Victorian Maternity Record (VMR) Pilot – a Change Management project

1. Victorian Maternity Record (VMR) Pilot – a Change Management project Leanne Holmes 25th HIMAA National “SEE- CHANGE” conference Four Points by Sheraton Hotel Geelong July 28th 2005

2. MISSION

3. M8 Pilot Record Dec 04 M9 Final Draft Dec 05 M10 EHR Plan Feb 06 Establish/Manage Plan/ Document Design Consult Pilot Disseminate / Train M20 M1 M4 M6 M11 M14 Sites Agreed & Approved Apr 04 – Nov 04 Secure host Dec04 Write project plan Apr – Aug 04 Initial design criteria written & approved Apr 04 Methods approved May – Aug 04 Communication Strategy Written & Approved Feb 06 M2 Establish project team& management strategies Mar – Aug 04 M12 Complete pre Pilot consultation Jun - Dec 04 Pilot methods agreed @ sites Jun - Dec 04 M15 M21 M7 Dissemination strategy developed & approved Feb 06 Initial Design Options May 04 M5 Progress Reports Ongoing M16 Pre Pilot Nov - Dec 04 M17 Preliminary site visits Feb 05 M3 Establish Reference Group May –Aug 04 M18 M13 Pilot Jan 05 – Dec 05 Consultation during Pilot Feb 05 – Dec 05 M19 Survey/ process evaluation completed Jun 05 – Feb 06 project plan

4. Consultation with women -Consumer Workshops • Women carry it • Women read it • Women keep it • Consumer- friendly language • 78% of participants agreed it would be useful to carry a hand held record

5. Using the Generic information booklet with the VMR Even non English speaking women thought including booklet about medical tests was useful

6. Consultation with clinicians -Scenario workshop • Clinicians test the VMR • Identify strengths and weaknesses • Hospital and GP will takes copies for their records

7. Carry Wallet Information booklet

8. VMR Page 1-4 Women can write in the 1st four pages : • Demographics • Appointment details • Birth preferences

9. VMR Instructions for clinician and women • Women must consent to carry it • Frequently asked questions included

10. Clinician notes p 5 - 14 . • Maternity History and Examination • Tests and Investigations • Progress through pregnancy • Labour & Birth • Baby Summary • Discharge and Going Home • Glossary of clinical terms

11. Progress through pregnancy • Giroform high quality carbonless paper • ISO 9001 compliant • NCR copies in triplicate • WOMEN KEEP THE ORIGINAL!

12. Labour & Birth Summary

13. Baby summary

14. Going home

15. Additional Notes • Use as progress notes • antenatal in ER • post natal in ward • GP rooms • Pads of 50 in triplicate • Use writing guard

16. VMR poster • Display on doctors/clinic waiting room walls • Reminder to women to bring their VMR

17. pilot process 7 sitesSunshine, Mercy, Angliss, Mildura, Orbost, Kyneton, Seymour 1000+health & other professionals midwives, obstetricians, GPs, paediatricians, managers, health information, emergency staff, allied health, interpreters & translators, graphic designers, packaging experts, change management and group facilitation consultants, medico legal, policy/DHS/MSAC, project managers, IT experts, software designers, students, clinical educators, public relations, RANZCOG, ACMI, GPDV, consumer reps 5000+women

18. Establish Prepare Begin Monitor Close P1 P7 P10 Select Pilot sites Dec 04 Process Evaluation Feb 05 – Dec 05 Collect data Mar - Dec 04 P11 Survey staff Dec 05 – Feb 06 P4 P6 Set aims and measures Jan – Mar 05 IntroduceVMR Feb - May 05 P2 P8 Establish pilot management strategies Dec 04 - Feb 05 Identify and act on issues Mar - Dec 04 Pilot plan P5 P12 Design Processes Jan – Feb 05; Ongoing Final Recommendations Apr05 - Feb 06 P9 Consult & inform Feb 05 – Dec 05 P3 Schedule & timelines Nov 04 - Feb 05

19. Process mapping-what stays & what goes? Pre-pilot Map 1 prior to VMR Pilot Map 2 changes after VMR Post Pilot Map 3 final changes after using the VMR over time.

20. Action Research • This Pilot is based on what is known as an “action research” improvement method. • The strength of action research is its responsiveness and the ability to turn unpromising beginnings into effective endings by converging on an appropriate outcome over time. • The VMR is encouraging pilots to innovate and change their current work practices

21. Plan, Do, Study and Act cycle (PDSA) The pilot sites are encouraged to apply PDSA cycles to their processes to assist them with learning and reflection. People identify issues and actions. • Site teams respond with a plan of action (PLAN). • The plan is actioned for a period of time (DO). • This may involve measuring or observing. They study and reflect on the effects (STUDY). • They act again. (ACT). • PDSA cycles are built around issues identified from the ‘floor’, and from the routine measurement of progress towards aims.

22. Example of an issue:“The VMR is taking longer to complete” could mean??? • It takes longer but it is worth it. • Consultations were too short prior to the VMR • Documentation was lacking previously • It takes longer because people are still getting used to it. When familiar it will take less time. • It takes longer because women are asking questions • It takes longer because the midwives are repeating what the doctor/GP has done. POSSIBLE SOLUTION: Change toappointment times

23. Change “Change is complicated by the fact that organizations are social systems whose participants have identities, relationships, communities, routines, emotions and differentiated powers. Thus managers must be alert to how a change will conflict with existing social systems and routines.” Harvard Business Essentials, Managing Change and Transition 2003

24. “The primary difficulty with change… • is that it is 10% logical/physical and 90% social/emotional. • No matter how much we try to justify our proposed change with logic...or resources, change is tough because it is primarily cultural in nature. • Cultures are primarily emotional, not logical. • Those of us who value logic like to explain our preferences from a sensible framework but when it all boils down, emotion runs deep.”

25. Future impact on Health Information Services?

26. Leading Change with the VMR THE VMR project is about leading change The VMR project provides an opportunity to change and innovate in the workplace The VMR project identifies staff resistance but also staff readiness The VMR project provides an opportunity for us to step back and look at the way we do things! The VMR has the promise of new vision, streamlining structures and provides a catalyse for people towards a common goal – provision of better health care for our women.

27. The VMR has changed my thinking! Initially I thought : • that this was a forms design project – WRONG! • that only an electronic health record would solve all our paper record problems – WRONG! • Women felt empowered in their decision making when having a baby – WRONG! I now know: • there is a lack of CONSISTENT information available for women about maternity care • HIM’s should review their role as forms design experts and custodians of medical records. • HIM’s should embrace the notion that there is a place for personal hand held records in the future! • change requires greater consideration of the social influences within ourselves and our organisation rather than just the logical influences.

28. Evaluation and findings • This pilot is well underway across 7 sites. • 1,500 women are carrying the VMR so far. • 95% of woman are consenting to carry it • No lost records were reported in May or June. • A final evaluation will be undertaken in February 2006. • Only after feedback is received from all consumers and staff will a decision be made about whether to implement state-wide. Watch this space!!

29. Thank you: Jo Campbell (03) 8345 0430 jo.campbell@wh.org.au Leanne Holmes (03) 8345 1685 leanne.holmes@wh.org.au