On Best Practices

Lean classics worth a second look

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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 canstockphoto19155139“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.

Gemba Walks:

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 →

The power of co-location

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There continues to be a lot of focus on telecommuting and open office space for knowledge workers in large organizations. Both are important yet not everyone agrees they are good – a lot depends on the canstockphoto12582566 for colocationorganization and the culture.

But I want to focus on another “space planning” topic, co-location. As health care organizations grow, administrative departments including IT often end up being spread out in many office buildings, sometimes at great distances from the hospital with a lot of traffic in between.

The investment needed to centralize all the administrative functions in one building often takes backseat to investing capital in clinical space. No surprise. Video conferencing is always an option for bridging the miles. This technology continues to advance and become more of a commodity. National and global companies must leverage technology but health care systems are mostly local or regional.

In my many years of health IT management, I’ve experienced a variety of space situations: Continue reading →

6 tips for successful huddle boards

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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 huddlecanstockphoto19155139 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 →

Learning from the annual industry list ritual

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Holiday gift lists, baking lists, family fun lists while kids are out of school and “honey do” lists while off from work…..we have personal to do lists everywhere. But as the year ends, it’s interesting to canstockphoto18647021look back on some of the industry based 2016 lists and look ahead at what to expect in 2017.

I’ve compiled some of the most interesting health care and technology lists to share as we approach this annual turn of the year. You’ve probably seen some of them already.

There are the best places to work lists where we can all learn best practices to attract and retain talent in a competitive market: Modern Healthcare’s Best Places to Work in Healthcare 2016 and Becker’s 150 Great Places to Work in Healthcare 2016. And more specific to IT, there is Healthcare IT News’ Best Hospital IT Departments 2016. Check out their profiles and possibly get some new ideas to apply in your own organizations. Continue reading →

Aspiring to Stage 7

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I recently participated as the CIO reviewer on a HIMSS Analytics Stage 7 validation. The long travel to the West Coast aside, I was happy to contribute my time and expertise to be exposed to an advanced

Source: HIMSS Analytics

Source: HIMSS Analytics

organization and to meet a wonderful group of leaders. The review team also included a Chief Medical Information Officer and the HIMSS Analytics Regional Director for North America.

As of the 3rd quarter this year, only 4.6% of hospitals have achieved Stage 7 while 30.5% have achieved Stage 6. Just over a third of hospitals are currently at Stage 5.

All three hospitals I’ve served as CIO have achieved Stage 6. Getting from Stage 6 to 7 is a significant leap. There is a greater focus on analytics and using the data from the electronic health record to improve patient outcomes.

From the HIMSS Analytics website, here is how Stage 7 is described: Continue reading →

Ensuring smooth leadership transitions

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Transitions of leadership are going on all the time in our organizations: a new CEO, a new VP, or new management at another level; it is change.

As I’ve written about, I just completed such a transition. I have served as an interim CIO for 8 plus canstockphoto33589643months. The agreement for the engagement was that I’d stay through the successful transition to the new CIO. We envisioned a 30 day overlap.

As the start date for the new CIO approached, 30 days seemed very long. Wouldn’t the new CIO want to get in and get started without me around? But as she and I started planning that time, 30 days seemed reasonable for all that we needed to do. When it came time to start the transition, there was so much else going on each day we found it hard to find the time to focus on the transition work. In the end, we both agreed 30 days was the right amount of time and extremely helpful to her.

But a 30-day overlap and transition period can be a luxury. Organizations often go through leadership transitions with far less time or even no time for the old and new leaders to work together. When I took the interim engagement, I had an hour conversation with the previous CIO on his second to last day; that was it. Continue reading →

Improving value, reducing costs

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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 canstockphoto17385502value. 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 →

One of those weeks…

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People often ask me how I find time to write a weekly blog with a big, busy CIO job. I tell them all the same thing – it’s a discipline. I try to start early in the week with an idea, draft it one night, come back to itcanstockphoto6248723 the next night to finalize and then post it on Thursday or Friday morning. Topics are often timely; something strikes me and I tell myself “that will blog”. I add the idea to my running list. This week it included tips on doing presentations for executive groups, personal organization challenges and tips, and what’s possible to accomplish as an interim leader in just 6 months.

But this week I had as many as five new ideas but no time to start writing any of them. By Thursday night if I haven’t settled on a topic and started, I’m in trouble. Taking time to write may compete with critical work I need to finish up by the end of the week. This week was one of those weeks.

This week started out with a bang.  By 9AM Monday, I was juggling 4 different issues. Continue reading →

Puppies and rainbows

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“You need to go beyond puppies and rainbows”. That’s the advice this week from a search firm expert. I’m part of the search committee for the new president of a non-profit organization where I am a board canstockphoto15113488member. The search expert was telling us to go deeper in our questioning. Get past the fluff and canned responses. He said it’s ok to make candidates uncomfortable.

I’ve done a lot of hiring in my management career for direct reports. And I’ve been on search committees for executive positions. I’ve also been on the other side of the search process being interviewed for CIO positions.

You review resumes, you listen to the search firm’s summary comments on each candidate, and then you finally meet the candidates in the first round of interviews. It’s a process. And you only have an hour or so to get to know each person.

What you see on paper are the qualifications. In the interview you get to know the person. I said in one of my first blog posts, hiring the right people is one of the most important decisions managers make. For executive positions, the process is more rigorous with more people involved. After all there is much more at stake when you are choosing one of the top executives.

You are all working off the same position description and the organization’s mission and strategy. Yet search committee members come to the process with different perspectives. Continue reading →

Making the invisible visible – part 2

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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.visual management board

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 →