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
Remember those first few days on a new job? You were officially onboarded, and signed a lot of forms. You learned all the basic processes and policies that new employees need to know. And you got the big picture of the organization’s mission, vision, values and culture. Your head is spinning by the end of day one and even week one, but everyone is patient with you. They recognize that it is a lot to take in.
In that early period when you are introduced to lots of people, everyone is so happy to see you. Everyone is offering to help you get up to speed, and do whatever they can to make your onboarding smooth.
And then you realize they all need something from you. They all think you can solve all the problems. But you are still given some time before you start waving your magic wand.
You’re on a honeymoon. It will be measured in days or weeks but usually not months. You must drink from the firehose, get to know all the key people and start adding value. “Proving yourself,” as they say.
You may have relocated, so you’re also getting to know your new town.
It can be exhilarating and overwhelming all at the same time. 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
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
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 this 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
Many organizations have a Project or Program Management Office (PMO). If not at an organization wide level, at least within the IT department. There are different models. Some PMOs provide standards, tools, methodology and overall tracking. Others provide this foundation as well as a team of project managers (PMs) who can be assigned as needed to major projects. Our PMO at University Hospitals is the latter model.
Our PMO has evolved under our new manager, Joe Stuczynski. He and his team are making significant improvements with the support of IT leadership. They have developed a roadmap for further changes and improvements for the next year.
It is refreshing to be in an organization where we are not debating about the tools and whether they are good enough. We are not debating about what projects need to run through the PMO and if everyone needs to follow the standards.
Instead, we are embracing and leveraging the tools and the PMO is able to focus on what it should be – tracking projects and providing PMs to manage projects. 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