Presentation on theme: "Planning for Sustainable Change"— Presentation transcript:
1 Planning for Sustainable Change Start Early and Think Beyond ‘Go-Live’
2 Panel outline Making a Case for Change Making Early Plans Cassie Frazer, Canada Health InfowayMaking Early PlansIan Hodder, Centre for Health Information, Newfoundland & LabradorMaking Change StickKnut Rodne, OntarioMD
4 eHealth change management is: “…a strategic and systematic approach that supports people and their organizations in the successful transition and adoption of electronic health solutions. The outcomes of effective eHealth change management activities include solution adoption by users and the realization of benefits.”Pan-Canadian Change Management Network March 1, 2011Consensus based definitionGroup of CM leaders working in health IT spaceSharing best practices and ideas since November 2009
5 The change management iceberg Management of Perceptions and BeliefsManagement of Power and PoliticsCostQualityTimeBottom line: 70 % Failure85% of our time = 15%of the change15% of our time = 85%Experience shows us that we live in a very process oriented, project management focused, kind of world.There is emphasis on cost, quality and time with less focus given to the large iceberg hidden under the water. That is – less time and energy given to consider influence, power, politics, perceptions and beliefs.5
6 Unique industry, unique challenges eHealth presents unique CM challenges:Complex healthcare delivery structuresOrganizational change resistance and fatigueEmerging technologiesHealth industry regulationsStrong, disparate professional culturesSuccessful health IT implementations dedicate between 10-15%1 and upwards of 30% of project budget towards CM activities.2References: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]. Accessed at: (November 2010).Laflamme, F., Pletraszek, W., Rajadhyax, N. (2010). Reforming hospitals with IT investments. Mckinsey on Business Technology. Number 20, Summer 2010: Accessed at (May 11, 2012).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:
7 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-In the world of eHealth, change management has can have lasting impacts on all elements of organizational performance, including quality outcomes, project delivery, risk management and financial health.
8 A Look at the Numbers ROI of good change management Effective CM strategies support average 143% ROI vs. 35% ROI with poor/non-existent CM.1With execution of CM activities:296% of projects achieve project management objectives95% of projects achieve IT management objectivesConsequences of poor change managementCross 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; and7% do not achieve scope/ functionality.”3“70% of health IT projects fail or do not provide end-user satisfaction.”4References: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.Coplan, S. Redefining health IT project success, Journal of Healthcare Information Management (HIMSS), Spring 2012, vol. 26, no 2. Accessed at (May 11, 2012).Sauer, C., Cuthbertson, C. (2003). The State of IT Project Management in the UK University of Oxford, England.Anderson M. Six levels of healthcare IT.Davidson PL ed. Healthcare Information Systems, Auerbach Publications, Boca Raton (2000), pp. 97–1081 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 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
9 Change Management enables Realization of Benefits This graph demonstrates the relationship between the breadth of change management activities and the capture of benefits and overall return on investment (ROI) of a project.Focused and appropriately resourced change management is a driver of adoption and for achieving benefits linked to organizational performance, staff engagement and morale, as well as delivery of value to patients, providers and the health system alike.In order to achieve realization of benefits:Must hardwire reliable measurement processes into the ongoing operation of the health care system, including efforts to:Link strategic goals and objectives to operational outcomesCreate synergy between existing measurement programsEnhance technology system design for cliniciansPromote measurements that support course correctionPromote buy-in to the selection and deployment of measuresOperationalize the assessment of value and opportunities for improvement using a sustainable, reliable approach
10 What is required? Effective governance & leadership investment Comprehensive stakeholder engagementWorkflow analysis & integrationConsistent communicationsTraining & educationOngoing monitoring & evaluationhttps://www.infoway-inforoute.ca/index.php/progress-in-canada/managing-changeThe National Change Management Framework, developed by the Pan-Canadian Change Management Network gives an overview of the required elements of an effective change management program.More information about the framework, as well as helpful tools and resources related to each of the framework elements, are available on the Canada Health Infoway website.
11 “You can’t have a successful project without organizational CM “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
13 Telepathology & HEALTHe NL, Newfoundland & Labrador eHealth experience Making early plansTelepathology & HEALTHe NL,Newfoundland & Labrador eHealth experienceIf you look at models, research presented by Cassie, what are take home messages, considerations for early planning and sustaining change?Key to early planning is considering many of the points mentioned by Cassie, i.e. defining benefits realization objectives, post go-live, what elements of framework do we need to assess within early project change planning for beyond go-live?Given NL status, our operational needs are focused DIS, HEALTHe, and other ehealth projects, i.e.. Telepathology
14 Considerations & Questions, Telepathology Early readiness planning, strategies, activities, 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, solutionsTake time for a broad assessment of project change to enable CQI, beyond go-live.Although called many things, gap assessment, or readiness assessment, a key step to understand many framework elements for success project and operational needsIn case of NL Telepathology, early readiness planning informed many project initiation steps, while uncovering many current to future state needs, very early in project planning, solution requirements, work flow/process/barriers/solutions, clinical governance learning’s and application to early project implementation
15 Considerations & Questions, HEALTHe NL Early Clinical governance needs, planning to implementation phasesStakeholder engagement, early & often, Regional Health Authorities, acute care services, end usersMonthly Clinical Working Group (CWG) meetings: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
16 Considerations & Questions, HEALTHe NL Results of early project governance, focus on Implementation & Adoption:Mandate“The Telepathology Implementation Leads Team (TILT) will provide advice and support to the Telepathology Project Team regarding the implementation of the provincial Telepathology network for Newfoundland and Labrador. In addition, team members will act as leads for their respective RHAs Telepathology Implementation”MembershipIdeally, one (1) representative for each of the following areas, from each RHA will be identified by the key contacts/leads in each RHA, based on roles and expertise to take part on the team:Information TechnologyTechnologist/HistotechnologistPathologistLaboratory ManagersChange Management1. Flipping back to Telepathology, we have a better needs based (draft) clinical governance structure to facilitate post go-live adoption, again, as a result of early CM planning and adoption
17 Considerations & Questions, HEALTHe NL Results of early project governance, focus on Implementation & Adoption:ResponsibilitiesTeam members will be asked to provide input and take part in activities from the following areas:Stakeholder Communication and EngagementEducation and TrainingImplementation planningSolution User Acceptance TestingAdoption support and reinforcement1. All framework elements reflected in TOR
18 In Summary A strategic, tactical, relevant change plan Early defined change scope, integrated with project scopeEarly defined clinical governanceOperational plan that includes:Ongoing monitoring & evaluation strategies for benefits realizationOngoing Clinical governance needs for benefits realizationStrategic, tactical, relevant CM plan is possible, but in alignment and integrated with early project planning activities,Defined as project scope is being defined
19 Making change stickSecure Adoption & Continuous Learning
20 Funded EMR Adoption Since 2005 Adoption by Community Primary Care Physicians and Specialists Actuals & Targets to March 31, 2014
21 The Changing Environment of Adoption 65%Upgrades & SwitchesFamily physiciansNew eHealth apps:(OLIS, HRM)85%EMR Maturity assessmentsMoving from “having” an EMR to “using” an EMR (becomes an asset)Moving from logging patient encounters to managing data in the EMRFocus on data quality and health outcomes- Now a deliverable under the new programDeveloped an EMR Maturity Model and tool in pilot stageExisting UsersPrevious ProgramsNew enrollmentsEnrolled physicians2012NewApplicants2014
22 #1: support to new EMR adopters: From paper to electronic records Make sure that practice is ready to take on the transformation - Readiness assessmentStake out EMR vision & goalsSpend time on identifying needs of practice, functional requirements and understand how the change will impact workflowTraining, training, trainingChange management strategies used to support sustained change:Vision and goals: The end game here is not just about getting rid of paper charts….the EMR can do so much more and its important to state this clearly up frontAt this point in the EMR journey, you have spent a significant amount of time, energy and money to get the system up and operating in your office. And, as a result of determination and patience on your part, you are now as proficient at the day-to-day tasks of entering and retrieving electronic patient information as you were with the old paper charts. This is an essential and laudable first step. But, if this is where you stay, what would be the payoff for all your efforts? The answer is simple: not much. The payoff truly comes when you begin to use your EMR system to improve patient care, obtain better health outcomes for your patients, and facilitate practice management for you.Available Change Management and Peer Leader SupportThe foundation for a successful and sustained change is created up front..
23 #2: AFTER “GO-LIVE”: EMR Maturity Assessment Looking at the result of the EMR Progress Assessment after EMR go-live:Most change initiatives will experience a drop in efficiency and productivity before starting to realize the benefits that justified the change in the first placeInitiate follow-up and review immediately following go-liveImportant to push forward, make corrections/ adjustments, address questions/concernsIt takes time to gain familiarity, confidence and speed with a new EMRMost change initiatives will experience a drop in efficiency and productivity before starting to realize the benefits that justified the change in the first placeInitiate follow-up and review immediately following go-liveImportant to push forward, make corrections/ adjustments, address questions/concernsEMR Progress Review, Assessment results…it takes time to gain familiarity, confidence and speed with a new EMR…
24 #3: …AND BEYOND: Continuous improvement & learning Continued support to EMR users through Maturity Model, CM and Peer Leader Program:Review the results with the entire groupIdentify priority key measures for improvementExplore Root CausesDeveloping Action PlanImplement improvementsEvaluate the progressReview the results with the entire group – celebrating the wins and looking at improvement opportunitiesIdentifying priority key measures for improvementRoot Causes – looking at roadblocks and resistance in the way of realizing improvementsDeveloping Action Plan – to address what, who and how and whenImplementation of improvements – communications, resistance management, etc..Evaluating the progress – lessons learned and deciding on next steps for improvementsEMR Progress Review, Assessment results...focus on “continuous improvement” and make it a part of the practice culture.
25 So, what have we learned about sustainable change? #1: You need to plan to achieve sustainable change and continuous improvement #2: Even the best plans and intentions can fail if not managed/championed/sponsored properly #3: No change or improvement initiative will magically happen by itself – only continued focus and determination will make it successful #4: Evaluate the effectiveness of the change process
29 Emerging Focus – Clinical Governance ChallengesManagement 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 structuresBe 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.
30 A Few Questions to Consider in Planning, Implementation, Adoption & Beyond National Change Management Framework ElementsConsiderationsGovernance & LeadershipWho “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 EngagementHow 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?CommunicationsHow will stakeholders be kept informed about upcoming release changes?How will their feedback reported?How will they be kept informed?Workflow Analysis & IntegrationHow will workflow be affected by future enhancements?How will stakeholders be involved in understanding these impacts?What education and training will be provided?Education & TrainingWho 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 & EvaluationWhat 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?
31 Pan-Canadian Change Management Network 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.A refresh on our mission/mandate & vision which has stayed true since 2009a grassroots collaborative of change leader enthusiasts from across the country sharing best practices and ideas since November The Network facilitates a national community of practice for change management leaders involved in the implementation of electronic health solutions, providing an environment for discussion, networking and knowledge sharing. It was founded to share experiences and identify common goals that address ongoing change management (CM) related issues and concerns within the eHealth space across the provinces and territories.CMWG’s are formed on an as needed basis to work on deliverables of the PCCMN, and provide National expertise, insights and input to shape change management strategies and outputs to accelerate adoption and benefits realization of health information and communication technologies and the electronic health record.
32 Are you effectively leading change? Consider these questions: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?These questions can help leaders determine whether they have the required processes and resources in place for effective change to take place.For example, when considering your organization’s change management approach, consider:Do you have a formal change management process in place across the 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?When considering the leadership supports required for effective CM, you may want to ask yourself:How have you communicated this internally?How have you structured your team to support these beliefs?Measuring and reporting on change is also a crucial element of success. Consider the following: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 communication?
33 What can you do as a leader? Governance & LeadershipEstablish a clear, concise vision for the change initiativeCreate time-bound, measureable, specific goals to evaluate successConduct a realistic evaluation of the internal climate to improve focus of leaders and team efforts on key challengesImprove visibility and focus for executive/sponsor supportIncrease accountability for change initiativesImprove and expedite the decision-making processStakeholder EngagementProvide a means to communicate and validate issues and barriers and ensure proactive management of these itemsCommunicationsProvide stakeholders with timely information and allow for interaction with change leadership and project teamEngage in open & honest conversationsTraining & EducationEquip stakeholders with the necessary training, information about new processes, technologies, and skills required in order to achieve success post-changeMonitoring & EvaluationEvaluate the success of the change initiative against vision and goalsContinually monitor performanceReinforce change messaging with stakeholdersReference for leadership actions:Department of Health & Human Services (HHS) Office of the National Coordinator for Health Information Technology (ONC) Change Management:Strategies and Resources for the State HIE Program Accessed at (October ).
34 Change Management Promotes: Speed of adoption – improved stakeholder engagement, improved ease of uptakeUtilization – improved adoption ratesProficiency - i.e.., effective use & improved efficiencyAvoidance of unnecessary costs – i.e.., due to resistance, need to re-plan, employee turnover etc.Improved access to informationAnimation note: Benefits Realization and Check Mark appear upon clickBenefits Realization
35 National CM Framework Governance & Leadership Stakeholder Engagement 26National CM FrameworkInformation & perspectives garnered through CMWG activities resulted in creation of a National CM Framework, based on six core elements:Governance & LeadershipStakeholder EngagementWorkflow Analysis & IntegrationCommunicationsTraining & EducationMonitoring & Evaluation
36 Available Change Management Resources A Framework & Toolkit for Managing eHealth Change – People & Processeshttps://www.infoway-inforoute.ca/about-infoway/approach/managing-changeOnline Toolkit RepositorySample of tools provided in CM Guide PLUS many more offeringsEnglish version:French version:Join us on LinkedIN
37 PM & CM - Working Together DefineProject ObjectivesCommon Goals and Metrics for SuccessCommunicateReporting RelationshipRoles and ActivitiesResponsibilities and DeliverablesCrystallize & document PM vs. CM rolesPM shares information for communicationCM creates communication deliverablesPM determines training schedulesCM determines training approachPM informs sponsorsCM coaches sponsorsRole documentationThe language and defined deliverables are very important –e.g. TrainingPM –determines the Microsoft project training schedule at the high level the actual Training deliverables are managed by the CM and Training team.
38 Three Pillars of Benefits Realization Know your objectivesIdentify and manage the critical success factors to get thereMeasure & iteratively improveCritical Success FactorsObjectivesMeasurement & ImprovementBenefits RealizationThere are a lot of different theories about BR, but essentially it is about getting to a desired end-state. Infoway’s approach essentially incorporates three perspectives: BE, CM and Adoption. A focus on all three is required to achieve BR. And within that, you need to establish your objectives, your critical success factors, measure and iteratively improve.Change Management requirements are embedded within each of these pillars
39 Infoway Benefit Evaluation Framework In looking at the framework, how many of you have organizational scorecards or performance monitoring systems that would include elements such as displayed on the right hand side of the framework?Idea: IT projects are not always driven as an organizational initiative; sometimes they pop up as something that is aside from organizational objectives. How many of you have objectives that align with the right hand side of this framework as part of your organizational goals, e.g., managing costs, ensuring access to services, reducing adverse events etc.?For how many of you are your IT initiatives aligned to meet these objectives?
40 Increasing focus on adoption and benefits Common scope of IT projectsNET BENEFITSSystem qualityQualityUseClinical AdoptionInformation qualityAccessUser SatisfactionService qualityProductivity
41 Maturity model – stages of EHR adoption Adoption is a process, not an end stateClinical TransformationFully integratedAdvanced functionalityData drives qualityimprovementMaximum BenefitsOccasional useNot well integratedLow functionalityLow measurementand analysis capabilityLow-hanging benefits