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Please give an example of a system in your organization (either successful or fail)—this could be the same system you mentioned in the previous topic discussion (Topic 1). Do you think that the organization appropriately managed the change or not? Think about ADKAR model that we just learned.
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About PACS system, it can be much improved according to ADKAR model.
A – / everyone should be well aware of it by now
D – O indeed, not everyone really like it
K – X should exists formal training
A – X should exists formal training, good UX and resilient design
R – XIndeed, the improvement should start from formal training, both on creators and end-users’ sides.
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I think, the example of a system in my organization is Electronic Integrated Disease Surveillance System (EIDSS). It is a disease surveillance online programs similarly with 506report program that collect data of communicable diseases follows criteria about 58 disease. EIDSS is coming to change the office system to online cloud server that are many impact for officer and every related agencies to change. I think ADKAR model is very important before change the system.
A = organization must create awareness. And create understanding for officer and related agencies. Why it is necessary to change and the risk that will occur if there change by a stakeholders meeting.
D = Motivation in various fields to stakeholders and related agencies have a positive attitude and the desire to participate and support change.
K = provide and coach the job description information that must be changed providing knowledge in new roles related to change.
A = training the pilot agencies
R = Continuous providing support pilot agencies and evaluation to the goal. -
The systems “X” mentioned earlier is a long run preestablished system implemented before I work there, so I don’t know much about the pre-implementation change management. However, the system is underused nowadays. It supports options that helpful for both operational and decisional. The system supports, for instance, medical coding, a location identifier, messaging system, expenditure log, but none of these is is used. Usage of the system must be redesigned by bringing all stakeholder discussing on what they want from the system and what the system can help them work. Considering the ADKAR for the executed system; all have already been awarded about the system, and there is no resistance, so we may skip the “Awareness” and “Desire” as they are already mandated to their jobs and jumping into the “Knowledge” by giving all operational agent a formal training and coaching on how the system work and what it can contribute to work. The “Ability” maybe only to catch up on options of the system that not regularly use but vital. After the usage has been re-implemented, we must have to measure some critical or bottleneck step and correct the inappropriate usage as the “Reinforcement”.
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I had not been in the hospital during implementation though I assumed that the hospital board did not complete ADKAR model. Some high-level staff did not aware whether EMR in the hospital can reduce the redundancy of the work. They did not have an appropriate orientation to guide all staff to the new EMR system hence most of them did not aware why they need to use EMR. Some of the staff did not want to adapt to a new system. Even those who understood and want to be a part of a new system, they did not clearly perceive the new EMR system. Furthermore, a small group of staff that received the training merely knew the software well enough and could use it properly. An only reinforcement which is beyond the hospital level is the insurance claim. An IT staff need to fill in the standard data table and submit the EMR for insurance claiming every month.
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OpenRMS system in our organization, mentioned in topic discussion 1, seem to be successful now. But our organization is not managing the change appropriately.
Our organization has Awareness , Knowledge and ability to change but no Desire to change or Reinforcement to change might be due to funding or leadership decision. OpenMRS has no standard data concept but still not develop it. -
About the eHIS system, our organization tries to have appropriate change management. However, due to the very long period of the developmental process and involved with a lot of peoples that comes and goes (medical student and post-graduate residency) the change management is not easy to smooth as project manager wishes. Even though, our head of organization agreed and actively supported this change.
For these change failure, I think it may be due to
A: Awareness
– Some of the people who get involved in the change, such as medical staff and pharmacists, agreed to change to improve the quality of care. While major of end-user such as medical residents might not want to change, due to a lot more workload on them, but they have no choices as they are in training. As well as nurses, who currently have a lot of workloads, don’t want to change the way to do their work from paper to computer.
D: Desire
-According to a lot of workload for medical personnel in combination with, they don’t feel they will get more benefits form changing systems. This resulted in; they have a minimal desire for the new systemsFor A&D, Project manager implements a lot of communication session and get them involve in the early developmental process. However, this project takes a long period of the developmental process. The awareness and desire are fade upon the time pass by. And they did not re-boost awareness shortly before the launch of the project.
K: knowledge
-The project manager provided a lot of detailed experience for end-user, including hands-on training. However, we have a lot of people who get involved in this project, who do not have awareness and desire for this project, and also the training took place a very long period before the system has launched, people who learned already forgot what they learned.
A: Ability
The project manager had a mock-up system, and after the launch project, they have on-site training. But it fails due to the user-unfriendly appearance and not well prepared for change. a lot of end-users call for their help from everywhere at the same time. They fail to handle this situation, and end-user have the struggle to order treatment for their patients. All of these brings an under-standard health delivery for their patients during that time and make a bad impression on this system.
R: reinforcement
Our system can not go far enough to put a reinforcement for end-user. after the end-users feel this system brings an under-standard health delivery for their patient, we have a small striking and this project was withdrawn.-
Wow! Totally understand your situation. It’s a big challenge for developing and implementing a system for such a big organization, with many stakeholders involved. I’m not sure if it would work or not, if we could try to adopt the agile development process that we learned in project management topic. This process may help to speed up the system development, by trying to breakdown the system into small modules and then plan-develop-launch-evaluate each small module. You may set up a pilot ward or OPD that will be the first group to try this system and help in evaluation and modification process, before launching to larger users.
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Example of a system in my organization is Development of internet base TB cross-border referral system.
At first time when I want to develope application in HIV and show concept to referral HIV patients to Myanmar, nurse HIV coordinator in HIV clinic say that is very workload and not necessary sending migrant HIV patients to care in his country.
When I already develope application and training. Nurse HIV coordinator say application is so good and want to do it.
In ADKAR module, when stakeholder not Awareness, motivate people by comnunication and training.
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In my opinion, DMSc was failing when changing to use the ilab system. If we consider the ADKAR model,
A (Awareness) DMSc wanted to change the sample registration system because the iLab system showed very successful work when using in regional Medical sciences centers.
D (Desire) We can use this system to implement every step from the sample receiving until reporting, and we can track every sample in the system.
K (Knowledge) We want to change the system but we don’t know how the system works exactly (knowledge). Before changing, we should know and study the system, how it can be work or fit with our environment. If it seems to not work, we need to adjust or add some options.
A (Ability) Everyone tried to use the new system
R (Reinforcement) The system was not fit with DMSc (centre) environment, so we can work on some part of the system. -
For the example, Electronic Bank Guarantee on Blockchain Technology has a meduim risk in implement and deploy phase. This project adopts new technology, for example, blockchain, Devopt, BCI bank interface and some processed are changed. It has just deployed and launched about two weeks ago in my organization. A project team get some vary feedbacks and issues, for example, lack of knowledge, system bug or defect, human error, process change.
From ADKAR chang maangement model, I think that the organization appropriated managed the change as below:
A = Awareness of the need of change : organization accepts the issues and join a meeting with the project team to find the root cause and solution together.
D = Desire to support the change : organization support a change request from end-user and project team.
K = Knowledge of how to change : all stakeholders discuss to find the proper solution together. In case of hi-level infrastructure, the organization provice the specialist give the advice to project team.
A = Ability to demonstrate skill & behavior: provide the end user traning to all user can user the system effectively.
R = Reinforcement to make the change stick : provide support, tracking status and evaluate to the goal. -
About the eHIS system, our organization tries to have appropriate change management. However, as I said before that during development of the system, we involved just only the hospital administrative board but did not involved with people from other facilities such as the nurses, phramcists, lab technicians, and also medical students and hospitalists etc. . The change management will be not easy as the hospital administration wishes.
For these change failure, I think it may be due to
A: Awareness
– Some of the people who get involved in the change, such as medical staff, nurses, and pharmacists, agreed to change to improve the quality of care. While major of end-user such as medical residents might not want to change, due to a lot more workload on them, especially for the in-patient care. Therefore the nurses, who currently have a lot of workloads, have to duplicate the work to fill in physician order entry especially the prescription and investigation orders instead of the physicians who wrote in the paper-based order.D: Desire
-According to a lot of workload for medical personnel in combination with, they don’t feel they will get more benefits form changing systems.K: knowledge
-We have a lot of people who get involved in this eHIS project, who do not have awareness and desire for this project, and also the training took place a very long period before the system was just implemented, people who just entry recently may lack of the hand-on knowledge of how the system operates.A: Ability
-Because of the user-unfriendly appearance of the eHIS project, a lot of end-users may need help at any time. The peoject manager fail to handle this situation, and end-users have to consult each other selves and can not give the feedback in timely manner. All of these brings an under-standard health delivery for their patients during that time and make a bad impression on this system.R: reinforcement
-The eHIS project lack of reinforcement to keep change in the hospital physician, nurses, hospitalists, pharmacists or IT staff to be ongoing. -
Considering ADKAR model to implement Health Information System, I think the organization somewhat managed the change.
Awareness: I think all staffs know that HIS is necessary because of clear public health policy across the country
Desire: some staffs may not want to use the new system
Knowledge: Inadequate training and coaching for some users
Ability: no enough support when users have problems
Reinforcement: No positive reinforcement for successful users
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