Delivering IT Enabled Business Change Helen Walsh and Sally Chadwick-Rock Change Management Team Greater Manchester South West Sector December 2007

NHS Operating Framework for 2007/08 –Renewed commitment to the vision set out in Delivering 21 st Century IT support for the NHS –Sustained focus on information management and technology –Improvements must be owned and delivered by clinicians, managers and front line staff Local IM&T plans –Forward looking plans to exploit the NPfIT opportunities –Alignment across the Local Health Community to enable patient centred service transformation –Further guidance is now available NAO - Delivering successful IT enabled business change –Recurring themes in successful programmes and projects The level of engagement of senior decision makers The organisations’ understanding of how to be an ‘intelligent client’ The importance of determining at the outset what benefits they are aiming to achieve and how these could be optimised Delivering IT Enabled business change

When planning a change programme, there are some key principles that need to be kept in mind: Different people react differently to change Everyone has fundamental needs that have to be met Change often involves a loss, and people go through the “emotional cycle" Expectations need to be managed realistically Fears have to be dealt with

Level of Optimism Informed Optimism Rewarding Completion Uninformed Optimism Negative Positive The Emotional Cycle of Change Informed Pessimism Hopeful Realism TIME

The Role of Change Management in NPfIT The National Programme for IT has the potential to deliver major benefits for both patients and staff, but this will only happen if NHS organisations undertake service review and redesign in advance of the new systems being implemented A critical success factor in IT deployments that achieve their objectives is the engagement of key stakeholders at every stage in the project. Change Management is crucial in managing this engagement, looking in particular at five main areas; –Organisational Strategy –Service redesign –Benefits –Stakeholder management –Communications

Organisational Strategy There is evidence to suggest that the measure of success is proportional to the level of interest from the executive team…therefore engagement at executive and senior management level is essential to ensure alignment of IT systems deployment with local business objectives. Identification of local service transformation programmes and local service planning priorities for which enabling IM&T is required to reduce the impact of change upon staff and patients Potential benefits of service redesign across a local heath community, and the use of IT systems as enablers, is required to allow healthcare, ensure that these benefits are achieved. There needs to be a shared approach to implementation – the NHS Operating Framework suggests that improvements must be owned and delivered by clinicians, managers and front line staff

Service Redesign Work is carried out at an operational level to map out current and future state work in order to identify areas of benefit and service / system redesign. Identifying current processes, existing policies and procedures and staff distribution Reviewing opportunities for service improvement and redesign Developing future state processes Communicating the benefits that can be realised through service improvement and redesign Conducting gap analysis – current vs future, risks and issues, impact of changes on staff Working to close the gaps by providing system functionality, information, work flow, technical and people requirements

Benefits Identification and Management The fundamental reason for beginning a project or programme is to realise benefits through change Identify benefits and their dependencies Develop Benefits Realisation Plan to include: –Benefit description –Benefit owner –Unit of measure –Dependencies –Baseline –Targets –Actions –Timeframe Ongoing review and monitoring of the benefits plan is necessary post go-live in order to achieve continuous improvement.

Stakeholder Management Stakeholder; an individual, group or sub-group who has an interest in the outcome of a project or programme and the environment in which the project or programme applies The objective of analysing stakeholders is to achieve an understanding of their requirements and interests in, and impact on, the project. Stakeholders’ positions, in terms of influence and impact, may be rational and justifiable or emotional and unfounded, but in either case must be taken into account as they can affect the change process and hence the outcomes of the project. Stakeholder groups should be analysed to assess the level of interest and impact, potential power and influence they have. This will form a basis for the prioritisation of communications and help concentrate effort where it will contribute most to a successful outcome.

Communications Communication is central to any project and there needs to be clear communication about the reasons and rationale behind it, benefits expected and plans for its implementation. Communications are required to keep awareness and commitment high, maintain consistent messages and ensure expectations are managed in line with what is delivered. Communication channels should be established to ensure that stakeholders’ expectations of the project can be managed and maintained An ongoing two-way interface between the project team and stakeholders is essential.

Change Management and NPfIT A Case Study

Facilitating Change Scenario 1 IT Project Lead Service ( full buy in ) Full Change Management support Service redesign Use of Sector Training Team Scenario 2 IT Project Lead Service ( ??? engagement ) Scant Change Management support No Service redesign Use of Sector Training Team

Service re-design

Methodology Work shopsOutputs Stakeholder Management1day Stakeholder Map Communication Plan1day + 5days Communication plan Benefits Identification2days + 4wks Benefits Realisation Plan and baseline measurements Systems overview1day Process Mapping Current state1day + 10days Service Process Map Future state1day +5 days Service Process Map

Comparison of activities Scenario 1 All of the above Scenario 2 Benefits workshop 2hrs Stakeholder identification & Communication planning 1day Revision of generic Process maps 1/2day per service area

Outcomes Scenario 1 Benefits Base Lining Process mapping Training plan produced Planned changes to working practice :- Scenario 2 No Benefits base lining. Generic process maps No Training plan No planned changes to working practice

Service Re-design? Scenario 1 1.Roles redesigned – clerical officer duties. 2.Reception – area(s) re- positioned 3.Appointments- Booking office - expanded. “Choose and Book” extended. 4.All telephone enquires – redirected. 5.Patient pathway and flow through improved Scenario 2 No service redesign undertaken ? Whether national benefits achievable.

Some final thoughts… We would rather be ruined than changed; We would rather die in our dread Than climb the cross of the moment And let our illusions die. ~W.H. Auden "There is nothing more difficult to take in hand, more perilous to conduct, or more uncertain in its success, than to take the lead in the introduction of a new order of things." — Niccolo Machiavelli The Prince (1532) It is not necessary to change. Survival is not mandatory. ~W. Edwards Deming