If you are a regular reader of this blog, you know I am a fan of lean concepts and practices. In fact, my posts on lean have been some of the most popular ones over the years. So, it is no surprise that I have
embraced a form of rounding or “gemba” now that I am serving as interim CIO at Boston Children’s Hospital.
As part of our commitment to being a High Reliability Organization (HRO), Boston Children’s Hospital has a program called “Rounding to Influence” (RTI). With this program, senior leaders meet with staff in their areas to discuss a specific topic and solicit input. The Rounding to Influence program is facilitated by David Davis, Vice President, Patient Safety, Quality and Regulatory Affairs. When I learned about the RTI program several weeks into my interim engagement, I was quick to start participating.
My first experience was tagging along virtually with Laura Wood, EVP Patient Care Operations / System CNO, on her rounds with clinical staff along with a few of my IT leaders. Given the topic for that session was about having the right information to perform your work, it was a great place to start and hear from our clinicians and support staff. Here were the questions:
Having the right information and data is important to everyone in order to perform their roles effectively. Depending on your role, do you have trouble finding the information or data you need to do your job? Do you know how and where to get the information/data you need? Do you have concerns you are seeing incomplete or unreliable data? How would you know? How can we be more reliable in our information and data sharing?
The obvious next step was to start virtual rounds with our own IT staff. Here is how it works.
Senior leaders at Boston Children’s Hospital block an hour every second and fourth Wednesday from 10-11AM. There is a topic / set of questions provided to them by David Davis a few days in advance. When I get the questions, I send out a notice to all IT staff inviting them to join Scott Ogawa, VP for IT & Chief Technology Officer, and me virtually for ½ hour to discuss the topic. We limit the group each time to 10 people so everyone gets a chance to contribute. If we get more than 10 we can split up and have two sessions. The idea is for Scott and me to listen. If there are actionable items that come from the conversation, we follow-up. To ensure that we as IT leaders also hear from clinicians we support, I encourage Dr. Marvin Harper, CMIO, and Dr. Jon Bickel, Senior Director Clinical Applications/BI, to join the rounds that Laura or other senior clinical leaders conduct. During the second ½ hour the senior leaders join a virtual session to share what they heard as themes emerge across the organization.
The topics the past few sessions have covered a preoccupation with failure, paying attention to detail, and communication regarding priorities. Here are the specific questions – you can see how they all apply to IT:
High reliability organizations have a “preoccupation with failure”. They strive to detect small, emerging failures because they may point to more dangerous or systematic failures elsewhere in the organization. HROs try to anticipate failures and ensure that those risks are mitigated. When we talk about attention to detail, how are we paying attention to small gaps in our systems or processes that might be the ‘tip of the iceberg’? How could we do better at anticipating issues in our work, systems, and environment?
What challenges or obstacles do you have in your work area or work processes that make it difficult to “pay attention to detail” and complete your work successfully? What changes or supports would make you more successful?
Clearly communication about projects and initiatives is important to everyone in order to perform their roles effectively or simply for awareness. Depending on your role, do you feel you are aware of the initiatives and projects that have been prioritized by the organization or your local work area? Regardless of role, do you know the safety priorities for your work area? Are you involved in these efforts? How can we be more reliable in clearly communicating our safety concerns? Do you feel comfortable pointing out opportunities for improvement?
In IT we have had less staff participating so far than I had hoped for. I realize it will take some time to catch on. The discussions have been valuable for Scott and me in identifying areas of improvement needed. I want our IT staff to trust that as specific items are raised that we can act on, we will. And that we truly do want to hear from them.
While “going to the gemba” may be harder in a work environment that is largely virtual, we can still find ways to hear from our staff. Our participation as IT leaders in the broader RTI program is part of fostering an open, transparent, and supportive culture and working environment where we strive to continually improve together.
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