On Best Practices

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 →

Teamwork at its best

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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 →

Power of a PMO

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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, canstockphoto10610367methodology 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 →

What upgrade?

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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 →

Just breathe

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Our quarterly IT Town Hall was this week. It’s a chance to bring all staff together, welcome new employees, and recognize promotions and special individual accomplishments. Each IT leader highlightedcanstockphoto15842113 3 successes in their areas this quarter and their 2016 priority projects. I commented on the changes we’ve made: re-establishment of IT governance, process improvements to ensure a more stable production environment, and our new visual management board.

We squeezed all of that into the first half hour so we could get to our guest speaker, Dr. Francois Adan, Medical Director of UH Connor Integrative Health Network. She gave us something we could all use: techniques to manage stress.

In 50 minutes, through very compelling stories, we learned what seemed like relatively simple techniques. It’s all about breathing, mindfulness, positivity, and gratitude. Basic practices we can apply every day. With Dr. Adan’s engaging speaking and teaching style, it was a delight to learn from her.

So what did we learn? Continue reading →

Who’s on first?

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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.

Putting a face on IT

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As IT leaders, we get used to hearing complaints about IT: we are not being responsive enough; our systems are unstable; too many clicks in the applications; not knowing who to call. The list goes on and canstockphoto20456258on. There are times when you think you can’t possibly please everyone. It’s may be why so many people have sat across my desk and said they’d never want my job. But I have learned that proactive, honest communication with your users is critically important.

One step is to survey your users about their issues and their satisfaction with your solutions and services.  This can be an extensive survey about a particular system or of one group of users. Or it can be a simple, few question survey after calls to the service desk. Regardless of the type of survey, make sure to let your customers know you’ve heard them. Publish the results and action steps to address problems. No matter how negative some of the results may be, you have to be transparent. And re-survey at the right interval to check if you have moved the dial.

Another step is to make the IT leadership team very visible and accessible. Provide easy to find information on who is responsible for what and how to contact them. Get out to the right leadership meetings and forums to provide IT updates; solicit feedback and concerns. Show you care and are listening. Continue reading →