Teamwork at its best

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 thiscanstockphoto16328410 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

What upgrade?

This past weekend we did another major upgrade – this time the ambulatory EMR. It went extremely well and was met with smiles and kudos from our senior executives. While we’ve done several major upgrades canstockphoto13469755recently including revenue cycle and acute EMR, this one had a lot of eyes on it. Those same senior executives have been rightly concerned about the performance of our ambulatory EMR while we worked through some significant issues during the past several months, including software, hardware and infrastructure. So, kudos to the team that turned the corner on those issues and pulled off a very successful upgrade with minimal issues and disruption to our physician providers and operational practice teams.

We called our 200+ physician practices before the upgrade to make sure they felt prepared.  A few actually said “what upgrade?”. Apparently they had not read the any of the advance communications. So we worked with each of them to make sure they were ready.

The command center was open all week and will close early today as we have fewer and fewer calls.  Over 62% of the reported issues had been resolved as of late yesterday. Our users gained a lot of new functions and features which has made everyone happy.

In addition to a strong and collaborative relationship with your vendor, here are some critical success factors for any major software upgrade: Continue reading

Who’s on first?

Picture this. One of your IT leaders tells you they have been pulled into a project by a senior executive; they are trying to figure out who in IT owns it. You tell them that another of your leaders owns it. They arecanstockphoto2538045 working out the specific issues with yet another leader. The first person says it’s still not clear. So you pull all three of them together for 15 minutes and try to sort it out.

With a collaborative team that works well together, that 15 minutes is relatively easy. Your first question is who’s on first? You want to know who owns it and what’s going on.

My team has learned that one of my questions about problems is “who wakes up in the morning worried about it?”  Not that I want people worrying and losing sleep. But, it’s a way to identify who owns something and is accountable for it. “Who’s on first?” is another one of those questions. It may be a messy, complex project. It may be off to the side or on the fringe but it still needs a clear owner.

After just 15 minutes, my three leaders and I confirmed the right roles for each of them, and next steps. And of course we talked about lessons learned. So what did we learn again in this situation?

Role clarification – this is critical for all projects, small or large, high priority or not. Clarifying and communicating sponsor, business owner, project manager, and decision makers is key.

Communication – proactive communication throughout the life of a project to all members of the core team and the stakeholders is another key.

Setting and managing expectations – this is especially true when dealing with many concurrent efforts with the same set of users and stakeholders. It’s also important when a project that seems simple actually has a lot of complex issues:  technical, operational, legal or something else.

I’ll bet you can think of a messy project in your experience that swirled or stalled. You might have some bad memories. Most likely, what went wrong ties back to one of these basics. So clarify roles, communicate, and manage expectations, but make sure you know who’s on first.

Making the invisible visible

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 canstockphoto26356044managers. 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

Lessons from an aspiring lean leader

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 canstockphoto16267629where 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

7 tips for managing in the fast lane

It’s generally a bad sign when the seat belt warning light for the passenger seat comes on but you are the only one in the car. You’ve got too much weight on that seat and the car thinks it’s a person who needs to fasten their seat belt.

This has happened for me a few times lately.  It’s when I have thrown my briefcase and stacks of work for the weekend or the evenings on the seat.  Or I’m out of my office at hospital meetings for several days in a row and need various files with me.  The passenger seat becomes my file cabinet until I’m back in my office.

If I’ve been out of town to visit family or on business, it gets even harder to manage the volume.

People say they don’t know how I do it….how do I keep on top of everything. I respond, typically, “I don’t do it that well.” I’m my own worst critic. But I try my best.

So how do you survive and be your best at times like this?

Triage skills – Review your email inbox and make sure that the time sensitive ones are answered. Look for emails from your direct reports, boss, peers and customers to handle. Continue reading

So you didn’t get the job

Last week I wrote about how to stand out in the interview for a new job. I promised that I would write about what to do when you don’t get the job.  I’ve been there before and it’s not easy.

You think you’ve nailed the interview. You’ve met with lots of people. You like them and your potential new boss. You think it’s a great opportunity and you are excited about the prospects. You anxiously wait for “the call”. And then it comes. The hiring manager, HR person, or recruiter says “we’re going in another direction” – that common euphemism to say that someone else is getting the job.  They go on to say some nice things about you and that you interviewed well but all you hear is that you didn’t get the job.

Your friends and family are supportive. They may say “it wasn’t the right one anyway”. Or “something better will come along”. They tell you how to feel but what you want to say is what my youngest daughter would say to me – “you can’t tell me how to feel, you’re not inside my body!” 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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Making time for reflection

“Hansei” is the Japanese word for reflection. One of my UMHS colleagues, Dr. Jack Billi, told me he’s impressed that I am writing a blog and sees it as an example of Hansei. He says as leaders we don’t take enough time to reflect. I agree.

A typical day for me is running from one meeting to the next, driving back and forth from my office to the hospital campus, and squeezing in email when and where I can. Evenings are more email and prepping for the next day’s meetings.

The practice of writing a blog has indeed caused me to be more thoughtful about a range of topics. I find myself observing things differently. I reached out to one of my industry colleagues, Anthony Guerra, Editor-in-Chief of healthsystemCIO.com, for advice when I first considered writing a blog earlier this year. He encouraged me to do so. He told me that through the practice of writing a blog I’d start looking at things differently, observing things in new ways. He was right. Continue reading