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An Innovative Story: Change Management ~ It’s Not Just About
Technology October 8, 2015
11am – 12pm
Kathy Ross, MBA, CHCIO
Greg Wolverton
Ellen Swoger
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Kathy Ross, MBA, CHCIOVP & CIO, Gulf Coast Market
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• Largest nonprofit health system in the United States
• World’s largest Catholic health system• 131 hospitals, more than 30 senior care facilities
in 24 states including the District of Columbia.• More than 150,000 associates and 40,000
employed and affiliated providers serve in 1,900 sites of care
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• Providence hospital is located in Mobile, Alabama and services 349 beds
• 480 physicians service Providence • The Medical Group has 9 locations a employees over 100
physicians.
• Sacred Heart Hospital in Pensacola, FL is a 566-bed facility that includes the region's only Children’s Hospital.
• Sacred Heart on the Emerald Coast located in Miramar Beach, FL is a 58-bed facility
• Sacred Heart on the Gulf located in Port St. Joe, FL is a 19- bed facility.
• Total of 1,227 physicians serving these three ministries.• The Medical Group has over 95 locations and employees 410
providers including ED.
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Change Management Objective
• Protecting activity critical dates
• Providing comparable and consistent documentation of change details
• Developing awareness of changes in business and technology groups
• Ensuring planning and testing is done before a change is implemented
• Articulating the procedures which should be followed during the change
• Centralizing the process for participants, such as the Change Owner, Business/Departments affected, Assignee/Implementer, Approvers/Reviewers and end-users
• Communicating change throughout the entire account
• Better performance in audits and possibly less remediation items
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Change Management: Rx for EHR Survival
Ellen SwogerAssociate CIO, University of Mississippi Medical
Center
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UMMC…
• Mississippi’s only academic medical center
• Mississippi’s only level I trauma center
• Four hospitals (Jackson) – Adult, Critical Care, Wiser Women’s, Children’s
• UMMC - Holmes County – critical access hospital
• UMMC Grenada – 150 bed facility
• Ambulatory Care – 120 specialties – 500+ providers
• FTE’s - approx. 9,000
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UMMC – Story…
• Change - very little up to this point
• Culture – receptive but didn’t know what to expect
• Technology – limited
• IT Staff – limited
• Clinical and financial workflows – very problematic
• Communication between IT and operations/missions – limited
• Change management processes- limited
Implementation of our
electronic health record in
2010..
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UMMC…we had to do something
• Hospital and program administrators
• Nursing staff
• Physicians, residents, and hospitalists
• Ancillary service employees (e.g., radiology, pharmacy, physical therapy)
DIS leadership conducted individual
interviews and focus groups
with 87 employees from all levels within the organization
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UMMC Findings…
Communication –type, level, and frequency of messages about the change communicated to employees.
Training and Support –adequate training –Without adequate training, employees lack a complete understanding of how to
use the new technology
Customer-centered Accountability –end-user input needs to be solicited and heeded. End-users need to be involved in project planning, implementation decisions, or evaluating the systems.
Participants reported that past technology change projects have been “done to us” or “done for us,” rather than “done with us.”
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UMMC.. what did we do?
• Use multiple communication channels
• Ensure a cascade of information down from the highest levels of leadership to the front-line employee
• Communicate change information well in advance of project implementation
• Streamline communications so that only important and relevant information is included –
• Provide continuous feedback on project status and keep staff informed of unanticipated project changes.
• “Sell” the change by describing how the change will meet user needs
Communication
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UMMC.. What did we do?
• Provide “just in time” training to engage staff and avoid forgetting –
• Ensure easy access and adequate time for training
• Vary the formats of training to account for different learning styles and different roles in implementing the system.
• Make training mandatory and standardized
• Use “super-users,” identified during training and piloting stages, who can become internal resources for departments.
• Develop DIS resources, ensuring that support staff members have appropriate knowledge and skills relevant to user needs and are sensitive to users’ knowledge and lack thereof. Do not presume a baseline of user understanding.
• Create a Web page of FAQs that is searchable and provides information on basic skills and answers to frequently encountered problems.
• Plan for staff (user) turnover and the need for re-training.
Training
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UMMC.. What did we do?
• Execute careful and thorough planning, that includes representatives from all employee groups, particularly end-users.
• Learn the business and priorities of users and ensure that this becomes the focus for change and implementation strategies.
• Conduct full pilot testing with users
• Make sure infrastructure can support applications
• Identify project champions from various UMMC groups
• Actively monitor systems once implemented
• Conduct post-implementation assessment with end-users
User accountability
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Examples
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Greg WolvertonCIO, ARcare/KentuckyCare
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A Bit about ARcare
• ARcare operates
• 43 primary care sites in Arkansas and Kentucky
• 1 oral health site
• 16 Ryan White Care Act Service sites (RWCA Part B provider for Arkansas)
• 3 retail pharmacies
• 4 administrative sites
• Education center
• 3 fitness centers
• Cancer and Longevity Center
• KMS (Knowledge Management Systems) Operations
• Delivers “Knowledge and Information Services” to over 60 sites within our “network”
• KMS staff includes 4 IT staff members and 4 education staff members
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KMS Vision
• Established our medical record vision in 2004 with first EMR…
• 2008: Received HIMSS Nicholas E. Davies Award of Excellence
• 2010: Began studying next-level EMRs
• 2013: “ePMS” (electronic patient management system) implemented
• Focus on PCMH, care plans, cancer, longevity, wellness and patient engagement
• Embracing interoperability, HIE, Direct messaging
• 2014 Achieved Stage 7 HIMSS EMRAM
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Initial Barriers
• Provider leaders wanted oversight of:
• Implementation
• Teaching
• Learning
• Also requested workflow specific to facility and provider
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What Happened
• Physicians trained other physicians
• Nurse practitioners trained other nurse practitioners
• Nurses trained other nurses
• Results:
• Immediate complaints that training was insufficient or inadequate
• Peer-to-peer training did not address needs
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What Happened
• After complaints, CEO met with the CIO (me) to determine several factors that led to training program failure:
• Some healthcare professionals unwilling to reveal lack of IT skills
• Assuming peer trainers would be effective in teachers
• Objections to process with other colleagues
• Understanding vs. Explaining complex technology and process
• Focus on the provider instead of the patient
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•
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What Happened
• After the “meeting” we:
• Removed providers from entire process
• Designed new governance model led by the CIO
• Created a Change Management Team
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•
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Challenge
• Success in change management did not translate to clinical staff training
• Challenges included misunderstandings of workflow, process and technology
• Providers wanted to be a part of change but did not “get it”
• How can we include stakeholders’ input AND participation in activities?
• The answer was a governance change
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Governance
ChangeManagement
Team
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Change in Governance
• Diversity
• Footloose – Think Outside the Box
• Organizational Knowledge
• Early Adopters
• Change Agents
• History of Past Team Success
• Time Commitment
• Leadership Support
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What did we do?
• Standardized workflow
• “Embracing change includes the possibility of failure”
• KMS (Knowledge Management Systems) created 3-day training programs
• Feedback informed future sessions
• Trainer “comfort zones” eliminated for fresh perspectives
• Small group training programs rolled out at each facility
• Ongoing training for ALL staff now mandatory
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•
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The Outcome
• Immediately improved training and increased satisfaction
• Change can and should be a positive experience
• Greater confidence quiets fear of change
• Failure—slightly painful—but valuable outcome
• 5 months later: Stage 6 of HIMSS Analytics EMR Adoption Model
• 1 year later: First FQHC to achieve Stage 7 EHR usage
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•
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Major Takeaways
• Major factors helped manage
• Create the right teams
• Allow for self-discovery of optimal processes
• Teams developed own patient-focused, boundary-crossing process maps
• Accept the possibility of failure
• Testing erroneous assumptions accelerates progress
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Questions?
Kathy Ross - [email protected]
Ellen Swoger - [email protected]
Greg Wolverton - [email protected]
