Change Management Plan for Palms West Hospital (PWH)
The Palms West Hospital (PWH) plans to implement a change to the use of Electronic Medical Records (EMR). Implementation of this change will require leadership to examine barriers to implementation of the system including overcoming resistance to change among personnel. The hospital is a major employer in surrounding areas. Implementation of EMR will allow the hospital to transfer medical records quickly and easily among facilities within the organization and to outside facilities that request them.
EMR represents state of the art in patient medical record keeping. EMR is gaining in popularity and old paper systems are quickly becoming outdated. The main reason for EMR's success is that it improves quality, tracking ability, and most importantly, patient safety due to the speed with which staff can access the patient's medical records and history. This time savings can result in better survival rates and outcomes in patients that are critically ill. The EMR system is a necessary change in technology that will allow the hospital to serve their patients using the most current technology available.
The technological aspects of the change are manageable in terms of upgrading current systems to meet the specifications needed for the software and system. Implementation of the system will require hospital staff to make many changes to their work environment. Staff will have to be trained on how to use the system and rules that govern medical record transfers and security issues surrounding patient medical records. Many of these procedures and policies will be alien and different from what they are used to under the old paper system.
The transition may be difficult for some employees, particularly those that have been with the hospital a number of years. The old system represented a culture and set of behaviors within the hospital system. It represents routine, but represents outdated methods in terms of technology. Spector stated, "A dynamic competitive environment prompts organizational leaders to alter their strategies, that process of strategic renewal place new expectations on employees at all levels " (Spector, 2010). The EMR system represents a change in strategy that will allow the hospital to remain competitive. These changes will affect staff on all levels of the organization.
It is expected that the transition from paper medical records to EMR will be difficult within the organization as a whole. The change will be made easier if staff is on board with the change and willing to take a positive attitude on the outcome of the change on the hospital. The EMR represents a complete change in the hospital system and the way patient records are managed. It will require a complete replacement of the old record keeping system, with very few components and familiar methods left in place. Because the transition acquires a dramatic shift in the old ways of doing things, Lewin's Freeze Phases was chosen as the change methodology.
Lewin (1947) stated that groups gravitate toward a state of constancy and resistance to change, provided that their environment does not change. An absence of environmental changes means that staff will tend to remain stable and constant in their behavioral patterns. In the case of the hospital, many aspects of the hospital environment will remain the same. The building will be the same, the cafeteria will be the same, the patient rooms and nursing procedures will be the same, and many other aspects will represent a familiar environment. Only one element of the hospital environment will change, but this element will permeate every area of the system. When one takes the daily work environment at the hospital into account, it could appear from the workers' perspective that the only change will be the record keeping system. This will promote resistance to patterns that represent change within the familiar environment.
Lewin's Three Phases Change theory is designed for organizations that must change a significant aspect of the employees daily work environment. Lewin's Three Phases are unfreeze, transition, and freeze. Unfreeze refers to reducing forces that strive to maintain the status quo. It refers to dismantling the mindset surrounding the old system. People must realize that they need to change in order to unfreeze old habits. The unfreeze portion of the EMR project will be drastic. After a certain date, the old system will no longer be available.
The transition period is a process for developing new behaviors and attitudes throughout the organization. Lewin has several developmental techniques to achieve the transition more easily. The staff will undergo training on the new system as far as technological aspects are concerned. A help line will be established so that they can quickly access the information that they need, should a problem occur. They will be given as many tools as possible to provide them with the technological information that they need to adjust to the new system. This will help lessen the confusion caused by the transition period, but there are still likely to be some unanticipated problems during the process. The most difficult part of the transition process will be to encourage people to maintain a positive attitude in light of the confusion.
The transition period is an excellent time to establish positive behaviors that need to be encouraged for the future. The third phase of Lewin's model is the freeze stage. This stage involves crystallizing acceptance of the new system and promoting a sense of ownership in the quality of the hospital as a whole. Unless methods are used to freeze new behaviors in place, old habits will quickly replace the new ones. They will not be able to go back to the old paper method of hospital record keeping, but this phase could represent disgruntlement over the new system. A poor attitude among employees could undermine the effectiveness of the system in enhancing overall quality of the hospital.
Lewin's change model utilizes social facilitation as a means to garner support for the changes. Social facilitation occurs when the behavior of an individual is changed due to the influence of others in a group. It occurs whether the group is present or imagined (Mather and Brand, 2012). Organizational culture plays a pivotal role in the ability of the leader to successfully implement organizational change (Latta, 2009). Leadership acceptance and promotion of the EMR system will play a key role in the ability to change organizational culture that results in positive attitudes towards the new system. Developing a positive attitude towards the new system will be a key to its success in overcoming any problems that occur in the initial phases of implementation.
Lewin's Three Phase change model has been successfully utilized in hospital for the optimization of many processes. A study conducted at a German University hospital found that the change model was successfully applied for a project involving hospital records keeping (Suc, Prokosh, & Ganslandt, 2009). The study concluded that Lewin's change model was successful in the hospital setting as written with few changes to the model necessary. Organizational change models can be divided into two main types, prescriptive, and emergent (Liu, 2012). Lewin's change model falls into the prescriptive category of change models because it prescribes a certain process and procedure to follow.
Measuring success of the organization will focus on success in changing attitudes and gaining acceptance of the system. MITRE's Organizational Assessment Approach will be used to monitor success of the new system at PWH. MITRE's Organizational Assessment Approach has five primary activities. The project begins with the project mobilization phase. The first activity is to conduct a background review, develop a work plan, and to conduct a kickoff meeting. The second phase involves data collection on a macro scale. The purpose of this phase is to gain an overview of the key issues of the project. During this phase interview protocols are developed, phase one interviews are conducted with the management team and key staff members (MITRE, 2012).
Phase 2 data collection takes a more targeted approach and collects data on the key issues discovered in the first data collection phase. This data is designed to help guide in the development of alternatives and solutions to the problem. The next phase is analysis and identification of strategic changes. This phase engages the management team to identify strategic changes. This space involves collaboration in the development of change recommendations. The final step is action planning. In this phase action plans are developed to address the change priorities. In this space, briefings to review plans occur (MITRE, 2012).
MITRE method is an excellent method for determining key issues that will affect the success of the project. However, methods need to be devised to determine if the change has been successful after the project is implemented. Assessment of the project success will entail use of both qualitative and quantitative research methods. Success of the project can be measured through a number of metrics. Quantitative metrics will be used to determine the success of the project in terms of cost, productivity, patient outcomes,…