If you live in a large metropolitan area, chances are you have been either a patient or a visitor in an academic medical center that has 500 to 1000 beds. If you live in a rural area, you are probably more familiar with a small local community hospital with less than 100 beds.
Because of healthcare mergers and acquisitions, these two different kinds of hospitals are likely to be part of one integrated health system. While different in size and scale, they both deliver healthcare to their community 24×7.
Small, independent hospitals are often very agile, extremely customer service oriented and supported by a loyal community. In IT, the staff are often generalists and less specialized. They may have a single integrated system from one vendor with basic functionality and limited integration points with other applications.
In contrast, large academic medical centers can be slow to make changes and appear more bureaucratic. They provide advanced medicine with subspecialists and clinical services not found elsewhere. They have to work harder to create a culture of customer service. Their community is broader and they attract patients from greater distances, including international patients. And their IT teams are larger with many specialized roles. In addition to their core electronic health record, they have many specialized departmental applications, many interfaces. Overall, it’s a far more complex environment.
So how do these different profiles mesh at merger time? Continue reading
Communicate, communicate, communicate. How often have you heard it said that you can’t communicate enough?
A best practice for CIOs is to have “all staff” meetings at least quarterly or semi-annually. Regardless of the size of the IT department and the logistical challenges of getting people in one place, these meetings have value. Depending on the geographic spread of the IT team and availability of meeting space, you can always leverage technology to allow staff to dial in from their workspace.
Connecting with colleagues that they only hear on conference calls or “see” via email has value. If you are able within your budget to provide food, all the better to encourage social time before or after the actual meeting.
Such meetings allow you or guest speakers to provide the big picture on your organization’s strategy and priorities so everyone understands how their work fits in. You can communicate key updates and information on major projects and new processes that impact all or most of the staff. You can use it as a forum to provide education on key topics that all IT staff need to understand such as cybersecurity or bring in a motivational speaker.
At one organization where I served as CIO, shortly after I started, one of my direct reports was quick to tell me the exact number of years, months, and days since their last all staff meeting. How do you really feel about that was what I wanted to ask him. But I quickly understood he was representing staff who missed those meetings and wanted them re-introduced. I did ask why they were discontinued. The story I got was that the previous leader was asked a difficult question by a staff member, felt on the spot and didn’t want that to happen again.
As a leader, I welcome questions, even if I can’t answer them. Continue reading
As we all watch events in Washington unfold, each of us knows that the organizations we work for expect us to behave ethically in all that we do. We sign confidentiality agreements; we complete conflict of interest disclosures and we receive ethics training.
Whether you consider yourself a “rules follower” or one who likes to “ask for forgiveness, not permission”, you know that you must act ethically and lawfully.
I appreciate the advice I received from a boss early in my career – always do what’s right for the organization. If there is any doubt when I fill out my conflict of interest form, I error on the side of disclosing more rather than withholding information.
And then there’s nepotism – something both small and large organizations need to manage. They figure it out. Unless you are a family owned business, you should not be hiring or managing family members.
I worked at an organization that was named by the Ethisphere Institute as a “World’s Most Ethical Company” five times since 2012 – University Hospitals in Cleveland, Ohio. Their Chief Compliance Officer, Kim Bixenstine, and the entire executive team took great pride in this honor. And they should. University Hospitals is one of only seven healthcare providers named to the list in 2017.
Ethics starts at the top. 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
I’ve written many posts on leadership. As we witness the peaceful transfer of power in the Office of the President, it seems fitting to reflect again on leadership and what we should expect of leaders.
When I think of critical leadership qualities at the executive level, I think of vision, integrity, presence, communication, and authenticity. If you look at position descriptions for executive level leaders in business, you will see all of these and more.
I’ve talked in the past about the core principles and values I share with my staff when starting a new leadership position. In that early period, I want my team to get to know me and to understand what’s important to me. I want them to hold me accountable for living these values every day in every situation. And I also expect everyone on my team to live them as we work together.
Here they are again but with a more generic description that can fit any leadership position: 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
Most of us won’t live to be a 100. Yet organizations that are the foundation of our communities celebrate 100 year or more anniversaries. I have been fortunate to be part of 225 and 150 year anniversaries at my churches in Worcester, MA and Ann Arbor, MI. Brigham and Women’s Hospital in Boston was making plans for its 100th anniversary celebration when I left there in 2012 for the University of Michigan Health System, yet another institution with a long and rich history. And now as a member of the University Hospitals team in Cleveland, I am joining in celebrating our 150th or Sesquicentennial anniversary.
The UH history dates back to May 14th, 1866 when a single hospital in a two story wooden house was established. As noted on our new UH 150th website, “For 150 years, the people of Northeast Ohio have looked to University Hospitals as a trusted health care provider. Our roots date back to 1866, when civic leaders established a hospital in a small Cleveland home to care for the sick and disabled. From these humble beginnings, UH has grown into a multihospital system, serving 1 million people annually. The medical advancements made at UH touch lives worldwide, yet we remain true to our roots as a community health care provider.”
UH has a long history of care and caring. To continue that commitment to our community, 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
Chris Greene Hutchings is staff specialist in the Office of the CIO. We have worked together closely during my tenure at UMHS. With my pending departure, Chris asked to be guest blogger this week.
When the leader you report to announces she is leaving, a parade of emotions marches through your life.
The first is denial. “NO! She can’t leave, because we need to. . .”
Then it’s the blues. “What does this mean for me?”
And ultimately, acceptance. “We did some good work, didn’t we?”
It’s a bittersweet feeling because it’s the first time you stop to look back and see how far you have come together. And you realize you didn’t take enough time to celebrate the successes, or appreciate the good along the way.
Our CIO, Sue, is starting the next chapter in her professional life. As I look back, I see how much our organization has changed. Continue reading