Helping Employees Adapt to Change at Texas Children's Hospital

by Stephanie Elam and Tammy Christensen, Texas Children's Hospital

Special guest authors for the Change Management Learning Center and winners of the 2009 Global Conference success story competition

Introduction
In 2006, Texas Children's began an aggressive $1.5 billion expansion project. The expansion includes the erection of four new buildings, and the addition of new service lines and programs, leading to a large increase in employee resources. By 2010, the organization is expected to grow from 6,600 to 9,000 employees and increase medical staff by 70. Simultaneously, the organization is transitioning from a paper to an electronic medical record system. This expansion initiative is considered to be the largest ever in the United States to be completed within a four-year window.

Project Background
Texas Children's has begun the implementation of an electronic medical record system that will provide immediate access to patient records and information across the organization, thus promoting improved patient care and patient safety while streamlining efficiencies. The electronic medical record will facilitate instant communication between the primary care and specialty services while also allowing on-going access to patient information for research purposes. The first phase of the project was deployed in two major business units in the organization, impacting approximately 6,000 employees or 85% of the workforce.

Change Management Overview

To assist with the people side of change associated with the system implementation, a change management team was created. Throughout the project, the change management team partnered with the project implementation team and organizational leaders to facilitate activities designed to reduce employee resistance and build commitment for the implementation. Two notable activities included creating a Change Agent Network and conducting dress rehearsal activities.

Local leaders selected individuals to make up a Change Agent Network. The network was comprised of participants from throughout the organization who served as extensions of the change management team as on-the-ground peer champions. The change management team provided Network members with ongoing information, reminders, and tips which they shared with their peers. Periodic meetings and conference calls allowed change agents to connect with each other and exchange ideas about how to build commitment, as well as keep the change management team informed about issues and major areas of resistance that required attention. In addition to the Change Agent Network, the change management team developed dress rehearsal activities to help prepare end users for the implementation. The activities were set up as real-life simulations and provided an opportunity for end users to walk-though and practice system and process changes prior to implementation. The dress rehearsals were intended to help end users understand what to expect at Go-live and minimize anxiety. Additionally, the activities helped identify any potential hiccups that might not otherwise have been identified until the system went live, including incorrect end user security settings. Being proactive prior to Go-live was important because experiencing problems upon Go-live could have contributed to a mind-set that the system didnt work and created unnecessary resistance.

Measurement
To gauge end user commitment throughout the project, the change management team conducted four end user surveys:
y y y y

Baseline: Sent 6 - 8 months prior to Go-live Pre Go-live: Sent 2 weeks prior to Go-live Post Go-live: Sent 30 days after Go-live 90 Day Post Go-live: Sent 90 days after Go-live

Data from these surveys will be used throughout this case study to indicate where change management practices were effectively utilized and increased the success of the change. The business units involved in the initiative each had unique characteristics. Business Unit 1 had fairly standardized processes, and was geographically dispersed throughout the region. Business Unit 2 was centralized, but had vastly different processes between the many sub-units. These differences created a variety of implementation challenges. Overall the same basic change management strategy, processes and tools were available for each unit. The degree to which the change management practices were utilized by the units leadership team differed greatly. Comparative data gathered from the Post Go-live surveys of both units showed a significant difference in the average increase of favorable responses to key questions about the implementation, as indicated in Figure 1.

Average Increase in Favorable Responses by Question - Figure 1 This comparative data indicates the benefits of employing effective change management practices. It also suggests potential best practices, including the importance of appropriate end user engagement, leadership sponsorship, and dedicated, on-going support.

Strong Executive Sponsorship

During the planning phase of the project, Business Unit 1 demonstrated strong executive support and involvement in the project as a whole, and specifically the change management activities. The business units executive closely partnered with the change management team, discussing various change management ideas and concepts; tailoring tools and activities to better meet the needs of the business unit; and consistently participating in change management events and activities. A clear example of her commitment was her sponsorship of the Change Agent Network. She publicly championed the Network to leaders and staff. She appealed to her leadership team to seek volunteers and select individuals to participate in the Network. She and local leaders supported the Network by joining conference calls, participating in

activities and personally thanking change agents for their time and commitment. This support proved to be critical to the successful operation of the Change Agent Network. Leadership from Business Unit 1 encouraged and held change agents accountable for fulfilling their responsibilities in the role, which ensured ongoing participation and followthrough. Another clear example of this executives support was her willingness to champion dress rehearsal activities. She conducted a careful review of the planned activities to ensure they were appropriate for each area, and required participation for all end users. The simulations depended on various roles working together to complete real-life tasks, and required a significant time investment. Some locations temporarily closed during dress rehearsals to ensure staff had adequate time and attention to devote to practicing and mastering the new skills required for the implementation. Following the dress rehearsals, the executive reviewed the status report from each site. Feedback from Business Unit 1s leader specified the Change Agent Network and dress rehearsals were keys to the successful Go-live for her business unit. She noted the Change Agent Network increased end user engagement and helped keep end users informed by spreading key project messages. She also indicated the peer-to-peer communication was especially helpful in ensuring important messages were received and understood by end users. The visible sponsorship and participation of the executive sponsor enabled success of the activities by ensuring that leaders and end users understood the importance of managing change as well as their role in it. Business Unit 2 implemented the new system two months after Business Unit 1. During the planning phase, leaders of Business Unit 2 were involved in the project at a high level, and their degree of sponsorship and support of change management was less visible to end users. Though the leaders agreed to engage in the same change management activities employed with Business Unit 1, they demonstrated less active support of the activities to the end users. The leaders complied with general requests, such as providing lists of users to participate in activities; however, few leaders reached out to the selected end users to show their support and encouragement, or participated in the various end user engagement meetings to demonstrate sponsorship. Throughout the phases of the project, Business Unit 2s end user participation in Change Management activities steadily decreased. Though leadership from Business Unit 1 publicly advocated the necessity of dress rehearsals, most areas in Business Unit 2 failed to engage in the dress rehearsal process. Many leaders from Business Unit 2 failed to review the dress rehearsal activities or to check for applicability to their specific areas. Few made the activities mandatory or actively encouraged their staff to participate. Most neither held end users accountable for practicing for the Go-live, nor did they provide staff with adequate time to do so. As a result, the percentage of staff who participated in Business Unit 2s dress rehearsals was significantly less than the percentage from Business Unit 1, as seen in Figure 2 below.

Figure 2 Analysis of the Pre Go-live survey for Business Unit 2 indicated that those employees who did participate in the Dress Rehearsals were more ready for Go-live than those who did not, as indicated by Figure 3 below. Question: I have the skills and knowledge to effectively complete my tasks following the Go-live.

Figure 3

In addition, a comparison between the Pre Go-live results for both business units showed that Business Unit 1 had significantly more favorable results than Business Unit 2. A greater percentage of end users from Business Unit 1 reported that they understood how the implementation was going to impact them (Figure 4), had the skills and knowledge to effectively complete their tasks (Figure 5), and were ready to Go-live with the new system (Figure 6). Additionally, end users from Business Unit 1 indicated higher levels of commitment to the project, as seen by the 17% difference in favorable responses between the two units to the question: I feel that the new system will work for me (Figure 7). Question: I understand how the new system will impact my daily work.

Figure 4

Question: I have the skills and knowledge to effectively complete my tasks following the Go-live.

Figure 5

Question: I feel ready to go live with the new system.

Figure 6

Question: I feel that the new system will work for me.

Figure 7 As demonstrated, data from the Pre Go-live surveys for both units indicate that the effective use of change management practices and leader sponsorship of the change activities in Business Unit 1 made a significant impact to the success of the project. The activities helped raise end user confidence and ability and increase end user commitment.

Commitment to End User Engagement

Leadership from Business Unit 1 also demonstrated a commitment to end user engagement activities throughout the project. They set up project road shows and individual visits by project team members to each impacted area prior to the Go-live. These visits allowed team members to gain understanding about specific site needs and considerations while personally connecting with end users. The visits also helped build excitement for the changes through demonstrations and informative conversations with end users. In addition to site visits, the leadership team from Business Unit 1 ensured leaders and staff received on-going and frequent communications throughout the project. These tailored communications from business unit leadership provided key status updates and reminders. Additionally, online meetings were offered so that participants could attend virtually. These webinars were scheduled with leaders and staff throughout the project to ensure engagement and increase end user commitment. The webinars were used to provide on-going updates to end users, showcase top features of the software, and

provide ad-hoc training as needed. These frequent communications helped end users feel more engaged and less anxious about the changes that were occurring. In contrast, communications for Business Unit 2 were primarily project driven; end users received general communications from the project team, but minimal information from local leadership. There was less active involvement from leaders of Business Unit 2 to provide updates and communications about what to expect and how to prepare. The importance of leadership commitment to engagement and communications can be clearly demonstrated by the greater percentage of end users from Business Unit 1 who responded favorably to the question: I have sufficient information about the project in the Pre Go-live surveys. (Figure 8) This data further helps demonstrate the importance of active change management.

Question: I have sufficient information about the project.

Figure 8

Dedicated Support Team

Leadership from Business Unit 1 also demonstrated best practices following go-live through proactive end-user support. After the initial implementation period, end user support for Business Unit 1 transitioned from the project team to a dedicated support team. As a result, in the months following go-live, end users reported few concerns over the support process.

To further support end users and build commitment to the change, following the implementation the executive and support team from Business Unit 1 held weekly calls with the sub-units. This allowed them to understand issues, share information and troubleshoot common problems. The executive actively followed up with sub-units who were not consistently participating in the calls to ensure they had the support they needed. Additionally, the calls coming into the support team each week were analyzed to determine top issues and provide further instructions and training to help reduce issue reoccurrence. An easy access, one-stop portal was designed to ensure end users could easily find instructions, troubleshooting material, and necessary updates. This proactive approach to end user support following Go-live helped reduce end user resistance. The comparative results from the initial 30 day Go-live survey and the 90 day Go-live survey showed an increase in the percentage of end-users from Business Unit 1 who responded favorably to the question: I have been supported on the job after the implementation. (Refer to Figure 9 below) Though Business Unit 2 provided the same degree of initial on-site support for the implementation, post Go-live support calls were transitioned to the organizations general help desk rather than a dedicated support team following the initial implementation period. End users from Business Unit 2 reported that the Help Desk was not adequately trained for the transition and was not always effective in assisting with problems and questions. End users experienced long wait times and frustration since Help Desk team members often had to contact the project team to get answers. This resulted in delays in getting questions answered and problems resolved. The results from the initial 30 Day Post Go-live survey and the 90 Day Post Go-live survey for Business Unit 2 showed no improvement over time in the percentage of end users who responded favorably to the question: I have been supported on the job after the Implementation. (Refer to Figure 9 below) I have been supported on the job after the IRIS Implementation.

Figure 9

Remedial Training
To help ensure that end users were adequately supported in Business Unit 1, remedial training was offered on an ad-hoc basis following the implementation. Members of the dedicated support team visited various areas to ensure end users were performing activities correctly and provided coaching as needed. While end users still reported a desire for additional training, a greater percentage of end users responded favorably to the question: I can successfully perform my job using the new system than with Business Unit 2, where there was no dedicated support team to offer remedial training (see Figure 10.)

I can successfully perform my job using IRIS.

Figure 10

Conclusion
Comparisons of data between the business units for the 90 Day Post Go-Live Surveys show that while favorable results for Business Unit 1 increased an average of 8%, results for Business Unit 2 only increased an average of 1% overall (see Figure 1 above.) Through there are many possible reasons for the significant differences in improvement, the survey data for each business unit underlines the importance of effective change management practices on the overall success of the project. Specifically, a commitment to strong executive sponsorship, end user engagement, a dedicated support team, and remedial training were shown to be key components for ensuring a successful change.