Management Case Studies D Midyear Clinical Meeting

Transcription

1 Management Case Studies D Managing Change for Successful Implementation of New Pharmacy Systems Wednesday, December 7, :30 PM 5:00 PM Michael Melby, MS, FASHP Director of Pharmacy Indiana University Health Bloomington Hospital 1 Disclosure The presenters for this continuing pharmacy education activity report no relevant financial relationships. Learning Objectives Name five change management principles. Describe how change management can affect the success of new technology in the pharmacy. Describe how data can be used to reinforce acceptance of change. Self-Assessment Questions True or False: 1. Awareness, desire, knowledge, ability, and reinforcement are key components of change management. 2. Staff buy-in is critical i to the success of new pharmacy systems. 3. Change management strategies are of no value after implementing the change. Implementing New Technology 6 Page 1 of 9

2 Implementing New Technology IU Health Bloomington Hospital installed an IV room barcode scanning system in November 2010 Prior to this new technology the decades old method of verifying compounded sterile products was employed Empty vial Plunger pullback Pre-Implementation Process Label print Label sort Dose preparation Verification 8 Post-Implementation Process Dose selection Dose preparation Dose verification Barcode scan Image capture Implementation Process Needs analysis Vendor selection Workflow mapping Definition of scope Project approval Hardware/software acquisition & installation Database build & test Staff awareness Training Go-live support 9 10 Staff Awareness Additional Preparation 2 months Status updates at staff meetings Pharmacy web page updates Nursing announcement Staff training 1 month Newsletter Page 2 of 9

3 Everything Under Control, Right? Wrong! We experienced some Issues In fact, we nearly turned the system off! Early Problems System Running slow on network Unable to process IV batch Multiple downtimes User Unfamiliarity with new system Uncomfortable with new workflow Complicating Factor Highest patient census in 5 years Early Observations Slow turnaround time Upset nursing customers Distrust of system Staff frustration and even anger Most Critical Issue Staff resistance to the change Survey says. Old way was working fine We don t make many errors I want to see & hold the bag System is too slow We need more staff This was management s idea Page 3 of 9

4 Turnaround Times Dose Type Pre Implementation Week 1 Week 2 CSP 15 min. 60 min. 53 min. Premix 15 min. 76 min. 33 min. Chemo 60 min. 130 min. 145 min. Why? The unwilling are unteachable 19 User Non-compliance System bypassed Un-sorted dose (lacked final label) Rejected dose Issue Week 1 Week 2 Bypassed Doses Un sorted Doses Rejected Doses Why? The unhappy are uncooperative 20 What was missing? Needs analysis Vendor selection Workflow mapping Definition of scope Project approval Hardware/software acquisition & installation Database build & test Staff awareness Training Go-live support Change management 21 2 months 1 month Newsletter Project Announcements 22 Where did we go wrong? Old Habits are Hard to Break We didn t make it personal We didn t address WIIFM We failed to build desire to change Communication desire Page 4 of 9

5 Management Actions Course of Action Assess situation Gain control of situation Address staff resistance to change Tactics Week 1 Tactics Week 2 Reiterated full commitment to system Called in additional support Pharmacy staff workload Vendor software issues IT hardware issues Persevered with system despite heavy workload and approaching weekend Compliance is not optional Optimization inservice for staff Reinforced need for IV room barcoding Addressed training issues Staff opportunity to voice concerns Additional equipment Workflow modifications Additional staffing Management pledge to address concerns Optimization Inservice Objectives Optimization Inservice Content System Workflow People Staffing 29 Page 5 of 9

6 Who Likes Change? Mostly nobody, except for these guys 1. People 2. Process Change Creates Uncertainty Adoption of Change Awareness Desire Knowledge Ability Reinforce Employee A Employee B Employee C Employee D People accept change at different pace All must get to the finish line Prosci is a registered trademark of Prosci, Inc. All rights reserved. management.com. Prosci Inc. All rights reserved. ADKAR, and 'Awareness, Desire, Knowledge, Ability, Reinforcement' are trademarks of Prosci, Inc. management.com. Prosci ADKAR Model Awareness of the need for change What is the nature of the change? Why is the change happening? What is the risk of not changing? Desire to support the change Personal motivation and organizational drivers to support the change. What s in it for me? Knowledge on how to change Knowledge, skills and behaviors required during and after the change. Understanding how to change. Prosci ADKAR Model Ability to implement the change Demonstrated capability to implement the required skills and behaviors. Reinforcement to sustain the change Recognition, rewards, incentives, successes. Mechanisms to keep the change in place. Prosci, ADKAR, and 'Awareness, Desire, Knowledge, Ability, Reinforcement' are trademarks of Prosci, Inc. All rights reserved. management.com. 36 Page 6 of 9

7 Awareness Fatal reconstitution errors 5 premix dispensing errors in past 2 weeks Staff estimate of 0-15 CSP errors/week How many errors are NOT caught by pharmacist? Doing things the same way produces the same results Customer complaints pharmacy didn t mix this correctly Standard of care in 5 years Desire What s in it for me? Protect the patient Protect tself Can t train desire Desire is a personal choice Others ME My Stuff Stuff I Like The WIIFM Universe Decision Heirarchy Patient Hospital Pharmacy Knowledge Dose preparation Dose verification Dose sorting Workflow monitoring Problem solving Downtime Me 39 Ability Assignments Workflow Et Extra printer it 3 rd workstation Break-fix Reinforcement Ongoing support Superusers Lead RPh, lead tech Vendor, IT Recognition Improvements Page 7 of 9

8 Tactics Week 3 Shared data with staff Intercepted errors Turnaround times User compliance Workload Demonstrate The value of the system User learning and progress Data Prevented Errors Examples of Prevented Errors Error Prevented By Week 1 Week 2 Week 3 Barcode scan intercept Pharmacist reject TOTAL Drug Scanned Correct Drug Promethazine Phenylephrine Heparin Magnesium sulfate Ciprofloxacin i Fluconazole l Cefoxitin 1g Cefoxitin 2g D51/2NS + 20KCl D51/2NS + 30KCl I.V. Errors Prevented Prevented Errors by Type # Prevented d/week concentration too low exact diluent required exact drug required incorrect drug expired other Week Post Implementation Rejected Doses Prevented Errors Page 8 of 9

9 Rejected Doses by Type 160 Dose Turnaround Times by Type 140 Reject Bad Picture Reject Wrong Amount Reject Wrong Concentration Reject Incorrect Preparation Reject Other utes per Dose Average Minu Week Post Implementation CSP PREMIX CHEMO Pre DoseEdge (excluding chemo) Two Key Components # Doses of Ea ach Status User Compliance Week Post Live Bypassed Un Sorted 1. Project management technical, operational a) Initiate b) Plan c) Execute d) Monitor e) Close 2. Change management people a) Build case for change b) Assess individual acceptance c) Reward and recognize d) Reinforce Reasons Why Change Fails Treating change as an event, instead of a process Lack of agreement regarding the need for change Complacency with the status quo Limited time, budget and resources Lack of trust for the initiators of the change Failing to communicate how the change will affect individuals Failure to generate short term wins Failure to sustain the change Summary Success of any implementation depends on: Good project management Good change management Change management strategies Pre-live is optimal Post-live still effective Many proprietary models available Page 9 of 9