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The Impact of Change Frameworks in Supporting Complex Change Initiatives 8.1

Student’s Name

Institutional Affiliation

Course Code

Date
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System-Wide Transformation Project

The healthcare sector is dynamic because of the constant changes in research and

development. For instance, the usage and development of electronic medical records is one

technological advancement that has been developed in recent decades. These technologies have

changed how patient data are recorded, retrieved, and sent. They also have the potential to

improve healthcare workflow, reduce errors, and support wise decision-making (Honavar, 2020).

Nonetheless, it is critical to comprehend that the electronic medical records implementation

process is broad and complex, requiring a thorough understanding of the stakeholders and an

effective training strategy. Thus, this paper discusses the main takeaways from, difficulties faced

during, and tactics for long-term EMR integration in a rural hospital.

System-Wide Transformation Project

The use of electronic medical record systems in a rural outpatient clinic in America owing to

a system-wide revolution was selected for discussion. Before this, the hospital used a hybrid

system in which radiology and laboratory findings were displayed on a rudimentary electronic

message board, and physician notes and prescriptions were completed on paper. A new web-

based integrated electronic medical record system for inpatient, outpatient, and emergency

departments will replace the manual, localized system. This adjustment addresses better clinical

efficiency, care quality, and safe care delivery problems. Clinical decision-making tools,

computerized physician order input, and health information sharing are some features introduced

during its development. These features all help providers offer safe and affordable healthcare.

Additionally, the system guarantees the seamless transfer of information from the hospital to its

various outreach centers and the local and regional population. The following phases may be

used to break down the process of putting a structural plan into action. The following stages are
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part of the implementation process. The initial step is for the core informatics team subculture to

instill confidence and faith in the system. Furthermore, they should EMR system construction.

Additionally, end users' buy-in is ensured via meetings with them, presentations, and workshops

that go over the system's capabilities. The system's operations should also align with their needs.

Before the go-live phase, ongoing training should be held for the personnel's key users, including

doctors, nurses, and other supporting staff. This guarantees a more straightforward transition,

reduces stress, and improves user capability. Moreover, the creation of governance frameworks

is necessary. A governance framework facilitates discussion of concerns, decision-making, and

the accomplishment of clinical and nonclinical aims. Ultimately, local in-house teams may

provide user-oriented assistance to guarantee that users in clinical settings get the most out of the

system's capability.

Healthcare Facility

The healthcare facility in rural America is a rural outpatient clinic, which helps

underprivileged rural residents get easily accessible treatment. The clinic serves the local

populations by providing basic and standard medical services such as regular, acute, preventive,

and ongoing treatment for chronic and other illnesses. It’s intended to switch from paper-based

or semi-digital record keeping to an electronic medical record (EMR) system as part of a more

significant endeavor to improve healthcare delivery. Also, to enhance patient treatment flow, this

modification connects the network's outreach institutions and leading hospitals to the rural

outpatient clinic.

Population That May Be Positively Impacted

The specific populations served by the rural outpatient clinic include patients with chronic

illnesses, children, the elderly, pregnant women, and those with limited access to physicians.
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Typically, they often face issues including distant location, a lack of funding, and subpar medical

services. Indeed, since the EMR system allows for thorough documentation, shared records, and

cooperation across several locations, its installation addresses these difficulties. Predominantly,

by improving decision-making time, eliminating mistakes, and ensuring that patient data are up-

to-date, this digital integration increases the well-being of patients in these minority groups.

Staff That Would Be Involved

They are the major players whose actions will determine the new EMR system's success or

failure. For instance, the staff at the remote outpatient clinic consists of medical professionals,

administrative assistants, and information technology specialists. The workers will be instructed

on workflow characteristic of rural regions so that the numerous upgraded workflows may be

properly implemented. Notwithstanding several difficulties, the clinic's operational efficiency,

coordination, and service quality have increased since implementing the EMR system. These

features of the system impact and improve the utilization of correct information in patient

management, which improves health care results for the rural population.

Frameworks to Implement System-Wide Transformation Project

Variables Embedded

The model to be utilized is Kurt Lewin's Change Management Model. This paradigm is

beneficial for addressing healthcare needs since it guides firms through the change process by

identifying the factors driving and restricting change. A crucial element is Lewin's Force Field

Analysis, which aids stakeholders in analyzing and balancing pressures to upset the equilibrium

and accomplish desired results (Bozak, 2003; Kaminski, 2011). Restrictive factors like staff

reluctance or a lack of resources must be outweighed by motivating factors like better

recordkeeping and access to clinical information (Sassen, 2009). Several variables that are
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essential to the process of bringing about and maintaining change are discussed below. These

factors are divided into equilibrium conditions, restraining, and driving forces. Driving forces

support or motivate change, assisting the organization in achieving its objectives. The following

factors are motivating the shift from paper-based to electronic documentation. Better records are

one of them, as it aims to improve recordkeeping's precision and effectiveness. Additionally, it is

information accessibility. Healthcare data may be accessed quickly and thoroughly using

electronic platforms. Technological readiness is equally significant. A supportive environment

ensures sufficient funding, managerial assistance, and enough training initiatives. Furthermore,

variables known as restraining forces oppose or fight the change, making its implementation

difficult. These forces may consist of a lack of training. Typically, employees who get

insufficient training are unable to manage new systems. Also, negative attitudes. Opposition

from employees who fear technology or prefer paper paperwork may happen. Besides, adequate

funds to purchase and successfully deploy the system may limit the implementation. Also, fear of

upsetting established habits and reluctance to embrace new processes are examples of workforce

reluctance that can be faced.

This variable quantifies the intensity of the driving and restraining forces and is a State of

Equilibrium variable. Usually, when the two forces are equal, the system cannot change. Because

doing so throws off the delicate equilibrium of organizations, change must be sparked by either

strengthening the driving factors or weakening the restraining forces. Furthermore, according to

Hidayat, Purwarini, and Susilo (2023), the model is separated into three stages: unfreezing,

changing, and refreezing. The organization stimulates backing for change during the unfreezing

stage because it helps stakeholders understand how important the necessary change is (Hidayat et

al., 2023). The following are important factors at this stage. The ideas of comprehending the
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need for change, recognizing it, and establishing the necessity and pertinence of the shift to

electronic documentation. Additionally, it’s vital to teach employees to avoid negative

connotations and address worries or concerns instead of rejecting them. Besides, organizational

changes are implemented during the planned changing phase (Hidayat, Purwarini & Susilo,

2023). Implementation strategies, such as system change, expansion of the electronic system, and

sufficient support, are essential factors. During this phase, it’s also vital to check on employees'

adaptation and handling of their worries to prevent disruptions throughout the transition to

change. The change is finalized and formalized by this refreezing, making it a practice (Hidayat,

Purwarini & Susilo, 2023). Reinforcement strategies are essential, including ongoing teaching

and instruction on utilizing the new system. Policies are also developed by implementing new

policies within the organization or proposing new guidelines for approval by the institution's

authorities. Eventually, technical support is provided by suggesting hardware or software to be

used to improve results. Also, the results are evaluated to see if the implemented policies have

achieved the institution's intended goals and to make sure that adjustments are made as needed.

Challenges, Limitations, and/or Barriers

The following difficulties, restrictions, and hurdles that can happen in the EMR system's

deployment. The first challenge is that change can be met with resistance from workers during

the unfreezing phase. That is, if stakeholders aren't actively involved, the results may not be up

to standard with what the business requires and the expectations. This matters because people are

less likely to embrace the new change if they are unaware of the benefits of EMR. In addition,

employees are likely to experience additional frustration and setbacks throughout the transition

due to practical problems like as software failures, network challenges, and system outages.

Furthermore, there are levels at which employees may feel hopelessly inadequate in their jobs as
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a result of inadequate preparation, education, or experience. Finally, maintaining system usage

after refreezing may be rather tough without sufficient support, teaching, and technical aid.

Organizational competence or a lack of funds are also further constraints that might hinder the

change's efficiency.

A Variable or Concept That I Would Propose

Company culture is a significant variable to consider when implementing an EMR system.

According to Akpa, Asikhia, and Nneji (2021), organizational culture is the pattern of

presumptions, ideas, and practices that permeate a healthcare environment and influence how

staff members see and react to change. In Lewin's model, this variable is significant throughout

the unfreezing and changing stages. Hence, it’s vital to be open to the transition to EMR by

encouraging an inventive culture, fostering a learning culture, and maintaining open lines of

communication. Analyzing the elements that can impede the transformation and assessing the

potential worth of the current organizational culture are necessary to support the reasoning

behind this variable. Furthermore, the organization's managers and leaders must ensure the

workplace is friendly, engages employees, and asks questions (Nikpour et al., 2022). Before

implementing change, it is crucial to evaluate the current organizational culture and address any

unfavorable elements hindering the process of successfully integrating this variable. By actively

involving employees and soliciting their opinions, leadership may foster a welcoming and

inclusive atmosphere (Nikpour et al., 2022). Therefore, it is a strategy that increases a company's

motivation and lowers resistance, enabling specific changes to be implemented gradually and

sustainably.

Formative and Summative Evaluation Process

Formative Evaluation Processes

Formative assessment is helpful while the system-wide change program is being

implemented since it offers ongoing input on what needs to be changed. According to Elwy et al.

(2020), formative evaluation focuses on the process rather than the outcome. Several components

make up the formative assessment procedures when implementing an EMR. First, healthcare

practitioners, administrative personnel, and patients would fill out feedback forms that would be

used to gather stakeholder experiences with the new system. This information would then be

used in surveys, interviews, and focus groups. Furthermore, before expanding the system, a pilot

study will be carried out to identify any issues with system performance or data accuracy. It’s

also vital to assess how practical the training sessions are in preparing the staff to switch from

paper-based writing to the EMR technique. Additionally, monitoring would be an activity to help

identify issues with the new system. Lastly, technical monitoring would be carried out to analyze

the system's efficiency. This evaluation should focus on response times, data storage, and

security.

Summative Evaluation Processes

Following the completion of the implementation project, a summative evaluation is

conducted to determine the project's efficacy (Daka et al., 2021). Results are utilized for

assessment, and much focus is put on intangible and concrete elements that lead to changes, such

as precision, error-free practice, and collaborative patient care. Analysis of the degree of efficacy

is also carried out to ensure that the current financial costs incurred by the EMR system are

represented (Daka et al., 2021). It is also possible to determine if the expenses of the EMR

system have been justified by doing a cost-benefit analysis. The usage, implementation, flow,

and general satisfaction of the organization may be gathered from surveys. Moreover, it’s vital to

perform certification and conformity checks. This is because they are critical for making the
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EMR system work better and for making sure it complies with all the laws. Ultimately, by

analyzing data collected both before and after the program's launch, improvement can be

determined using performance metrics like documentation, flow, and mistake rates. Jointly, they

make it easier to evaluate the EMR system's worth and how the organization may enhance its

operations.

Dissemination of Findings and Outcomes

For the sake of holding everyone accountable, we will communicate the broad conclusions

from both the formative and summative assessments with the relevant parties. One way to share

the project's outcomes is to write a report outlining the goals, methods, and outcomes of the

project. The performance factors and other ideas for improvement will be shown via various

visual aids. Additionally, some advantages, such as less paperwork errors, more rule and

regulation adherence, and better patient care overall, will also be highlighted. In addition to

highlighting additional results, it will include recommendations for how to enhance the project.

Along with quantitative data, this study will also include qualitative data on how the EMR

system has affected staff work and patient care. To complete the data, a survey will be sent out to

both staff and patients to gather their feelings and experiences with the system. Additionally, a

method will be presented to the Board that would display the pertinent information. A session for

questions and answers as well as feedback will take place. Then, the focus will shift on

suggestions for keeping the transformation going, fixing the system's evolution gaps, and

preparing for future technology advances.

Conclusion

Conclusively, electronic medical record system implementation is a significant step for

healthcare facility. This shift helps with patient information management and clinical and
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operational procedures. However, there is more to the process than just making such a

complicated system a reality. This is because success relies on integrating the necessary

technologies and evaluating the system at every point of its lifespan. Feedback on the system's

real-time efficiency is provided by these formative evaluations carried out during

implementation. Later on, once the system is fully integrated, summative evaluations help

determine how well the project did.

References

Akpa, V. O., Asikhia, O. U., & Nneji, N. E. (2021). Organizational culture and organizational

performance: A review of literature. International Journal of Advances in Engineering and

Management, 3(1), 361-372.

https://www.publications.calebuniversity.edu.ng/caleb_uploads/2024/04/Organizational-

Culture-and-Organizational-Performance-A-Review-of-Literature.pdf

Daka, H., Mulenga-Hagane, M. L., Mukalula-Kalumbi, M., & Lisulo, S. (2021). Making

summative assessment effective. https://dspace.unza.zm/handle/123456789/8339

Elwy, A. R., Wasan, A. D., Gillman, A. G., Johnston, K. L., Dodds, N., McFarland, C., & Greco,

C. M. (2020). Using formative evaluation methods to improve clinical implementation:

Description and an example. Psychiatry Research, 283, 112532.

https://www.sciencedirect.com/science/article/pii/S0165178119308170

Hidayat, I., Purwarini, J., & Susilo, W. H. (2023). The Effectiveness of Leadership Styles and

Strategies to Improve Nurses ‘Electronic Medical Record Quality Based on Kurt Lewin’s

Theory. Jurnal Keperawatan Komprehensif (Comprehensive Nursing Journal), 9(4).

https://www.researchgate.net/publication/376541338_The_Effectiveness_of_Leadership_Sty

les_and_Strategies_to_Improve_Nurses'_Electronic_Medical_Record_Quality_Based_on_K

urt_Lewin's_Theory

Honavar, S. G. (2020). Electronic medical records–The good, the bad, and the ugly. Indian

journal of ophthalmology, 68(3), 417-418.

https://journals.lww.com/ijo/fulltext/2020/68030/Electronic_medical_records___The_good,_

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Nikpour, J., Hickman, R. L., Clayton-Jones, D., Gonzalez-Guarda, R. M., & Broome, M. E.

(2022). Inclusive leadership to guide nursing's response to improving health equity. Nursing

outlook, 70(6), S10-S19.

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