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Author: Elyse, PMP, CPHIMS
July 31, 2010

With 5010, ICD10, ARRA and general technology improvements, some healthcare it organizations are moving forward with initiatives which have impact across the health system. It is about changing the way business is done to provide better care for our community. These are risky initiatives not for the faint of heart. As an IT leader, how can you launch programs destined to be successful? Here are a couple of approaches which will assure the risks are worth the rewards.

Let's be truthful, the scope here is gargantuan. It is about changing how people work. Unfortunately, the rate of success for clinical implementations, large scale financial system enhancements, or even technology adoption is abysmal in a healthcare setting. After almost 15 years in the field, we have not seen significant improvements in EMR Adoption.

We are about to undertake a violent evolutionary approach to modernization, replacing legacy system and paper based workflow with automated systems still developing. Additionally skilled expertise in healthcare it is becoming increasing rare. The key to success will be breaking down the gargantuan scope into manageable phases and resourcing those phases appropriately.

Establishing Manageable Phases

Identify managing phases - how a module or phase will be released or deployed - from a business perspective is critical for managing the transformational change. We all know with transformational changes optimizing rewards and managing risks increases complexity with increased size. Sponsors and champions need to consider phasing as a mandatory exercise, not a nice to have. After all imagine the difference of rolling out Bedside Medication Administration with a big bang across multiple hospitals.

In order to phase or stage project rollout explore the following options:

  • Service Line - Perhaps it is best to start with endo before rolling out to the ICUs.

  • Departmental - Another place to look is by departments, for example health information management, patient access and then patient accounting.

  • Patient Segments - It may also be an initiative which can be parsed into impacted patient segments - inpatient, ambulatory, or recurring

  • Hospitals - Examine a rollout at a newer facility before imposing upon the flagship hospital or rural care facilities. Assure the first facility has a

  • Health systems - If your healthcare organization has multiple systems across the united states. Look for those which are risk takers, and begin your deployment there. Make sure the CIO is invested in shared success and willing to pony up the resources.

  • Process or Business Function -Again in a multiple health system organization, if consolidation efforts are in play look at process or business functions. For example, centralizing the materials management and purchasing departments across all systems will show the value before beginning on clinical services.

Another key technique is to establish goals and align phasing options with those goals. Clearly assess the outcomes desired for the phase.

  • Must Have - The absolute bare essential outcome which must be in place as a result of the change

  • Should Achieve - These need to be in place because the workaround to achieve the outcome are difficult and cumbersome.

  • Stretch Goals - Great benefit but not essential for the implementation or outcome.

  • Would be Nice - Would be great to have but will wait until the must haves and should achieve goals are completed

Phasing and Staging relates to the different approaches to implementing a solution given the amount of risk the organization is comfortable and how much money the organization is willing to invest. Avoiding "big bang" implementation and starting with smaller achievable pieces and parts can help to improve stakeholder buy-in, mitigate risks, and enhance deployment by applying lessons learned.

While deciding how to establish managing phases it is important to vet the possibilities with senior leaders and senior stakeholders. This will help to consider which elements make sense to pair up and help increase accountability and buy-in with the outcome.

The Take Away

Given the complexity and risks of those gargantuan transformational changes, it is important to break the mold and not do it all at once.

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1 Comments to “Understanding Change Transformation Programs - Establishing Manageable Phases”

Now we see a soft spot in dealing with health system, The techniques you mentioned are quite simple but gives a good credit to an excellent result. Every phase you include plays a big role and shows productivity with in the whole system.

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