In the current world of health care, most provider organizations are undertaking significant cost management efforts. Health care providers need to deliver care more cost effectively while improving value. We are no exception.
At University Hospitals we call it “Value Improvement Program” (VIP). At the University of Michigan Health System, we called it “Value and Margin Improvement” (VMI). I don’t remember what we called it at Brigham and Women’s Hospital, but it was similar.
Often it starts with the use of outside consultants. They identify the overall opportunity at a high level using the organization’s cost data and industry benchmarks. In some cases, consultants stay on and help staff the teams. In other cases, the organization staffs the teams internally to do a deeper dive, find the specific opportunities, and implement.
Depending on an organization’s executive leadership, culture, management and staff buy-in and their approach to system wide initiatives, results can vary greatly. Continue reading
I was fortunate to work with an excellent executive coach several years ago. He helped me gain new insight into who I am and how I lead. I am a much better leader as a result of our year-long work together. And I periodically reconnect with him now to bounce around ideas when going through major transitions.
Deciding to work with a coach can be unsettling.
I told myself, “sure there are things on my performance evaluation I could work on but mostly I’m fine and don’t need any help; after all no one is perfect”.
And I also told myself, “ok, I admit I could use some help but how much do I really have to expose and what will people think if they know I’m using a coach”.
So yes, I had those kinds of thoughts when I started and expect you might as well.
But my coach put me at ease. He got to know me and started helping me look critically at my leadership style and areas I needed to improve. He was not there to judge me or make me feel inadequate. He took me where I was at.
A good coach doesn’t have all the answers but knows how to ask the right questions. Continue reading
I am now networking for my next opportunities and need to update my resume. This week someone offered to make an introduction for me and asked me to send a current one. So I did a quick pass and added a section for my interim CIO engagement at University Hospitals.
I went right to my CIO focus areas that I had documented back in week 5. I added a few more focus areas a month ago, in response to some new needs. Good news; with the help of my IT leadership team I either finished or made great progress on all of them.
Interim CIOs can just keep the seat warm and make sure things are running smoothly. Or they can be change agents who shake things up. Or they may help set a new strategy and direction for the permanent CIO to execute.
Basically, University Hospitals wanted an experienced CIO with a fresh perspective to run IT while helping to find the next permanent CIO. The work has been a combination of operations and consulting. Operations means a lot of meetings, long days and plenty of issues. Consulting means there’s an opportunity to look at things differently and make incremental improvements. Continue reading
It’s been seven months since I started my next life chapter. In January, I Ieft my position as CIO of the University of Michigan Hospitals and Health Centers to begin a more independent and flexible path. I wanted to be able to live near my family and work less than full-time over the course of a year. The first page of this chapter has been to serve as interim CIO at University Hospitals in Cleveland. I had just one weekend between finishing up in Michigan and starting in Cleveland. CIO positions are more than full-time but I knew that when we hired a permanent CIO, there would be time for me to get a break.
This week, the new permanent CIO at University Hospitals was named. Joy Grosser will be joining UH on September 12th. I am confident she is a great match for us. She is very accomplished, and has significant experience in other large health care organizations. She most recently served as Vice President and Chief Information Officer at UnityPoint Health in West Des Moines, Iowa, a 17 hospital health system. I have agreed to stay for several weeks past Joy’s arrival to orient her and to ensure a smooth transition.
For me, this engagement has been a terrific opportunity to work in a very strong organization with an excellent team. Much can be accomplished in a short time and our IT team proves that. They have been wonderful to work with and I will miss them.
For this final stage of my interim engagement, I will focus on two things. One is to keep everything moving including a host of projects and the day to day issue escalation. The second is to prepare a transition plan and do the turnover. I will be stepping back and letting Joy take the front seat come September 12th. I’ll be there to support her.
A new position means drinking from a firehose. Continue reading
“You need to go beyond puppies and rainbows”. That’s the advice this week from a search firm expert. I’m part of the search committee for the new president of a non-profit organization where I am a board member. The search expert was telling us to go deeper in our questioning. Get past the fluff and canned responses. He said it’s ok to make candidates uncomfortable.
I’ve done a lot of hiring in my management career for direct reports. And I’ve been on search committees for executive positions. I’ve also been on the other side of the search process being interviewed for CIO positions.
You review resumes, you listen to the search firm’s summary comments on each candidate, and then you finally meet the candidates in the first round of interviews. It’s a process. And you only have an hour or so to get to know each person.
What you see on paper are the qualifications. In the interview you get to know the person. I said in one of my first blog posts, hiring the right people is one of the most important decisions managers make. For executive positions, the process is more rigorous with more people involved. After all there is much more at stake when you are choosing one of the top executives.
You are all working off the same position description and the organization’s mission and strategy. Yet search committee members come to the process with different perspectives. Continue reading
History was made this week. For the first time, a woman was nominated by a major party for President of the United States. Nearly 100 years after women won the right to vote and 240 years after the founding of our country, Hillary Clinton has broken this barrier. Did you hear the glass breaking? I did and it was music to my ears.
Across this country, women have proven they can do anything a man can do in any field. Yet women lag behind in pay, in executive roles and are poorly represented in fields like technology. In a longitudinal salary assessment, HIMSS found that women’s share of health IT salaries for comparable jobs is smaller than it was ten years ago. That means we are losing ground!
I’ve written and spoken about this and will continue to do so. As I was quoted in a recent article, Removing the Glass Ceiling in Health IT, we need to be open about this problem. Naming a problem is the beginning of addressing it. I could sit back quietly but I won’t. I owe it to the next generation of women, my daughters and my granddaughters to speak up. I was influenced by the women’s movement of the 1970’s, so I know that if we don’t speak up, we will never make the changes we need.
At last year’s Take Our Daughters and Sons to Work Day, I was greeted by a 10-year-old boy with, “I thought only men were managers”. Continue reading
It’s been 3 months since the IT leadership team here launched a visual management board and started a thrice-weekly huddle. Since then, we have made numerous adjustments to improve our process.
Initially, the board was in a conference room; we sat around the table for the 15 minute huddles on Monday, Wednesday and Friday mornings. While it was not the ideal setup, it was the way to deal with a distributed leadership team. A few weeks ago, we moved the board out into an open area where everyone walks by and started doing the huddle standing up. We installed a speaker phone next to the board. It’s not a perfect arrangement but it works.
No surprise that it is very different when the group is standing in an open area: more transparency and visibility. We can invite people to observe our huddle and show the board to others who want to learn about it.
Working with the leadership team, we refined our goals to be:
- Reduce cycle time – “get things unstuck”
- Reduce preventable incidents
- Ensure ownership and accountability
- Reduce variation
- Increase coordination and communication between teams
- Ensure we deliver on top priorities
- Focus constantly on customer satisfaction and provide superior service to end users
The sections of the board are the same ones we started with:
- Production environment – To track major incidents and any open tickets that need escalation. We display the number of open tickets by system, critical open tickets, and approved system changes for the week.
- Top priority initiatives – To confirm our highest priorities and review issues that need to be addressed. We display the go live calendar, project successes from the previous week, and the dashboard from the Project Management Office.
- Metrics – To track key department wide metrics. We display metrics including key infrastructure stats, and operating budget vs plan.
- People – To highlight new hires, recognize staff, and raise awareness on recruitment efforts. We list open positions, pictures of new hires, and employee appreciation awards.
- Everyday Lean Ideas (ELI) – To provide a central place for staff to suggest improvements.
We have a standard script for our huddles. Continue reading
If you are an IT professional supporting major production environments and applications, you have most likely experienced a significant system outage at some point. We had one of those events this week. As in previous experiences in other organizations, I saw people at their best come together as a team working diligently to restore systems. This team included IT, clinical and operations staff.
I know CIO colleagues who recently managed through a week long outage of their business systems in one case and a multiple day outage of their electronic health record in another. They could probably share similar lessons following those experiences.
In the spirit of teaching and learning from one another, I offer these key points if you have a significant event: Continue reading
While I try to stick to the topics you would expect in a professional blog, there are times when I can’t ignore the events we all witness. Whether they are joyous or tragic, they all leave a mark on us. Last July I wrote about marriage equality sharing the story of my Aunt Dorothy.
During the fall as a US presidential candidate repeatedly talked about building a wall along the Mexican border, my post “Build bridges, not walls” was a message about the importance of embracing diversity. In that post, I quoted a church hymn that really struck home for me. “Our World is One World” by Cecily Taylor included this verse:
Our world is one world, the thoughts we think affect us all. The way we build our attitudes, with love or hate, we make a bridge or wall.
I closed that post with this statement: “Let’s continue to work together to build the kind of world we want for our children and grandchildren and generations to come.”
My fourth grandchild is due next week. I look forward to holding this new baby and welcoming him into our family. I am busily crocheting his baby blanket trying to get it done in time. While I crochet at night, I watch hours of television news about the worst mass shooting in US history – 49 people were killed in a gay nightclub, a place they considered safe and welcoming.
My maternal grandparents were born in Slovenia and came to the United States as immigrants in the early 1900’s. My grandfather was one of 11 children. One of his sisters had 10 children; two of her sons and one of her son-in-laws were rounded up and executed along with 30 others in their Slovenian village by the Fascists in 1942. They were my mother’s cousins. Continue reading
The first three months of my interim CIO engagement at University Hospitals has flown by. I’m fortunate to be working with a very talented IT team and we recognize there is always room for improvement. We have already made some very positive changes and improvements. We are tightening up how we manage and monitor the production environment to reduce preventable incidents. We do a root cause analysis on every major incident and review them as a team at our bi-weekly leadership meeting, tracking all subsequent action items. We are making progress on numerous major priority projects and there have been several system upgrades and go lives during this period. We are doing detailed planning for our new hospital integration efforts. We are launching our visual management board and leadership huddle next week as part of our lean efforts. And we have re-established an executive level IT steering committee addressing the critical need for IT governance.
Our third IT steering committee will be Monday evening. Our CEO and other senior executives are engaged – exactly what we needed. They are developing a deeper understanding of our current work and the many new requests we have received since this year’s budget was approved. We have reviewed with Continue reading