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Installing Effective Change Management in Healthcare


In the rush to innovate, practices cannot forget to document their current work flows. Otherwise, they may replicate broken processes.

There’s a lot to think about any time a practice contemplates a large-scale technology implementation whether it’s installing a new EHR or updating the practice management system. However, in the rush to innovate, don’t underestimate the importance of thoroughly documenting what you are doing currently. That’s one of the most common mistakes practices make when it comes to designing a change management plan that elevates clinical quality and enhances financial performance.

It is admittedly counter-intuitive to spend a lot of time and money to document work flows that you know are about to be modified, especially if you have to hire outside resources to do it. Yet without a formal, detailed evaluation of current work flows, practices risk merely replicating broken processes rather than fixing and improving them through new technology.

One way to ensure that an objective look at the current state fuels progress is to create transformation teams - one on the clinical side and another on the revenue cycle side. These teams must be empowered by practice leadership not just to document existing workflows, but challenge those workflows and act as a catalyst for advancement.

After all, at the heart of positive change management lies organizational buy-in to dramatic cultural adjustments. Transformation teams are a tangible way to formalize a practice’s commitment to those adjustments. They are the infrastructure through which practices can realize the potential of new technology to foster clinical, operational, and financial benefits.

To that end, practices should work in conjunction with transformation teams to take these four steps toward successful change management outcomes:

1. Document the current state

2. Identify desired work flows and standards

3. Build IT to support desired clinical and revenue cycle processes

4. Train staff on the new workflows and standards

Enabling substantive change

Within one Northeastern healthcare organization, for example, changes associated with an EHR implementation were spearheaded by the vice president of clinical transformation. She was a nurse with previous technology implementation experience whose authority was sanctioned by the organization’s executive leadership.

Although leadership support was one crucial factor in the transformation team’s success, another was the ability to work months prior to the implementation. To achieve maximum value, transformation teams must be created early in the implementation process with a mandate to evaluate affected work flows and ensure that work flow redesign is completed and documented. The first order of business for the Northeastern organization, for instance, was a comprehensive analysis of clinical work flows and billing processes.

It started with the clinical transformation team asking each practice in the group to fill out a detailed work flow questionnaire. The questionnaire delved into everything from when and where labs were drawn, to how medical assistants, LPNs and RNs were used to support physicians, and more. After the nurses on the transformation team reviewed the responses, they then sat down with the physicians, nurses, and staff at each practice to further understand - and document - the current state.

Armed with this insight into existing work flow successes and challenges, the transformation teams worked closely with the EHR build team to redesign processes to ensure work flows that were not only optimized, but consistent. Quality and other measures, for example, now are tracked consistently from location to location. The transformation team had the power to approve validated clinical and business work flows with an eye toward long-term clinical and financial improvement.

Although the clinical transformation team demonstrated new work flows to practice staff, it was not responsible for conducting organization-wide training. Training was provided separately, yet in the same spirit of transformation, training took a high-level approach long before diving to the point of discussing features and functionality.

Even the best-designed work flows are of little use without comprehensive staff training, but this organization recognized that it’s also not enough just to offer functional training.  Instead, the organization made sure that staff members clearly understood the concepts and contexts behind the clinical or revenue cycle work flows being put into action. Focus shifted more specifically to functionality training only in the last few weeks before go-live.

In other words, practices should take the time to first explain “why” before they explain “what” staff needs to do to revamp their work flows. In this way, staff members gain valuable insight into the roles they play in achieving the practice’s big-picture clinical and financial improvement goals.

Time well spent

There are never enough hours in the day for those who work in a physician practice. Still, it’s essential to take the time to establish a formal change management infrastructure prior to any large scale technology implementation. Empowering transformation teams to understand the current state - and to then use that knowledge to drive better work flows - is one key to ensuring that new technology will indeed optimize clinical and financial performance. 

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