Managing Change in Healthcare Implementations: an Introduction was created for managers preparing to implement health information and communication technology (HICT) systems in their organizations—hospitals, clinics, or government departments. The module presents a framework for understanding how HICT implementations affect organizations and individual workers and shares basic information on how to manage change to an organization so as to promote a positive outcome, and how to avoid the pitfalls that occur.

1. Managing Change in
Healthcare IT Implementations
AN INTRODUCTION
Sherrilynne Fuller, Center for Public Health Informatics
School of Public Health, University of Washington
Seattle, Washington June 2010
Content licensed under Creative Commons Attribution-Share Alike 3.0 Unported

2. Learning Objectives
At the conclusion of this class the student will be able to:
 Describe at least four effects of introducing information
technology into a group or organization
 Define change management and describe why it is important to
health information system implementation success
 Describe three key ways of preparing a group or organization
for change
 Identify at least four elements critical to successful
management of change
Sherrilynne Fuller, University of Washington

3. Change…
As Mark Twain, a well known American author,
once said:
"I'm all for progress,
it's change I object to.”
Sherrilynne Fuller, University of Washington

4. Effects of Information Technology Introduction
on Individuals and Organizations
 Changes individual team members’ tasks
 Blurs roles and increases team interdependence
 Can be threatening to individuals’ view of their role
in the organization
 When the implementation and related changes in
work are managed well there are improvements in:
 The function of the organization
 The individual’s job skills and satisfaction
Sherrilynne Fuller, University of Washington

5. Ways to think About Change as a “HOW” Problem
The problem of introducing change in an organization
is often expressed as how do I…
 How do I get people to be more open to change?
 How do I get people to look at new ways of doing
things?
 How to I make this organization adopt an electronic
medical records system?
 This approach often doesn’t work --rather –you need
to look at this as a “What” problem….
Sherrilynne Fuller, University of Washington

6. Thinking About Change as a “What” Problem
 What are we trying to accomplish?
 What changes are necessary to get there?
 What will signal success?
 What measures of performance are we trying to
affect?
Sherrilynne Fuller, University of Washington

7. Thinking About Change as a “Why” Problem
 Why do we do what we do?
 Why do we do it the way we do?
 Why do we need to change how we do what we do?
Sherrilynne Fuller, University of Washington

8. Change Questions…
 “How” questions tend to cluster in core units (e.g. IT staff)
 People in clinical units tend to ask “what” and “how”
questions (What will this do to my ability to see more
patients? How will I ever learn to use a computer?)
 “Why” questions are typically the responsibility of the
hospital management
 BUT --in times of rapid change, everyone must be
concerned with all of these questions and think through
them together before a system is implemented
Sherrilynne Fuller, University of Washington

9. Preparing for Change
 What is the current situation?
 What does the ideal future look like?
 Why do we need to change?
 What is going to change?
 What is NOT going to change?
 What are the key challenges?
 What are the key success factors?
Sherrilynne Fuller, University of Washington

10. Managing Change
• What is the best way to integrate changes into
operation?
• How do we reduce impact on those most affected by
change?
• How do we ensure that all units are coordinating
effectively?
• How do we ensure that everyone is involved?
Sherrilynne Fuller, University of Washington

11. Change Requirements & Strategies
 Clear shared vision of future
 Create ownership and involvement
 Commitment of institutional leadership
 Education and training
 Reward system
 Measurement and evaluation
 Communication is vital!
Sherrilynne Fuller, University of Washington

12. Leading and Managing:
Strategies for Success
Many ways to earn authority and influence:
 Knowledge
 Information
 Hard work and evident commitment
 Outside influence in authorizing environment
 Keeper of a respected or needed process
 Have something to give in a trading relationship
 Bring resources, allies
 Bring order and direction out of confusion
Sherrilynne Fuller, University of Washington

13. Process Model for New IT Implementations
Step 1: Step 2: Step 3:
Preparation Training and Review Data OUTCOME
Practice
Leader: Leader: SUCCESS!
Leader:
• Explain • Discuss with
selection • Signal teams
• Carefully select openness and • Listen
team members feedback
• Define roles and • Communicate
responsibilities reasons
• Explain team Team
for
learning change Members: Team
approach Team New routines
Members: Members:
• Participate become
fully • Collect data established
• Listen and accepted
• Ask questions; • Review data
• Ask practice in the
make • Contribute to
questions organization
suggestions discussions
• Agree to
• Try new
participate
approaches
Sherrilynne Fuller, University of Washington

14. Steps to Implementation Failure
Leader’s
Leader’s Actions: Leader’s Actions: Actions:
• Ask people to • Discourage or Analyze and
participate but don’t remain neutral to evaluate data late
provide reasons for team’s input in
the changes • Reject new ideas
• Decide on implementation
from team members
technology
with no consultation
• Don’t show
up for Team Members’
practice Team Members’ OUTCOME:
Actions:
training Actions:
•Show up for IMPLEMENTATION
• Notice signals from
training FAILS
leader
• Re-evaluate behavior
•Interpret absence
• Hold back from
of leader as
participation
message that team
work not important
Sherrilynne Fuller, University of Washington

15. Ensuring Action
 No one “must” do anything
 Action relies on agreements, accountability, process,
incentives, recognizing needs, having authority
 Use tools that are realistic; realistic goals
 Work to remove barriers to others’ success
 Be sure you have effective internal channels of information
exchange regarding key issues
 Apply power and influence to priorities, not secondary
issues that interest you
 Measure and be accountable for results
Sherrilynne Fuller, University of Washington

16. Team Learning and New Technology -- Summary
When a new technology disrupts existing work
routines, the adopting organization must go through
a learning process, making interpersonal and
organizational adjustments that allow new routines
to become ongoing practice.
Sherrilynne Fuller, University of Washington

17. Learning Objectives
At the conclusion of this class the student will be able to:
 Describe at least four effects of introducing information
technology into a group or organization
 Define change management and describe why it is
important to health information system implementation
success
 Describe three key ways of preparing a group or
organization for change
 Identify at least four elements critical to successful
management of change
Sherrilynne Fuller, University of Washington

18. Presenter Information
Sherrilynne Fuller, Ph.D.
Center for Public Health Informatics
School of Public Health
University of Washington, Seattle, Washington
Content licensed under Creative Commons Attribution-Share Alike 3.0 Unported