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EHR Implementation, ERP/ January 2018
January 18, 2018

We Successfully Installed Our New EHR – Why Haven’t Things Changed?

New software implementations require a change that affects people and processes. The implementation of an organization-wide Electronic Health Record (EHR) or Enterprise Resource Planning (ERP) software system involves significant change throughout the organization that impacts most, if not all, employees and patients. Healthcare systems have improved their ability to implement major software systems and success is often celebrated when an organization proclaims; “We came in on time and under budget!” Meeting these two critical goals involves careful budgeting, project planning and execution against milestones.  But is it enough? Should you consider a more robust organizational change management plan?

Most major software implementations carry expectations for organizational transformation beyond checking the boxes for the software implementation itself. The more significant challenge is to manage the change required to transition an organization to an envisioned future state, which the new software is designed to support. The critical element is to get people to change and that, we believe, depends on a robust approach geared toward influencing and changing the culture, through organizational change management.

Successful organizational change management is constructed on three pillars; strategy, structure, and human behavior. These three dimensions become a dynamic integrated system. The strategy is the vision and goals that define the future state. The structure includes the elements needed to successfully implement the program, such as governance, project plans, budgets and proper staffing. Human behavior requires as much attention as the first two pillars as successful organizational change rests upon people and their behavior. Changing the behavior of people will make or break a transition, yet it is the most challenging goal to achieve.

We submit three elements, often overlooked or minimized, but critical to a successful change initiative, to incorporate into the human behavior aspect if you are to be successful in leading people into a future state:

Organizational Change Management

Process and Skill Changes

Implementing a new EHR or ERP is an opportunity to transform current operations to a more patient-centric, leading practice operation. It is more than just activation of new technology; it’s changing workflows, skills of your end users, and how your organization interacts with patients along with many other aspects of process improvement.

This effort changes the day-to-day activities of physicians, clinical teams, patient financial representatives, supply chain teams and most other areas of the organization. A change management program should clearly define the change, understand the impact of the change, and assemble the tools and techniques necessary to support your organization through the change. Tools and techniques will range from simple and straightforward to programs targeting complex changes.

Learning

When implementing an EHR or ERP system, attention is focused on shifting, changing, and restructuring technological systems and business processes. People affected by new processes are often not aware of upcoming changes or how new processes will impact their work. As bits of information are shared (or leaked), concerns and resistance surface among staff. For this reason, it is critical to include personnel at initial, as well as ongoing stages in the change process to convey accurate information and gather their input and concerns. In this way, staff begin to think about what their work life will become and how they will function in the new environment. Establishing a communication plan that communicates the vision and goals for the transition at the outset is a best practice step.

Training is a traditional element included in the implementation of a system-wide software installation. Training is often provided by software companies, organizational trainers, and/or consultants administered in intensive sessions lasting several hours or days with little ongoing development. This type of training is insufficient because learning is an iterative process. Sustained change requires smaller steps over long periods of time leading to greater understanding, success, reflection, and adjustment.

Learning occurs and is strengthened when employees are engaged, can interact with content and colleagues, and with repetition of new skills. By providing multiple training formats, methods, and delivery systems, employees’ demonstrate greater interest and a higher degree of participation, leading to change in behavior and attitude.

Measurement

In addition to iterative learning techniques, it is important to establish a few, key goals to measure and share with the organization, so they remain engaged in the transformation. Milestones should mark progress toward achieving the goals. Organizations should measure the progress toward achievement of those goals and communicate the measurement data proactively.  The milestones should be easily understood and tied to key goals.  They should be specific but not overwhelming in number.  Measurements should be collected and regularly reported throughout the implementation. These measures may include: 1.) Individual Employee metrics looking at adoption, proficiency, engagement, and satisfaction, 2.) Project Performance metrics such as performance improvements, progress, measuring key performance indicators, adherence to timeline, and speed of execution, and 3.) Organizational Change Management activity effectiveness including tracking change, training participation and effectiveness, and communication effectiveness.  Progress toward change will be visible to all and transparency is maintained.

For instance, a goal for transformation could be to improve the coordination of care within a Clinically Integrated Network (CIN) though better in-network referral retention.  Referral management is a complex process that requires on-going, real-time performance monitoring at every point in the process to ensure improvements are realized. As we know, we cannot manage if we do not measure. Therefore, insight tools are a necessary component to sustain transformation.

Completing a project on-time and on-budget is only half the story. Engaging and transitioning people to new and more effective behaviors that will bring real and long-lasting change to an organization is another critical factor. A focus on process and skill changes, effective learning and proficiency techniques and measurements that demonstrate real progress in behaviors will get organizations to another level of success with change initiatives. Successful organizational change management is vital to long-term success.

Co-Author

I would also like to thank Michael Hyder, MD, President of Clearsense for his editorial contributions. Clearsense provides revolutionary technology to embed insight into workflows, combined with the subject matter experts and professional services needed to engineer, implement, and manage change. Once a change is implemented, Clearsense Data Science supports continuous improvement. Learn more at www.clearsense.com.

Additionally, I would like to thank Toni Jarrett, Executive Director of Advisory Services at Optimum Healthcare IT, for her editorial contributions.

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