by Quang Nguyen
Recently, I was on an engagement where I was asked to develop an EHR change management program for a multi-hospital, multi-regional health system going through multiple acquisitions through an EHR instance that was stood up 15 years ago to support one facility. On top of that, there was no formalized change control processes – much of the system development relied on hyper-talented staff and heroics when there were things needing to be saved. This was the equivalent of pushing up a bolder that had rolled down a hill for 15 years picking up any object that got in its way while trying to do a multi-facility rollout in a year. Needless to say, I had my work cut out for me.
Our EHR Change Management philosophy at Divurgent is aligned with typical implementation plans: Plan, Engage, Transform, Implement/Monitor. Our key difference is that we believe in transforming the organization’s mindset and attitude with Change Management before implementing any tangible tools. This approach organically allows users to understand the value of change management and prepares them for processes that change their day-to-day work. After we implement the tools, we assign ongoing owners of the process along with analytics to help the new process “stick” at the organization. Another key emphasis is that our philosophy is heavily based on ITIL practices of working together with the client’s Service Desk organization.
For this project, we took the same approach with a group that had greater inertia than your typical EHR implementation – an establish client taking on new IT organizations with the purpose of using the same process. Below are some of the key lessons and wins I learned during each phase:
Wins: Identify key stake holders early on, engage, and incorporate feedback. Referencing the past helps users understand the problem we’re trying to solve now.
Challenges: One size does not fit all. Implementing new processes into an organization with historically rich processes requires merging of the two to “get in the door,” not shoehorning an industry practice.
Wins: Transparency of your own process is important; being transparent about what you are seeing currently with all teams is even more important. Much of change management acceptance is getting teams to talk to each other and smoothing out incorrect assumptions.
Challenges: Find your toughest skeptics first – they will be the first ones to spotlight how a new change control process won’t work, but also will be your biggest ally once it gets off the ground.
Wins: Integrating with the Service Desk places a connection at the epicenter of where customers provide feedback. ITIL methodologies are key here where incident, problem, and change management program all use the same starting point. Utilizing the Service Desk software helps carry information through the ITIL lifecycle and provides automation and analytics to your change management process.
Challenges: Emphasizing accountability in training is vital in user acceptance. Untrained users are the 20% that make 80% of the noise.
Wins: By implementing tangible activities such as auditing and analytics, it provided all users visibility and data behind the process. Takes the emotion out of the process and makes it more personable and approachable, encouraging continuous improvement.
Challenges: Integration into a broader IT Governance Structure proves to be difficult if other Enterprise-level systems have undeveloped change management programs. This challenge can be overcome by using your EHR change management process as a model for the other Enterprise-level systems in the organization and consult with those stakeholders on finding the right-sized process.
The most important factor not mentioned above, but woven throughout the process, is making sure you meet face-to-face with your stakeholders, users, and leadership as much as you can. The message and execution of a change management program requires a bit of blind acceptance, trust with your users, and a system of accountability – this is elevated by putting a face to the message.
The ivory tower approach is what I’ve seen most commonly used, which perpetuates the view of change control as a bureaucratic, red-tape process that impedes change. Change management processes provide a forum for IT staff to express ideas, concerns, and collaborate with their peers in a non-judgmental setting.
By utilizing the approach above, my client’s EHR change management process has grown from using an email process to utilizing a program that has automated workflows for approvals, code migrations, and the ability to coordinate changes with visibility across all IT teams and transparency to users utilizing ITIL methodologies and Service Desk data.