How to use change champions for a more successful go-live [podcast]

In every organization, there are people who inspire their colleagues to work harder, complain less, and get involved in company initiatives. If you can identify these people and encourage them to carry your organization's banner, you'll find it a lot easier to implement large-scale change across your hospital or health system. Suddenly, you'll find that even the most challenging people are on board with the change – simply because they're following a natural leader they respect. 

In this episode of the HIT Breakdown, we sat down with implementation experts Lindsey Manzuk and Kristi Kempe and affiliate/Community Connect expert Scott Isaacson to discuss how to leverage change champions for a more successful go-live. If you'd prefer to read rather than listen, the transcript is below.


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Call Notes

[00:00] Intros
[01:54] Key characteristics of successful change champions
[05:10] Which role is best for change champions? 
[09:00] SMEs and super users 
[11:02] Preparing everyone for the reality of go-live
[16:05] What about the affiliate perspective? 
[18:38] Creative ideas for change management 


Lindsey Manzuk: Hi, thank you for joining us. My name is Lindsey Manzuk, and I am Nordic's implementation strategy director. Today we are talking about change management with a focus on having effective change champions. I am here with Kristi Kempe and Scott Isaacson. Hi guys.

Kristi Kempe: Hi, Lindsey.

Scott Isaacson: Hello.

Lindsey Manzuk: Do you wanna share a little bit about our backgrounds with us?

Kristi Kempe: Absolutely, so my name is Kristi Kempe, and I'm a director of business development here at Nordic. I have about 10 years of healthcare IT experience and about seven and a half of those were spent at Epic. I then independently consulted before coming to Nordic and have worked on change management, change adoption, clinical readiness, rev cycle readiness programs throughout all of those 10 years.

Scott Isaacson: Great, thanks Kristi. My name is Scott Isaacson. I work on the affiliate team here at Nordic, and like Kristi I have about 10 years of experience. I started at Epic and later moved to be a full-time employee and an Epic customer. I then started consulting and then ended up here at Nordic, where I worked as a consultant and more recently in my current role as director of affiliate solutions.

Lindsey Manzuk: Thank you. So change champions, I have seen this role have a lot of different names at a lot of different organizations. But essentially what we are talking about is the group of people responsible for making sure that the organization is ready for this big change. So when you guys think about that role, what are the key characteristics that you see those people have?

Kristi Kempe: Lindsey, I am going to start with kind of the opposite of that. One of the big mistakes that I see organizations make is trying to fulfill a number quota, so getting really worried that they are not going to have enough super users or clinical champions, and really putting just anyone in the role. I think we'll talk about a couple of characteristics now, but really identifying the right people and determining how many more people they can reach as opposed to just finding a number to fit in a box.

I think one of the most important characteristics that a change agent has is to be positive, but also be realistic. They need to have a positive view about the change that's going to happen, but they also need to not sugar coat and not over-inflate the benefits that the project might bring.

Scott Isaacson: I would say that I would agree with you and say if nobody accepts that this is going to be a hard change, then you are setting yourself up for failure. Being realistic is really really important.

Lindsey Manzuk: One thing that I will add is that I see these folks have a lot of patience. A lot of times they are talking with a lot of end users. Some might be upset, and just being able to let folks talk to them, and share their feelings and share their thoughts and take that feedback. Sometimes it can take some time, so patience is a big key.

Kristi Kempe: I think that goes along with listening as well. It's really easy to have a super user or a champion that is really good about talking about the program and talking about the changes that are going to happen. But when end users are frustrated, it's also having that ability to take a step back, and hear what they are saying, being able to digest that, and then translate the message to appropriate parties.

Scott Isaacson: Absolutely, that active listening is really important, and I was recently in a meeting when they called out somebody who listened, took down everybody's concerns, and then actually followed up on them. Whether that actually meant there was a change that was going to be made, at least they were acknowledged, so that was really important and very successful.

In terms of that, it always takes a great communicator, and I think as part of that it's being able to tailor your message to the particular person you have been talking to. Especially as we all work with a diverse groups of folks, and being able to tailor your message to your different peers is really important.

Part of that good communication is also expertise in your area. Those change agents should be experts in their department or their area. But they should also have credibility as experts as well so that folks look to them, for the appropriate way to act when change is coming.

Lindsey Manzuk: I think adaptability is also important. These EHR implementations are huge projects, and there are a lot of things happening. You go in with a plan. But the plan is going to change. You are going to have risks, and you are going to have problems. You are going to need to change things midway through. Having a change champion who can be thinking, "I see this happening; how can we adjust our approach to ensure that we are still successful?" is important.

Kristi Kempe: Lindsey, I just want to talk, just for a second about provider champions specifically. As an organization, you should think long and hard about who your leaders and your role models are, and then you can overlay that with their availability and then the people that your provider leaders trust. Odds are that the people that your provider leaders trust are not going to have a lot of extra bandwidth. How can you use them strategically throughout the project, to really emphasize, use them as enforcers, or use them as a project hype person, but leverage them because of the respect that they have from the organization.

A couple of other groups you can consider leveraging are PAs and NPs, as well as if you are an academic facility that has residents, especially well-respected residents, that can do a great job and help you get your message out about the project, as well as provide kind of a more realistic view of how the system will be used on the day-to-day basis. Think about your clinic and your departmental directors, so who has influence, and who has built trusted relationships with your clinicians.

The title itself doesn't matter, so if they have letters after their name, then that's great, but if they're a person who can deal with challenges from your clinicians, and they can address those, and they're respected, that's going to be the right person for the role. Consider your clinician informaticists, any existing provider support that you have, if you have a branch of your existing training that happens today. If you have any clinical documentation improvement folks, so those that are already working one-on-one with providers on documentation improvements, they would be a great group to consider. That's as well as clinical educators.

Lindsey Manzuk: Great, so talking about change champions, and then Epic also has readiness programs both for revenue cycle and the clinical side. How do you see organizations successfully build on what Epic brings to the table, to make sure that they can reach all parts of their organization?

Kristi Kempe: Lindsey, that's a really good question. Epic provides a framework, but lot of times I hear from organizations, "Okay, but when the rubber hits the road, how does this actually look?" It's not only identifying your area owners, but actually holding them accountable. Accountability is a very scary word, but what are the things that the project team can help support and make sure are defined? What are some prescribed adoption activities that those owners can own, and make sure are executed in their area?

So making sure they have the project team's support, but actually translating it to what happens in their departments.
I think the other thing there is, I mentioned this I believe in a previous podcast, what is the takeaway? So for your project meetings, for your project sessions, what is their responsibility to take back to their units, to their departments, to their clinics.
So giving them those talking points, and then providing a mechanism for them to return questions from those same areas.

Lindsey Manzuk: I think it's important for organizations to think about all of the different departments and areas that they have. If you have a single readiness owner overseeing a really large group of end users, they probably can't go talk to all the different areas, so how do you build a smaller team around them to help make sure that you reach all of those users?

Kristi Kempe: I think making it part of their responsibilities from the beginning of the project as well: these are the things that these super users are responsible for, these are the things that a department lead is responsible for.

Lindsey Manzuk: So you mentioned super users, can you guys talk a little bit about how organizations have successfully used SMEs and super users from a change management standpoint?

Kristi Kempe: So I can't say this enough. Ideally your SMEs and your super users are the same people, so you are providing that consistency through the project. You're providing your foundational knowledge about project terminology, about system terminology, and then when you get closer to go-live, and you have maybe some of that frustration about, "Well, I wasn't there for this; this wasn't how I did it previously," you have those project experts that say, "Guess what, I was there at the beginning, and I do know why we made this decision, and I support it, and here's how it translates, and here's how we can make it better/easier/workable for you."

Scott Isaacson: Absolutely, and I'll also say that when it comes to Community Connect programs, you've got different clinic organizations that are there. A really important change champion can actually be somebody from a different organization who has had a really positive experience with your particular Connect program, might come to one of your road shows, might be part of your demo, and can credibly speak to the positive things that are there.

Also, as we had talked about earlier, it helps to earlier admit where are the challenges, where are the areas that we need to focus on, to make sure that they are successful as well.

Lindsey Manzuk: Scott, have you seen a lot of organizations use SMEs and or super users from their Epic implementation on affiliate projects, and how have you seen that be successful?

Scott Isaacson: Absolutely, and that's something that we always recommend. If you think about really adopting the vendor mindset, you're now basically now selling a product, so making sure that folks understand the value of what they're getting and what they're paying for oftentimes means choosing SMEs and super users from your organization to be a part of the Connect project team. Make sure that they are really positive, polished, and knowledgeable ambassadors for your system, and folks will obviously feel much more comfortable about and realize they are getting a great value. There's not somebody new and green who's not experienced with the system.

Lindsey Manzuk: Something else I have heard a lot when we talk about change champions is local accountability for readiness. Can you guys talk a little bit about what that means to you and how you have seen that be successful?

Kristi Kempe: Yeah, a lot of times we see the designated person in the department ask the question, "What does my area need to do to be ready for this?" That's great that they are being proactive, and the answer is anything and everything that will translate from an EMR to what your unit department clinic does today.

That may involve having lunch and learns or creating specific exercises for specific workloads that you deal with. And yes, those can occur in the playground. I know that the playground may not match your production environment. Every single client that I have worked with has that issue. It's not about the environments matching. It's about reps in the system and getting hands-on time with your real-life tools and examples.

Scott Isaacson: I would say those super users who are local and asking those questions should be empowered to do whatever activity they think is going to work best for their department. It's going to be better received. If I look to the lead nurse in my department, they're my subject matter expert, they're my super user, and they're asking the questions. Empower them to do what they think is right, because 99 percent of the time it's going to be the most effective in that organization or in that department, and also something that you can probably learn from and use in other departments as well.

Kristi Kempe: Your change champions that actually take accountability ... I don't care if they fill out the checklist to say that they did the tasks. I want to see that they are actually taking ownership and executing some of those activities in their department. So they're having their own dress rehearsal, or they created their own just-in-time training. That means so much more than just attending the meetings, which is important, and checking the boxes, which is also important. What's most important is how are they translating from the application training, the lessons learned throughout the install about change, and making them real life for their end users?

Lindsey Manzuk: I actually have a really great example of this. I worked with an organization, and there was a manager of one of the ambulatory surgery centers, and they did a lot of eye procedures, so they were very fast, and they were very worried about go-live because they thought it was going to slow everyone down.

So the manager actually brought everyone in on a day that the ASC was closed, and they had their own dress rehearsal, and they had one of the smoothest go-lives that I have ever seen. It was really an example of someone in that area saying, "For us to be ready, we need to put in these few extra hours before we actually start using this to make sure that we are successful."

Scott Isaacson: I think that in a lot of those activities, especially as they are internal to that department or that area, it just calms everybody's stress pretty effectively. They don't know what they don't know, and as soon as they sit down with their peers, and they struggle through a few things, they feel good about their dress rehearsal. Then you have got a bunch of great change champions just in the clinic itself.

Kristi Kempe: I think for the project teams as well, I've seen a couple of great examples of creative scheduling with those dress rehearsals, whether it's done by the clinic or department or it's a project team-sponsored clinic hours. If they're 9-to-5, have it at 8 or have it over lunch. There's not always a need to disrupt patient care. Have it after hours. Be thinking about those times that may be convenient for the areas that you are going to for those dress rehearsals. I have seen it translate to higher level adoption levels for those dress rehearsals.

There's also something that I wanted to add to about departments that I've seen be the most successful. Certainly there's that high level of ownership. There's that ability to be realistic, so stay positive, but you can also acknowledge that change is hard. You don't need to sugarcoat anything. You don't need to be overly rosy and a constant cheerleader. Really emphasize that there are project goals, a project mission, and that they are going to be feeling different feelings. They're going to be feeling all the feelings as they go through training.

They're going to walk out of that application training, and they are going to feel like they know nothing and that it all flew over their head and nothing sinks in. That's normal, and that's okay, and then maybe their next training class, they're starting to grasp a bit more, and then they have some playground time, and a provider may go to personalization lab.

There's this feeling of better understanding over time, and there's going to be that excitement on Day 1 of go-live, and it's going to be fantastic, and then Day 2 everything crashes, and they don't know how to use the system again. It's about acknowledging those feelings prior to go-live and helping them anticipate what that first day is going to look like the first week, the two weeks after that, how it's going to translate to your project team, and what they are able to fix, and the changes they're able to put in the system.

Painting that picture is something that I have seen successful department champions be very good at.

Lindsey Manzuk: Thanks. Scott, from an affiliate standpoint, how do you see this typically built into a program offering to be successful?

Scott Isaacson: Sure. I think the most important thing is making it an expectation and part of that partnership. That means including it in roles and responsibilities and talking about it early and the importance of it and what the time expectations are can be really important. 

When it comes to mergers and acquisitions, there are a few things to think about. As separate organizations become one, focusing on those key integration areas, including the business side of the house as well as the clinical side of the house. We had a particular customer we worked with that had a director of integration that was absolutely critical to both communication and change management. She was just really effective and actually had worked at both organizations. We had really lucked out there, so definitely something to think about.

When it comes to those change champions, especially when it comes to those mergers and acquisitions, look to those folks that obviously have long tenure, who are also well-respected, but also think about those folks whose job roles are completely changing or are getting eliminated as their job duties are sunset.

If you're getting rid of a lab person, make sure that you are giving them the training that they need to help with the new lab system, but also really enabling them to act as a role model for folks like that. It's also important to think about if you are doing large affiliate implementations, whether that's Connect or merger and acquisition, that you're going to have multiple change agents, and I think that's kind of across the board. It's maybe a little obvious to say, but still important.

Then if you think about on the smaller side of things, covering all your bases. So patient access, revenue cycle, and clinical.
So many times we end up relying on the clinical manager, who kind of has their hand in everything, but also a provider champion if there are multiple providers there both on the nursing and physician side.

Lindsey Manzuk: What final thoughts do you guys have as we wrap up?

Kristi Kempe: A couple unique ways of using your change champions: consider having a dedicated clinician help desk at go-live, so you are able to answer some of those workflow questions immediately without having to put in a help desk ticket and then having someone from the project team call them back. That can do a lot as far as building confidence, especially in those first few days of go-live.

Potentially consider a deployable resource or some kind of SWAT team. That means someone that is a champion on your project or participated in training on the project that can go out to the units, can be scheduled into a physician office, if they have a few moments before their day begins. It's really taking a look at how to be creative with those resources at go-live. 

Lindsey Manzuk: One organization I worked with had a lot of success using their credentialed trainers for go-live support. They had a SWAT team that they could deploy, and they actually had chat, so you could ask a question over chat. They used CTs to do three to four chats at the same time, and it was an easy way to get some quick questions answered.

Scott Isaacson: I have also seen on the affiliate standpoint, where you see some leaders really kind of talk the talk, but also walk the walk. We have seen it be really effective for the CMO or the CMIO from the hub organization to round and show support at the affiliate. That goes a really long way in showing your leaders' dedication to the project.

Lindsey Manzuk: Alright, thank you both very much for being here.

Kristi Kempe: Thanks Lindsey.

Scott Isaacson: Thanks Lindsey.

Topics: change management, mergers and acquisitions, Epic Community Connect, Implementation

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