Innovations in Nursing Informatics: Change Management
This is an installment of a series of posts on Innovations in Nursing Informatics. Be sure to read the last post, "Wired in Rural Washington."
Change is a constant within the healthcare information systems (HIS) environment. Although there is a wealth of theory related to change few tools currently exist to deal with real-world problems related to change such as: lack of physicians' buy-in to CPOE and clinicians remaining stuck in a mindset of "we've always done it this way, why change?"
Brenda Kulhanek, PhD, RN-BC, CPHIMS who currently practices as a performance improvement specialist acknowledges: "There really are a lack of tools and models to effectively do this work ... Part of the problem is everyone and everything is painted with the same brush ... Often when an error or problem occurs the same solution is utilized for this problem as was applied to the previous problem.
"What does not occur is a thorough individualized investigation of what really is going on, what is being done incorrectly. Perhaps it's an educational issue - people were not trained properly. Maybe it's an environmental barrier - no room on the mobile cart to write when needed or carry supplies, etc."
Kulhanek holds a master's degree in nursing leadership and management and a doctorate in performance improvement combined with many years of experience providing training to multiple organizations across the U.S. in health information technology. This has all contributed to her developing a tool to operationalize change management within HIT. "Hospitals and healthcare organizations are very political environments, especially when it involves implementing an EMR. IT changes the social structure of an organization. In the past the doctors had the power. Changes resulting from implementation of new technology, workflows and care practices frequently turn the previous power structures upside down giving others more of a voice."
Including the organization's mission statement in the project charter of the HIT initiative is but a one- time fix. Post the initial go-live change requests do not cease but should be expected to continue, if not increase. This leaves those who have to decide on the change requests without a best practice methodology and the tools needed to objectively prioritize the changes. "Your technical people may not understand the significance of clinically related requests and your clinical staff may not be able to fathom the nuances of technical change requests," says Kullhanek.
How once a performance gap is identified do we connect the solution to the organizations' mission? Does this request align globally with the organizations' strategic plan? Does it represent a true enhancement? Or does it only reflect the agenda or personal preference of one person, department or user segment? Kulhanek has developed an interdisciplinary change management methodology and tool that does all the above.
Additional benefits of using this change management tool include: "educating the clinical end-users on how to think organizationally and come out of the silos of their individual disciplines or departments. It gets people to thinking globally and functioning more as a team," Kulhanek says.
Every organization has its mission, use of a real-world change management tool can help a nurse translate what she/he does at the bedside to how work supports the mission. This is an Innovation in Nursing Informatics!