In the first chapter of John Kotter's book, "Leading Change", he writes that, to date, major change efforts have helped some organizations adapt significantly to shifting conditions, have improved the competitive standing of others and have positioned a few for a far better future. But in too many situations, the improvements have been disappointing and the carnage has been appalling with wasted resources and burned out, scared or frustrated employees. I think it's so interesting that this book was written based on a variety of organizations that he researched, not specific to health care. But as we're reading this statement, burned out, scared or frustrated employees, it's amazing because for those of us in health care, it almost reads like what's happened in the Health IT industry as a result of EMR implementations, changes to EMRs, this stage of optimization that we're in, what the HITECH Act ushered in, meaningful use, so many changes. Even though Leading Change in John Kotter's work here has primarily focused on organizational level change, many of the concepts really relate to micro changes as well. In this next segment, you're going to hear me speak with Carrie Smith. She's a software engineer here at Johns Hopkins, focused on the Wilmer Eye Center and the Department of Ophthalmology. Carrie is an expert in all things related to our electronic medical record and is the go-to person for many queries and reports that I often need run regarding how a particular alert is running, how some data is structured on the back end. In this discussion, you'll hear Carrie talk about some of her approaches and some of the success that they have when it comes to change management, both at a larger enterprise-wide level and the support that they get from the larger institution, but also the approaches they take to successful change management when it might be a micro change that's taking place. Take a listen here. I have with me Carrie Smith, a software engineer at Johns Hopkins Ophthalmology Information Services. Carrie, thanks for taking some time out to answer a few questions for me. Of course. Now, in your role, you have a really good sense of the IT infrastructure behind a lot of the systems. You work in the division of ophthalmology, you're dealing with a lot of different provider types, right? Yes. Physicians, nurses, medical assistants, you name it. When there is a change that takes place, how do you ensure that the change management process goes smoothly for all of these different users? I mean, that's a huge challenge. Yes. That's a hard thing. So, the biggest challenge in managing a change is making sure that you have a complete understanding of the workflow that you're replacing. The Director of Wilmer IT is a clinician, so as a rule, we spend a lot of time embedded with the clinicians, making sure that we understand what they're doing with the various pieces of technology. So, when we're replacing something specific, we will develop a bit of a deeper dive and make sure that we have a full understanding of any dependencies or any downstream effects that the change is going to have. We are very vocal with everyone. I mean, we don't surprise our clinicians with changes. Everyone knows ahead of time what's coming. They know why and they're asking these questions. We do for a larger institutional changes, the Hopkins IT team will provide us with documentation to distribute to our users, but we will also produce our own Wilmer specific documentation. We have a Wilmer internet site with training documents, training videos, things like that. So, we make sure to keep that up-to-date. We make sure that everybody is aware that that resource exists and knows how to use it. We just make sure that it's comprehensive and that anytime a new change is coming out we have this email blasts system. If it's a big change, we might send them one email a month ahead of time. If it's a smaller change, we might start a week ahead of time and then the night before and the day, we send out reminder emails with links to the videos or training resources that we've created. Right. Because the change management process, how smoothly that goes can really impact morale and support. Yes. It can and nobody wants to feel like a victim of a change, so it doesn't work well for our users if you just go to them and say this is going to be different as of this day. We talk to them about why the change is being made. What's the requirement or the regulation that's driving the change? Or what's the new capability of a piece of technology that might make this change appealing to them? We always try to help them see why a change is being made, what will the benefit be to either them or to the patient. We just try to make sure they understand what's happening so that they don't feel like things are happening to them but that they feel like it's a system that's just evolving and they're part of it. Right and we've been talking about your role as a software engineer, focused on your local ecosystem in ophthalmology, but here we are today at the Strategic Planning Summit, that's more enterprise-wide. Can you speak a little bit to how valuable you found it, to hear about the road map, to get a sense of the timeline, to have them communicating a vision this morning? Yes, it's great. I mean, I think this whole day has been amazing to see in the larger picture like you said I live in this little microcosm of ophthalmology so I know about telemedicine for eye visits or things like that. It's great to see how these same pieces of software being used in larger and larger contexts in the institution and it's just cool stuff. There's just neat things that they're doing, that are really going to improve patient care. So, it's nice to see Hopkins as a whole entity, how we're moving this whole thing forward, where I'm just typically only looking at my little piece of the pie. Yes. Yes. Now, change management is tricky. It's being done on a daily, weekly basis, and then getting a sense of the larger vision of where the change is going in the months and years to come. It's really valuable for everyone as well. Yes, I would agree. I think everyone here today is just lit up with things that they didn't know existed. Things you know are possible or you might here about other institutions doing but it's great to see that Hopkins is actually actively involved in these sort of things. Well, thanks a lot for taking your time, Carrie. You're welcome.
