Fundamentals of Workflow Process

Analysis and Redesign

Leading and Facilitating Change
This material Comp10_Unit9 was developed by Duke University, funded by the Department of Health and Human Services,
Office of the National Coordinator for Health Information Technology under Award Number IU24OC000024.
Leading and Facilitating Change
Objectives
1. Explain concerns expressed by participants in a
process analysis & redesign scenario in terms of
common change management concepts.
2. Propose strategies to gain acceptance of
changes in work processes.
3. Create and critique a facilitation plan, including
appropriate facilitation tools for a given process
analysis & redesign scenario.
4. Given a health care change management
scenario, explain outcomes in terms of common
change management concepts.

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Health IT Workforce Curriculum
Version 3.0/Spring 2012
Fundamentals of Workflow Process Analysis & Redesign
Leading and Facilitating Change
Working With People
Tell me and Ill forget;
show me and I may remember;
involve me and Ill understand.
Chinese Proverb

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Health IT Workforce Curriculum
Version 3.0/Spring 2012
Fundamentals of Workflow Process Analysis & Redesign
Leading and Facilitating Change
Change Concepts
What is it that causes some change
management efforts to be successful?

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Health IT Workforce Curriculum
Version 3.0/Spring 2012
Fundamentals of Workflow Process Analysis & Redesign
Leading and Facilitating Change
Employees Perspective
From the employees
perspective, there can
be a lot of changes,
and a lot of changes
can be overwhelming.

Remember that work
process change may
be only one of several
changes an
organization is
undergoing.

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Health IT Workforce Curriculum
Version 3.0/Spring 2012
Fundamentals of Workflow Process Analysis & Redesign
Leading and Facilitating Change
Regulatory
Changes
Market
Changes
Departmental
Changes
Personnel
changes
Requests
From
Manager
Re-
structuring
Work
Process
Change
Merger /
Acquisition
Project
change
Employee
Janssens 4-Room Apartment
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Health IT Workforce Curriculum
Version 3.0/Spring 2012
Fundamentals of Workflow Process Analysis & Redesign
Leading and Facilitating Change
Key Concept 1:
Humans and organizations are complex
Many factors that come into play
Organizational constraints
Management style
Organizational, departmental, division,
and personal goals
Personalities
Environmental factors

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Health IT Workforce Curriculum
Version 3.0/Spring 2012
Fundamentals of Workflow Process Analysis & Redesign
Leading and Facilitating Change
Key Concept 2:
Organizations are living, changing biological
systems
If you push on the system, it will compensate
Behavior dependent on culture and level of trust
Reductionist treatment rarely explains the whole
Measures and numbers
Are not complete
Cannot capture the complete complexity.

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Health IT Workforce Curriculum
Version 3.0/Spring 2012
Fundamentals of Workflow Process Analysis & Redesign
Leading and Facilitating Change
Key Concept 3:
Change happens through individual choice
and freedom not through top-down control or
coercion.

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Health IT Workforce Curriculum
Version 3.0/Spring 2012
Fundamentals of Workflow Process Analysis & Redesign
Leading and Facilitating Change
Key Concept 4:
John Gall, MD in his 1970s book Systemantics
said it most insightfully:

Systems run best when designed to run
downhill.


(Gall, 1978)

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Health IT Workforce Curriculum
Version 3.0/Spring 2012
Fundamentals of Workflow Process Analysis & Redesign
Leading and Facilitating Change
Key Concept 4 Example:
Sure, walk in my garden!
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Health IT Workforce Curriculum
Version 3.0/Spring 2012
Fundamentals of Workflow Process Analysis & Redesign
Leading and Facilitating Change
istockphoto.com/nahm001, 2011.
Key Concept 5:
Change starts with a deeply meaningful
purpose
Which of the following would you rather be
a part of?
Getting a system in production
Implementing a system so your practice
would get the Meaningful Use incentives
Using health IT to improve the health of your
patients

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Health IT Workforce Curriculum
Version 3.0/Spring 2012
Fundamentals of Workflow Process Analysis & Redesign
Leading and Facilitating Change
Key Concept 6:
Make and keep the gap
between as is current
reality and to be vision
visible, and talk about it
at every opportunity.

Making gaps visible
maintains a creative
tension as Peter Senge
calls it, that motivates
forward progress.

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Health IT Workforce Curriculum
Version 3.0/Spring 2012
Fundamentals of Workflow Process Analysis & Redesign
Leading and Facilitating Change
istockphoto.com/nahm001
Key Concept 7:
Dont pull.

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Health IT Workforce Curriculum
Version 3.0/Spring 2012
Fundamentals of Workflow Process Analysis & Redesign
Leading and Facilitating Change
istockphoto.com/nahm001
Thought Exercise
Think back to a time in your career when
you woke up in the morning excited about
coming to work.

List three things about your situation that
made your job so engaging.


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Health IT Workforce Curriculum
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Fundamentals of Workflow Process Analysis & Redesign
Leading and Facilitating Change
Thought Exercise
Common responses include
Your own project / feeling of ownership
You were making the decisions, / feeling of
being in control
Autonomy
Trust with co-workers

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Health IT Workforce Curriculum
Version 3.0/Spring 2012
Fundamentals of Workflow Process Analysis & Redesign
Leading and Facilitating Change
Key Concept 8:
The Engagement Gap
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Health IT Workforce Curriculum
Version 3.0/Spring 2012
Fundamentals of Workflow Process Analysis & Redesign
Leading and Facilitating Change
CEO
Steering Committee
CEO
Team of the
Best & the Brightest
Key Concept 9: Transparency
tell the truth, the whole truth and nothing
but the truth


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Health IT Workforce Curriculum
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Fundamentals of Workflow Process Analysis & Redesign
Leading and Facilitating Change
Pulling it all together
Change happens best when individuals have
Deeply meaningful purpose
Sincere invitation to influence
Acknowledgement of opportunities for personal
control or choice
Transparency
Shared understanding
Change is impacted by:
Individuals and organizations
Culture and trust
How a change project is structured and managed

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Health IT Workforce Curriculum
Version 3.0/Spring 2012
Fundamentals of Workflow Process Analysis & Redesign
Leading and Facilitating Change
Applying All of This
Facilitation Plans and Tools:
Facilitation F Plan
A facilitation plan is an outline for how a meeting or an entire change
effort will be run. A facilitation plan includes:
Description of who is included.
Description of how included individuals will be selected or
invited.
Schedule or agenda.
Outline of what methods or tools will be used
Description of how the rest of the organization will be kept up-to-
date
Description of how leadership will be kept in the loop

A facilitation plan should be made available to the entire
organization to maintain transparency.

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Health IT Workforce Curriculum
Version 3.0/Spring 2012
Fundamentals of Workflow Process Analysis & Redesign
Leading and Facilitating Change
Facilitation Plan Scenario
A mid-size internal medicine practice has decided to select,
purchase and implement an Electronic Medical Record (EMR). They
have hired you as a consultant for Process Analysis and Redesign.
Your agreement with the practice is that you will provide instruction,
training and oversight for members of their staff as they analyze
their processes, redesign their processes around an EMR, and
define the functionality that they need in an EMR.

You have already had an initial meeting with practice leadership and
have had a tour and met the 75 person staff. At your next meeting,
you will present the facilitation plan and get the analysis and
redesign started.

Over the next several slides, we will look at Big F facilitation plan
for the entire effort, and a little f agenda for the initial meeting.

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Health IT Workforce Curriculum
Version 3.0/Spring 2012
Fundamentals of Workflow Process Analysis & Redesign
Leading and Facilitating Change
Big F
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Health IT Workforce Curriculum
Version 3.0/Spring 2012
Fundamentals of Workflow Process Analysis & Redesign
Leading and Facilitating Change
Group 1 work week:
Process inventory
Group 1 work week:
Process Analysis
Group 1 work week:
Process Redesign
Group 1 work week:
Finalize
Group 2: Weekly
Walkthroughs 1 hour
Leadership
briefing / debriefing
1 hour
Week 1 Week 2 Week 3 Week 4
Little f for Process Inventory
This occurs early in the process
Need
To facilitate the team in creating a list of all of the
major processes
Logistics
Usually this is an initial meeting followed by someone
creating the list or spreadsheet,
Followed by group review and revision
Product
Process inventory that can be provided at
Walkthrough 1
Expect some revisions based on the broader review

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Health IT Workforce Curriculum
Version 3.0/Spring 2012
Fundamentals of Workflow Process Analysis & Redesign
Leading and Facilitating Change
Little f Week 1 Agenda
Introduction to overall project
How the team was selected
What their charge is
The Big F plan
Timeline and scope
Context diagram overview
Group context diagram creation
Think-pair-share
Sorting & grouping
Assignment of processes inventory work
Assignment for preparing for/conducting walkthrough

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Health IT Workforce Curriculum
Version 3.0/Spring 2012
Fundamentals of Workflow Process Analysis & Redesign
Leading and Facilitating Change
Little f for Process Analysis
Discussion:
Process Inventory Results
Training:
Flowcharts
Training:
Analysis
Spotting opportunities for improvement
Group exercise with 1 process
Independent work time
With assigned processes
Paired feedback
Present each process and group discussion
Assignment
Processes for analysis; preparing for/conducting walkthrough


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Health IT Workforce Curriculum
Version 3.0/Spring 2012
Fundamentals of Workflow Process Analysis & Redesign
Leading and Facilitating Change
Little f Redesign
Training:
Common EHR functionality
Matching analysis results to EHR functionality
Group exercise with one process
Independent work time with assigned processes
Paired feedback
Present each process and group discussion
Assignment
Processes for redesign
Preparing for/conducting walkthrough


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Health IT Workforce Curriculum
Version 3.0/Spring 2012
Fundamentals of Workflow Process Analysis & Redesign
Leading and Facilitating Change
Little f post-Week 1 Walkthrough
Introduction to overall project
How the team was selected
What their charge is
The Big F plan
Timeline and scope
Context diagram exercise
Create one as a group
Pin-the-tail on the donkey
Process Inventory
What did we miss

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Health IT Workforce Curriculum
Version 3.0/Spring 2012
Fundamentals of Workflow Process Analysis & Redesign
Leading and Facilitating Change
Little f Leadership Briefing /
Debriefing
Brief review of progress
Presentation of challenges
Review and what did we miss exercises
Engaging questions:
Any surprises based on whats presented
Get help strategizing about challenges
Leadership should have input into prioritizing
processes for analysis and redesign

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Health IT Workforce Curriculum
Version 3.0/Spring 2012
Fundamentals of Workflow Process Analysis & Redesign
Leading and Facilitating Change
Leading and Facilitating Change
Summary
The method and plan dont matter as
much as adhering to principles of Change
Management
The example method here Big F/little f and
the two group process is only one example

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Health IT Workforce Curriculum
Version 3.0/Spring 2012
Fundamentals of Workflow Process Analysis & Redesign
Leading and Facilitating Change
Leading and Facilitating Change
References
References
Axelrod, R. H. (2000). Terms of engagement: Changing the way we chnage organizations. San Francisco: Berrett-
Koehler.
Block, P. (2002). The answer to how is yes: Acting on what matters. San Francisco: Berrett-Koehler.
Block, P., & Nowlan, J. (1999). Stewardship, Flawless Consulting: A guide to getting your expertise used. San
Francisco: Jossey-Bas/Pfeiffer.
Gall, J. (1978). Systemantics: How systems really work and how they fail . New York: Pocket.
Janssen, C. F. (n.d.). About The Four Rooms of Change. Retrieved February 29, 2012, from Quarternity The
Home of Claes F Janssen website: http://www.claesjanssen.com/four-rooms/about-the-four-rooms-of-
change/index.shtml
Senge, P., Kleiner, A., Roberts, C., Ross, R., & Smith, B. (1994). The Fifth Discipline Fieldbook: Strategies and
tools for building a learning organization. New York: Crown Business.

Acknowledgement: Material used in this lecture comes from the following sources
Koestenbaum, P. (1991). Leadership: The Inner Side of Greatness. San Francisco: Jossey-Bass, Inc.
Senge, P., Kleiner, A., Roberts, C., Roth, G., Ross, R., Smith, B., (1999).The Dance of Change. New York:
Doubleday

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Health IT Workforce Curriculum
Version 3.0/Spring 2012
Fundamentals of Workflow Process Analysis & Redesign
Leading and Facilitating Change
Leading and Facilitating Change
References
Images
Slide 5: Diagram showing organizational changes. Fendt, K. Rowan-Cabarrus Community College, 2011.
Slide 6: Janssen, C. F. (n.d.). About The Four Rooms of Change. Retrieved February 29, 2012, from Quarternity The
Home of Claes F Janssen website: http://www.claesjanssen.com/four-rooms/about-the-four-rooms-of-
change/index.shtml and Nahm, M. Duke University, 2011.
Slide 11: Photograph of stepping stones through a garden. [Stock Photography] Retrieved from
istockphoto.com/nahm001
Slide 13: Picture of a hand stretching a rubber band. [Stock Photography] Retrieved from istockphoto.com/nahm001
Slide 14: Picture of a person's hands in a "Chinese Finger Trap"[Stock Photography] Retrieved from
istockphoto.com/nahm001
Slide 17: Organizational chart of employees and CEO. Fendt, K. Rowan-Cabarrus Community College, 2011.
Slide 17: Image of a Steering committee reporting to the CEO. Fendt, K., Smith, C. Rowan-Cabarrus Community
College, 2012.
Slide 22: Diagram showing alternating work sessions and communication events. Nahm M. Duke University, 2012.
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Health IT Workforce Curriculum
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Fundamentals of Workflow Process Analysis & Redesign
Leading and Facilitating Change