AN INTRODUCTION

Managing Change in Healthcare IT

Implementations

Sherrilynne Fuller, Center for Public Health InformaticsSchool of Public Health, University of WashingtonSeattle, Washington June 2010

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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’ tasksBlurs roles and increases team

interdependenceCan be threatening to individuals’ view of

their role in the organizationWhen 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 futureCreate ownership and involvementCommitment of institutional leadershipEducation and trainingReward systemMeasurement and evaluationCommunication is vital!

Sherrilynne Fuller, University of Washington

Leading and Managing:Strategies for Success

Many ways to earn authority and influence:Knowledge InformationHard work and evident commitmentOutside influence in authorizing environmentKeeper of a respected or needed processHave something to give in a trading relationshipBring resources, alliesBring 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 learningapproach

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 goalsWork to remove barriers to others’ success Be sure you have effective internal channels of

information exchange regarding key issuesApply power and influence to priorities, not

secondary issues that interest youMeasure 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 InformaticsSchool of Public HealthUniversity of Washington, Seattle, Washington

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