You are on page 1of 122


A Framework and Toolkit for Managing eHealth Change
A Framework and Toolkit for
Managing eHealth Change:
People and Processes
Pan-Canadian Change
Management Network

About Canada Health Infoway
Canada Health Infoway (Infoway) is an independent, not-for-
profit organization funded by the federal government. Infoway
jointly invests with every province and territory to accelerate
the development and adoption of electronic health information
systems in Canada. These secure systems will allow authorized
health care providers to have quick access to their patients’
vital health information when and where they need it. This
will contribute to better patient care. As well, these systems
will eventually provide Canadians with electronic access to
their health information to help them manage their own health.

For more information about Canada’s efforts to implement
information and communications technologies in health care,

For questions related to this guide, or Infoway’s
approach to change management, contact

(March 2013)


A Framework and Toolkit for Managing eHealth Change
3.3.1 Resources and Tools 26
3.3.2 Further Reading 26
1.1 Objectives and Purpose 6
1.2 Intended Audience 6
1.3 Key Inputs 7
3.4.1 Resources and Tools 28
1.3.1 Current State Assessment 7
3.4.2 Further Reading 28
1.3.2 Literature Review 7
1.3.3 Glossary of Terms 7
3.5.1 Resources and Tools 31

3.5.2 Further Reading 31

2.1 What is Change Management? 8 3.6 MONITORING & EVALUATION 32

2.2 Organizational Change Management 9 3.6.1 Monitoring & Evaluation 32

2.3 Change Management in eHealth 11 3.6.2  Formative (Process) Evaluation 32

2.4 eHealth Change Management 11 3.6.3 Evaluating 32
in Canada 3.6.4 Key Questions 32
2.5 Building a Case for Change 12 3.6.5 E
 xamples of Commonly Used 33
Testing Methods
3.0 A NATIONAL CHANGE 13 3.6.6 Summative (Outcomes) Evaluation 33
3.6.7 Resources and Tools 33
3.6.8 Further Reading 34
3.1.1 Governance 15
3.1.2 Leadership 17 4.0 CONCLUSION: FUTURE DIRECTIONS 35
3.1.3  Key Roles in the Change Process 17
3.1.4 Resources and Tools 19
3.1.5 Further Reading 19
3.2.1 Why Involve Stakeholders? 20
3.2.2  Individual Stakeholder Engagement 21
3.2.3  Process for Engaging Stakeholders 21 8.0 INDEX 116
3.2.4  Coaching and Resistance Management 22
3.2.5 Addressing Challenges 23
3.2.6 Resources and Tools 24
3.2.7 Further Reading 24

Based on this experience. not yet have any for jurisdictional formal education. level and large institutional projects and programs. this guide and toolkit has been developed as: • a support for change • a useful resource for • an introductory management (CM) front line clinicians. particularly quality / risk focus. 2 A Framework and Toolkit for Managing eHealth Change Who is this for? People and Processes reflects leading practices and lessons learned for managing change in eHealth projects from across Canada. . resource for leaders and managers and senior individuals with practitioners leaders with a project CM as part of their working within implementation / role but who may eHealth.

and as such. successful and art to form a comprehensive CM strategy. health solutions.” to people and organizations undertaking change within the context of eHealth projects. people to new and often stressful situations. This observation provides an opportunity that different approaches to CM are in play. implementation of change is achieved when the systems. which are just as crucial to overall project success. successful change recognized approach to CM.2 Prosci. must remain fluid and dynamic. tangible . A focused and appropriately resourced These members have defined CM as: approach to CM has been demonstrated as an essential driver of adoption and for realizing the many benefits of “…a strategic and systematic approach that eHealth initiatives across Canada thus far. CM plans to reflect on new approaches for improving and influencing must try to anticipate the various individual reactions of user adoption and benefits realization. implying that there is a need to mesh both science organizational efficiencies. Change leaders from across the country also report that often. National Change Management Framework Experience from the front lines. despite best efforts. tools and technology of the change initiative to support improvements in CM with information and are embedded in the new way health care providers communications technology (ICT) for health projects. Canadian Change Management Network (Network) processes. plans are not fully executed into actual. 3 A Framework and Toolkit for Managing eHealth Change Executive Summary Change Management Change management (CM) is about supporting people through change. The term “change management” includes a wide range of activities and means different things to different people. an internationally In the world of eHealth. there are tangible and measurable elements to CM. Canada Health Infoway (Infoway) established the Pan. as well as less tangible elements. supports people and their organizations in the ICT project failures often have root causes associated successful transition and adoption of electronic with CM shortfalls.” 3 Others refer to it as the art of long-term benefits such as improved patient care and change. as well as an analysis of the practice. In other words. but remain a vague ideal of how the change ought current state of pan-Canadian CM activities have shown to have occurred. do their work. such as behaviours and culture change. refers to this concept as the implementation results in solution adoption and other “people side of change.1 Conversely. The outcomes of effective change management activities include solution This document is focused on CM practices as they relate adoption by users and the realization of benefits.

to solution adoption and clinical value. based on the collective wealth of expertise and knowledge. monitoring and evaluation take place throughout the lifecycle of the project. benefits realization and overall health care delivery Communications: transformation. steer or regulate the EVALUATION course of a project. Change Management in order to ensure success. STAKEHOLDER The Network has developed an integrated framework ENGAGEMENT COMMUNICATIONS for describing CM activities within the context of eHealth projects that consists of six core CM elements: Governance & Leadership: MONITORING & The mechanisms used to guide. Their behaviours and needs must be defined. 4 Discussion among the Network concluded that there The CM framework is shown in the figure below: A Framework and Toolkit for Managing eHealth Change were key elements within the CM process that needed to be addressed. including how stakeholders can affect the priorities and progress of a project as well as the CM activities occurring within a project. positively impacting health The process of providing stakeholders with what outcomes for all Canadians. issues and expectations of stakeholders are learned and managed. so that new for further reading as derived from the literature review processes using eHealth solutions can be sustainably and other sources. experiences from embedded into the culture. As proposed in this framework. both in planning and in execution. and the extent to which they were effective. in order to prompt appropriate responses and/or actions. Monitoring & Evaluation: The process of reviewing whether CM activities took place as planned. as evidenced through Canadian jurisdictions are highlighted throughout. Training & Education: The act of imparting both knowledge and specific skills among key stakeholders to promote adoption. and suggestions and opportunities for improvement. Each section of this document contains a brief overview Workflow Analysis & Integration: of the key concepts for each element of the framework. they need to know. . Where applicable. understood Outcomes of successful eHealth change lead and considered when implementing eHealth projects. Stakeholder engagement includes focused attention on the individuals who are expected to change. The process of understanding current work processes links to relevant tools and templates. The group also recognized Framework that sharing information and lessons learned across projects and jurisdictions is critical for promoting rapid GOVERNANCE improvement and a common understanding in process & LEADERSHIP and approach. their presence within steady-state operations. WORKFLOW Stakeholder Engagement: ANALYSIS & TRAINING & INTEGRATION EDUCATION The process by which the perceptions.

this collection offers expertise. 5 CHAPTER Background 1 BACKGROUND A Framework and Toolkit for Managing eHealth Change The Pan-Canadian Change Management Network (Network) is a grassroots collaborative supported by Canada Health Infoway’s (Infoway) Clinical Adoption team. A Framework and Toolkit for Managing eHealth Change: People and Processes . and accelerate undertake a number of activities listed in their 2010/11 adoption and the realization of benefits associated with established work plan. 2. Glossary of Terms to develop a “common language” for discussing CM among CMWG members. the Change Management Together. Literature Review to compare and contrast CM approaches and methods in use nationally and internationally. formed in early 2010 to best practices to help shape CM strategies. this network of CM leaders came together to set common priorities and establish a plan to guide their work. the major deliverables for 2010/11 included the development of the following: 1. and consolidation of the above three items into: 4. Recognizing the importance of CM. It was founded to share experiences and identify common goals that address ongoing change management (CM) related issues and concerns within the eHealth space across the jurisdictions (i.e. A subset of the Network. Current State Assessment of jurisdictional CM methodologies and tools. 3. Specifically. the use of information and communications technologies (ICT) for health. provinces and territories). insights and Working Group (CMWG).

1.2 Intended Audience This document is developed as: • a support for CM leaders and practitioners working • an introductory resource for individuals with ‘change within eHealth. approaches and tools have been successfully implemented. managers and senior leaders with a project implementation / quality / risk focus. as well as successful outcomes. as an additional resource to highlight where particular • promote sharing of knowledge. • a useful resource for front line clinicians. CM toolkits. Key challenges identified by CMWG survey participants included both a difficulty finding appropriate resources • promote dialogue on what constitutes CM to support change in health care settings. 6 1. regionally This document is not the definitive guide to CM. by senior leaders.1 Objectives and Purpose of this Document A survey of CM practices undertaken by the CMWG in • introduce a CM framework that is based on 2010 identified that change leaders have varying degrees of leading practices. • communicate the findings from the CMWG deliverables and serve as a practical resource to highlight key elements of an effective CM plan. have any formal education. based on People and Processes addresses these challenges and serves evidence of leading practices. and . access to tools and supports. lessons learned. challenges obtaining recognition and ‘buy-in’ of the need • act as an early step in the process of achieving a for formalized CM programs. particularly and the important role it plays in achieving in a large and geographically dispersed region. and nationally. rather. while others indicated they had access to more comprehensive • inform and guide the practice of those new to CM. national dialogue on leading CM practices for A Framework and Toolkit for Managing eHealth Change: implementing ICT in health projects. country and internationally that align to the key elements of an effective CM plan. BACKGROUND A Framework and Toolkit for Managing eHealth Change having no formal or structured access to tools and supports. and challenges at a project level. Some jurisdictions have developed their own templates and guides. particularly for jurisdictional level management’ as part of their role but who may not yet and large institutional projects and programs. Some practitioners reported • provide sample tools and templates for use. while others have researched and • highlight current practices and trends across the developed tools as needed within a project or program. successes. and it is intended to: • build a common language for eHealth CM in Canada.

the CM framework). the group. based on direct relevancy to the widely across Canada ranging from jurisdictions with topic of CM and its activities within eHealth. with approximately 40 slated for inclusion in the final glossary. In total. and identify applicable tool sets and resources that align with the proposed key elements of an effective CM plan (i.3. to those with some locally consensus was sought for the final listing of terms and developed templates. Yukon. The survey focused on the that confirm successful execution and link to ongoing following areas: continuous quality improvement activities. a review of eHealth Communications. This synthesis environmental scan. Results were compiled and validated reflected that the availability of tools and supports varied by CMWG members. These materials have guided the • Tools and Supports population of content into A Framework and Toolkit for Managing eHealth Change: People and Processes.e. structured feedback via a standardized template that centered on five core elements of the CM Framework: 1. New Brunswick and added to reflect the importance of evaluating processes Newfoundland & Labrador. 29 documents were deemed to meet the inclusion criteria and objectives • Resources and Structure of the deliverable. In sum. strengths and gaps noted. • Current State Assessment BACKGROUND A Framework and Toolkit for Managing eHealth Change Methodology: A comprehensive literature search • Literature Review was initially conducted by Infoway’s Clinical Adoption • Glossary of Terms eHealth Information Services team. Ontario. the CMWG undertook a literature review with two key objectives: • To compare and contrast CM methodologies / approaches in use. • Approach After secondary review and discussion. 69 terms were initially identified by formal CM methodologies. Between June and October 2010. Stakeholder Engagement. Nova Scotia.3. element..1 Current State Assessment Governance & Leadership.3 Glossary of Terms CM terms and descriptions were identified and Responses were consolidated into a single dataset with documented during the current state analysis and overall themes. a total of 49 documents were reviewed by the CMWG.4 A sixth responses received from Alberta.2 Literature Review Between June and November 2010.3. Workflow Analysis & Integration CM methodologies and approaches was undertaken to and Training & Education. with was created using specified inclusion criteria. to those that had implemented descriptions. Group no formal CM supports. . this resource has been developed • To assist in the creation of a Glossary of Terms by using three pieces of work undertaken by the CMWG: listing and describing commonly used words and phrases within eHealth CM. Saskatchewan. 1. CMWG members each reviewed a selection of documents and provided Each of these inputs is briefly described below. “Monitoring & Evaluation. A survey was distributed to all jurisdictions. both nationally and internationally. • Successes and Lessons Learned • Sustainability 1. 7 1. Results were reviewed by gain a better understanding of current practice across the CMWG and a proposed ‘final’ list of documents Canada.” was subsequently Manitoba.3 Key Inputs to this Document As described previously.

8 CHAPTER 2 Introduction INTRODUCTION A Framework and Toolkit for Managing eHealth Change 2.8 When supporting activities focus on both people and Ultimately. risk. strong leadership. attitudes and/or work processes to achieve business objectives.1 What is Change Management? In general terms. adequate resources (capital and human). supporting activities over a sustained period of time. contract/procurement. CM is an integral on developing and implementing a meaningful approach part of project management processes. within the context of eHealth projects. change management (CM) is about supporting people through change. The term “change management” includes a wide range of This document is focused on CM practices as they activities and means different things to different people. an identifiable and measureable. transforming health care quality and efficiency. human resources. CM activities result in solution adoption and their organizations. The figure on the following page was developed by the a skilled team and the utilization of appropriate change CMWG to illustrate how successful change is dependent management techniques.” 12 organizational commitment.9 outcomes is created.5 The end result of effective CM is a change in behaviours. . This difference is reflected in the “…a strategic and systematic approach that reporting structures: in some jurisdictions.” 11 while changes. others refer to it as the art of change. implying that there yet they are crucial to overall project success. communications and more. Research undertaken by the Change Management Working Group (CMWG) identified that many CM Members of the Pan-Canadian Change Management practitioners focus on change at an enterprise or strategic Network (Network) have defined CM as: level. which are “tangible.” and there is a ‘soft’ side internationally recognized approach to CM. The outcomes activities contained within a single project. is a need to mesh both science and art to formulate a comprehensive CM strategy. refers to to CM that deals with intangible behaviours and culture this concept as the “people side of change. CM is a set of electronic health solutions. while others are focused on CM within the context of a single project. Typical requirements of successful CM include processes. relate to people and organizations undertaking change There are ‘hard’ aspects to CM. tools and techniques to proactively manage the human elements of change to achieve desired business results. quality. the potential for successful use. sound project methods.6 These are more difficult to measure and manage. impacting project to a transition that includes a series of relevant and scope. “requiring realization of benefits. of effective change management activities Implementing information and communications include solution adoption by users and the technologies (ICT) in health care is not easy.10 Prosci. CM is at supports people and their organizations in a programmatic level overseeing all aspects of change the successful transition and adoption of for healthcare technology and in others.” 7 As such. cost. time.

13 SUCCESSFUL A study by AMR Research found companies that OUTCOMES had successful software implementations spent 10 to 15 per cent of their project budget on CM implementation activities.19 One must also understand and activities required to facilitate an effective change process. 9 Literature has identified that poorly managed change can Figure 1 result in negative consequences including: turnover of valued What is Change Management? employees. disinterested.” 20 by providing them with the right tools and supports. serious). cancellation of projects.2 Organizational Change Management Organizational CM is focused on supporting people the organization and the degree of alignment between any to change their behaviours in specific. resistance in all forms (passive.17 Effective leadership that clearly communicates this vision From a leadership perspective. implementing change with a staged solution and information. and organizational decision making. offering system about the importance of data in supporting clinical sustained support for new users of a solution / system.15 COACH: Canada’s Health Informatics Association. desirable ways. lower productivity. mild. choosing a well- designed and resourced CM program that is aligned with working to optimize their engagement and use of the organizational culture. as PEOPLE ORGANIZATIONAL the necessary focus can be placed on supporting the people CHANGE CHANGE in the organization who make things happen. appreciate the political environment and culture within Hiatt & Creasey’s Prosci model refers to these key elements as occurring within three phases: 21 Figure 2 Prosci Model: Three Phases of Organizational Change Phase 1 – Preparing for Change Phase 2 – Managing Change Phase 3 – Reinforcing Change • Define your CM strategy • Develop CM plans • Collect and analyze feedback • Prepare your CM team • Take action and implement plans • Diagnose gaps and • Develop your sponsorship model manage resistance • Implement corrective actions and celebrate successes . and little or negative return on investment (ROI). easing disruption and facilitating demonstration provide helpful feedback and education for users of the of the benefits of the change as quickly as possible. increased absenteeism. and Activities INTRODUCTION A Framework and Toolkit for Managing eHealth Change slow or non-adoption of new methods and procedures. there are a number of is a critical first step. overt. suggests that best practices for dealing with implementation Current State challenges of ICTs for health include: recruitment of strong champions and sponsorship for change. unengaged. and monitoring data quality to approach.14 Allocating funds that support the adoption and execution of CM practices increases the odds of success. new ideas and the organization’s perceived “real needs.16 2.18. detached Approaches Future State employees.

Measurable. when and where this change will happen? happen and why it • What is required to keep the initiative moving forward? needs to happen within the planned • Is the objective data needed to convince the skeptics available? timeframe. • Are project management principles and methods being used? • Is the proportion of goal and task assignment appropriate? Grow Build organizational • Is the training plan sufficiently scoped and adequately resourced? capability systems and people • Are teams being developed and supported for high performance? competencies • Is support in place ensuring transfer of training to the workplace? necessary for affecting the change.10 Another way to consider organizational change is by in Allen’s (2008) The CHANGE Approach© and noted analyzing the change against six key phases. the organization? • Are implementation plans in place supporting attainment of goals? • Are performance measurement and reporting systems set up? Nominate Assign esponsibility • Are CM and new operational accountabilities clear? roles to specific individuals • Are the right people selected for the right roles? for the various tasks • Do people with responsibilities have the necessary skills? and outcomes. human resources and other systems support the new operational environment? Entrench Institutionalize the • Are performance results reported and successes celebrated? changes change to make • Is planning sufficient to ensure some quick wins? it “the way we do • Are terms the desired Realistic and Timely) goals? organizational • Are people involved in devolving the goals to lower levels of outcomes. • Has a communication plan been developed? • Are all stakeholders engaged in the change process? Articulate Define in specific • Do stakeholders take ownership of the vision and goals? goals and measurable • Are program goals SMART (Specific. summarized in the table below. • Is there a focus on soft skills as well as technical skills? • Do information. • What are the motivators for each stakeholder? resource holders and • Does the senior executive team support this change? those impacted by the change. • Do people feel the urgency to change? Harness Get on board the • Who are the stakeholders in this change? support key decision makers. businessperform. Figure 3 Six Phases of Organizational Change INTRODUCTION A Framework and Toolkit for Managing eHealth Change Creating Articulate why • Is there a clear and compelling reason for adopting this change program? vision change needs to • Is it clear how. rewards and recruitment systems aligned with things around here.html .” the change objectives? • Are new meanings provided through creating workplace symbols? • Do managers and supervisors lead by example? Used with permission of author. Attainable.

people aspects of implementation.4 eHealth Change Management in Canada Adoption and benefits realization of electronic health • Demonstrating early results based on comprehensive solutions is accomplished using an integrated approach data is important. CM efforts across Canada led the CMWG to undertake its current state assessment (please see Section 1. • change team diverted to other projects. reasons. and and the mandate of its regional teams. This combined team includes members with deep 2. health systems and care management and effective use of cross-functional teams. and management support. processes to increase the successful adoption of eHealth The need to integrate CM activities into many aspects solutions.3. including project planning. as well as the CM teams integrated within the overall project team. including: 24 • hope rested on a one-dimensional solution. • absence of a change champion or one who is too junior in the organization.1 for Other key findings from the current state analysis are additional details). nor did any jurisdiction formally reference a set of principles guiding their CM approach. INTRODUCTION A Framework and Toolkit for Managing eHealth Change • poor executive sponsorship or senior • poorly defined organizational objectives. . • Those individuals and organizations who directly this tactic resided within project-level implementation benefit from the initiative are often the most effective methodology. In a number of jurisdictions. one particular CM model. described below: Key findings of the CMWG assessment of change projects Approach to CM: All responding jurisdictions across Canada identified the following best practices: recognized the importance of CM and have developed unique delivery approaches. With the exception of Manitoba. Integrated project planning fully considers the of eHealth projects necessitates having multidisciplinary technology.3 Change Management in eHealth CM is a necessary component of all aspects of eHealth clinical knowledge and understanding of the effect initiatives. which has at executing the initiative. project of technology on clinicians. CM efforts are • Initiatives that demonstrate clinical value will be underway in every jurisdiction to support eHealth supported and those that do not include clinical solution implementation and adoption. no other jurisdiction referenced technology are most often successful. wholly adopted Prosci 25 as its approach for supporting • Initiatives that leverage standards and proven people through change. adoption and benefits evaluation. clinical and business processes. 2. to CM. 11 Failed organizational change tends to occur for several • poor project management skills. Recognizing the adoption as a goal from the beginning will struggle importance of documenting and sharing the breadth of or fail to be adopted. • political infighting and turf wars. Infoway’s Clinical Adoption team works to support this • Continuous quality improvement cycles should be pan-Canadian effort through its investment programs applied.


Resourcing: Responsibility for CM resides with senior change, end user sites or privacy and security; while no
management in all jurisdictions and is mostly delivered tools were identified to support the development and
by contracted resources. Across all respondents, no formal communication of value propositions or user adoption. In
governance mechanism guides or supports CM executives addition, the questionnaire administered by the CMWG
and resources. The percentage of total project budget identified sustainability as a critical CM concept, and the
INTRODUCTION A Framework and Toolkit for Managing eHealth Change

spent on CM varies considerably across the jurisdictions relationship between sustainability and continuous quality
and with size, scope and type of project. improvement was confirmed as an important area for future
consideration. Only one jurisdiction reported formally
Tools and supports available: Readiness assessment, identifying sustainability as a required CM deliverable
stakeholder engagement, workflow integration and training within its project management processes, backed by the
are supported with a wide array of tools across the eight support of a Reinforcement Sustainment Plan.
responding jurisdictions. Fewer tools support individual

2.5 Building a Case for Change
The value and benefits of eHealth solutions are not Making a strong case for investing resources in CM will
always readily apparent to all stakeholders. Building a focus stakeholders’ attention on the value proposition; act
compelling case for change is an important first step in as a vehicle to discover value for all stakeholders; act as a
the CM process. For most stakeholders, demonstrating building block for communication and training material;
the WIIFM (what’s in it for me) proposition is essential. and be used to secure additional resources for the project and
communicating value to senior leaders in the organization.
The case for change can be articulated formally as a
business case or a vision statement that clearly articulates The case for change also identifies the positive or negative
the reasons for changing linked to the desired outcomes. 26 influences on the objective of a project. A number of
In either case, leaders should help to build the case for methods can be used to obtain this information:
change and identify the consequences of not changing
by profiling the: • think tank, brainstorming sessions;

• clinical imperative that people understand and support • focus groups, working groups;
(i.e., articulate why the change is important and how • interviews with various individuals from selected
it makes a difference to the work of the organization target populations;
and its stakeholders (clinicians, administrators, other
staff, patients and so on)); • results of questionnaires or grounded studies on
organizational climate;
• desired benefits and value proposition;
• observations, field study;
• forces (external and internal, economic, political,
social) that make this change necessary; and • work flow mapping, process analysis;

• cost of the status quo (i.e., the opportunity cost of • management reports on organizational performance; and
doing nothing).
• analysis of actual clinical use cases.


A National Change CHAPTER

Management Framework 3

A NATIONAL CHANGE MANAGEMENT FRAMEWORK A Framework and Toolkit for Managing eHealth Change
A change management (CM) framework has been developed by the
Pan-Canadian Change Management Network (Network). Below is a
discussion of the framework’s key components, a brief overview of
important concepts, links to relevant tools and templates, and
suggestions for further reading as derived from the literature review
and other sources. Where applicable, findings from the current state
assessment are highlighted.
Some tools and templates may be used more than once key elements within the CM process that need to be
through the course of a change initiative and as such, may addressed, both in planning and in execution, to ensure
also be referenced in other sections of this document. success. Additionally, the group recognized that sharing
information and lessons learned across projects and
jurisdictions is critical for achieving rapid improvement
Rationale for a National Change in process and approach based on this wealth of CM
Management Framework experience and knowledge.
Experience from the front lines, as well as an analysis of the The Network membership concluded that information
pan-Canadian current state assessment, show inconsistencies and communications technologies (ICT) for health
in approach to CM. In many instances, elements of CM projects should incorporate the following six core
are done well, but may not have been completed to their CM elements:
full extent. Further, some CM plans are often outdated
or irrelevant by the time solution implementation occurs. Governance & Leadership
As such, they are never fully executed into actual, tangible
practice; thus failing to have the desired strategic impact Stakeholder Engagement
of influencing user adoption and benefits realization to Communications
their maximum potential.
Workflow Analysis & Integration
According to “lessons learned” documents and anecdotal
evidence from change leaders across the country, issues Training & Education
in user adoption were often a result of CM elements
Monitoring & Evaluation
that were either delivered ineffectively or missed
completely. This most often occurs because of a primary The national CM framework is shown on the
focus on technology implementation rather than a following page.
strategic, tactical focus on people. Discussion among
the Network membership concluded that there were


Figure 4 to obtain buy-in from stakeholders and overall
Change Management Framework loss of productivity.

Stakeholder Engagement: Without considering
stakeholders, particularly the actual people who need
A NATIONAL CHANGE MANAGEMENT FRAMEWORK A Framework and Toolkit for Managing eHealth Change

to make the change, there is risk of failed solution
GOVERNANCE uptake, creation of angst and emotional upset, loss of GOVERNANCE
respect for leaders and project implementers, as well
as failure to achieve any return of investment or value.
STAKEHOLDER Communications: Consistent and repeated STAKEHOLDER
communication about the strategy or project and the
desired end goals and objectives is vital. Without it,
information would not reach those who need to know.
EVALUATION The value of what is trying to be achieved may not EVALUATION
be recognized, stakeholders would not be aware or
engaged in the process, innovation and creative ideas
would never be shared, and the required education
WORKFLOW and training would not be successfully delivered.WORKFLOW
Workflow Analysis & Integration: Without
considering the ways that people work and how business
is conducted, it is not possible to incorporate a new tool
Outcomes of successful eHealth change lead or practice, disrupting the workplace and potentially
to solution adoption and clinical value, benefits duplicating efforts. If people are unable to easily use the
realization and overall health care delivery technology or fail to see its value, it will not get used,
transformation, positively impacting health wasting valuable resources and halting progress.
outcomes for all Canadians.
Training & Education: An education plan that
considers approaches to prepare the organization
Why these elements? and users for the upcoming change is critical. It
forms the foundation upon which solution training
Much literature exists to reflect the importance of each occurs, and continues over the longer term, ensuring
of these key elements 27 and the concepts are covered in sustainability and optimal use. Without execution of
more detail throughout this chapter. The value of each of comprehensive education and training plans, few, if
these domains of activity is realized when one considers any of the project goals can be achieved.
the negative consequences of not incorporating them.
Monitoring & Evaluation: Paying attention to
Governance & Leadership: Without an effective process through ongoing monitoring and evaluation
governance structure, the strategic view that links provides opportunity to identify risks. Without
project tasks together – the “what are we doing” focusing on these issues, opportunities to improve
and “why are we doing it,” never gets answered process, to identify gaps or to recognize success do
and the project risks loss of aim, direction and not take place. Ongoing monitoring and evaluation
successful execution. Without an engaged leadership is essential to understand and manage progress
structure supporting the change activities, as well toward the future state. Lessons learned and process
as desired future state, there is risk of discord and improvements need to be integrated in real-time, to
negative impact to organizational culture, failure avoid repeated mistakes.

steer or governance framework for eHealth are identified as useful principles regulate the course of an organization programs. 30 An to which the governance model(s) approach developed in the province should adhere. greater alignment with organizational priorities and governance structure.1 Governance objectives of each organization. Figure 5 it is important to establish formal Alberta’s eHealth Governance Framework arrangements for governance (and management) of change programs to Planning clearly establish roles. responsibilities and “who does what” throughout the • Visioning • Prioritization program or project. benefits to the project later on. The governance • Goal-setting • Global budgeting structure identifies the mechanism • Policy formulation • External liaison by which stakeholders can affect the priorities and progress of a project.1 initial planning process may reveal below describes the scope of Alberta’s key partners that. aiming also supports the integration of technology into practice. to minimize negative consequences. The figure more buy-in from stakeholders. delivery and operations. 15 A national CM framework helps to proactively focus solutions and presents communication opportunities. • Project approval • Schedule maintenance stakeholder analysis and engagement • Status tracking and reporting • Resource allocation at the outset of a project can • Budget monitoring • Change control contribute to successful governance and long term project success. It attention to these core and vital activities. Thoughtful and overall. Delivery Effective project planning. both in planning transition from the current state to the newly desired end and in execution. Simplicity. Governance concerns the mechanisms of Alberta is one example of a useful efficiency.1. There is no single best model for The approach also identifies three governance. one of terms of principles. This is the goal of the national CM framework. 29 With respect to eHealth projects. it will look different in elements of a governance model in each organization. the . For example. structure GOVERNANCE the most critical success factors of and processes. supports people and their organizations as they contemplation of these undertakings. A NATIONAL CHANGE MANAGEMENT FRAMEWORK A Framework and Toolkit for Managing eHealth Change 3. as follows: & LEADERSHIP effective governance is that the model must match the unique culture and • Principles: the guiding policies 3. to better decisions. clarity and transparency that are used to guide. This model addresses both for a complex environment such or system. if included in the eHealth governance projects from governance structure. Indeed. Operations Engaging end users/stakeholders • Infrastructure maintenance • Service level monitoring when defining governance structures • Staff management • Procurement and supplier has been shown to contribute to management • Troubleshooting successful outcomes in complex • User support solution projects. 28 Strong governance leads scope and key components of a good as eHealth. proactively considers users of eHealth state. may result in three different dimensions: planning.

In a project-based to project management that provides Figure 6 Integration of Change Management Processes into a Project Process and Governance Structure Adapted from PRINCE2 Project Process and Governance Structure Diagram – (CCTA. committees and strong governance and project project has to be adjusted when it organizational units. knowledge of this methodology is • Processes: the operating modes but has since evolved to become a required for some CM leadership and “ground rules” for operating globally recognized standard project roles in Canadian jurisdictions. 31 incorporating CM into a project CM is an important contributor to process and governance structure PRINCE2 is a structured approach such as that suggested by PRINCE2. environment. the model and making decisions. how to design and supervise A NATIONAL CHANGE MANAGEMENT FRAMEWORK A Framework and Toolkit for Managing eHealth Change governance model. 1996) 32 Corporate or Program Management Directing a Project Project Project Project End Stage End Project Lessons Authorization Initiation Advice Reports Mandate Brief Reports Reports Learned Document Starting up Initiating Controlling Managing Closing a Project a Project a Stage Stage Transition a Project Work Pack Quality Checkpoint Authorization Work Pack Closure Managing Project Delivery Project Planning Change Management Planning . among the major participants in work hand-in-hand to ensure that PRINCE2 describes procedures to the information management/ projects progress as expected. governance mechanisms a method for managing projects responsibilities and relationships and project management structures within a clearly defined framework.16 • Structure: the roles. including rigorous project management with the project. structures was originally developed doesn’t develop as planned. known as the Figure 6 provides a graphical Having effective governance PRINCE2 (Projects in Controlled representation of one approach for mechanisms in place to support Environments) methodology. project success. A coordinate people and activities in a information technology common model for integrating project. management approach. Working for use in the United Kingdom. and what to do if the individuals.

leadership is distinct from management. Figure 7 – NEWFOUNDLAND & LABRADOR EMR DEFINITION PROJECT A NATIONAL CHANGE MANAGEMENT FRAMEWORK A Framework and Toolkit for Managing eHealth Change EMR Project Governance Structure – PROJECT GOVERNANCE Newfoundland & Labrador displays the governance model that is in place for their electronic medical record Department of Health and Community Services (Project Sponsor) (EMR) program. including and unqualified support of the • The Initiating Sponsor – CM related roles. beginning The executive who launched the been reflected in the table below. 17 Newfoundland & Labrador’s Centre Figure 7 for Health Information (NLCHI) has EMR Project Governance Structure – Newfoundland & Labrador adopted an integrated approach to project planning with a core project team which includes CM. Every project needs to have strategic. and a template to assist that are required to meet them. 3. In this context. • The Sustaining Sponsor – Could in further defining roles and including CM. Ideally. reflect a clearly articulated future state.1. Successful Team Manager Infoway CM requires that a variety of organizational and/or other Clinical governance structures and roles be Change Business Technical Working Privacy Standards Management Services in place to provide the leadership Group and accountability for ICT projects. and a group of local projects on time and budget. .3 Key Roles in the operational and tactical level Change Process success. leaders who are accountable for successfully implementing change. the objectives be the program or project steering responsibilities (e. lead role. but also the activities and accountability. translate the vision into a reality. with the CEO of the organization. rather than simply executing committee. Many projects lack change leadership and direction to achieve leadership and accountability. Informatics Association (COACH) Although there is no exact formula has developed a Health Informatics The guiding team often includes to follow in implementing an Professional Career Matrix 34 which multiple levels of leadership and eHealth system. Usually remains committed The associated toolkit for this The senior leadership needs to but is a little more removed document also provides a sample support not only the objectives of from the daily leadership job description for a CM project the project. and and change agents is required to of distinct roles. some of which have senior executive team. RACI chart). change progress.g. Canada’s Health project success. including: success appears to be the complete and related competencies. is an important characteristic of 3.1.2 Leadership Project Steering Committee Clearly defined leadership and accountability structures at the outset of the project will motivate Centre Project Project Canada Health others to adopt change. • The Target Sponsor – The local although effective management level leader of the change. one ingredient for identifies 65 health informatics roles management. A CM initiatives require highly the required balance of decision “guiding team” of change leaders integrated teams involving a number making. 33 idea.

• expected to behave differently in the ‘changed’ organization. and “users” • will be accountable for sustaining future state performance. and • support. physicians. • is able to command resources and the attention of the executive team. nurses. Champions for adoption. and will benefit from the change. and by creating be well articulated and agreed to by a sense of urgency around the need those fulfilling the roles. Leadership is required at all vision through their advocacy. leaders. • set up environments so change can happen.. and Chief Technology Officer • the program succeeds. console and coach others through the change process. i. Individuals who: Team leaders • are responsible for supporting and communicating change initiatives. • problems are solved. e.. A senior member of the organization who: Allied Health Director.g. and • maintain the overall responsibility for detailed planning and implementation of one or more components of the change program. and researchers. The executive’s representative for ensuring that: Chief Nursing Officer.g. Clinical Informatics Director. Front line supervisors.e. of the solution Clinician leaders who embrace the as well as roles and responsibilities across all aspects of the organization / change contribute to the project for all positions including change initiative. • has a strong personal commitment to the success of the program. Director Change Agent(s) Project Manager. A NATIONAL CHANGE MANAGEMENT FRAMEWORK A Framework and Toolkit for Managing eHealth Change e. Advocates Middle managers. Chief Information Officer. and Information Technology • is the principal trouble-shooter. • appropriate resources are committed. these individuals: • manage and perform tasks to bring about change.e. administrative staff. demonstrated use. • allocate required resources within their area of control. • use their influence with others to support the initiatives. Stakeholders Front line clinicians. Medical Director. CHANGE LEADERSHIP ROLES Change Leader(s) Business Sponsor. • directly affected by. Members of the project team who are seen to be implementers and CM Specialist enablers of change. Transition & CM Lead. Governance structures. participate in. of the change need to be cultivated . Individuals who are: allied health professionals.18 Figure 8 Change Leadership Roles Description Examples Executive Sponsor(s) Program Sponsor. i. agents and advocates must levels of participating stakeholders. Chief Medical Officer.

) Governance Advisory Committee project close-out.1. Pare. L’auteur explique Infoway’s online Resource Centre.) It has been structured to follow the implementation process and provides • Job Fact Sheet – Sample Template The aim of this presentation was to items to consider and activities that equip organizations with relevant will happen. Change Management for 3. Clinical selected industries outside health care continue to invest in information Deployment Guide for Clinicians: A with lessons that could be applied to technologies to improve quality One Stop Guide to Clinicians Involved the Canadian health care context. 18p.» at all levels of the organization.1. Change Electronic Medical Record (EMR) Health Projects Management Strategies Workshop: implementation and the associated Change Management Strategies for Electronic Health Record (EHR) • Roles and Responsibility Effective EMR Implementations services within the physician clinic. Charting (RACI) (2011. It • Risk Assessment Form Saskatchewan Medical Association. White Primer. understanding the factors that influence organizational readiness “The guide is designed to help for change represents an important clinicians involved in business avenue for future research. or in initiatives. Varkey.” change projects enabled by information technology by helping them understand how they can contribute effectively and what roles and responsibilities they may be asked to undertake. 33p.) the odds of success because focus pan-Canadian EHR and describes is placed on the people in the “ Organizational readiness is arguably a organization who make information governance mechanisms key factor involved in clinicians’ initial things happen. American Journal of Medical Paper on Information Governance of G. and continuity of care and reduce in Deploying IT Systems (50p.4 Resources and Tools Cancer Care Ontario. It P. Adoption of change security implications for personal Surveys Implementation Science management practices increases health information in an interoperable (March 2011.) costs.” • Control and Influence Assessment skills and the understanding required to develop targeted CM strategies. The following list refers to resources Method for Large-scale Clinician L’Actualité médicale (Mars 2011) and tools available in the online Change Management Initiatives « La résistance au changement est toolkit located in Canada Health (2011. 19p. Clinicians’ Perceptions Quality (Jul-Aug 2010) the Interoperable Electronic Health of Organizational Readiness for “The authors provide an overview Record (EHR) (March 2007) Change in the Context of Clinical of the steps to design and execute This paper addresses information Information System Projects: QI projects that require change governance topics with privacy and Insights from Two Cross-sectional management. identify the right les résistances et de susciter Readiness Assessment stakeholders and create momentum la coopération. “ This guide is for clinic champions • Determining a Project who have to coordinate the Governance Structure for Kaiser Permanente. Morazain.) incontournable.5 Further Reading provides a set of successful practice Effective Quality Improvement: a approaches and lessons learned.” that are currently in use in health care support for clinical information system in Canada and other countries. 19 3.” . 14p. A Three-Step J. As healthcare organizations NHS Connecting for Health. discusses how to build sustainability into efforts from the beginning to EMR Champion Guide. Canada Health Infoway. Gérer le changement. Ministry of • Sample Terms of Reference – ensure continuous improvement past Health (2010.36 This presentation describes how l’importance d’apprendre à bien A NATIONAL CHANGE MANAGEMENT FRAMEWORK A Framework and Toolkit for Managing eHealth Change to match CM strategies to specific gérer le changement afin d’atténuer • Organizational Change objectives.

Stakeholders are described strategic direction and operational empowered to devolve decision- as “…persons. the implementation of this strategy. These Engagement can be mapped distinctions are described in the “any group or individual who can on a continuum. to the maximum extent possible • increase the likelihood of an Empower We will implement what you decide initiative’s success and minimize the risk of failure. Ideally. 40. .” 38 on the need for engagement. for the purposes of sharing with the goal of creating stakeholder information.41 being implemented. Stakeholder engagement that must somehow be taken into and to contribute to the kind of goes beyond informing and account by leaders. Stakeholder Stakeholders may be involved for any STAKEHOLDER engagement strategies are then one or combination of the following: ENGAGEMENT defined in response to these needs. understood and openness for sharing of information. making. creating an involved and interchanged with partners and stakeholder engagement is to “drive or shared resolution or being customers. considered when implementing The model below is widely used to eHealth projects.20 3. one of describe stakeholder engagement the most important stakeholders and forms the basis for this A NATIONAL CHANGE MANAGEMENT FRAMEWORK A Framework and Toolkit for Managing eHealth Change is the end user of the solution stakeholder engagement strategy. developing frequently. involvement and seeking feedback. Stakeholder engagement front-line members.2. feedback on how your input influenced the decision • prepare stakeholders for the work Collaborate We will incorporate your advice and recommendations necessary to complete the project. at a minimum. Often.” 37 They can be organisations. listen to you. their stakeholders and requires. but is often confused trust. and provide and involved.” 39 of involvement or collaboration Stakeholders can be considered as during the change process. as the level of table below and are used to inform affect or is affected by the achievement engagement will vary depending the tools developed to support of the organization’s objectives. The overall purpose of consensus. providing education. wider society can benefit.2 Stakeholder behaviours and needs stakeholder and the degree of must be defined.1 Why Involve Continuum of Stakeholder Engagement Stakeholders? All initiatives can derive benefit or be put at risk through the degree Inform We will keep you informed to which stakeholders are engaged Consult We will keep you informed. groups or organizations excellence for organisations. Figure 9 3. some degree internal or external to an organization. The term “stakeholder” is used commitment. managers and sustainable development from which consulting. stakeholder feedback on how your input influenced the decision involvement will: Involve We will work with you to ensure your concerns are • ensure stakeholder input into considered and reflected in the alternatives and provide the project.

processes and approaches to engage initiation. stakeholders and key partners. and difference between stakeholder stakeholder identification and analysis groups will provide an • as participants in formal and are the foundation for effective opportunity to target messages informal clinical advisory groups.2. . re-visiting this assessment at regular 3. A NATIONAL CHANGE MANAGEMENT FRAMEWORK A Framework and Toolkit for Managing eHealth Change and programs. 21 • create and sustain winning and other forms of engagement such 3. values and beliefs essential. as well as 1.2 Individual Stakeholder Engagement • through regularly scheduled work intervals throughout the project group sessions. that strong stakeholder engagement minimal compared with costs of Each is briefly described below. There are four key components of • ensure long-term viability of any good stakeholder engagement organizations. Analysis: Understanding the ascertained and managed from the and testing of the solution phases. plans The Change Management Working process: identification. Successful implementation engagement process is stakeholder that can be integrated into the projects must have structured identification during project change program. indicating • mitigate risk – time investment is understanding and incorporation. requirements and timelines should be anticipated. Group (CMWG) survey supports the analysis and prioritization. Segment and and participate in a number of Prioritize Stakeholders: There may be different ways. prototype and build. issues that matter most to beginning to avoid misunderstanding stakeholders will assist project and/or disappointment. gathering. communication and training activities.3 Process for coalitions. but often include: a wide range of views into their buy-in throughout the project internal stakeholders. and involve key clinical end user many projects either neglect this • help stakeholders understand the groups. literature in this regard. policies. to engage other end users across understand and mitigate Stakeholder identification and the jurisdictions. segmentation. external developing a case for change and lifecycle and beyond. Investing time organizational stakeholders. supporting and promoting the near the beginning of a project and change initiative. of communication. as working groups and requirements Engaging Stakeholders gathering undertakings. analysis is often the first exercise in a series of CM and implementation • for ad hoc information and Segmentation: Identifying the activities. Although self-evident. • in formal project leadership roles teams to better prioritize. and training. 42 Stakeholders can be engaged 2. the project duration. Results from a complete feedback sessions. planning. Their • at structured sessions during components to this step: expectations with respect to benefits strategy. lifecycle improves the likelihood Stakeholders must be identified at of success. Experience reported from altogether or limit the attention value proposition and specifically Saskatchewan indicates building and paid to even the most obvious their “WIIFM”. and methods of engagement. frequency and quality not involving stakeholders. in articulating both clinical and patient benefits.2. Identify Stakeholders: The • provide access to a wide range of clear communication channels are first step to any stakeholder views. expertise. Analyze. engagement risks. Frameworks for with stakeholders is important for categorization may vary by • support the incorporation of demonstrating value and sustaining project. and maintaining strong relationships stakeholders. including: This step attends to the issues and considerations for individual concerns of stakeholders throughout stakeholders compared with • as champions and super-users. There are three key the outset of change projects.

44 approach to take when coaching Perspectives: Anticipating team members. Incorporate Stakeholder • GROW: A model sequence to • using questioning techniques Perspectives: The extent to follow when coaching. is the “process that to do to improve their performance enables learning and development and where the person is accountable Some specific and simple to occur and thus performance to for achieving the agreed actions. 47 in making real. listening and explicit at the outset. A NATIONAL CHANGE MANAGEMENT FRAMEWORK A Framework and Toolkit for Managing eHealth Change project’s outcome and who Connecting for Health website 46 Coaching increases the knowledge are highly influential. counselling and more inclined to participate Where the coach and coached and networking. • Options – where possible recommended courses of action • applying tools and techniques. solutions are explored are not adopted. and for Performance. 43 These details some of the styles of coaching and skills of the change agents (e. A detailed explanation of the • managing the relationship to GROW model can be found in ensure the individual receives the John Whitmore’s book “Coaching appropriate level of support. experience required in the areas that it out. the “ground rules” long term aims for such involvement will be made • observing. with specific them manage and support the change • Checklist: Where a coach gives engagement and management process. confidence or desire questions can be unique to each project. techniques for undertaking these improve.4 Coaching & • ensuring training and education have a higher degree of influence. skills and thought the project. in future projects as well as much agree the action to be taken and more likely to support. This is an opportunity to to do it. The skill/will matrix • exploring needs. Understand Stakeholder skills and techniques. establish the short. Parsloe (1999). have “super-stakeholders” who an individual’s confidence in their are particularly invested in a The National Health System’s ability to accept and adopt a change.g. in Figure 10. some projects may Developing knowledge is critical to individual need. even if their individual’s situation. Coaching. training and and understanding stakeholder of benefits to the individual understanding of the individual perspectives is another key step in transitioning through a change and and the will refers to their the engagement process. managers are guided on the best process as well as the variety of styles.” 48 . Regular feedback including one-to-one training.2. The skill is the Coaching provides a number experience. skills-transfer coaching is offered. supervisors. Ideally. etc. “super-stakeholders” must be that a leader may choose to employ: managers. and how stakeholders and Blanchard and is depicted processes to assist the individual wish to participate. Specific is based on: 45 motivation.) to help identified early on. 3. lasting change. Stakeholders asking questions that reflect • Reality – exploring the current need to know their voices an understanding of the situations and discussing obstacles have been heard. reach out to solicit views about is the original work of Hersey desires. adopt and • possessing the qualifications and make a commitment to carrying champion the change.22 Prioritization: Some stakeholders 3. to facilitate an individual’s own which stakeholder perspectives thought processes in order to • Goal – the questions you ask to are incorporated into projects will identify solutions and actions. 4. motivations. will make stakeholders feel valued • Will – what is to be done next? facilitating. Resistance Management programs are aligned with the In fact.” Successful coaching requires analyses are included in • Skill/will matrix: Where knowledge and understanding of the toolkit. medium and vary. as defined by guidance on what the person needs strategies identified for each.

any change will have and converts. 23 Figure 10 Change is often met with resistance Skill/Will Matrix for a variety of are some suggestions for dealing with resistance. by Laura Whitworth et al. 50 depending on where your organization is at in implementing a • From the UK’s Northumbria change AND where the individuals University. but being prepared to need.” 52 and discussion. addresses a short term As such. • do not feel the wider community would see the value of the proposed change. attends to skills and wouldn’t want to change it. 49 • Accommodating new reality Considering the above. co-active coaching • Initial disbelief – it won’t happen! aims and objectives. • cannot identify “what’s in it for me” (WIIFM). nor have any shared High Will GUIDE DELEGATE opinions or views been considered.5 Addressing Challenges or time to adjust to the changes. help it! changing more urgently. • have not been given the support • Co-active: Based on the belief that 3. Joint Information within the organization are at with Systems Committee Change accepting the change. reactions: 51 As coaching is about working in • do not have clarity about change partnership. Stakeholders can feel they: • have not been consulted or A NATIONAL CHANGE MANAGEMENT FRAMEWORK A Framework and Toolkit for Managing eHealth Change involved in the change or its design. emphasizes feedback and working with the early adopters to the learner. planning for In essence. requires active participation from • Anger – it won’t happen if I can • believe other things need both the coach and the stakeholder. and Details on this coaching model. • do not trust/do not respect/do not Low Skill High Skill like the person/group proposing the change. a person has the answers and the Most major change processes • are expected to change too many coach helps to unlock that person’s elicit some or all of the following things at the same time. . enthusiasm for the change process performance. Low Will DIRECT EXCITE • like the present status quo and question their confidence and competency in the new context.2. and enables explicit feedback its supporters and its resistors challenge and win over the skeptics. coaching: focuses – that works quite well and I change involves “not only generating on tasks. and the skills and techniques can • Acceptance – if it’s going to happen • do not think the time is right for be found in “Co-active Coaching” then I might as well do it! this particular change. ac. potential to achieve their goals. Management toolkit (jiscinfonet.

interventions. Framework National Health Service explains the value of working with stakeholders Assumptions within the force field 3. and why leaders might use stakeholder “Employee engagement is the art identification and analysis techniques • Reducing resisting forces is and science of engaging people in to help their organizations meet authentic and recognized connections preferable because it allows their mandates. and implementing.” with Stakeholders analyze ways to increase the driving forces and decrease the restraining • Force Field Analysis NHS. review resistance can require the need and adoption.54 A NATIONAL CHANGE MANAGEMENT FRAMEWORK A Framework and Toolkit for Managing eHealth Change 2. creating ideas leveraged. movement in the desired direction and create public value. and transformed force in resisting and shaping for strategic interventions. (50 p. without increasing tension. Recognise that there will and politically acceptable. including into result. building a winning coalition employee engagement. roles. Clinicians Involved in Deploying • Stakeholder Analysis 3.) “The guide is designed to help 4. Identify and NHS Connecting for Health. A range of organization. The following list refers to resources to both challenge and change an monitoring and evaluating strategic and tools available in the online toolkit individual’s perceptions and beliefs. Work with the early adopters and help frame issues that are solvable then move onto the main group in ways that are technically feasible • Are You EMR Ready? of staff. Acknowledge that managing 3. and techniques is reviewed.” 53 problem formulation and solution 14 element model for defining search. energy.6 Resources and Tools around proposal development. Zinger Model of equilibrium is maintained but This article focuses specifically on how Employee Engagement under increased tension. Reflect on activities and processes • Target Audience clinicians involved in business undertaken to date. 21-53. .24 1. community.2. relationship. the current vol. listening and involving • “Increasing the driving forces Stakeholders Matter. and that A Pre-Implementation always be some staff that finds advance the common good.” This guide provides a organizational change. stakeholder identification and analysis customers.2. work with this group to minimize • Stakeholder Engagement Clinical Deployment Guide for their impact by ensuring the Planning Template clinicians: A One Stop Guide to majority are on board. them understand how they can Stakeholders contribute effectively and what roles Undertaking a force field analysis • Communicating and responsibilities they may be may be one way for a CM leader to asked to undertake. Question if Analysis Template change projects enabled by there are other ways to achieve information technology by helping • Model for Prioritizing the desired outcomes. The article argues that located in Canada Health Infoway’s wise use of stakeholder analyses can online Resource Centre. and Segmentation IT Systems. Public stakeholders is the key to successfully Management Review (2004) delivering service transformation. 6 (1) pp. fulfill their missions to strategy. performance. including • Group norms are an important well-being as work connections are organizing participation. Bryson. Thus. Additional Stakeholder Engagement information regarding this approach • Resistance Management This slide deck developed by the can be found in the toolkit section. Practical Guide to forces of a change. Confront the sceptics head on. Readiness Assessment change difficult. results in an increase in the resisting forces.M. development.7 Further Reading and uses case studies to show how analysis theory include the premise that: J. What to do when consulting. sustained.

Specifically. CMWG Current State Assessment need to understand their respective found that in Yukon. and other stakeholders. including the consequences of not changing.3 • reporting progress – or lack of • consider who the message is – so people can be responsible coming from. Workflow analysis (described roles in communicating with a broad well-timed and well-considered below) can also contribute to range of stakeholders. knowledge objects. and feedback mechanisms. communications delivered by a single communications activities by As applied to the eHealth context. information about the need format. point of responsibility have been a identifying the magnitude of the the goals of communication include: major contributor to project success. • key messages. messages to these audiences. comply with or commit to the initiative. at the right time • required frequency and format. organization. and dialogue. message. language. • ensure there are two-way dialogue The ability to deliver the right • information requirements. change required from stakeholders. outlet. frequent. what and how. Targeted approaches messages for specific stakeholder • create a feeling of belonging. the achievements regularly and widely to need to know to make informed approach to communications should: keep people motivated and involved choices about whether/how to • start early in a project and and the initiative moving forward. of changing. An effective communications approach • responsibility for the provision • identify and gather “requires a matrix of thinking and of information. etc. 25 3. is very important. contributors to success. COMMUNICATIONS • definition of target audience. and . and prompt appropriate responses CM planning exercises to identify and/or actions. Communication approaches Significant changes will require a • soliciting feedback – engaging in heightened communications effort two-way communication that promote awareness and understanding of the expected over a longer period of time. • make use of a variety of tools Minimum core components of and outlets. A NATIONAL CHANGE MANAGEMENT FRAMEWORK A Framework and Toolkit for Managing eHealth Change communications plans include the following: • provide a mechanism for sharing project information.” 55 Communications Communications planning builds • manage rumours and handle serve to inform diverse stakeholders upon stakeholder analysis and misinformation. • organize the content of messages through the right channel. The • evaluate the effectiveness of the Change leaders and implementers communications approach. and to communications are defined in groups and various ways to deliver response to the stakeholder analysis.). describe the why. by the right person. • building trust with candid • consider the audience (messages. for change and the difficulty frequency. to the after consulting the final users and right audience. change by all affected stakeholders Change leaders should report • providing people with what they are required.

26 3. A NATIONAL CHANGE MANAGEMENT FRAMEWORK A Framework and Toolkit for Managing eHealth Change • Key Questions Associated with  his book discusses general reasons T to communicate. Eastman.) . Infoway’s online Resource Centre. This tool is based primarily on Dan S.3. Chicago: 2010. Cohen • Sample FAQ Template “The Heart of Change Field Guide” (2005) also contains numerous templates.3.1 Resources and Tools 3.56 HiMSS. • Communications Plan Template Communications Planning Slide deck that provides a • Preferred Media – Project comprehensive guide to Communications communications planning and is closely aligned with the Stakeholder • Communication Diagnostic Engagement domain of the CM • Simple Communications Tools Framework. Change and tools available in the online management strategies for an toolkit located in Canada Health effective EMR implementation. (Available in the online toolkit. successful practices Communication Planning for effective communication • Communication Planning Tools – and includes a communication Audience Assessment Template implementation checklist (pg 107).2 Further Reading The following list refers to resources C. McCarthy. D.

the Ideally. designing new workflow this can be done by involving team implementation approach for their processes should incorporate best members in a variety of planning drug information system (DIS) practices from both the clinical activities and by producing an supports integrated strategic practices and technological requirements. meet the requirements of the system. current environment. or processes Integrating people. workflow assessment and about processes that might have been integration is considered to be a key in place for many years. Business requirements are contribute to a successfully aligned There is often a struggle between documented early in the project and implementation and appropriate technical and clinical requirements cover business and information flow. teams are often pressured can ensure timely delivery of related substantive understanding of how to change their workflows solely to project activities. people change within organizations. manual scanning of communications plans. be weakened significantly if there A NATIONAL CHANGE MANAGEMENT FRAMEWORK A Framework and Toolkit for Managing eHealth Change the business analysis team conducts is poor correlation or integration the process mapping with the with project plans. a workflow analysis can and integration into CM plans. • opportunities to communicate the represents an opportunity to think potential benefits of change. 58 serve as a “petri dish” for other The objective of workflow analysis aspects of CM occurring later in the and integration is to embed new Often. etc. Accomplishing In New Brunswick. and electronic medical record into opportunities for progress afforded a physician office environment by new or enhanced technology.). training and other Requirements Plan’ address workflow equipment. Implementing new systems provides to implementing new technologies an opportunity to reexamine • stakeholders who may become will stimulate critical analysis on workflows and processes so that champions or who may create how work is performed in the they may take full advantage of resistance to the change process. Analyzing systems can impact workflow. which these current processes can • additional opportunities for For example. Typically. In integrated deployment plan that that include a deeper and more reality.4 to discuss and create workflow clinical needs are represented in the integration. 57 communications at ALL stages of when implementing new solutions. the ways in capabilities of these new systems. process and component of CM. CM tactics ensures that all activities impact. 59 • potential early wins or roadblocks and integrating work processes prior to implementation.g. For example. Current state stakeholder working group and then workflows are typically documented WORKFLOW ANALYSIS early in the change process. communications. In Alberta. newly designed workflows. & INTEGRATION transitions the information to the CM team for further consideration therefore. The project team makes full use CM leaders play an important role of stakeholder working groups in ensuring stakeholder-identified . physical location of redesign efforts. as part systems (e. implementing a new be improved and identify further change. knowledge management and training plans to create a collective vision to Even the strongest CM plans can direct the change process.. workflow of their ‘Organization Change documents. Projects that that have been adapted to meet the technology through coordinated follow their project management demands of other technologies or implementation plans. office framework must. 27 3. implementation. the implementation of new project. change leaders processes using eHealth solutions systems focuses on training users can get a first-hand look at: into the operations of health service rather than examining how the new delivery organizations.


The work of the CMWG found that 3.4.1 Resources and Tools S. McLaren. Successful EMR
introducing standard, consistent, The following list refers to resources Adoption: Optimizing your
repeatable processes throughout the and tools available in the online Workflow. Ontario Medical Review
provincial and territorial projects has toolkit located in Canada Health (September 2010, 2p.)
reduced the variance across project Infoway’s online Resource Centre.62 This article provides a practical
A NATIONAL CHANGE MANAGEMENT FRAMEWORK A Framework and Toolkit for Managing eHealth Change

delivery. Manitoba successfully utilizes look at physician office workflow
this approach to reduce process • Analyzing Workflow – and assessment.
variance and improve quality of project Questions to Consider
outputs. Organizational commitment G.R. Hayes. Organizational
• Mapping Current Workflow Routines, Innovation, and
to CM has increased and the practice
and Processes Flexibility: The Application of
is now an integral component of
project delivery in Manitoba. • Flow Process Chart Template Narrative Networks to Dynamic
Workflow. International Journal of
A conceptual maturity model 60 • Systems Flow Chart Medical Informatics (2011, 17p.)
used by Alberta benchmarks
The purpose of this paper is to
progress of health technology use 3.4.2 Further Reading demonstrate how current visual
toward a notional ideal state where California Healthcare Foundation. representations of organizational
processes, solution functionality Workflow Analysis: EHR and technological processes do
and solution use are optimized and Deployment Techniques (2011, 10p.) not fully account for the variability
become integrated into continuous present in everyday practices. The
process improvement. As comfort This issue brief explores the stages
authors further demonstrate how
of workflow analysis, process
and traction are gained over time, narrative networks can augment these
mapping and process redesign. By
meaningful opportunities to extend representations to indicate potential
documenting and mapping all back
the change are identified and areas for successful or problematic
office, front office, IT, and provider
implemented, with workflows being adoption of new technologies and
processes, the clinic team can
continuously improved. potential needs for additional training.
identify the waste and bottlenecks
embedded in its system. This current Stratis Health. Health Information
eHealth Ontario has developed a
workflow is then used as a foundation Technology Toolkit. (2010.)
guide about process integration
for envisioning an improved workflow
written specifically for implementers facilitated by the EHR. The Health Information Technology
of new technologies in clinical Toolkit for Physician Offices helps
environments. 61 This guide eHealth Ontario. Guide to Process these health care organizations
introduces a systematic methodology Integration (May 2009.) assess their readiness, plan, select,
that provides a step-by-step approach implement, make effective use of
(Available in the Workflow Analysis &
to process integration. and exchange important information
Integration folder available in the
about their clients. The toolkit contains
online toolkit located at:
Integrating workflow improvements numerous resources, including tools
and technology adoption into for telehealth, health information
operations that become engrained This Guide and its associated tools exchange and personal health records.
in organizational culture over time are intended to provide readers with
can be particularly challenging. a systematic methodology to develop,
Sustainable culture change is one of in a step-by-step fashion, a customized
the last things to occur and is highly process integration approach. Using
dependent on results that add lasting this approach will allow practitioners
to align business processes to realize
value. Clinician champions play
the value of eHealth solutions and
a significant role here, as they can
incorporate their new functionality
provide insight into how work gets
into day-to-day processes.
done using the new systems.


3.5 • Training is defined as an • Tends to be narrowly focused;
organizational activity aimed leads to a high proficiency in
at imparting information a specific skill
or instructions to improve a
recipient’s performance or to • Effectiveness is measured

A NATIONAL CHANGE MANAGEMENT FRAMEWORK A Framework and Toolkit for Managing eHealth Change
help him/her attain a required by what you can do when you
level of knowledge or skill. have completed it

TRAINING & One of the main objectives • Focuses on doing and
EDUCATION of a training encounter is the improvement in performance
ability to perform a skill to a
When implementing new eHealth specified standard at the end When considering the nuance
systems, approaches to user of a session. Key attributes of between these two ideas, those
education, training, knowledge training include: leading and those receiving the
development and capacity will have education or training may find it
to be specific, practical and offered helpful to ask some key questions:
on the job in a timely fashion.

Education and training are sometimes Figure 11
simply described as the difference Key Training and Education Questions
between “knowing” and “doing.” 63

• Education refers to a program of Role Education Training
instruction in which knowledge Perspective
or skill is developed or obtained
through a learning process. The Leader Are we educating the Are we getting staff
overall goal is to know more at the team so that they are up to speed so that
end of the process than you did aware of the reasons they can hit the
at the start. Knowledge tends to for the change? ground running?
be focused more on the longer-
term tenure. As such, it is a key Recipient What are we How do I use the
influencer of project sustainability. implementing and what transactions to enter
Key elements of education include: does this mean to me? data, display information
and get the reports to
• Provision of a broad perspective do my job?

• Flexibility of approach

• Measured by tenure

• Encourages general approaches
to problem solving


While educational initiatives should Training strategies should focus Experience from the CMWG activities
begin early in a project and be on achieving skills through, for suggest the CM resources should lead
tightly linked with communications example, putting education into the education and training components
messaging (i.e., clearly and practice, with an instructor standing of the initiative. Even if requirements
consistently delivered, relevant back, monitoring and correcting. are established at the outset and the
A NATIONAL CHANGE MANAGEMENT FRAMEWORK A Framework and Toolkit for Managing eHealth Change

to the target audience, frequently Common mantras like “tell, show procured vendor is contractually
delivered), training activities are and do” are effective strategies in compelled to deliver training, the
often most successful (in terms supporting individuals to implement CM team is often best positioned to
of improving retention of both and achieve new skills. know the unique requirements of the
knowledge and skill) when offered environment, and its key players.
through ‘just in time’ delivery. An effective long-term training
strategy needs to incorporate Infoway’s Clinician Peer Support
When planning for education and the concept of maturity of use. Network 64 is supporting CM efforts
training, remember to take the time Users have different needs at across the country. The peer-to-
to do the education (i.e., educate different stages: new users need peer programs are supporting the
on process and procedure) prior to to be acquainted with the basic education and training of eHealth
the training. Dedicating time and functionality, while advanced solutions for physicians, nurses and
resources to produce quality education users should be empowered to use pharmacists within their practice
and training materials presented by technology as a tool for innovation. settings – from clinician to clinician.
qualified instructors, is also critical for Each program in the network is
reducing as much stakeholder angst Key components of an integrated and managed and operated autonomously
and adoption risk as possible. effective training strategy include: to meet the unique requirements of
• analyzing learning needs regarding the jurisdiction.
Standardized plans, tools, resources
and media should be in place to the new clinical workflow and A recent example of the support
meet initial needs prior to and system functionality; this program provides comes from
during implementation to ensure • linking stakeholder analysis and Newfoundland & Labrador’s Peer-to-
sustainability of adoption. The communications plan; Peer Network. In this project, both
content and delivery of these education and training on specific
resources should have consistent • linking changes to what we are eHealth solutions were identified
core components, while allowing for changing, why we are changing as needs for practicing and student
customization where necessary. and how we are changing; clinicians. Throughout the initiative,
physician, nurse and pharmacist peer
Educational programs can make • determining learning objectives leaders shared their experiences about
use of tools like videos, manuals, and content;
incorporation of eHealth solutions
web-based programs, workshops into clinical settings with colleagues
• developing appropriate methods
and seminars, but should focus on and students, and at conferences such
to deliver content;
giving an individual the information as the Primary Healthcare Partnership
needed to promote a particular topic • assessing the results of education Forum. Peer leaders promoted EHRs/
or idea. This could be as simple (but delivery approaches and EMRs through articles published
important) as the reason behind a methods; and in their respective professional
process change. While the individual association newsletters and also at
may not be ready to take the • offering a means of continuous
in-person workshops around the
controls, they know what needs to learning (continuous
province. Lastly, peer leaders received
be done; they just may not have yet improvement and ongoing
CM training and support through
developed the necessary skills. learning for new staff).
Newfoundland & Labrador’s Centre
for Health Information.

This program is seen to be an appropriate time-limited incentive a critical first step in educating front. Doing Gap: How Smart Companies users of eHealth solutions is also Training Strategies: EHR Turn Knowledge into Action. National doing gap.) in Training initiative. and Canadian workflow and standardize policies based on research undertaken in Association of Schools of Nursing and procedures. technology. Sutton. 31 From a national perspective.66 • Training Roles and Responsibilities • Training Session Evaluation Template • Computer Training Needs Assessment • Training and Course Planning Matrix .2 Further Reading J.) in the first place. program to actively encourage care line users and supports successful providers to purchase and implement CM initiatives. e-Health and Information Principal and how still others avoid the gap enabled. Harvard provided through the Clinicians Deployment Technique (2010. high priority eHealth solutions as they become available. Infoway’s online Resource Centre. R.I. nationally available toolkit located in Canada Health eHealth practitioners. clinical environments and Committee (September 2008. 3. 6p.) Business School Press (2000. improve quality of care. 65 a joint This book addresses the challenge A NATIONAL CHANGE MANAGEMENT FRAMEWORK A Framework and Toolkit for Managing eHealth Change This issue brief explores some collaborative effort between Infoway of turning knowledge about how to approaches to training. practice in modern. of Canada (AFMC). The goal of this program some firms overcome the knowing- is to better prepare students to National e-Health Strategy. their influence and national associations like the improve performance into actions on the implementation strategy.5. private industry. why others try but fail. The Knowing- education and support for front-line California Healthcare Foundation. Pfeffer. It also 3. Authors show how (CASN). access and This resource notes that education productivity through the use of ICTs campaigns should be supported by for health.1 Resources and Tools discusses the need to implement changes to vocational and tertiary The following list refers to resources training programs to increase the and tools available in the online number of skilled. Association of Faculties of Medicine and the ways they can streamline that produce measurable results.5.

stemming of project implementation.and engage and enhance user optimization MONITORING later phases of implementation and of the solution.4 Key Questions outcomes evaluation. and if so.6 3.6. functionality from the use of information and and instructional effectiveness. of the solution. need to be established project lifecycle and across all key questions) should be developed to during the planning phase of major mechanisms including governance best align with the following types projects. information below.6. evaluations include: Building a CM plan around the framework outlined in this guide Formative evaluations are intended to • Are the CM activities being will help to ensure that evaluation be built into the overall components effectively executed? takes place at the appropriate stages of a CM approach. I intended? of formative and summative Additionally. • What were the unintended differentiating between process-related identify issues and develop mitigation consequences? evaluation of change management plans. the more likely an effective 3. The concepts rollout and solution integration. Benefits. A sustained effort is required structure and leadership support. anticipated to? Ideally. or is an integrated evaluation plan. evaluation also provides evaluation provide a foundation for an opportunity to assess project risks. It also provides a structure to monitoring and evaluation differ • What were the obstacles? implement and test innovative ideas as depending upon the context of a means to support effective ongoing • Did the users benefit in the way the change initiative. education throughout the lifecycle of eHealth use and user satisfaction of a solution etc. of questions: to ensure these benefits can be realized formative evaluation provides an over the longer-term.g. surveys. Infoway’s System and Use form and content of the Monitoring and evaluation are Survey is an available survey tool that implementation plan. (Process) Evaluation 67 interventions and processes.2 Formative the effectiveness of change activities. opportunity to engage those leading. including important concepts that extend facilitates evaluation and analysis of communications. interview health care. but are often of a project’s lifecycle. communications technologies ( ICT) 3.6. The earlier formative evaluation (CM) activities and benefits-focused begins. how – A NATIONAL CHANGE MANAGEMENT FRAMEWORK A Framework and Toolkit for Managing eHealth Change of the project – from key milestones and also identify opportunities to at the outset through to mid. training. For eHealth Examples of formative evaluation projects. 68 such as usability.3 Evaluating for health in delivering and supporting Conducted at every stage of the Test methods (e. • Did I achieve my goals managing and affected by the and objectives? The methods and timeframes for solution. A variety • Does your solution accomplish ad hoc and not always part of of examples are included in the what it is supposed to.1 Monitoring & Evaluation below.6. formative evaluation questions and tools are provided offers a means of examining the 3. project that achieves its intended Key questions evoked by formative objectives will result..32 3. & EVALUATION solution integration. and assures the technology is projects and into the operational life that can be administered at any phase meeting all levels of requirement. Formative Formative evaluation helps to or process evaluations can evaluate confirm if goals and objectives are whether targeted users are actually being achieved across the continuum using the solution. a CM plan will contain a comprehensive approach to measuring .

73 stakeholders (i. etc.6. toolkit located in Canada Health • Electronic communications with outcomes evaluation examines Infoway’s online Resource Centre.6. Observer should Information (NLCHI) are key ask questions upon completion resources to assist in the design of an outcomes evaluation protocol..e. .. In the context of eHealth • Observation: This is usually done • Methodology Used in NB iEHR / projects. There are many • Evaluation Methodology Used in methods. etc.6 Summative • Have users been satisfied with (Outcomes) Evaluation be aligned and integrated. Step 7: Agree on recommendations • Has the communications strategy in things like appeal of the and forward them to influenced the target audience course.6. etc.g.5 Examples of Commonly implementation. (or participating in educational Step 2: Orient key stakeholders session. as well as whether to the rationale for why instructions? the instruction is necessary evaluation is needed • Are users able to navigate • Surveys: Users can complete Step 3: Agree on when through the solution? a survey to indicate their to evaluate • Are the headings and buttons expectations.. Surveys are Step 5: Agree on how to evaluate • Is it visually appealing and particularly useful if you are Step 6: Analyze and report easy to read? doing mass testing of a solution and are looking for trends (e.and post-tests: Test people A NATIONAL CHANGE MANAGEMENT FRAMEWORK A Framework and Toolkit for Managing eHealth Change doesn’t get in the way of the before and after using the solution Step 1: Identify key stakeholders learning (use)? i. training Summative evaluation is a method evaluation survey)? of judging the impact of a project 3. asynchronous whether the initiative achieved • Benefits Approach to Evaluation discussion) via list servs or targeted levels of adoption and bulletin boards anticipated benefits. etc. educational instruction. for any kind of measurement and evaluation: • Does it ensure the interface • Pre.g. 71.e.7 Resources and Tools or program at the end of the The following list refers to resources 3. Infoway’s Benefits Evaluation by observing two or more people Lab Scoping and Planning Initiative Framework 70. but should ideally 3. the training (e. first key stakeholders (e. at what point they ask & Use Survey & Labrador Centre for Health questions.) initiative through a survey or key Outcome evaluations are often distinct informant interviews)? initiatives from CM. 33 • Does it impose minimum • Online chat interview: Conduct The NLCHI framework provides a obstacles between the user one-on-one or group discussions common sense set of considerations and use? for direct feedback. measuring awareness of the impressions.. anticipated benefits. timeframes and data sources Evaluation of Newfoundland & • Focus groups or 1-1 interviews that may contribute to an outcomes Labrador TeleHealth Strategy evaluation.) to measure strengths • Are users able to understand and weaknesses.g. how long things take • Canada Health Infoway – System as described by the Newfoundland to finish. The focus is on and tools available in the online Used Testing Methods the outcome. rate the Step 4: Agree on what to evaluate clearly labeled? communications. 69 Generally speaking. 72 and considerations using the solution.. Record where for measurement and evaluation they click.

the eHealth the public. and health research and benefits use to adaptation. eHealth Chair position. and then share this evaluations.6. researchers and health A NATIONAL CHANGE MANAGEMENT FRAMEWORK A Framework and Toolkit for Managing eHealth Change Observatory was established system decision makers.34 3. also includes the development and Their website contains resources. implementation of a confidential methodologies and publications and secure provincial electronic authored by eHealth Observatory health record (EHR). deployment.8 Further Reading NLCHI Framework and University of Victoria. The centre’s mandate new knowledge to advance the field. prepares can evaluate the effects of eHealth and distributes health reports. maintains as a laboratory where researchers key health databases. eHealth Evaluations (website) Observatory (website) The NLCHI provides quality As part of a joint Infoway/CIHR information to health professionals. Health were to: review current approaches Information Technology Evaluation to evaluating the impact of health Toolkit (website) information systems (particularly those leading to an EHR). The goals US Agency for Healthcare of the project referenced above Research and Quality. . The centre to monitor the effects of ICT supports the development of data deployment in Canada. and  his toolkit provides step-by-step T develop an evaluation framework guidance for project teams who which addresses the information are developing evaluation plans for needs of key stakeholders and their health information technology the identified best practices in the (health IT) projects. evaluation of such initiatives. including the staff and associates. and through the entire system lifecycle supports and carries out applied from requirements. It is to serve and technical standards. CM required to support adoption by end user clinicians.

Successful change implementation results in solution adoption and other long-term benefits such as improved patient care and positive organizational impacts. This document and toolkit represent a synthesis of that work and a starting point for future directions. As Canadian investments in eHealth continue. learn from and share lessons around CM activities. it is essential that we continue to examine. The Pan-Canadian Change learning process. 35 Conclusion: Future Directions CHAPTER for Change Management 4 CONCLUSION: FUTURE DIRECTIONS FOR CHANGE MANAGEMENT A Framework and Toolkit for Managing eHealth Change eHealth change management (CM) is foundational to achieving effective and efficient use of information and communications technologies (ICT) for health. and to a continuous its efforts in different areas. realizing many benefits of eHealth initiatives across Canada. Collaboration is essential! Management Network (Network) has made considerable progress toward developing a repository of knowledge and leading practices to foster learning across Canada. CM practices vary across Canada. . successes and failures. Each jurisdiction is Canada Health Infoway and its CM partners remain at a different place on the CM journey and has focused committed to this objective. processes. CM is an essential driver of adoption. tools and technology of the change initiative are embedded in the new way clinicians do their everyday work. Success occurs when the systems.

these resources have been used in Canadian eHealth presentation. To better support this valuable collection of eHealth CM practices. please and to suggest inclusion of new items. working assets and to ensure ongoing relevancy and currency of collaboratively to achieve successful outcomes that information. Get connected Connect with members of the Pan Canadian Change Management Network through their LinkedIN group located at: http://bit. exchange of best practices and facilitate knowledge dissemination. recognize and note any of the specific references or citations template. delivery system overall. our providers and our health care http://bit. we would love to hear from you! Contact us at clinicaladoption@infoway-inforoute. You are welcome to adopt and adapt these tools to best We hope you will visit there often to access the materials fit your environment and and have been shared by the jurisdictions to support collaboration amongst peers. For the most part.36 CHAPTER 5 Change Management Toolkit TOOLKIT A Framework and Toolkit for Managing eHealth Change Introduction to Toolkit In this section you will find a sampling of tools and templates that relate to the proposed change management (CM) framework and content presented earlier in the guide. we can continue to profile and support effective are available. If you have a tool. .ly/PCCMN-LinkedIN. success story or case study example located on some of the examples. When doing so. Resources provided within this document represent a sampling of the wealth of information and supports that Together. one step at a time. of a challenging situation. These tools are intended to provide practical support for readers of this document. an online toolkit has been created at: benefit our patients.

6 Communicating with Stakeholders 67 6.4 Systems Flow Chart 89 1.4 Target Audience Analysis Template 65 6.7 Sample FAQ Template 81 .3 Communications Plan Template 74 3.2 Example Evaluation Methodology 98 2.6 Job Fact Sheet – Sample Template 53 5.4 Training and Course Planning Matrix 95 A Pre-Implementation Readiness Assessment 60 6.3 Computer Training Needs Assessment 93 2.2 Stakeholder Engagement 63 6.4 System & Use Assessment Survey 100 2.1 Organizational Change 39 & INTEGRATION Readiness Assessment 4.8 Resistance Management Framework 69 3.1 Training Roles and Responsibilities 91 1.3 Sample Terms of Reference for 47 4.0 TRAINING & EDUCATION 90 1.5 Communication Diagnostic 78 3.1 Are You EMR Ready? 5.2 Training Session Evaluation Template 92 2.7 Control and Influence Assessment 58 5.0 GOVERNANCE & LEADERSHIP 38 4.3 Stakeholder Analysis and 64 (Used in Evaluation of Newfoundland Segmentation & Labrador Telehealth Strategy) 2.0 COMMUNICATIONS 71 3.4 Determining Project Governance 49 4.1 Key Questions Associated with 72 Communications Planning 3.0  WORKFLOW ANALYSIS 84 1.0 STAKEHOLDER ENGAGEMENT 59 5.1 Analyzing Workflow – 85 1.6 Simple Communications Tools 80 3.7 Force Field Analysis Process 68 2.4 Preferred Media – 75 Project Communications 3.2 Mapping Current Workflow 86 Governance Advisory Committee and Processes 1.5 Model for Prioritizing Stakeholders 66 (Used in NB iEHR / Lab Scoping and Planning Initiative) 2.3 Example Evaluation Methodology 99 2.0 MONITORING & EVALUATION 96 2.2 Communications Planning – 73 Audience Assessment Template 3. 37 Contents TOOLKIT A Framework and Toolkit for Managing eHealth Change 1.5 Roles and Responsibility Charting (RACI) 51 5.1 Benefits Approach to Evaluation 97 Planning Template 6.3 Flow Process Chart Template 88 Structure in eHealth Projects 4.2 Risk Assessment Form 45 Questions to Consider 1.

0 Governance & Leadership TOOLKIT / GOVERNANCE & LEADERSHIP A Framework and Toolkit for Managing eHealth Change Contents Organizational Change Readiness Assessment Risk Assessment Form Sample Terms of Reference for Governance Advisory Committee Determining Project Governance Structure in eHealth Projects Roles and Responsibility Charting (RACI) Job Fact Sheet – Sample Template Control and Influence Assessment .38 1.

the team can share their change. and some champions. Version Date 0. supervisors. how the levers are currently aligned. They can agree where they will need to focus their the questions.0 yyyy/mm/dd About the Change Readiness Questionnaire This questionnaire is ideally used when planning for 1. should each fill out and score This questionnaire should be repeated at different times the questionnaire. Project Sponsor Target Project Completion Date yyyy/mm/dd Project Manager Version No. yield two important results: . in the eyes of the people who answered 2. change agents. initial efforts. profiles the “change readiness” of the organization at a point in time. Managers. during the change process as a way of monitoring how They should then share their profiles as a group. It will take no more than 15 minutes. and the organization’s and people’s readiness for change. if available. 39 1. By comparing their profiles. This will change is progressing. It is designed to give a quick snapshot of the assumptions and come to a common agreement about organization.1 Organizational Change Readiness Assessment TOOLKIT / GOVERNANCE & LEADERSHIP A Framework and Toolkit for Managing eHealth Change Project Name Project Acronym or No. and what pitfalls may emerge later down the road.

1 2 3 4 5 TOOLKIT / GOVERNANCE & LEADERSHIP A Framework and Toolkit for Managing eHealth Change 1 To achieve the directions and priorities. priorities and the Well Understood Somewhat Not  ot at all N reasons for the change are: understood by staff understood understood understood by staff by staff by staff by staff 3 The external pressure to change is: Well Understood Somewhat Not  ot at all N understood by staff understood understood understood by staff by staff by staff by staff 4 The external pressures and trends Greatly Encourage Neither Discourage Greatly will encourage us to change: encourage encourage Discourage nor discourage 5 Commitment by all staff to the new Very high High Average Low Very low directions. Clearly Defined Somewhat Not Very what we have to change is: Defined Defined Defined Ill-Defined 2 The directions. priorities and changes is: 6 The culture and organization Greatly  ssist with A Neither Inhibit the Greatly values will: assist with the change assist nor change inhibit the the change inhibit change 7 In terms of helping us reach our Greatly Assist Neither Inhibit Greatly directions and priorities. the existing staff are: 11 Our human resource systems (human Very well Well  either well N Not well  ot at N resource planning. the existing assist assist nor inhibit management style will: inhibit 8 The current organization structure Very Conducive Neither Not  ot at all N and job classification system is: conducive to change supportive conducive conducive to change nor resistant to change to change to change 9 The management team leading Works  orks well W Neither Does not  oes not D the change: very well together works well work well work at together nor poorly together all well together together 10 In terms of the competency Very well Well Somewhat Not well  ot at all N and training required to achieve equipped equipped equipped equipped equipped and sustain the planned change.40 Organizational Change Readiness Assessment Please check the appropriate box (1 through 5) for each item below. compensation systems and training and development systems) support change: . performance nor poorly all well management.

we are: Very open  pen to O Neither Not open  ot at all N to risk taking risk taking open nor to risk open to closed to taking risk taking risk taking 17 In terms of the capability. we are: 22 In terms of having people in the Well Prepared Somewhat Not  ot at all N organization who will champion. prepared prepared prepared prepared influence and support the change. 41 Organizational Change Readiness Assessment Please check the appropriate box (1 through 5) for each item below. we are: 21 In terms of having experienced Well Prepared Somewhat Not  ot at all N resources who will work on the design prepared prepared prepared prepared changes and provide the required consultation and implementation support. we are: nor ill- equipped 18 Change efforts that we have Very Successful Somewhat Not  ot at all N undertaken in the past have been: successful successful successful successful 19 In terms of having an executive Well Prepared Somewhat Not  ot at all N sponsor who will initiate and authorize prepared prepared prepared prepared the change and give credibility to it. we are: 20 In terms of having project support Well Prepared Somewhat Not  ot at all N staff who will carry the changes down prepared prepared prepared prepared into the organization and support and monitor the changes. motivation Very well Well Neither Not well  ot at all N and confidence to bring about the equipped equipped equipped equipped equipped change. we are: . Very well Well  either well N Not well  ot at N and has the courage to support and nor poorly all well sustain the change: 15 We will be able to overcome any Very well Well  either well N Not well  ot at N initial resistance to change that is nor poorly all well likely to surface: 16 In terms of risk taking. 1 2 3 4 5 TOOLKIT / GOVERNANCE & LEADERSHIP A Framework and Toolkit for Managing eHealth Change 12 Our communication processes and Very well Well  either well N Not well  ot at N vehicles are aligned and positioned nor poorly all well to support this change: 13 We recognize and reward behaviours Very well Well  either well N Not well  ot at N that will help move us forward toward nor poorly all well achieving our priorities: 14 Our leadership will support the vision.

” not organized into complete complete incomplete into “bits” into complete jobs. we are: 25 Information to assist us with the Readily Available Somewhat Not  ot at all N change process is: available available available available 26 Productivity tools to support the Readily Available Somewhat Not  ot at all N change process are: available available available available 27 Our work is organized into “silos. we are: 24 In terms of being well equipped Very well Equipped Somewhat Not  ot at all N to deal with the “pain” that will be equipped equipped equipped equipped experienced by various groups and individuals in the organization.” Not very  little A Somewhat Mostly Very so that groups who work on different organized organized organized organized organized parts of the same work have little to into silos into silos into silos into silos into silos do with each other. complete jobs 29 Our organization structure supports Strongly Mostly Somewhat Mostly Weakly getting decisions made: strongly weakly . 28 Tasks are broken down into Organized Mostly Somewhat Mostly  roken down B sequential “bits. 1 2 3 4 5 TOOLKIT / GOVERNANCE & LEADERSHIP A Framework and Toolkit for Managing eHealth Change 23 In terms of being clear on which Very clear Clear Neither clear Not clear  ot at all N organizations or groups will be most nor unclear clear affected by the change.42 Organizational Change Readiness Assessment Please check the appropriate box (1 through 5) for each item below.

28 & 29)   +  +  +  = /4 = E Management Processes Q12 +Q18 +Q23 Q24 and Communication (Questions 12. Norms and Morale Q6 +Q15 +Q16 (Questions 6.4. 19 & 22)   +  +  +  +  = /5 = C Strategic Direction Q1 +Q2 (Questions 1 & 2)   +  = /2 = D Organization Structure..e. below (round up to the nearest whole-number for each the average is 3. decimal > . 17. enter “5” for Q3) each response (> . 14. round up) A External Environment Q3 +Q4 (Questions 3 & 4)   +  = /2 = B Leadership Q7 +Q9 +Q14 +Q19 +Q22 (Questions 7. 27. 10. however this hides the extreme range. the X’s tell you which levers will prove a hindrance to change. Using the average scores calculated for each lever in (e.g. 18. Lever A: External Environment is represented by part A. In Part B. place an X in the appropriate box (1 to 5) TOOLKIT / GOVERNANCE & LEADERSHIP A Framework and Toolkit for Managing eHealth Change Questions 3 & 4) If you find you have extreme scores making up an average Calculate the average score for each lever in the chart score (i. and which will provide support. 20 & 21)   +  +  +  +  = /5 = I Information Processes Q25 +Q26 (Questions 25 & 26)   +  = /2 = . 9.4) Place an asterisk (*) beside the average score to alert yourself to discuss the underlying scores with your change sponsor and project team members. you have 2 questions with answers of 5 and 1).. 15 & 16)   +  +  = /3 = G Human Resources Systems Q11 +Q13 (Questions 11 & 13)   +  = /2 = H Employees’ Personal Goals Q5 +Q10 +Q17 +Q20 +Q21 and Competencies (Questions 5. Change Readiness Questionnaire Scoring Profile – Part A Insert your previous responses from the Add the Divide & Questions from change readiness questionnaire below numbers from round the total Lever Change Questionnaire (e.g. 23 & 24)   +  +  +  = /4 = F Culture. 43 Change Readiness Questionnaire Scoring Profile – Instructions Part A Part B Each lever is represented by a particular set of questions. Tasks Q8 +Q27 +Q28 +Q29 and Work Processes (Questions 8.

28 & 29)                                                                                 E Management Processes and Communication (Questions 12. Norms and Morale (Questions 6. 10.44 Readiness for Change Questionnaire Scoring Profile – Part B Will likely greatly support Will likely greatly inhibit change effort change effort TOOLKIT / GOVERNANCE & LEADERSHIP A Framework and Toolkit for Managing eHealth Change Questions from Change Lever Questionnaire 1 2 3 4 5 Business Directions A External Environment                                                                 (Questions 3 & 4)                 B Leadership                                                                 (Question 7. 18. 23 & 24)                                                                                 Support Systems F Culture. 27. 14. 20 & 21)                                                                                 I Information Processes (Questions 25 & 26)                                                                                 . 17. Personal Goals and Competencies (Questions 5. 19 & 22)                 C Strategic Direction                                                                 (Questions 1 & 2)                 Operations D Organization Structure. 9. Tasks and Work Processes (Questions 8. 15 & 16)                                                                                 G Human Resources Systems (Questions 11 & 13)                                                                                 H Employees.

Mitigation/Contingency Plan Contingent actions. It implies an identified risk is either not possible because it is outside the that the response is an identifiable action that will form project’s sphere of influence or not cost effective. The most obvious example of risk transfer is This approach is often used in the planning stage of a project. A sentence that or issue. project objectives fundamentally flawed. and why of the risks. anxiety. Schedule. Actions to be Taken Actions which are immediately incorporated in the work plan to avoid or mitigate the risks. contracting to suppliers for whom the risk is reduced. Context: The what. that negative outcome(s) of the current conditions. possibly briefly describes the key circumstances. Risks should be borne by the party that is best equipped Avoid: Use an approach that avoids the possibility of to deal with them and will benefit most from the rewards risk occurrence of success. and related issues (include background and additional information that is not included in the risk statement).M. Quality. etc. how.M. . Mitigate. which are included in the project risk mitigation plan.L) Probability: (H. describing the circumstances. Avoid. It is still important to Transfer: Shift the risk to another party document these risks even if no actions can be taken. An example might be using a tried and trusted technical solution rather than depending on one that is less understood. might be the expected development of new technology or An example might be resolution of technical issues during the imposition of legislation that might leave some of the a design phase.L) Risk Category: (Scope. doubt. have caused concern. controlling response to This is by far the most common risk response. Examples part of the project plans and will be monitored regularly. Potential Impact Impact: The criticality of the loss or effect of the undesirable event on the project if the risk occurs. when.) Risk Statement A Risk Statement should include: Consequence: The impact(s) of the actualization of the risk Condition: A concise statement of risk. etc.2 Risk Assessment Form – Part 1 TOOLKIT / GOVERNANCE & LEADERSHIP A Framework and Toolkit for Managing eHealth Change Project Name Project Manager Risk Item # Date: Risk Owner Priority: (H. Approach (Accept. contributing factors. 45 1. or uncertainty. and which will only be included in the work plan if and when the corresponding risks occur. situations. A brief statement that describes the key. Cost. Transfer) Accept: Recognize the risk and its uncontrollability Mitigate: Take action to reduce risk likelihood or impact Sometimes implementing a positive.

Transfer) Actions to be Taken Mitigation/Contingency Plan . Cost.L) Probability: (H. Quality.L) Risk Category: (Scope. Schedule. etc.M.) Risk Statement Potential Impact Approach (Accept.46 Risk Assessment Form – Part 2 Project Name Project Manager TOOLKIT / GOVERNANCE & LEADERSHIP A Framework and Toolkit for Managing eHealth Change Risk Item # Date: Risk Owner Priority: (H. Mitigate.M. Avoid.

use and disclosure of personal health Responsibilities information. Chairs The Committee shall be co-chaired by a representative Scope of the Organization and an elected representative of the The Insert Project Name Governance Advisory remaining members. CEO will appoint the members policies that are associated with the collection. & roles. and will not have legal or Leader Position. and & roles. e. • Other Advisory Committee members may be included at the discretion of the Leader Position. • Reviewing reports on user compliance and other • List participating organizations & associations activities of the Insert Project. use and of the Advisory Committee to represent key stakeholders. & roles. The elected co-chair shall serve a Committee (“Advisory Committee”) is responsible term of two years. Specific responsibilities of the Advisory Committee include but are not limited to: Membership • Providing advice on the development of Insert Project The Leader Position. • Recommending changes to the personal health • List participating organizations & associations information disclosed to the Insert Project.g. for both users and the public. CEO and with the advice of the Committee. Insert Project. and • Advising on written agreements associated with the • etc. CEO of the Organization to contractual responsibility for the Insert Project and the support Insert expected benefits. for advising on all Insert Project matters related to the collection. long-term trust in the Insert Project / Program Name. as well as creating information associated with it. disclosure of personal health information. e.3  Sample Terms of Reference for Governance Advisory Committee TOOLKIT / GOVERNANCE & LEADERSHIP A Framework and Toolkit for Managing eHealth Change Insert Project Name Governance Advisory Committee Terms of Reference mm/dd/yyyy Mandate The Insert Project Name Governance Advisory To provide advice and make recommendations to the Committee is not a legal entity. These appointments will be based on the recommendations of representatives of the following organizations: • Making recommendations for policies on secondary use and disclosure of personal health information • List participating organizations & associations associated with the Insert Project.g. e.g. 47 1. .

the Leader Position. CEO Quorum for meetings will be attendance by a will be made by consensus. The Board of Directors may of the Advisory Committee. • If a consensus in the Advisory Committee cannot Duration be reached on an issue that requires action by the The Advisory Committee will remain in place Organization. the Indicate higher authority.48 Recommendations and Decision-making Quorum Recommendations to the Leader Position. but not less than once per quarter. . simple majority of Advisory Committee members and must include representation from the Indicate • It is desirable that recommendations are acceptable to required bodies. e. The Organization will reimburse reasonable travel costs associated with the meetings in accordance with the Organization travel policy.g. CEO for Indicate timeline or until such time as the will be advised. therefore the process regulatory colleges.g. e. Organization Board of Directors authorizes an alternative governance structure.g. including but not limited to. should be continued until a consensus is achieved. CEO Amending the Terms of Reference and the Advisory Committee shall be documented by The Terms of Reference may be revised by the the Advisory Committee and directed to the Board of Leader Position.g. CEO upon the recommendation Directors for resolution. solicit advice from other parties. Meetings will take place in person or via telephone conferencing. e. such as representatives from TOOLKIT / GOVERNANCE & LEADERSHIP A Framework and Toolkit for Managing eHealth Change all Advisory Committee members. Meetings Meetings will be held as required.g. Dispute Resolution A dispute between the Leader Position. e. Minister of Health. e.

but if a group of users will be impacted by the senior-level individuals to make decisions are first. Decision-Making Task Organizational Unit to Make Decision Release of funds Contract approval Contract negotiation Benefits expectation setting/benefits realization Project staffing/steering committee formation Community engagement Contract management Communications plan Code of conduct Goal setting Strategic plan Acceptance testing Project management/domain team formation Project budget Functional requirements Chart conversion and pre-load strategies Turnover and rollout strategies Issues management Super user identification Clinical documentation standards Design of screens Adoption of care plan templates. bear in mind your organization may encounter in its eHealth projects. decision. the decision should be made by representatives Identify for your organization at what level each of of the group. or delete tasks that don’t apply.4 Determining Project Governance Structure in eHealth Projects TOOLKIT / GOVERNANCE & LEADERSHIP A Framework and Toolkit for Managing eHealth Change Following is a list of many of the decision-making tasks In assigning decision-making authority. 49 1. Add additional tasks as required. the decisions should be made. order sets . that one individual may be the decision maker for some The list is sequenced so tasks generally requiring more tasks.

Accessed at: Stratis Health at stratishealth. .50 Decision-Making Task Organizational Unit to Make Decision Clinical work flows Customization of screens and templates TOOLKIT / GOVERNANCE & LEADERSHIP A Framework and Toolkit for Managing eHealth Change Alert rules Customization of reports Data dictionary/master files and tables Data conversion Contingency planning Staff development Medical staff introduction End user training Data quality management Interface testing System testing Go-live readiness Archive requirements Network bandwidth requirements Change control Document management and control Security controls Other (specify): Copyright © 2009. Used with permission of author. Margret\A Consulting.

51 1. Used with permission of author.5 Roles and Responsibility Charting (RACI) TOOLKIT / GOVERNANCE & LEADERSHIP A Framework and Toolkit for Managing eHealth Change • RACI is an acronym that stands for Responsible.” Supporting personnel or groups provide C Consulted with prior to the activity being performed resources for a task to be performed. issues because it reconciles the three elements of roles and responsibilities: • Responsibility Charting is a technique for identifying functional areas where there are process ambiguities. • Role Conception: what people think their jobs are. 2004-2008. actions that must be accomplished in order to deliver a successful end product or service. bringing the differences out in the open and resolving them through a cross-functional collaborative effort. Consulted and Informed. A I Develop draft of 4 C R A I communications plan Draft email. some groups add a category entitled “S” for A Accountable for the task being completed “Supports. same or different organizational levels or programs to actively participate in a focused and systematic • Role Behaviour: what people actually do in discussion about process related descriptions of the carrying out their job. Accessed at: spaffordconsulting. newsletter and 5 C R A briefing note content R Performs the task Note.html . Spafford Global Consulting. RACI Chart Example Department: Change Management Procedure: Communications Plan – Project Planning Phase Updated: 06/01/11 Front Line Working Project Project Advisory Step Task Staff Group Change Team Manager Committee 1 Develop key messages C R A 2 Identify target audiences C R A 3 Identify critical timelines I C C • Role Expectation: what others in the organization think another person’s job function is and how it • Responsibility Charting enables managers from the should be carried out. • Developing RACI charts surfaces many organizational Accountable. These variations are I Informed that the task has been completed known as “RASCI” Charts.

Spafford Global 2004-2008. Accessed at: spaffordconsulting.52 RACI Chart Tool Department: Procedure: TOOLKIT / GOVERNANCE & LEADERSHIP A Framework and Toolkit for Managing eHealth Change Updated: Step Task Group A Group B Group C Group D 1 2 3 4 5 R Performs the task A Accountable for the task being completed C Consulted with prior to the activity being performed I Informed that the task has been completed Used with permission of author.html .

the job to ensure that answers are as complete as • Consider the major activities or responsibilities possible. In addition. It should be agreed to by sections are used for recruitment. organization. or region of responsibility. Include a one-year period. identification of training requirements. supervision. It may be so that a person unfamiliar with the work would helpful to make a checklist of the components of be able to understand it. of the position. (usually 3 to 5). Take your time and think about • Estimate the percentage (to the nearest 5%) of the job before you begin to respond to each time spent on each. create a job description (section 2) as well as detail This form can be completed by incumbents and/or the qualifications for the job (sections 3 & 4). 53 1. impact of errors.6 Job Fact Sheet – Sample Template for a Provincial Level CM Project Lead Role for EHR Program TOOLKIT / GOVERNANCE & LEADERSHIP A Framework and Toolkit for Managing eHealth Change The following template was developed by the form provides information that enables job evaluation Newfoundland & Labrador Centre for Health and benchmarking for pay purposes. selection and all parties and signed off (Section 1). independence of action. the 1. demands and working conditions (Sections 5 – 12) are all essential in addition to the job description and the Purpose of Form qualifications to enable full and equitable evaluation This form is used to identify the job (Section 1). Areas such as Information and can be adapted to a specific project. . Then describe each activity a detailed breakdown to provide examples so using details or examples. If there are fluctuations in the section. Describe each activity or responsibility level of work activities. These managers and supervisors. describing it any reader can relate to the functions. Job Identification Organization Division or Department Name Job Title Change Management Project Lead Title of Immediate Supervisor Branch or Section Change Management Location Date Approval Signatures (Employee) (Supervisor) (Manager) Instructions for Creating the Job Description • Provide a brief overview of the job. consider the work over with a phrase at the top of each box. program.

Change Management (CM) is a critical aspect of Electronic benefits. EHR within the region. Job Description & Purpose In the space below. for the future. Describe each by a phrase and provide additional detail with examples. The outcomes implement a CM plan that serves to guide the project of eHealth CM activities result in solution adoption by team(s) and appropriate stakeholders.g. ‘train the trainer’ sessions relationship management to support CM (15%) or direct training by the incumbent). The colleagues at insert organization and others to incumbent will identify and partner with necessary identify and leverage best practices and lessons personnel to create the environment for positive learned to facilitate optimum implementation change. such that identification of necessary individuals regional stakeholders regarding the EHR and vision and functions will be included for CM activities.54 2. so that end user clinician end users and ultimately. focus appropriate CM plans. CM will require involvement and support of key • participation with regional CM coordinators. The ability to establish and maintain key and adoption of the EHR. • communication to various stakeholder audiences The incumbent should be knowledgeable in terms of through numerous media and venues. provide a brief description of the job and its purpose. and relationships with professional groups and associations. the structure and functions within the provincial health • development and implementation of education for system. Education and training staff. In order initiatives to enable smooth implementation of the EHR. Activity D: ( %) Activity E: ( %) . The incumbent will be the organization’s CM Health Record (EHR) implementation. Activity A: Measurement of Current State Activity C: Tactical deployment of the EHR CM and Change Readiness (15%) strategy within the insert name of organization / Introduction of the EHR will require significant locale (70%) attention to CM. the incumbent will lead CM are key components of the CM strategy. in order to engage groups of front line clinicians and • evaluation of CM initiatives and creation of other key stakeholders. • implementation of education and training programs Activity B: Engagement of key stakeholders and with appropriate staff (e. These assessments are part of the cycle for continued improvement to support adoption of the • development and implementation of CM plans. and indicate others. their organizations in moving forward and successfully The purpose of this position is to develop and employing electronic health solutions. Break down the job into major activities or responsibilities. but not limited to: the incumbent will require skills to perform current • development/implementation of change state and/or change readiness assessments to build readiness assessments through surveys. the full realization of adoption is maximized to its potential. lead for specific project(s) to support adoption by end TOOLKIT / GOVERNANCE & LEADERSHIP A Framework and Toolkit for Managing eHealth Change systematic approach that supports individuals and users. to understand the needs/requirements for CM. stakeholders within the provincial health system. complementary new interventions to support will be important to the success of this position. from both the technical/workflow Working in consultation with the organization’s CM and human change aspects. CM will include various tactics including. a strategic. and therefore benefits realization of the EHR. and to identify the current state groups and interviews. EHR adoption as required. or baseline. while engaging CM champions.

Final sign off for training plan once developed 3. nursing. • As above. TOOLKIT / GOVERNANCE & LEADERSHIP A Framework and Toolkit for Managing eHealth Change human resources. 4. 5. Please Specify: allied health or other) – highly recommended. business or • The proven abilities to organize and multi-task organizational development. Budget to implement training activities 2. • Minimum requirement Bachelor’s degree. education. quality improvement would be a definite asset. in your opinion. Other Key Abilities and Competencies List other key abilities and competencies required • She/he will be required to coordinate travel and to perform this job. would be the minimum What. are assets. or CM. Final sign off for communications plan .. workload to meet the needs of the region within • CM specialists can have a background in specified time constraints. experience specific to adult education • Experience in adult education. is highly recommended. • The individual should be self-motivated. 55 3. and • Familiarity with the Insert organization / program / project etc. in your opinion. Education and Specific Training (a) What. Initiative (Independence of Action) (a) List the decisions made or duties performed (b) List the decisions that require the supervisor’s without seeking supervisory approval. Mandatory Preferred Not applicable • Clinical background (e. should be the minimum (b) Is there any provincial or other vocational or schooling or formal training for a new person being professional certification or degree necessary hired into this job? to perform in this position.g. 1. Relationship management 3. results-driven and action oriented. would be the minimum experience necessary to do this job effectively? “on the job” learning time required for a new person to be fully effective in this job? About: 1 month 3 months 6 months About: 1 year 2 years 3 years 1 month 3 months 6 months 5 years 7 years 10 years 1 year 2 years 3 years more 5 years 7 years 10 years more 6. approval. pharmacy. Identification of key provincial stakeholders 1. Work Experience What. Coordination of training plan 2. in your opinion.

evaluation of interventions Project teams and Varied Gap analyses. e. Poor key stakeholder identification and relationship reasonably be made in this job.g. Organization to project team and teleconference. 8. (In Person. Telephone. procedures. • Numerous documents relevant to EHR CM sales. manuals etc. care. budget. face Regional Health to face Authorities Clinical and IM/IT Daily Strategy and tactics Varied personnel Users of EHR Daily Training. Varied Organization organization relationship management. inventory. cash. damage. evaluation of interventions . provincial EHR strategy. Indicate the worst consequences. time lost.56 6. Impact of Errors Describe two typical major errors that could 1. CM training. 2. TOOLKIT / GOVERNANCE & LEADERSHIP A Framework and Toolkit for Managing eHealth Change strategy and plan • Travel budget (TBD) • Organizational Administrative Policy and • Training budget (TBD) Procedure Manual 7. with resulting low adoption of EHR. Initiative (Independence of Action) (c) What guidelines. Varied others relationship management. money lost.) People Contacted How Often Purpose How Within CM Team internal Weekly Strategy and tactics Telephone. even with due management. Working with Others With whom will the employee be required to communicate in doing this job? Use titles. are (d) State any financial responsibilities available to guide decision-making and actions? (and amounts) the job involves e. injury. money and delays. waste. education Outside CM team from the Varied Gap analyses. effect most importantly negatively impact success of the on people. which could result in loss of time.g. CM training. Writing. Poor organizational skills may result in wasted time and money.

g. Comfortable.. Intense concentration (visual. carrying. assign work to be done. danger.g. 57 9. Other heavy physical effort 12. E. Lead hand): Integration with project team. please indicate the total actual number of staff for whose work the employee will be accountable. (e. 1-3 4-10 11-20 21-30 31-60 61-150 151 Plus Full time Combined Total employees Part time Full time equivalent employees (2000 hrs/yr) 11. 8:30am to 4:30 pm What. 10. Supervision or Direction Exercised Indicate any jobs or work groups that the employee (b) Provide technical or functional guidance to other will supervise under one or more of these categories: staff (as above in (a)). TOOLKIT / GOVERNANCE & LEADERSHIP A Framework and Toolkit for Managing eHealth Change (a) Assign and check work of others doing similar work (c) Supervise a work group. work of the group (as above in (a)). Lifting. climbing. work interruptions. Employees Supervised On the appropriate line. and responsibility for all the internal and external stakeholders is required. outside work. cold. Minor unpleasant aspects Major unpleasant aspects (b) What is the scheduled work week? Monday to Friday. tactile) X c. if any. listening. noise. Indirect reporting may be required. few exceptional demands X b. cramped conditions. Mental and Sensory Demands Enter estimated percentage in appropriate box Percent of Total Work Time Explain any condition that applies to the job 0-5% 5-20% 20-40% 40-70% Over 70% a. standing d. shift work is required? Other unusual hours? (c) Overnight travel: % of time away? Approximately 25 % travel potential Driving vehicle during work: % time? Approximately 25% . odours. heat. Physical. methods to be used. Working Conditions a) Explain any unpleasant aspects of the working environment.

OUT OF OUR CONTROL/INFLUENCE WITHIN OUR INFLUENCE IN OUR CONTROL *Reproduced with permission .58 1.7 Control and Influence Assessment TOOLKIT / GOVERNANCE & LEADERSHIP A Framework and Toolkit for Managing eHealth Change The following diagram was developed by British Columba Interior Health* and is useful for conceptualizing and listing those factors and stakeholders that are within or out of the control / influence of the project or its mandate.

0 Stakeholder Engagement TOOLKIT / STAKEHOLDER ENGAGEMENT A Framework and Toolkit for Managing eHealth Change Contents Are You EMR Ready? A Pre-Implementation Readiness Assessment Stakeholder Engagement Planning Template Stakeholder Analysis and Segmentation Target Audience Analysis Template Model for Prioritizing Stakeholders Communicating with Stakeholders Force Field Analysis Process Resistance Management Framework . 59 2.

the following guide was created to provoke your thinking and consideration of EMR system implementation in your practice. from project 3. Leveraging lessons learned from physician peers and their patient care teams. Make your way through the five key areas of but no matter what stage you’re in. understanding contemplation will help ensure your a local Clinician Peer Support Network. for example.60 2. In studying the diverse clinics. and what will You consider your office team knowledgeable be involved in your implementation will set the about EMRs in general. your practice. implementation. Managing change There are five key areas of the pre-implementation stage. . 5. it is clear that there are factors 4. You can clearly articulate the reasons prompting your office to implement an EMR system. care team’s readiness for an EMR implementation: Your office team culture is one that is open to discussion. Engaging your team. Solution provider and system support selection inception to execution. and what you can do to support a smoother transition from paper to electronic. “Experiences from What is your EMR area of focus? the Forefront of EMR Use” captures the implementation 1. Contemplation Reviewing this EMR pre-implementation guide You have begun gathering information about EMRs might be your first step in contemplating an EMR and the implementation process that lies ahead. You have taken advantage of any available Making sure you have taken the following steps in EMR system implementation support. Contemplation experiences from 20 Canadian primary care offices in 2.1  Are you EMR Ready? A Pre-Implementation Readiness Assessment TOOLKIT / STAKEHOLDER ENGAGEMENT A Framework and Toolkit for Managing eHealth Change The following tool was developed by the Clinical Use this guide to gain a better understanding of the Adoption Team at Canada Health Infoway in support impact that an EMR system implementation will have on of electronic medical record implementations. foundation for your EMR journey. EMR Pre-implementation Guide Undertaken by academic researchers. identifying what it will mean to your practice. there’s a lot to consider. Preparation and readiness common to every successful EMR implementation. Leadership and commitment Canada. pre-implementation to self-assess your EMR readiness.

example. between both clinical and administrative workflows. You have identified your office requirements in an EMR system – considering your needs now and You have discussed the pros and cons of the those of the future. electronic prescribing. . an EMR implementation: newsletters and regular face-to-face meetings. etc. Solution Provider and System Support Selection If you’ve done the following. You have the commitment from at least one In your project plan. which is communicated to them throughout all privacy and security impact and a clearly defined implementation stages. for practice needs. This is a valued and for your office EMR system implementation including essential role ensuring that all team members are dedicated resources for the work required? For TOOLKIT / STAKEHOLDER ENGAGEMENT A Framework and Toolkit for Managing eHealth Change engaged and understand the value and progress example. chronic disease management. 61 Leadership and Commitment Every successful EMR implementation has been You have developed a comprehensive project plan led by a practice champion. for example. etc. with other electronic health information systems. interoperability various EMR systems with your office team. standardized terminology. you will need additional champions to support your team needs). (In a large inter-professional practice. Your office team understand the benefits of implementing an EMR system. Making sure you have taken the necessary steps You have identified channels that will support in understanding leadership and commitment communicating most effectively with your office team will help ensure your care team’s readiness for about the EMR system implementation. for example. you are on the right You have EMR system provider selection criteria path to selecting an EMR that will meet your available to use during the selection process. process for how decisions will be made. You have identified ongoing support and maintenance resources required for the EMR Your EMR system will support integration in the office system once implemented. a plan for team education and training. system implementation with your team. you have identified when physician to champion the implementation and how you will measure the success of your EMR through all stages of EMR system implementation.

consultation notes. how their work will be impacted by go-live. and relevant skill and knowledge. change and support for one another. ensure that the right team member with the right skill level is doing the right job at the right time You have communicated to your patients about with the right resources or equipment. paper patient chart to an electronic medical record TOOLKIT / STAKEHOLDER ENGAGEMENT A Framework and Toolkit for Managing eHealth Change as you approach your EMR system go-live date: You have decided if your hardware devices will be hardwired or wireless connections. considered all resources including financial. You plan to involve your patients in viewing the Your office team is capable of performing initial and screen along with you – so you can show them ongoing workflow analyses and improvements to their health information and provide education. lab results. a computer skills training for each team member. . the EMR system implementation explaining what it means to their care and how it may impact them. Full EMR system functionality training has been completed as scheduled for all targeted team members. You have a plan in place for how to manage incoming paper from external points of care. You have short term and long term plans in place for your paper chart storage. You have identified your approach for rolling out the EMR system functionality in your office. Alternatively. can successfully support them through the EMR implementation: Your office practice using an inter-professional. Managing Change Ensure that you understand your practice team’s Your office culture encourages continuous level of readiness in making changes and how you improvement. collaborative team approach. there is someone from your office team appointed to be responsible for You have worked with your system provider information management and technology. for example. month looks like. You have a plan in place for handling for example.62 Preparation and Readiness Refer to the checklist points below to ensure that Your office team will be involved in hardware your practice is well positioned to transition from a selection and placement. time commitment. for You have identified who will be responsible for example all functionality at once (big bang) or a ongoing support of software and hardware issues staged rollout. You have coordinated a from an overall office perspective what a day/week/ practice run — with one of you acting as the patient. This includes identifying what they will stop doing and You can identify a team member who understands what they will start doing. computer in a patient exam room so results can be reviewed together. general your patients can be involved. system downtimes. Your office team is comfortable with making suggestions about alternative workflows when All team members have a clear understanding of supported by EMR functionality. You have identified what needs to be done to prepare and support your office team for the EMR You will place hardware in locations where system implementation. You’ve to create feasible project plan timelines. You have planned an approach for entering data from paper patient charts into the EMR. for example. after go-live.

63 2.2 Stakeholder Engagement Planning Template TOOLKIT / STAKEHOLDER ENGAGEMENT A Framework and Toolkit for Managing eHealth Change Key Interests & Engagement Key Stakeholders Priorities Objectives Activities Customers Delivery Partners Strategic Partners .

Stakeholder Level of Impact Current Context & Level of Approach/ Relationship Group influence level of major issues engagement strategy for manager support or concerns required involvement Level of influence Impact Current level of support 1 = No decision making authority or influence 1 = Low 1 = Negative 2 = Some influence but not critical 2 = Medium 2 = Resistant 3 = Influencer but no decision making authority 3 = High 3 = Compliant 4 = Medium level of influence and decision making authority 4 = Interested 5 = High level of influence and decision making authority 5 = Positive . • Impact indicates the degree to which they will be impacted directly by the project. This may vary by project phase. • Level of influence defines their breadth of power and • Level of project engagement required identifies influence in the project.64 2.3 Stakeholder Analysis and Segmentation TOOLKIT / STAKEHOLDER ENGAGEMENT A Framework and Toolkit for Managing eHealth Change This grid identifies the groups who can affect the project • Level of support identifies their anticipated support or are affected by the project according to: and commitment toward the success of the project. the intensity and type of engagement required during the project.

however. Position Number of Staff Vendor Tools / Solution Tools / Training Solution Comments Tasks Tasks .4 Target Audience Analysis Template TOOLKIT / STAKEHOLDER ENGAGEMENT A Framework and Toolkit for Managing eHealth Change The following table was developed to support a PACS implementation. it is easily adaptable for other eHealth uses. 65 2.

who groups stakeholders into cohorts: any actions that could potentially harm the project. foundation of support. further cultivating these champions.66 2. plan countermeasures that could help • Low Influence Champions: Ensure that positive neutralize any actions they might take that could relationships are maintained. but put less energy into converting these challengers • High Influence Challengers: Outreach efforts should into champions focus on converting these individuals to champions. Failing that.5 Model for Prioritizing Stakeholders TOOLKIT / STAKEHOLDER ENGAGEMENT A Framework and Toolkit for Managing eHealth Change High PRIMARY FOCUS 1 Influence OF STAKEHOLDER HIGH INFLUENCE HIGH INFLUENCE ENGAGEMENT CHALLENGERS CHAMPIONS EFFORTS & 2 RESOURCES 3 4 LOW INFLUENCE LOW INFLUENCE CHALLENGERS CHAMPIONS Low 5 Influence 1 2 3 4 5 Low Support High Support (“Challenger”) (“Champion”) The above model presented above has been adapted from • Low Influence Challengers: Maintain awareness of Sharma (2008). project leaders are best advised to the positive energy from these individuals / groups allocate stakeholder engagement resources to the High to further your objectives and to build a strong Influence Challengers and High Influence Champions. . • High Influence Champions: Proactively leverage According to Sharma. but put less energy into potentially harm or derail the project.

6 Communicating with Stakeholders TOOLKIT / STAKEHOLDER ENGAGEMENT A Framework and Toolkit for Managing eHealth Change The following stakeholder map can be used to identify The four groups identified within the stakeholder map the most appropriate means of keeping stakeholders (Monitor. • Contact phone line Low e. flyers. newsletters • Project email address Power • Monitor communication traffic from this sector for items requiring a response Low Interest High Interest Source: NHS Practical Guide to Stakeholder Engagement . press releases.. etc.g. Keep Informed. explain project and respond first points of contact for news to queries and concerns (positive and negative) • Presentations at stakeholder events • Workshops to develop involvement • Regular item on key committee agendas and exploit knowledge and skill available. High Keep Satisfied Manage Closely Power • Exploit existing management • Frequent personal briefings and Q&As meetings and committees to • Proactive risk and issue awareness. 67 2. and Manage informed of developments within the project. Closely) can provide the basis for a communication strategy. and tie-in key stakeholders Monitor (Minimum Effort) Keep Informed • No specifically targeted • Newsletters. posters. Keep Satisfied. communication effort websites. • Receives general information.

An example of a force field analysis is identified and then indicated pictorially with lines of shown To use: • Describe your plan or proposal for change in the middle. you can decide against in the other column. and all forces • Once you have carried out an analysis. The driving forces and resisting forces are of each aspect.7 Force Field Analysis Process TOOLKIT / STAKEHOLDER ENGAGEMENT A Framework and Toolkit for Managing eHealth Change A force field analysis usually involves the development differing strengths indicating the relative importance of a diagram. co-workers or team members. just as long as you do not change it in any way. • Assign a score to each force. 2006-2011. visit mindtools. whether or not a project is viable. • List all forces for change in one column. from 1 (weak) to 5 (strong). .68 Force Field Analysis Worksheet For further instructions on force field analysis. Forces FOR change Score Change Proposal Forces AGAINST change Score Total Total © Copyright Mind Tools Ltd. Please feel free to copy this sheet for your own use and to share with friends. Force Field Analysis Example (Force Field Analysis – Kurt Lewin) DRIVING FORCES RESTRAINING FORCES (Positive forces for change) (Obstacles to change) PRESENT STATE OR DESIRED STATE Source: change-management-coach.

stay calm is at. respond with the next step depending on the situation. you feel” or “I understand how time sensitive this is for you. ensure that perspective and if the problem or issue cannot be you’ve got agreement from the person on the issue. circle back to the question. coming from and then Step 4: Re-state and respond: Re-state the person’s specific concern to ensure you’ve heard correctly. By repeating Affirmation: Begin with a statement of empathy the listen and affirmation steps you are helping to calm to show understanding of where the person is the person down. Listen: Listen closely to what the person is saying and how the person must be feeling as a result. I can understand how to as the “CLARA” framework. identify and follow through on an Step 2: escalation path. there is agreement. Once resolved. Once you think you are clear on what the issue is. respond to the person’s problem. speak to something positive about the Step 1: project from your perspective. “Did I do my and people aspects]?” Stay calm at all times in order to best to create a positive customer experience?” If the issue cannot be resolved. try not to interrupt the person in the process. find an appropriate escalation path. Add a new piece of information from your Before you move forward to resolve the issue. work to resolve the issue to the best of your ability in a timely fashion. Explanation of the CLARA Framework: Step 5: Add: In closing. you are checking for In closing.8 Resistance Management Framework TOOLKIT / STAKEHOLDER ENGAGEMENT A Framework and Toolkit for Managing eHealth Change The following model has been reproduced with Step 3: permission from British Columbia’s Interior Health Affirmation: With the first words out of your mouth. you’ve heard to be the specific issue. Share a positive comment Customer experience: Begin each conversation with a you’ve heard about Insert Project / Solution name along customer service mindset: “What can I do to create an the way or share a helpful tip that will benefit the person. Listen: Seek first to understand what the problem Empathy absorbs emotion so you may need to repeat the or issue is before you speak. Once you think you listen and affirm steps several times before moving on to are clear on what the issue is. empathy statements must at all times in order to be genuine. Re-state and respond: By re-stating what you think If accurate. “That is really frustrating. This say something that demonstrates empathy. In order to be effective. Change Management Super User’s Toolkit. respond with . Statements resistance management framework is sometimes referred like.” Empathy statements acknowledge to the person you are serving that you understand where he or she Customer experience: Begin with the mindset to create a positive customer experience. understanding before you attempt to resolve anything. 69 2. excellent customer experience [focus on both technical In your mind.

. you can I. “I’d feel (frustrated. have one that will be of help for the future. Be aware of your emotional response to the person’s statement/attitude. a feeling. W  ays to listen and look for common ground with the person you are helping: get easier with practice. a concern. If the person continues to talk. State your common ground as a part of Solution that you think will help the person to see your empathy statement. a positive angle on the project. “I am here to help. Relate the comment 3. “I agree with you about…” . iii. Ways to affirm and acknowledge the 3. other person: identify the appropriate next step in order to 1. or disagree with you. too” 3. Share a quick user tip or cheat sheet reference to weight or step slightly toward the person to catch leave with the person if he or she does not already his or her attention. 1. Acknowledge the feeling expressed. “I can see that this has been difficult for you” head while the person is talking. this step must be genuine. If necessary.” spontaneously rather than develop “pat” answers. “I understand why…” • Following up with your manager iii.. Listen and look for common ground. Even if you cannot find common ground to affirm. send a you have just had. This may include: best guess about what it is: i. a question. Focus on your breathing. 2. PAUSE so the person can clarify their feelings or listening by positive eye contact and other attentive reactions. for what IV. “I think you are right about. Include a positive comment about Insert Project / a value. shift your 2. “I share your concern about. III. Ways to calm yourself if the person you are probably genuinely empathize with a feeling that TOOLKIT / STAKEHOLDER ENGAGEMENT A Framework and Toolkit for Managing eHealth Change helping is upset: is expressed: i. again for what you can next affirm or acknowledge. Silently say to yourself 3. listen non-verbal cues. but it will II. To be affirming. If you are unable to resolve the issue yourself. Affirm the common ground you share with your ensure the issue gets resolved.” iv. Affirming may not feel natural at first. “This is not easy” 2. your shoes. and open the possibilities: an experience.. Try counting to ten in your i.” “I want to turn not perceived as sweet or slick talk. subtle message by your body language. an interest. Clarify your intentions. upset. Add – to continue to build the relationship you share with this person: a hope.e. ii. Try to not interrupt the person when he or she to a value you picked up on in the conversation is talking.e.” • Contacting the service desk ii. Speak this person’s concern into a positive experience. Take 3-5 deep breaths. • Finding an appropriate super user i.” “I want to help. 1. Listen respectfully and demonstrate you are 4.. 1... angry) if I were in Feel your tension de-escalate.70 Other helpful tips for applying CLARA: 2.

71 3.0 Communications TOOLKIT / COMMUNICATIONS A Framework and Toolkit for Managing eHealth Change Contents Key Questions Associated with Communications Planning Communications Planning Tools – Audience Assessment Template Communications Plan Template Preferred Media – Project Communications Communication Diagnostic Simple Communications Tools Sample FAQ Template .

72 3. messages and information that need to be communicated? • What is the desired response? • Who must receive the message (internal/external)? • What is the likely response? • What do the stakeholders need to know? • How will information be communicated to the organization? • What is the desired and likely response? • How should the message be delivered (via what • What is the organization’s flow of communication channel)? How often? and tools and processes? • Who should deliver the message? • Who should deliver the message? • How will we capture feedback and input? • What channels will reach different stakeholders effectively? • How will we follow through on feedback and input? • How should the message be delivered (media)? • How will we measure communication effectiveness? How often? • How will communication effectiveness be measured? .1 Key Questions Associated with Communications Planning TOOLKIT / COMMUNICATIONS A Framework and Toolkit for Managing eHealth Change Questions to consider when building the plan: Change-Specific Communications Planning • Who is the audience? • What are the goals? • What information needs does this audience have? • What are the themes.

2 Communications Planning – Audience Assessment Template TOOLKIT / COMMUNICATIONS A Framework and Toolkit for Managing eHealth Change Adapted from Cohen. The Heart of Change Field Guide Stakeholder Description Criticality How the Effort Concerns / Degree of or group of stakeholder to success change required issues (what commitment* or groups (1-5) affects this to change this audience (Negative (-)/ audience (1-5) needs) Neutral (0)/ Positive (+)) 1 = Low 5 = High In addition to using the “-” or “+” symbols. * .g. E.. 2005. +4 or -3. 73 3. numeric values can be applied to further note level of commitment.

74 3.3 Communications Plan Template TOOLKIT / COMMUNICATIONS A Framework and Toolkit for Managing eHealth Change Adapted from Cohen. 2005.Key Audience Due date Channel Develop Review Deliver Status cation messages targeted /approve /action /details . The Heart of Change Field Guide Communi.

e. kick- Ensures message is consistent Must be perceived to be relevant offs/launches and targeted to stakeholder Written reports Ensures message is consistent and targeted Does not provide on the spot feedback Allows stakeholders to choose convenient Unsure if document is read time to review Email/memos Ensures message is consistent Does not provide on the spot feedback and targeted Unsure if document is read Allows stakeholders to choose convenient May be lost in the “shuffle” time to review . i. standing and targeted committee/council meetings Ad hoc meetings/ Provides opportunity for dialogue Difficulty in finding time in presentations Ensures the message is delivered exactly stakeholders’ calendars with project team as intended Time intensive for project team(s) members member(s).. i. Ensures message is consistent steering committee and targeted meetings/ other standing meetings Written reports Ensures message is consistent Does not provide on the spot feedback and targeted Unsure if document is read Allows sponsors to choose convenient time to review Email/memos Ensures message is consistent and targeted Does not provide on the spot feedback Allows sponsors to choose convenient Unsure if document is read time to review May be lost in the “shuffle” Leaders Standing meetings/ Provides opportunity for dialogue Difficulty in finding time in presentations Ensures the message is delivered exactly stakeholders’ calendars with project team as intended Time intensive for project member(s) team(s) members Ensures message is consistent i.4 Preferred Media – Project Communications TOOLKIT / COMMUNICATIONS A Framework and Toolkit for Managing eHealth Change The following tool describes the advantages and disadvantages of using various communications media / channels for key stakeholders. Stakeholder Preferred Media Advantages Disadvantages description Sponsors Standing meetings/ Provides opportunity for dialogue Difficulty in finding time in sponsors’ presentations with Ensures the message is delivered exactly calendars senior project team as intended Time intensive for senior project team(s) member(s).e.. Adapted with permission from Manitoba eHealth.e. 75 3..

76 Stakeholder Preferred Media Advantages Disadvantages description Leaders Website Ensures message is consistent Does not provide on the spot feedback (continued) Allows stakeholders to choose Unsure if stakeholders use website convenient time to review TOOLKIT / COMMUNICATIONS A Framework and Toolkit for Managing eHealth Change Resource intensive to create and keep updated Newsletters Ensures message is consistent Does not provide on the spot feedback and targeted Unsure if stakeholders review material Allows stakeholders to choose Must be “targeted” for stakeholder group convenient time to review May be lost in the “shuffle” Resource intensive to create Project Team Project Team Provides opportunity for dialogue Difficulty in finding time in team Meetings Ensures the message is delivered members’ calendars exactly as intended Ensures message is consistent and targeted Ensures team has current information Email/memos Ensures message is consistent Does not provide on the spot feedback and targeted Unsure if information is read Allows team members to choose May be lost in the “shuffle” convenient time to review Newsletters Ensures message is consistent Does not provide on the spot feedback and targeted Unsure if team member reviews material Allows team members to choose Must be “targeted” for team members convenient time to review May be lost in the “shuffle” Resource intensive to create Website Ensures message is consistent Does not provide on the spot feedback Allows team members to choose Unsure if team members use website convenient time to review Resource intensive to create and keep updated End Users Email/memos Ensures message is consistent Does not provide on the spot feedback and targeted Unsure if information is read Allows stakeholders to choose May be lost in the “shuffle” convenient time to review Question: Are all end users on email? .

) managers of credibility Time intensive for supervisors/managers Must be perceived to be of value by both parties Resource intensive Question: is message being delivered consistently and in a timely manner? Lunch and Learns Provides opportunity for dialogue Must be perceived to be of value by end Increases visibility of team members users to attend as many may not consider their lunch hour as “working time” Ensures message is delivered consistently . 77 Stakeholder Preferred Media Advantages Disadvantages description End Users Newsletters Ensures message is consistent Does not provide on the spot feedback (continued) and targeted Stakeholders may not believe information Allows stakeholders to choose convenient is credible TOOLKIT / COMMUNICATIONS A Framework and Toolkit for Managing eHealth Change time to review Unsure if stakeholders review material Must be “targeted” May be lost in the “shuffle” Resource intensive to create Website Ensures message is consistent Does not provide on the spot feedback Allows stakeholders to choose Unsure if stakeholders use or have convenient time to review access to website Resource intensive to create and keep updated Face-to-face Provides opportunity for dialogue Difficulty in finding time in meetings with Ensures the message is delivered stakeholders’ calendars Project Team exactly as intended Time intensive for project team members Ensures message is consistent Must be perceived to be of value and targeted Face-to-face updates Provides opportunity for dialogue Difficulty in finding time in stakeholders’ from supervisors/ Provides end users with strong sense calendars (shift work etc.

. Your responses should reflect what you have experienced as well as what you have generally observed in your organization. Your responses are crucial in improving the change initiative. • Be honest in your responses. • Answer the questions using a 5-point scale. There are no right or wrong answers.78 3. and your answers will remain completely confidential. Please respond by checking the box that corresponds most closely to your situation. the far left of the scale indicates that you strongly disagree and the far right of the scale indicates that you strongly agree. • Please take the time to respond to the open-ended questions at the end of the survey.5 Communication Diagnostic TOOLKIT / COMMUNICATIONS A Framework and Toolkit for Managing eHealth Change Instructions • Please read each statement and indicate the extent to which it describes the norm in your organization as a whole.

e-mails. because communications have been clear and heartfelt See multiple forms of communication (e. 1-to-1 discussions.g. but lead by example Feel that activities in our organization that are inconsistent with our change vision have been clearly explained Receive clear (not mixed) signals about the change initiative See that feedback mechanisms for employees to express their opinions and interests in the change initiative are in place Believe that those feedback mechanisms are being used Feel that there is constant dialogue between all levels of the organization regarding the change initiative Subtotal x1 x2 x3 x4 x5 Grand Total . large and small meetings. I… Strongly Strongly Don’t Disagree Agree Know Feel that the change initiative is communicated effectively.. giving TOOLKIT / COMMUNICATIONS A Framework and Toolkit for Managing eHealth Change everyone a solid understanding of our future Feel that the change initiative has been explained in clear terms Feel that the change initiative is communicated frequently Feel informed on the progress of the initiative Do not feel overloaded with data. newsletters. etc. memos.) being used to communicate the change initiative See leadership avidly communicating the need for change and why it is in our best interest See managers avidly communicating the need for change and why it is in our best interest See that leadership doesn’t just talk about the change vision. but leads by example See that managers don’t just talk about the change vision. conference calls. 79 As a member of this organization.

Elevator Speech • What is Insert Project / Solution name about? • Why is it important to do? • What will success look like? • What will we need from you? Why Change? What are the Benefits? Short Term Long Term .80 3. straightforward Management Super User’s Tool Kit messages for a variety of communications pieces.6 Simple Communications Tools TOOLKIT / COMMUNICATIONS A Framework and Toolkit for Managing eHealth Change The following two tools – the elevator speech and simple Simple Speaking Statements speaking notes – have been reproduced with permission Completing the cells in the table below will assist change from British Columbia’s Interior Health Change practitioners in developing simple.

value proposition name of legacy system? (i. Why not complete a pilot project first. Articulate WHY a user would want to get on board with the new project? Q. 81 3. Who will pay for the implementation of Insert Project Name? A. What is the governance structure of the project? A. how A. target audience. A. . Q. What is the Insert Project Name Project? e.g. Indicate who the decision makers are. so that we know the A. Who makes the decisions about Governance: Insert Project Name? Q. Specify functionality that will become accessible for use through project implementation. clinicians. How does this project contribute to Indicate Jurisdiction eHealth Vision? Q. Why would Indicate type of user. users support moving to a new application when we have Insert A. The overall Project governance is identified on the collaboration is undertaken. how feedback is received following page. Answer as relevant. Indicate project goals. why is the project being done).e. What will be delivered through the implementation? Q. Who is leading the project? What are the expected benefits? A. etc.7 Sample FAQ Template TOOLKIT / COMMUNICATIONS A Framework and Toolkit for Managing eHealth Change The following tool has been reproduced with permission Project Scope: from British Columbia’s Change Management Super Revise these questions as relevant to the project User’s Tool Kit / implementation Project Background: Q. or remove question Q. or a phased implementation. public health. Q. and incorporated.’ application works? What is the jurisdiction’s vision for eHealth? A.. Indicate how this project fits into the ‘bigger picture.

with the authority to direct resources. What is the relationship between the e. Organization type. Issues Management Team Provides project staff support to the JEC and the Implementation Leads Committee to assist in resolving escalated issues. Q. Implementation Leads Committee … Implementation Working Group Provides input. eHealth Strategic Council … Joint Executive Committee (JEC) Has a decision making role with regard to the implementation project. ______ will have input into the project in a number Q.g. What role do Indicate ‘players’. data conversion scope. Project Management Committee its membership consists of jurisdictional representatives. TOOLKIT / COMMUNICATIONS A Framework and Toolkit for Managing eHealth Change Manages operations and enhancements for Project over the long-term. Q. What is the mandate and membership of of ways – most notably through the Implementation the Implementation Leads Committee? Leads Committee and Implementation Working A. etc. How will ______ have input into the Project? A. Implementation Working Group and the Ministry. What is the mandate and membership of A. functionality. Regional Health Authorities. How are ______ Chief Information Officers (CIO) Working Group identifies a gap between the involved in this Project? current application’s functionality and desired A. is there a process for addressing those gaps? Q. communicate with constituents in their own organizations. In the situation where the Implementation Q. Implementation Leads Committee? play in the governance structure? A. Group processes. . data access models. the Implementation Working Group? A. Q. allocate funding and determine project scope. Q. business scenarios to support the Conference Room Pilot process. A. advice and recommendations on configuration..82 Revise table as required Project Management Office Manages the process and procedures governing access to all Project functions/ modules in all jurisdictions. LHINs.

Will tools and materials be available to support configuration as well as implementation as training efforts? a whole? A. Would there be user defined data in the training TOOLKIT / COMMUNICATIONS A Framework and Toolkit for Managing eHealth Change A. Q. A. Q. How does Insert Solution name compare to the A. Q. . What is the role of ______ in data conversion? A. included in the training materials and scenarios? A. Q. data conversion? A. 83 Q. How many trainers are expected to be trained? Is Q. What is the role of the Complete this question for all other stakeholders involved Q. How will Project decisions be communicated? Q. Configuration: Q. How will jurisdictional enhancements (add-on functionality) be funded? Q. database specific to each ______? A. What is the training approach that will be used for the implementation? A. Role and Responsibilities: Q. A. What is the role of Canada Health Infoway? Q. Q. Training: Q. What is the role of Vendor? A. Q. Will ______ be able to develop reports? A. What is the role of the Ministry / Department of Health? Q. A. What is the Project Team’s role in A. Change Management: Q. What is the role of ______ in configuration? there a limit and a location for training? A. Will ______ be able to develop ad hoc queries? in the project A. What is the change management approach for the Project? Q. User Defined Forms (UDF)? A. existing system – Insert Legacy system name? A. Will every ______ be able to develop their own A. What skills are needed from ______ to support Q. What is the approach to ensure realistic data is A. Q.

0 Workflow Analysis & Integration TOOLKIT / WORKFLOW ANALYSIS & INTEGRATION A Framework and Toolkit for Managing eHealth Change Contents Analyzing Workflow – Questions to Consider Mapping Current Workflow and Processes Flow Process Chart Template Systems Flow Chart .84 4.

2011. California Healthcare Foundation.) What are the tasks or steps involved? (For example. Workflow Analysis: EHR Deployment Techniques. checking a patient’s health number or confirming a prescription is up-to-date.1 Analyzing Workflow – Questions to Consider TOOLKIT / WORKFLOW ANALYSIS & INTEGRATION A Framework and Toolkit for Managing eHealth Change The following template provides a list of some questions that can be used to help describe a process from end-to-end. must the same data be entered at different points during patient check-in?) Template adapted from source: Kushinka.) What are the variations to these processes? Are there acceptable reasons for process variations by clinic site? Who completes the process? Do several types of staff perform the same tasks? Is this a good example of cross-training or is it a duplication of effort? How long does it take? Where are the bottlenecks where the process gets interrupted or slowed? Has some staff member already found a way around such points? Do some tasks need to be done more than once in a given process? (For example. 10p. Question Response What is the process? (For example. 85 4. SA. . dealing with an abnormal lab result.) Are there important patient care processes that do not involve seeing a patient? (For example. registering a patient or refilling a prescription.

Obtain benchmark data to define expectations for Physical layouts as applicable change and for use in benefits realization studies. Ensure that people know Unnecessary steps the purpose is to get automation right. those that will be impacted by the eHealth solution being acquired. all data collected (the information Relations diagrams payload). You may need to hold a retreat or some virtual meetings with field personnel to ensure Rework due to errors they become engaged in the activity. Lack of quality controls 4.86 4. following areas: 2. . Instruct persons on process mapping. Force field analysis Cause and effect diagrams 7. Statistical charts Radar Pareto Control 5. Then. A 1. Bottlenecks They know it best and they need to own the Sources of delay impending change. Map current processes.2 Mapping Current Workflow and Processes TOOLKIT / WORKFLOW ANALYSIS & INTEGRATION A Framework and Toolkit for Managing eHealth Change The following steps should be used to map current Workflow and Process Redesign workflow and processes: The following steps should be used to map how workflows and processes will be performed with eHealth solutions: 1. Encourage staff to identify all problem Lack of information areas so they can be addressed through automation. be sure no one insinuates blame for Lack of adherence to standards current issues. Collect all forms and reports that are part of processes to be automated through eHealth solutions. Study the is those you have envisioned for eHealth solutions. and how it is done. Tree diagram Affinity diagram 6. why it is being done. Use individuals who actually perform the process. Validate maps to ensure they reflect current processes. Avoid identifying opportunities The following tools may be helpful in identifying root cause: for improvement now because critical controls built into current processes may be overlooked. not to lay Long cycle time blame. Role ambiguity Unnecessary duplications 3. and all decision making. Identify potential problems in current workflows and good place to start identifying processes to be mapped processes and determine their root cause. Identify processes to be mapped. all variations.

different locations. 5. the sticky note tool is change/correct course as necessary.” A diamond shape denotes where a 4.” For TOOLKIT / WORKFLOW ANALYSIS & INTEGRATION A Framework and Toolkit for Managing eHealth Change (HIT) and electronic health records (EHR) and identify instance. It uses two basic symbols: A rectangle denotes the step in a process where a task 3. Implement these and revise maps to reflect relatively easy to construct and especially easy to use the changes. 7. the nurse’s aide may need to decide whether the temperature is within the normal range. The disadvantage of the tool is that it is more difficult to spot decision points and clearly see the various branches in thought processes when making a decision. Use maps reflecting new processes to create use case and if not. the temperature. It should answer “who does what. and later to build out the HIT shape. temperature. what to do next. and one branch denoting “No” and desired improvements. Identify changes that may be able to resolve problems • Systems flow chart: a commonly used tool that is today. 87 2. Where the system flow chart addresses the issue of envisioning decision 6. A variety of tools are available for process mapping: • Flow process chart: a template that enables steps in a process to be enumerated in a list format. in visualizing workflow. description in its symbols. with one branch denoting “Yes” and leading application during implementation to achieve the to the next step. Such a decision would scenarios to identify HIT functional specifications incorporate the decision “Normal?” in the diamond for vendor selection. Conduct benefits realization and celebrate successful tasks are noted to be missing. . This tool is often used by clinicians who are unfamiliar with flow charting. using • Systems flow chart with sticky notes: A final option for the maps as guides. a disadvantage is that it does not enable much into the HIT. For example. Incorporate changes from the maps into policy flow chart with sticky notes. Test new workflows and processes once incorporated points. Educate about health care information technology is performed. after recording reflecting desired improvements. a task may be “nurse’s aide records patient further changes that will be possible and are desirable. and tilted the note forms a diamond. constructing a process map is in the form of a systems 8. Train all staff on new workflows and processes. or where there is potential variation among different Process Mapping Tools staff. leading to the alternative next step. Because sticky notes can be placed on a blank wall or large sheet of paper and then moved around if 9. especially useful where mappers are new to mapping. the note forms and procedure. themselves to construct their policies and procedures. Some organizations use the maps a rectangle. Upright. Document in a new map the potential new processes decision must be made. etc.

O > D 5.88 4. Time Operations > Transportations Inspections Decisions D Delays Storages Totals: Used with permission. Time No. O > D 9. Flow Process Chart Process: Performed by: Present Proposed Analysis () Date: Why is it done this way? Why is it done by this person? Transportation Why is it done at this time? Inspection Operation Why is it done at this location? Quantity Decision Storage Delay Why is it done – is it necessary? Time Details of present/proposed process: Notes O > D 1. O > D 3. M. (Note: Additional rows will be needed) Totals: Present Proposed O Summary: No.html . O > D 7. (2007). Available by contacting author at: margret-a. Amatayakul. O > D 2. O > D 8. O > D 10. Margaret \ A Consulting. O > D Flow Process Chart Template TOOLKIT / WORKFLOW ANALYSIS & INTEGRATION A Framework and Toolkit for Managing eHealth Change The two types of tools are illustrated below. O > D 4. Strategies for the digital future of healthcare information.

Check out meds for shift in blister pack by charge nurse OR 3. The numbered items in the symbols represent variations in how nurses perform the specific component of the process. MAR in room OR 2. MAR on counter OR 4. MAR outside room on cart Administer med after ID and Compare med to MAR in room watch patient take med OR 3. Leave blank until given and signs out med. 89 4. MAR at nurses station Used with permission. Available by contacting author at: .4 Systems Flow Chart TOOLKIT / WORKFLOW ANALYSIS & INTEGRATION A Framework and Toolkit for Managing eHealth Change Below is a process map for medication administration from a Critical Access Hospital with five nurses. Verbal communication 1. Check out meds for 24-48 hours OR 2. Write time. M. Med put on tray with MAR OR 5. cross through sticky note and gives to charge Yes and initial under date nurse who goes to pharmacy OR 3. Check med out of pyxis for single dose 1. Margaret \ A Consulting. Take out of blister pack Med nurse checks med with MAR ID patient with 1 form of ID Chart med on 1. 1. Notification of nurse giving new medication Medication Transcribe order dosage put on MAR. Sticky note on patient MAR order on chart by RN or LPN May or may not OR 2. Write time on MAR under date given to indicate that med is checked out Med nurse writes down med needed. route. Take med to patient room Medication given to med nurse OR 2. MAR taken out of 3 ring binder include time OR 3. Never told for one patient OR 2. (2007). All patient meds put on large tray with all MARS OR 3. 1. ect on OR 2. Medication Administration Medication. patient name. Put meds on cart with MARS No Is med in pyxis? 1. Amatayakul. Strategies for the digital future of healthcare information.

0 Training & Education TOOLKIT / TRAINING & EDUCATION A Framework and Toolkit for Managing eHealth Change Contents Training Roles and Responsibilities Training Session Evaluation Template Computer Training Needs Assessment Training and Course Planning Matrix .90 5.

g. specific to clinic/department • Provides high level direction to master trainers of • Establish location for training (e. 91 5. training rooms. super users • Facilitates classroom training.. site teams within clinics) • Approves and oversees the co-ordination of • Co-ordinates vendor training vendor training • Develops training schedules and planning • Guides and coaches training resources with needs assessment. • Partners with Communications and Trainers Change Management Identify scope of role.g. as appropriate • Assists with the development of clinic/department specific training materials/support materials for learners • Conducts “1 on 1” training with physicians. if necessary ..1 Training Roles and Responsibilities TOOLKIT / TRAINING & EDUCATION A Framework and Toolkit for Managing eHealth Change The following role descriptions have been adapted Master Trainer from those used as part of a Clinical Documentation Identify scope of role. design/development of materials and • Establishes an evaluation process for each training activity delivery as well as the evaluation process • Creates and coordinates communication with • Assists teams with planning and project management Coordinators/Super Users/Learners • Assesses and obtains resources • Escalates issues to Master Trainer Strategist • Escalates major issues to Clinical Core Team • Partners with other Master Trainers. clinical staff. as appropriate Improvement (CDI) program in London. clinic / Identify scope of role. as appropriate department workflow) • Provides overall training strategies and framework • Provides direction to training resources for materials for all sites and delivery. • Conducts needs assessment for target audiences Master Trainer Strategist • Identifies training needs (e. Clinical that impact the project deliverables Coordinators and Super Users. Ontario.

92 5. Disagree Agree The trainer was knowledgeable and able Stronly Disagree Neutral Agree Strongly to answer your questions. Disagree Agree Your Feedback What positive feedback would you like to share? What feedback would you like to share for improvement? Job Title Date Dept/Clinic Your feedback is so important to the success of this project. Stronly Disagree Neutral Agree Strongly Disagree Agree Trainer 1 2 3 4 5 The trainer communicated clearly and in Stronly Disagree Neutral Agree Strongly a language you understood. Stronly Disagree Neutral Agree Strongly Disagree Agree The classroom pace was comfortable. Stronly Disagree Neutral Agree Strongly Disagree Agree Materials 1 2 3 4 5 The training materials were sufficient.2 Training Session Evaluation Template TOOLKIT / TRAINING & EDUCATION A Framework and Toolkit for Managing eHealth Change Please complete and return to: Classroom 1 2 3 4 5 The classroom setting was a comfortable Stronly Disagree Neutral Agree Strongly environment for learning. Disagree Agree The amount of training time was sufficient. THANK YOU! .

taskbar. maximize & close programs Not Familiar Sometimes have difficulty Can easily complete Start programs. Word. Please take a few minutes to complete this form and return to your department/unit manager. Windows Operating System Log-on to Windows Not Familiar Sometimes have difficulty Can easily complete Log-off of Windows Not Familiar Sometimes have difficulty Can easily complete Identify screen elements. / Unit In order to prepare for implementation. i. Outlook Not Familiar Sometimes have difficulty Can easily complete Use cut and paste within applications Not Familiar Sometimes have difficulty Can easily complete Install printers from the network Not Familiar Sometimes have difficulty Can easily complete Open and save files to a hard drive.. Dept. start button.e. toolbar Use the right and left mouse buttons Not Familiar Sometimes have difficulty Can easily complete Use computer keyboard Not Familiar Sometimes have difficulty Can easily complete Minimize. menus.3 Computer Training Needs Assessment TOOLKIT / TRAINING & EDUCATION A Framework and Toolkit for Managing eHealth Change The following document has been adapted from Employee Name Computer Training Needs Assessment tools developed by British Columbia’s Fraser Health and Interior Job Title Health Authorities. Not Familiar Sometimes have difficulty Can easily complete network drive or other storage medium Use SharePoint Not Familiar Sometimes have difficulty Can easily complete Use Windows Help & Support Not Familiar Sometimes have difficulty Can easily complete Request assistance from Help Desk Not Familiar Sometimes have difficulty Can easily complete 1 2 3 4 5 6 Write the number of the screen component on the blank line to the left of its description. 93 5.. Not Familiar Sometimes have difficulty Can easily complete icons. we need to identify your computer training requirements.e. Maximize Button Title Bar Minimize Button 7 Scroll Bar Close Button Menu Bar Toolbar Button . i.

self-paced) Not very effective Somewhat effective Very effective On-line user guide (self-paced) Not very effective Somewhat effective Very effective Please select the most desirable day(s) and time(s) for you to attend training programs (select as many as apply): A.M.94 Internet Browser Describe the difference between Not Familiar Sometimes have difficulty Can easily complete Internet and Intranet Start Internet Explorer Not Familiar Sometimes have difficulty Can easily complete TOOLKIT / TRAINING & EDUCATION A Framework and Toolkit for Managing eHealth Change Start corporate Intranet Not Familiar Sometimes have difficulty Can easily complete Search for and view information Not Familiar Sometimes have difficulty Can easily complete over the Internet Use of sophisticated web based applications Not Familiar Sometimes have difficulty Can easily complete such as online banking and/or shopping sites Identify file and shortcut to desktop Not Familiar Sometimes have difficulty Can easily complete I have taken the following training: Yes No Don’t know Computer Basics & Windows Tasks    Outlook E-Mail & Contacts    Outlook Calendar & Tasks    Word: Introduction    Word: Intermediate    Word: Advanced    File Management    Excel: Introduction    Excel: Intermediate    Which method of training do you feel would be most effective to achieve your learning goals: Classroom training (hands-on) Not very effective Somewhat effective Very effective Presentation (demo) Not very effective Somewhat effective Very effective On-line tutorials (hands-on. P.M. No preference Monday    Tuesday    Wednesday    Thursday    Friday .

clinical Identify recommended category. etc.4 Training and Course Planning Matrix TOOLKIT / TRAINING & EDUCATION A Framework and Toolkit for Managing eHealth Change The following matrix was developed to support the training needs of the North Network.g.. a telehealth organization that is now part of Ontario’s Telemedicine Network.g. e. training staff / group • General • General operations administrative support Information staff. 95 5. staff.. managers.. • Troubleshooting • Hardware • Roles and • Software responsibilities • Peripherals • Other content specific to the • Information for audience physicians • Train the Trainer • Privacy • Other .g. e. module name content. Category Training Modules Content Audience Primary / Backup Trainer One row per Identify training Describe module e. physicians.

0 Monitoring & Evaluation TOOLKIT / MONITORING & EVALUATION A Framework and Toolkit for Managing eHealth Change Contents Benefits Approach to Evaluation Example Evaluation Methodology Used in Evaluation of Newfoundland & Labrador Telehealth Strategy Example Evaluation Methodology Used in NB iEHR / Lab Scoping and Planning Initiative Canada Health Infoway — System & Use Survey .96 6.

happiness. do they freed up and used to deliver additional represent ‘quick wins’ which keep people services. staff career opportunities. 97 6. time. or values of achieving this? (Once again. resources the longer-term benefits? If not. and also enable you to establish baselines and quantify improvements. etc.1 Benefits Approach to Evaluation TOOLKIT / MONITORING & EVALUATION A Framework and Toolkit for Managing eHealth Change A benefits approach will help you to engage different stakeholders and organizations. . achieving this (and does the value I get growth. quality of life / length of active life for a do the short-term benefits contribute to segment of the population. contribute to my longer-term aim)? Organizational • Outcome: What will we as a community / • Outcome: For each project: what is the organization look like at the end of this outcome of this project? Projects may transformational programme? have milestones indicating a particular achievement. motivated and engaged?) Adapted from UK National Health Service. etc. • Benefits: What will the value-add be? Organizational or community benefits • Benefits: What are the short-term benefits are more likely to be population health. Long Term Short Term Personal • Outcome: How would I like to be? • Outcome: What will I achieve this week? • Benefits: What will that give me? • Benefits: What value do I get from These could be in health.

that is. . to key stakeholders: Likelihood of agreement on Step 3: recommendations increases if stakeholders are involved Agree on when to evaluate: Ideally. the evaluation of complex health information systems initiatives such as the Telehealth Strategy should involve data collection at three or more points: (1) baseline (pre-system implementation).2 Example Evaluation Methodology Used in Evaluation of Newfoundland & Labrador Telehealth Strategy TOOLKIT / MONITORING & EVALUATION A Framework and Toolkit for Managing eHealth Change Step 1: Step 4: Identification of key stakeholders in each jurisdiction: Agree on what to evaluate: There are virtually an It is important that a wide range of stakeholders be endless number of other evaluation questions that involved in and/or apprised of the evaluation efforts could be posed about complex health information within their own jurisdictions because it will improve systems such as the Telehealth Strategy.98 6. complex information systems should involve longitudinal evaluation. evaluation is needed: It is important to orient key Step 6: stakeholders to the telehealth initiative and the evaluation Analyze and report: Many researchers have noted that process as early as possible. However. feasible methods for approaching the selected evaluation Step 2: questions will involve consideration of the tradeoffs Orient key stakeholders to the rationale for why involved with the methods chosen. in terms of (2) comparable evaluation approaches will be introduced. Whenever possible. (2) during implementation and (3) post implementation (preferably multiple measures at 6 and 12 months post implementation). wherein an overview of the telehealth Step 7: strategy and key initiatives is presented. to determine their: (a) expectations of the telehealth initiatives and (b) views the task of consolidating the findings of a multi-method on what an evaluation plan should address. engagement. and/ or involves multiple data collection points. A workshop evaluation is perhaps the most difficult component of the format has proved useful for this type of stakeholder study of complex health information systems. resources to pursue these issues are limited. the likelihood that: (1) information exchange will occur. and (4) champions for evaluation Agree on how to evaluate: A discussion of the most will be engaged. the broader health system and the goals of the specific Step 5: initiative will occur. expectations Agree on Recommendations and forward them documented and views on evaluation elicited. evaluation of in their development and dissemination. evaluation that occurs over time. funding and availability of personnel with expertise to (3) greater strategic alignment between the goals of conduct the evaluation.

sponsors. e. circular nature highlights the process of learning. and growing the depiction of benefits. experts. timing tbd .g.3 Example Evaluation Methodology Used in NB iEHR / Lab Scoping and Planning Initiative TOOLKIT / MONITORING & EVALUATION A Framework and Toolkit for Managing eHealth Change The benefits evaluation model below demonstrates the deliverable addresses the first three elements: broad strokes of defining and identifying benefits. refining and Indicator Selection. Its Evaluation & Issue Identification. annuallly • Final report on benefits achieved. This planning Elements of the Benefits Evaluation Framework Evaluation Issues & Questions • Sets out questions of interest to the evaluation Evaluation • Why are we doing what we’re doing? Issues and What do we hope to learn? Questions Logic Model Interm and Logic • Shows connections between actions and Final Report(s) Model expected results • Allows us to clarify our thinking re outcomes BENEFITS EVALUATION Indicator Selection PROCESS • Prioritization of potential indicators • Input from literature. Infoway Technical Indicator • Relevance and feasibility Reports Selection Reports • Technical where applicable Measurement Protocol • Interim reporting throughout the evaluation. 99 6. Logic Model.

1. Assist in identifying barriers to adoption so that The S&U Survey process is divided into four phases. clinical information systems. The questions that make further information please contact the Infoway Clinical up the survey were developed by evaluation Subject Adoption team at clinicaladoption@infoway-inforoute. a number of projects such as those listed in The customizable System & Use Assessment Survey is the following domain areas have successfully customized intended to be administered soon after a project has the System and Use Survey: drug information systems. Identify additional functionality which could be that require additional explanation are discussed following provided in future releases the table. and to flag obstacles to adoption and the realization For any questions relating to the S&U Survey or for of net benefits from the system. remedial action may be initiated The activities that make up each the phase are outlined in Table 1. Matter Experts and Infoway’s Benefit Evaluation team. 4. Its purposes are to: diagnostic imaging. Provide analysis of the viability of communication and training strategies 5. More detailed descriptions of select activities 3. gone live. Evaluation Objectives To date. EMR pharmacy integration. Provide stakeholders with the assurance that their adoption of the solution is important. . used to assess quality and use components of health IT systems.100 6. Provide benefits statements to drive adoption in later implementations Survey Process 2. and clinical outcomes data projects.4 System & Use Assessment Survey TOOLKIT / MONITORING & EVALUATION A Framework and Toolkit for Managing eHealth Change This document is designed to detail the process of adapting Background and administering the System & Use Assessment Survey The S&U Survey was created with the intention of being (S&U Survey).ca.

e. • BE Lead • Information Management and Technology (IMT) . survey leads etc. 101 Table 1: Survey Activities Activity Involvement Timeframe Plan and Adopt Survey TOOLKIT / MONITORING & EVALUATION A Framework and Toolkit for Managing eHealth Change Identify opportunity for survey use and assess Project Ideally during planning appropriate timing of administering survey. web-based version of Infoway See above survey is created. • Project Evaluation Lead Infoway • BE Lead Project approves final version of survey. Project See above • Project Evaluation Lead Infoway • BE Lead Electronic. stages of project The inclusion of Infoway’s Core Questions is Infoway discussed with Project team (Appendix D). timelines. survey instructions. • Project Evaluation Lead stages of project Infoway • Benefits Evaluation (BE) Lead Survey template shared with Project team Project Ideally prior to and questions are customized to suit project • Project Evaluation Lead implementation (please see appendix B for survey template). • BE Lead Process agreed upon for distribution for survey Project See above i.

Project 3 weeks after • Project Evaluation Lead initial email Paper-based survey is distributed by Project 3 weeks after Project team. Infoway • BE Lead Reminder email #2 sent out to non-responders. Project • Project Evaluation Lead Infoway • BE Lead • Information Management and Technology (IMT Survey software automatically collects Infoway participants responses. Infoway • BE Lead Link to electronic S&U Survey enabled. • Project Evaluation Lead initial email . • Information Management and Technology (IMT) Reminder email #1 sent out to non-responders. • Project Evaluation Lead initial email Infoway • BE Lead Infoway provides Project team with copy Project 2 weeks after of paper-based survey and Project team • Project Evaluation Lead initial email prepares to distribute it. Data Collection TOOLKIT / MONITORING & EVALUATION A Framework and Toolkit for Managing eHealth Change Project compiles a list of potential survey par Project ticipants and decide on method to distribute • Project Evaluation Lead survey (both electronic and paper versions). Project 1-2 weeks after • Project Evaluation Lead initial email Discussion of need to administer paper-based Project 2 weeks after survey to non-responders.102 Table 1: Survey Activities (continued) Activity Involvement Timeframe 2.

Data Storage Both Project and Infoway retain data sets with Project no personal identifiers. project Infoway • BE Lead • Information Management and Technology (IMT) Project may choose to conduct additional Project Once collection of analysis of raw data. . 103 Table 1: Survey Activities (continued) Activity Involvement Timeframe 3. • Project Evaluation Lead responses is complete • Evaluator and/or • Third party organization (responsibility of Project) 4. Analysis and Report TOOLKIT / MONITORING & EVALUATION A Framework and Toolkit for Managing eHealth Change Project evaluation lead provided with raw survey Project Frequency to be data results throughout survey and at completion • Project Evaluation Lead determined with (see Appendix C for sample reports). • Project Evaluation Lead Infoway may aggregate the survey data with Infoway results from other evaluation projects and use • BE Lead it in pan-Canadian studies.

collecting the completed surveys. The In order to calculate a response rate for the survey it collection and storage of the paper version will be the is necessary to track the number of people invited to responsibility of the project evaluation team. or any other information that is potentially identifying. Possible methods of distributing the paper survey include: 1. Privacy and data storage The survey sponsor needs to determine who in their Confidentiality organization will take the survey. it is important to Infoway’s survey software will collect and store the raw determine the number of potential survey participants. pharmacists. name or employee ID number. version is possible. TOOLKIT / MONITORING & EVALUATION A Framework and Toolkit for Managing eHealth Change participate in the survey. Some choices are: the whole company. The data will not have any result in low response rates. support staff). seen as more accurate. Administering paper based version of survey To ensure confidentiality compliance. The project evaluation team will be responsible for ensuring the paper copies of the survey are kept confidential. Sending out survey attached to employees’ pay stubs 2 Organizing sessions in which groups of employees complete the survey together (either in regular group- meeting times or in larger groups at a special event) 3. or only certain job positions (i. and how many people complete the survey. The survey does not ask for employees. only permanent and/or full-time The survey is anonymous.e. the findings are for examples of the two formats that data is presented in. but will require additional labour from the project team. and survey in accordance with stringent data protection and inputting the responses into the electronic version of management requirements to protect the confidentiality the survey. Please see Appendix A large percentage of its target participants. physicians. however. A high response rate is important to legitimize Infoway will provide the project evaluation lead with a survey’s results. When a survey elicits responses from a data result reports periodically. Project evaluation team personally handing out surveys to individuals or departments and arranging a convenient drop off location . of the data and to prevent unauthorized use or access. Distributing a paper copy personal identifiers. the electronic method can sometimes Infoway’s secure server. data collected from electronic survey participants.104 Sample Size Results Prior to administering the survey. the project Data retention evaluation team will be responsible for distributing the Infoway will maintain the results from the electronic paper version. participants to provide any personal identification such as nurses. Infoway will provide the project evaluation team with a paper version of the electronic survey. The server administrator will of the survey to participants in addition to the electronic require a password to access the data. all responses While the S&U Survey is designed to be administered inputted into the electronic survey will be stored on electronically.

The key attribute of an advocate is having the trust and confidence of potential sponsors and being able to influence the sponsor’s decision. Business Process Business transformation is the institutional capability of translating the strategic business Transformation 77 vision for products. Late majority (skeptical). stakeholder expectations. Adoption 76 The acceptance of technological innovation in everyday practice regardless of the degree of infusion. and ultimately a way to rethink stakeholders’ needs to be responsive. new ways of influencing and support business change. It entails new ways of working. and development of action plans to address them. Benefits Realization Benefits realization is the process of achieving objectives. change is typically outcome or results focused. Benefits Evaluation An assessment of the impact. Early majority (deliberate). by selling the idea of change. which generally includes three components: (1) Articulation of the benefits. 105 CHAPTER 6 Glossary GLOSSARY A Framework and Toolkit for Managing eHealth Change The following terms and descriptions have been assimilated from the efforts of the Pan-Canadian Change Management Network and are intended to present a foundation of common language and dialogue within the eHealth change management community. Change 78 Change involves a shift in action or thinking. . etc. It is about the events or circumstances that impact and affect the organization. program or effort. Thus. Early adopters (respectable). changes in government policy. Advocates do not need to be people in authority or in the organization. Descriptions come from multiple sources as cited. Laggards (traditional). (2) Identification of key assumptions or conditions. technology. Term Description Adopters of Change 74 Adopters of change are grouped into five categories: Innovators (venturesome). services and processes into a commitment and plan for execution. These could include a new leader. benefit or change resulting from participation in an initiative. reconfiguration of people and competence to deliver strategic objectives. in that organizational change is usually a solution to someone’s perception of a problem or opportunity. and (3) Measurement against objectives. Advocate 75 An advocate is a person who helps build a case for change by drawing support from within the industry. This listing is expected to be further developed and refined.

They are stakeholders. and outcomes measurement. but the role often falls to middle managers because they have the influence and authority to make the change happen. They design the change process. They do not have to have management responsibilities. workflow integration. A consultant role is not the same as a staff role sanctioned by senior management to use specific expertise to implement a project or initiative. They will need to know the reasons behind the change as well as the intended effect on them and their work practices. They design the communication strategy and contingency plans for the change. Change Maintenance 84 Too frequently. colleagues who want the change implementation to succeed. as well as support for performance adjustments on an “as needed” basis to facilitate acceptance of the change in the organization. For instance. stakeholder engagement. GLOSSARY A Framework and Toolkit for Managing eHealth Change Change Champions 80 These are the early adopters. . Change Managers 83 Change managers have the expertise to lead the change and can act as role models. They are given responsibility for the day-to-day change implementation. monitor progress and communicate the change results throughout the organizational structure. and is designed to achieve strategic objectives. Change Consultant 81 The role of consultant is very different from a line manager who has authority. training and education. communications. Change Management 82 A strategic and systematic approach that supports people and their organizations in the successful transition and adoption of health information systems. strategy and approach. but the change may not have any immediate impact on their working practices. effective change management requires ongoing support through the measurement of compliance with the change. The change champions will be staff affected by the change. the funding bodies or governors may have a stake in seeing a change implemented. The outcomes of these change management activities result in solution adoption by users and the full realization of benefits. Consultants use their expertise. and believe the change will be beneficial to the institution. Change Management The Change Management Framework is a model of the fundamental elements needed Framework 85 for inclusion in an integrated change management approach. This will depend on the nature of the change. but a change may also have stakeholders who are not directly affected. They facilitate key events to build commitment for the change. Change Participants 86 Change participants are all those affected by the change. The framework strives to provide information supporting the complexity of change and includes the core elements of: leadership and governance. In fact. responsibility and accountability for specific results and outcomes. and confirm these with the change team.106 Term Description Change Agents 79 Change agents are those who make the difference in implementing change at a local level. influence and personal skills to facilitate a client-requested change without formal authority to implement recommended actions. organizations discontinue their support of change management on completion of implementation.

It is essentially a technique for looking at all the forces for and against a decision and weighting these factors to determine if a plan is worth implementing. power.) . They will need to be given the time from their regular job functions and recognition to undertake the role of implementing change. force field analysis helps to identify changes that could improve it. Sponsors approve the change strategy and approach. Facilitator 93 A facilitator eases the way for all stakeholders in the change process. Gap Analysis Gap analysis evaluates the difference between the organization’s current position and its desired future. Culture 90 An organization’s culture is the set of values and beliefs that cause people to behave in certain ways. They support the change manager in undertaking his or her role and responsibilities. Change will only occur if that balance is altered by adding forces. ongoing approach to care delivery excellence that measurably improves quality. facilitators use participatory methods and have a broad base of knowledge and experience as adult educators and leaders of change. This person ensures the availability of necessary resources and accepts ultimate responsibility for the successful change implementation. 107 Term Description Change Sponsor 87 Someone who has the authority. When they behave that way and get the results they expect. Ideally. Early Majority 92 Those who adopt new ideas just before the average member of a social system (deliberate). strengthening the forces for change. Any status quo is a balance of the current forces acting on the system. and reduces costs through the effective alignment of people. They must have the confidence of both the management and the staff affected by the change. Gap analysis results in development of specific strategies and allocation of resources to close the gap. Clinical Transformation 89 A comprehensive. enhances service. Early Adopters 91 Those who are opinion leaders in most social systems (respectable). it reinforces those values and beliefs. Force Field Analysis 94 Force field analysis is a specialized method of weighing pros and cons. or reducing forces hindering change. This self-reinforcing cycle creates a culture. process and technology. When a decision is made to carry out a plan. They should be drawn from all areas affected by the change and it is essential they demonstrate commitment to the change. enthusiasm and time to lead/carry through/oversee changes. (Sometimes referred to as “Fit” analysis. providing the environment where they can be actively engaged and empowered. The change sponsor may not get involved with the day-to-day management of the change but should support and monitor progress. They are active champions and role models for the new reality and they monitor and communicate change progress to interested parties. seniority. Change Team 88 The change team is made of staff members charged with implementing the change. Usually the change GLOSSARY A Framework and Toolkit for Managing eHealth Change sponsor is a senior member of the management team given responsibility for affecting the change.

telemedicine services.” it measures outputs and outcomes (including unintended effects) to determine program effectiveness. Change management for planned and unplanned change is easier in such organizations. Outcomes Refers to the extent to which a program achieves its stated objectives. Innovators 99 Those who are very eager to try new ideas (venturesome). Also referred to as Measurement103 “outcomes evaluation. and track and report progress in alignment to the business change strategy. health portals. Examples include health information networks. Information and ICTs are defined as technologies that facilitate communication and the processing and Communications transmission of information by electronic means. health monitoring and lifestyle management. treatment.108 Term Description Governance 95. institution-to-institution transmission for Health 97. steer or regulate the course of an organization or system. governance refers to the structures and processes needed to ensure GLOSSARY A Framework and Toolkit for Managing eHealth Change organizational ICT strategies and objectives are achieved. This type of information can be used to adjust activities in real-time throughout a program’s life. but may also assess program process to understand how outcomes are produced. the ability to monitor performance and determine the impact of the change on stakeholders. Their knowledge is needed to ensure the compliance of all enterprise solutions with the appropriate architecture and registration. or peer-to-peer communication between patients and/or health professionals. 106 Evaluation that focuses on what occurs in a program as it is delivered and documents the extent to which intervention strategies and activities are executed as planned. integrating new business processes and selecting enterprise solutions. diagnosis. They define investment strategies and assist with transition plans. The process owners have direct influence on stakeholders. In the ICT context. including alternative delivery procedures. 98 of data. electronic health records. and many other technology-based tools assisting disease prevention. Within the realm of information and communications technology (ICT). Laggards 100 The last group to adopt an innovation (traditional). Involves monitoring implementation activities and processes. Learning Organization 102 The learning organization facilitates the learning of all its members and continuously transforms itself. . 96 Governance concerns the mechanisms that are used to guide. Process Owners104 Process owners are involved in identifying the business capabilities that need to be developed. They are often involved with providing information for solutions across business units and from end-to-end. it can refer to the process of delivering the program or technology. Process Measurement105. ICT for health refers to the interaction Technology (ICT) between patients and health service providers. They may establish and support a change leader / agent network to drive change management activities. Late Majority 101 Those who adapt new ideas just after the average member of a social system (skeptical). wearable and portable systems that communicate.

responsibilities etc. position. nature of work: tasks. working relationships. identity. Project phases and activities Impact Map 111 are assessed against key stakeholders and results of each assessment are compiled to reflect the overall impact. Changes that negatively interfere with a person’s power. status. Stakeholder A tool used to assess a project’s impact on various stakeholders. psychological re-orientation experienced by people coming to terms with a change.. stakeholders could consist of the organization’s own members.” Transition 113 Transition is an internal. job security. It is timed differently from the external changes that caused it. suppliers. Thus. issues and expectations of stakeholders are Engagement 109. 110 learned. their stakeholders and wider society can benefit. WIIFM criteria could include: deeply held values and beliefs. Sustainability 112 Described as “when new ways of working and improved outcomes become the norm. The overall purpose of stakeholder engagement is to drive strategic direction and operational excellence for organizations. What’s In It For Me A useful way to consider the different needs and attitudes of those who will be key (WIIFM) 114 stakeholders in an improvement initiative is to carry out a “what’s in it for me” analysis. The more criteria that are negatively affected by the change. and power: status. The results yield a chart indicating the overall level of change needed and the aspects of the project most likely to be affected.” Sustainability is achieved when processes have changed and benefits are realized and have even further evolved over time. It is a process or inner experience not necessarily focused on outcome or results. the greater the resistance to change. Stakeholder The process by which the perceptions. Sustainability results when the change becomes an integrated or mainstream way of working rather than something “added on. etc. position and identity will evoke the most emotion. . GLOSSARY A Framework and Toolkit for Managing eHealth Change Stakeholder 109 An individual or group with an interest in the success of an organization and its products. 109 Term Description Sponsorship An analysis of the level of support and the sponsorship competency of all key business Assessment 107 leaders involved in the change. Stakeholders are groups internal and external to the organization that affect the organization’s interests. conditions of work: place.. hours etc. senior authorities either within or outside the organization. salary. and to contribute to the kind of sustainable development from which organizations.

.coachorg. 10  hile some tools and approaches may be used for W 2  hile some tools and approaches may be used for W enterprise CM. Retrieved from: health information technology project practice. was to support CM at a project level. minimal to no copyright or proprietary licenses to consider. Management. March 1. B. T. 15  arkey. Use and adoption challenges ncbi. (1998) McMaster University. C.(1).110 CHAPTER 7 Endnotes & References ENDNOTES & REFERENCES A Framework and Toolkit for Managing eHealth Change 1  agle. L. (2003).pepperdine. Antonio. Management Repository – Change Management Roles. Toward a model of N 9  aluzny.. . our intention was to support CM enterprise change management (CM).com/content/19838. Jones & Bartlett. Retrieved from: http://www. Am J Med Qual. Discrepancies were resolved through discussion. V. for health information systems. 12  s accepted by the Pan-Canadian Change A 4 I nclusion criteria included: source easily accessible. Montag-Schultz. Catford. American 7  anada’s Health Informatics Association.. 2003).nih. World Congress on changemanagementlibrary. 16  anada’s Health Informatics Association. (2009). (2009). Hunter. P.. Use and adoption challenges a key integrative function of project management in for health information systems.(2010). P Center Publications. our intention at a project level. D. 2009 change-management/. Available at: transition economies. (2008).asp.D. J. ON. 7. Trust and the Management of e-Business..1 (1998) Security. International Journal of Project coachorg. Chandler. (2010). Management Telehealth Change C aligned to core element(s) of the proposed framework. K. T.html.nlm. 25(4):268-73.html. prosci. CPHIMS-CA: Canadian supplemental review and 2010 Jul-Aug. L project ROI’s? Graziadio School of Business and Integrating change management into clinical Management. The business impact of change management: What is the common denominator for high 6  eyland.. 5 Available at: coachorg. Accessed at: 3rd edition. A. M. Hamilton. 16. Continuous quality improvement in health care. 11  ore information on Prosci’s approach M 3  ore information on Prosci’s approach M to CM can be found at: to CM can be found at: prosci. CO: Learning 14  etouhoff. K successful electronic health record adoption. Change management – V examination guide. Change management: H The people side of change. Change management V for effective quality improvement: a primer. Creasey. Retrieved from: examination guide. J.. gbr.. C Journal of Medical Quality. (2010). and information contained within source 13  anadian Society for TeleHealth. longwoods. N. P. Electronic Healthcare. Dietrich. 2009. McLaughlin. (Loveland. (2010). C CPHIMS-CA: Canadian supplemental review and 8 Pepperdine University. 2011.

(2003). Change management: The H people side of change. Issue 6. 2011 from: http://www. matter. (2004). A. L. White Paper on C — The new imperative. 26  or further information.. et al. S. J. Cady. Accessed from: businessperform. L. Change program roles. Boston: Pitman. Business Performance Pty 33  ollege of Healthcare Information Management C Ltd. Organizational change management A Association for Human Resource Information — The new imperative. (2003). Health Record (EHR). Available at: businessperform. (2007). Australia. (2008). Business Performance Pty 32  entral Computer and Telecommunications Agency C managing_change. 31  alder. (1996). (2006). 25  ore information on Prosci’s approach to CM can be M 34  anada’s Health Informatics Association. whole systems. Health informatics professional career matrix.htm. 6 (1) 111 17  llen. T. Business Performance Pty Information Governance of the Interoperable Electronic Ltd. (2003). Volume XIV. CA. Executives (CHIME). 2003). p. change_program_roles. L. J. governance-of-the-interoperable-ehr. Change management: The H 29  annoni. (2003). R. CO: Learning Center Management to Governance – A Framework for Publications. A governance-and-prince2-project-management. Public Management Review (2004) vol. PRINCE2: Project Management for Business. please see The case Career_Matrix_11_2009. (2010). T. Creasey. January 2010.html. (2009). Increasing Success with measuring the ROI for December 2009/ Ltd.. The change handbook – The definitive resource for today’s best methods for engaging 36 Located at: http://bit.13. com/change-management/ reviewed by Peggy Barton in: Barton. (Loveland. (2007). J. Berrett-Koehler Publishers R. Accessed at: razorlearning. International 20  llen. (2010). Business A Performance Pty Ltd. (CCTA). IT Project Governance and C 22 Ibid. 21  iatt. Implementing EHRs in the HITECH Era. including a case for F coachorg.html. Accessed on April 11. Creasey.. C found at: prosci. Accessed from: businessperform. The CIO’s Guide to management/change_management.infoway-inforoute.pdf. (Loveland.pdf. L. (2003). (1984). Managing change in the workplace. Devane. (2003). From Change P people side of change. CO: Learning Center 30 Ibid. PRINCE2 Project Management. blog/2010/03/change-management-governance- framework-increasing-success-technology/#_edn2.html.. 38  reeman. Ricketts. P. T. The Stationery Office. Business Performance Pty Management. London. Publications. Strategic Management: F A stakeholder approach. [Electronic document]. 24  llen. 35  llen. Accessed from: businessperform.php/ component/docman/doc_download/75-information- ENDNOTES & REFERENCES A Framework and Toolkit for Managing eHealth Change 18 Accessed from: projectsmart. .uk/pdf/project- 23  llen. 2003). https://www. management/change_management. 19  iatt. Available from: management/change_management. What to do when Stakeholders B San Francisco. Organizational change management A — The new imperative. Organizational change management A 28  anada Health Infoway. (2nd Ed).. 37  ryson. G. 21-53. Accessed 27  ore than 60 different CM approaches have been M from: businessperform. for change management: Three people side ROI factors at: change-management.

December 2009. C Retrieved from: 39 AccountAbility. W standard. (2009). matter. (2005). uk/systemsandservices/icd/informspec/careerplan/phi/ personal/learningweb/personal/mentoring. Executives (CHIME).uk/resourcecentre/ Current state analysis – Alberta’s response.33. J. London.pdf. Kimsey-House. What are 56 Located at: http://bit. 21-53. Richards. Stakeholder engagement 49 Davies-Black Publishing. Current state analysis – New Brunswick’s response. benefits and journey (2010).com/ integration. C coachingNetwork. New skills [Electronic document]. Sandahl.nationalarchives.connectingforhealth.connectingforhealth. (1999). 55  ollege of Healthcare Information Management C CIPD House. A guide to process Leadership Theory can be found at: mindtools. (2011).htm. 58  hange Management Working Group. http://bit.. R. 43 S harma. Exposure 47  ore reading on Hersey and Blanchard’s Situational M 59 e Health Ontario. 45  ist abstracted from: Willis. (2006). Retrieved from: for coaching people toward success in work and life. CA. whatarecoachingandmentoring. London. (Available in the online toolkit located at: pages/article/newLDR_44. 52 Ibid. Supply chain management review 53 Ibid. 42  ational Health Service (NHS). Mountainview. Coaching for uk/systemsandservices/icd/informspec/careerplan/phi/ Information available by contacting personal/learningweb/personal/mentoring. accountability21. London. N Northumbria University. Accessed at: iap2. Public Management Review (2004) vol.isip. L The coaching and mentoring network. The manager as coach and mentor. Information available by contacting 46  ational Health Service (NHS).ca. Kimsey-House. 4th Quarter. .ly/infoway-CM-toolkit. Retrieved from: Practical Guide to Stakeholder Engagement. Retrieved from: webarchive. performance and purpose. (2011). Good practice and innovation.. (2007). coaching and mentoring? Retrieved from: 57  hange Management Working Group. (2009).nhs. (1999). (HCIM & C). Change management – resistance to change. (2010). W 60  ore information on Maturity Models can be M GROWing people. The CIO’s Guide to Implementing EHRs in the HITECH Era. Co-active coaching.. 3rd edition. uk/20100809114547/http://www. Canadian EHR: Early Nicholas Brealey Publishing. Connecting for Health. P Chartered Institute of Personnel and Development. 51 J ISC infoNet. 2010 p. Mentoring and coaching. K. 48  hitmore. M. (2004). Mentoring and coaching. 44  arsloe. Britain. (2009). 41 I nternational Association for Public Participation. N 40  ryson. The six principles of stakeholder engagement.nhs. (2010). 54 Located at: http://bit. L. ENDNOTES & REFERENCES A Framework and Toolkit for Managing eHealth Change 50  ational Health Service (NHS). management/resistance/. 1-9. UK. (2002).htm. S. P. found at: Hagens. 6 (1) Retrieved from: http://www. J. What to do when Stakeholders B Connecting for Health. (2008). N clinicaladoption@infoway-inforoute. United Kingdom. (October) pp. clinicaladoption@infoway-inforoute. Health Care Information Management and Communications. E.


61 Ibid. 73 Located at:

62 Located at: 74  ade, T., Nori, A. (2006). General Practitioner (GP)
Change Management Strategy: Engagement with
63  feffer, J., Sutton, R.I. (2000). The Knowing-Doing
P General Practice. HealthConnect SA, October 2006.
Gap: How Smart Companies Turn Knowledge into

ENDNOTES & REFERENCES A Framework and Toolkit for Managing eHealth Change
[Electronic document]. Retrieved from: http://www.
Action. Harvard Business School Press, 2000.
64  ore information on the Clinician Peer Support
M HCSA%20Change%20Management%20in%20
Network program is available at: infoway-inforoute. General%20Practice.pdf.
ca/lang-en/working-with-ehr/health-care-providers/ 75  anadian Society of Telehealth. Telehealth Change
clinician-peer-support-network. Management Repository – Change Management Roles.
65  e recent Clinicians in Training media release is
Th Retrieved from:
available at: changemanagementlibrary.asp.
infoway/news/news-releases/694-canadian-medical- 76  ar, J., Black, A., Anandan, C. et al. (2008).
schools-to-strengthen-training-on-effective-clinical- The Impact of eHealth on the Quality & Safety of
use-of-information-a-communications-technologies. Healthcare – a Systematic Overview & Synthesis
66 Located at: of the Literature. Report for the NHS Connecting
for Health Evaluation Programme, March. 619p.
67 Landau, V. (2001). Topic 10: Developing a project
management plan. Formative evaluation. Retrieved on 77  orello, D. Olding, E. (2008). Rethinking Change:
October 12, 2010 from: Practical Realities of Successful Transformation.
module10/notes10.html. Gartner Research, Publication Date: 6 February 2008.

68  ore information on Canada Health Infoway’s
M 78 J ISC InfoNet. (2002). Change Management InfoKit.
System and Use Survey can be obtained by Retrieved Sept 19, 2010 from:
contacting: infokits/change-management/transition-management/
69  hola, H. S. (1990). Evaluating “Literacy for
development” projects, programs and campaigns: 79 J ISC InfoNet. (2002). Change Management InfoKit.
Evaluation planning, design and implementation, and Retrieved Sept 19, 2010 from:
utilization of evaluation results. Hamburg, Germany: infokits/change-management/roles/agent.
UNESCO Institute for Education; DSE [German 80 J ISC InfoNet. (2002). Change Management InfoKit.
Foundation for International Development]. Retrieved Sept 19, 2010 from:
xii, 306 pages. infokits/change-management/roles/champion.
70  anada Health Infoway. (2005). Benefits Evaluation
C 81  anadian Society of Telehealth. Telehealth Change
Technical Report. [Electronic document]. Retrieved Management Repository – Change Management Roles. Retrieved from:
Techical%20Report%20(EN).pdf. changemanagementlibrary.asp.
71  anada Health Infoway. (n.d.). Benefits Evaluation
C 82  anada Health Infoway. (2011). Pan-Canadian
Forum. More information available at: Change Management Network. Change management working group – 2010/11 deliverables.
in-canada/benefits-realization. Information available by contacting
72  anada Health Infoway. (n.d.). System & Use Survey
Tool. Accessible by contacting the Clinical Adoption
team at:


83  anadian Society of Telehealth. Telehealth Change
C 93  amsden, V.R.,Vilis, E., White, H. (2006).
Management Repository – Change Management Roles. Facilitation as a Vehicle for Change (p1) in Guiding
Retrieved from: Facilitation in the Canadian Context: Enhancing Primary
changemanagementlibrary.asp. Health Care. Department of Health and Community
Services, Government of Newfoundland & Labrador
ENDNOTES & REFERENCES A Framework and Toolkit for Managing eHealth Change

84  ickenscher, K. (2010). A New Model for Healthcare
F with four other provincial Ministries of Health
Transformation. Dell Services. Accessed at: (Ontario, Manitoba, Saskatchewan, British Columbia).
Documents/hc-transformation-kevin-fickenscher.pdf. 94  ade, T., Nori, A. (2006). General Practitioner (GP)
Change Management Strategy: Engagement with
85  anada Health Infoway. (2011). Pan-Canadian
C General Practice. HealthConnect SA, October 2006.
Change Management Network. Change management [Electronic document]. Retrieved from: http://www.
working group – 2010/11 deliverables.
Information available by contacting HCSA%20Change%20Management%20in%20 General%20Practice.pdf.
86  anadian Society of Telehealth. Telehealth Change
C 95  anada Health Infoway. (2007). White Paper on
Management Repository – Change Management Roles. Information Governance of the Interoperable Electronic
Retrieved from: Health Record (EHR), March. Available from:
87 J ISC InfoNet. (2002). Change Management InfoKit. component/docman/doc_download/75-information-
Retrieved Sept 19, 2010 from: governance-of-the-interoperable-ehr.
infokits/change-management/roles/sponsor. 96  eratarbide, E., Kelsey, T. (2009). Implementing
88  anadian Society of Telehealth. Telehealth Change
C eHealth governance: eHealth Governance – a key
Management Repository - Change Management Roles. factor for better health care. [Electronic document].
Retrieved from: Available at:
changemanagementlibrary.asp. eHealthGovernance.pdf.

89  ickenscher, K. (2010). A New Model for
F 97 I nternational Information Resource Centre.
Healthcare Transformation. Dell Services. Information Development Study: Davies, J. (2006).
Accessed Information and Communication Technologies (ICT) in
healthcare/en/Documents/hc-transformation-kevin- the Health Sector – a literature review. Available from:

90 I nstitute for Healthcare Improvement (IHI). (2005). 98  urope’s Information Society. “What is eHealth?”
Going Lean in Health Care. IHI Innovation Series white
paper. Cambridge, MA. Available on index_en.htm.

91 J ISC InfoNet. (2002). Change Management InfoKit. 99 J ISC InfoNet. (2002). Management InfoKit.
Retrieved Sept 19, 2010 from: Retrieved Sept 19, 2010 from
infokits/change-management/adoption/index_html. infokits/change-management/adoption/
92 Ibid.
100 Ibid.


101 Ibid. 110 AccountAbility. (2005). Stakeholder engagement
standard. Exposure draft. London, United
102  ade, T., Nori, A. (2006). General Practitioner (GP)
Kingdom. [Electronic document]. Retrieved from:
Change Management Strategy: Engagement with
General Practice. HealthConnect SA, October 2006.
[Electronic document]. Retrieved from: http://www.

ENDNOTES & REFERENCES A Framework and Toolkit for Managing eHealth Change 111  anada Health Infoway. (2008). Change
HCSA%20Change%20Management%20in%20 Management Forum. Case studies for effective change
General%20Practice.pdf. management: Projet Imagerie médicale dans le cadre
du Dossier de santé du Québec. Plan de gestion
103  nited States General Accounting Office. (2005).
de changement et de communication. P-02 RUIS
Performance Measurement and Evaluation:
Laval, ID2-2 RUIS Montréal McGill, P-03 RUIS
Definitions and Relationships. May, 2005. Retrieved
Sherbrooke. (Change Management Plan as Part
of a Telehealth Project. (Québec) Prepared by the
104  anadian Society of Telehealth. Telehealth Change
C Telehealth Team, Montreal RUIS, fall 2008. 11p).
Management Repository – Change Management Roles. Available by contacting
Retrieved from:
112  ational Health Service (NHS). (2010).
105 WestEd. (n.d.). Evaluation toolkit for Magnet Institute for Innovation and Improvement.
Schools Programs. Glossary. United States Sustainability: Ensuring Continuity in Improvement.
Department of Education. Accessed at: Available from: general/welcome_to_sustainability.html.

106  rochim, W. (2006). Research Methods Knowledge
T 113 J ISC InfoNet. (2002). Change Management
Base. Introduction to Evaluation. Available from: InfoKit. Retrieved Sept 19, 2010 from: jiscinfonet.
107  iatt, J. (2006). ADKAR: A Model for Change in
Business, Government and Our Community, How to 114  ational Health Service (NHS). (2005).
Implement Successful Change in Our Personal Lives and Institute for Innovation and Improvement.
Professional Careers. Prosci Research. Improvement leader’s guide: Managing the human
dimensions of change – Personal and organizational
108  niversity of British Columbia. Business
U development. 55p. [Electronic document].
Terminologies. Organizational Development Available at:
& Learning. Retrieved July 21, 2010. inc/files/documents/improvement-methodology-
109  ational Health Service (NHS). (2007).
N resources-section/ilg_3.1_managing_the_human_
Practical Guide to Stakeholder Engagement. [Power dimensions_of_change.pdf.
point presentation]. Available from: webarchive.

31. 41. 25. 99. 2. 22. 106. 21. 35. 27.116 CHAPTER 8 Index A Framework and Toolkit for Managing eHealth Change Acknowledgements Culture Innovators Sponsor 117 3. 25. 14. 33. 25. 18. 15. 91. 22. 26. 108 21. 90. 18. 86. 3. 98. 14. 109 82. 30. 27. 24. 15. 13. 7. 63. 9. 10. 28. 54. 108. 92. 43. 14. 54. 4. 65. 14. 55. 24. 24. 29. 62. 32. 14. 27. 30. 8. 106. 4. 87. 21. 21. 87. 106. 7. 64. 106 Advocate 18. 30. 43. 12. 49. 11. 56. 106 Resistance Information and Coaching 9. 53. 46. 12. 47. 31. 7. 67. 20. 7. 106. 13. 86. 106 Framework 100. 7. 93. 35. 33. 85. 15. 14. 35. 54. 68. 72. 15. 20. 40. 29. 105. 20. 6. 25. Definition 4. 91. 54. 14. 102. 92. 18. 3. 12. 68. 108 32. 5. 107 Adoption Laggards 3. 45. 14. 13. 72. 23. 36. 12. 105. 104. 97. 19. 33. 105. 31. 16. 55. 106. 32. 80. 5. 28. 72. 87. 28. 10. 43. 51. 33. 99. 69. 33. 107 33. 15. 13. 19. 12. 18. 4. 54. 24. 14. 7. 22. 32. 27. 7. 86. 9. 6. 26. 83. 11. 71. Stakeholder Engagement 62. 41. 106. 39. 78. 105 Training Change Measurement 4. 4. 32. 99. 66. 15. 22. 60. 91. 101. 73. framework 22. 30. 22. 7. 17. 17. 60. 109 3 3. 98. 12. 107 104. 60. 13. Executive Summary Outcomes 4. 13. 41. 8. 73. 101. 27. 91 69. 21. 34. 105. 11. 49. 8. 9. 41. 16. Workflow 9. 19. 38. 34. 7. 108 Gap 23. 13. Evaluation 2. 106. 35. 61. 27. 51. 59. 56. 47. 108 27. 106 30. 44. 34. 61. 68. 56. 95. 36. 56. 108. 12. 43. 109 technology (ICT) Communications 3. 30. 109 12. 91. 20. 23. 42. 19. 53. 42. 25. 40. 18. 14. 81. 7. 105. Education 105. 33. 31. 6. 10. 21. 62. 99. 33. 83. 85. 19. 82. 28. 90. 17. 31. 83. 8. 84. 109 3. 9. 27. 49. 14. 14. 62. 10. 19. 108 17. 10. 7. 108. 61. 108 50. 3. 15. 13. 51. 4. 13. 6. 54. 14. 60. 16. 86. 32. 8 Governance 30. 34. 28. 88. 105. 32. 79. 33. 23. 9. 100. 27. 51. 75. 9. 109 31. 13. 109 55. 24. 19. 95. 5. 7. 10. 22. 31. 26. Impact 51. 48. 33. 29. 3. 43. 20. 32. 54. 105. 38. 53. 14. 54. 11. 109 Leadership 49. 6. 32. 90. 82. 48. 8. 6. 4. 4. 35. 10. 107 35. 96. 106 26. 49. 4. 86. 16. 89 106. Benefits evaluation Learning Sustainability 15. 50. 4. 47. 30. 7. 61. 4. 12. Transformation 79. 108 2. 109 2. 44. 12. 9. 18. 17. 21. 11. 10. 53. 36. 24. 29. 3. 94. 13. 17. 8. 32. 56. 105 eHealth 60. 79. 14. 30. 97. 82. 107 34. Monitoring 23. 35. 54. 27. 33. 15. 22. 28. 6. 55. 81. 8. 105. 44. Process Force field analysis 21. 43. 31. 54. 28. 40. 12. 108. 91. What’s In It For Me (WIIFM) 24. 8. 107. 30. 108 65. 29. 75. Roles 4. 100. 44. 9. 55. 32. 16. 17. 103. 13. 108. 9. 8. 62. 15. 99. 5. 25. 27. 15. 14. 105. 27. 60. 21. 14. 28. 31. 6. 61. 39. 39. 24. 25. 92. 24. 107 107. 11. 85. 29. 29. 56. 86. 12. communications 18. 14. 54. 16. 32. 10. 24. 8. 109 . 96. 16. 78. Transition Change management Facilitator 106. 4. 14. 106 105. 74. 14. 80. 108 Sponsorship 18. 4. 34. 21. 107 62. 89. 15. 30. 7. 14. 106. 5. 9. 15. 4. 100. 12. 32. 99 99. 24. 61. 13. 98. 8. 17. 8. 24. 36. 24. 13. 3. 18. 13. 56. 29. 35. 19. 86. 41. 9. 4. 107. 4. 13. 61. 32.

Ian Hodder Senior Implementation Transition Services Team Manager. who provided invaluable guidance and efforts in developing the core content for A Framework and Toolkit for Managing eHealth Change: People and Processes. & Clinical Adoption Management Division eHealth Saskatchewan Clinical Information System Specialist Manitoba eHealth Health PEI Manitoba eHealth Glen Paskiw Cindy Fajardo Martin Hodgkinson Transition and Change Change Management Change & Evaluation Management Coordinator Specialist Specialist. Clinical eHealth Ontario Projects Coordinator Information Programs Department of Health Ken Collins & Quality Alison Loh-Kandylis and Social Services. Clinical Leader. Margaret Duffy Change Management Director. & Labrador eHealth Ontario Newfoundland & Labrador Karen Zimmer Lori Holuk Siddall James Nick Director. Change Management Lead Centre for Health Change Management Government of the Centre for Health Information. Newfoundland Specialist Northwest Territories Information. Specialist. 117 CHAPTER 9 Acknowledgements ACKNOWLEDGEMENTS A Framework and Toolkit for Managing eHealth Change Canada Health Infoway (Infoway) would like to acknowledge and thank the many individuals and organizations that contributed to the development of this product. Ontario Region eHealth Saskatchewan eHealth Ontario Canada Health Infoway Joan Rabillard Cindy Hollister Manager. Atlantic Region l’arrimage des projets Alberta Health and Wellness Clinical Adoption Team Canada Health Infoway et des déploiements Canada Health Infoway Ministère de la santé et des Tim Bedo Rosamund Levy services sociaux. Québec Team Lead. Infoway would like to acknowledge and express its appreciation to the members of the Pan-Canadian Change Management Network (Network) and especially the Change Management Working Group (CMWG). Change Management Working Group Susan Anderson Cassie Frazer Dave Kerr Pierre-Martin Tardif Executive Director. Program Corporate Services Business Clinical Lead. In particular. Primary Health Care Clinical Adoption Team Fraser Health Authority Canada Health Infoway . Direction de Information Management Quality Improvement Leader. Change and Adoption Specialist Jessica Young eHealth Saskatchewan Management. Benefits Realization & Change & Evaluation Directeur.

Services Director. Simon Hagens and Maureen Charlebois. Christina Scicluna. Clinical Oversight ACKNOWLEDGEMENTS A Framework and Toolkit for Managing eHealth Change Specialist. . Benefits Adoption Team Realization & Quality Canada Health Infoway Keren Taylor Hughes Myriam Brel Improvement. Government of Yukon Special thanks to Ian Hodder (co-chair CMWG and Pan-Canadian CM Network) and Infoway’s Clinical Adoption core project team members Cassie Frazer (co-chair CMWG and Pan-Canadian CM Network). eHealth Co-Chair. Specialist. Committee. Clinical and Long Term Care Health PEI Director. Mark Simmons Disease Prevention / eHealth Information Ontario Ministry of Health Management Simon Hagens Services. Mel Petreman Change & Evaluation Consultant Manager. Clinical Change & Evaluation Change & Evaluation Adoption Team Michelle Medland Specialist. Information & Group Director. Quebec Region Canada Health Infoway Project Coordinator Mid-West Region Canada Health Infoway Fraser Health Authority. iEHR/PLIS. Western Region Rob Crawford & Associates Information Services. Primary Care Change Management Nicole Lemyre Networks & Chronic OntarioMD Information Specialist. BC Canada Health Infoway Dave Harrhy Maureen Charlebois Change & Evaluation Janet Nyberg Chief Nursing Executive Specialist. Manager. Clinical Mid-West Region Systems (CIO) Adoption Team Canada Health Infoway Department of Health Canada Health Infoway and Social Services.118 Pan-Canadian Change Management Network Members & Other Contributors Anne Baldwin Rob Crawford Virgine Jamet Dr. & Canada Health Infoway Clinical Adoption Team PITO Peer Mentor (BCMA) Dennis Ferenc Canada Health Infoway BC Ministry of Health Marilyn Barrett Manager.


Pan-Canadian Change Management Network 03/13 .