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Case study - impact of effective change management From the "why change management" tutorial series
Prosci is releasing a four-part series on "why change management" to
provide several different perspectives on how to make the case for
applying a structured approach to manage the people side of change for
organizational initiatives. This series includes:
• Correlation data
on the impact of effective change management
• Cost-benefit analysis
for change management
• Case study on project impact of effective
change management
• Emergence of change management
This tutorial
presents a case study at Texas Children's Hospital, and demonstrates
the impact of effective change management with real project data.
Helping
Employees Adapt to Change at Texas Children's Hospital
by Stephanie
Elam and Tammy Christensen, Texas Children's Hospital
Special guest
authors for the Change Management Learning Center and
winners of the
2009 Global Conference success story competition
Introduction
In
2006, Texas Children's began an aggressive $1.5 billion expansion
project. The expansion includes the erection of four new buildings, and
the addition of new service lines and programs, leading to a large
increase in employee resources. By 2010, the organization is expected to
grow from 6,600 to 9,000 employees and increase medical staff by 70.
Simultaneously, the organization is transitioning from a paper to an
electronic medical record system. This expansion initiative is
considered to be the largest ever in the United States to be completed
within a four-year window.
Project Background
Texas
Children's has begun the implementation of an electronic medical record
system that will provide immediate access to patient records and
information across the organization, thus promoting improved patient
care and patient safety while streamlining efficiencies. The electronic
medical record will facilitate instant communication between the primary
care and specialty services while also allowing on-going access to
patient information for research purposes. The first phase of the
project was deployed in two major business units in the organization,
impacting approximately 6,000 employees or 85% of the workforce.
Change
Management Overview
To assist with the "people side" of change
associated with the system implementation, a change management team was
created. Throughout the project, the change management team partnered
with the project implementation team and organizational leaders to
facilitate activities designed to reduce employee resistance and build
commitment for the implementation. Two notable activities included
creating a Change Agent Network and conducting dress rehearsal
activities.
Local leaders selected individuals to make up a Change
Agent Network. The network was comprised of participants from throughout
the organization who served as extensions of the change management team
as "on-the-ground" peer champions. The change management team provided
Network members with ongoing information, reminders, and tips which they
shared with their peers. Periodic meetings and conference calls allowed
change agents to connect with each other and exchange ideas about how
to build commitment, as well as keep the change management team informed
about issues and major areas of resistance that required attention.
In
addition to the Change Agent Network, the change management team
developed dress rehearsal activities to help prepare end users for the
implementation. The activities were set up as real-life simulations and
provided an opportunity for end users to walk-though and practice system
and process changes prior to implementation. The dress rehearsals were
intended to help end users understand what to expect at Go-live and
minimize anxiety. Additionally, the activities helped identify any
potential "hiccups" that might not otherwise have been identified until
the system went live, including incorrect end user security settings.
Being proactive prior to Go-live was important because experiencing
problems upon Go-live could have contributed to a mind-set that the
system "didn't work" and created unnecessary resistance.
Measurement
To gauge end user commitment throughout the project, the change
management team conducted four end user surveys:
• Baseline: Sent 6 -
8 months prior to Go-live
• Pre Go-live: Sent 2 weeks prior to
Go-live
• Post Go-live: Sent 30 days after Go-live
• 90 Day Post
Go-live: Sent 90 days after Go-live
Data from these surveys will be
used throughout this case study to indicate where change management
practices were effectively utilized and increased the success of the
change.
The business units involved in the initiative each had
unique characteristics. Business Unit 1 had fairly standardized
processes, and was geographically dispersed throughout the region.
Business Unit 2 was centralized, but had vastly different processes
between the many sub-units. These differences created a variety of
implementation challenges. Overall the same basic change management
strategy, processes and tools were available for each unit. The degree
to which the change management practices were utilized by the unit's
leadership team differed greatly. Comparative data gathered from the
Post Go-live surveys of both units showed a significant difference in
the average increase of favorable responses to key questions about the
implementation, as indicated in Figure 1. 
Average
Increase in Favorable Responses by Question - Figure 1
This
comparative data indicates the benefits of employing effective change
management practices. It also suggests potential best practices,
including the importance of appropriate end user engagement, leadership
sponsorship, and dedicated, on-going support.
Strong Executive
Sponsorship
During the planning phase of the project, Business Unit 1
demonstrated strong executive support and involvement in the project as
a whole, and specifically the change management activities. The
business unit's executive closely partnered with the change management
team, discussing various change management ideas and concepts; tailoring
tools and activities to better meet the needs of the business unit; and
consistently participating in change management events and activities.
A
clear example of her commitment was her sponsorship of the Change Agent
Network. She publicly championed the Network to leaders and staff. She
appealed to her leadership team to seek volunteers and select
individuals to participate in the Network. She and local leaders
supported the Network by joining conference calls, participating in
activities and personally thanking change agents for their time and
commitment. This support proved to be critical to the successful
operation of the Change Agent Network. Leadership from Business Unit 1
encouraged and held change agents accountable for fulfilling their
responsibilities in the role, which ensured ongoing participation and
follow-through.
Another clear example of this executive's support
was her willingness to champion dress rehearsal activities. She
conducted a careful review of the planned activities to ensure they were
appropriate for each area, and required participation for all end
users. The simulations depended on various roles working together to
complete real-life tasks, and required a significant time investment.
Some locations temporarily closed during dress rehearsals to ensure
staff had adequate time and attention to devote to practicing and
mastering the new skills required for the implementation. Following the
dress rehearsals, the executive reviewed the status report from each
site.
Feedback from Business Unit 1's leader specified the Change
Agent Network and dress rehearsals were keys to the successful Go-live
for her business unit. She noted the Change Agent Network increased end
user engagement and helped keep end users informed by spreading key
project messages. She also indicated the peer-to-peer communication was
especially helpful in ensuring important messages were received and
understood by end users. The visible sponsorship and participation of
the executive sponsor enabled success of the activities by ensuring that
leaders and end users understood the importance of managing change as
well as their role in it.
Business Unit 2 implemented the new system
two months after Business Unit 1. During the planning phase, leaders of
Business Unit 2 were involved in the project at a high level, and their
degree of sponsorship and support of change management was less visible
to end users. Though the leaders agreed to engage in the same change
management activities employed with Business Unit 1, they demonstrated
less active support of the activities to the end users. The leaders
complied with general requests, such as providing lists of users to
participate in activities; however, few leaders reached out to the
selected end users to show their support and encouragement, or
participated in the various end user engagement meetings to demonstrate
sponsorship. Throughout the phases of the project, Business Unit 2's end
user participation in Change Management activities steadily decreased.
Though
leadership from Business Unit 1 publicly advocated the necessity of
dress rehearsals, most areas in Business Unit 2 failed to engage in the
dress rehearsal process. Many leaders from Business Unit 2 failed to
review the dress rehearsal activities or to check for applicability to
their specific areas. Few made the activities mandatory or actively
encouraged their staff to participate. Most neither held end users
accountable for practicing for the Go-live, nor did they provide staff
with adequate time to do so. As a result, the percentage of staff who
participated in Business Unit 2's dress rehearsals was significantly
less than the percentage from Business Unit 1, as seen in Figure 2
below. 
Analysis
of the Pre Go-live survey for Business Unit 2 indicated that those
employees who did participate in the Dress Rehearsals were more ready
for Go-live than those who did not, as indicated by Figure 3 below.
Question:
I have the skills and knowledge to effectively
complete my tasks
following the Go-live.
In
addition, a comparison between the Pre Go-live results for both
business units showed that Business Unit 1 had significantly more
favorable results than Business Unit 2. A greater percentage of end
users from Business Unit 1 reported that they understood how the
implementation was going to impact them (Figure 4), had the skills and
knowledge to effectively complete their tasks (Figure 5), and were ready
to Go-live with the new system (Figure 6). Additionally, end users from
Business Unit 1 indicated higher levels of commitment to the project,
as seen by the 17% difference in favorable responses between the two
units to the question: I feel that the new system will work for me
(Figure 7).
Question: I understand how the new system
will
impact my daily work.
Question:
I have the skills and knowledge to effectively
complete my tasks
following the Go-live.
Question:
I feel ready to go live with the new system.
Question:
I feel that the new system will work for me. 
As
demonstrated, data from the Pre Go-live surveys for both units indicate
that the effective use of change management practices and leader
sponsorship of the change activities in Business Unit 1 made a
significant impact to the success of the project. The activities helped
raise end user confidence and ability and increase end user commitment.
Commitment to End User Engagement
Leadership from Business Unit
1 also demonstrated a commitment to end user engagement activities
throughout the project. They set up project road shows and individual
visits by project team members to each impacted area prior to the
Go-live. These visits allowed team members to gain understanding about
specific site needs and considerations while personally connecting with
end users. The visits also helped build excitement for the changes
through demonstrations and informative conversations with end users.
In
addition to site visits, the leadership team from Business Unit 1
ensured leaders and staff received on-going and frequent communications
throughout the project. These tailored communications from business unit
leadership provided key status updates and reminders. Additionally,
online meetings were offered so that participants could attend
virtually. These webinars were scheduled with leaders and staff
throughout the project to ensure engagement and increase end user
commitment. The webinars were used to provide on-going updates to end
users, showcase top features of the software, and provide ad-hoc
training as needed. These frequent communications helped end users feel
more engaged and less anxious about the changes that were occurring.
In
contrast, communications for Business Unit 2 were primarily project
driven; end users received general communications from the project team,
but minimal information from local leadership. There was less active
involvement from leaders of Business Unit 2 to provide updates and
communications about what to expect and how to prepare. The importance
of leadership commitment to engagement and communications can be clearly
demonstrated by the greater percentage of end users from Business Unit 1
who responded favorably to the question: I have sufficient information
about the project in the Pre Go-live surveys. (Figure 8) This data
further helps demonstrate the importance of active change management.
Question:
I have sufficient information about the project.
Dedicated
Support Team
Leadership from Business Unit 1 also demonstrated best
practices following go-live through proactive end-user support. After
the initial implementation period, end user support for Business Unit 1
transitioned from the project team to a dedicated support team. As a
result, in the months following go-live, end users reported few concerns
over the support process.
To further support end users and build
commitment to the change, following the implementation the executive and
support team from Business Unit 1 held weekly calls with the sub-units.
This allowed them to understand issues, share information and
troubleshoot common problems. The executive actively followed up with
sub-units who were not consistently participating in the calls to ensure
they had the support they needed. Additionally, the calls coming into
the support team each week were analyzed to determine top issues and
provide further instructions and training to help reduce issue
reoccurrence. An easy access, one-stop portal was designed to ensure end
users could easily find instructions, troubleshooting material, and
necessary updates. This proactive approach to end user support following
Go-live helped reduce end user resistance. The comparative results from
the initial 30 day Go-live survey and the 90 day Go-live survey showed
an increase in the percentage of end-users from Business Unit 1 who
responded favorably to the question: I have been supported on the job
after the implementation. (Refer to Figure 9 below)
Though Business
Unit 2 provided the same degree of initial on-site support for the
implementation, post Go-live support calls were transitioned to the
organization's general help desk rather than a dedicated support team
following the initial implementation period. End users from Business
Unit 2 reported that the Help Desk was not adequately trained for the
transition and was not always effective in assisting with problems and
questions. End users experienced long wait times and frustration since
Help Desk team members often had to contact the project team to get
answers. This resulted in delays in getting questions answered and
problems resolved. The results from the initial 30 Day Post Go-live
survey and the 90 Day Post Go-live survey for Business Unit 2 showed no
improvement over time in the percentage of end users who responded
favorably to the question: I have been supported on the job after the
Implementation. (Refer to Figure 9 below)
I have been supported on
the job after the IRIS Implementation.
Remedial
Training
To help ensure that end users were adequately supported in
Business Unit 1, remedial training was offered on an ad-hoc basis
following the implementation. Members of the dedicated support team
visited various areas to ensure end users were performing activities
correctly and provided coaching as needed. While end users still
reported a desire for additional training, a greater percentage of end
users responded favorably to the question: I can successfully perform my
job using the new system than with Business Unit 2, where there was no
dedicated support team to offer remedial training (see Figure 10.)
I
can successfully perform my job using IRIS.
Conclusion
Comparisons of data between the business units for the 90 Day Post
Go-Live Surveys show that while favorable results for Business Unit 1
increased an average of 8%, results for Business Unit 2 only increased
an average of 1% overall (see Figure 1 above.) Through there are many
possible reasons for the significant differences in improvement, the
survey data for each business unit underlines the importance of
effective change management practices on the overall success of the
project. Specifically, a commitment to strong executive sponsorship, end
user engagement, a dedicated support team, and remedial training were
shown to be key components for ensuring a successful change.