Change Management in Dynamic Health Care Systems Implementing the Str

Question: Discuss about theChange Management in Dynamic Health Care Systemsfor Implementing the Strategies. Answer: Introduction Change occurs continuously, it may be that we are indifferent to it, support it or be passive to it. The complexity in these changing surroundings is managing the change efficiently. It is all about planning, evaluation and implementing the strategies, tactics and operations that make sure that the changes are relevant and worthwhile. According to Kotter, change is both situational and emotional and therefore he proposed a multi step model. The model has 3 phases that can be used to change a technology that ensures the provision of efficient, safe and high quality care for the patients. Kotter change management model involves why the organisation needs the change, why the changed state would be better for the patients and the hospital, what changes are necessary, what new skills will be required along with the technology, and how the staff will be trained regarding these new skills (Chappell,et al.,2016). Managing change in any setting is a challenging, complex and dynamic process. C hange is never a choice between people oriented solutions or technology but it is a combination of all. Healthcare organisations around the world have a continuous and sustained push to implement electronic records based on the promise that the technology will improve productivity, function and quality of the healthcare organisations and for the patients(Al-Abri RK, 2007). One of the main concerns in the health care sector is the management of change. It is difficult to ensure that the health care professionals acquire and maintain the change. Reform driven changes or disruptions; continue to impact the healthcare industry in cost control efforts and its transparency. Changes in health care sector are moving at a fast pace, as practices strive to implement policy requirements and regulatory requirements. (Menachemi N, 2011),( Stewart, et al.,2007) Understanding new models like PCMHs that is patient centered Medical Homes and EMR electronic medical record deployments are not only about technology. They are about equipping the organisation to reach business objectives by enabling people with technical knowledge and capability that make things possible (Reed, et al.,2012). In Maryland State University the change that is going to take place is the implementation of the certified electronic health record technology or CEHRT. This is an academic medical centre that has hospitals, 2 campuses, and 40 outpatients sites that are located on the campus of the university. EMR implementation is beginning this year with the introduction of the ambulatory EMR. This will be followed by implementation phases which will include outpatient sites and lastly will be followed by a BIG BANG implementation process all across the campus. We will replace the numerous systems for revenue cycle management, scheduling, registration, and orders and compile all of them in a single record for ambulatory and inpatient documentation. This year in October we started the meaningful use reporting for professionals that are eligible for supporting the change. This change will happen simultaneously when providers are attending to patients and are trying to maintain a work life balance. Electronic medical record keeping create a lot of oppurtunities for the healthcare sector as they transform the way in which the care is delivered. Medical errors are reduced therefore increasing internal efficiency for administrative and clinical users. This in turn increases the revenue along with other critical benefits (Rouette, et al., 2016). Times like these can be stressful for the staff and the providers as electronic medical record implementation can be disruptive. Therefore to oversee a smooth transformation in the organisation it is crucial that the change management process is well developed. In the case of Maryland State University there are several reasons why switching to EMR will be quite useful. Some of these reasons are paper records are limited and it cannot be shared or stored. In spite of the fact that the hospital has a template for the clinicians the handwriting does not allows for the documents to be shared(Rodriguez-Vera FJ, 2002). Hardcopy of each record is quite expensive to copy by the photo copier machine when the numbers are quite high(Menachemi N F. E., 2007). The records are not private as files can be seen by someone who has access to the storage. Electronic medical records in Maryland State University will add to the organised way that is needed to record details of the patients. Through the use of EMRs the clinicians will be able to navigate through the history of the patient easily which will help in reducing time that is wasted in finding a specific detail about the patient(Blumenthal D, 2010). Another goal that the management is aiming for is increase in productivity and efficiency which EMRs will be able to provide. Through the use of EMRs redundant paper work will be decreased but it could be achieved only when the templates provided are used judiciously. (Erstad,2003),( Attieh, et al.,2013) The approach that we would use in Maryland State University is a gradual rollout which is followed out with a BIG BANG approach that is for all the locations. Each approach has its own advantages and disadvantages. As for some it would be easier to implement and install everything at one place, which works best for hardware. However if we thing about the user perspective a physician wants the same workflow at any location. Same goes for the patient who wants that his records should be shared with all providers and locations. For us the physicians preference was the top priority therefore we choose the specialty focused rollout for each location keeping in mind the specific need for that location (Kokkonen et al., 2013). This enabled us to meet the needs of all locations and our planning involved representatives leaders from all the locations. This approach will also help the medical record department as they have to choose dates for orders and documentation for the transition from ha rd copy (Paper) to electronic format. (DHuyvetter, 2014) The key elements that we have to manage during the change process are ensuring leadership support. Leadership communication and support is a key factor for successful implementation therefore leaders have to be identified at each level whether it is division, system, department, hospital or unit. In this we would also include the medical school as it is also associated with the organisation. The areas of compliance that would be closely monitored are patient safety, privacy, legal, and security. For this we would implement a scorecard system for feedbacks, this system will enable the leaders to identify areas that are lagging in compliance and are addressed easily. We appointed a physician leader in each location who was trained in the use of the application and would encourage the staff to accept the electronic records and its implementation (Noble, et al.,2011). Another key element that we have to manage during the change is the training. Training would be provided at regular inter vals during the implementation process (Bossen et al.,2013). We had already decided that training will be continuously provided till two months after the go-live. Training is necessary for the users to learn about the system and to practice the relevant components. It is crucial that the training should not be done beforehand as we want that the material should be fresh in users mind at the time for go live. This also maintains a sense of impending activity and urgency. We would train similar users and would tailor content accordingly as it is more effective (Sung, Choi, 2013). Users are found to be more attentive when the training material is tailored specifically for their needs. Training can only provide a preparation for the EMR use but it in the go-live phase that the users actually interact with the system in their daily work environment. Therefore it is critical to provide well planned support at the go-live phase. The most important part in this planning is deciding the pro portion for support personnel per user which determines the timing the intense support will go on. We would take the ratio of 1:1 for providers and 1:3 for the remaining staff (Campbell, 2012). The length of the timing after the go live is taken as 4-6 weeks which will depend on how frequently the user interacts with the system. Initially we would provide at the elbow intense and active support which will allow the user to use the maximum tools in the EMR application. This will also allow them to explore options for the patient care which will only enhance the system use. Through this the users will gain confidence which will allow us to taper the support gradually. The gradual removal of trust will reduce the feelings of being deserted . Therefore the transition will be from direct support to calling the helpdesk if they need any help. We are prepared that implementation process will be overwhelming even after the prework and training. A plan is also needed to ensure that support s taff and trainers are able to return regularly in order to help users. Therefore it was decided that trainers would return in intervals of 2-3 months in the first year after go live and then in six months the next year. We need to keep in mind that there is a people side of any change management and same goes for implementing electronic medical records. The main issue during transition is the messiness of it and when in case of a hospital the staff can have issues with numerous factors. Some of these factors are their comfort with use of computers, fear from change and commitment to the hospital. The enhancements and the new system are determined by the users who have different backgrounds, experiences with technology and references. Therefore managing the change needs an adoption plan that ties workflow harmonization, reinforcement, sponsorship, communication and training with the business part of the organisation. The key elements that have to manage during this change process are changing the way how the people work, the technology, and the processes. Changes create uncertainty in the minds of the people even when they are not happy with the current state. This is due to the fear of loss which in this case could be fear of losing their jobs, social position and loss of self esteem. Team pressure is another element the staff has to deal with as, not all would be happy with the change. These people would try to influence other to not accept the change as well. These people will resist the change as they think that change is not in their best interest especially when they would have heard negative stories about IT implementations in health sector. The only remedy to overcome these issues is to involve the staff in all planning and implementation at all levels. Just as people have to change their way to work because of the EMR addition, many existing organisational processes and practices would also be changed. This would require that the staff responsible for these processes is able to implement the changes that are required to deal with the organisational changes taking place. They are experts in their respective processes therefore they can recommend and head changes that ar e needed for desired outcomes. The best move is to rely on your staff as they are able to pilot changes to achieve desired goals. The transition from paper to EMRs will be tough as many practices will not transition from paper to electronic record. This would require implementing other initiative to improve patient care. This stage cannot be understated. Technology is another key element that has to be managed as the staff has to meet the patient engagement measures simultaneously with the change taking place. This means that many factors such as security measures for patients personal data, additional storage, patient portal access and secure messaging application have to be taken care of. It is also crucial that the patients are informed about the new technology and the implications associated to it. This could be attained by developing a one page poster or handout in the office that explains the changes and the planned benefits from the change. This implementation would engage th e patients into discussing about their quality of health with the care they are achieving. Keeping track of the progress is equally important to fix problems throughout the implementation process. Implementing change can be hard and stressful for everyone in the hospital but identifying some success factors is a strategy that can help in determining which management interventions are needed (Chaudhry et al.,2006). Measurement of the success of change process has to be planned during the planning of the change process. This measurement serves numerous purposes as it guides towards the goal achievement and also alerts the managers about the mid course correction. There are many ways in which the success of the change process can be measured. Some of these ways that are applicable in case of a hospital are individual employee assessments which include how the staff is handling the change and how it is progressing. This can be done with the help of utilization and usage reports, proficiency measures, adoption metrics, employee or staff feedback, observations of the behavior ch ange, surveys for employee satisfaction, error logs, issue and compliance logs(Walker et al.2005). These ways also measure the performance of the change by checking the business and change readiness, checking if the change is adhering to the timeline, and how it has improved the performance of the organisation. It is also important to measure the effectiveness and success of change process. To measure this we would check for trainings effectiveness. This could be easily tracked by checking for training participation and through skill tests. Another way to measure change process success is by knowing that how many stakeholders approve and understand the reason for change. A project can be unsuccessful if it has project delays due to decision delays and low commitment from the stakeholders. The approach that we would follow to incorporate the learnings from this change management would be an empowerment approach for any future change management. This approach enables collaboration between the staff, managers and leaders in the implementation of any new system or technology. High staff involvement is primary to this approach that involves the staff in decision making at levels (Farnham, 2003). Sharing of responsibilities and power is practiced in this approach. The core of this approach is empowerment which provides the employees with control, redistributed authority, adaptability, increased organisational flexibility and shared decision making and all of these are required for successful change whether it be in IT industry, manufacturing or any other sector or industry. EMRs have tremendous potential to improve productivity, outcomes in patient care, and quality but they also require a major change in the healthcare sector (Hillestad et al.,2005). A well planned change process and implementation of the process requires leadership support and involvement from the staff. With the help of effective training along with optimization the process of transitioning can be made smooth and can reduce the effects on the organisation productivity. 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