2. Series 2: Project Management Understanding and Using 6 Basic Tools 9/2013 From the CIHS Video Series “Ten Minutes at a Time”

3. Module 5: Change Management Overview Define and identify basic principles of change management Two levels Organizational readiness for change Project Schedule Activity/Task changes that impact constraints Example of a Change Management model Link Change Management to workflow diagramming

4. Change Management Projects make changes to processes, systems, tools, job roles and even organizational structures Require individuals to change how they do their jobs Change management is the application of the “set of tools, processes, skill and principles for managing the people side of change to achieve the required outcomes…” Goal is to support individuals through the required changes – not impose change (Prosci, Inc. 1996. Retrieved February 2012 from www.change-management.com)

5. Change Management in the Project Management Plan Goal is always to keep project on time, on budget and in scope without sacrificing quality Integrated throughout Plan: Communication Plan - includes project sponsor, project manager and project team/stakeholders Risk Management Plan - based on validated change management tools applied to common and expected project risks Project Schedule – requires time and space for implementation, so considered in the project duration

6. Ten Principles* 1)Address change systematically and proactively 2)Start with executive level leadership (via the Project Steering Committee) 3)Involve every layer of the organization 4)Make a formal case – why and how 5)Leadership has “ownership” of the change 6)Communicate the change plan 7)Consider the organizational culture 8)Address the organizational culture 9)Expect the unexpected 10)Engage the individual *Ten Guiding Principles of Change Management (2004). Reggie Van Lee, John Jones, Paul Hyde, Gary Neilson, Andrew Tipping, DeAnne Aguirre, Wolfgang Schirra, Jörg Krings, and Claudia Staub. Booz Allen Hamilton, 2004.

7. Change Management Removes Barriers* Pressure about developing new skills Fear of looking stupid or incompetent in these new skill sets Fear of losing professional status Pressure re: management expectations for improved performance and effectiveness Pressure connected with a perception of more control by management resulting in an expectation of fewer errors Fear of job loss due to the new technology, changing roles *Hostgaard, A., & Nohr, C. "Dealing with Organizational Change when Implementing EHR Systems." Paper presentation. MEDINFO 2004, San Francisco, CA.

8. Force-field Analysis and the Lewin* Change Model Forces for change Forces resisting change Driving forces Restraining forces Equilibrium? No change! Driving force MUST exceed restraining force Kurt Lewin's Contribution and a Summary of Methodology in Analyzing Change (2004). Retrieved 9/2013 from http://www.valuebasedmanagement.net/methods_lewin_force_field_analysis.html.http://www.valuebasedmanagement.net/methods_lewin_force_field_analysis.html

9. Lewin’s Model: Unfreeze-Change-Refreeze Lewin’s model Unfreeze – Shake up stage, focus on developing awareness for need for change, nature of change needed, methods planned, needs of those affected Change – Define challenges, identify solutions, create and follow project plan to implement change, troubleshoot to find solutions Refreeze – Lock in changes and stabilize, consolidate, evaluate and support, prevent regression to old ways

10. Lewin Force Model With Scoring – Pre-Analysis 1)Implement certified EHR system 2) Attain Meaningful Use 3)Demonstrate HIE Forces for changeForces against change Grant $$$ Good business Best practice Scarce Resources Confusion Not welcome 5 3 3 5 4 4 Total = 11 Total = 13

11. Intervene to “Unfreeze,” Disturb Equilibrium and Reduce Opposing Force “Unfreeze” Intervention: Create a shared vision Increase awareness about the new health care paradigm Underscore role EHR systems have in its implementation Link Meaningful Use to national health reform and role of behavioral health “Unfreeze” Intervention: Create individual motivation Why exchange BH information using NwHIN Direct? What are the underlying best practice principles? How will individual staff person benefit (what are the personal rewards?) http://www.cms.gov/Research-Statistics-Data-and-Systems/Computer-Data-and- Systems/MedicaidInfoTechArch/Behavioral-Health-MITA.html

12. Intervene to Strengthen Forces for Change Implement and “Freeze” (Stabilize) Change “Change” Interventions What will their job look like when the project is fully implemented? What workflows will be affected? How will the change be monitored and controlled? Where are staff involved in the planning? “Freeze” (Stabilize) Intervention Reward skill development, active project support Set a cut-off date for doing things “the old way” and 100% transition to the “new way” Implement training plan (for start up and for new staff orientation; peer-to-peer model for those lacking skill needed for the change)

13. Post- Intervention Force Field Analysis Scoring 1)Implement certified EHR system 2) Attain Meaningful Use 3)Demonstrate HIE Forces for changeForces against change Grant $$$ Good business Best practice Scarce Resources Confusion Not welcome 5 4 4 3 2 3 Total = 13 Total = 8 Plan/Do/Study/Act (PDSA) http://www.ihi.org/knowledge/Pages/Tools/PlanDoStudyActWorksheet.aspx http://www.ihi.org/knowledge/Pages/Tools/PlanDoStudyActWorksheet.aspx

14. Change Management and Workflow Analysis Requires a Process Identify the need for change in “As Is” state Summarize need and “To Be” vision in change request Log the change request (name, date, brief description, any additional follow up for clarification) Project Manager evaluates the change impact on project schedule (time, cost and scope), includes in request Submit change request internal change control board (Steering Committee, IT Governance group, GPO) Obtain decision Implement change (use PDSA) OR document reason for no change in log

15. Summary “People skills,” stakeholder consideration are valued during all stages of the project Employees and clinicians are informed and engaged (on the project team, included in Communication and Risk Management Plans) Consideration given to what will motivate stakeholders to make the transition Staff involved in workflow analysis and redesign Training (online, classes, one-on-one) offered pre- and post implementation, as needed Lorenzi, Nancy M., and Riley, Robert T. (200) "Managing Change: An Overview."

16. We Have Solutions for Integrating Primary and Behavioral Healthcare Contact CIHS for all types of primary and behavioral health care integration technical assistance and training needs 1701 K Street NW, Ste 400 Washington DC 20006 Web: www.integration.samhsa.govwww.integration.samhsa.gov Email:integration@thenationalcouncil.orgintegration@thenationalcouncil.org Phone:202-684-7457 Prepared and presented by Colleen O’Donnell, MSW, PMP, CHTS-IM for the Center for Integrated Health Solutions