Planning for Sustainable Change

1. Planning for Sustainable Change Start Early and Think Beyond ‘Go-Live’

2. Panel outline • Making a Case for Change • Cassie Frazer, Canada Health Infoway • Making Early Plans • Ian Hodder, Centre for Health Information, Newfoundland & Labrador • Making Change Stick • Knut Rodne, OntarioMD

3. Making a case for change Creating awareness

4. eHealth change management is: “…a strategic and systematic approach that supports people and their organizations in the successful transition and adoption of electronic health solutions.  The outcomes of effective eHealth change management activities include solution adoption by users and the realization of benefits.” Pan-Canadian Change Management NetworkMarch 1, 2011

5. The change management iceberg • 85% of our time = 15% • of the change • 15% of our time = 85% • of the change Bottom line: 70 % Failure 5

6. Unique industry, unique challenges eHealth presents unique CM challenges: • Complex healthcare delivery structures • Organizational change resistance and fatigue • Emerging technologies • Health industry regulations • Strong, disparate professional cultures Successful health IT implementations dedicate between 10-15%1 and upwards of 30% of project budget towards CM activities.2 1 Petouhoff, N., Chandler, T., Montag-Schultz, B. (2006). The business impact of change management: What is the common denominator for high project ROI's? Graziadio School of Business and Management, Pepperdine University. [Electronic document] 2 Laflamme, F., Pletraszek, W., Rajadhyax, N. (2010). Reforming hospitals with IT investments. Mckinsey on Business Technology. Number 20, Summer 2010: 27-33.

7. The Value of Change Management “Change Management, done well, done badly, or not done at all, will have a lasting impact on the sustainability of an organization.” • Les Harrison, CEO, Yellowknife Health and Social Services Authority, GNWT

8. A Look at the Numbers 1 Laclair, J., Pao, R. (2002). Helping employees embrace change. Managing change is the responsibility of everyone in the corporation—from senior managers on down. McKinsey Quarterly. November 2002 (4), 17 – 20. 2 Coplan, S. Redefining health IT project success, Journal of Healthcare Information Management (HIMSS), Spring 2012, vol. 26, no 2. 3 Sauer, C., Cuthbertson, C. (2003). The State of IT Project Management in the UK 2002-2003. University of Oxford, England. 4 Anderson M. Six levels of healthcare IT.Davidson PL ed. Healthcare Information Systems, Auerbach Publications, Boca Raton (2000), pp. 97–108

9. Change Management enables Realization of Benefits

10. What is required? • Effective governance & leadership investment • Comprehensive stakeholder engagement • Workflow analysis & integration • Consistent communications • Training & education • Ongoing monitoring & evaluation https://www.infoway-inforoute.ca/index.php/progress-in-canada/managing-change

11. “You can’t have a successful project without organizational CM. It is as important as good project management. All of the elements of CM including training, communications are an integral part of a major initiative. You can’t implement without it. You will manage the change or the change will manage you.” • Roger Girard • Chief Information Officer, Manitoba eHealth

12. Thank you Cassie Frazer, Benefits Realization Leader – cfrazer@infoway-inforoute.ca 12

13. Making early plans Telepathology & HEALTHe NL, Newfoundland & Labrador eHealth experience

14. Considerations & Questions, Telepathology • Early readiness planning, strategies, activities, outcomes: • Pre RFP, requirements validation • Potential implementation & adoption learning's • Readiness report and Project Steering Committee decision needs • Early clinical governance, RFP site visit evaluations • Early clinical governance informed project implementation approach; Clinical Working Group development (formalized terms of reference) • Revised CM plans, recognizing adoption targets, barriers, solutions

15. Considerations & Questions, HEALTHe NL • Early Clinical governance needs, planning to implementation phases • Stakeholder engagement, early & often, Regional Health Authorities, acute care services, end users • Monthly Clinical Working Group (CWG) meetings: • Alignment & validation of requirements, pre-design • Engagement on Education & Training design • Production environment testing, pre-pilot, go-live • CWG engagement, post go-live strategies & activities; conferences, Regional Health Authorities, community clinician adoption

16. Considerations & Questions, HEALTHe NL Results of early project governance, focus on Implementation & Adoption: Mandate • “The Telepathology Implementation Leads Team (TILT) will provide advice and support to the Telepathology Project Team regarding the implementation of the provincial Telepathology network for Newfoundland and Labrador. In addition, team members will act as leads for their respective RHAs Telepathology Implementation” Membership • Ideally, one (1) representative for each of the following areas, from each RHA will be identified by the key contacts/leads in each RHA, based on roles and expertise to take part on the team: • Information Technology • Technologist/Histotechnologist • Pathologist • Laboratory Managers • Change Management

17. Considerations & Questions, HEALTHe NL Results of early project governance, focus on Implementation & Adoption: Responsibilities • Team members will be asked to provide input and take part in activities from the following areas: • Stakeholder Communication and Engagement • Education and Training • Implementation planning • Solution User Acceptance Testing • Adoption support and reinforcement

18. In Summary • A strategic, tactical, relevant change plan • Early defined change scope, integrated with project scope • Early defined clinical governance • Operational plan that includes: • Ongoing monitoring & evaluation strategies for benefits realization • Ongoing Clinical governance needs for benefits realization

19. Making change stick Secure Adoption & Continuous Learning

20. Funded EMR Adoption Since 2005 Adoption by Community Primary Care Physicians and Specialists Actuals & Targets to March 31, 2014

21. The Changing Environment of Adoption 65% Upgrades & Switches Family physicians New eHealth apps: (OLIS, HRM) 85% EMR Maturity assessments Existing Users Previous Programs New enrollments Enrolled physicians New Applicants 2014 2012

22. #1: support to new EMR adopters: From paper to electronic records • Change management strategies used to support sustained change: • Make sure that practice is ready to take on the transformation - Readiness assessment • Stake out EMR vision & goals • Spend time on identifying needs of practice, functional requirements and understand how the change will impact workflow • Training, training, training Available Change Management and Peer Leader Support The foundation for a successful and sustained change is created up front..

23. #2: AFTER “GO-LIVE”: EMR Maturity Assessment • Looking at the result of the EMR Progress Assessment after EMR go-live: • Most change initiatives will experience a drop in efficiency and productivity before starting to realize the benefits that justified the change in the first place • Initiate follow-up and review immediately following go-live • Important to push forward, make corrections/ adjustments, address questions/concerns EMR Progress Review, Assessment results …it takes time to gain familiarity, confidence and speed with a new EMR…

24. #3: …AND BEYOND:Continuous improvement & learning • Continued support to EMR users through Maturity Model, CM and Peer Leader Program: • Review the results with the entire group • Identify priority key measures for improvement • Explore Root Causes • Developing Action Plan • Implement improvements • Evaluate the progress EMR Progress Review, Assessment results ...focus on “continuous improvement” and make it a part of the practice culture.

25. So, what have we learned about sustainable change? #1: You need to plan to achieve sustainable change and continuous improvement #2: Even the best plans and intentions can fail if not managed/championed/sponsored properly #3: No change or improvement initiative will magically happen by itself – only continued focus and determination will make it successful #4: Evaluate the effectiveness of the change process

26. THANK YOU! knut.rodne@ontariomd.com Knut Rodne

27. Questions? Planning for Sustainable Change? Start Early and Think Beyond ‘Go-Live’

28. Reference slides

29. Emerging Focus – Clinical Governance Excerpt taken directly from: NEHTA. Making Sense of  eHealth Collaboration - A Guide to Getting Started.  2012.  Pg 29. http://www.nehta.gov.au/component/docman/doc_download/1605-making-sense-of-ehealth-collaboration-a-guide-to-getting-started

30. A Few Questions to Consider in Planning, Implementation, Adoption & Beyond

31. Pan-Canadian Change Management Network MISSION: The PCCMN collaborates to successfully communicate, educate and promote the value of using change management methodologies, approaches, and tools at every stage of ehealth solution implementation and adoption. VISION: To be recognized as a leading national Network for change management approaches and resources that support the successful adoption of ehealth solutions.

32. Are you effectively leading change? Consider these questions:

33. What can you do as a leader?

34. Change Management Promotes: • Speed of adoption – improved stakeholder engagement, improved ease of uptake • Utilization – improved adoption rates • Proficiency - i.e.., effective use & improved efficiency • Avoidance of unnecessary costs – i.e.., due to resistance, need to re-plan, employee turnover etc. • Improved access to information Benefits Realization

35. 26 National CM Framework Information & perspectives garnered through CMWG activities resulted in creation of a National CM Framework, based on six core elements: • Governance & Leadership • Stakeholder Engagement • Workflow Analysis & Integration • Communications • Training & Education • Monitoring & Evaluation

36. Available Change Management Resources A Framework & Toolkit for Managing eHealth Change – People & Processes https://www.infoway-inforoute.ca/about-infoway/approach/managing-change • Online Toolkit Repository • Sample of tools provided in CM Guide PLUS many more offerings • English version: http://bit.ly/infoway-CM-toolkit • French version: http://bit.ly/inforoute-outils-GC Join us on LinkedIN

37. PM & CM - Working Together

38. Three Pillars of Benefits Realization Benefits Realization Measurement & Improvement Objectives Critical Success Factors • Know your objectives • Identify and manage the critical success factors to get there • Measure & iteratively improve

39. Infoway Benefit Evaluation Framework

40. Increasing focus on adoption and benefits Common scope of IT projects NET BENEFITS System quality Quality Use Clinical Adoption Information quality Access User Satisfaction Service quality Productivity

41. Maturity model – stages of EHR adoption Adoption is a process, not an end state • Clinical Transformation • Fully integrated • Advanced functionality • Data drives quality • improvement • Maximum Benefits • Occasional use • Not well integrated • Low functionality • Low measurement • and analysis capability • Low-hanging benefits