National Nurse Week begins tomorrow. I’m fresh off a 4-hour shift shadowing a nurse on a busy inpatient unit with cardiac surgery patients. I was taking part in the “Walk in My Shoes” program at Stony Brook Medicine where I currently serve as interim CIO.
All the executives were asked to block out 4 hours this week to shadow a nurse. I looked forward to my shift despite the other work on my desk. And as I told the nurse I shadowed, spending time on their unit was more fun than some of the problems I deal with as a CIO.
But I wasn’t there to have fun. I was there to understand what a nurse’s day is like and find ways that administration can help. And as the CIO, I wanted to understand how they use the systems we support and to find opportunities to improve them.
I donned a pair of scrubs, the universal hospital uniform and a fashion neutralizer. It’s amazing how different it feels to be on a nursing unit in scrubs compared to being a “suit” who periodically does rounds with a bunch of other “suits”. The staff seemed more willing to just tell it like it is when I encouraged them to be candid with me.
As soon as got to the unit a nurse realized I was from IT. His first thought was that I was there about a system problem that had been reported in the patient safety system. I introduced myself and my role as interim CIO. I told him that while I was there to shadow another nurse, I wanted to hear about their IT issues. This was my “gemba” walk with a group of nurses. Continue reading
I am a lean leader and always willing to share my learnings. I’ve written several blog posts chronicling my lean experience at different organizations. Some of them have been quite popular with readers. I’ll call them my “lean classics”. Here’s a recap for your reference:
Huddles and Visual Management:
Leadership huddles: not just another meeting – describes my first IT leadership huddle launch back at University of Michigan Health System. As my lean coach said at the time, be willing to experiment, it doesn’t have to be perfect. We learned and tweaked it as we went through the PDCA cycle.
Making the invisible visible – describes the beginning stages of the visual board our IT leadership team created at University Hospitals in Cleveland.
Making the invisible visible – part 2 – describes that same effort several months after we launched it and how we used it as a team.
6 tips for successful huddle boards – based on experience, my advice to those considering their own huddle boards. Remember, you need to be willing to experiment.
Importance of rounding or going to the “gemba” – describes early experience with clinical and operational rounding both at Brigham and Women’s Hospital and University of Michigan Health System. Continue reading
I recently had an opportunity to advise an IT department on their overall lean initiative. While no two organizations have the same lean journey, there are common challenges. Visual management and huddle boards are components of a lean management system. Here are some of the common challenges you can expect to encounter and tips for success:
“Perfect is the enemy of good” – You must be willing to experiment and get messy. Visual boards take many shapes and forms. Do they help you focus on the right work and metrics as a team? It’s less important that they look pretty to the outside observer.
Standard framework with room for variation – Even if there is a standard for what all huddle boards in your organization should look like and include, there must still be room for variation by unit or team. What’s important to one team may not be important to another. If you’re ready to get started and wonder if there will be an organization standard at some point, don’t wait for it. Just get going and adapt later if a standard appears. Continue reading
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
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
Mergers and acquisitions in health care have been common in recent years. Small community hospitals are becoming part of much larger integrated health systems. One of the common challenges these systems face is providing effective local service from central corporate departments.
Health systems may span a large metropolitan area, a portion of a state, or a multi-state region. And there are systems with a national footprint.
The health systems I’ve worked for are mostly the first; they have covered a large metropolitan area. Local hospitals may be as much as 100 miles apart and the corporate office somewhere in the middle. While much of the work goes on every day without face to face interaction, people are often expected to drive to key meetings either at the corporate office or at the hospitals. But the distances and the traffic can challenge support models for corporate functions. Continue reading
The whiteboard in my office has become a working draft for our IT leadership visual management board. And it’s become a focal point of discussion as I socialize the idea with our IT VPs, directors and managers. I’m encouraged that everyone who gets the walkthrough supports the idea and sees the value in it. They see the potential it has to address some fundamental problems in how we work as a department.
Ownership of the board is shifting to the team. I’m using color coded sticky notes to add ideas and pose questions. I’ve encouraged IT leaders to stop by and put their own sticky notes up as we develop it together.
Some have asked if they should do something similar with their own team. The answer is yes! We need to commit at the leadership level and model behaviors. But to truly be effective, each team should have some kind of visual management and huddle that rolls up to the leadership huddle. Continue reading
This week I will be sharing lessons I’ve learned as a lean leader and champion – in particular around visual management. The Lean Enterprise Institute (LEI) holds an annual Lean Transformation Summit where experts and practitioners come together from all industries to learn from one another.
My talk will cover a multi-year journey that has involved learning from others both in and out of healthcare, site visits, training classes, lots of reading, and experiments with my leadership team. Most of my talk is based on my experience and lessons learned at the University of Michigan Health System.
I was delighted to see that University Hospitals where I’m currently the interim CIO has been on their own lean journey since 2011. At our hospitals you will see huddles and visual boards throughout. Thousands of staff have been trained in lean concepts and methods. In contrast, there have been limited experiments with lean at the corporate office. I have a few allies in my IT leadership team who have experience with lean in other organizations. A good start!
I would have been making a mistake to arrive at UH as the interim CIO and start introducing lean methods week one. I needed to see and hear the problems that need to be addressed. Continue reading
The past month has been a particularly busy one for me. I have spoken locally a few times and gone out of town on business several times as well. I’ve been to the CHIME Fall Forum, made a site visit at Duke, and attended an AAMI board meeting. During that same period, I’ve given a talk on “Women in Technology” and participated on a CIO panel at the Midwest Fall Technology Conference in Detroit. I spoke on “High Impact IT” at the 2015 ICHITA Conference sponsored by the Center for Health Information Technology Advancement at Western Michigan University in Kalamazoo. I was one of two CIO guests on the CIO TalkRadio Show last week. And we published our monthly newsletter and held one of our twice a year department all staff meetings.
I have a busy schedule of meetings at multiple UMHS locations every day, so how did all these commitments come off without a hitch? The visual board my support staff and I started some weeks ago has made the difference! The only commitment that I scrambled on at the last minute was the one that hadn’t made it onto the board. That’s telling.
Prior to our visual board, I sometimes scrambled at the last minute to finish a presentation or finalize flight arrangements in time to get a reasonable price. Now, as a team, we can see into all the major events and commitments and take an organized approach to the shared tasks involved. Continue reading
Recently I wrote that October was Quality Month and I highlighted Dr. Richard Shannon’s excellent talk, part of our Lean Thinker’s Series. I “teased” that I would comment on the Quality Month poster sessions in an upcoming post.
For two days, 48 quality improvement teams displayed their stories as posters. I spent about an hour checking out the posters and talking with people from the teams. I targeted the ones with potential scalability or an IT connection.
Jennet Malone, a manager at The Briarwood Center for Women, Children and Young Adults, explained how they increased use of the portal.
Here are a few worth noting:
Got Portal? –The Briarwood Center for Women, Children and Young Adults
We rolled out our patient portal more than 3 years ago. Patient enrollment has been fairly successful with over 200,000 active users but this is still not at the level we need. This health center established specific goals for making portal functionality part of everyday clinic workflow and used by patients and families. They increased their marketing efforts and established staff incentives for meeting short term goals. They purchased iPads to help staff sign up patients. They added the portal metric to their daily huddle. The result: Briarwood Center for Women, Children and Young Adults has the highest percentage of patients on the portal when compared to other clinics! Continue reading