LorenziBook

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Systems Projects consists of three parts:

1) Tech Skills

2) Project Management

3) People and Organizational Skills

Organizational Planning Styles:

1) Top Down -CEO Driven

2) Middle-in - (Whiz Kids) --> Middle managers /tech professionals

3) Bottom Up - entrepreneurial - decentralized, individuals with initiatives

4) Organizational Emergent - Organizational Learning/Non-planning plan - CIO leads based on org goals

Change Management Definition-1) The methodology that integrates change and the ability to adapt into the organization, 2) An organized systematic application of the knowledge , tools, and resources of change that provides organizations with a key process to achieve their basic business strategy, 3) planning, initiation, control process for implementing new ideas or processes into an organization with the idea stage to a stabilized organization with the change implemented

Three types of change:

1) Organizational Development - gradual/evolutionary approach to change--> align goals throughout the organization

2) Re-engineering --> Business transformation - radical form of change managmeent

3) Re-design- cross btw the other to where change is hgih focused on on a concerted area and combines strategies of both

Kubler Ross Grief Model :

1) Denial

2) Resistance

3) Exploration

4) Commitment

Kubler -Ross Stages :

1) Denial

2) Anger

3) Blame

4) Bargaining

5) Acceptance -

Typical Health Informatics Cycle for System improvement

Discontent -> Conceptualization--> Planning--> Development --> Testing--> Cutover --->

Acclimation--> Acceptance --> Discontent

First Order Change = variation in the way processes and proceedings have been done within a given system , leaving the system itself relatively unchanged - i.e. new reports for a system, creating new ways to collect data etc..

Second Order Change = System itself is changed --> strategic change or major crisis drives this i.e. paper to EMR, Legacy EMR to New EMR etc

Middle - Order Change - Compromise - Greater than first order change, but no impact on strategy or critical success factors --> i.e. new EMAIL system

Both Levels of change and resistance are Graduated -->

Classifying Types of Change in Organizations :

1) Operational - changes operations of the business - Affects the lower levels of organizations the most

2) Cultural - changes in basic organizational philosophies, by which the business is conducted--> i.e. implementing a CQI program- Affects the middle levels of the organization the most

3) strategic --> changes strategic business direction - Affects each level of organization evenly

4) Political - staffing changes due to political reasons, usually at top levels of the organization

Assessing Organization Culture: Seven Measures

1) Action and Innovation

2) Risk Taking

3) Cooperation

4) Openly supportive MAnagement

5) Decision-Making Autonomy

6)Clearly defined performance expectations

7) Pay for Performance/REward orientation

Political Models in the information management arena that cause issues-->

1) Technocratic utopianism --> Technology solves all issues , organization and people issues are irrelevant, focuses on producers/technocrats

2) Anarchy - Absence of an alternative prevailing model , usually through failure to provide a model of unified information management

3) Feudalism - strong divisional organizations which build their own systems to meet the individual needs both operational and political .

4) Monarchy - Highly centralized model where strong central information function is established

5) Federalism - good for large organization, respects needs of the individual divisions

Early Change theory :

Watzlawick -

1) Theory of Groups - relationships btw parts and wholes, model transcend systems,

2) Theory of Logical Types - collections of things are united by specific characteristics

Small Group Theories - sociology of groups --> MAJOR PRINCIPLE DERIVED --> to effectively manage change, it is imperative for change agnets to understand how people behave in groups and espcecially small groups

Field theory - Kurt Lewin - tension within people whenever a psychological need or intention exists and only released when it is acheived. Tension may be positive or negative. -- > Conflict situations -"force Fields"

3 types o confilct:

1) individual stands midway btw two positive goals of approximately equal strength

2) individual stands midway btw two negative goals of equal strength

3) individual is exposed ot both positive and negative forces simultatneously - common in Health IT

Small group theory is applicable because of the way hospitals are organized typical. Field theory allows diagramming of typical conflict situations.

note:

1) every change , actual or proposed is characterized by goal or termination point to result in change

2) every change creates effects on people and existing systems, some intended, some not

3) In most change processes, forces will be positive or negative , some strong, some weak

4) Forces can be real or imagined.

Lorenzi/Riley Change Management Model framework

1) Assessment and Information gathering

2) Feedback/Options -

3) Strategy Development

4) Implementation

5) Reassessment

Critical Issues for Change:

1. MAking proactive vs. Reactive change

2) Understanding the critical global and local issues

3) creating vision for change

4) identifying the key leader characteristics

5) Gaining commitment from organizational leadership

6)defining the end-user needs

7 Appreciating organizational stress

In teams, Productivity is based on three conditions -->

1) Collaboration - ensures involvement by stakeholders,

2) Commitment - empower people to act on their best judgement and the point of impact - where work is being done, meaninguful work is emphasized, teamwork is stressed, sense of community

3) Creativity - support allows for people to look for better ways to do something. Task environment promotes and facilitates, rather than obstructs the efforts .

types of Conflicts among healthcare personnel

1) Role Conflict - when each group has a expectations for their role and other groups roles that are different the expectations of the other groups

2) Issue Conflicts - disagreements among people concerning the solution for a problem

3) Interaction Conflicts - behavior of team member is motivated by external or situational causes

4) Functional Conflict - when one group reaches a goal , it is preventing another group from reaching theirs

5) Hierarchical conflicts - interest groups struggles over the organizational rewards of status, prestige, power and money

6) Duplicative conflict - different functional units have similar functional responsibilities

Sled Dog Model of Team Formation

1) Sniffing - to tease out who people are , what they are mad eof

2) Growling - test the toughness of other members of the teams

3) Acceptance - settle down and learn to work together

4) pull together for the common goal

IS Development Guidelines

1) Ask your customer - Benefits> techie features

2)Set Realistic goals - don't set goals too high

3)Break down Walls -Use integrated teams to achieve the best resutls

4)Create Gateways -create checkpoints along the way for status review and

5)Watch Testing - test at all stages

6)DO your post-mortems - REview issues and failures to improve

Project Management Set of ISsues:

1) Definition of Responsibiltiies

2) Objective Setting

3) Action Planning

4) Tight/Control - Feedback

5)Ongoing Problem Solving

6) Project completion

Project Concepts:

1) Put in ample time up front

2) resolve conflicts early with consensus building

3) set realistic performance onjectives

4) Get baseline data

5) Wary of the initial productivity curve - it usually dips and returns and then exceeds pre-implementation

6) manage customer expectations to a realistic levels

7) Don't oversell

8 Allow for organizational Delay

9) Manage top down limits that are unreasonable

10) Deal with add-on requests -

11) PLAN PLAN PLAN

12) Use project management software

13) All plans are forecasts made under certaine assumptions and these may need to be adjusted.

14 ) Adaptive Planning keeps plans flexible as long as possible

15) Complete Project planning is necessary

16) Use Team approaches - integrated teams as opposed to hand-offs and silos

17) Build flexible systems downstream using tools and systems to allow for change and maximise the end-users and organization benefit

18 MAnage Key Project Values

Key Project Values:

Key Person must define and prioritize the critical values for the project

Package the key values and priorites in effective communication for relevant audience

Communicate values and priorities repeatedly with management

MAnagers must be role models for teams

Adherence and support for values and priorities should be incorporated into the reward structure, continually reinforced , both positive and negative

Three types of Resistance

Resistance to the Changers - we/they relationship develops

REsistance to the environmental changes - i.e.. regulatory /political /reimbursement

Resistance to organizational changes -

Resistance to the Specific IT system /Implementation - because it is poor!

Important to know which type of resistance exist as the change management mechanism differs for each

TrOvercoming Resistance --> Key points to overcome

Gather Benchmark Data performance data on old system

Analyze the beneftis to answer " whats in it for me

Use sound organizational development techniques

Get Champions

Give ownership to the customes

Try implementing as soon as possible

Set Realistic expectations

Do timely training

Provide extensive support

Make sure the system is stable

protect physician egos

Try to have fun !!!

Key Strategies to Handle Political MineFields

Be Patient

Maintain sense of perspective

Identify and work with power people

Maintain good communication

Avoid isolation

Know the rules of the game

Maintain High Energy

Be directly involved

Manage your ego

Maintain a sense of trust

Maintain your sense of humor

Use the silver bullets wiesely

End Stage People Issues

Training to use new system should be delayed as long as possible, but planning the training should occur early

communicate thanks to teams

End user communication is key

Celebrate Success -

Part1

PArt 2