AN INTRODUCTION Managing Change in Healthcare IT Implementations Sherrilynne Fuller, Center for Public Health Informatics School of Public Health, University of Washington Seattle, Washington June 2010 Content licensed under Creative Commons Attribution-Share Alike 3.0 Unported

Learning Objectives At 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 change Sherrilynne Fuller, University of Washington

Change… As Mark Twain, a well known American author, once said: "I'm all for progress, it's change I object to.” Sherrilynne Fuller, University of Washington

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 satisfaction Sherrilynne Fuller, University of Washington

Ways to think About Change as a “HOW” Problem The 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

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

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

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 implemented Sherrilynne Fuller, University of Washington

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

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

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

Leading and Managing: Strategies for Success Many 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 confusion Sherrilynne Fuller, University of Washington

Process Model for New IT Implementations Step 1: Preparation Leader: Explain selection Carefully select team members Define roles and responsibilities Explain team learning approach Team Members: Listen Ask questions Agree to participate Step 2: Training and Practice Leader: Signal openness and feedback Communicate reasons for change Team Members: Participate fully Ask questions; make suggestions Try new approaches Step 3: Review Data Leader: Discuss with teams Listen Team Members: Collect data Review data Contribute to discussions OUTCOME SUCCESS! New routines become established and accepted practice in the organization Sherrilynne Fuller, University of Washington

Steps to Implementation Failure Leader’s Actions: Ask people to participate but don’t provide reasons for the changes Decide on technology with no consultation Don’t show up for practice training Team Members’ Actions: Show up for training Interpret absence of leader as message that team work not important Leader’s Actions: Discourage or remain neutral to team’s input Reject new ideas from team members Team Members’ Actions: Notice signals from leader Re-evaluate behavior Hold back from participation Leader’s Actions: Analyze and evaluate data late in implementation OUTCOME: IMPLEMENTATION FAILS Sherrilynne Fuller, University of Washington

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 results Sherrilynne Fuller, University of Washington

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

Learning Objectives At 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 change Sherrilynne Fuller, University of Washington

Presenter Information Sherrilynne Fuller, Ph.D. Center for Public Health Informatics School of Public Health University of Washington, Seattle, Washington Content licensed under Creative Commons Attribution-Share Alike 3.0 Unported