Implementation Insights Blog

Implementation Management Associates help organizations around the world achieve large-scale, complex change. This blog discusses our insights into organizational change.

Friday, March 27, 2009

Prescription for Electronic Medical Records Implementation Success

According to a recent New York Times article, the Obama Administration expects to spend about 19 billion dollars to accelerate the use of computerized records by Health Care systems and doctors offices. In the same article, Dr. Blackford Middleton, Chairman for the Center for Technology Leadership states, “What is underappreciated is the implementation challenge.”

These electronic medical records are the basis for both the diagnostic and economic lifeblood of any medical care practice, so getting the implementation right the first time is essential. Notes Dr. Patricia Korber, MD, "In my own practice, we thought we were ready, but we underestimated the degree of difficulty we were going to face.”

Unfortunately getting the technology “installed”, meaning that it is up and running, is not synonymous with gaining sustained adoption, or “implementation.” The
difference between installation and implementation is not mere semantics; it is a quantitative and qualitative difference that reflects the speed and return for the human and financial resources that will be invested in electronic medical records or EMR. EMR implementation speed is critical to health care providers both financially and because of the disruption to work flow and efficiency that directly impacts the quality of patient care.

Interestingly, the Obama Administration has set forth, but not yet defined, its term of “meaningful use” of Electronic Medical Records (EMR) as a criterion for subsidized payment for implementation in Doctors’ offices.

Based upon our thirty years of field research at IMA, over 70% of technology system implementations in Healthcare Systems (such as EMR implementations) fail to achieve on time and on budget what they promised to their organizations. In over 85% of the cases we have observed, technological integrity is not the issue. Ultimately, the technology will do what it is supposed to do. The stumbling block is in how to integrate the human beings with the technology as quickly as possible.

This literally becomes like those old Fram oil filter commercials: “You can pay me now or pay me later.” Any medical practice or health care system can either spend time to create readiness, or Prepay a substantial price for resistance to change and sub-optimized systems. After implementing technical systems in health care environments for two decades, we have yet to discover a situation where the third “no payment required” option came into play.

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Monday, March 9, 2009

Manage the People Side of SAP for Implementation Success

It would be easy, and generally incorrect, to assume that the reason for the less than stellar results for SAP implementation success is that the wrong technology solution was selected.

Instead, the data suggests, and our own experience in client systems confirms, that too many organizations pay too little attention in time and resources to the human aspects of SAP implementations. A robust implementation plan is needed that addresses critical factors like readiness for change, sponsorship, reinforcement, and communication— all applied with the same level of rigor and business-discipline that are followed in other areas of the business.

What’s more, because the track record on technology adoption in many organizations is littered with past failures or stalled installations, there is a past history that can’t be ignored. Each time an organization experiences failure, it is embedded in the institutional memory of the targets—those people most affected by the change. As a result, the next technology initiative is greeted with increased skepticism that translates into reduced management credibility, greater resistance, and even longer timelines to achieve user adoption.

Communication and Training Alone Aren’t Enough

While many organizations hope that a series of informational emails from top executives, cross-functional town-hall meetings, and training will overcome the barriers to adoption, these are rarely enough. Even involving subject matter experts from the business in the design of new processes and in requirements definition, while a positive step, is typically insufficient.

It is possible, however, to overcome the common barriers to SAP adoption by applying the structured, purposeful approach of AIM (Accelerating Implementation Methodology) as the technology adoption model. Each step in the AIM planning architecture addresses a likely adoption barrier. The AIM process also includes data-driven tools that allow you to measure predictable data points in the SAP technology integration process.

Five Lessons for Achieving Adoption

Lesson 1: Develop a clear definition of the desired future state
The AIM Project Overview tool enables core team members to arrive at a common definition of the change more efficiently, addressing critical information not included in typical project charters.

Lesson 2: Invest in the human side
Given that human and organizational issues represent the biggest risk in getting to adoption and Return on Investment, it’s short-sighted to not sufficiently budget for critical implementation activities.

Lesson 3: Spend the time to get the right kind of project sponsorship
To be successful, you will need to develop sponsors who will express, model, and reinforce the new behaviors, beginning at higher leadership levels and cascading down to include managers and supervisors of those employees most affected by the change.

Lesson 4: Plan and manage the implementation effectively
Integrate project management and the human elements into one cohesive implementation plan.

Lesson 5: Be prepared to deal with resistance to changes
Know up-front that resistance is inevitable. Apply the repeatable, practical AIM strategies and tactics to identify, surface, and manage resistance to SAP.

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Wednesday, March 4, 2009

Accelerating Your Business Recovery

As organizations confront radical challenges, leaders may contemplate seismic shifts in strategy. These strategic shifts must be implemented surely and swiftly. Speed has never been more important than it is today. But communication decrees from the top are not enough to ensure implementation success. The Accelerating Implementation Methodology (AIM) offers a simple, but not simplistic, framework for guiding implementation of new strategies through a complex web of organizational issues that can easily cause these strategic lifelines to stall out or even fail.

It’s tempting to delude ourselves that we can shortcut the critical AIM steps in order to gain speed, but these are the very steps that are needed to ensure our capacity to turn the organizational ship in another direction quickly. For example, without a clear definition of the strategic change, we can predict that diverse areas of the organization will provide their own interpretation of what this change will mean. The need for a compelling, easily understood Business Case for Action, is more critical than ever.

Other AIM deliverables are equally as critical, including:
A Sponsorship Strategy:
We must have a plan in place to generate active Sponsorship of the new strategic direction cascading down through senior, mid-level, and front-line ranks. The Sponsorship Strategy must be designed in concert with explicit changes in reinforcements so that there is personal accountability for implementation success at the local level.

A Readiness Strategy:
Even in a difficult economic environment, there will be resistance to change. People may “really oughta wanna” change and follow the new direction, but when we are talking about doing new things in new ways, there will be resistance. If we are prepared with a plan to identify the sources of resistance and manage it appropriately, we will be able to move much more quickly.

A Reinforcement Strategy:
To get the organization to do things differently, we must manage performance differently as well. Review your formal and informal reward systems to make certain that reinforcements are actually aligned with the behavioral changes being made, and that the reinforcements are in the “frame of reference” of the Targets. Telling people to change is not the same thing as motivating people to change.

A Communication Strategy:
While it may appear to be much more efficient to use email to drive key messages, we know it is actually not a very effective delivery mechanism because there is no formal system for getting feedback on the message. This feedback is a critical source of information on where there is likely resistance.

A Strategy for Building Change Agents
Too many organizations rely on subject matter experts to implement changes at the local level. These individuals may have the technical expertise needed, but lack the interpersonal skills and credibility required. Use the AIM Change Agent Assessment tool (available at our website store at to review individual capability to make certain that you are selecting the right people.

By following the AIM structured framework, organizations increase their ability to make changes quickly. When speed matters, AIM is the fuel for driving implementation success.

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