This document discusses change management and how understanding employee attachments can help ensure successful organizational change. It presents tools to define employee attachments, including qualitative interviews and a Change Diagnostic Index survey. Case studies show how the index was used to measure attachment risk for an EMR integration and ICD-10 transition. The index results identified needs for communication, training, and end user involvement by department and tenure. An effective change management approach involves assessing impact and effectiveness, sponsoring change, and providing support through the identified transitional objects. Understanding attachment behavior is key to integrating the human aspect of change.

1. CHANGE MANAGEMENT 2014
PRESENTED BY:
DR. VICTORIA GRADY
THE GEORGE WASHINGTON UNIVERSITY
KRISTEN LILLY, MHA, RHIA, CPHQ
PYA

3. 3
WHAT DO A PLANE CRASH, A DESERTED
ISLAND, AND A VOLLEY BALL HAVE TO DO
WITH ORGANIZATIONAL CHANGE?

4. 4
LEARNING OBJECTIVES:
• Identify the instinctual behavioral
response of individual employees who
are anticipating and implementing
organizational change.
• Explain the physical implications of
that response.
• Introduce tools to support accurate
identification of this behavioral
response.
• Discuss case studies with the
audience that include integration of
tools.
• Define a process for integrating the
response as a critical function of
Change Strategy Planning and
Implementation.

5. 5
THE CHALLENGE
Employee satisfaction is a critical factor in
maintaining high Customer satisfaction.
Ironically, employee satisfaction in our globally
competitive marketplace is a very complicated
challenge.

6. 6
THE ANSWER
The answer is rooted in the individual
employees who add a unique dynamic to the
organization.
Change management professionals
recognizing that individual employees are
collectively The Organization, is a massive
challenge and critical to change success.

7. 7
PEOPLE DETERMINE THE SUCCESS
OF ANY CHANGE…
So what are YOU attached to?
• A Leader (or Leadership)
• Technology (Software or Hardware)
• The Business Process
• An Office Space
• The Lunch Group
• Your Break Room
• An Idea…

8. 8
THE SYMPTOMS
Individual
Symptom
Organizational
Symptom
Suggested Mitigation or
Intervention Strategy
Anxiety Morale
Enhance and Increase Support
from Leadership/Sponsorship
Frustration Productivity
Increase Education/Training with
the Identified Change
Rejection of
the Environment
Conflict
Improve
Communication
Retardation of
Development
Motivation
Integrate Individual
Coaching
Refusal to
Participate
Absenteeism
Increase Employee
Engagement and Support
Withdrawal Turnover
Address Job Satisfaction
and Commitment

9. 9
TOOLS TO DEFINE ATTACHMENTS
Qualitative Tools
• Observation (Lurking)
• Interviews
• Focus Groups
Quantitative Tools
•Social Network Analysis
•Personality Assessment
•Attachment Assessment

10. 10
ATTACHMENT ASSESSMENT
Identify the
Risk
Measure the
Risk of
Change to the
Individual
Address /
Resolve the
Risk Prior to
Change
The Change Diagnostic Index© determines the risk of change to
the individual employee, which ultimately impacts the success of
change in the organization.
Define Employee Behavioral Response and Identify
Transitional Objects to Support the Process

11. 11
CASE STUDIES

12. 12
Baseline-Aug 2010 Calibration-Oct 2010 Final-Feb 2011
AverageChangeDiagnostic
Index©Score
Organizational Summary
CASE STUDY 1-
EMR INTEGRATION

14. 14
CASE STUDY 2 –
ICD-10 TRANSITION
• On October 1, 2014 the ICD-9 code sets used to report
medical diagnoses and inpatient procedures will be
replaced by ICD-10 code sets.
• The transition to ICD-10 is a requirement for everyone
covered by the Health Insurance Portability Accountability
Act (HIPAA).
• The change to ICD-10 does not affect CPT coding for
outpatient procedures and physician services.

15. 15
HEALTHCARE CHANGE: ICD-10
ORGANIZATIONAL IMPACT
• Physician Documentation
• Physician Integration
• Physician Performance
• Staffing Effectiveness
• Assessment of Revenue
Impact
• Process Improvement
• Decision Support Reporting
Impact
• Documentation Analysis
• Education
• Process Improvement
• Monitoring
Physician
Office
Post Acute
Services
• Front – Scheduling, Access Areas
• Middle – Coding, CDI, Case
Management
• Back – Billing, Reimbursement
Health
Information
Management
Revenue
Process
Physician
Operational
Planning
Information
Technology
• IT Systems
• Capability, Communication
• Functionality
• Vendor Preparedness
ICD-10

16. 16
HEALTHCARE CHANGE MANAGEMENT:
ICD-10 KEY PROJECT STAKEHOLDERS
Scheduling /
Access Areas
Health Information
Management
Information
Technology
Decision Support
Physician
Advocate
Billing &
Reimbursement
Human Resources

17. 17
CHANGE DIAGNOSTIC 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

18. 18
CHANGE DIAGNOSTIC 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

19. 19
CHANGE DIAGNOSTIC 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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PYA CHANGE MANAGEMENT
WORK STREAM INFRASTRUCTURE
• Impact Identification
• Knowledge Leveling
• Data Gathering
Awareness &
Assessment
• Sponsor Tree
Definition
• Identification of
Sponsors
• Communication Plan
Sponsorship
• Change Diagnostic
Index©
• Analysis of Results
• Action Identification
Effectiveness
Assessment
• Converge Impact &
Effectiveness
• Training
• Communication /
Sponsorship
Path Forward
Change Management Work Stream Focus:
 Communication plan detailed for specific audience knowledge levels
 Sponsorship tree definition and identification of individuals
 Effectiveness index summary results and action identification

21. 21
THE BOTTOM LINE:
WHAT YOU NEED KNOW
Attachment Behavior is instinctual human nature. Organizational Change
interrupts our attachments. EVERY TIME.
In order to understand the individual employees who are collectively the
organization, we must first define their attachments.
Use Qualitative and Quantitative Tools to define individual employee
attachments.
Create customized support during the change process through identification
of organizational transitional (support) objects.
Change Management Strategy cannot integrate the “human side of change”
without first understanding the role of attachment behavior in the process.

22. DR. VICTORIA GRADY
THE GEORGE WASHINGTON UNIVERSITY
KRISTEN LILLY, MHA, RHIA, CPHQ
PYA