PLANNING FOR
SUSTAINABLE CHANGE
Start Early
and Think
Beyond
‘Go-Live’
PANEL OUTLINE
 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
MAKING A CASE FOR
CHANGE
Creating
awareness
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, 2011
4
THE CHANGE MANAGEMENT ICEBERG
•
•
85% of our time = 15%
of the change
15% of our time = 85%
of the change
Bottom
line: 70 % Failure
5
5
UNIQUE INDUSTRY, UNIQUE
CHALLENGES
eHealth presents unique CM challenges:
•
•
•
•
•
Complex healthcare delivery structures
Organizational change resistance and fatigue
Emerging technologies
Health industry regulations
Strong, disparate professional cultures
Successful health IT implementations dedicate between 1015%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.
6
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
7
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.1
• With execution of CM activities:2
• 96% of projects achieve project
management objectives
• 95% of projects achieve IT management
objectives
1
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
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.
8
4 Anderson M. Six levels of healthcare IT.Davidson PL ed. Healthcare Information Systems, Auerbach Publications, Boca Raton (2000), pp. 97–108
CHANGE MANAGEMENT ENABLES
REALIZATION OF BENEFITS
9
WHAT IS REQUIRED?






Effective governance & leadership investment
Comprehensive stakeholder engagement
Workflow analysis & integration
Consistent communications
Training & education
Ongoing monitoring &
evaluation
htt ps : / / w w w. i nfo way - i nfo ro u te. ca /i n d ex . p h p /p ro g re s s - i n - ca n a d a /ma n a g i n g - ch a n g e
10
“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 Girard
Chief Information Officer, Manitoba eHealth
11
THANK YOU
Cassie Frazer, Benefits Realization Leader – cfrazer@infoway-inforoute.ca
12
MAKING EARLY PLANS
Telepathology &
HEALTHe NL,
Newfoundland
& Labrador
eHealth
experience
CONSIDERATIONS & QUESTIONS,
TELEPATHOLOGY
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,
HEALTHe NL
 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
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”
M e m b e rs hip
 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
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
IN SUMMARY
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
MAKING CHANGE STICK
Secure
Adoption &
Continuous
Learning
FUNDED EMR ADOPTION SINCE 2005
Adoption by Community Primary Care Physicians and Specialists Actuals & Targets to March 31, 2014
12,000
11,200
9,950
10,000
9,690
8,810
8,225
Actual Adoption
8,000
6,459
# Physicians
on EMR
6,000
7,475
6,710
Planned
Adoption
7,070
1,000
Primary Care
765
1,700
310
CHCs/AHACs
eHealth Ontario
4,009
4,700
1,700
1,181
4,000
3,000
1,845
2,000
572
985
1,155
860
1,759
490
413
2006/7
2007/8
2008/9
2009/10
2,475
2,100 2,620
375
2,975
500
341
1,264
Dec 31, 2012
490
572
2005/6
3,519
519
2010/11
2011/12
2012/13
2013/14
Community
Specialists
THE CHANGING ENVIRONMENT OF
ADOPTION
12,000
11,200
9,950
10,000
9,690
Upgrades
& Switches
Actual
Adoption
8,810
65%
8,225
Family physicians
1,000
Primary Care
8,000
6,459
New eHealth
apps:
(OLIS, HRM)
# Physicians
on EMR
6,000
Planned
Adoption
7,475
6,710
7,070
765
1,700
310
85%
CHCs/AHACs
eHealth Ontario
EMR 4,009
Maturity assessments
4,700
1,700
1,181
4,000
3,000
1,845
2,000
572
985
1,155
860
1,759
490
413
2006/7
2007/8
2008/9
2,975
2,475
New
2,100 2,620
375
341
500
enrollments
1,264
490
572
2005/6
3,519 Users
Existing
519
Previous Programs
Enrolled
2009/10 physicians
2010/11
Dec 31, 2012
New
2011/122012 2012/13
2014
2013/14
Applicants
Community
Specialists
#1: SUPPORT TO NEW EMR ADOPTERS:
FROM PAPER TO ELECTRONIC RECORDS
 Change management
strategies used to support
sustained change:
Available Change Management and Peer Leader Support
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
The foundation for a successful and sustained change is created up front..
#2: AFTER “GO-LIVE”:
EMR MATURITY ASSESSMENT
 Looking at the result of the 1. Most change initiatives will
EMR Progress Assessment
experience a drop in efficiency
after EMR go-live:
EMR Progress Review, Assessment results
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
…it takes time to gain familiarity, confidence and speed with a new EMR…
#3: …AND BEYOND:
CONTINUOUS IMPROVEMENT & LEARNING
 Continued support to EMR
users through Maturity
Model, CM and Peer
Leader Program:
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
EMR Progress Review, Assessment results
...focus on “continuous improvement” and make it a part of the practice
culture.
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
THANK YOU!
knut.rodne@ontariomd.com
Knut Rodne
QUESTIONS?
Planning for Sustainable Change?
Start Early and Think Beyond ‘Go-Live’
27
REFERENCE
SLIDES
EMERGING FOCUS – CLINICAL
GOVERNANCE
Challenges
• 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.
Management strategies
•
•
•
•
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 & BEYOND
National Change Management
Framework Elements
Considerations
Governance & Leadership
•
•
•
•
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
•
•
•
•
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?
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?
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.
ARE YOU EFFECTIVELY LEADING
CHANGE?
Consider these questions:
What is your
organization’s
approach to
change
management?
What leadership
supports are in
place to support
effective CM?
How do you
measure and
report on change?
• 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?
• 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?
• 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?
32
WHAT CAN YOU DO AS A LEADER?
Governance &
Leadership
Stakeholder
Engagement
•
•
•
•
•
•
•
Provide a means to communicate and validate issues and barriers and
ensure proactive management of these items
•
Provide stakeholders with timely information and allow for interaction
with change leadership and project team
Engage in open & honest conversations
Communications
•
Training &
Education
Monitoring &
Evaluation
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
•
Equip stakeholders with the necessary training, information about new
processes, technologies, and skills required in order to achieve success
post-change
•
•
•
Evaluate the success of the change initiative against vision and goals
Continually monitor performance
Reinforce change messaging with stakeholders
CHANGE MANAGEMENT PROMOTES:
 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
Benefits Realization
34
26
NATIONAL CM FRAMEWORK
Information & perspectives garnered through CMWG activities
resulted in creation of a National CM Framework, based on six core
elements:
1.
2.
3.
4.
5.
6.
Governance & Leadership
Stakeholder Engagement
Workflow Analysis & Integration
Communications
Training & Education
Monitoring & Evaluation
AVAILABLE CHANGE MANAGEMENT
RESOURCES
A Framework & Toolkit for Managing
eHealth Change – People & Processes
https://www.infoway-inforoute.ca/about-infoway/approach/managing-change
Online Toolkit Repository
•
Sample of tools provided in CM Guide PLUS many
more offerings
English version: http://bit.ly/infoway-CM-toolkit
French version: http://bit.ly/inforoute-outils-GC
Join us on LinkedIN
36
PM & CM - WORKING TOGETHER
Define
Communicate
Crystallize &
document PM vs.
CM roles
• Project Objectives
• Common Goals and Metrics for Success
• Reporting Relationship
• Roles and Activities
• Responsibilities and Deliverables
• PM shares information for communication
• CM creates communication deliverables
• PM determines training schedules
• CM determines training approach
• PM informs sponsors
• CM coaches sponsors
THREE PILLARS OF BENEFITS REALIZATION
 Know your objectives
 Identify and manage the critical success factors to get there
 Measure & iteratively improve
Benefits Realization
Objectives
Critical Success
Factors
Measurement &
Improvement
38
INFOWAY BENEFIT EVALUATION
FRAMEWORK
INCREASING FOCUS ON ADOPTION AND
BENEFITS
Common scope of IT projects
System
quality
Information
quality
Service
quality
NET BENEFITS
Use
Clinical Adoption
Quality
Access
User
Satisfaction
Productivity
40
MATURITY MODEL – STAGES OF EHR
ADOPTION
Adoption is a process, not an end state
•
•
•
•
Clinical Transformation
Fully integrated
Advanced functionality
Data drives quality
improvement
• Maximum Benefits
•
•
•
•
Occasional use
Not well integrated
Low functionality
Low measurement
and analysis capability
• Low-hanging benefits
41