the system” • Hold steadfast • Provide feedback • Influence peers • Furnish leadership • Understand other – Clinical advisory physicians committees – Opinion leaders • Solve problems • Provide a balanced • Connect units view • Influence peersAsh et al. (2003)
  30. 30. The Special People • Bridger/Support level –Skills –Trainers & • Possess clinical support team backgrounds • Necessary • Gain skills on the job • Provide help at the • Show patience, elbow tenacity, and • Make changes assertiveness • Provide training • Test the systemsAsh et al. (2003)
  31. 31. Change Management and Sociotechnical Issues in Informatics
  32. 32. Sociotechnical Systems • Coined in 1960s by Eric Trist, Ken Bamforth & Fred Emery • “An approach to complex organizational work design that recognizes the interaction between people and technology in workplaces.” (Wikipedia) • “Interaction between societys complex infrastructures and human behaviour.” (Wikipedia)http://en.wikipedia.org/wiki/Sociotechnical_system
  33. 33. People-Process-Technology Technology People Process
  34. 34. “People & Organizational Issues” (POI) • POI focuses on interactions between people and technology, including designing, implementing, and deploying safe and usable health information systems and technology. • AMIA POIWG addresses issues such as • How systems change us and our social and clinical environments • How we should change them • What we need to do to take the fullest advantage of them to improve [...] health and health care. • Our members strive to understand, evaluate, and improve human-computer and socio-technical interactions.http://www.amia.org/programs/working-groups/people-and-organizational-issues
  35. 35. “People & Organizational Issues” (POI) • We bring varied perspectives, methods, and tools from • Humanities, Social science, Cognitive science • Computer science and informatics • Business disciplines • Patient safety • Workflow • Collaborative work and decision-making • Human-computer interaction & Usability • Human factors • Project and change management • Adoption and diffusion of innovations • Unintended consequences • Policy.http://www.amia.org/programs/working-groups/people-and-organizational-issues
  36. 36. Considerations for a successful CPOE implementation Considerations Motivation for implementation CPOE vision, leadership, and personnel Costs Integration: Workflow, health care processes Value to users/Decision support systems Project management and staging of implementation Technology Training and Support 24 x 7 Learning/Evaluation/ImprovementAsh et al. (2003)
  37. 37. Minimizing MD’s Change Resistance • Involve physician champions • Create a sense of ownership through communications & involvement • Understand their values • Be attentive to climate in the organization • Provide adequate training & supportRiley & Lorenzi (1995)
  38. 38. User Involvement in Health IT: A True Story
  39. 39. Reasons for User Involvement • Better understanding of needs & requirements • Leveraging user expertise about their tasks & how organization functions • Assess importance of specific features for prioritization • Users better understand project, develop realistic expectations • Venues for negotiation, conflict resolution • Sense of ownership • Pare & Sicotte (2006): Physician ownership important for clinical information systemsIves & Olson (1984)
  40. 40. The Missing Piece in IT Adoption Technological Sophistication Functional Sophistication Integration Sophistication Managerial Sophistication Proposed AdditionTheera-Ampornpunt (2011)
  41. 41. Critical Success Factors in Health IT Projects Communications of plans & progresses Physician & non-physician user involvement Attention to workflow changes Well-executed project management Adequate user training Organizational learning Organizational innovativenessTheera-Ampornpunt (2011)
  42. 42. Theory of Hospital Adoption of Information Systems (THAIS)Theera-Ampornpunt (2011)
  43. 43. Gartner Hype Cycle Image source: Jeremy Kemp via http://en.wikipedia.org/wiki/Hype_cycle http://www.gartner.com/technology/research/methodologies/hype-cycle.jsp
  44. 44. Rogers’ Diffusion of Innovations:Adoption Curve Rogers (2003)
  45. 45. Leading a Changehttp://www.ted.com/talks/lang/th/derek_sivers_how_to_start_a_movement.html
  46. 46. Summary• All IT implementations are change• Changes differ in nature, scale, and magnitude• Change resistance is common and natural• Overcoming change resistance requires a good change management strategy• Pay attention to the “POI” or sociotechnical aspect• Balance between People, Process, & Technology• Shared vision & commitment, user engagement, communication, workflow considerations, & training are key• Understand the Adoption Curve
  47. 47. Case Studies
  48. 48. Case Studies on Change Management Leviss (Editor) Leviss (Editor) (2010) (2013)

×