Management’s Role in Major Information Technology Initiatives

Healthcare organizations routinely undertake projects or initiatives designed to improve the performance of the organization or advance its strategies through the use of new or existing information technologies. The leadership of health care organizations plays an essential role in managing the change that invariably accompanies the implementation of an IT application. The leadership must lead, establish a vision, communicate, manage the trust, plan the change, implement the change, and iterate as the organization experience the change.

The failure rate of IT initiatives is surprisingly high. Project failure occurs when a project is significantly over budget, takes much longer than the estimated timeline, or has to be terminated because so many problems have occurred that proceeding is no longer judged to be viable. It is the responsibility of the organization’s leadership to minimize the occurrence and severity of factors that threaten to undermine the change.

Managing Organizational Change due to IT Initiatives
A majority of IT initiatives involve or require organizational change, this change may be in processes or organizational structure or change in the form of expansion or contraction of roles or services. According to Keen (1997), there are four categories of organizational change:

 Incremental Change. Occurs through a series of small to medium-sized changes to processes, tasks, and roles. Example of such change include an upgrading of an existing application and adding new reports and features that require modest alterations to existing workflow. Techniques such as LEAN and Six Sigma emphasize continuous, incremental change. It is often accomplished without the need for leadership intervention.

 Step-shift change. Leadership is committed to making significant changes but is not changing the basic direction of the organization or how it generates value. Examples of such change include reducing the cost of care or improve patient safety.

 Radical change. It leaves the organization and its core assumptions intact but significantly alters the way the organization carries out its business. In healthcare, it is rare that IT will cause or lead to a decision to undergo radical organizational change.

Example of such change includes the movement from fee-for-service reimbursement to full capitation (that is, fixed fee per patient per year).

 Fundamental change. Leadership is committed to creating what in effect be a new organization that is in a different business from the one the current organization engages in. example of such change includes the Enron change of its core business from acquiring and managing natural gas pipelines to managing a complex web of businesses. Fundamental change is risky, and the failure rate is very high.

IT Project Implementation Checklist
Andrew McAfee has developed a short checklist for managers who are overseeing the implementation of IT projects:

 Treat the implementation as a business change effort and not as a technology installation.

 Devote the necessary resources to the project.

 Make sure the goals, scope, and expectations are clear from the outset.

 Track the project’s progress, results, and scope.

 Test the new system every way that you can before you go live.

 Secure top management commitment.