LorenziBook

Systems Projects consists of three parts: 1) Tech Skills2) Project Management3) People and Organizational Skills

Organizational Planning Styles:1) Top Down -CEO Driven2) Middle-in - (Whiz Kids) --> Middle managers /tech professionals 3) Bottom Up - entrepreneurial - decentralized, individuals with initiatives 4) Organizational Emergent - Organizational Learning/Non-planning plan - CIO leads based on org goals

Change Management Definition-1)  The methodology that integrates change and the ability to adapt into the organization, 2) An organized systematic application of the knowledge , tools, and resources of change that provides organizations with a key process to achieve their basic business strategy, 3) planning, initiation, control process for implementing new ideas or processes into an organization with the idea stage to a stabilized organization with the change implementedThree types of change:1) Organizational Development - gradual/evolutionary approach to change--> align goals throughout the organization2) Re-engineering --> Business transformation - radical form of change managmeent3) Re-design- cross btw the other to where change is hgih focused on on a concerted area and combines strategies of both 

Kubler Ross Grief Model :1) Denial2) Resistance3) Exploration4) Commitment 

Kubler -Ross  Stages : 1) Denial 2) Anger3) Blame4) Bargaining5) Acceptance - 

Typical Health Informatics Cycle for System improvement Discontent -> Conceptualization--> Planning--> Development --> Testing--> Cutover --->Acclimation--> Acceptance --> Discontent 

First Order Change = variation in the way processes and proceedings have been done within a given system , leaving the system itself relatively unchanged - i.e. new reports for a system, creating new ways to collect data etc..Second Order Change = System itself is changed --> strategic change or major crisis drives this i.e. paper to EMR, Legacy EMR to New EMR etcMiddle - Order Change - Compromise  - Greater than first order change, but no impact on strategy or critical success factors --> i.e. new EMAIL system Both Levels of change and resistance are Graduated --> 

Classifying Types of Change in Organizations : 1) Operational - changes operations of the business - Affects the lower levels of organizations the most2) Cultural - changes in basic organizational philosophies, by which the business is conducted--> i.e. implementing a CQI program- Affects the middle levels of the organization the most3) strategic --> changes strategic business direction - Affects each level of organization evenly4) Political - staffing changes due to political reasons, usually at top levels of the organization 

Assessing Organization Culture: Seven Measures 1) Action and Innovation2) Risk Taking3) Cooperation 4) Openly supportive MAnagement 5) Decision-Making Autonomy6)Clearly defined performance expectations7) Pay for Performance/REward orientation

Political Models in the information management arena that cause issues-->1) Technocratic utopianism --> Technology solves all issues , organization and people issues are irrelevant, focuses on producers/technocrats2) Anarchy - Absence of an alternative prevailing model , usually through failure to provide a model of unified information management3) Feudalism - strong divisional organizations which build their own systems to meet the individual needs both operational and political . 4) Monarchy - Highly centralized model where strong central information function is established 5) Federalism - good for large organization, respects needs of the individual divisions 

Early Change theory : Watzlawick -1) Theory of Groups - relationships btw parts and wholes, model transcend systems, 2) Theory of Logical Types - collections of things are united by specific characteristicsSmall Group Theories - sociology of groups --> MAJOR PRINCIPLE DERIVED --> to effectively manage change, it is imperative for change agnets to understand how people behave in groups and espcecially small groupsField theory - Kurt Lewin - tension within people whenever a psychological need or intention exists and only released when it is acheived. Tension may be positive or negative. -- > Conflict situations -"force Fields"3 types o confilct:1) individual stands midway btw two positive goals of approximately equal strength2) individual stands midway btw two negative goals of equal strength 3) individual is exposed ot both positive and negative forces simultatneously - common in Health ITSmall group theory is applicable because of the way hospitals are organized typical. Field theory allows diagramming of typical conflict situations. note: 1) every change , actual or proposed is characterized by goal or termination point to result in change 2) every change creates effects on people and existing systems, some intended, some not3) In most change processes, forces will be positive or negative , some strong, some weak4) Forces can be real or imagined. 

Lorenzi/Riley Change Management Model framework1) Assessment and Information gathering 2) Feedback/Options -3) Strategy Development4) Implementation 5) Reassessment 

Critical Issues for Change:1. MAking proactive vs. Reactive change2) Understanding the critical global and local issues3) creating vision for change4) identifying the key leader characteristics5) Gaining commitment from organizational leadership6)defining the end-user needs7 Appreciating organizational stress

In teams, Productivity is based on three conditions -->1) Collaboration - ensures involvement by stakeholders, 2) Commitment - empower people to act on their best judgement and the point of impact - where work is being done, meaninguful work is emphasized, teamwork is stressed, sense of community 3) Creativity - support allows for people to look for better ways to do something. Task environment promotes and facilitates, rather than obstructs the efforts .

types of Conflicts among healthcare personnel 1) Role Conflict - when each group has a expectations for their role and other groups roles that are different the expectations of the other groups2) Issue Conflicts - disagreements among people concerning the solution for a problem 3) Interaction Conflicts - behavior of team member is motivated by external or situational causes4) Functional Conflict - when one group reaches a goal , it is preventing another group from reaching theirs5) Hierarchical conflicts - interest groups struggles over the organizational rewards of status, prestige, power and money 6) Duplicative conflict - different functional units have similar functional responsibilities

Sled Dog Model of Team Formation 1) Sniffing - to tease out who people are , what they are mad eof2) Growling - test the toughness of other members of the teams 3) Acceptance - settle down and learn to work together 4) pull together for the common goal 

IS Development Guidelines1) Ask your customer - Benefits> techie features 2)Set Realistic goals - don't set goals too high3)Break down Walls -Use integrated teams to achieve the best resutls4)Create Gateways -create checkpoints along the way for status review and 5)Watch Testing - test at all stages 6)DO your post-mortems - REview issues and failures to improve 

Project Management Set of ISsues:1) Definition of Responsibiltiies2) Objective Setting3) Action Planning4) Tight/Control - Feedback5)Ongoing Problem Solving6) Project completion

Project Concepts:1) Put in ample time up front 2) resolve conflicts early with consensus building3) set realistic performance onjectives4) Get baseline data 5) Wary of the initial productivity curve - it usually dips and returns and then exceeds pre-implementation6)  manage customer expectations to a realistic levels7) Don't oversell8 Allow for organizational Delay 9) Manage top down limits that are unreasonable10) Deal with add-on requests - 11) PLAN PLAN PLAN 12) Use project management software13) All plans are forecasts made under certaine assumptions and these may need to be adjusted. 14 ) Adaptive Planning keeps plans flexible as long as possible15) Complete Project planning is necessary 16) Use Team approaches - integrated teams as opposed to hand-offs and silos17) Build flexible systems downstream using tools and systems to allow for change and maximise the end-users and organization benefit18 MAnage Key Project Values 

Key Project Values:  Key Person must define and prioritize the critical values for the project Package the key values and priorites in effective communication for relevant audience Communicate values and priorities repeatedly with management MAnagers must be role models for teams Adherence and support for values and priorities  should be incorporated into the reward structure, continually reinforced , both  positive and negative 

Three types of Resistance  Resistance to the Changers - we/they relationship develops REsistance to the environmental changes -  i.e.. regulatory /political /reimbursement  Resistance to organizational changes  -  Resistance to the Specific IT system /Implementation - because it is poor! 

Important to know which type of resistance exist as the change management mechanism differs for each 

TrOvercoming Resistance --> Key points to overcome Gather Benchmark Data performance data on old system  Analyze the beneftis to answer " whats in it for me Use sound organizational development techniques Get Champions Give ownership to the customes Try implementing as soon as possible Set Realistic expectations Do timely training Provide extensive support Make sure the system is stable protect physician egos Try to have fun !!!

Key Strategies to Handle Political MineFields  Be Patient Maintain sense of perspective Identify and work with power people Maintain good communication Avoid isolation Know the rules of the game  Maintain High Energy Be directly involved Manage your ego Maintain a sense of trust Maintain your sense of humor Use the silver bullets wiesely

End Stage People Issues  Training to use new system should be delayed as long as possible, but planning the training should occur early communicate thanks to teams  End user communication is key Celebrate Success -

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