Blog Post July 5, 2018 Training and Change Management: It Takes Two to Tango Authors Nate McCarthy We’ve all been there: the EHR project has been approved by stakeholders, the workflows have been designed, and the system launched, but what about training and change management? Tying a change management process to your EHR project is integral to the project’s long-term success. It will ease the transition for physicians, staff, and the organization as a whole. Scheduling Training to Support and Prepare EHR Users Foundational Trainings While the EHR build is taking place, stakeholders and representatives from each of the project teams should meet to discuss training topics for all users. Some standard topics to start with include: Basics (overview of real estate, common daily screens)Rudimentary new-patient visit (completing HPI, exam, ROS, treatment plan)Extensive new-patient visitCommunicating to coworkers within the EHRThese basics are the foundation for understanding the EHR system. Additional specialty-specific tools can be incorporated; however, the training sessions must be balanced and offered for all. Depending on the timing of the implementation, it is possible the curriculum prior to go-live may only touch the surface of the customized, specific tools and will need to focus primarily on the basics. Ongoing Specialized TrainingsSince it would be impossible to create training programs for all aspects of the EHR system before launch, it is important to develop the post-go-live training curricula, review stabilization plans, and discuss optimization strategies. Agreeing on these terms prior to the implementation and during curriculum development will help spread out what would otherwise be information overload. Holding monthly or biweekly touch-base trainings such as lunch and learns, e-learnings, or other in-class trainings can help staff with post-go-live knowledge enhancement. Topics might include: Reviewing comprehensive workflows specific to that specialty or practice (such as administering specific medications within a visit or documenting during a PT/INR clinic)Demonstrating detailed steps in the communication process between staff, patients, and physiciansTeaching new ways to document and trend certain protocols like asthma managementReviewing patient portal functionality and workflowsThese add-on trainings are meant to help physicians and staff learn system shortcuts and find additional ways to document and incorporate the added specialty- or department-specific tools into their daily operations. Setting ExpectationsTo ensure everyone receives training, it is necessary to require attendance and have leadership enforce the rule. All too often, many users will not attend the training sessions, causing the following problems: Reducing the know-how available within the clinicJeopardizing curriculum standardization due to variability during customized make-up sessionsReducing the number of subject matter experts available during the go-liveWithout required (and enforced) attendance, the new process and protocols will not be consistently followed and users will revert to old habits. Change management can set the standards and communicate the importance of compliance by all staff and physicians. Change Management: At the Center of the Training and Education Process Preparing for Lasting ChangeChange management involves a culture shift in which the organization adapts to the transforming environment. It is important to couple change management with training to create and reinforce the new processes for staff to follow. Moreover, without protocols or procedures to continue change beyond the launch, the curriculum would stagnate, the training classes would not develop, and the opportunity for knowledge growth among physicians and staff would be lost. Ongoing change management keeps the training fresh and ensures this functional area aligns with the rest of the organization. The most effective structure for change involves a trickle-down effect that starts with the executive leadership team prior to EHR implementation. Harvard Business Review described a study that showed the behaviors of top management and leadership—both good and bad—affected the employees they managed. Therefore, top management promoting the benefits of change, together with the creation of standard communication and protocols that are conveyed to employees throughout the organization, are strong first steps in this shift. Keeping Change Alive Change management should continue in perpetuity through committees and work groups. Creating standing meetings for change control, work groups for implementation and training, and an active steering committee representing each department affected by the implementation is a solid way to transform the culture. It is imperative to communicate decisions and updates from the organization and the work groups and committees as part of the change management plan, so all members of the organization or affected by the changes are aware of the plans and decisions. Sustaining Standards Another facet of change management is the creation and maintenance of standards that are uniform for all members of the organization. This will align everyone around the same vision and support the team’s transformation. A plan and process should be documented and communicated to all stakeholders describing steps to take with those resisting the change. Options to sustain the standards include giving EHR access only to those who attend the trainings and pass a graded test. Memos and alerts are typically provided through emails directly to training session attendees, and via other venues to organizational executives and practice managers to trickle down to the end users, to ensure multiple modes of communication are presented to the employees. While training and change management can be carried out separately, intentionally combining them into one blended initiative will create an organizational culture that is open to transformation. This change needs to begin long before the EHR implementation occurs, as it takes time. Eventually the new way of thinking will become routine. By the time training or other project-related classes and sessions begin, stakeholders should be aware of the organization’s expectations and more likely to embrace the training, the change, and the new culture.