On Best Practices

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 →

IT governance – basic but critical

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The first three months of my interim CIO engagement at University Hospitals has flown by. I’m fortunate to be working with a very talented IT team and we recognize there is always room for improvement. We canstockphoto22767750have already made some very positive changes and improvements. We are tightening up how we manage and monitor the production environment to reduce preventable incidents. We do a root cause analysis on every major incident and review them as a team at our bi-weekly leadership meeting, tracking all subsequent action items. We are making progress on numerous major priority projects and there have been several system upgrades and go lives during this period. We are doing detailed planning for our new hospital integration efforts. We are launching our visual management board and leadership huddle next week as part of our lean efforts. And we have re-established an executive level IT steering committee addressing the critical need for IT governance.

Our third IT steering committee will be Monday evening. Our CEO and other senior executives are engaged – exactly what we needed. They are developing a deeper understanding of our current work and the many new requests we have received since this year’s budget was approved. We have reviewed with Continue reading →

Corporate functions, local service

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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 canstockphoto34427718systems 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 →

Making the invisible visible

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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 canstockphoto26356044managers. 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 →