On Best Practices

Reducing costs while increasing value

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Except for maybe start-up technology companies, there isn’t an IT department anywhere that has an open checkbook. In health care, we know all too well the need to manage costs while answering what seems to be an insatiable demand for technology solutions. CIOs need to understand the technical debt of a large application portfolio and the total cost of ownership (TCO) for systems. They need to find ways to reduce the cost of commodity services, and to create capacity for new work.

At UMHS, we have an initiative called Value and Margin Improvement, or VMI.  The VMI program is a multi-year effort across the health system.  UMHS leadership launched VMI to help achieve our financial stewardship goals by empowering collaborative teams to design and implement sustainable improvements that enhance value and financial results.

VMI aims at reducing duplication, inefficiencies and non-value added work in order to more effectively manage our costs, improve the value we provide and increase our margin.  A positive operating margin allows us to invest in the future and better serve our patients, referring physicians, students, the research community, and other key stakeholders.

VMI projects take a balanced approach to improve and sustain overall value while still maintaining the desired safety, quality, service delivery, and employee engagement metrics. The program promotes the use of lean methodologies and collaborates with our central lean team, the Michigan Quality System (MQS).

We are systematically moving through Continue reading →

Commit to a healthy workforce

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Last week I joined the second “Summer Walk” that the MHealthy champions in our IT department organized. It was a 1.5 mile round trip between our two main office facilities during the lunch hour. We had about 60 participants for each walk. What a great way to get some exercise, connect with colleagues and show our shared commitment to healthy living!

I wasn’t planning to do the walk when I first saw the announcements and flyers around our office. I expected that I had meetings during that time. But when one of the MHealthy champions reached out directly and asked me to show my commitment to healthy living, how could I say no?  It turned out that I could join them if I left a meeting 15 minutes early. I’m glad I did; literally “walking the talk”.

Our department is so committed that we were recently recognized as being one of the top performing areas, with 58% of employees participating in the University’s MHealthy Rewards program. More than 21,000 people throughout the University took advantage of the annual opportunity to review their health status, develop an action plan for improvement, and participate in helpful programs and services such as Active U, Weight Watchers, tobacco treatment, or stress-management programs. This is the program’s seventh year.

Our department’s MHealthy workgroup is developing new plans for activities and events to promote physical activity, healthy eating, and other positive health behaviors. The Summer Walks on the last Friday of each month are just the beginning.

They have also started a FitBit community for the department. Continue reading →

Leaders learning lean — time for a field trip

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Say that title fast! We held our quarterly IT leadership retreat this week. As we continue on our lean journey, I decided a field trip was in order.

James Goebel explains how employee can see their scheduled tasks on the resource management digital board at Menlo Innovations.

We spent two hours at Menlo Innovations getting a private group tour from co-founder James Goebel. To prepare, we read the “The Joy of Lean Innovation: A Case Study of Menlo Innovations” and listened to a Gemba Academy podcast of an interview with Richard Sheridan, Menlo Innovation’s founder and CEO. Many others from University of Michigan Health System have visited Ann Arbor based Menlo over the years. I’d been encouraged to make a visit by my lean coach, Margie Hagene, and our internal UMHS lean champion, Dr. Jack Billi.

Menlo is a software design and development company. But we weren’t visiting to understand their approach to software. Rather, we wanted to understand how they have applied lean principles to run their business and create the culture that Richard Sheridan describes in his book, “Joy, Inc. – How We Built a Workplace People Love.”

Two of our new IT directors are in their third week, so we started the retreat by each describing the most effective leadership team experience we’ve had. The themes that emerged Continue reading →

Time to stop and smell the roses

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That old saying “stop and smell the roses” could be updated for the road warriors among us to “stop and look at the incredible aerial views”.  Recently, I was on a flight that included the dreaded holding pattern and circling.

The destination airport was closed due to heavy fog. But out my window was a beautiful sight. Light, fluffy clouds and green forests dotted with little towns as far as I could see.

I had been doing my usual on a business trip…..catching up on email and work reading. I prefer aisle seats but this flight I ended up in a window seat. So with a great view, why not “stop and smell the roses” a bit.  Or call it being mindful as many of us are now trying to be more often– fully aware and in the present moment.

The pace we go is faster and more intense than we may like. Weekends are filled with commitments, errands, and more work. I think “what would it have been like to live the slower or simpler life of my grandparents,” but then I’m quickly back to reality. I do appreciate the many advances we take for granted.

We’re in constant motion. Continue reading →

So what’s the problem – A3 thinking

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If you don’t know what an “A3” is, don’t worry. When I started at University of Michigan Health System, I didn’t either.  When I first saw an A3 meeting on my calendar, I asked “What group is that?”

Plan, do, check, act. PDCA on white isolated background. 3d

There were so many groups with different acronyms!  Turned out it was a meeting with a few colleagues to update our status report on major UMHS IT initiatives. We were using an A3 format for our report.

So what is an A3? It is a tool used as part of Plan-Do-Check-Act (PDCA).  The A3 name actually comes from the paper size (11 x 17 sheet) that tells a story laid out from the upper left-hand side to the lower right.

Telling the story of a problem on an A3 includes looking at the background (why and what), describing its current condition (where things stand), and doing a root cause analysis. And then, establishing goals and targets, proposing countermeasures, making an action plan and determining success metrics.   Continue reading →

Safety hurts, service heals

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Patient safety is at the top of our list as health care providers. My experience on a recent flight from Boston to Detroit reinforced the importance of “safety first.” We left an hour late due to weather. But, twenty minutes into the flight, the pilot told us there were problems with the landing gear; the safest thing to do was to return to the Boston airport. He told us he’d know more after we landed. Problems with the landing gear but we were going to land OK? Of course the next half hour was one of the longest ever. We did land safely, de-boarded and waited for news of when we’d depart.

The first word we got was via text and email notification – we’d depart on a different plane around 11:20PM. We originally were to arrive in Detroit at 9PM. In the next few hours, the departure notifications got worse and worse – 11:45PM, 12:20AM, 12:45AM, 1AM, and back to 12:45AM. Passengers with connecting flights tried to get re-booked on other flights that night or in the morning. Some decided to fly to other cities first adding to the number of connecting flights they’d have. I was on a direct flight heading home so I waited patiently for whenever we would eventually leave.

We finally departed at 1:45AM. I got to my house at 4:30AM – about six and half hours later than planned.

What amazed me during all this was that Continue reading →

7 tips for managing in the fast lane

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It’s generally a bad sign when the seat belt warning light for the passenger seat comes on but you are the only one in the car. You’ve got too much weight on that seat and the car thinks it’s a person who needs to fasten their seat belt.

This has happened for me a few times lately.  It’s when I have thrown my briefcase and stacks of work for the weekend or the evenings on the seat.  Or I’m out of my office at hospital meetings for several days in a row and need various files with me.  The passenger seat becomes my file cabinet until I’m back in my office.

If I’ve been out of town to visit family or on business, it gets even harder to manage the volume.

People say they don’t know how I do it….how do I keep on top of everything. I respond, typically, “I don’t do it that well.” I’m my own worst critic. But I try my best.

So how do you survive and be your best at times like this?

Triage skills – Review your email inbox and make sure that the time sensitive ones are answered. Look for emails from your direct reports, boss, peers and customers to handle. Continue reading →

Where do new ideas come from?

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New ideas can come from many places. Are new ideas the same as “innovation” which has become almost a buzzword these days? According to Webster’s Dictionary, the answer is yes. Innovation is defined as “the introduction of something new OR a new idea, method or device.”

In the past week, I’ve met with health care CIO colleagues from around the country, heard some excellent speakers at our UMHS annual leadership day and met with my staff at our semi-annual all staff meeting.  New ideas came from all those varied places.

Meeting with CIO colleagues last week, I heard a lot of great ideas. I learned about a new mobile app that addresses the stress that families feel when their loved one is in surgery because they lack information. I learned about a storefront “genius bar” service inside a hospital that helps patients and families sign up for the patient portal, get information about the best mobile health apps, and connect their FitBit or glucose monitoring device to health apps. I learned how one colleague is applying a successful implementation go live readiness assessment approach to ongoing project and support work. And I learned how a colleague is leveraging a product’s additional functionality only to realize that we haven’t begun to make the most of that same product here at UMHS. I will be sharing all these ideas in more detail with my leadership team in the coming days. Continue reading →

The power of learning from your peers

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I spent the better part of a day this week at the annual meeting of the Epic Michigan Users Group (we call it eMUG). But I don’t want to focus on Epic. I want to talk about the value of learning from your peers. It could be any vendor or any user group.

This was our fourth annual eMUG conference. Given space limitations, we had 200 attendees last year and with the venue this year we were able to accommodate 400, a significant increase. With 11 health systems in Michigan on Epic, that’s a good size group from each organization.

When asked for a show of hands on how many had been to Epic’s national user group meeting (UGM) before, only 25-30% of the attendees raised their hands. Local user group meetings like eMUG give many more staff a chance to attend and connect with their peers. National user group meetings are costly with airline and hotel expenses for a couple days.

This eMUG meeting was a content rich day: Continue reading →

Making the tough decisions

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We make all kinds of decisions every day. Some are small yet seem difficult at the time. One I sometimes joke about is ordering off a restaurant menu that has too many good choices. When I finally make my order, I tell the server that I have made my “major life decision” for the night.

Sometimes a group makes a decision after weeks or months of lengthy deliberation: many groups have weighed in, expressed their concerns, asked their questions, refined the plan or recommendation, and only then ultimately provided their support.

And then there are the potentially very impactful decisions that must be made in a matter of minutes with the best information you have available after a very quick weighing of the risks. I had to make one of those decisions last Friday.

We had scheduled our Epic version 2014 upgrade for the weekend. The plan was to bring down the production system at 12:30 AM Saturday. The system would be down until 5:00 AM while the final conversion tasks were completed. IT and operations staff were scheduled in the command center to monitor the upgrade and address any problems. Leadership calls were scheduled daily to review issues starting Saturday.

At 11:51 AM on Friday, I got a text Continue reading →