Introduction
Management of records is amongst the core functions of any health care institution especially in this era of evidence-based practice which is coupled with an increased demand for demonstration of quality and value in health care by various stakeholders like the government, Medicare and patients. This organizational change plan will focus on the implementation of electronic medical records in a not-for-profit community hospital by examining the need for EMR as well as the organizational and individual barriers to the implementation of EMR in the hospital. Further, it will identify the factors that are likely to influence the planned change and summarize the factors determining the organization’s readiness for the proposed change. Moreover, it will demonstrate how Kurt Lewin’s change model relates to the proposed change. Finally, it will identify the external and internal resources available for implementation of EMR.
Proposed change
Electronic Medical Records (EMR) is a concept that has been accorded different definitions which range from single files maintained in information systems of individual departments to aggregate collections of patient information on a longitudinal basis (Hayrinen et al, 2008). The EMR system envisioned by the hospital management is purposed to ensure that all patient information from history to findings of physical examinations and laboratory and radiological tests are recorded and maintained electronically by both the health care professionals as well as by the patients. In addition, the project aims to ensure that patient information maintained in the EMR system is accessible to all health care providers regardless of their geographical location as per the new EMR regulations. Currently, information on laboratory tests, medications and radiology is computerized but access to this information is limited to the hospital settings. This implies that the bulk of patient records in this 450-bed not-for-profit hospital are presently in form of paper work.
Need for EMR
The need for the implementation of EMR in the hospital setting has been exacerbated by recent developments in legislation. In particular, the 2009 American Recovery and Reinvestment Act made it mandatory for all health care settings to maintain electronic records for their patients and set a deadline for the latter to be 2014 failure to which they will be penalized by cuts in payments from both Medicare and Medicaid. Moreover, the hospital wants to capitalize on the incentives offered by the government to health care professionals who effectively utilize EMR in their practice which amounts to $44, 000 over 5 years via Medicare or $63,750 over 6 years via Medicaid. In addition, the increased demand for quality health care has also increased the need for EMR. Studies have shown a positive correlation between utilization of certain features of EMR and improved patient outcomes (Poon et al, 2009). Efforts to mitigate health care costs by minimizing duplication of work are also amongst the forces potentiating the need for implementation of EMR in the hospital.
Organizational and individual barriers to proposed change
Passive resistance from quarters that want to maintain the status quo is a significant barrier to the implementation of the change because such groups are likely to strangulate the change process through inaction and sarcasm although the impact may be insignificant if the two are in small doses. Individual barriers to the proposed change include lack of skills in technology amongst the staff particularly considering the fact that the electronic medical record keeping requires some technological know-how (Beaudan, 2006). Lack of commitment, initiative and unclear role perceptions on an individual basis will on the other hand impact negatively on the process of change implementation (Worley & Lawler, 2006).
Non-uniformity in terms of the time perspectives held by the various departments, groups and individuals within the organization is also likely to be a stumbling block in the implementation of the new change because the different entities will tend to implement the change according to their individual time perspectives. In addition, lack of an organizational structure that will facilitate the effective implementation of the intended change strategy will also present hurdles for the proposed change (Worley & Lawler, 2006). Lack of adequate resources in terms of time and material resources will also impair the proposed change since implementation of the new change will require availing time and other resources necessary for training of employees on EMR and the installation of a new technology based system which is an expensive affair (Beaudan, 2006; Worley & Lawler, 2006).
Factors that might influence proposed change
The organizational structure in terms of processes, reward systems and managerial structure will play a very significant role in determining whether the proposed change will be successful or not (Worley & Lawler, 2006; Beaudan, 2006). For the proposed change to be effective, the organizational structure will need to be orchestrated in a manner that is cognizant of the fact that implementation of change is a continuous process that will require the continuous allocation of resources in terms of time, human and material resources (Worley & Lawler, 2006). Competency of the chosen change agent in determining how the change should be made, in resolving change related issues that may arise, influencing people appropriately using behavioral science tools during the change process as well as determining the extent of change that employees are able to withstand change are amongst the various change agent factors that will greatly influence the proposed change (Beaudan, 2006).
Of further importance is the speed at which the change will be introduced since research has shown that tentative change is much more successful than abrupt change (Beaudan, 2006). On the other hand, the organization’s culture which is closely linked with history of change for this specific hospital particularly in reference to the response and subsequent adoption of previous change initiatives will also contribute to the success or failure of the proposed change. Generally, the change strategy will be more effectively implemented if the organizational culture is amiable and not rigid to change, that is the employees display initiative, are willing to accept new roles that are come with the change and show total commitment during the implementation of the proposed change (Beaudan, 2006).
Factors influencing organization’s readiness for proposed change
General factors influencing the organization’s readiness for the proposed change include the context of the change, for example if there is another change initiative that is currently ongoing since it will impact on the EMR project as the two have to share the resources available (Beaudan, 2006). Meanwhile human resource factors specifically in regard to clarity of new job descriptions to all employees, availability of ample incentives to motivate employees to partake in the implementation of the new change and employee competency in technology skills also determine the organization’s readiness for the planned change (Worley and Lawler, 2006). Availability of both internal and external resources necessary for the initiation and sustenance of the proposed change also influence the organization’s readiness for the new change, for example the hospital has already installed computers at a majority of the working stations but needs to install a new EMR system (Beaudan, 2006; Worley & Lawler, 2006).
Kurt Lewin’s change model
The theoretical framework that relates to the proposed change is Kurt Lewin’s change model. Lewin perceived change as a modification of the forces responsible for maintaining the behavior’s of a system. For change to occur, there needs to be a shift in the two group of opposing forces maintaining the system at a quasi-stationery equilibrium. According to Lewin, this change consists of three steps that are unfreezing, moving and refreezing. During unfreezing, the forces pushing for the maintenance of the status quo will be reduced by providing information about the gap that exists between medical record keeping currently practiced and that desired by various stakeholders amongst them the medical personnel, Medicare, Governmental regulations and patients a process termed psychological disconfirmation. The information on the existing discrepancies will motivate people to engage in the planned change (Cummings & Worley, 2009, pp.23-24).
In the second step, changes in the policies governing maintenance of medical records will be instituted so as to include elements that will guide the implementation, consequent use and preservation EM records. The most suitable EMS system will also be installed at this juncture. Subsequently, changes to the processes followed during medical record keeping will be initiated to suit those of the EMR system. Interventions at this stage will involve imparting employees with the required skills, attitudes, values and behaviors via organized training seminars on EMR. Afterwards they will be expected to implement EMR at their work stations. For this particular change, refreezing will entail the use of various support mechanisms to reinforce EMR such as giving rewards to individuals and departments who are excellent in EMR. Continuous support to employees during the process of implementation will also be provided by the change agent as well as the unit supervisors who will be specifically trained to be able to perform the latter role efficiently (Cummings & Worley, 2009, pp.23-24).
External and internal resources
External and internal resources available to support the change initiative include financial and human resources, corporate plans and other organizational documents, information on electronic management systems, time and as previously mentioned government incentives. Members of the hospital staff will be available for the EMR project and they include the hospital’s top management who will allocate the necessary material and time resources in the hospital’s budget as well as solicit for funds from other sources. In addition, there is the project manager who will be in-charge of running the change project. Moreover, a steering committee will ensure that the objectives of the project are attained in addition to ensuring that the resources allocated for the project are properly utilized. Finally, there are the staffs and consultants who will be mandated with carrying out day-to-day operations. Information on EMR will be available from consultants and from other health facilities that have implemented EMR. Corporate plans on EMR as well as other organizational documents such as results of study findings that highlight the need for EMR in the hospital will also be useful resources necessary to justify the need for the EMR project.
Conclusion
In conclusion therefore, the aims of the EMR project are to phase out manual records and replace them with electronic records by ensuring that the information of all patients is recorded and maintained in electronic form and can be accessed from any location within the nation.
Amongst the factors potentiating the need for EMR include the 2009 American and Reinvestment Act and prospect of reduced funding from Medicare and Medicaid for those who fail to adhere to the 2014 deadline, the demand for quality health care and efforts aimed at containing health care costs. Passive resistance, lack of technological skills, commitment and initiative, ambiguity in role perceptions, non-uniformity in time perspectives, lack of a suitable organizational structure and insufficiency of available resources comprise the individual and organizational barriers to the proposed change.
Organization’s structure, change agent, change speeds, organizational culture, history of change processes are amongst the factors that will potentially influence the planned change. On the other hand, the organization’s readiness for change will be significantly influenced by the context of the change, human resource factors like motivation and competency in technology skills and the availability of internal and external resources to support the change initiative. Kurt Lewin’s change model which consists of three stages that is unfreezing, moving and refreezing is the most relevant change model for the planned change. Moreover, human, financial and material resources are available for the initiation and subsequent maintenance of the proposed change.
References
Beaudan, E. (2006). Making Change Last: How to get beyond Change Fatigue. Ivey Business
Journal Online.
Cummings, T.G. & Worley, C.G. (2009). Organization development and change (2nd ed.).
Mason, OH: South-Western Cengage Learning.
Furukawa, M.F., Raghu, T.S. & Shao, B.B. (2011). Electronic medical records, nurse staffing,
and nurse-sensitive patient outcomes: Evidence from the National database of nursing
quality indicators. Med Care Res Rev., 68(3), 311-331.
Hayrinen, K., Saranto, K. & Nykanen, P. (2008). Definition, structure, content, use and impacts
of electronic health records: a review of the research literature. International Journal of
Medical Information, 77(5), 291-304.
Poon, E.G., Wright, A., Simon, S.R., Jenter, C.A., Kaushal, R., Volk, R.A., Clealry, P.D.,
Singer, J.A., Tumolo, A.Z. & Bates, D.W. (2010). Relationship between use of electronic
health record features and health care quality: results of a statewide survey. Medical
Care, 48(3), 203-209.
Worley, C.G. & Lawler, E.E. (2006).Designing Organizations that are built to Change.MIT Sloan Management Review, vol.48 (1): 19-23.
