Role of a Change Leader in the CIS Implementation Process

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The change process involved in the transition to an electronic Clinical Information System has proven to be very disruptive to a majority of organizations. Once an organization has made the commitment to transition to an electronic system, it is imperative that an effective “change leader” be designated. The role of the change leader is to manage the change process throughout the organization. The change leader serves as the bridge and is the “point person” between the organization, system designer and the end-users during the change process. Ultimately the job of the change leader is to effectively diffuse the change concepts throughout the organization. Everett Rogers outlined four elements of diffusion in his Diffusion of Innovations Theory. They consist of the innovation itself, communication channels, time, and the social system. He defined diffusion as “the process by which an innovation is communicated through certain channels over time among the members of a social system and described diffusion as a special form of communication with the message of a new idea in order to bring about change, a process by which changes occur within the structure and function of a social system”.(1)

Continuous, committed, and active leadership sets direction and develops vision and strategies required for organizational change to succeed. Effective change leaders need to posses and employ the following behaviors. They must embrace change when needed and take initiative. They must develop a vision for change and communicate its urgency. They must communicate with managers and employees, individually and through organizational communication, with feedback options. They must stay actively involved. They must direct and review change management planning and implementation. Most importantly, change leaders can set into motion the processes to determine if the intended changes really make sense to end-users who will be most affected by the changes. Change leaders can also spot problems and unintended consequences before they occur and increase the likelihood that changes that make sense will be implemented successfully.(2) One objective of the change leader is to facilitate and ease the burden of change that is experienced by the individual system end-users. Change leaders need to recognize individual differences between people in rates of adoption of innovation and then consider resources available in their own institution to assist in supporting and implementing the proposed change. Members of a group vary greatly in their willingness to adopt a particular innovation. People adopt in a time sequence, and they may be classified into adopter categories on the basis of when they first begin using a new idea. The distribution of innovativeness within a population resembles a normal curve beginning with “Innovators” who lead in adopting an innovation and make up about 2.5% of a population. “Early Adopters” make up approximately 13.5% of a population and this group contains the majority of the opinion leaders. Most people will fall into either the “Early Majority” (34%) or the “Late Majority” (34%) categories. They can be persuaded of the utility of new ideas, but the pressure of peers is necessary to motivate adoption. “Laggards,” who will resist adopting an innovation as long as possible, comprise about 16% of a population.(3)

To help assist the late majority and laggards in adopting new technology, the change leader should rely on the “special people” that currently exist in the organization. Joan Ash et al. describe “special people” as high level leaders, non-physician clinicians who assisted with the implementation or physicians who played a special role during implementation. Their roles spanned disciplines from administration to information technology to the clinical realm. Because they lived in more than one world and know the vocabulary of each, they also play the important role of interpreters between the technology and clinical worlds and can have significant impact to help overcome obstacles of communication between the system end- users, the change manager, upper management and the project development team.(4) The use of a change leader should be considered and required, in all CIS implementation or system enhancement projects, as standard protocol.

1. Rogers EM. Diffusion of Innovations. 4th Ed. New York, Free Press; 1999: p.13

2. John S. Luo, M.D. et al. Considerations in Change Management Related to Technology. Academic Psychiatry. 2006 November-December; 30(6): p 467

3. Nancy Lorenzi et al. Crossing the Implementation Chasm: A Proposal for Bold Action. Journal of the American Medical Informatics Association. 2008May / June; Volume 15 Number 3: p. 291

4. Joan S. Ash, P. Zoe Stavri, Richard Dykstra, Lara Fournier. Implementing Computerized Physician Order Entry: the Importance of Special People. International Journal of Medical Informatics 69. 2003: p. 240

Submitted by Jack Dainton