Reducing costs while increasing value

Except for maybe start-up technology companies, there isn’t an IT department anywhere that has an open checkbook. In health care, we know all too well the need to manage costs while answering what seems to be an insatiable demand for technology solutions. CIOs need to understand the technical debt of a large application portfolio and the total cost of ownership (TCO) for systems. They need to find ways to reduce the cost of commodity services, and to create capacity for new work.

At UMHS, we have an initiative called Value and Margin Improvement, or VMI.  The VMI program is a multi-year effort across the health system.  UMHS leadership launched VMI to help achieve our financial stewardship goals by empowering collaborative teams to design and implement sustainable improvements that enhance value and financial results.

VMI aims at reducing duplication, inefficiencies and non-value added work in order to more effectively manage our costs, improve the value we provide and increase our margin.  A positive operating margin allows us to invest in the future and better serve our patients, referring physicians, students, the research community, and other key stakeholders.

VMI projects take a balanced approach to improve and sustain overall value while still maintaining the desired safety, quality, service delivery, and employee engagement metrics. The program promotes the use of lean methodologies and collaborates with our central lean team, the Michigan Quality System (MQS).

We are systematically moving through Continue reading

Commit to a healthy workforce

Last week I joined the second “Summer Walk” that the MHealthy champions in our IT department organized. It was a 1.5 mile round trip between our two main office facilities during the lunch hour. We had about 60 participants for each walk. What a great way to get some exercise, connect with colleagues and show our shared commitment to healthy living!

I wasn’t planning to do the walk when I first saw the announcements and flyers around our office. I expected that I had meetings during that time. But when one of the MHealthy champions reached out directly and asked me to show my commitment to healthy living, how could I say no?  It turned out that I could join them if I left a meeting 15 minutes early. I’m glad I did; literally “walking the talk”.

Our department is so committed that we were recently recognized as being one of the top performing areas, with 58% of employees participating in the University’s MHealthy Rewards program. More than 21,000 people throughout the University took advantage of the annual opportunity to review their health status, develop an action plan for improvement, and participate in helpful programs and services such as Active U, Weight Watchers, tobacco treatment, or stress-management programs. This is the program’s seventh year.

Our department’s MHealthy workgroup is developing new plans for activities and events to promote physical activity, healthy eating, and other positive health behaviors. The Summer Walks on the last Friday of each month are just the beginning.

They have also started a FitBit community for the department. Continue reading

So what’s the problem – A3 thinking

If you don’t know what an “A3” is, don’t worry. When I started at University of Michigan Health System, I didn’t either.  When I first saw an A3 meeting on my calendar, I asked “What group is that?”

Plan, do, check, act. PDCA on white isolated background. 3d

There were so many groups with different acronyms!  Turned out it was a meeting with a few colleagues to update our status report on major UMHS IT initiatives. We were using an A3 format for our report.

So what is an A3? It is a tool used as part of Plan-Do-Check-Act (PDCA).  The A3 name actually comes from the paper size (11 x 17 sheet) that tells a story laid out from the upper left-hand side to the lower right.

Telling the story of a problem on an A3 includes looking at the background (why and what), describing its current condition (where things stand), and doing a root cause analysis. And then, establishing goals and targets, proposing countermeasures, making an action plan and determining success metrics.   Continue reading

Investing in the success of others

What do @TheWomenRising, @digitaldivas3, and #HITchicks have in common? They are some of the Twitter handles and hashtags that young women professionals in technology are using on social media to encourage Women around CR tablemore women to go into the field. I recently did a fireside chat with Kate Catlin, the organizer of Women Rising, and about 30 young women in downtown Detroit. It was the first in a new UpRising series where they invite in “high-powered women in technology” they want to learn from.

The questions covered a broad range of concerns, and not just about working in technology. We were scheduled for an hour but could easily have continued for several more. I answered their questions with advice and lessons from my own experience.

Some of their questions:

How did you get started in technology?  Continue reading

At work and at play: IT leaders connect with patients

Monday was the 42nd annual  C.S. Mott Children’s Hospital Golf Classic. While the golfers have a lot of fun, it is a significant annual fundraising event that makes an important difference in the lives of children and their families at Mott Children’s Hospital. Over the years, individual and organizational sponsors have provided support for computers at patient bedsides, medically safe camps for children with serious health issues, assistive devices for children with special needs, and many more important projects and services.

The Mott Golf Classic is committed to advancing pediatric medicine and enhancing the care experience for patients and their families. It supports unique initiatives that distinguish Mott Children’s Hospital which is ranked as one of the best children’s hospitals in the country by U.S. News & World Report.

Reminding all of us in health care why we do what we do, each year a child and their family are recognized as an honored guest and we hear their story.  This year Larry Prout Jr. and his parents, Larry and Kathy, along with his five older siblings and other family members were the guests of honor.  Larry Jr. was born with three birth defects – Spina Bifida, Cloacal Exstrophy, and a massive Omphalocele. His parents didn’t know if he would make it through the first 24 hours after birth and there were many times during his first six months that he had to fight for survival. With their love and the specialized medical care of a multi-disciplinary team at Mott, Larry Jr. overcame many setbacks. He is celebrating his 14th birthday on June 11th.

One of my IT leaders, Joe Kryza, Executive Director of Infrastructure and Systems Operations, has made significant contributions over the past 10 plus years to the Mott Family Network, a non-profit volunteer organization that many of our IT staff contribute time to. Continue reading

The power of learning from your peers

I spent the better part of a day this week at the annual meeting of the Epic Michigan Users Group (we call it eMUG). But I don’t want to focus on Epic. I want to talk about the value of learning from your peers. It could be any vendor or any user group.

This was our fourth annual eMUG conference. Given space limitations, we had 200 attendees last year and with the venue this year we were able to accommodate 400, a significant increase. With 11 health systems in Michigan on Epic, that’s a good size group from each organization.

When asked for a show of hands on how many had been to Epic’s national user group meeting (UGM) before, only 25-30% of the attendees raised their hands. Local user group meetings like eMUG give many more staff a chance to attend and connect with their peers. National user group meetings are costly with airline and hotel expenses for a couple days.

This eMUG meeting was a content rich day: Continue reading

Making the tough decisions

We make all kinds of decisions every day. Some are small yet seem difficult at the time. One I sometimes joke about is ordering off a restaurant menu that has too many good choices. When I finally make my order, I tell the server that I have made my “major life decision” for the night.

Sometimes a group makes a decision after weeks or months of lengthy deliberation: many groups have weighed in, expressed their concerns, asked their questions, refined the plan or recommendation, and only then ultimately provided their support.

And then there are the potentially very impactful decisions that must be made in a matter of minutes with the best information you have available after a very quick weighing of the risks. I had to make one of those decisions last Friday.

We had scheduled our Epic version 2014 upgrade for the weekend. The plan was to bring down the production system at 12:30 AM Saturday. The system would be down until 5:00 AM while the final conversion tasks were completed. IT and operations staff were scheduled in the command center to monitor the upgrade and address any problems. Leadership calls were scheduled daily to review issues starting Saturday.

At 11:51 AM on Friday, I got a text Continue reading

Leadership huddles: not just another meeting

It’s huddle time! No, I’m not joining a sports team.  But along with my leadership team, we are taking the next step on our lean journey. In a few weeks we’ll be starting twice a week 30 minute leadership huddles. This is part of Lean in Daily Work which also includes key visual metrics, visual boards, Everyday Lean Ideas (ELI), and leadership walks.

In a post last summer, I talked about the lean journey.  It is important for leadership to set common expectations throughout an organization.  So if we’re going to practice lean thinking as a department, our leadership team has to set the example.

The goals of this lean experiment include the following:

  • Create a common understanding of what our performance is compared to what we want it to be so that we can understand the gaps and improve
  • Make our work visual and actionable
  • Understand our business more deeply by asking questions and looking at trends
  • Surface, track and trend problems
  • Gain experience and practice with lean

Continue reading

Plans, processes, people: lessons from a successful EHR implementation

I had the opportunity to talk about lessons learned from EHR implementations as part of the faculty for the “Leadership Strategies for Information Technology in Health Care” course at the Harvard School of Public Health (HSPH) last week.  And yes, I was fortunate to make it in and out of Boston between snowstorms for the one day I was there.

The course is part of Executive and Continuing Professional Education at HSPH. It is a two week course with 4 modules.  The first week covers Module 1 on IT Strategy and Governance and Module 2 on the EHR.

The faculty lineup for the first week is impressive.  John Glaser, CEO Health Services at Siemens Healthcare and former CIO at Partners HealthCare System, lectured on “IT Strategy Considerations.” John Halamka, CIO at Beth Israel Deaconess Medical Center in Boston covered “The National Perspective and IT in the Era of Health Care Reform.”  Vi Shaffer, Research Vice President and Global Industry Services Director at Gartner, provided an “Overview of the IT Industry.” Meg Aranow, Senior Research Director and Health Care IT Advisor at The Advisory Board Company, discussed analytics. New care models including telehealth, retail clinics, and accountable care organizations were also covered by various faculty members.  Mary Finlay, Professor Simmons School of Management and former Deputy CIO at Partners, discussed IT Governance. Mary is the program director for the course and does a terrific job.

Students come from various roles in health care. The course has also become well known internationally at this point – with about 30% from other countries. For this session some students came from as far away as Australia and India.

I was happy to be part of the faculty and get a chance to hear a few other lectures that day as well as interact with the students over lunch. Here are some of the EHR implementation lessons I shared in my talk:

  • The CIO and executive leadership in health care organizations have many priority initiatives at any given time. The EHR implementation will become a primary focus, especially as it gets closer to the go live date. As the CIO, you need to know where and when to be deeply involved vs. maintaining an overall awareness of the project’s progress, being ready to address issues as they are escalated.
  • Engaged executive sponsors are needed throughout the life of the project. If the CIO is the only one worrying about the project, there’s something wrong. At the same time, the CIO should avoid saying “it is not an IT project”. To be successful, it has to be a true partnership between clinicians, operations, and IT.
  • An EHR implementation has a significant impact on your entire organization and all staff members. A robust change management program is critical given the multi-disciplinary effort that EHRs require.
  • Many decisions get made through the life of the project. Establish early on very clear decision rights. Know which group makes what decisions and define the escalation path when issues can’t get resolved at lower levels of the project governance structure.
  • Your plan should include a “Go Live Readiness Assessment” at 120, 90, 60 and 30 days prior to go live. All teams are expected to report out their progress and open issues in detail. Project leadership then creates a readiness scorecard. This allows leadership to focus on the areas that are behind schedule and address issues to ensure an on-time, successful go live.
  • Contingency planning needs to be part of the overall plan. Any major system implementation needs a back-out plan if something goes wrong. But you also need to account for the operational impact. You can’t stop the flow of patients into the emergency room but do you reduce your surgical or clinic schedules? Each organization has to determine what’s right for them. And then there’s the unrelated and unanticipated crisis that you have no control over – it could be a major facility issue like a power outage, a weather incident like the snowstorms we’ve seen the past few weeks, or a mass casualty incident in your area. Be sure to include your organization’s emergency management team in your activation and contingency planning.
  • At go live, it’s all hands on deck in the command center and throughout the organization. Everyone has their specific roles. Leaders need to be present. The CIO may not be running the project but maintains a very visible presence in and around the command center. It’s a 24/7 operation for the first few weeks after go live. And be sure to round – find out how things are going for front-line staff and thank them for their work.
  • Once the system is up and running, you have to recognize that optimization is ongoing. Don’t minimize the requests. Listen carefully to your users. At the same time, manage expectations about how much will get done and by when. Help shape the message. Multiple communications channels are important. Structured processes for intake of requests and a formal prioritization process with agreed upon criteria are critical. While optimization for your organization and the unique workflows is needed, don’t get stuck there. Learn from others how they have leveraged the product. Reach out to your colleagues and learn from them. Many have gone before you at this point.

And when you’re ready, be sure to share your own lessons with others.

 

Resources 

Harvard School of Public Health’s Executive and Continuing Professional Education program, “Leadership Strategies for Information Technology in Health Care

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Lead by example

How often have you heard that leaders have to “walk the talk”? But how often has a leader you admire disappointed you with either their comments or behavior? We ask ourselves “what were they thinking”?

Being a positive role model and leading by example is something I take very seriously – in both my professional and personal life.

I am deeply touched by the congratulatory notes and kind words I’ve received this week after it was announced that CHIME and HIMSS selected me to receive the John E. Gall, Jr. CIO of the Year Award.

Awards like this don’t happen for CIOs without great teams.  I’m extremely grateful for all the talented and dedicated IT teams I’ve worked with over the years. Special thanks to my MCIT team at Michigan for the excellent work they do every day!

This award is named in honor of John E. Gall, Jr. who Continue reading