PYA Principal Denise Hall and Consulting Manager Kristen Lilly broached the topic of ICD-10 implementation and employee readiness at the June 17 HIMSS ICD-10 Forum held in Washington, D.C.

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HIMSS Media ICD-10 Forum
June 17, 2013
Your Organization May be Ready
for ICD-10 . . . Are Your Employees?
How to Identify Your Team's Readiness for Change.

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 Identify the organizational impact
of ICD-10 preparation and
implementation
 Develop a communication
sponsorship tree
 Illustrate the Loss of Effectiveness
(LOE) Index® change readiness
tool
 Learn preliminary steps of
developing a change
management work plan
Learning Objectives

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Why Change Fails
Organizational change initiatives
continue to experience a failure
rate approaching 70%.
Sources: Standish 2009, IBM 2008, Raps 2004, Beer 2003, Miller 2002, HBR 2000, Senge 1999, Strebel 1996, Kotter 1995

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Organizational Change
Organizational change causes a loss of stability,
which results in the development of a
predictable and measurable set of symptoms
within an organization.
When a significant number of these symptoms
are present, an organizational loss of
effectiveness will occur.
Source: Grady, 2005

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ICD-10 Organizational Impact
• Physician Documentation
• Physician Integration
• Physician Performance
• Staffing Effectiveness
• Assessment of Revenue
Impact
• Process Improvement
• Decision Support Reporting
Impact
• Documentation Analysis
• ICD-10 Education
• Process Improvement
• Monitoring
Physician
Office
Post Acute
Services
• Front – Scheduling, Access Areas
• Middle – Coding, CDI, Case
Management
• Back – Billing, Reimbursement
Health
Information
Management
ICD-10
Revenue
Process
Physician
Operational
Planning
Information
Technology
• IT Systems
• Capability, Communication
• Functionality
• Vendor Preparedness

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Change Management:
Key ICD-10 Project Stakeholders
Scheduling /
Access Areas
Health Information
Management
Information
Technology
Decision Support
Physician
Advocate
Billing &
Reimbursement
Human Resources

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Initiating Sponsors
Change Management:
ICD-10 Sponsorship Tree
• Strategically legitimizes the implementation of change
• Ensures strategic alignment, support , and inclusion
• Sanctions the change in relevant area of responsibility
• Coordinates activity and defines consequences
• Orchestrates activities and
consequences within their
local area
Sustaining Sponsors
Change Recipients
Local Sponsors

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Chief Financial Officer
ICD-10 Team Resources
Sample Sponsorship Tree and Structure
PFS Manager
Director of Revenue
Management
Manager of IT Support
Director of Health
Information Management
Director of Coding
Chief Information Officer
Lead Sustaining Sponsor
Sustaining Sponsors
Training &
Development
Manager
Marketing/
Community
Relations Manager
Coding Manager IT Analyst
Local Sponsors
Initiating Sponsors
Director of
Patient Financial Services
Chief Compliance Officer
Practice Administrator
Patient Access/
Admissions
Manager
Decision Support
Analyst
Revenue Cycle
Manager
Marketing/Community
Relations Director
Clinic Manager

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Loss of Effectiveness®
Identify the risk
Measure the
risk of change
to the individual
Address/resolve
the risk prior to
change
The LOE Index® determines the risk of change to the person,
which ultimately impacts the success of change in the
organization.

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Loss of Effectiveness (LOE) Index®
Change Readiness Assessment
• People determine the success of any change
• Loss of Effectiveness (LOE) Index® measures six defined symptoms that
determine the risk of change to the person, which ultimately impacts the
success of change in the organization
Individual Symptom Organizational Symptom
Anxiety Decreased Morale
Frustration Loss of Productivity
Rejection of the Environment Increased Conflict
Retardation of Development Decreased Motivation
Refusal to Participate Increased Absenteeism
Withdrawal Increased Turnover

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LOE Index®
Results by Department
1.00
1.20
1.40
1.60
1.80
2.00
2.20
2.40
2.60
A D F G P R W AVG.
Coding Information Systems Medical Records Patient Access Services Patient Financial Services Transcription Utilization Review

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LOE Index®
Results by Leadership
1.00
1.20
1.40
1.60
1.80
2.00
2.20
2.40
2.60
A D F G P R W AVG.
Director Or Manager Front Line Employee Supervisor Or Team Lead

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LOE Index®
Results by Years of Service
1.00
1.20
1.40
1.60
1.80
2.00
2.20
2.40
2.60
A D F G P R W AVG.
0 To 5 Years 6 To 10 Years 11 To 20 Years 20 Years

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LOE Index®
Qualitative Responses: Examples
Communication
“It would be helpful to have a "heads-up" prior to
implementing changes. At times, changes are
made and put into place and then those who are
supposed to follow through with these changes
are informed.”
~
“Sometimes having more of a heads up to
upcoming changes would be great. We have
expressed this to our leadership before and they
have made vast improvements to do so.”
Training
“I believe there should be MANDATORY
training classes for those that the
changes are going to effect. This would
result in less confusion when changes are
implemented.”
~
“Training immediately prior to, during and
after implementation.”
~
“More training in all departments to make
the workflow more efficient. A better
understanding of why things are done a
certain way.”End User Involvement
“The most important thing to me is to include the
persons that the change will most affect in the
process. Take their concerns into consideration
before a final decision is made and the change is
implemented.”

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Change Management
Work Stream Infrastructure
• Impact Identification
• Knowledge Leveling
• Data Gathering
Awareness &
Assessment
• Sponsor Tree
Definition
• Identification of
Sponsors
• Communication Plan
Sponsorship
• LOE Index
• Analysis of Results
• Action Identification
Effectiveness
Assessment
• Converge Impact &
Effectiveness
• Training
• Communication /
Sponsorship
Path Forward
Change Management Work Stream Deliverables:
 Sponsorship Tree Definition and Identification
 Effectiveness Index Summary Results and Action Identification
 Enterprise Training Blueprint

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Questions?

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Contact Information
Denise Hall, RN, BSN
Principal
dhall@pyapc.com
Kristen Lilly, MHA, RHIA, CPHQ
Manager
klilly@pyapc.com
Thank you for allowing us to share our thoughts
and expertise with you.
Pershing Yoakley & Associates, P.C.
(800) 270-9629
www.pyapc.com