Effective Strategies for Change

Claire McCarthy, Dave Garets, Doug Eastman

• Publisher: HIMSS Publishing
• Year: 2018
• ISBN:
  9780429619755
• Edition: 1
• Topic: Business
• Subtopic: Business General
• Index: Business

Effective Strategies for Change is a newly revised edition of HIMSS' bestseller Change Management Strategies for an Effective EMR Implementation. Published in 2009, Change Management Strategies prepared readers to lead or participate successfully in change management/technology adoption efforts to achieve meaningful use of EMRs. The authors provided successful strategies to plan and implement change-based on their decades of combined experience managing the people side of implementation.This revised edition explores how healthcare has changed since the first edition was published. It equips readers with the tools to create an environment for success in their organizations that not only ensures EMR, ICD-10 or clinical integration efforts are successful, but that organizations can build change capacity and flexibility in the process. The authors provide concepts and methodologies applicable to both large and small healthcare organizations, as well as lessons learned from healthcare stakeholders who utilized tactics from the first edition in their organizations' EMR implementations.

CHAPTER 1
The Business Case for Change Management

“Were not in Kansas anymore…”

EMR and other large scale CHΔNGE™ initiatives with a big IT component have been justifiably compared to a tornado that whips through an organization, turning life upside down and throwing users into a world filled with new ways of doing things and seeking ways to recapture some sense of balance and control. CHΔNGE™ initiatives disrupt the status quo, and along with the many opportunities they promise, they also bring a whirlwind of seemingly never-ending changes; these changes can have an entirely different effect on different people. While even an initiative that is effectively managed brings these challenges, a poorly managed one can be disastrous and will cost the organization much more time, energy, and money to get things back on track. Its a case of pay up front or pay more later; either way there is a price, but it costs less if done right in the first place.

CHΔNGE™ initiatives don’t have to be nightmarish for organizations, but there certainly will be obstacles and challenges along the way. The key is to help the people in the organization through the roadblocks and enable them to experience a positive journey. This process is always easier when people know what they are getting into, feel supported, and are prepared for what lies ahead—both good and bad. This is the role of change management.

Change Management Defined

Its important to understand why you should make an investment in the people side of your initiative. Joining an accountable care organization (ACO), standing up for a clinical integration initiative or implementing the best technology possible doesn’t mean anything unless your employees/users are comfortable and proficient with it. The truth is just because you build it doesn’t mean they will come.

Let’s start by answering the two questions we are most often asked, “What is change management anyway? What is it change managers do?”

To avoid confusion, we’ll say up front we are not talking about change management as it relates to technical issues, such as version or change control. We also want to be clear that change management is not project management. What we are talking about is the human side of CHΔNGE™ initiatives, the human-focused work of engaging and preparing people to succeed in the new world created by CHΔNGE™.

A word about project management: while good project management facilitates change management, the two disciplines are not the same. Project management is more linear and task focused, whereas change management deals with the complexities of human behavior. But a good project plan creates a structure and a foundation in which the change management process occurs. The two disciplines, though different, complement and support each other.

A word of caution: do not confuse the project plan with the end result. The plan is necessary, and it guides you throughout the process. The plan is proactive; its the order in the chaos. But technology adoption is kind of like herding cats—it’s unpredictable, and you need to maintain flexibility to respond as things evolve. This is a more reactive process than what may be expressed in a plan. In our experience, a CHΔNGE™ initiative requires both structure and flexibility.

There is a saying in change management circles: When one door closes another one opens, but sometimes its hell in the hallway. Change management deals mostly with the hallway situation, facilitating the human transition from the present to the future. These days, change is ongoing and requires focused leadership if it is to be as fast and painless as possible. One of the great benefits of doing change management well is that the process creates increased change capacity in the organization—meaning that subsequent changes occur in an environment that is more change enabled.

Key Tip

Our assumption is that the software you are implementing works. If the software doesn’t work, you have another kind of problem—one that even the best change management won’t resolve.

The four legs of the project or business initiative stool represent the critical components of an implementation (see Figure 1-1)—People, Process, Technology and Data. The people are the most important! When technology projects fail, it is primarily due to a lack of use, not failure of the software. The focus of change management is people and the objective is to change behavior. Change management is not about fluff—being nice or placing an emphasis on feelings. Its about performance and results. This is good for business because it accelerates the change process so benefits are achieved faster.

Figure 1-1: The Four-legged Stool

As shown in Figure 1-1, the leg of the stool representing data is an addition to what was once referred to as the three-legged stool because of the significance data plays in the overall picture. Now that many HCOs have implemented their EMRs and are accumulating vast amounts of structured and hopefully standardized data, there’s a hype-filled rush to “big data,” business intelligence (BI), and analytics to turn that data into information and knowledge. That, in turn, will reshape and accelerate the transformation of healthcare delivery and provide a more global and strategic impact on how we must approach CHΔNGE™.

If you search the literature, you will find a variety of definitions of human-focused change management. They all cover similar concepts, sometimes using different terminology. The simplest explanation of change management is to say, “Its all about the people!” But for the purposes of this book, we expand on that concept and use the following definition of change management:

• A structured process designed to deal directly and intentionally with the human factors involved in not just planning and implementing a CHΔNGE™ initiative but through behavior change, achieving the anticipated benefits that justified the initiative in the first place.
• Desired behavior change is achieved by helping people understand and internalize change and by preparing them to be successful contributors in the future state. In the case of EMR implementations, effective change management delivers users who are willing and able to use an EMR in a way that satisfies the requirements of the job, the needs of the patient, and the health of the organization.

Well-designed, integrated, people-focused work builds logically over time in a way that makes sense to the user. It brings users along, guiding and supporting them so they arrive where you want them to be. This is about willingness and ability, hearts and minds. You must have both.

The overarching purpose of change management is to accelerate the speed at which people move successfully through the change process so that anticipated benefits are achieved faster. And there are additional benefits to change management. Through optimizing the efficiency and efficacy of users, an effective change management program will also:

• Improve organizational outcomes and performance. Effective use of a new system or process generates value to patients and the organization.
• Enhance employee satisfaction, morale, and engagement. When people learn new skills, meet performance expectations, and contribute to a greater good they feel pride in their accomplishments.
• Improve service quality. Users feel valued and supported by an organization that makes an investment in them; this positively impacts how they treat patients.
• Help achieve hoped-for benefits benefits that include CHΔNGE™ value realization, reduction of errors, return on investment, etc.
• Create higher levels of openness, trust, involvement, and teamwork (develop an engaged workforce).
• Build change capability and capacity in the organization, resulting in improved ability to respond quickly and effectively to new situations (create organizational nimbleness through embedded change management knowledge, structure, and process).

In other words, it really is all about the people. Intentionally managing the cultural, behavioral, and organizational changes that need to take place to make the desired CHΔNGE™ future not only a reality but a sustainable reality pays off on many levels in that it also facilitates organizational transformation. Building on individual capability and organizational capacity, change management results in a change-capable culture—a huge advantage in todays competitive and fast-changing world.

Change Management, Technology Adoption—What’s the Difference?

There are a number of terms that people use to refer to the work involved in managing the people side of a change effort. We think of change management as the mother ship, that is, the umbrella term that embraces all specialties within the field. Similar to the various specialties or domains of service within a healthcare system, change management professionals may choose specific areas of focus. Technology adoption, specifically information technology (IT), is one such area, and it involves the application of change management principles to the implementation of IT.

Effective technology adoption professionals align themselves with the operational/business side of the organization and tailor solutions that drive behavioral change and tangible outcomes. They participate in CHΔNGE™ initiative projects from the beginning, driving the people side of change throughout and continuing to add value post-live as the CHΔNGE™ becomes part of the central nervous system of the organization.

The Importance of the People Side of a ChΔnge™ Initiative

There are many references in the literature to failed change efforts and the IT implementations that support them. Estimates are that only a third of these projects achieve success, which means two thirds fail to meet expectations. The good news is that failure is optional, as much has been learned about why some change efforts fail and others succeed. The irony is that though much has been learned, there is not a lot of evidence to show increasing success with change. Our belief is that this is due, at least in part, to the way change is handled. It is still mostly episodic, one project or initiative at a time. What is needed is the development of change-enabled culture so that future changes take place in an environment that nurtures change rather than resisting it at every turn.

The environment in which the change occurs is important because while the change itself is an external event—the EMR implementation, clinical integration, a reorganization, proposed outsourcing, a promotion, etc.—the transition from old to new that those who are impacted experience is a psychological and emotional process. It is this transition that is difficult, even when a change is self-imposed or considered positive. So to the extent that the environment enables change, the psychological process that people go through is made easier.

In the words of William Bridges, a key thought leader in management of transitions, “It isn’t the changes that do you in, its the transition after the change that does!”¹

For an implementation team, part of the problem encountered during transition is that change is messy: people start where they are, not where we want them to be. And when considering the personnel within a typical hospital, people can be all over the place in terms of comfort with computers, stage in life, commitment to the organization, fear of change, etc. Add to this the...