Change Management in the implementation of Health ICTs

What is Change?

• Change is a process of  cultural diffusion
• Change at organizational level is linked to the Vision
• The envisioned change is associated with certain benefits (faster simpler & better)
• Change can be partial or Comprehensive (second order change)
• Change can be simple or complex  (first order change)
• Physical Structural Changes are simple
• Process Changes are more difficult
• Cultural changes difficult and takes longer

Effects of Change

• Fear and anxiety
• Threat to available  current skills and expertise and Knowledge
• Fear of Failure
• Resistance to change 
• Stress and frustration
• Despair  and poor job performance
• Death

Major Changes in the Health Environment 1994- 2006 in SA

• Implementation of Information Systems in National and Provincial Offices
• Implementation of  Information Systems at District offices and Hospital
• Implementation of Information Systems at Primary Healthcare level
• Development and Implementation of an National Health Electronic Record (eHR.ZA)

Success of the Health Information Systems in the Country

• Success rate not known
• Small unrelated studies conducted
• Success Measures difficult
• Anecdotes  suggests poor success
• Major contributor to poor success is lack of change management

How Change is viewed

• Effort to learn
• Loss of time and energy that could be used elsewhere
• Unnecessary as people are happy with current system
• No benefits as benefits are long term
• Managers are distracted from their work
• Top down approach
• Developing  conflict with personal interest
• Demands new sets of rules and behaviour
• Reducing personal contact
• Change in KRAs
• Technocratic

Impacts of Change at Different Levels

High Level

• Political Pressure for change
• High economic stakes and high Risks
• Court Litigations
• Finger Pointing
• Hiring and Firing
• Instability in organisations

Lower Level

• Major operational changes
• Users changing behaviour
• Skills and Knowledge challenged
• IT Specialists intimidating everyone with IT concepts
• No password, borrowing password, no done if people are on leave or off
• No typex to correct mistakes
• Dual systems
• Patients bored and complaining
• Systems refusing to take males in maternity wards
• IT support very poor

Management of Change

STEP 1

• Understand that HIS is a People Process
• HIS  implementation is 80% people and 20% IT ( People first)
• Be part of meetings for sourcing and implementation of HIS at an early stage
• Demand to be part of Specification development Team
• Develop your own Implementation Plan
• Develop your own Change Management Plan
•  Let people think, be creative and learn to solve problems

STEP2

• Managers in the driving seat not IT Speciaslits
• Establish teams and identify champions
• Implement Teams:
  • Implementation Team
  • Performance Measurement Team
  • Communication Team
  • Learning organization team
  • Start small
  • Be in charge as a manager of the hospital

Identify opportunities for staff