THE USE OF PESTEL AS A CHANGE MANAGEMENT TOOL TO INFORM CHANGE MANAGEMENT OF POLYPHARMACY AND ADHERENCE WITHIN SIMPATHY PROGRAM

Methodology Change management within SIMPATHY, following Kotter’s eight steps, includes: The creationof Climate for Change towards 2025 PolypharmacyVision The development of tools towards enablingstakeholders tobuild consensus The tool developed is PESTEL analysis (Political, Economic, Social, Technological, Environmental and Legal), which aimed to prompt stakeholders and professionals to address influential factors and understand the degree of their impact s well as the degree of uncertainty they do impose in the different health systems, towards building a common EU professional culture against Inappropriate Polypharmacy.


Background and Aim
Polypharmacy and medication adherence in the elderly are significant public health issues throughout the European Union (EU).SIMPATHY aims to stimulate innovation around polypharmacy and adherence, ultimately providing the tools for EU policy makers to adopt new programmes into existing healthcare systems.The development of a concrete Change management approach is essential and critical.The transformation process towards the 2025 Polypharmacy Vision should be built on the common understanding about how various factors could impact the dynamics of change, in order to deliver the Strategy.

Methodology
Change management within SIMPATHY, following Kotter's eight steps, includes: -The creation of Climate for Change towards 2025 PolypharmacyVision -The development of tools towards enablingstakeholders to build consensus The tool developed is PESTEL analysis (Political, Economic, Social, Technological, Environmental and Legal), which aimed to prompt stakeholders and professionals to address influential factors and understand the degree of their impact s well as the degree of uncertainty they do impose in the different health systems, towards building a common EU professional culture against Inappropriate Polypharmacy.
The tool has been built in three steps-phases and it is still an ongoing process: The Structure of the tool • Building PESTEL analysis framework and prepare guide to help the partners to conduct the analysis; a pilot testing performed, prior, in three partner countries for assessing the specificity, objectivity and robustness of the multidimensional content, before the finalization of the Framework and the relevant Handbook.

Building Comprehensive Change Process and enabling Stakeholders towards 2025 Polypharmacy Vision
The PESTEL Workshops are all scheduled , but not all of then finalized yet.
The process itself requires high competencies in facilitating the process and deep understandingof the framework.The first results, as delivered until now, seem to agree that: -The prescription systems (who prescribes and IT support) have high impact 5 -The role of professionals (pharmasists, doctors etc) has high impact 5 -The reimbursement system has, also, high impact 5 Bui lding the tool Bui lding the tool Rea ch consensus Rea ch consensus

The Handbook
A Handbook has been prepared and finalized, after consultation with piloting partners, and then circulated in order to support all SIMPATHY members to: -Get familiar with the Change Management theory and selected Process , -Understand the PESTEL tool, not as a questionnaire but as a prompt for deep discussion, for new questions and answers, for achieving consensus -Conduct the Workshop process, being able to facilitate and enrich the process The framework consists of 22 Questions-Statements, as factors, structured in the PESTEL dimensions as following.The principle-idea is to be used as prompt for discussion in a stakeholders' workshop than an anonymous questionnaire.
All factors should be discussed and assessed, within the workshop process, of Higher or Lower as well as Negative or Positive Impact ; also the degree of the Uncertainty is a critical aspect.The following screen gives the structure: PESTEL seems to be a tool that can successfully capture the beliefs of stakeholders, and also help consensus towards a comprehensive approach of Polypharmacy Vision in 2025, in ten years horizon.Since the process is still ongoing, SIMPATHY will use the final results in order to suggest a strategy that will include and address all the important and common factors across all EU countries, systems, cultures.

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Theme 4 2 nd step • Conducting the analysis, across all partner countries, by discussing the final PESTEL framework during a well prepared workshop; the participants in each country should be stakeholders, decision makers and professionals and the discussion has been designed to be open and dynamic, stimulating and constructive.3 rd step • Interpretation of the results in orde r the evident common and important drivers and ba rriers that impact the potential of Change in Polypharmacy landscape in ten years time 2025, to be taken into consideration for future Strategy development.P1.Health services delivery/Health services network -coordination of services P2.Primary health care -Chronic disease management (planning, performance) P3.Governance structure/ decision making and resulting impact Polypharmacy Vis E1.Overall economic success E2.Health system's structure and financing (methods, criteria _payment by results..) S1.Access to health care S2.Attitudes and beliefs S3.Education T1.Existence of ICT integrated systems T2.Innovative drugs and relevant policies (HTA…) E1.Seasonal influentials E2.Communicable diseases (Finally not developed) L1.Legal authorities and regulatory bodies, roles and responsibilities L2.Empowerment of Patients' rights L3.EU Guidelines and policies to be implemented