The Art & Science of ICT Implementation: Part II. Lynn M. Nagle, RN, PhD, FAAN

Transcription

1 The Art & Science of ICT Implementation: Part II Lynn M. Nagle, RN, PhD, FAAN

2 Theories and Models Ac0on Research (Lewin, 1946, 1947, 1951) Diffusion of Innova0ons, (Rogers,1995) Model of Change, (KoFer, 2007) Transforming Healthcare Organiza0ons (Golden, 2006)

3 Diffusion of Innova0ons (Rogers, 1995)

4 8 Step Change Model Create a sense of urgency Create a powerful guiding coali0on Create a vision Communicate the vision Empower others to act Plan and create short-term wins Consolidate improvements Ins0tu0onalize new approaches KoFer, 2007

5 Phases of Change Determine the desired end state Assessing readiness for change Broaden support and organiza0onal design Reinforce and sustain change (Golden, 2006)

6 Organiza0onal Issues Risk Tolerance Management & Leadership style Poli0cal climate Culture Educa0on Sustainability Transforma0on

7 People Issues Leadership Engagement Preparedness Perceived value Adequate support Communica0on

8 Change Leadership or Change Management? Leadership Se]ng Direc0on Aligning People Mo0va0ng People Management Planning & Budge0ng Organizing & Staffing Controlling & Problem Solving Frank, Mar3neau & Pascal, 2005

9 Change Leaders Influen0al Connected Skilled Personal convic0on Broad range of perspec0ves High self confidence

10 Process Issues Slow & steady vs Big Bang Tension between prac0ce and technology integra0on How to engage clinicians? Policies & procedure impacts? Approval bodies & structures who is accountable for what? Redesigning processes

11 Current State Communica0on Path

12 Process Change Future State 12 step to a 6 step process

13 Technology Issues End user engagement in selec0on Consider op0ons Human factors considera0ons Ergonomics Privacy & Security Training & Educa0on

14 EHR Maturity Knowledge Genera0on Knowledge Management Genera3on 5 The Mentor Genera3on 4 The Partner Integrated Decision Support Genera3on 3 The Helper Results Review, Order Entry, Clinical Documenta0on Genera3on 2 The Documenter Infrastructure, Registra0on, Departmental Systems Genera3on 1 The Founda0on Adapted from Gartner 2003

15 Rela0onship between EHR Maturity, Change Investment and Adop0on EHR Maturity EHR Investment Change Investment Time Rate of Adop0on Nagle & Cagord 2008

16 Rela0onship between EHR Maturity, Change Investment and Adop0on Genera0on 5 EHR Maturity Genera0on 3 Genera0on 4 Genera0on 2 Genera0on 1 EHR Investment Change Investment Time Rate of Adop0on Nagle & Cagord 2008

17 Implementa0on Lessons ü Avoid reinven0ng the wheel ü Workflow redesign is itera0ve ü Expect to uncover clinical prac0ce issues ü Credible champions essen0al ü One size does not fit all

18 ü Expect poli0cal interference ü Con0nuous communica0on ü Proac0vely manage expecta0ons ü Take 0me to celebrate

19 Important considera0ons for success Effec0ve leadership User involvement in design and implementa0on Flexibility during design and implementa0on Demonstra0on of benefits to pa0ents Adequate systems training (Waneka & Spetz, 2010)

20 Suggested Resources Canada Health Infoway (2013). A Framework and Toolkit for Managing ehealth Change. hfps:// Golden, B. (2006). Change: Transforming healthcare organiza0ons. Healthcare Quarterly, 10, *Note this en*re issue focuses on MOE/MAR experience at UHN. Kash, B.A., Spaulding, A., Johnson, C.E., Gamm, L., Hulefeld, M.F. (2014). Success Factors for Strategic Change Ini0a0ves: A Qualita0ve Study of Healthcare Administrators' Perspec0ves. Journal of Healthcare Management, 59, Heather Stagl -How to Deal with Resistance to Change hfps:// v=79li2tnz2k&index=24&list=plgydzcg2isqaiox7rgrn2kojksvuri3hvvideo resources KoLer The difference between change management and change leadership hfps:// v=2ssunbrhf_u&index=5&list=plgydzcg2isqaiox7rgrn2kojksvuri3hv