In this lecture, we'll be discussing organizational readiness for change. So, why is this topic so important in the field of Healthcare Informatics? Remember that in healthcare, in organization's readiness for change can make the difference between a successful implementation and a failed roll out. Hearken back to the early 2000's, Cedar Sinai in Southern California. You'll recall the tens of millions of dollars that were invested in the electronic health record but because of a lack of stakeholder engagement, because of a lack of input from front line clinicians, providers after the roll out, ended up wanting to cling to pen and paper. They walked out of the EHR. So remember, an organization's readiness for change can be crucial in your future success in the field of Clinical Informatics. When it comes to change, it's important to be familiar with some of the frameworks that have led us to our current understanding of successfully leading change. Kurt Lewin is known for his change model. This three-step change model involves unfreezing, changing, and then refreezing. What exactly is meant by Lewin's change model? In the first step unfreezing, what he's trying to get at is it's important for an organization to stop, pause, undo some of the current practices in order to really get ready for the new environment. This can be so important because clinicians, frontline staff are often very comfortable, have lots of habits that they've been following. They have a certain workflow you'll need to unfreeze before you can move on to that next step of change. During this time, it's so important to support the change to the future state. Following the change, it's again time to refreeze. What's meant by this? It means that don't just create an implementation and then check out. You need to reinforce the new behaviors. You need to ensure that there aren't manual workarounds or that individuals aren't regressing into past habits. In order to anchor change, it's important to follow this third step in Lewin's Change Model. Now pretty soon, we'll start talking about some tools and assessments that can be used to assess an organization's readiness for change but let's start with the definition. What exactly is meant by organizational readiness for change? It can be thought of as a shared psychological state in which organizational members feel committed to implementing an organizational change, where they feel confident in their collective abilities to do so. Especially in the arena of Healthcare Informatics, it's important to garner this commitment to foster this collaboration and to make sure that your organization is ready for the large-scale change that's up ahead. When it comes to readiness for change assessment, a variety of factors can be taken into account and these really vary based on the assessment tool or the use case. Some of the factors that need to be assessed might include management capacity, whether or not you have clinical champions. That means, do you have boots on the ground, providers who can rally the other troops to encourage them to use the new technology, operational capacity, organizational alignment, is the change consistent with the strategic vision for the particular organization? You also want to take into account technical capacity. Do you have the support staff, the infrastructure? Do you have the ability to hire new subject matter experts, new engineers to ensure that your technological change will be implemented and supported in a way that will allow for successful adoption? Some changes that's been also factor in the reimbursement and the financial situation. For example in Telehealth, is the technology something that providers will use and will they be reimbursed for it? That can be so important and that's where regulatory and policy changes are something that need to be factored in. If a new CPT code that reimburses for a particular service isn't going to come into play for another two years or hasn't become a part of Medicare policy, then your chances of adoption will be much lower, that's just the facts, even in a value-based healthcare system. Now, let's walk through some sections of an organizational readiness for change assessment. In this particular use case, we're thinking of a health system that wants to offer Telehealth in certain settings. So, here's a particular part of a Telehealth readiness assessment, where we're looking into an organization's values and culture. So, what exactly do we mean by this? As I stated earlier, you want to make sure that the organization's values and cultures are in alignment with the new technology. So, in this particular case, if you have an organization that's forward thinking, innovative, where providers, patients and the leadership are expecting you to embrace Telehealth, then you might want to mark that there's full support when it comes to taking in input in the readiness assessment. On the other hand, if you're working in a health system where there's often been resistance to change and there's a culture that's very traditional, old-school, it supports face-to-face interactions and has an aversion to innovation, and there's going to be concerned about the virtual care environment, then the readiness assessment might mark that there are substantial barriers. All of this is important to take into account. When it comes to having an organization undergo readiness assessment, keep in mind that it's not just the leadership that need to be weighing in. It's not just the IT support staff, it's not just the clinicians but it's a variety of stakeholders. You need to make sure that you have representatives from project management that you have representatives from finance that you have representatives from accounting. This variety of stakeholders weighing in to the process of organizational readiness assessments, allows for a few things to happen. You're able to avoid bias either positive or negative regarding the change and it's also a great way to foster collaboration, get this environment where you're having this pool type of change rather than the push type of change that we've covered earlier. So now, what I'd like to do is go through an example of a few more sections of a readiness for telehealth change assessment. At this time, we'll be focusing on available resources. So, when it comes to resources, you want to have a sense of whether there's funding that's available for the initial planning activities. Will there be enough staff available to work on the project or are they going to be spread thin and pulled from other projects? Are there going to be other initiatives competing against your project? If it's the same resources being expanded on your new project, then they might not be dedicated in a way that will allow for a successful implementation. So, in your particular health system looking into telehealth options, is your leadership budgeting for staff that can really be dedicated to this effort? If so, are they hiring an experienced medical director who's had other successful telehealth implementations? Is the right amount of IT support being allocated? If you're able to answer yes to these, then you might say that yeah, just minimal changes are needed in being able to onboard some of the new individuals. On the other hand, if your existing IT staff is handling several EMR go-lives in other departments and they're the same IT staff who are expected to be helping with this embracing of telemedicine, and if no additional resources are being dedicated in the budget or in the operational road-map, that's where in the readiness assessment you'd mark that significant changes are needed or that there's substantial barriers. Depending on the severity of this resource issue, you might even indicate that there are major barriers when it comes to resources. After completing the various sections of the readiness assessment, teams can tally up the scores to determine an overall rating. This is so important and as you can see, we talked about a variety of different factors that need to be taken into account. The examples we walked through were regarding organizational values and culture as well as resources. But remember, all of these other factors for your particular readiness assessment are also important. Looking at this overall rating can be very telling in again, making the decision about whether your organization is ready for the change or might need to anticipate that there's going to be a failure. In which case, delaying the change process might be the right way to go. Now, on the website, we have provided some other examples of readiness for change assessment. Take some time to review these. There's the California Telemedicine and eHealth center example that we walked through a few sections of during this particular lecture. You'll also see from the Health IT.Gov website, readiness assessments that were specific to organizations early in the meaningful use era that were looking into EMR adoption. We also have a readiness assessments specific to certain ambulatory clinics. This is provided by the Agency for Healthcare Research and Quality, AHRQ. Walk through those assessments, get a feel for those sections and think about what your particular organization might score on for its next type of change that it's tackling. At this time, I'd like you to watch a scenario. It takes place in a large health system. Following a weekly staff meeting a few of the employees stick around and are talking in the meeting room. They've just been notified by leadership that the health system is looking into offering telemedicine services in some of its ambulatory clinics. This is a huge undertaking and requires a lot of resources, and it's going to be an interesting change for the health system. They were notified that an organizational readiness for change assessment will be taking place over the next few weeks. While you're watching this scenario, see if you can figure out what's incorrect in the conversation that's taking place. That's an interesting announcement, right? About potentially offering telemedicine services to patients. Yes to us. It sounds like they're going to perform an organizational readiness assessment. I wonder though, who will take part in that? I'm sure the questions will be answered by employees from the finance and the management department. I doubt they would include the frontline clinicians for this. They should definitely ask the doctors and nurses to weigh in. I doubt the IT teams will play a role, but this is a clinical intervention after all. Now that you've watched that particular scene, what stuck out to you as being incorrect in the discussion? Remember the part where two of the individuals talked about how the readiness assessment should only take into account input from engineers and IT and business folks and management or someone else felt that it should only take into account the input of clinicians? Remember, that with an organizational readiness for change assessment, you want to take into account the input of a diverse range of stakeholders. This can help limit bias in favor of, or against a decision. It can help foster a sense of collaboration and ownership from staff regarding the potential change. So, even if it's a clinical intervention, even if there's a large amount of IT infrastructure and change that needs to take place, it's not the opinion of readiness of just a select few in the health system that can make or break a successful roll-out. Having the diverse range of stakeholders weigh in is very important. So, include leadership, include management. Clinicians will be delivering care. Engineers designing or integrating the system, operational staff. All of these are important to remember. At this time I'd like to end the lecture with one question. What would you do in this particular situation? Imagine that you work at a health system that's thinking of offering remote video visits to patients for certain non-urgent clinical appointments. Leadership, has notified folks that they will be performing an organizational readiness assessment taking into account the input of variety of stakeholders in the organization. One of your co-workers hears about this and asks you if this type of readiness assessment is primarily intended to help figure out if the health system is financially ready with the right funding sources to successfully tackle this change. How would you reply to your coworker? Yes, no, or what's a readiness assessment? The answer that you should give to your coworker is no. Even though an organizational readiness assessment takes into account financial support in resources, there are a variety of other factors that we covered in this lecture that also need to be taken into account. So, an organizational readiness for change assessment is not exclusively focused on financial support. Remember, it also takes into account the issue of whether you have enough clinical champions. Whether there's alignment with organizational strategy and the cultures and values that currently exist. Whether there are operational resources in play. So, again no. It's not exclusively focused on financial readiness.
