Table 1 Examples from the case study of implementation of electronic medical record (EMR) of the corresponding actions to the eight domains of Kotter’s change management model
From: Electronic medical record implementation in a large healthcare system from a leadership perspective
Domains of Kotter’s model | Corresponding actions |
|---|---|
Creating a sense of urgency | Creating readiness assessment tool that captured critical actions needed for implementation and could be used across the different clinical and non-clinical departments Sharing the readiness assessment tool with hospital and department leaders frequently to tract preparedness, stimulate peer-feedback and increase progress |
Building the guiding team | Transforming the EMR implementation committee to the active and engaged mode Forming departmental implementation teams to drive change from within |
Developing a change vision and strategy | Integrating the continuum of care from the community to specialized care in a seamless fashion Standardization of care through protocols, order sets, and clinical pathways Setting the basis for a data-driven organization Creating communities of practice Implementing a multidisciplinary approach in the new workflows The emphasis on safe implementation for patients Recognizing the highest potential threats (e.g. errors in transferring data on drug allergies) and having multiple layers of protection Emphasizing staff-friendly process |
Understanding and buy-in (Communicate the vision) | Official communications Emails and text messages Pamphlets and posters Screen savers Digital signage system Presentations and forums Huddles Immediate supervisors and super users |
Removing obstacles | Addressing resistance at departmental and individual levels Understanding the emotions of people Engagement in the process of implementation Training Taking input seriously Peer feedback Converting resistant individuals to strong advocates Rarely executive interventions |
Creating short term wins | Winning key people at executive level and clinical chairs Creating easy training sessions Using tools for feedback Simulation Daily briefing in the week preceding the implementation Emphasizing safe process: for example: allergies/medication Command center Multiple testing Support at go-live |
Building on change (consolidating gains) | Daily debriefing Sharing data from the command center with frontline staff Having multiple rounds of training Emphasizing the benefits of the new system |
Anchoring the change in corporate culture | Emphasizing how the organization had altered incoherent practices Demonstrating the value of working together (communities of practice) Emphasizing that patient safety was at the core value of go-live Demonstrating that post-implementation issues were much lower than expected Development of EMR enhancement committee |