CHANGE MANAGEMENT INCREASE EFFICIENCIES IN OPERATIONS Annette Hurlbut

CHANGE MANAGEMENT INCREASE EFFICIENCIES IN OPERATIONS Annette Hurlbut, RHIT, CTR Quality Engineer Elekta Impac Software Fulton, NY ahurlbut@impac. com NAACCR 2009 Annual Conference

Overview • Define ‘change’ • Identify sources of change that influence the registry • Identify requirements of change § Rationalize, Improvise, Stabilize the Transition • Prepare a ‘change toolkit’ for the registry

Define ‘Change’ • Noun: Change is a requirement in data collection items/procedures over time • Verb: How we do what we do as an industry to keep moving effectively into the future • Noun & Verb: Inevitable for growth

Examples of Change Agents • • • Diagnostic and Treatment modalities Reportability changes Standard setters implementation plans State/central registry funding Registry software updates

Technology Changes • Computer technology § § § Faster processing More storage capacity Much more sophisticated software Downloadable manuals Registry Plus Online Help • Internet tools and better communication § § § § e-mail/IM List-servs Online training Web-based modules Web access – ie webex /-inars Rapid reporting (RQRS) Sharepoint

Our Gut Level Response • AJCC 7 th Edition • Collaborative Staging version 2 • Many data items and file length x 300%+ being added to NAACCR version 12 History shows us there may well be: • Delays in release of parts/pieces • Errata, clarifications, upgrade(s) All of these leave us frustrated… anxious… uncomfortable… questioning…

Wait, there’s more… • Reportability rules for Hematopoietic Disease and more… • Increase in length of State Requestor section and Text fields (NAACCR flat file expansion from 6694 bytes to 22824 bytes record length) http: //www. naaccr. org/filesystem/pdf/Vol %20 II%20 Version%2012_Release%20 S ummary_lah. pdf §

Introduce Change • “Continuing investigation of cancer” • Increased interest in national standardization with heath care • National Health care initiatives § Economics § Standard setters o NPCR; SEER; ACOS COC; AJCC

Influence Change • Change is influenced by: § YOU § Registry - personnel and personalities § Hardware and software requirements

Accept Change • Personal attributes for positive change: § Ability to understand the need for change § Accept that change is going to happen § Identify and implement an action plan § Example: NCRA 2009

Stabilize Change • Stabilize change: § Stabilize the transition for the registry § Review progress and follow through until the change has become the new standard § Be flexible if met with negative results o If what you’re doing isn’t working, you need to change SOMETHING!

Goals • Provide a practical approach for a positive outcome • Don’t fight change § Participate from the inception § Embrace change

Change Management • Accept the rule: Some amount of change is a constant for the registry • Start as soon as change is announced • Research, review, and determine impact • Appoint staff to assist with staff ‘buy in’ § Getting staff to ‘buy in’ is crucial • Network! Communicate! Collaborate! Cooperate!

Analyze • Identify potential impact of the change on: § Data collection and reportability § Productivity § Staffing education and coverage § Associated costs – hardware/staffing § Participation in the change process

Prepare a ‘Change Toolkit’ • Maintain Registry procedure manual and log • Bookmark web pages and check them monthly § § NAACCR and Standard Setter website(s) Source documents downloadable from NAACR, NPCR, SEER, ACOS COC, AJCC and state/central registry websites

‘Change Toolkit’ • Network with other registries (NAACCR conference; NAACCR Town Hall) • Schedule inter-/intra- departmental training sessions and educational inservice • Schedule staff to attend local/regional workshops

Staff-wise • Assign a staff member as the ‘point person’ for new implementation • Plan 2 hours per week per staff member for educational process; minimum of 30 minutes per week • Schedule regular staff meetings to monitor implementation and follow-up of change

Educate • Monitor § Professional publications o o o § § § NAACCR Narrative Journal of Registry Management, The Connection Co. C Flash Software vendor literature Yours and Other State/central registry publications Bookmarked websites mentioned earlier o NAACCR; NPCR; SEER; COC; AJCC • Share with staff so that the impact of the change can be identified early

Your Vote • Participate in discussions, conference calls related to new standards implementation § Provide input at NAACCR Town Hall § Participate on NAACCR Committees § Share your findings with the standard setters and your vendor – errata are identified through use § Share tips, tricks, and ID what worked, what didn’t work for you § Be active - Be heard!

Software-wise • Look to your registry vendor/information systems department for instructions on the upgrade that supports the new standards • Review ALL printed materials and any Help instructions § Be as familiar with the upgrade instructions as your IT representative • Share information so that all registry staff know what to expect

Upgrade • Be sure that your hardware will accommodate the software upgrade • ALWAYS have a complete and accurate backup prior to any software upgrade • Safeguard your backup database and routine

Stabilize • Proceed into daily operations • ‘Point person’ may have to repeat some of the educational lessons • Remain flexible to the change • Expect some staff resistance • Lighten the load when change is first introduced § Plan an ‘end of the first week’ staff celebration with lunch!

State-wise • Determine readiness of state/central registry to receive data in new format • Obtain and apply instruction pertinent to your reporting requirements prior to installing ANY software upgrades • You and your registry are NOT alone in the process • However - Do not be blind-sided – ie look at the retired fields for 2010 ie Tobacco, Alcohol, Family History – do you still want to collect? State Requestor section expanded to 1000 bytes

Change = TEAM effort! • Keep others informed § Registry staff (full-time, part-time, outsourcing staff, temporary employees and volunteers) § Registry’s IT support § Software vendor communication § …especially the facilities reporting to you…

Implementation Guidelines … • 2010 Standards Implementation Guidelines (Central Registry; Vendor; Facility) § § § AJCC Cancer Staging Manual 7 th Edition Collaborative Staging Manual version 2 Hematopoietic Database (SEER) Code Conversion Edits

2010 - NAACCR v 12. 0 • Standards for Cancer Registries, (Volume II) Data Standards and Data Dictionary (revisions), fourteenth edition, Version 12 http: //www. naaccr. org/index. asp? Col_Section. Key=7&Col_Co ntent. ID=133 • Standards for Cancer Registries, (Volume IV) NAACCR Standard Edits http: //www. naaccr. org/index. asp? Col_Section. Key=7&Col_Content. I D=136

NAACCR’s Answer • NAACCR Standards Implementation Guidelines http: //www. naaccr. org/filesystem/pdf/SIGcomplete 1 -2703. pdf 2010 is due for Major version change year

Change Motto Change is encouraged when it’s for the betterment and quality of life for the cancer patient… through improved data collection, analysis and better end results for our patients. Our tolerance to change – for the good of the cancer patient!

Websites to Monitor § NAACCR http: //www. naaccr. org/Webinars/2010 Changes http: //www. naaccr. org/index. asp? Col_Section. Key=7&Col_C ontent. ID=431 § Collaborative Staging http: //www. cancerstaging. org/cstage/index. htm § SEER http: //www. seer. cancer. gov/publications http: //www. seer. cancer. gov/seerinquiry/index. php § COC Inquiry & Response http: //web. facs. org/coc/default. htm

Registry Library Resources • Spencer Johnson, M. D. Who Moved My Cheese? : An amazing way to deal with change in your work and in your life. New York, NY, 1998. • Stephen C. Lundin, Ph. D. Fish! Sticks. New York, NY, 2003. • Stephen C. Lundin, Ph. D. Fish! Tales. New York, NY, 2003. • James A. Belasco, Ph. D. Teaching the Elephant to Dance: The Manager’s Guide to Empowering Change. New York, NY, 1990. • John P. Kotter. The Heart of Change: Real-Life Stories of How People Change Their Organizations. Boston, MA, 2002. • B. L. Johnson & V. R. Davis. Leadership Matters: HIM Responds to Change. For the Record, Jan 12, 2004 - 17 -19

Questions & Comments Email: ahurlbut@impac. com