In 2006, Texas Children's Hospital began transitioning from a paper to an electronic medical record system. The hospital has begun the implementation of an electronic medical record system that will provide immediate access to patient records and information across the organization, thus promoting improved patient care and patient safety while streamlining efficiencies. The first phase of the project was deployed in two major business units in the organization. To assist with the change associated with the system implementation, a change management team was created. Throughout the project, the change management team partnered with the project implementation team and organizational leaders to facilitate activities designed to reduce employee resistance and build commitment for the implementation. Two notable activities included creating a Change Agent Network and conducting dress rehearsal activities. Local leaders selected individuals to make up a Change Agent Network. The network was comprised of participants from throughout the organization who served as extensions of the change management team as "on-the-ground" peer champions. The change management team provided Network members with ongoing information, reminders, and tips which they shared with their peers. Periodic meetings and conference calls allowed change agents to connect with each other and exchange ideas about how to build commitment, as well as keep the change management team informed about issues and major areas of resistance that required attention. In addition to the Change Agent Network, the change management team developed dress rehearsal activities to help prepare end users for the implementation. The activities were set up as real-life simulations and provided an opportunity for end users to walk-though and practice system and process changes prior to implementation. The dress rehearsals were intended to help end users understand what to expect at Go-live and minimize anxiety. The business units involved in the initiative each had unique characteristics. Business Unit 1 had fairly standardized processes, and was geographically dispersed throughout the region. Business Unit 2 was centralized, but had vastly different processes between the many sub-units. These differences created a variety of implementation challenges. Overall the same basic change management strategy, processes and tools were available for each unit. The degree to which the change management practices were utilized by the unit's leadership team differed greatly. During the planning phase of the project, Business Unit 1 demonstrated strong executive support and involvement in the project as a whole, and specifically the change management activities. The business unit's executive closely partnered with the change management team, discussing various change management ideas and concepts; tailoring tools and activities to better meet the needs of the business unit; and consistently participating in change management events and activities. A clear example of her commitment was her sponsorship of the Change Agent Network. She publicly championed the Network to leaders and staff. She and local leaders supported the Network by joining conference calls, participating in activities and personally thanking change agents for their time and commitment. Leadership from Business Unit 1 encouraged and held change agents accountable for fulfilling their responsibilities in the role, which ensured ongoing participation and follow-through. Another clear example of this executive's support was her willingness to champion dress rehearsal activities. She conducted a careful review of the planned activities to ensure they were appropriate for each area, and required participation for all end users. Some locations temporarily closed during dress rehearsals to ensure staff had adequate time and attention to devote to practicing and mastering the new skills required for the implementation. Following the dress rehearsals, the executive reviewed the status report from each site. Feedback from Business Unit 1's leader specified the Change Agent Network and dress rehearsals were keys to the successful Go-live for her business unit. She noted the Change Agent Network increased end user engagement and helped keep end users informed by spreading key project messages. She also indicated the peer-to-peer communication was especially helpful in ensuring important messages were received and understood by end users. The visible sponsorship and participation of the executive sponsor enabled success of the activities by ensuring that leaders and end users understood the importance of managing change as well as their role in it. Business Unit 2 implemented the new system two months after Business Unit 1. During the planning phase, leaders of Business Unit 2 were involved in the project at a high level, and their degree of sponsorship and support of change management was less visible to end users. Though the leaders agreed to engage in the same change management activities employed with Business Unit 1, they demonstrated less active support of the activities to the end users. The leaders complied with general requests, such as providing lists of users to participate in activities; however, few leaders reached out to the selected end users to show their support and encouragement, or participated in the various end user engagement meetings to demonstrate sponsorship. Throughout the phases of the project, Business Unit 2's end user participation in Change Management activities steadily decreased. Though leadership from Business Unit 1 publicly advocated the necessity of dress rehearsals, most areas in Business Unit 2 failed to engage in dress rehearsals. Many leaders from Business Unit 2 failed to review the dress rehearsal activities or to check for applicability to their specific areas. Few made the activities mandatory or actively encouraged their staff to participate. Most neither held end users accountable for practicing for the Go-live, nor did they provide staff with adequate time to do so. As a result, the percentage of staff who participated in Business Unit 2's dress rehearsals was significantly less than the percentage from Business Unit 1. In addition, a comparison between the Pre Go-live results for both business units showed that Business Unit 1 had significantly more favorable results than Business Unit 2. A greater percentage of end users from Business Unit 1 reported that they understood how the implementation was going to impact them, had the skills and knowledge to effectively complete their tasks, and were ready to Go-live with the new system. Additionally, end users from Business Unit 1 indicated higher levels of commitment to the project, as seen by a 17% difference in favorable responses between the two units to the question: I feel that the new system will work for me.

1. The unit 1 executive did a much better job of change management than the unit 2 executive. What are 3 reasons ways that unit 1 executives did a better job handling the change management. What metrics show the success of the transition process? Should there be other metrics used to measure the success of this type of project besides these?

2. Select any three of Kotters eight steps for managing change and explain how the Unit 1 executive successfully conducted that step in the case study scenario. Kotter's eight steps for managing change

1. Create a sense of urgency

2. Form a powerful coalition

3. Create a vision for change

4. Communicate the vision

5. Remove obstacles

6. Create short-term wins

7. Build on the change

8. Anchor the change

3. Change management is often needed when new technology adoptions require employees to change the way that they do their jobs. Imagine yourself working in an organization such as a hospital and you are required to abandon your familiar work processes and adopt new work processes that are dependent upon some new technology. How would you want to be supported during this transaction? Provide at least three "support mechanisms" that would be helpful to you.

4. If you were the supervisor over the unit executives, and the Unit 1 executive was much more effective at change management than the Unit 2 executive, how might you support the Unit 2 executive to improve his or her ability to manage change?