Www.abreon.com Change Performance. The Psychology of Implementing HIT HIT Summit West Andrew Schaer Chief Marketing Officer Michele Snead Director, Performance

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Change Performance.The Psychology of Implementing HITHIT Summit West

Andrew SchaerChief Marketing Officer

Michele SneadDirector, Performance Consulting

© 2003 The Abreon Group Change Performance.© 2004 The Abreon Group. All Rights Reserved

1. Does user adoption play a role in the success of your HIT implementation?

2. Inherent user resistance to change – why adoption can be so difficult

3. How to optimize adoption: one provider’s approach

4. How to measure success5. Q&A

Agenda


“(HIT)… disasters are not technical, they’re people and culture related…

“The soft stuff is the hard stuff.”

Bryan Fiman

Principle and Co-Founder,

Implementation Management Associates

How Important is Adoption?


Support Requirements

“…. uneducated users require 3 to 6 times more support than educated users over the life of a new technology and process.”

Research Note


575% Return on Investment

1 Hour IT training saves the organization 5.75 hours:4.5 hours of experimentation:

An untrained IT employee will likely spend up to 45 hours to achieve the same skill level that it takes a trained employee 10 hours to achieve (including training).

0.25 hours of help:

IT professionals require 0.25 hours less help from peers and centralized support desks for every hour of training they received vs. untrained professionals acquiring comparable information.

1 hour of rework: IT professionals spend an hour less time finding and correcting errors for every hour of training they received vs. untrained professionals performing comparable tasks.

Research Note


Boost Workforce Productivity

1 Hour end-user training = 5 hrs. to the organization4 hours of experimentation:

An untrained end user may take up to 22.5 hours to achieve the same skill level that it takes a trained employee 5 hours to achieve (including training).

0.5 hours of help: End users require 0.5 hours less help from peers and centralized support desks for every hour of training they received vs. untrained end users’ acquiring the same information.

0.5 hours of rework: End users spend 0.5 hours less time finding and correcting errors for every hour of training they received vs. untrained professionals performing comparable tasks.

Research Note


What does poor adoption look like?• Screens are up, but little else has changed• Cycle times are the same or worse• Quality of care is the same or worse• Patient Satisfaction metrics are the same or worse• Employee turnover is increasing• Cost savings are intangible

How Important is Adoption?


Whether it’s a new install or an upgrade, all aspects of the implementation are important…

…but in the end, if users, particularly clinical users, don’t know how to use it, or don’t want to use it, nothing else really matters.

Takeaway #1


“Vanilla” training = How

HIT Education = Why, Who and Where

Answering the right questions?


The Psychology of Change

B.F. Skinner’s theories of conditioning and positive reinforcement:

• Conditioning is not sustainable

• Over time, subjects revert to learned behavior


Training vs. Sustainability


How people process change

A neural receptor in the brain enabling one to process and embrace change?


• Your user adoption plan must take human behavior into account

• We’re creatures of habit• We inherently resist change



Prochaska’s Stages of Change model:

• Accepted behavior modification model today

• No shortcuts

• Without contemplation, preparation and maintenance, change is not sustainable

Pre-contemplation

Contemplation

Preparation

Action

Maintenance

Relapse



The ADKAR Model:

Post Implementation

Implementation

Concept & Design

Business Need

Awareness Desire Knowledge Ability Reinforcement

Successful Change

Source: Prosci, 1998



Overcoming Resistance

Force-feed Training

“This is how we’re going to work, don’t be left behind.”

Result: Short term behavior modification; relapse to comfort state

Create Attraction

“Here’s how this approach will solve some of the problems you’re having...”

Result: Satisfied users, sustainable value


Takeaway #2

Training alone is insufficient to drive sustainable value.

In order to successfully adopt new technology, your clinicians need to……be able to process what’s going to happen,…understand why, …have the tools and knowledge to know how, …with the necessary support.


Who do you educate, when?

Who?It is absolutely vital that the whole team receives adequate end-user education.

When? Start before users begin to test the new system and finish before the end of the project.

Users must:– be comfortable with the new functionality, – able to identify major problem areas and ask for help

before the project team leaves.


How much should you spend?

On average, successful enterprise software implementation projects allocate approximately 13% to 17% to human performance needs, such as change management, communication, education, training, and performance support.

Research Note


More Examples Wanted?

$1 spent on corporate IT education can translate into as much as $30 in productivity gains within three years.

“Training – Key to Retaining” by Maria Seminerio


Takeaway #3

Money spent on end-user education and adoption translate to a defensible and positive return to the bottom line.


Applying the Psychology

Preparing and opening minds

• Campaign & communications strategy and development

Supporting users and sustaining value

• Service desk support and optimization

• eLearning

Filling open minds with the right knowledge at the right time

• Situational assessments

• Tailored solutions to address the unique needs and resistance of users

• Blended delivery approach


Education Strategy

4 Phases of Adoption

1. Education Strategy

2. Create Communications and Learning Materials

3. Delivery

4. Measurement


Phase 1: Education Strategy

1.Perform instructional analysis• Learning environment

• Application review

• Workflow / processes review

• Process Review

2.Create Learning Track/Catalog• Role definitions

• Process changes

• Application functionality



3. Create course objectives• Preliminary course outlines• Preliminary competencies / models of performance

• Estimate course hours for end users• Recommend delivery options (leveraging existing details)• Blended approach• Traditional delivery (one-on-one)• Train-the-trainer approach• Technology-based delivery • Self-paced learning• Confirm instructional materials• Participant guides, eLearning courses• Quick reference guides• Training database strategy• Detailed work effort based on current estimates• Instructional Design & Delivery



4.Baseline Education Management and Delivery Plan• Define facility requirements• Define staffing requirements• Develop draft of delivery plan• Estimated work effort to execute training• Education management risks and assumptions

5.Build Training Database Strategy6.Develop plan for Level, Level 2, & Level 3 Measurement7.Build Strategy for Electronic Performance Support System


Learning Track


Course Catalog


Phase 2: Learning Materials

1. Create Detailed Course Designs / Outlines2. Create Training Materials

• Participant Guides• Presentation including: key changes, key terms, key processes, policy &

procedure overviews, demonstrations• Exercises

• Day-in-the-life scenarios mirroring daily business events• Work Instructions

• Procedures for entering information in application• Job Aids

• Quick reference materials• Competency Assessments

• A short test that ensures knowledge transfer immediately post training

3. Enter Training Data into Training Instance4. eLearning Development5. Begin End User Scheduling6. Deliver a Pilot for Validation



Detailed Course Design


Phase 3: Education Delivery

1. Ensure All Work Instructions are Posted & Final Materials are Prepared in the EPSS

2. Engage End Users•Create an end-user focused communication campaign •Prepares end users for training and the support that follows

• email campaign,

• call downs,

• posters


Phase 3: Education Delivery

3. Schedule End Users

4. Conduct Train-the-Trainer Courses if super user approach is deployed

5. Measure, analyze and prepare• Level 1 and Level 2 assessment results• Prepare for Level 3 assessment

6. Deliver training

7. Provide coaching and/or other support after go-live







Key Considerations

•It is critical that end users understand the process / workflow they will use to enter / output information from HIT.

•Relevant scenarios throughout the training help reinforce the tasks end users will be asked to complete on a daily basis

•End users typically require 16 to 24 hours of education in large-scale HIT rollouts

•For Super User approach, ensure selected trainers are certified and can train

•Ensure a single point-of-contact for questions, communication, and confirmation

•Ensure a safety net for end users (coaching, floor walking, and/or help desk support)


Takeaway #4

Curriculum content goes well beyond the manual and only a small part of it relates to the technology, the majority of the content is tied to the business process surrounding the application.

The process doesn’t end when the education is delivered, ongoing support is key.


Phase 4: Measuring Results


Measuring Results

Level 1 Assessment (Reaction) – Measures how participants in a learning program react to it. It answers questions such as:

•Did they like it?

•Was the material relevant to their work?

The results of these assessments are typically used to continually enhance the program.


Level 2 Assessment (Learning) – Measures participants attitude change, improved knowledge, and increased skills as a result of attending the program. It answers the question:

-- Did the participants learn anything?

This assessment is typically completed through the use of pre / post testing, short answer assessments, and completion of rigged exercises where technology is involved.

Measuring Results


Level 3 Assessment (Performance) – Measures participants capabilities to perform learned skills while on the job. It answers questions such as:

-- Do people use their newly acquired learnings on the job?

This assessment is done through formal testing and informal observation. The results of this assessment provide data and insight into the transfer of learning from the classroom to the work environment and the barriers encountered when attempting to implement their new skills.

Measuring Results


Level 1 Assessment


Level 2 Assessment


Level 3 Assessment


Level 3 Assessment


Level 3 Assessment


•Send post-training surveys

•Use the results to offer ongoing, sequenced training and coaching over time—education is a process, not an event

•Conduct follow-up needs assessment

•Check metrics (e.g., scrap, re-work, errors, etc.) to measure if participants achieved objectives

•Interview trainees and their managers, or their customer groups

Key Recommendations


“I feared the go-live would be the first week of the end

of my career (and my life). But thanks to great trainers

and support staff, I not only survived but look forward

to the next 20 years!”

John Schmidt, M.D.

Family Practitioner (75 years old)

Tangible Results


Measure, measure, measure…as much as you can, before and after implementation. Push for higher level metrics. Use the learning to identify productivity problems before they translate to business issues, and as a gauge for your own success.

Takeaway #5


1.If users don’t use it nothing else matters, but training alone is insufficient to drive sustainable value.

2.Money spent on end-user education and adoption translate to a defensible and positive return to the bottom line.

3.Curriculum content goes well beyond the manual and only a small part of it relates to technology, the majority of the content is tied to the business process surrounding the application.

4.The process doesn’t end at completion of education delivery, support is key.

5.Measure, measure, measure…as much as you can, before and after implementation.

Key Takeaways


Thank you.


Questions??

Your turn…

Documents

Www.abreon.com Change Performance. The Psychology of Implementing HIT HIT Summit West Andrew Schaer Chief Marketing Officer Michele Snead Director, Performance