Table 3.

Framing EHR Implementation as Organizational Change Management

Kotter's Eight-Steps Guiding Change Management (1995)	Representative Quotations Describing Facilitators of EHR Implementation Characterized as Steps Toward Change
1. Establish a sense of urgency	“I mean it was really part of the burning platform … just to try to get people to recognize that status quo was not acceptable. We couldn't keep doing what we were doing and sustain it.” “So you've got to go quickly and you've got to make it the exclusive focus if you really have a transformational type situation.”
2. Form a powerful guiding coalition	“I think that there's a leadership … the administration and the medical staff leadership and with the support of the boards.” “We had 12 physician leaders that were all part of the physician coalition to lead the vision from a medical staff perspective.”
3. Create a vision	“We established a vision in our EHR adoption and set out a plan about 5 years ago.” “So that vision is what's really driving all of our attention and willingness to go along with this.”
4. Communicate the vision	“This was the focus and that's all we talked about and everybody's goals and compensation were all aligned to what the vision was.” “So, if management is saying this is why we are doing it, this is the reason we are doing it, this is how much money we are going to make, this is how much we are going to save, etc., and these people are going to act on our behalf to do that, then that's the way to be successful.”
5. Empower others to act on the vision	“…strong steering committee, strong work group meetings, and then as you're working through the workflow at the clinic level, making sure that participation, people are showing up, that they're doing their tasks … strong project management.” “We took anything else of major substance off of the plate that cut across institutional lines.”
6. Plan for and create short-term wins	“So when we started doing this roll out on medications for patients and we were able to demonstrate reductions in medication errors and you get some of those ‘wow’ moments where a nurse is barcoding this medication before they administer it and it comes up in the electronic medical record that there could be this fatal complication, you literally save a life there.” “It was about the wins … at one of our practices, there were seven docs … A doc was on call, got a call over the weekend from a hospital in [Name], for a patient that wasn't his, and had to do with [a problem] … And this doc was able to bring up the chart and see everything that he needed to see to give the answer. So needless to say, he was now less resistant to [the EHR, thinking,] ‘this might be worth it.’”
7. Consolidate improvements and produce still more change	“Once you started producing results and getting where you wanted to get to, then you could start being a little more focused on sub-areas or things that you needed to get at and you could start bringing other key goals for the institution back into play.” “The next phase is to go ‘ok, now you got the basics, now, how can we leverage some of this? What's taking you the most time?’ And stay with them to work with them to get processes in the whole practice and then get them rolling in the whole practice.”
8. Institutionalize new approaches	“Now it's not something that somebody has to do to make sure it happens. It happens naturally in our system so we get less errors and much better flow and in paper, you just can't physically do things in paper. It just is the way it is.” “I think it's now an absolute part of the culture and who we are and how we do things here.”