Jonathan P. DeShazo, MPH PhD, Laishy Williams- Carlson, & Rich Pollack, MS

 Jonathan P. DeShazo, MPH PhD, Assistant Professor, Virginia Commonwealth University, Richmond, Virginia  Laishy Williams-Carlson, Vice President and CIO, Bon Secours Health System Inc. Richmond, Virginia  Rich Pollack, MS, Vice President and CIO, Virginia Commonwealth University Health System, Richmond, Virginia

 History and significance of change management  Transformational impact of IT  Way in which IT changes an organization  Organizational readiness for change  Barriers to change  Overcoming barriers to change

It's not the progress I mind, it's the change I don't like. — Mark Twain

 Transformation is more than acquiring IT and inserting it into existing workflows and processes Requires reengineering health care processes Requires changing resource allocations  Processes must be changed to optimize the contributions of IT The Lewing Group. (2005). Health Information Leadership Panel Final Report.

 Historically Stakeholders had no experience or frame of reference Stayed away from IT Had low expectations  Now Internet fueled information revolution Stakeholders demand new IT capability Expectations are very high Briggs, B. (2002). CIOs Double as Change Agents. Health Data Management.

 Information technology in health care is increasing in importance in critical areas: Clinical Revenue cycle Strategic  Moving from ‘old way’ to ‘new way’ usually includes information technology  Because of this, now CIOs are high profile change agents Briggs, B. (2002). CIOs Double as Change Agents. Health Data Management.

 Manage unrealistic expectations  Educating executive management  Partnering internally and externally  Communicating the role of information technology in meeting organizational goals Briggs, B. (2002). CIOs Double as Change Agents. Health Data Management.

 Is the process by which an organization migrates to its future state (its vision)

CHANGE MANAGEMENT  Starts with vision for change  Facilitates journey  Total systems approach  Empowering individuals to be change agents TRADITIONAL PLANNING  Starts with vision for change  Delineate steps on journey  ‘Roadmap’ or path oriented

 IT projects are a convergence of different stakeholders and different needs  Different backgrounds interpret data and view decisions differently  Culturally ingrained believes and practices are enormously resistant to change Friedman, C. (1999). Information technology leadership in academic medical centers: a tale of four cultures. Academic Medicine, 74(7),

 Major challenges to success are often more behavioral than technical  A ‘technically best’ solution can still fail because of people and organizational issues  Change normally involves some threat to individual E.g. job security or disruption of routine Lorenzi, N. M., & Riley, R. T. (2000). Managing Change An Overview. J Am Med Inform Assoc, Mar-Apr; 7(2),

 Technology never been embraced by clinicians  Clinicians view IT as support, outside of their important activities  Threat to patient privacy compared to paper  Threat to rapport between providers and patients  Depersonalization and deskilling  Reluctance to learn new skills

 History of highly visible system failures  IT is viewed as cost center not a strategic enabler  Measuring ROI is expensive and neglected  Perceived inequity: EHR benefits the organizations, patients, and payers, but not the people encumbered by using the system

 Fragmented organizations Decision-making is usually optimized for local benefit Decisions are made by a hospital but many users do not work for the hospital  Lack of generally accepted standards

 Transformative leadership roles in key areas  Executive leadership style supporting change  Project & project management designed for transformative success

 Role is frequently underestimated yet makes a significant difference  Must be personally committed to goals of project  Must communicate frequently about commitment, reasoning, and link to mission  Build consensus/ support across other functional areas (finance, QI, care, etc.)  Must allocate and protect sufficient resources Merola, P., & Hopkins, R. (APR 2010). How Hospitals Can Successfully Implement Evidence-Based Guidelines. In M. H. R. B. Paper (Ed.).

 CMO, CNO, or CMIO  Ensure medical staff involved in decisions  Address and coach providers about upcoming change  Display (and expect) commitment to multidisciplinary collaboration Merola, P., & Hopkins, R. (APR 2010). How Hospitals Can Successfully Implement Evidence-Based Guidelines. In M. H. R. B. Paper (Ed.).

 CIO Takes responsibility and resolve issues Communicates value to leadership Ensures multidisciplinary approach Protects resources Project management Clinicians Technical Training

 Project Manager- Identify scope and required resources. Maintain project plan. Communicate progress.  Business Sponsor and/or Business Manager – Represents business function. Identifies support and removes business obstacles. Should be appropriate level for magnitude of project.  IT Manager – Senior IT person assigned to project. Supports IT decision-making. Helps remove IT obstacles.

 History and significance of change management  Transformational impact of IT  Way in which IT changes an organization  Organizational readiness for change  Barriers to change  Overcoming barriers to change