Driving Change through Clinical Informatics Dorothy DuSold, MA 1

Transcription

1 Driving Change through Clinical Informatics Dorothy DuSold, MA 1

2 Conflict of Interest Disclosure Dorothy DuSold, Master of Arts Has no real or apparent conflicts of interest to report. 2

3 Session Objectives Describe the change methodology employed for successful EHR adoption and sustainment Explain the role of the clinical informaticist in driving change Discuss the organizational structure and support systems needed to successfully position the clinical informaticist role in your organization 3

4 Session Objective #1: CHANGE METHODOLOGY 4

5 Results Why Should we Manage Change? Speed Adoption Achievement of benefits Sustainment of gains Continuous improvement MEANINGFUL USE! High expectations Realization of effort and complexity Despair baseline Change implementation Unmanaged change Managed change 5

6 Installation vs. Adoption Installation Focus on user training Focus on go-live event Focus on go-live success factors Adoption Focus on user adoption Focus on long term sustainment and value realization Focus on embedding new processes and work flows and continuous improvement Installation Adoption and Sustainment Go-live Event Post Go-Live Benefits 6

7 Change Model CHANGE DRIVERS CHANGE DEFINERS CHANGE PROMOTERS CHANGE GUARDIANS Sponsorship and Governance Visioning and Branding Readiness Assessment Communications Change Strategy Implementation Sustain Protocol Value Realization Process Redesign Build & Test Training Must be influential, compelling, an d defined to drive the change through the organization Defines what needs to be changed regarding People and Process (supported by Technology) Determines how to prepare the organization to perform and embrace the change Dell Services Change Model Operationalizes and sustains the change as part of the permanent culture of the organization 7

8 Sponsorship & Governance Established New Governance Bodies Executive Steering Operations Committee Clinical Advisory Council Physician Advisory Council Hospital Steering Hospital Clinical Process Improvement Committee IMPACT Project Organization Change Management Tools Charter template Agenda & minutes template Meeting facilitation Decision making process Executive workshops High performance team and onboarding session Shared online repositories Team All Hands & Education: Taking it to the Next Level December

9 Visioning & Branding Established project vision and mission Developed project name, logo, tagline Created identity guidelines Developed collateral with branding Developed communication strategy for promoting the brand Change Management Tools Visioning workshop agenda and facilitation presentation Naming and logo development process Identity Guidelines Graphic Standards for the Tenet IMPACT Program Version 1 IMPACT booth at Tenet Strategy Conference - April

10 Value Realization Business intelligence dashboard captures data from EHR and reports performance on all Meaningful Use metrics Meaningful Use and quality targets built into workflows and application Hospital A Hospital B Hospital C Hospital D Hospital E Hospital F Hospital G 10

11 Communication Planning A communication plan template is provided to each hospital communication lead to tailor and manage Project background Communication guiding principles Communication objectives Audiences Communicators Vehicles Key messages Approval process Communication repository Feedback mechanisms Communication roles and responsibilities Communication calendar EHR/CPOE Communication Strategy & Plan For [Hospital] 11

12 Degree of Support for the Change Communication Campaigns Hospitals are given monthly communication campaigns with predesigned messages throughout the project life cycle OPTIMIZE Monitor benefit metrics - Measure user satisfaction - Implement sustaining governance - Sustain Campaign GO-LIVE TEST & TRAIN Command center support - Provide physician shadowing - Conduct downtime drills - Conduct future state workflow walkthroughs - Conduct testing - Conduct training - Go-Live Campaign Pre Go-Live Prep Campaign BUILD & PROOF Complete training materials including WBTs- OF CONCEPT - Revise HR policies as needed Conduct POC demos - (POC) Revise hospital policy/procedures - Complete local system build and interfaces - Training Campaign IMPACT ANALYSIS Select devices- - Host conference room pilots - Gather baseline metrics Develop training plan - - Design future state Validate/create physician engagement approach - - Complete gap analysis Value Realization Campaign - Create rewards & recognition program Meaningful Use Campaign - Conduct executive engagement session KICKOFF - Engage Clinical Informaticist - Develop communication plan Readiness Assessment Campaign - Complete stakeholder analysis - Conduct cultural readiness assessment - Establish value metrics Awareness Campaign - Establish governance & sponsorship model Project Inception Time Project Closure 12

13 Readiness Assessment Hospital stakeholder interviews Hospital-wide readiness survey Communication collateral Change readiness report presentation for hospital Process for follow up Adoption score card Corporate dashboards Physician adoption assessment Hospital A Hospital B Hospital C Change Management Tools Survey Monkey Readiness Communication Campaign Data analysis and reporting Change strategies Hospital Hospital D Hospital E Hospital F Above: Multi-hospital dashboard Left: Single hospital readiness survey dashboard 13

14 Process Redesign Future State Standard Process, workflow, configurati ons for standard build and practice Meets regulatory (including Meaningful Use) compliance Impact Analysis Current/future state gaps Local configurations Workflow facilitation Workflow transition preparation Workflow Localization Process maps Scenarios for used for walkthroughs, testing, trainin g, and downtime planning 14

15 Training Training strategy Instructor led Web based training One on one (physicians) Roles based curriculum development Hospital-specific training plan Computer skills assessment and elearning modules Trainer and super user identification and skills tracking Train-the-trainer curriculum Learning management system 15

16 Change Strategies Objective Shared ownership in overcoming change barriers Common understanding of how all owners support each other Approach Describe each owner s expected behavior Have owners for escalation Practice role play! 16

17 Sustain Protocol Defines post-live operations Roles and relationships Governance Communication and escalation Ongoing user training Meaningful use tracking Support and issue tracking Change request management Upgrades and releases Continuous process improvement 17

18 Session Objective #2: ROLE OF THE CI IN DRIVING CHANGE 18

19 CI Sphere of Influence National Sets direction Provides CI and education Regional Aligns with regional operational domains (nursing, physician, information systems, case management, etc.) Supports CIs at hospital level during and beyond implementation Hospital Hospital CI director/manager becomes permanent role Consulting CIs experienced in EHR mentor hospital CIs during implementation National Regional Hospital 19

20 Clinical Informaticist Role Serves as a strategic change agent Pushes the hospital out of its comfort zone Promotes the big picture Establishes relationships and credibility Partners with sponsor, physician champion, clinical and technical leaders Promotes adherence to clinical and technical standards Drives the hospital to operationalize the future state 20

21 Sponsorship and Governance 21

22 Visioning and Branding IMPACT booth at Tenet Strategy Conference April

23 Value Realization 23

24 Communications Communications Clinical Informaticists Partner with hospital sponsors and physician champions as key communicators Monthly communication campaigns 24

25 Readiness Assessment 25

26 Process Redesign 26

27 Change Strategy 27

28 Training 28

29 Sustain Protocol 29

30 Session Objective #3: POSITIONING THE CI FOR SUCCESS 30

31 Sponsorship Project is supported by IT, but not driven by IT An operational project COO and CFO (executive sponsors) allocate resources Control hospital budgets and performance score cards CMO (sustaining sponsor) oversees quality operations post go-live Focus on long term sustainment Clinical Informaticists are key roles in achievement of Meaningful Use targets and ongoing sustainment and optimization of EHR benefits 31

32 SUPPORT STANDARDS EHR Operational Relationships Info Systems Applied Clinical Informatics Clinical Operations Technology Standards User & Application Support Clinical IT Standards System design & change Implementation Practice Standards Quality Improvement 32

33 Tenet Informatics Career Path Hospital Super User/Trainer/Educator Hospital CI Director or Manager Based on hospital size, complexity, need for reporting staff, and level of CI skills Regional CI Director Aligns with regional clinical and IT operations Serves as mentor for hospital CIs National CI Managing Director Vice President, Applied Clinical Informatics 33

34 CI Development at Tenet Focus on hospital clinical informaticist for skills and career development Build time for monthly CI education On-the-job training with IMPACT and Regional CIs Weekly one-on-one calls with Regional CI CI Collaborative bi-monthly calls CI SharePoint sites Annual CI Academy Skills assessment tool measures progress Based on Tenet CI job description and industry trends Use as self-evaluation and external evaluation by the CNO with input by the Regional CI Director 34

35 Tenet Cl Academy Annual educational work session in Dallas Attended by 20 RNs in 2010, 41 RNs in 2011 Academy lapel pin Certificate for 18 nursing continuing education credits awarded in

36 Ten Competencies of a Successful CI 1. Be credible 2. Be knowledgeable 3. Be objective 4. Be collaborative 5. Be a communicator 6. Be an integrator 7. Be calm 8. Be available 9. Be an agent of change 10. Be worth it! 36

37 Questions 37

38 Contact Info Dorothy DuSold, MA Senior Director, Adoption & Sustainment Tenet Healthcare mobile office 38