Managing Change in Healthcare IT Implementations: Selected References

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Managing Change in Healthcare Implementations: an Introduction was created for managers preparing to implement health information and communication technology (HICT) systems in their organizations—hospitals, clinics, or government departments. The module presents a framework for understanding how HICT implementations affect organizations and individual workers and shares basic information on how to manage change to an organization so as to promote a positive outcome, and how to avoid the pitfalls that occur.

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  • HIBB Prepared for AMIA by Sherrilynne Fuller, Ph.D., June 7, 2010 1. Subjects covered: Change management in healthcare IT implementations: organization and individual effects and strategies for ensuring success 2. Date: June 7, 2010 3. Author: Sherrilynne Fuller, Ph.D. Professor, Biomedical and Health Informatics, School of Medicine and Co-Director, Center for Public health Informatics, School of Public Health, University of Washington, Seattle Washington 4. Development funded by: contributed by author 5. Target Audience: Individuals leading and/or participation in IT implementations (with particular relevance to those in resource-constrained settings) 6. Pre-Requisites: none 7. Available formats: Powerpoint presentation with notes (PDF format) 8. Technological requirements for users: ability to read PDF files 9. Length of module: 17 slides (approximately 45-60 minute presentation – including discussions) 10. Self-assessment: based on responding to learning objectives 11. Learning objectives: At this conclusion of this class the student will be able to: Describe at least four effects of introducing information technology into a group or organization Define change management and describe why it is important to health information system implementation success Describe three key ways of preparing a group or organization for change Identify at least four elements critical to successful management of change
  • Change is not easy for anyone; when one plans to implement a new information system in a hospital or healthcare setting even if everyone agrees that it is critical to improving the care of patients, the actual implementation requires changes in all aspects of the work of the individuals involved in the care and those involved in the supporting the administrative processes. CHANGE is difficult for everyone and unless it is directly addressed in the planning process -- an approach termed “change management”, the implementation may fail. The goal of this training is to provide a practical approach to planning for change related to information systems implementations in health settings.
  • Change as a “How” Problem The change problem is often expressed, at least initially, in the form of a “how” question. How do we get people to be more open, to assume more responsibility, to be more creative? How do we introduce self-managed teams in Department W? How do we change over from System X to System Y in Division Z? How do we move from print medical record environment to one that accommodates and integrates PCs? How do we get this hospital staff to be more innovative and productive? In short, the initial formulation of a change problem is often the “means” with the goal more or less implied. Rather than looking at Change as a “how” do I get people to change, turn the question into a “what” Problem.
  • A focus on the “how do I?” misses the key goal -- WHAT am I doing now? AND WHAT exactly is the problem? Ensuring that these questions are answered by the group who are the focus of the changes -- based on the mission of the hospital or organization – is CRITICAL.
  • AND, beyond “what” questions it is critical to ask “why” questions to get at the ultimate purposes of functions and to open the door to finding new and better ways of performing them through information technology. Why do we do what we do? Why do we do it the way we do it? Asking “why” questions also gets at the ultimate purposes of people in the hospital.
  • Managing Change in Healthcare IT Implementations: Selected References

    1. 1. Managing Change in Healthcare IT Implementations AN INTRODUCTION Sherrilynne Fuller, Center for Public Health Informatics School of Public Health, University of Washington Seattle, Washington June 2010Content licensed under Creative Commons Attribution-Share Alike 3.0 Unported
    2. 2. Learning ObjectivesAt the conclusion of this class the student will be able to: Describe at least four effects of introducing information technology into a group or organization Define change management and describe why it is important to health information system implementation success Describe three key ways of preparing a group or organization for change Identify at least four elements critical to successful management of changeSherrilynne Fuller, University of Washington
    3. 3. Change… As Mark Twain, a well known American author, once said: "Im all for progress, its change I object to.”Sherrilynne Fuller, University of Washington
    4. 4. Effects of Information Technology Introduction on Individuals and Organizations Changes individual team members’ tasks Blurs roles and increases team interdependence Can be threatening to individuals’ view of their role in the organization When the implementation and related changes in work are managed well there are improvements in:  The function of the organization  The individual’s job skills and satisfactionSherrilynne Fuller, University of Washington
    5. 5. Ways to think About Change as a “HOW” ProblemThe problem of introducing change in an organization is often expressed as how do I… How do I get people to be more open to change? How do I get people to look at new ways of doing things? How to I make this organization adopt an electronic medical records system? This approach often doesn’t work --rather –you need to look at this as a “What” problem….Sherrilynne Fuller, University of Washington
    6. 6. Thinking About Change as a “What” Problem What are we trying to accomplish? What changes are necessary to get there? What will signal success? What measures of performance are we trying to affect?Sherrilynne Fuller, University of Washington
    7. 7. Thinking About Change as a “Why” Problem Why do we do what we do? Why do we do it the way we do? Why do we need to change how we do what we do?Sherrilynne Fuller, University of Washington
    8. 8. Change Questions… “How” questions tend to cluster in core units (e.g. IT staff) People in clinical units tend to ask “what” and “how” questions (What will this do to my ability to see more patients? How will I ever learn to use a computer?) “Why” questions are typically the responsibility of the hospital management BUT --in times of rapid change, everyone must be concerned with all of these questions and think through them together before a system is implementedSherrilynne Fuller, University of Washington
    9. 9. Preparing for Change What is the current situation? What does the ideal future look like? Why do we need to change? What is going to change? What is NOT going to change? What are the key challenges? What are the key success factors?Sherrilynne Fuller, University of Washington
    10. 10. Managing Change• What is the best way to integrate changes into operation?• How do we reduce impact on those most affected by change?• How do we ensure that all units are coordinating effectively?• How do we ensure that everyone is involved?Sherrilynne Fuller, University of Washington
    11. 11. Change Requirements & Strategies Clear shared vision of future Create ownership and involvement Commitment of institutional leadership Education and training Reward system Measurement and evaluation Communication is vital!Sherrilynne Fuller, University of Washington
    12. 12. Leading and Managing: Strategies for SuccessMany ways to earn authority and influence: Knowledge Information Hard work and evident commitment Outside influence in authorizing environment Keeper of a respected or needed process Have something to give in a trading relationship Bring resources, allies Bring order and direction out of confusionSherrilynne Fuller, University of Washington
    13. 13. Process Model for New IT Implementations Step 1: Step 2: Step 3: Preparation Training and Review Data OUTCOME Practice Leader: Leader: SUCCESS! Leader: • Explain • Discuss with selection • Signal teams • Carefully select openness and • Listen team members feedback • Define roles and • Communicate responsibilities reasons • Explain team Team for learning change Members: Team approach Team New routines Members: Members: • Participate become fully • Collect data established • Listen and accepted • Ask questions; • Review data • Ask practice in the make • Contribute to questions organization suggestions discussions • Agree to • Try new participate approachesSherrilynne Fuller, University of Washington
    14. 14. Steps to Implementation Failure Leader’s Leader’s Actions: Leader’s Actions: Actions: • Ask people to • Discourage or Analyze and participate but don’t remain neutral to evaluate data late provide reasons for team’s input in the changes • Reject new ideas • Decide on implementation from team members technology with no consultation • Don’t show up for Team Members’ practice Team Members’ OUTCOME: Actions: training Actions: •Show up for IMPLEMENTATION • Notice signals from training FAILS leader • Re-evaluate behavior •Interpret absence • Hold back from of leader as participation message that team work not importantSherrilynne Fuller, University of Washington
    15. 15. Ensuring Action No one “must” do anything Action relies on agreements, accountability, process, incentives, recognizing needs, having authority Use tools that are realistic; realistic goals Work to remove barriers to others’ success Be sure you have effective internal channels of information exchange regarding key issues Apply power and influence to priorities, not secondary issues that interest you Measure and be accountable for resultsSherrilynne Fuller, University of Washington
    16. 16. Team Learning and New Technology -- Summary When a new technology disrupts existing work routines, the adopting organization must go through a learning process, making interpersonal and organizational adjustments that allow new routines to become ongoing practice.Sherrilynne Fuller, University of Washington
    17. 17. Learning ObjectivesAt the conclusion of this class the student will be able to: Describe at least four effects of introducing information technology into a group or organization Define change management and describe why it is important to health information system implementation success Describe three key ways of preparing a group or organization for change Identify at least four elements critical to successful management of changeSherrilynne Fuller, University of Washington
    18. 18. Presenter Information Sherrilynne Fuller, Ph.D. Center for Public Health Informatics School of Public Health University of Washington, Seattle, WashingtonContent licensed under Creative Commons Attribution-Share Alike 3.0 Unported

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