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
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
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.
Harvard School of Public Health’s Executive and Continuing Professional Education program, “Leadership Strategies for Information Technology in Health Care”
Three Days and Counting. . .
Values in action. . .
MiChart summer interns – a win-win!
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
You start in a new leadership position and you want to make changes. Should be easy, right? After all, you’re the boss. You call the shots.
You inherit a history and a culture, ways of working and thinking and behaving. You inherit a leadership team and a staff. You inherit a department that works within a broader organization and its culture. Still, you are the leader; you can make some changes, but it will take more time.
When I started at UMHS, there had been a 6 month gap with an internal interim CIO. She had kept things going but was happy to handoff to me. Continue reading
How often have you heard an IT leader say they want a position that’s “more strategic” and “less operational?”
The reality is that there is always a balance of both, depending on the level you work at in your organization. Sometimes, it’s not the balance you’d like to see.
As the CIO, my typical day is back to back meetings. Plus, I squeeze in email and phone calls on a range of additional issues. I read and answer email well into the evening after I get home.
In the past week, I’ve reviewed presentations and read articles on health care in the future and how technology enables innovation: reflective thinking and planning. Continue reading
Last November, I started the practice of hosting monthly breakfasts for up to 20 of my department staff at a time. We skipped two months around the time of our major inpatient go live in June. That means I’ve spent time with at least 160 staff getting to know them, listening to their concerns and answering questions in a small, informal setting. There’s a small group of “frequent flyers” who have come to more than one so far. I tease them that it must be the food but I know it’s them wanting to have a voice which I’m happy to listen to. “Make your voice heard” is a theme I’ve been encouraging all year.
At the most recent breakfast, there was a lull in the conversation. I called upon one of my frequent flyers whom I have come to know is willing to tell it like it is. Continue reading
Many leaders use a musical analogy to describe leadership: the leader is like a conductor. I wonder how many of them have actually been part of an orchestra or a choir member? I have been in HIT management for 30 years and I have sung in church choirs for over 20 years.
When I walk into our weekly choir rehearsal, I am just one of about 50 voices ready to take direction from our leader – an extraordinary young man, Glen Thomas Rideout, who just completed his PhD in Musical Arts in Conducting. Regardless of the job we hold or the day we had, we are there to take direction from him, to listen to one another and to make music. Continue reading
When I started here at the University of Michigan, I told the people I was to lead about my core values and expectations.
Prioritizing issues at our “11 at 11” meeting today.
- Teamwork – I expect people to respect one another and work together for common goals.
- Transparency – I practice and expect open, proactive communication.
- Customer service – While we don’t touch patients directly, we are all part of the extended care team; clinicians and caregivers rely on our systems to safely care for patients. We must provide excellent customer service in every interaction.
- Accountability – Each of us needs to take ownership and deliver on our commitments.
- Innovation – We work for a leading organization in health care, as IT professionals we must always look for ways to innovate.
- Continuous improvement – I was delighted to learn of the culture of continuous improvement within UMHS and the focus on lean health care. There are always opportunities to improve.
- Results focus – We need to focus on end results. Even though process is important, we shouldn’t get bogged down in it.