change management: targeting the human element to ensure successful implementations
DESCRIPTION
The primary driver underlying the need for a change management program is the need to alter human behavior. Mount Sinai's Program Management Office understood their EMR implementation could not be successful utilizing traditional IT methods so it rolled out a robust Change Management plan to ensure a successful go live.TRANSCRIPT
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Change Management: Targeting the Human Element to Ensure Successful
Implementations
February 25, 2014
Felicia Mattson, Change Management and Communication Lead, Mount Sinai Health System
Dave Shiple, Vice President, Client Services, Divurgent
DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.
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Conflict of Interest Disclosure
Felicia MattsonChange Management and Communication Lead
Has no real or apparent conflicts of interest to report.
© 2014 HIMSS
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Learning Objectives
Define the six pillars of the Mount Sinai Health System’s Change Management methodology.
Demonstrate how to structure a Change Management program during a large scale implementation.
Describe the value of utilizing a Change Management program and the benefits resulting from it.
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Satisfaction
Provider Satisfaction
Improved Communication with Staff
An Introduction to the Benefits Realized for the Value of Health IT
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Glimpse at Mount Sinai Health System
3,571 total beds Certified by New York Sate DOH
138 Operating Rooms
12 Free-standing Ambulatory Surgery Centers
31 Affiliated Community Health Centers
6,600 Physicians
2,000 Residents and Fellows
35,000 Employees
177,000 Inpatient Admissions
500,000 Annual ED visits
2.6 million Ambulatory Visits to Offices and Clinics
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Mount Sinai Hospital Implementation
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Implementation Planning
Dozens of new workflows, a large workforce, and lack of change management tradition had
to be considered
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What We Were Facing
Over 60 workflows had to be redesigned and validated
7,149 physicians and nurses had to be trained
A history of not using change management best practices
A skeptical physician community witness to a history of choppy implementations
Transitioning a fragmented culture to one of shared responsibility within context of new level of interconnectedness
An aggressive timeline
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Investing in a Change Management Program
The Mount Sinai Hospital knew it was going to have to invest heavily in a Change Management program
Successful implementation of a complex EMR meant changing human behavior
Change Management was a key factor to its success
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Investing in a Change Management Program
For the inpatient EMR implementation, Mount Sinai developed an intricate, formal Change Management program, assigned project managers to oversee the plan, and appropriately funded the project.
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The Change Management program’s budget was 4.44% of the overall implementation budget.
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Go Live Resources
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840 total resources engaged DAILY on two 12-hour shifts
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Involving Senior Leadership
Enlisted senior management early in the project to provide visible leadership and communication through various mediums from the time of contract signing until well after go-live.
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Clinicians were the face of the project NOT Information Technology!
Our Change Management Methodology
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Project Team
Change Readiness
Stakeholder
Management
Communication
Organization Impact
Education
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Change Readiness
The purpose of the change readiness component is to determine if an organization is ready to embrace the changes ahead and to learn about concerns, fears, competing initiatives, and past experiences that may pose challenges along the implementation path.
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Change Readiness Survey Participants
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Our Change Management Methodology – Change Readiness
Pre-implementation readiness survey:
1,112 employees expressed concerns
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Change Readiness Survey
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Stakeholder Management
Stakeholder Management is the process of identifying key stakeholders within an organization impacted by the implementation. The project team strategizes ways to build support and identifies ways to minimize resistance.
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Our Change Management Methodology – Stakeholder Management
We created a stakeholder map to outline all the areas impacted by a clinical transformation, even the non-clinical areas.
This is the backbone of all communication efforts to ensure that all impacted stakeholders are aware of and appropriately involved in the implementation.
Leveraging senior leadership during this phase is critical to show that support for the initiative is coming from the “top.”
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Communication
The communication plan helps stakeholders develop an understanding for the project. Articulating the project goals and working to appropriately set stakeholder expectations through consistent and timely communication minimizes confusion and anxiety.
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Our Change Management Methodology - Communication
Getting feedback is essential to a successful communication plan.
Don’t rely on a single communication vehicle.
When cascading information, the person in the middle is key.
You must understand your stakeholders’ Frame of Reference (Point of View).
Acronyms are confusing.
Communication must be to the point.
Live by the “three try” rule.
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Our Change Management Methodology - Communication
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Our Change Management Methodology - Communication
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Our Change Management Methodology - Communication
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Our Change Management Methodology - Communication
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Organization Impact
Organization impacts are identified by assessing current state, developing the desired future state and defining action items necessary to bridge the gap between the two. These gaps are analyzed to determine the organization and change impacts.
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Our Change Management Methodology – Organizational Impact
Conducted a study showing impacts from new workflows; document was processed and mitigated with affected stakeholders
The project team worked together to identify specific departments and enterprise-wide high, medium and low impacts
Impacted stakeholders were identified for every item to ensure that mitigation plans were appropriately crafted
The summary findings were reviewed with each senior executive to showcase not only the magnitude of the change, but also the plans to support stakeholders as they journeyed through the clinical transformation
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Our Change Management Methodology – Organizational Impact
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Training and Education
The training plan includes identifying the end user requirements and developing courses and materials to properly educate the organization for a successful go live. Properly training users for the change in their daily work flow is critical to ensure a smooth transition during the implementation.
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Our Change Management Methodology
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The training component of the change management program proved to be a crucial part of the implementation.
Our Change Management Methodology – Education
In New York City, space is at a premium. In order to accommodate 24/7 training for thousands of clinicians, the project team became very creative searching for solutions.
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Our Change Management Methodology – Education
The 100 credentialed trainers, alongside Mount Sinai principal trainers, delivered 116 days of 24/7 training.
Nurses attended 23 hours of training
Most physicians were required to attend 8 hours of training (some specialties required as many as 16 hours)
This was double the training the vendor initially recommended, but was critical to a smooth go live.
To help ensure adoption throughout training, clinical champions were engaged and paired with peers for training efforts, which proved to be a key success factor.
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Our Change Management Methodology – Education
A novel patient case simulation was used in the Emergency Department (ED) instead of using conventional computer training.
ED staff acted alongside technology-enabled mannequins
This ensured ED clinicians, physicians, residents, and staff members were properly trained using real life scenarios.
In the end, the go-live was characterized as a “non-event,” with very few training or workflow issues, and the project was completed on time and on budget.
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Simulation Labs are now replicated across the country
Our Change Management Methodology
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Our Change Management Methodology
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Our Change Management Methodology – Lessons Learned
Initial validation sessions were very poorly received
Vague workflow examples were shown, and stakeholders were very unhappy
Workflows were redone and new validation sessions were held
Champions demonstrated new workflows in skits which proved successful
Surgery had an especially difficult time at go-live; course correction included:
Champion had to give step-by-step instructions to Super Users
Specific education materials had to be developed
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Our Change Management Methodology – Lessons Learned
Nurse training had to be completed in 11.5 hour training sessions
Was done not to interrupt shifts, negating need for replacements mid- shift and affecting patient care
Nurses were not happy – said they could not remember everything from training
The governance committees understood the risk but continue to believe this was the best approach
No matter how much you communicate – you are not doing enough
Numerous communication channels were used throughout the implementation, but more can always be done
Face to face communication proved the most costly and the most impactful
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Conflict of Interest Disclosure
David ShipleVP, Client Services, Divurgent
Has no real or apparent conflicts of interest to report.
© 2014 HIMSS
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Increased Training Opportunities
Clinician involvement, becoming part of the DNA of the EHR initiative
Over-communication
Tenacious overkill
Change Management – What Works?
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Change Management Challenges
Pressure to implement EHR without customizing
Change will be costly later
Operators and Clinical Leaders – do they know what they’re agreeing to?
Green lights from vendor
It’s your implementation, what do you think?
Accelerated timeframe due to Meaningful Use or other drivers
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Millions of line of code – every line has to work to customer expectations
The special skillsets IT brings – Project Management, Vendor Knowledge, Past EHR deployments, Process Redesign
Recent multi-day downtimes because of EHR vendor infrastructure failures
Consequences of not Using Change Management Methodologies
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Change Management Mobilized Modify contractual productivity requirements for individual physicians
Helpdesk numbers and resources for “physician only” support during implementation
Clinicians in mock clinical settings present to other clinicians during validation sessions
CEO quoted widely that he wants EHR to be his/her legacy
ED (& other care settings) simulation training
Giveaways with promotional message before live
Roadshow of new system with WOWs on the floors
Button on home screen for issues/suggestions
When you talk to one MD, you've only talked to one MD
Alert and sometimes compensate physicians for expected low productivity immediate post live
Realistic expectations upfront (e.g. productivity loss and disruption)
Buddy system
Individual system personalization session with each physician
“Man on the street" video for reactions after go live
“American Idol” trainer recruiting (emphasize passion over technical skills)
Contest to name application Top 10 at 10 – daily issue review with all the “C’s”
Jeopardy contest after training
Mock-up of “Hospital/Exam Room of the Future”
Senior leadership rounding Grand rounds: CMIO holds weekly webinar
Senior management accompany reluctant physicians to training
Use of outside, activation specialists for at-the-elbow support
24x7 centralized nurse training center
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A Review of Benefits Realized for the Value of Health IT
http://www.himss.org/ValueSuite
Satisfaction
Provider Satisfaction
Improved Communication with Staff
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Questions?
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Thank You! Felicia Mattson
Change Management and Communication Lead
Mount Sinai Health System
Twitter: @feliciamattson
Email: [email protected]
David ShipleVice President, Client Services
Divurgent
Email: [email protected]