Introduction
Change is a perpetual in today’s fast paced world. What is modern today becomes obsolete tomorrow. New technologies mean a change in the way on thinks, learns and gets his information or uses it. Any organization may feel the challenges brought about by those new technologies and why they need to implement them within their culture. Any change within or outside an institution is sure to incite mixed reception and perception among its members and clients. The essay applies a change theory to an organizational-based on Kotter’s change model and plans a change process. The change process will be evaluated for all from Kotter and Cohen's The Heart of Change (The Heart of Change. 2002), and all eight steps would be covered. The “Heart of Change” implies that to bring a change in an organization, it is essential to bring a change in its workforce from within rather than applying analytical and financial measures from outside. This is essential to overcome any resistance to behavior change. The real-life stories in the book offer real and practical examples provide a comprehensive message regarding transition challenges for the players of organizational change.
John Kotter model
John Kotter observed difficulties associated with change efforts in hundreds of organizations and designed his model based on strategic management of the change. Kotter has described eight steps in his model, and the first step is the sense of urgency in setting the goals and objectives of the change efforts. The second step is to create strong guiding coalition while the third step is that of a communal vision that helps in developing strategies to achieve the change. Once the vision is made, the fourth step is to communicate the vision clearly and thoroughly. The fifth step talks about authorizing others to act on the vision and get rid of any barriers and look ahead. In the next step, Kotter suggests breaking up the larger change initiative into smaller parts and creating short-term wins. The seventh step is about consolidating improvements and making more positive changes. The final and the eighth stage in Kotter’s model focuses on initiating new approaches, and defining connections between the success of the organization and new behaviors (Metre, 2009).
The healthcare organizations across the world are undergoing constant changes to contain costs and improve the quality of healthcare. With the digital age of medicine arrived, it is essential for the healthcare systems to fully leverage the use of electronic health records or EHRs (Martin and Voynov, 2014). Today, healthcare is not just limited to the well-developed countries but is surfacing in the developing countries. There are standards set for the electronic exchange of information and the security and privacy of health information. The adoption of EHRs in outpatient systems is mainly dependent upon clinicians. For the development of health promotion initiatives and their successful implementation, it is essential to have a clear understanding of the organizational change and the change efforts. It is vital to focus on the influential factors in order to select the right strategies to bring the desired changes (Batas, Duff & Smith, 2016).
Health promotion practitioners looking towards an organizational change need to select the right model that can fit with the internal context. They need to focus on the amount of time repaired, short-term success of their implementation plan and how the shared group experience can bring in positive or negative changes. The intended recipients of change and other internal factors too should be addressed when deriving strategies for facilitating the change in diverse organizational settings as asserted by Batas, Duff & Smith (2016). It is essential to align health promotion with organizational change effectively. The purpose behind these actions is to develop new approaches and structures for addressing health issues that are a concern and build sustainable systems.Adoption of EHR system It is essential to build a safer health system in the hospitals today. In shocking statistics’ it is estimated that more than 95,000 people die in each year in the US hospitals because of avoidable medical mistakes. The Canadian Institute for Health Information (CIHI) suggests that one in ten Canadians would be given wrong medication because of human errors. There are different reasons behind those medical errors, but those point to transcription errors, lost medical records, incomplete information, delay in getting information, absence of computerized medication alert systems and lack of clinical decision support tools as asserted by (Neumeier, 2013). Moving towards the adoption of EHR system means building a safer health system and increase patient safety. The objective behind is to connect health care providers with patient information timely and accurately. Electronic medical record or EMR allows faster and competent access to patient information. Computerized prescriber order entry (CPOE) and electronic medication administration record (eMAR) can further improve access to complete patient information, thus enhancing medication safety and reducing any human errors. Despite the multiple benefits of implementing EHR system, the adoption is slow in many health care organizations. Initiatives to implement the electronic systems fail and there are several barriers to the successful implementation of EHR system that include dearth of standardization, high costs, the reluctance of staff to accept new changes and concerns about privacy.
What is an EMR?
EHR is also referred to as EMR where the clinical information of the patient is collected, stored, and displayed in computerized systems. The EMR is designed to collect and store the medical record in a legible and organized manner. It comprises of patient data, laboratory results, prescription records, and other notes. EMR provides support features such as computerized provider order entry , computerized clinical decision support and electronic medication administration record that can enhance patient safety and reduce medical errors. To successfully implement an EMR, an effective change management is integral. After all, it is all about engaging, preparing and motivating people to maximize abilities and achieve maximum results. The paper demonstrates how Kotter’s change model can be applied to identify and anticipate barriers so as to create strategic solutions when implementing an EMR system in a healthcare organization.
Implementing an EMR in in Nairobi County hospital in Kenya
The application of Electronic Medical Records Technology is widely used in Kenyan hospitals today. The paperless transactions in health care are much in demand but still, the application of EMR technology has not been able to keep pace with its demand. There are several factors that can influence the positive application and adoption of the new technologies. For example, the accessibility to network infrastructure, the influence of resource availability, levels of education, the willingness of staff to adopt EMR technology and more (Chepkwony, 2015).
Kotter’s Change Management Theory has been used in health care successfully and especially to address the adoption and implementation of technological innovations. The dynamic model is made of the eight-stage process that can be organized into three phases (Neumeier, 2013). The setting is a small Medical Center, in the county of Nairobi that is located in a suburb of the city. The health care was founded several years ago and takes care of about seventy patients a day.
The first phase involves creating the grounds for change by establishing a sense of urgency, develop a guiding coalition, and create a vision and strategy.
The second phase focuses on engaging and enabling the organization. This includes communicating the vision, empowering action, and creating short-term success.
The third phase is about implementing and sustaining the change. This phase includes merging gains and making more change and securing new approaches in the culture (Neumeier, 2013).
The first phase The first step in Kotter’s model is to create a sense of urgency. The health care leaders of the hospital should examine the market position and financial performance of the hospital and share the information with their workforce. This first step is critical as it prepares the ground for bringing up the change and motivates aggressive cooperation of the participants. The key stakeholders and employees of the hospitals hood believe that change is necessary. They should be given facts and statistics to feel the urgency of the situation and why a change towards implementing EMR technology is a must. The biggest mistake one can make during this change is to allow complacency. If the participants do not absorb the sense of urgency, they can develop a laid back attitude towards change and even resist change. Creating urgency will help people see and feel why a change needs to occur. The director, president and staff such as the practice manager and billers should be encouraged to discuss the problems facing the practice. They can discuss the use of physical space for storage of medical record, lack of physical space, the time and effort wasted in locating the lost medical records of the hospital. It is essential to pin tot the inefficient way of using several databases and spreadsheets to manage the practice and the data of the patients. These problems will highlight the perceived benefits of using EHRs and create a sense of urgency. Other aspects that can increase the urgency of implementing EHRs are the monetary gains made by handling more patients, faster and efficiently. Saving time means saving money.
The next step is to develop a powerful coalition group that should lead the change. The specific group should be focused and must be composed of just a small number of members, to begin with. More embers can be added through transformation and with the growth. The team can include influential physicians, nurses, board members, senior managers, and pharmacists. The team members should carry the knowledge, skills, and influence required to mobilize change. This coalition would be responsible for identifying all positive and negative forces for implementing the EHR without disrupting the clinical and administrative operations. The senior medical assistants, nurses, and technicians are expected to resist the EHR, and they need to be involved actively with the benefits due to the use of EHR. Participation in the training and adoption of the EHR is the responsibility of the coalition team. It is essential to know the possible barriers to successful implementation of EMRs and the major one is not the lack of financial resources but resistance to change (Neumeier, 2013). Implementing an EMR means making a significant change in the work endorsements. The willingness and acceptance of the health care staff to EMR are seen as major determinants of the successful implementation of the technology. One should know that nurses are a primary stakeholder in healthcare and work closer with the patients and for a longer time. It is necessary to study their attitude towards the EMR. They should be actively involved in the decision-making process right from the start and be made an important part of the coalition team.
Crafting a vision and defining is the third step in Kotter’s model. The coalition group at the top should create a clear vision of what the future of the hospital should look like. The vision should be collective and measurable and provide a clear picture. It is imperative that the vision should be communicated convincingly as well as frequently to all groups. Leading by example is the best way rather than just communicating the vision in words. Thus, a continuous dialogue with stakeholders and workforce is essential to building commitment and trust. The vision for change with the implementation of the EHR at the Medical Center is to deliver quality in their care and be known as the leading medical center in Nairobi.
The second phase
The second phase focuses on engaging and enabling the organization. What needs to follow is the fourth step which is to communicate the vision. The employees, staff, and stakeholders should be able to comprehend the vision. Just talking about the vision and goals of the hospitals is not enough. The leaders need to exemplify and advertise change on all channels of communication. The vision established by the coition group needs to be communicated to the director and president of the hospital and the stakeholders and the workforce. One-on-one conversations are important and the communication should focus on how EHR implementation should not be seen as just a project but a significant shift in the culture of the hospital. The immediate benefits such as improving patient care and saving efforts and time with enhanced diagnostic monitoring tools and how it can increasing revenue and lower medial errors need to be communicated to the administrative staff. The healthcare team and service providers will spend less time trying to locate missing records and duplicating data entry. There would be fewer missed appointments, no double bookings, and a more transparent billing.
The coalition’s team should empower others and encourage participation, which is the fifth step. The participants should be encouraged to develop new ideas to get rid of all obstacles. The teams need to work together and empower each other to participate and remove barriers. There should be incentives for embracing change and how the change benefit the physicians, nurses, and the patients. One can expect obstacles in the form of resistant from the health staff, who might not see any immediate or direct advantages of the implementing EHR. Individual and group training would be given to show how an EHR works by setting up dummy patients in the system. The health care workers can be watch training videos and support one another. The team should be encouraged and kept motivated at all times.
Setting up short-term goals is the sixth step, and it can be exciting and motivating to see expected results in short term. Focus should be on the short-term wins to keep the momentum going. Aby success should be highlighted and celebrated. However, it is essential to analyze what went right or wrong where and analyze what needs improvement. The coalition team should set the timeline for the EHR implementation and signal achievements and reward them when the milestones are crossed. For example, they can measure a meaningful use in a particular measure, such as the specific medications to avoid for allergies. This is essential from the safety standpoint as it can prevent adverse outcomes from a wrong prescription to a patient that can induce an allergic reaction. Any such preventions and successful outcomes can be talked about and appreciated as to how implementing an EHR have resulted in a greater patient safety culture.
The third phase
The third stage covers the seventh and eighth step in Kotter’s model which is about producing more change and anchoring new approaches in the health care organization culture.
The seventh step is about is consolidating improvements and sustaining the change. The team should be reminded of the smaller victories from short-term goals and motivate them to preserve the change and move towards bigger goals. There should regular management meeting between the coalition team and the healthcare staff once a week to discuss any issues and achievement. This can reinforce motivation to realize the forthcoming challenges and overcome the hurdles. Implementation of easier measures is followed to encourage competence and confidence in the EHR. The perceived proficiency and self-reliance among those implementing the change as well as those influenced positively by the change can boost the change efficacy within the hospital.
The eighth step in Kotter’s model focuses on institution ling new approaches. The changes should be linked to the success and culture of the health care organization. It is essential to strengthen the coalition team at the top by developing future leaders who can keep the transformation consistent and confident in the future. The implementation of the EHR at the hospital needs to be assessed after a couple of months, say, about three months of implementation. The degree of implementation and the percentage of improvement in operational efficiency should be assessed. How the attitude of all staff and the nature of administrative work has changed can act as the pointer to the successful implementation of EHR. Still, the hospital should focus on further initiatives on expanding the use of EHR and provide more individual and group training to leverage the EHR model fully.
One should be careful in this phase as to avoid declaring the victory prematurely as this can remove the sense of urgency. The heath care organization will face the risk of slipping back into the old way of doing. The team should focus on continued stress on the desired vision and keep taking the strategic steps until the change becomes permanent in the hospital. The strategic decision to implement an EHR in a health care practice can be challenging, especially in a country like Kenya with limited expertise and resources.
However, following the steps in Kotter’s model, one can implement change successfully, regardless of the size of the organization, its resources, the managers, and technologists. It is essential to give importance to the human side of technology implementation, or the whole project could lead to serious challenges and failure for the model to be adopted.
It is essential to gain an understanding of the opinions and experience of the staff with computers and their expectations for the EMR. Once the working staff realizes the benefits of using EMR, safety measure and how the electric systems can help save time and efforts, the attitudes and expectations of staff can shift in the positive direction. When an individual believes that the new change will help them perform their job better, faster and eff3eicnty, he or she is more receptive to the change. Social influence can be another significant factor in EMR adoption, and the attitudes and perceptions of the coworkers in the health care staff can have a strong influence.
References
Batras, D., Duff, C., & Smith, B. J. (2016;2014;). Organizational change theory: Implications for health promotion practice. Health Promotion International, 31(1), 231. doi:10.1093/heapro/dau098
Chepkwony, C. M. (2015). Factors Influencing The Adoption Of Electronic Medical Records Technology In Public Health Institutions In Kenya: A Case Of Hospitals In Nairobi County. University of Nairobi, 1(1), 1–74.
Metre, Chirag. (2009). Deriving Value from Change Management. University of Pennsylvania, 1(1), 1–43.
Martin, W. and Voynov, S. (2014). Electronic Health Records and Change Management. International Journal of Computer and Information Technology, 3(3), 626–630.
Neumeier, M. (2013). Using Kotter’s Change Management Theory and Innovation Diffusion Theory in Implementing an Electronic Medical Record. Canadian Journal of Nursing informatics, 8(2), 1–8.
The Heart of Change. (2002). cu.edu Retrieved from https://www.cu.edu/sites/default/files/ExecSummaries-Heart_of_Change.pdf
