On Best Practices

Most popular blogs in 2019

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It’s the new year and time for top 10 lists and countdowns so I’m adding mine to the mix. These are my most read blog posts in 2019. If you missed any of them first time around now is your chance to check them out.

I am a practitioner and always willing to share experiences pulling lessons from everything that I do. I continue to cover a range of topics from leadership to women and work to technology and healthcare. It looks like my readers appreciate the variety. Here are the top 10 as measured by total views:

A passion for health care – a classic one from previous years about why we do what we do

6 tips for successful huddle boards – another classic from previous years that doesn’t go out of style

“We’re at meeting norms” – this one is about best practices I learned from my IT colleagues during my interim CTO engagement at University of Vermont Health Network (UVMHN) this past year.

10 best practices for project success – another one from my experience at UVMHN as we approached the November Epic Go Live.

Where do new ideas come from? – another back to the classics from a previous year.

Develop women leaders, transform leadership – at StarBridge Advisors, we launched a new service early in 2019 call C-Change focused on developing women leaders in health IT. Continue reading →

Taking stock – goals for your next decade

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January 1, 2020 marks more than just another new year, it marks a new decade. And a good time to take stock.

What are your personal highlights of the past decade? What does the new decade hold for you? Are you living the life you want to live?

I have never been a “bucket list” kind of person, but I did set four big, broad goals for myself early in this decade. They involved family, work, travel, and friends.

My family goal involved grandkids that weren’t yet born. I told my husband that I wanted to spend a lot of time with my grandkids if I was fortunate enough to have them someday. That someday came for us four times between 2012 and 2016. Happy to say, I’m meeting my family goals. Once we had grandkids, there was no question I wanted to make the changes needed to live near them so I could see them often. We made the move back to New England in 2016 and it was one of our best decisions ever. They are now 7, 5, almost 5, and 3 ½. I fondly call them the “Fab Four” and we see them often.

That decision to move was tightly coupled with a major career decision. Leaving a fulltime position as a healthcare CIO to start down a path of interim management, consulting and leadership coaching. It’s a decision I have never regretted as I now have more control and flexibility in my career and work. This period has included launching and growing a successful health IT advisory firm, StarBridge Advisors, with two colleagues for the past 3 years. Continue reading →

Bridging the gap with an interim leader

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My husband and I have both served in interim roles this year. Tom left IT in the mid-1990s to become a Unitarian Universalist minister. He is now a retired minister who does a lot of guest preaching and writing and is very active in our denomination nationally. He did part-time interim ministry at two different churches in our area this year. The first was for 3 months early in the year, and the second was for 4 months this Fall. He was filling in for ministers who were on sabbatical. His role was to preach and lead worship on Sundays, work with the board and staff, and be available as needed for pastoral care.

Compare this to the interim CTO engagement I’ve done since late May. A full-time role keeping infrastructure projects moving forward, helping to ensure a successful Epic go live, dealing with day to day issues, and helping recruit the permanent CTO.

Interim leadership roles take different forms. They range from “keeping the seat warm” to turnaround situations where significant change is needed. Regardless of the role, an interim needs to be able to confidently step into the role, build relationships, gain respect, and get up to speed quickly. Continue reading →

Getting ready for 2020 – 10 steps for health IT leaders

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One of my greatest joys when we started StarBridge Advisors back in 2016 was to be able to partner with someone as smart and insightful as David Muntz. He has a long career history as a healthcare CEO, a CIO and as a senior leader in the Office of the National Coordinator. I continually learn from David and appreciate his provocative thinking,

David’s advice for 2020 is no exception. In his recent post, “10 Steps to Prepare for 2020 – Big Challenges – Bigger Opportunities” on our StarBridge Advisors blog “View from the Bridge”, David starts off by challenging CIOs to begin thinking of themselves as CDSOs – Chief Digital Services Officer. He goes on to highlight the importance of encouraging innovation, embracing AI, addressing governance issues, physician burnout and more. And ever mindful of how leaders must take care of themselves to be at the top of their game, he closes with a message on self-care.

Here’s David’s blog post in its entirety:

10 Steps to Prepare for 2020 – Big Challenges – Bigger Opportunities

It’s that time of year again when prognosticators and futurists compile a top 10 list for the upcoming year. Please joining me in welcoming 2020 with a call to action for our wonderfully challenging and opportunity rich healthcare IT environment.

Before starting the list of recommended actions, I suggest that we IT professionals change the way we refer to ourselves — now, even before the turn of the year. Please join me in a self-directed evolution by shifting our reference from IT to Digital Services. That change would suggest using the title CDSO instead of the familiar CIO. The rationale for doing so, though relatively obvious, will be suggested in another blog.

Digital Service (DS) leaders will need a steady hand on the rudder to lead their organizations through some rough waters. Some of the themes below are repeated from last year…they still deserve your attention and efforts. Continue reading →

Conducting project “lessons learned” as continuous improvement

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As I caught up on my industry reading this past weekend, I saw several implementation best practices articles – advice from experts on EHR, Telehealth, Pop Health, and Medical Device implementations. These kinds of resources are always helpful to think beyond your organization’s experience, get a different perspective, and learn from others.

At the same time, conducting lessons learned sessions internally after major projects is critical. While it’s still fresh in your mind, being able to look as a team at what worked well and what didn’t work well over the life of the project is an important step before moving on to the next project or next phase of a multi-year project. This should be done in the spirit of continuous improvement. Ask yourself, what can be learned from this project that can be applied to future projects. And be sure to document that in a way that is referenceable in the future.

We are just over 3 weeks post go live for Wave 1 of our Epic project at the University of Vermont Health Network (UVMHN). We start a series of lessons learned/debrief sessions this week. IT managers have been asked to think about three questions and submit them in advance so they can be compiled for review and discussion:

  • What worked well?
  • What didn’t work well that we should modify?
  • What didn’t work well (or was unnecessary and we should no longer do)?

As we planned for the sessions, I suggested that we have a few guidelines – no blame, assume positive intent, and ensure everyone is heard. UVMHN has a very collaborative and team-oriented culture so that shouldn’t be difficult.

Often, it’s easy to go right to what didn’t work well. Those examples may be top of mind. But there is so much in a project of this magnitude that is done well. Capturing those points and making sure you repeat them in the future is important.

Wave 2 planning started before the Wave 1 go live. Certain lessons have already been looked at as part of that planning. But the upcoming sessions will be an opportunity to look more broadly and get the input of all areas involved. Given I’ve been interim CTO since late May, my involvement did not span the entire project but rather certain aspects in the last few months including the go live. I look forward to hearing everyone’s perspective on how we can do better and build on the successes to date.

Related posts:

10 Go Live Command Center lessons from the field

Epic Go Live – report from the field

9 Tips for Go Live support success

Plans, processes, people: lessons from a successful EHR implementation

10 Go Live Command Center lessons from the field

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Week 2 post Epic Go Live has begun. We continue to learn and adjust. Building on my previous Epic Go Live and Command Center planning posts, there are more lessons to share.canstockphoto15204222 (1) keep calm

The last point in my most recent post was about camaraderie – defined as “mutual trust and friendship among people who spend a lot of time together”. I should add, in close quarters!

I continue to be impressed with the hardworking, dedicated IT team at the University of Vermont Health Network. I have seen many examples of teaching, helping one another and stepping up to new roles since the November 9th Go Live.

The rate of new tickets slowed down as Week 1 ended but the issues became more complex as expected. We have resolved over 65% of the tickets opened since cutover and addressed many cross cutting issues.

As promised, more lessons to share:

  • Handoffs between shifts – Ensure that key issues and work in process is reviewed and turned over to the next shift to keep things moving smoothly. Try to have people scheduled several days in a row for continuity vs on one day and off the next.
  • Seeing the “forest for the trees” – In the first few days, the focus is on closing tickets but as cross cutting issues and themes emerge, the focus needs to shift. As broad issues are defined, you need clarity on what teams and modules are involved, who is on point to lead the issue resolution, and what help is needed.
  • Escalations – It is very helpful to have highly engaged executives and operational leaders rounding and raising up the greatest pain points for users that need more focus. These escalations may come through in-person visits to the command center or email.
  • Ticket analysis – Have resources available who know the tool and can slice and dice the data to help leaders and teams see trends and where to focus.
  • Hospital daily huddle – If the organization has a daily huddle, the command center lead should attend. It’s good way to hear firsthand how all departments are doing and what their key concerns are.
  • Command center “walk-ins” – If the main command center is at the hospital you may get walk-ins – well intentioned users who want to escalate a specific ticket or issue. Command center leaders should manage this so the teams working tickets aren’t given conflicting direction on priorities.
  • Email management on steroids – Staff working tickets stay in the system and don’t watch their email. But leaders get a lot of emails and it’s hard to keep up given the pace. At the end of each command center shift, go back through your inbox to ensure that any escalations are dealt with – other email can wait.
  • Multiple locations for support – If there are a main command center and multiple other locations for support staff and triage, ensure they are well coordinated with good communication between.
  • Document management – Everyone involved needs easy online access to reference material. Dynamic information such as shift schedules need to be maintained. Having at least a few binders of printed reference information helps as well.
  • Ramp down plan – When you start adjusting command center hours, it will help to have a checklist ready on what needs to be considered and implemented (i.e. staff schedules, re-location of teams, communication to users, logistics like food and transportation, etc).

Stay tuned for more reports from the field….

Related Posts:

Epic Go Live – report from the field

9 Tips for Go Live support success

Epic Go Live – report from the field

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Many of you have been through a major EHR implementation and go live. I’ve been through them before as well. The teamwork of a go live is like nothing else I’ve ever experienced.canstockphoto16071239 (1) teamwork

There is the overnight cutover period that was practiced numerous times as “cutover dry runs” with the goal of making sure it goes smooth and can be done in the shortest time possible. After all, you are asking a hospital to go to downtime procedures until you can bring up the new system.

There is the excitement as others gather for the proverbial “flip the switch” moment. The applause and high fives for people who have been working hard towards this moment for many months. The appreciation from operations leaders on hand.

There is the wait for the first user calls and tickets to roll in. The wondering if all the planning for the command center and support structure was on target.

There is the settling in as ticket volume increases, teams start working them, and tickets start getting resolved.

There are the periodic reports from operational leaders who are rounding on the floors. They report on the pulse of staff who are dealing with a new system while trying to care for patients. They report on the issues that seem most problematic.

There is the dashboard monitoring to see which teams are getting the most tickets and whether adjustments in staffing need to be made. There is the ongoing review of tickets to ensure they are prioritized appropriately. Continue reading →

9 Tips for Go Live support success

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My first blog post published back in 2014 was called “Three Days and Counting…” written as we approached a major Epic go live at Michigan Medicine. This week’s post could be called “Five days and canstockphoto15204222 (1) keep calmcounting….” as we approach our Wave 1 Epic go live at University of Vermont Health Network on Saturday 11/9.

We were originally scheduled for a 11/1 go live. But in mid-October after much deliberation with operations and IT leadership, our CEO, Dr. John Brumsted, made the decision to move the go live back one week. As he said in his communication to the entire organization, “This decision is in the best interests of our patients, our people and our Network. It gives us the time we need to get to a place where we are confident to go live and it allows users additional opportunities to prepare”.

Planning for the two-week 24/7 command center and support structure started a few months ago. With just five days to go, the plan is pretty much finalized. Highlights and some tips to share based on our game plan:

  • Physical setup/location – Where your command center is located will depend on space available but ideally it will be in the hospital. We are fortunate to have primary and secondary locations at the University of Vermont Medical Center where we’ll have approximately 80 people. We will also have a triage team (to review and route the tickets entered online) and trainers (to answer “how to” questions) co-located offsite. In addition, we’ll have local support centers at each of the hospitals involved in Wave 1.
  • Overall call flow and phone setup – We have a documented decision tree/call flow starting with the super users reporting issues they can’t address. Phones are programmed to route calls to the appropriate support staff depending on user role and/or application involved.
  • Reporting issues – When you are dealing with thousands of issues, you need to use a common tool and standard process. We use ServiceNow and all tickets will be entered and tracked through this tool. Dashboards have been created for leaders to monitor ticket volume and trends.
  • Staffing – A command center operating 24 hours a day for two weeks means people are scheduled for 12.5 hour shifts including time for handoff to the next shift.
  • Leadership roles – Multiple leadership roles have been defined and scheduled for these same shifts. Roles include a physician and nurse leader from IT, someone to monitor ServiceNow tickets and trends, and someone to be overall command center leader.
  • Huddles – There are huddles scheduled throughout the day for each operational area to review broad issues and trends that will then role up to the executive huddle at the end of the day.
  • Communications – This is a critical function to embed in any command center. As high impact issues are resolved and trends are identified, communications staff will work closely with command center leadership to push out daily updates and specific tip sheets.
  • Reference documentation for support staff – Wwith the intensity and pace of a major go live like this, you can’t rely on personal knowledge. Documentation will be available to all support staff and will be reviewed in advance to ensure everyone is comfortable with the plan and what is expected of them.
  • Logistics – And last, but not least, don’t forget about food, parking and transportation arrangements.

Our command center and support plans for go live are well defined. They may not be perfect, but a lot of thought and preparation has gone into them. The key is to be flexible and adaptive as the days go by.

As I always tell my IT teams, we are part of the extended care team. While we don’t touch patients directly, the staff who do depend on the systems and support services we provide. This is never truer than at go live time!

Related Posts: 

Crunch time and why IT matters

IT takes a village

Three Days and Counting…

Plans, processes, people: lessons from a successful EHR implementation

The power of your network and learning from others

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Healthcare is one of the most collaborative industries I know. Granted, my entire professional career has been in health IT so maybe that’s a bold but uninformed statement. Healthcare organizations are very canstockphoto12450988 (1) networkingopen, transparent and willing to learn from one another. Whether it’s sharing best practices, hosting site visits, or the many collaborative groups that leaders participate in, we are constantly learning from one another.

Our upcoming Epic go live at the University of Vermont Health Network is no exception. Of course, we rely on the experience that our implementation partner and vendors have had at other similar organizations. That’s why organizations utilize their services.

But there’s also the professional networks that we develop and nurture over the years to draw on. When our CIO, Adam Buckley, asked me to look at an area that he was concerned about as we approach the go live, I did what I do. First, learn from the people doing the work and find out their concerns and what they think we need to do to ensure success. Then, turn to colleagues who have gone before us.

While I wasn’t close to this specific area when I was CIO at University of Michigan Hospitals and Health Centers and we implemented Epic, I knew I could talk to someone who was. I reached out to my CIO successor and one of the executive directors there to get a contact to talk to. Within an afternoon I had gotten a good sense from them of how they handled that function and insights from colleagues at two other large healthcare organizations. And then a follow-up call to drill down further with someone who manages the function. That’s the power of having a strong network and being able to learn from others. I owe them one! Continue reading →

12 tips for effective vendor management

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An EHR implementation involves more than just the EHR vendor. As we approach the November 1st Epic go live at the University of Vermont Health Network, the interfaces and interdependencies with other canstockphoto26237556 (1) VRMvendors become more critical. As we review issues and risks that need executive level attention, multiple vendors are involved. Whether it’s ensuring their system implementation and interfaces are ready on or in advance of November 1st, or it’s a product that we already use that just needs to work in a new environment, we are counting on them to share our sense of urgency and deliver as expected.

As I assist with some of these vendor relationships and escalations, I’m drawing on many years of experience with IT vendors – both software and infrastructure. We are fortunate to have a strong supply chain management team that partners with IT. They are involved from early on in vendor evaluations through contracting. They stay connected to IT and step in to lead or assist when we have vendor issues after implementation.

Two of my previous blog posts provide guidance on creating win-win relationships with vendors. In “Keys to successful vendor management” I outlined some key success factors:

  1. A good product roadmap: It should be clear what core solutions are available now and what their path forward is for the next several years.
  2. More service than sales – a strong service culture should be evident in the sales cycle and demonstrated throughout the duration of the relationship. A focus on service should be engrained in every one of their employees.
  3. Total Cost of Ownership (TCO) – you and the vendor should develop this together. It should include initial one-time fees, ongoing costs for their products and services, all required 3rd party products, and your internal staff. There should be no hidden costs or “gotchas” later.
  4. Reputation – be sure to do your in-depth reference checks. Colleagues in similar organizations are a great source of honest, candid information and experience – good and bad. If your vendor is going to host or manage the application/service for you, check on the change management and operational maturity with colleagues and references. Resources like KLAS, Gartner and others can be leveraged as needed.
  5. Solid contract – once it is negotiated and signed, you may never have to look at it again. But if you do, ensure you are protected.  There is growing market consolidation among larger vendors; start-ups are often acquired by larger firms. Ensure you are protected under these scenarios. Ideally you have someone in your Legal or IT department who focuses on technology contracts and knows the common issues and standard terms.
  6. Implementation – your vendor should provide onsite resources that are integrated with your internal team. Issues tracking and resolution is a joint effort. Status reporting should be a shared effort with a very objective, accurate view.  It should include an executive dashboard on status, milestones, issues and budget.
  7. Escalation – problems will inevitably occur. Escalation process should be clear from the start with a point person for both the vendor and your organization.

Continue reading →