Tag Archives: lessons learned

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….

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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 →

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 →

Project in trouble? Some dos and don’ts

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If you work in IT, you’ve probably seen your share of projects that need help getting back on track. I could share a lot of stories from my many years in IT in multiple organizations. The complexity and scale of what canstockphoto12827499 (1) dowe do in IT continues to amaze me. Drawing on that experience, I want to share my tips on what to do and not to do if you find yourself taking on a troubled project.

What to do if you want to ensure success:

  • First, stop the churn
  • Get up to speed on the project scope, issues, and challenges as quickly as possible
  • Seek to understand enough of the past to inform the future
  • Focus on getting the project back on track and moving forward
  • Figure out who’s who, what their respective roles are and who owns what
  • Assume positive intent
  • Show respect and gratitude for all involved
  • Ensure all issues are surfaced, assigned to an owner for resolution, and tracked
  • Remove obstacles as they arise
  • Be transparent with leadership about the status and issues
  • Track progress using key metrics
  • Use daily huddles to ensure team members are on the same page, focused, and raising issues
  • Manage expectations for all involved and impacted
  • Document decisions so you don’t have to revisit or rehash them later
  • Consider what levers you can pull such as timeline, resources, budget, or scope
  • When you can’t change the timeline, be ruthless about scope changes
  • Keep calm – reduce team stress, diffuse conflict, and avoid finger pointing

And some tips on what not to do: Continue reading →

Spring can’t come soon enough

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As my daughter says, “You didn’t really think that through, did you?” She wasn’t referring to getting a new puppy which we’d talked about for months. She was referring to getting a “winter puppy” in the North.IMG_0295 (002) puppy

We trained new puppies in the summers of 2006 (Pepe) and 2008 (Coco). We had to let go of Pepe in 2017 due to a tumor on her liver; since then, we focused all our love on Coco. Then, we decided Coco needed an “intern”. Coco would have a friend that she could help train. What a concept!

We got our new puppy, Rosie, in late January. She was about 10 weeks old then.  We bought her a little dog sweater and puffy dog coat. We got her a collar and a leash. We hadn’t really thought that through.

Because, when we picked her up, the breeder said she was like an infant. She couldn’t go outside until probably end of March or she might catch a cold or pneumonia. Plus, she needed her three puppy shots – second was due mid-February and the last one mid-March – before she could be outside around where other dogs have been. Coco is up to date on shots, so they can share space in the backyard. That is, after the snow and cold is gone.

I haven’t even gotten to the two dogs getting to know each other part yet.

We set up Rosie in the shower stall of our guest bathroom. We made a little bed for her, put her food and water dishes nearby and put down papers for her to do her business on at the other end of the shower stall. We leaned a baby gate across the entrance to the shower. We let her out and played with her on the bathroom floor several times a day. We brought her down to the living room at night to sit on our laps while we watched TV. Mostly this worked and she was content. Continue reading →

2018 Countdown – top 10 blog posts

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It’s the time of year for top 10 lists and countdowns so I’m adding mine to the mix. These are my most read blog posts from 2018. If you missed any of them first time around now is your chance to check them Top10out.

I cover a range of topics and it looks like readers appreciate the variety. Here are the top 10 as measured by total views with a countdown from number 10:

#10 – Find your voice, a mentor and be bold – Career advice is always a popular topic whether you are early or late in your career.

#9 – What does a high value conference look like? – There are many ways to spend time and money on professional development, some conferences provide unique value.

#8 – Family ties – we all have a story – It’s important to know where we come from to understand who we are.

#7 – Technology making a difference at scale – One of my personal favorites! The power of technology takes many forms. In Africa, drones can be lifesaving.

#6 – 8 Signs of a strong security culture – Security is always a topic of interest as threats continue to increase and organizations are challenged to keep up. Continue reading →

Never underestimate the importance of good communication

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When you go into business for yourself, you have to make a lot of decisions. One of the most important decisions is who to partner with. I have learned a lot from my two colleagues, David Muntz and Russ canstockphoto9328194 (1) communication word cloudRudish, in our StarBridge Advisors venture over the past two years. They have very different styles, skills, knowledge and experience. But together we make a great team!

Communication skills are critical no matter what business you are in or what level you are at in an organization. David recently wrote an excellent piece on communications for our StarBridge Advisors “View from the Bridge” blog – Meaningful Communication – 10 Lessons from Life.

His life lessons provide an important framework for successful communication in all forms. And as he says, without communication, collaboration is difficult.

I highly recommend you check out David’s blog post. And if you like what you see, read more of our View from the Bridge posts and subscribe to receive notifications of new posts.

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What can we learn from sports?

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My husband and I recently went to a Red Sox game. We are not the biggest of sports fans, but we like to get to a game or two each year. It was a glorious summer day – sunny sky with a temp in the mid-70’s. A canstockphoto56121 (1) baseballperfect Sunday afternoon for a baseball game. We all know that baseball can be slow at times with brief moments of intense action. I put my crowd dynamics lens on and observed.

First there’s the “wave”. How do they start? And what does it take for them to be successful? The first one started in a section near right field, had to go through the grandstand area, and over to the “green monster”. If you don’t know Fenway Park, the green monster is a special section that probably has no more than 200 people in it. A prime spot for the wave to lose momentum. But it didn’t. It went all the way around the ballpark at least twice.

When another section started a second wave later in the game, it fizzled quickly. But my husband made sure he did it when the wave rather pathetically got to our section. He didn’t want to be the one to kill it. The takeaway – everyone must participate to make it successful.

Then there was the “dance off” between innings. The cameras focus on different fans around the park and when people see themselves on the big screen they do their best dance moves. You never know what you’ll see. Inhibitions are off for many people, especially kids. It was a young middle school age boy who won – he had the moves and the fans loved it. The takeaway – be less inhibited and you may go further.

And then there is the rhythmic clapping that starts and grows in intensity. It’s either to encourage the home team at a critical moment or to make the other team nervous. Continue reading →

Advice for bloggers: valuable content and discipline

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In the early 2000s, there was an explosion of blogs, but I never pictured myself as a blogger.  But that changed four years ago when I started a weekly blog to share my health IT experiences and insights with canstockphoto13207113others.

It is a weekly discipline I’ve maintained ever since.

I love data. So, I look at the statistics on views per week and per post. I’ve published over 200 blog posts and have had close to 100,000 views.

Over the four years, the posts on lean are by far the most popular – 6 of the top 20 posts – including huddles, visual boards, Gemba walks, and use of an A3. The lean community shares content broadly and openly as they learn from one another. A very good practice! So, maybe I shouldn’t be surprised at the popularity of these posts.

I ask myself “what generates views”? Is it the opening tease and blog title that attracts readers? Is it the title or general topic that causes subscribers to read a blog when they get the email notification? Is it the re-publishing by other publications or links from other sites?

Despite all the analytical tools and articles available on how to increase blog subscribers and readers, it comes down to valuable content. Yes, the catchiness of the title and the use of keywords make a difference. I learned that decades ago writing headlines when I was editor of my high school newspaper. But back then the world of content was all paper; now you can search for anything online in seconds. We all know that on social media you must compete for “eyeballs.” Hence, the importance of keywords.

When I first considered starting a blog, I sought out an expert to give me advice. I called Anthony Guerra at HealthSystemCIO.com. Was it a crazy idea or should I go for it? He encouraged me early on and I’m truly grateful for that. It helped me go from considering blogging to actually being a blogger.

I’ve learned how important amplification is in the world of social media: tagging people, likes, comments, and shares. Then there’s “going viral” – nobody knows the secret formula to that. Continue reading →