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Start Early and Think Beyond ‘Go-Live’
PLANNING FOR SUSTAINABLE CHANGE
Making a Case for Change Cassie Frazer, Canada Health Infoway
Making Early Plans Ian Hodder, Centre for Health Information, Newfoundland &
LabradorMaking Change Sti ck
Knut Rodne, OntarioMD
PANEL OUTLINE
Creati ng awareness
MAKING A CASE FOR CHANGE
“…a strategic and systemati c approach that supports people and their organizati ons in the successful transiti on and adopti on of electronic health soluti ons. The outcomes of eff ecti ve eHealth change management acti viti es include soluti on adopti on by users and the realizati on of benefi ts.”
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eHEALTH CHANGE MANAGEMENT IS:
Pan-Canadian Change Management Network
March 1, 2011
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THE CHANGE MANAGEMENT ICEBERG
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Management of Perceptions and Beliefs
Management of Power and Politics
CostQuality
Time
Bottom line: 70 % Failure
•85% of our time = 15% of the change
•15% of our time = 85% of the change
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eHealth presents unique CM challenges:• Complex healthcare delivery structures• Organizational change resistance and fatigue• Emerging technologies• Health industry regulations• Strong, disparate professional cultures
UNIQUE INDUSTRY, UNIQUE CHALLENGES
Successful health IT implementations dedicate between 10-15%1 and upwards of 30% of project budget towards CM activities.2
1 Petouhoff, N., Chandler, T., Montag-Schultz, B. (2006). The business impact of change management: What is the common denominator for high project ROI's? Graziadio School of Business and Management, Pepperdine University. [Electronic document]2 Laflamme, F., Pletraszek, W., Rajadhyax, N. (2010). Reforming hospitals with IT investments. Mckinsey on Business Technology. Number 20, Summer 2010: 27-33.
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THE VALUE OF CHANGE MANAGEMENT
“Change Management, done well, done badly, or not done at all, will have a lasting impact on the sustainability of an organization.”
- Les Harrison, CEO, Yellowknife Health and Social Services Authority, GNWT
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ROI of good change management
• Effective CM strategies support average 143% ROI vs. 35% ROI with poor/non-existent CM.1
• With execution of CM activities:2
• 96% of projects achieve project management objectives
• 95% of projects achieve IT management objectives
Consequences of poor change management
• Cross industry studies suggest that with poor or non-existent CM:• “84% of projects do not hit their
targets;• 18% average over run on budgets;• 23% average over run on schedule; and • 7% do not achieve scope/
functionality.”3
• “70% of health IT projects fail or do not provide end-user satisfaction.”4
A LOOK AT THE NUMBERS
1 Laclair, J., Pao, R. (2002). Helping employees embrace change. Managing change is the responsibility of everyone in the corporation—from senior managers on down. McKinsey Quarterly. November 2002 (4), 17 – 20.2 Coplan, S. Redefining health IT project success, Journal of Healthcare Information Management (HIMSS), Spring 2012, vol. 26, no 2. 3 Sauer, C., Cuthbertson, C. (2003). The State of IT Project Management in the UK 2002-2003. University of Oxford, England.4 Anderson M. Six levels of healthcare IT.Davidson PL ed. Healthcare Information Systems, Auerbach Publications, Boca Raton (2000), pp. 97–108
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CHANGE MANAGEMENT ENABLES REALIZATION OF BENEFITS
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Eff ecti ve governance & leadership investmentComprehensive stakeholder engagementWorkfl ow analysis & integrati onConsistent communicati onsTraining & educati onOngoing monitoring &
evaluati on
htt ps://www. infoway- inforoute.ca/ index .php/progress - in-canada/manag ing-change
WHAT IS REQUIRED?
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“You can’t have a successful project without organizational CM. It is as important as good project management. All of the elements of CM including training, communications are an integral part of a major initiative. You can’t implement without it. You will manage the change or the change will manage you.”
Roger GirardChief Information Officer, Manitoba eHealth
Telepathology & HEALTHe NL,
Newfoundland & Labrador eHealth experience
MAKING EARLY PLANS
Early readiness planning, strategies, acti viti es, outcomes:Pre RFP, requirements validationPotential implementation & adoption learning'sReadiness report and Project Steering Committee decision
needsEarly clinical governance, RFP site visit evaluationsEarly clinical governance informed project implementation
approach; Clinical Working Group development (formalized terms of reference)
Revised CM plans, recognizing adoption targets, barriers, solutions
CONSIDERATIONS & QUESTIONS, TELEPATHOLOGY
Early Clinical governance needs, planning to implementati on phases
Stakeholder engagement, early & oft en, Regional Health Authoriti es, acute care services, end users
Monthly Clinical Working Group (CWG) meeti ngs:Alignment & validation of requirements, pre-designEngagement on Education & Training designProduction environment testing, pre-pilot, go-liveCWG engagement, post go-live strategies & activities;
conferences, Regional Health Authorities, community clinician adoption
CONSIDERATIONS & QUESTIONS, HEALTHe NL
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Results of ear ly project governance, focus on Implementati on & Adopti on:Mandate “The Telepathology Implementati on Leads Team (TILT) wi l l provide advice and
support to the Telepathology Project Team regarding the implementati on of the provincial Telepathology network for Newfoundland and Labrador. In additi on, team members wi l l act as leads for their respecti ve RHAs Telepathology Implementati on”
Membersh ip Ideal ly, one (1) representati ve for each of the fol lowing areas, from each RHA
wi l l be identi fi ed by the key contacts/ leads in each RHA, based on roles and experti se to take part on the team:
Informati on Technology Technologist/Histotechnologist Pathologist Laboratory Managers Change Management
CONSIDERATIONS & QUESTIONS, HEALTHe NL
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Results of early project governance, focus on Implementati on & Adopti on:
Responsibiliti esTeam members will be asked to provide input and take part in
acti viti es from the following areas:Stakeholder Communicati on and EngagementEducati on and Training Implementati on planningSoluti on User Acceptance Testi ngAdopti on support and reinforcement
CONSIDERATIONS & QUESTIONS, HEALTHe NL
1. A strategic, tacti cal, relevant change plan2. Early defi ned change scope, integrated with project
scope3. Early defi ned clinical governance4. Operati onal plan that includes:
Ongoing monitoring & evaluation strategies for benefits realization
Ongoing Clinical governance needs for benefits realization
IN SUMMARY
Secure Adopti on & Conti nuous Learning
MAKING CHANGE STICK
FUNDED EMR ADOPTION SINCE 2005
Adoption by Community Primary Care Physicians and Specialists Actuals & Targets to March 31, 2014
985
1,845
3,000
4,700
6,710
2,000
4,000
6,000
8,000
10,000
12,000
2005/6 2006/7 2007/8 2008/9 2009/10 2010/11 2011/12 2012/13
572 413860
# Physicianson EMR
2013/14
3,519
1,7592,100
1,700
572
1,155
490
Actual Adoption
PlannedAdoption
519
1,700
490
1,264
341
1,181
3755002,475
2,975
4,009
6,459
8,810
9,950
11,200
7,475765
1,000
8,225
CommunitySpecialists
Primary Care
CHCs/AHACseHealth Ontario
310
9,690
7,070
2,620
Dec 31, 2012
THE CHANGING ENVIRONMENT OF ADOPTION
985
1,845
3,000
4,700
6,710
2,000
4,000
6,000
8,000
10,000
12,000
2005/6 2006/7 2007/8 2008/9 2009/10 2010/11 2011/12 2012/13
572 413860
# Physicianson EMR
2013/14
3,519
1,7592,100
1,700
572
1,155
490
Actual Adoption
PlannedAdoption
519
1,700
490
1,264
341
1,181
3755002,475
2,975
4,009
6,459
8,810
9,950
11,200
7,475765
1,000
8,225
CommunitySpecialists
Primary Care
CHCs/AHACseHealth Ontario
310
9,690
7,070
2,620
Dec 31, 2012
65%
85%
New Applicants
Enrolled physicians
New enrollments
2012 2014
Family physicians
Existing UsersPrevious Programs
New eHealth apps:(OLIS, HRM)
Upgrades & Switches
EMR Maturity assessments
1. Make sure that practice is ready to take on the transformation - Readiness assessment
2. Stake out EMR vision & goals3. Spend time on identifying
needs of practice, functional requirements and understand how the change will impact workflow
4. Training, training, training
#1: SUPPORT TO NEW EMR ADOPTERS: FROM PAPER TO ELECTRONIC RECORDS
The foundation for a successful and sustained change is created up front..
Available Change Management and Peer Leader Support
Change management strategies used to support sustained change:
1. Most change initiatives will experience a drop in effi ciency and productivity before starting to realize the benefits that justified the change in the first place
2. Initiate follow-up and review immediately following go-live
3. Important to push forward, make corrections/ adjustments, address questions/concerns
#2: AFTER “GO-LIVE”: EMR MATURITY ASSESSMENT
…it takes time to gain familiarity, confidence and speed with a new EMR…
EMR Progress Review, Assessment results
Looking at the result of the EMR Progress Assessment aft er EMR go-live:
1. Review the results with the entire group
2. Identify priority key measures for improvement
3. Explore Root Causes 4. Developing Action Plan 5. Implement improvements6. Evaluate the progress
#3: …AND BEYOND:CONTINUOUS IMPROVEMENT & LEARNING
...focus on “continuous improvement” and make it a part of the practice culture.
EMR Progress Review, Assessment results
Conti nued support to EMR users through Maturity Model, CM and Peer Leader Program:
#1: You need to plan to achieve sustainable change and conti nuous improvement#2: Even the best plans and intenti ons can fail if not managed/championed/sponsored properly#3: No change or improvement initi ati ve will magically happen by itself – only conti nued focus and determinati on will make it successful#4: Evaluate the eff ecti veness of the change process
SO, WHAT HAVE WE LEARNED ABOUT SUSTAINABLE CHANGE?
QUESTIONS?
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Planning for Sustainable Change? Start Early and Think Beyond ‘Go-Live’
REFERENCE SLIDES
EMERGING FOCUS – CLINICAL GOVERNANCE
Challenges Management strategies
• HIT may create new orcompound existing clinical risks.• If there is a perception that the newsystem may create risks, confidencein the system may fall.• Governance bodies may lack clinical governance representation or fail to make links with existing clinical governance structures.• Where clinical risks arise across the continuum of care there may be a lack of clarity as to who is responsible and what action should be taken.
• Establish robust clinical governance structures and processes, ensuring they are integrated into the project’s overall governance.
• Ensure that there are links between the project’s governance and the existing clinical governance structures
• Be proactive in the monitoring of clinical risks and respond promptly where risks are identified. Formalise risk monitoring systems and escalation strategies.
• Include the examination of the likelihood for the generation of new clinical risks as a routine part of the system design and testing phase.
Excerpt taken directly from: NEHTA. Making Sense of eHealth Collaboration - A Guide to Getting Started. 2012. Pg 29. http://www.nehta.gov.au/component/docman/doc_download/1605-making-sense-of-ehealth-collaboration-a-guide-to-getting-started
A FEW QUESTIONS TO CONSIDER IN PLANNING, IMPLEMENTATION, ADOPTION & BEYONDNational Change Management Framework Elements
Considerations
Governance & Leadership • Who “owns” the program after go-live? • Who will make decisions?• Who will be accountable for continuously reporting on the project?• How will issues & risks be escalated and managed?
Stakeholder Engagement • How will stakeholders provide feedback on the solution? Whose feedback will be sought? How will this occur?
• How will they access technical, operational, clinical support? • How will stakeholders be involved in enhancements or modifications?• Who will be involved in the sustaining Operational Team?
Communications • How will stakeholders be kept informed about upcoming release changes? • How will their feedback reported?• How will they be kept informed?
Workflow Analysis & Integration
• How will workflow be affected by future enhancements? • How will stakeholders be involved in understanding these impacts?• What education and training will be provided?
Education & Training • Who will continue to participate as clinical champions / super-users?• What training will be offered for new users? With new release cycles? Refresher training? • How will this be communicated?
Monitoring & Evaluation • What indicators will continuously be measured?• Who will capture, analyze and report on the data?• Who will ensure data and report integrity?• How does the data get reported? How does it fit into organizational performance
measurement?
MISSION: The PCCMN collaborates to successfully communicate, educate and promote the value of using change management methodologies, approaches, and tools at every stage of ehealth solution implementation and adoption.
VISION: To be recognized as a leading national Network for change management approaches and resources that support the successful adoption of ehealth solutions.
PAN-CANADIAN CHANGE MANAGEMENT NETWORK
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Consider these questi ons:
ARE YOU EFFECTIVELY LEADING CHANGE?
What is your organization’s
approach to change management?
• Do you have a formal CM process in place across your organization?• Is CM facilitated at an enterprise or program level, or project by
project?• Has CM been profiled within your organization as an expectation?• Is there evidence of CM on your organizational chart?
What leadership supports are in place
to support effective CM?
• How have you communicated this internally?• How have you structured your team to support these beliefs?• Do you visibly demonstrate support for transformational change
initiatives?• How do you deal with stakeholder resistance?
How do you measure and report on
change?
• What indicators do you use to track progress?• How do you measure, analyze and mitigate risk?• How do you embed these findings into ongoing reporting and
communications?
WHAT CAN YOU DO AS A LEADER?
Governance & Leadership
• Establish a clear, concise vision for the change initiative• Create time-bound, measureable, specific goals to evaluate success• Conduct a realistic evaluation of the internal climate to improve focus of
leaders and team efforts on key challenges• Improve visibility and focus for executive/sponsor support• Increase accountability for change initiatives• Improve and expedite the decision-making process
Stakeholder Engagement
• Provide a means to communicate and validate issues and barriers and ensure proactive management of these items
Communications• Provide stakeholders with timely information and allow for interaction
with change leadership and project team• Engage in open & honest conversations
Training & Education
• Equip stakeholders with the necessary training, information about new processes, technologies, and skills required in order to achieve success post-change
Monitoring & Evaluation
• Evaluate the success of the change initiative against vision and goals• Continually monitor performance• Reinforce change messaging with stakeholders
Speed of adopti on – improved stakeholder engagement, improved ease of uptake
Uti lizati on – improved adopti on rates Profi ciency - i.e.., eff ecti ve use & improved effi ciency Avoidance of unnecessary costs – i.e.., due to resistance, need
to re-plan, employee turnover etc. Improved access to informati on
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CHANGE MANAGEMENT PROMOTES:
Benefits Realization
NATIONAL CM FRAMEWORK
Informati on & perspecti ves garnered through CMWG acti viti es resulted in creati on of a Nati onal CM Framework, based on six core elements :
1. Governance & Leadership2. Stakeholder Engagement3. Workflow Analysis & Integration4. Communications5. Training & Education6. Monitoring & Evaluation
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A Framework & Toolkit for Managing eHealth Change – People & Processes
https://www.infoway-inforoute.ca/about-infoway/approach/managing-change
AVAILABLE CHANGE MANAGEMENT RESOURCES
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Online Toolkit Repository• Sample of tools provided in CM Guide PLUS many
more offeringsEnglish version: http://bit.ly/infoway-CM-toolkitFrench version: http://bit.ly/inforoute-outils-GC
Join us on LinkedIN
PM & CM - WORKING TOGETHER
• Project Objectives• Common Goals and Metrics for SuccessDefine
• Reporting Relationship• Roles and Activities• Responsibilities and Deliverables
Communicate
• PM shares information for communication• CM creates communication deliverables• PM determines training schedules• CM determines training approach • PM informs sponsors• CM coaches sponsors
Crystallize & document PM vs. CM roles
THREE PILLARS OF BENEFITS REALIZATION
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Know your objecti ves Identi fy and manage the criti cal success factors to get thereMeasure & iterati vely improve
Critical Success Factors
Objectives Measurement & Improvement
Benefits Realization
INFOWAY BENEFIT EVALUATION FRAMEWORK
INCREASING FOCUS ON ADOPTION AND BENEFITS
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Use
User Satisfaction
System quality
Service quality Productivity
Quality
Access
NET BENEFITS
Information quality
Common scope of IT projects
Clinical Adoption
MATURITY MODEL – STAGES OF EHR ADOPTION
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Adoption is a process, not an end state
• Occasional use• Not well integrated• Low functionality• Low measurement and analysis capability• Low-hanging benefits
• Clinical Transformation• Fully integrated• Advanced functionality• Data drives quality
improvement• Maximum Benefits
