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Start Early and Think Beyond Go-Live PLANNING FOR SUSTAINABLE CHANGE.

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Presentation on theme: "Start Early and Think Beyond Go-Live PLANNING FOR SUSTAINABLE CHANGE."— Presentation transcript:

1 Start Early and Think Beyond Go-Live PLANNING FOR SUSTAINABLE CHANGE

2 Making a Case for Change Cassie Frazer, Canada Health Infoway Making Early Plans Ian Hodder, Centre for Health Information, Newfoundland & Labrador Making Change Stick Knut Rodne, OntarioMD PANEL OUTLINE

3 Creating awareness MAKING A CASE FOR CHANGE

4 …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. 4 eHEALTH CHANGE MANAGEMENT IS: Pan-Canadian Change Management Network March 1, 2011

5 5 THE CHANGE MANAGEMENT ICEBERG 5 Bottom line: 70 % Failure 85% of our time = 15% of the change 15% of our time = 85% of the change

6 eHealth presents unique CM challenges: Complex healthcare delivery structures Organizational change resistance and fatigue Emerging technologies Health industry regulations Strong, disparate professional cultures 6 UNIQUE INDUSTRY, UNIQUE CHALLENGES Successful health IT implementations dedicate between % 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:

7 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

8 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 8 A LOOK AT THE NUMBERS 1 Laclair, J., Pao, R. (2002). Helping employees embrace change. Managing change is the responsibility of everyone in the corporationfrom senior managers on down. McKinsey Quarterly. November 2002 (4), 17 – 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


10 Effective governance & leadership investment Comprehensive stakeholder engagement Workflow analysis & integration Consistent communications Training & education Ongoing monitoring & evaluation 10 WHAT IS REQUIRED?

11 11 You cant 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 cant implement without it. You will manage the change or the change will manage you. Roger Girard Chief Information Officer, Manitoba eHealth

12 THANK YOU 12 Cassie Frazer, Benefits Realization Leader –

13 Telepathology & HEALTHe NL, Newfoundland & Labrador eHealth experience MAKING EARLY PLANS

14 Early readiness planning, strategies, activities, outcomes: Pre RFP, requirements validation Potential implementation & adoption learning's Readiness report and Project Steering Committee decision needs Early clinical governance, RFP site visit evaluations Early 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

15 Early Clinical governance needs, planning to implementation phases Stakeholder engagement, early & often, Regional Health Authorities, acute care services, end users Monthly Clinical Working Group (CWG) meetings: Alignment & validation of requirements, pre-design Engagement on Education & Training design Production environment testing, pre-pilot, go-live CWG engagement, post go-live strategies & activities; conferences, Regional Health Authorities, community clinician adoption CONSIDERATIONS & QUESTIONS, HEALTHe NL

16 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 Membership Ideally, 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 Technology Technologist/Histotechnologist Pathologist Laboratory Managers Change Management 16 CONSIDERATIONS & QUESTIONS, HEALTHe NL

17 Results of early project governance, focus on Implementation & Adoption: Responsibilities Team members will be asked to provide input and take part in activities from the following areas: Stakeholder Communication and Engagement Education and Training Implementation planning Solution User Acceptance Testing Adoption support and reinforcement 17 CONSIDERATIONS & QUESTIONS, HEALTHe NL

18 1.A strategic, tactical, relevant change plan 2.Early defined change scope, integrated with project scope 3.Early defined clinical governance 4.Operational plan that includes: Ongoing monitoring & evaluation strategies for benefits realization Ongoing Clinical governance needs for benefits realization IN SUMMARY

19 Secure Adoption & Continuous Learning MAKING CHANGE STICK

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% 85% New Applicants Enrolled physicians New enrollments Family physicians Existing Users Previous Programs New eHealth apps: (OLIS, HRM) Upgrades & Switches EMR Maturity assessments

22 1.Make sure that practice is ready to take on the transformation - Readiness assessment 2.Stake out EMR vision & goals 3.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:

23 1.Most change initiatives will experience a drop in efficiency 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 after EMR go-live:

24 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 improvements 6.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 Continued support to EMR users through Maturity Model, CM and Peer Leader Program:

25 #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 SO, WHAT HAVE WE LEARNED ABOUT SUSTAINABLE CHANGE?

26 THANK YOU! Knut Rodne

27 QUESTIONS? 27 Planning for Sustainable Change? Start Early and Think Beyond Go-Live


29 EMERGING FOCUS – CLINICAL GOVERNANCE ChallengesManagement strategies HIT may create new or compound existing clinical risks. If there is a perception that the new system may create risks, confidence in 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 projects overall governance. Ensure that there are links between the projects 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 Pg 29.

30 A FEW QUESTIONS TO CONSIDER IN PLANNING, IMPLEMENTATION, ADOPTION & BEYOND National 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?

31 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

32 Consider these questions: 32 ARE YOU EFFECTIVELY LEADING CHANGE? What is your organizations 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?

33 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

34 Speed of adoption – improved stakeholder engagement, improved ease of uptake Utilization – improved adoption rates Proficiency - i.e.., effective use & improved efficiency Avoidance of unnecessary costs – i.e.., due to resistance, need to re-plan, employee turnover etc. Improved access to information 34 CHANGE MANAGEMENT PROMOTES: Benefits Realization

35 NATIONAL CM FRAMEWORK Information & perspectives garnered through CMWG activities resulted in creation of a National CM Framework, based on six core elements: 1.Governance & Leadership 2.Stakeholder Engagement 3.Workflow Analysis & Integration 4.Communications 5.Training & Education 6.Monitoring & Evaluation 26

36 A Framework & Toolkit for Managing eHealth Change – People & Processes AVAILABLE CHANGE MANAGEMENT RESOURCES 36 Online Toolkit Repository Sample of tools provided in CM Guide PLUS many more offerings English version: French version: Join us on LinkedIN

37 PM & CM - WORKING TOGETHER Project Objectives Common Goals and Metrics for Success Define 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

38 THREE PILLARS OF BENEFITS REALIZATION 38 Know your objectives Identify and manage the critical success factors to get there Measure & iteratively improve Critical Success Factors Objectives Measurement & Improvement Benefits Realization


40 INCREASING FOCUS ON ADOPTION AND BENEFITS 40 Use User Satisfaction System quality Service quality Productivity Quality Access NET BENEFITS Information quality Common scope of IT projects Clinical Adoption

41 MATURITY MODEL – STAGES OF EHR ADOPTION 41 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

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