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Change Management

General

• CPOE projects are more about organization-wide change than IT implementation

• CPOE requires major changes in hospital operations including physician workflow and the workflow in every ancillary and clinical department 

• Large-scale organizational change is difficult to manage well  

• Managing the change successfully requires a large commitment from hospital leadership

Suggested Strategies for Change Management

Engagement

• Engage the energy and knowledge of all the clinical, medical, ancillary and many other departments.  You cannot afford to have any of these departments uninvolved.  Create a project structure that involves everyone who is affected.

Urgency 

• Establish a compelling reason for change.  Focus this around patient safety and clinical outcomes.  Create a document that convinces people the organization must change.  State the reasons clearly and simply.  Appeal to logic and emotions.  Include factual data.   Include information about problems in your hospital that must be addressed.
• Possible compelling reasons for change:
• Accurate, legible orders
• Reduced delays in order fulfillment
• Patient safety – such as reduction in medication errors
• Improved outcomes through improved adherence to best practices
• Improved workflow, ultimately saving physicians, pharmacists and other clinicians’ time (after the change curve / learning curve has passed)
• Lower cost of healthcare through reduction in medical errors, duplicate orders and length-of-stay (LOS)
• National and payor initiatives including public reporting of quality and outcomes (such as The Leapfrog Group), and financial incentives (such as ARRA stimulus and pay for performance)

Vision

• Create a vision of the transformed organization.  What will the new organization look like?  How will it be better than the existing one?  
• Describe “What’s in it for me?” for each organizational stakeholder (Physicians, employees, patients)
• Assign each department and committee to create a statement about how CPOE will affect them

Communicate

• Create a communication strategy to keep in touch with people regularly.  
• Create an interesting newsletter.  
• Create two-way communication channels through small groups and discussion sessions. 
• Meet with current medical staff and hospital committees 
• Include face-to-face meetings with leadership and physicians.

Plan

• Develop a change management plan at the outset of the project. The plan should include assessing the scope of the change and the organization's readiness for change. The plan should address
• Leadership                               (Who will oversee this organizational change?)
• Communication                        (How will you communicate about the change?)
• Removing barriers to change    (How will barriers be identified and addressed)
• Stakeholder participation          (How will all stakeholders participate?)
• Learning/education                   (How will stakeholders learn about the change?)
• Goals & measurement              (How will you measure our progress and the unltimate success of the change?)
• Reinforcing the change             (How will you maintain what you have gained?)

References: 

HIMSS Management Engineering and Process Improvement Change Management Tools

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