Sunday, July 10, 2011

I Am Pretty Sure The Basic Rules Of Change Management Are Being Ignored with the PCEHR.

The following press release appeared a few days ago.

More Progress in e-health Consultation and Engagement

7 July 2011

Two important milestones in the development of Australia’s e-health system have been met with the key appointment of the National Change and Adoption Partner and the release of the Personally Controlled Electronic Health Record System: Legislation issues paper.

“E-health records will drive safer, more efficient and better quality healthcare for Australians. It is one of the important elements of national health reform,” Minister Roxon said.

“Patients will no longer have to remember every immunisation, every medical test, and every prescription as they move from doctor to doctor.

A consortium headed by McKinsey and Company has been selected to lead the national change and adoption process as Australia moves to introduce Personally Controlled Electronic Health Records (PCEHR) next year.

“The National Change and Adoption Partner will help educate and support the training and information needs of the health workforce who will use the system,” Minister Roxon said.

“The consortium will plan, design and develop training, guidance and tools in collaboration with clinicians and software providers. It will also provide change management support for clinicians including at the 12 lead implementation sites.

“From 1 July 2012, Australians will be able to choose to have a personal eHealth record, giving individuals a level of control over their health information never previously available.

“For doctors, nurses, pharmacists and other health professionals, PCEHRs will help transform Australia’s health system, improving the security of patient information and allowing for better clinical assessments and more efficient, effective treatment.”

“The Commonwealth is investing up to $29.9 million for this important contract for e health implementation.

.....

The Change and Adoption Partner consortium led by McKinsey and Company also includes PricewaterhouseCoopers, Hill & Knowlton, Workstar, Event Planet, Ocean Informatics, Alfred Health, Salmat and the Australian General Practice Network (AGPN).

Submissions made on the Personally Controlled Electronic Health Record System: Legislation issues paper will inform the drafting of legislation around the PCEHR system. Draft legislation will later be released for a further round of public consultation before introduction in Parliament later this year.

The legislation issues paper may be viewed, and submissions made, at www.yourhealth.gov.au, for a period of four weeks until 5pm Wednesday 3 August 2011.

The release is found here:

http://www.health.gov.au/internet/ministers/publishing.nsf/Content/mr-yr11-nr-nr138.htm

Press coverage is found here:

Team McKinsey bags major e-health deal

  • Fran Foo
  • From: Australian IT
  • July 07, 2011 5:24PM

A MCKINSEY and Co-led consortium has been given the thumbs up by the Gillard government to run a key component of the $467 million personally controlled e-health record project.

The news comes as Health Minister Nicola Roxon today called for input into the proposed PCEHR legislation.

As national change and adoption partner for the project, McKinsey will lead a cohort that includes PricewaterhouseCoopers, Workstar, Event Planet, Ocean Informatics, Alfred Health, Salmat, the Australian General Practice Network and public relations agency Hill & Knowlton.

Ms Roxon said the government was investing up to $29.9m in the change management aspect of the project.

"The national change and adoption partner will help educate and support the training and information needs of the health workforce who will use the system," Ms Roxon said in a statement.

She said the consortium was charged with planning, designing and developing training, guidance and tools in collaboration with clinicians and software providers to support the PCEHR rollout.

The group will provide change management support for clinicians that will also cover 12 lead implementation sites.

"From July 1, 2012, Australians will be able to choose to have a personal e-health record, giving individuals a level of control over their health information never previously available.

"For doctors, nurses, pharmacists and other health professionals, PCEHRs will help transform Australia's health system, improving the security of patient information and allowing for better clinical assessments and more efficient, effective treatment," she said.

More here:

http://www.theaustralian.com.au/australian-it/government/team-mckinsey-bags-major-e-health-deal/story-fn4htb9o-1226090028555

And here:

$29.9m dedicated for e-health training

By Suzanne Tindal, ZDNet.com.au on July 7th, 2011

McKinsey and Company has lucked out again, winning another deal for the implementation of the Federal Government's plan for personally controlled electronic health records.

Health Minister Nicola Roxon today said that the government has appointed a consortium headed by McKinsey and Co to lead the national change and adoption process for the records scheme, which the government has committed to have up and running by July 2012.

Other members of the consortium include PricewaterhouseCoopers, Hill and Knowlton, Workstar, Event Planet, Ocean Informatics, Alfred Health, Salmat and the Australian General Practice Network (AGPN).

"The National Change and Adoption Partner will help educate and support the training and information needs of the health workforce who will use the system," Roxon said in a statement. "The consortium will plan, design and develop training, guidance and tools in collaboration with clinicians and software providers. It will also provide change management support for clinicians, including at the 12 lead implementation sites."

Roxon said that up to $29.9 million would be spent on the contract.

More here:

http://www.zdnet.com.au/299m-dedicated-for-e-health-training-339318093.htm

Just so we know what we are talking about - here is the work program requested in the Tender.

Change and Adoption Work Program

The Change and Adoption Work Program comprises five major work components:

Component 1 – National Change and Adoption Strategy;

Component 2 – Strategic Stakeholder Engagement Program;

Component 3 – Marketing and Communications Program;

Component 4 – National Change Program; and

Component 5 – Local and Regional Change Program.

National Change and Adoption Strategy: This is the work required to develop and maintain an overarching strategy for the Change and Adoption Program. This work will include strategies and implementation planning for stakeholder engagement, marketing, national eHealth change programs, eHealth Site change programs, workplace change programs and the integration of the Benefits Realisation and Evaluation Framework. This work will be the first deliverable that the National Change & Adoption Partner will produce and will be informed by the eHealth Site learnings, national and international research and experience, industry best practice, and will be performed in consultation with DoHA and NEHTA. The National Change and Adoption Strategy will be a key PCEHR Program document and will contribute to the PCEHR system business case for Government funding, post June 2012.

Strategic Stakeholder Engagement Program: This is the work necessary to continue to plan and execute strategic stakeholder engagement for policy and business design consultation, concept validation and requirements verification from a national perspective. The strategic stakeholder engagement work performed by the National Change and Adoption Partner, will build on the planning and stakeholder engagement activities completed by DoHA, NEHTA and eHealth Sites, conducted during the first year of the PCEHR Program. This program will need to align with DoHA’s overall engagement program and will need to take into account the wider eHealth environment and the National Health and Hospitals Reform Agenda. This work will include engaging with a widening spectrum of stakeholders including: Australian Government agencies, state and territory governments, healthcare providers, software vendors and consumers, including early target areas (those suffering from chronic and complex conditions, older Australians, Aboriginals and Torres Strait Islander peoples, mothers and their newborn children), under the guidance and direction of DoHA The Change and Adoption Partner will also participate in a Communications Working Group, which will coordinate all stakeholder engagement and marketing communications for the PCEHR Program.

Marketing and Communications Program: This is the work associated with planning, design, alignment and implementation of national marketing and communication campaigns in a way that maximises stakeholder participation and engagement with the PCEHR Program and which delivers the outcomes outlined in Table 1, defined within the Benefits Realisation and Evaluation Framework (delivered in quarter 2 of 2011 by the Benefits and Evaluation Partner). This work will be led by DoHA, co-ordinated with NEHTA and supported by the National Change and Adoption Partner.

National Change Program: This is the work necessary to develop a National Change Program which will be overarching, integrated and will result in an evidence-informed change management plan for the PCEHR system. This work will be co-ordinated by the National Change and Adoption Partner and will be informed by the Benefits and Evaluation Partner, DoHA, NEHTA, eHealth sites “lessons learned”, external bodies such as the National Workforce Agency, clinical training and registration organisations and other key stakeholders. It will result in the development of tools and national training projects for clinicians, administration staff and the public so that the rollout of the PCEHR system occurs effectively and safely, to deliver the outcomes stated in Table 1. In particular, it will involve co-ordinating the change programs deployed at a local clinical or workplace level across Australia, incorporating activities such as education, technical, data support and on the job training. This program will also link to other national health reform initiatives such as the Practice Incentives Program, GP After Hours, chronic disease management services, telehealth incentives and GP super clinics.

Local and Regional Change Program: This is the work which will be initiated by the eHealth Sites and will be carried out by local change companies or agents. These local agents will be required to integrate and align with the National Change and Adoption Strategy, developed by the National Change and Adoption Partner. This work will be co-ordinated by NEHTA and the results and effectiveness of this program will need to be reported on by NEHTA and provided to the National Change and Adoption Partner.

----- End Extract.

So what we have here is a team to deliver a program to foster change and adoption leading up to the June 30, 2012 deadline. The contract has options for 2 years extension but no guarantee that will happen.

On the basis of the partners involved it seems there are planning, marketing, educational and consumer interaction tasks being requested.

Change management 101 makes it clear that in a complex domain like planning and implementing a PCEHR what is needed is:

1. Clarity as to what the desired future state is and an agreed plan involving all the stakeholders to move to that future state.

2. Clarity as to what the benefits and problems that will be faced by each stakeholder group (consumers, clinicians, service providers etc.)

3. Clarity as to the incentives and support that will be provided to assist in the desired transition.

Wikipedia gives a nice summary of some of the critical success factors:

“Successful change management is more likely to occur if the following are included:

  1. Benefits management and realization to define measurable stakeholder aims, create a business case for their achievement (which should be continuously updated), and monitor assumptions, risks, dependencies, costs, return on investment, dis-benefits and cultural issues affecting the progress of the associated work.
  2. Effective Communications that informs various stakeholders of the reasons for the change (why?), the benefits of successful implementation (what is in it for us, and you) as well as the details of the change (when? where? who is involved? how much will it cost? etc.).
  3. Devise an effective education, training and/or skills upgrading scheme for the organization.
  4. Counter resistance from the employees of companies and align them to overall strategic direction of the organization.
  5. Provide personal counselling (if required) to alleviate any change related fears.
  6. Monitoring of the implementation and fine-tuning as required.”

---- End Extract.

Found here:

http://en.wikipedia.org/wiki/Change_management

Given that there is no established evidence based benefits case for the PCEHR, that to date there are no planned incentives for adoption and that many clinical organisations struggle to see much utility in the program the risk that this whole change and adoption exercise will be a waste of $29.9 million spent over a little under a year must be pretty high.

It is quite amusing that DoHA wants an evidence informed change management program to work on the evidence free PCEHR program!

One wonders if McKinsey and Co might just have the honesty and intestinal fortitude to say to the Government that this exercise is just too rushed and too unclear in the desired end state for a worthwhile change management initiative to have any realistic chance of success. One can dream I guess!

David.

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