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    Chris Harrop
    Chris Harrop

    Industry trends of consolidation go well beyond a medical group’s clinical team, and the trend of mergers and acquisitions (M&A) appears consistent year to date. More than 80 deals were announced or closed in February, March and April, respectively, according to ECG Management Consultants and Provident Healthcare Partners LLC.1

    One of the major effects of these strategic changes is the need for organizations to invest in change management for their IT teams, according to Larry Dux, BSIE, MBA, CPHIMS, LFHIMSS, DSHS, director, patient care informatics and process improvement, Froedtert Health Community Hospital Division, who outlined the challenges and barriers at the 2019 HIMSS Global Conference & Exhibition.

    The challenge for chief information officers (CIOs) and other IT leaders in organizations is no longer just implementing EHRs and integrations, Dux noted: “You’re now also being asked to take on the responsibilities of trying to merge organizations that have been acquired … Typically, IT departments and definitely CIOs play a significant role in that.”

    A major challenge is recognizing the legacy systems in some organizations that, despite being well-liked by employees and clinicians, “may not support the long-term needs of the enterprise as they become part of a larger organization going forward,” Dux said.

    Change starts with “C”

    Dux pointed to four Cs to gauge when managing change among health IT professionals:

    1. Competence: The ability of your people and their skill sets to do the work.
    2. Confidence: The sense of your staff that they can do what’s asked of them.
    3. Comfort: The ability to work with others and develop relationships.
    4. Control: The understanding of ownership of processes and duties.

    Components of change management

    In many cases, managing organizational change begins with phases of personal change that trigger emotions. Dux outlined three key phases to navigate with M&A activity in healthcare:

    1. Endings: Letting go of the past and feelings — anger, denial or sense of loss — about systems you may have helped build
    2. Transition: Searching for a new direction amid uncertainty, anxiety or disorientation
    3. Beginnings: Setting off in a new direction with renewed energy and anticipation.

    A leader’s role in managing these phases for the staff is crucial. “People will not have all of the answers to all of their questions” amid these changes, Dux cautioned. To address this, Dux recommended acknowledging that “change” is the external force on the team while stressing that “transition” is largely internal — how the team reacts to that change.

    Many staff inevitably will fear for job security or the uncertainty posed by possible relocation or simply a general mistrust of management motives. Dux encourages IT leaders to highlight opportunities for personal growth and career development that become available in a larger organization.

    Models to consider

    When preparing for a significant change, Dux said that the three-step “unfreeze, change, refreeze” model developed by Kurt Lewin — based on the concept of melting and reshaping a block of ice — is especially helpful by ensuring that employees are ready for change and that they understand it before executing an intended change.

    Other models to consider include:

    • Jeff Hiatt’s awareness, desire, knowledge, ability, reinforcement model,2 which matches individual motivations of change with phases of a broader project, from business need for change through post-implementation
    • The eight-step Kotter model3 that begins by creating a sense of urgency around an opportunity and works through building support, removing barriers and generating short-term wins to support sustainable change.

    Regardless of the model, Dux stresses that the work is for the overall goal but not really about the goal. “The people side of the change is really what the change management process addresses,” he said, and that competence for those people involved likely will require some education or training on how best to navigate the change.

    Resistance and sustenance

    Resistance to change among staff is not just natural, Dux said — it can be very healthy to the process. “Don’t discount it,” he said, as comments about how things are happening can help check assumptions about the process and force you as a leader to clarify what you are doing.

    Similarly, the role of a CIO or IT leader should be focused on ensuring that the rest of the organization’s executive leadership is on the same page as those involved with IT. Consistent engagement with a chief executive, operational and/or financial officer will be important to ensuring that the necessary resources are provided. “This is going to cost money for the organization,” Dux said. “Make sure that they understand that it’s not going to be for free.”

    Establishing the level of financial and people resources needed to manage this change should be combined with a method to measure progress, with metrics defined at the beginning to track where the process is at any given time and measures to course correct when needed.

    Dux recommended using forms of communication that encourage feedback to sustain change. While the decision-making may have occurred at a higher level than the CIO or IT leader, it is important for that leader to work to explain the “why” behind the business reasons for the change or explain the consequences of not doing the work of the change.

    “Make sure the message gets out there a lot,” Dux stressed.


    1. Pazanowski MA. “Health-care deals steady, strong through first third of 2019.” Bloomberg Law. May 21, 2019. Available from:
    2. Prosci. “What is the ADKAR Model?” Available from:
    3. Kotter Inc. “8-step process.” Available from:
    Chris Harrop

    Written By

    Chris Harrop

    A veteran journalist, Chris Harrop serves as managing editor of MGMA Connection magazine, MGMA Insights newsletter, MGMA Stat and several other publications across MGMA. Email him.

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