Tag Archives: process improvement

Leadership and crisis management lessons from Pennsylvania

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I love seeing stories of success with lessons to apply to our work in health IT. The recent I-95 collapse in Philadelphia and the re-opening in just 12 days is one of those stories. There was a great opinion piece in the Washington Post on July 16th by Pennsylvania Governor Josh Shapiro – “Opinion: We fixed I-95 in 12 days. Here are our lessons for U.S. infrastructure”. Initially experts told the Governor it would be months before they could reopen the highway and get traffic flowing. Instead, they reopened it in just 12 days. Indeed, there are many lessons for leaders in all industries.

Here are the four key takeaways he comments on:

  1. Empower strong leadership
  2. Speed up the bureaucracy
  3. Encourage creativity
  4. Work together

In the face of a crisis, empowering strong leadership is critical. We’ve seen it in healthcare during the pandemic and when responding to any kind of disaster. As Governor Shapiro describes it – “Managers of every component of the project were empowered to be decisive, take ownership and make a call when necessary — not defer and delay to the often-circular bureaucracy. Decisions were made quickly and in a synchronized manner.”

We have plenty of bureaucracy in healthcare including many processes in IT that seem burdensome. Governor Shapiro described how an executive order he signed shortly after taking office that catalogued each of the 2,400 permits, certificates and licenses the state issues and set timelines for each of them resulted in significantly reducing wait times – with one example cutting the time from eight weeks to two days. IT leaders take note – how many processes can be streamlined in your shop?

Innovation in healthcare is greatly needed and there are many bright spots we read about each day. But innovation is not just the new big flashy stuff, it can be a creative and new way to solve a problem that comes from someone on the team or an observer. Governor Shapiro wrote, “Encourage creativity and allow everyone to bring their ideas forward”. The backfill solution to rebuild the collapsed freeway using a recycled glass product was a result of that creativity from PennDOT engineers.

We all know there is no “I” in team. We accomplish great things by working together. In Pennsylvania, state and federal officials coordinated closely with each other and private contractors and organized labor collaborated working 24/7 to get the job done.

While we never want a crisis to manage through, there will be more. These lessons will be key then and every day.

Related Posts:

Leading through a crisis

Unlocking the power of time: insights from an inspiring leader

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Today is the longest day of the year and the official start of summer. This longest day leads me to reflect on how we spend our time.

I recently had the pleasure of interviewing Saad Chaudhry, Chief Digital and Information Officer at Luminis Health, for a Townhall episode on This Week Health. Saad is an inspiring leader on so many levels so preparing interview questions was easy. I had heard Saad talk in the past about what he calls his Manifesto of Time, so I wanted to make sure we discussed it in the interview. For Saad, looking at the number of hours the average person has in their lifetime means looking at how we choose to spend it and whether we give or take time from others.

As a health IT leader, he says we are in the business of time. He is committed to giving time back to staff and patients. He asks in his manifesto – “Does a process/technology/policy steal time from a fellow human? Is there a better alternative to simplify the experience?” He challenges us to make systems and processes easier for patients and staff, giving time back rather than taking more time from them.

I can’t say it nearly as well as Saad, so I encourage you to read The Manifesto of Time and listen to the short clip on time from our interview – Spending Time: Why It’s Important to Maximize Giving Back Our Most Valuable Commodity. We covered much more in the full interview if you are interested and willing to spend 30 minutes of your time listening – A Realigned Role, Generational Diversity, and Giving Back Time.

I know your time is precious – thanks for reading and listening!

End of year thoughts and advice for 2023

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This week in between holidays is a time when leaders may be working a more relaxed schedule and planning for the coming year. When I was a full-time CIO, I appreciated this last week of the year with few to no meetings and the opportunity to cleanup, catchup, and prepare for the new year.

While the past three years have at times been a blur as I try to recall when certain pandemic related events and changes happened, and the political discourse is incredibly discouraging at times, I remain optimistic about our collective future.

Health IT leaders will continue to face staffing challenges and cost constraints as organizations are under increased financial pressures. The successful health IT leaders in 2023 will be those who can partner effectively with their peers as a member of the executive team, support their organization’s strategic priorities and goals, find ways to reduce costs without reducing services, create flexible work environments with workforce strategies that ensure the best talent on the team, and embrace new and innovative technologies that solve real problems and improve the patient, clinician, and employee experience.

As in previous years, my StarBridge Advisors colleague, David Muntz, has again written an excellent year end blog – 12 Steps to Prepare for 2023 – Big Challenges – Bigger Opportunities. His 12 steps are worth considering as you plan for 2023. And his intro is a powerful reminder of why we work in healthcare and the kind of people we should strive to be in all our interactions:

“Healthcare is a people business.  We need to remind ourselves and our coworkers that mercy and compassion, not anger, define our profession and us as professionals.  We need to model mercy and compassion in our personal lives, in our interpersonal relationships, not just with family and friends, but with strangers and, equally important, our coworkers and business partners.  One way to do that is through genuine listening in pursuit of true understanding – so easy to say, so difficult to do.  Give others an avenue to express themselves.   For your own sake, lower your defenses.  As you create a list of resolutions for the new year, please add to it active and courageous listening, building trust, and treating everyone with kindness.”

May your 2023 be a healthy, peaceful year filled with kindness!

Rounding in a virtual world

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If you are a regular reader of this blog, you know I am a fan of lean concepts and practices. In fact, my posts on lean have been some of the most popular ones over the years. So, it is no surprise that I have embraced a form of rounding or “gemba” now that I am serving as interim CIO at Boston Children’s Hospital.

As part of our commitment to being a High Reliability Organization (HRO), Boston Children’s Hospital has a program called “Rounding to Influence” (RTI). With this program, senior leaders meet with staff in their areas to discuss a specific topic and solicit input. The Rounding to Influence program is facilitated by David Davis, Vice President, Patient Safety, Quality and Regulatory Affairs. When I learned about the RTI program several weeks into my interim engagement, I was quick to start participating.

My first experience was tagging along virtually with Laura Wood, EVP Patient Care Operations / System CNO, on her rounds with clinical staff along with a few of my IT leaders. Given the topic for that session was about having the right information to perform your work, it was a great place to start and hear from our clinicians and support staff. Here were the questions:

Having the right information and data is important to everyone in order to perform their roles effectively.  Depending on your role, do you have trouble finding the information or data you need to do your job?  Do you know how and where to get the information/data you need?  Do you have concerns you are seeing incomplete or unreliable data?  How would you know?  How can we be more reliable in our information and data sharing?

The obvious next step was to start virtual rounds with our own IT staff. Here is how it works. Continue reading →

Conducting project “lessons learned” as continuous improvement

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As I caught up on my industry reading this past weekend, I saw several implementation best practices articles – advice from experts on EHR, Telehealth, Pop Health, and Medical Device implementations. These kinds of resources are always helpful to think beyond your organization’s experience, get a different perspective, and learn from others.

At the same time, conducting lessons learned sessions internally after major projects is critical. While it’s still fresh in your mind, being able to look as a team at what worked well and what didn’t work well over the life of the project is an important step before moving on to the next project or next phase of a multi-year project. This should be done in the spirit of continuous improvement. Ask yourself, what can be learned from this project that can be applied to future projects. And be sure to document that in a way that is referenceable in the future.

We are just over 3 weeks post go live for Wave 1 of our Epic project at the University of Vermont Health Network (UVMHN). We start a series of lessons learned/debrief sessions this week. IT managers have been asked to think about three questions and submit them in advance so they can be compiled for review and discussion:

  • What worked well?
  • What didn’t work well that we should modify?
  • What didn’t work well (or was unnecessary and we should no longer do)?

As we planned for the sessions, I suggested that we have a few guidelines – no blame, assume positive intent, and ensure everyone is heard. UVMHN has a very collaborative and team-oriented culture so that shouldn’t be difficult.

Often, it’s easy to go right to what didn’t work well. Those examples may be top of mind. But there is so much in a project of this magnitude that is done well. Capturing those points and making sure you repeat them in the future is important.

Wave 2 planning started before the Wave 1 go live. Certain lessons have already been looked at as part of that planning. But the upcoming sessions will be an opportunity to look more broadly and get the input of all areas involved. Given I’ve been interim CTO since late May, my involvement did not span the entire project but rather certain aspects in the last few months including the go live. I look forward to hearing everyone’s perspective on how we can do better and build on the successes to date.

Related posts:

10 Go Live Command Center lessons from the field

Epic Go Live – report from the field

9 Tips for Go Live support success

Plans, processes, people: lessons from a successful EHR implementation

Press 1 for… Press 2 for…

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Does hearing this cause anxiety and impatience? Or do you think, great, I’ll soon be talking to the right person to help me? I am usually impatient when it comes to getting help with something. I find it frustrating canstockphoto20456258to listen to a long list of phone options, to wait for someone to be available, then get bounced around between call center staff and repeat my information multiple times.

But call centers and automated attendant systems are our new reality. There will be more use of artificial intelligence (AI) and Chatbots in the future. If designed properly, the customer experience can be a positive one.

I admit that I quickly forget the experiences that are smooth and positive. But I remember the ones that aren’t. I had one of those not so positive experiences this week.

While driving on the freeway last Friday, something flew off a truck and hit my windshield creating a crescent like crack the size of an orange. Not something to ignore and put off.

Making the call to my insurance company and being routed to the auto glass service they partner with involved getting redirected to different numbers, providing the same information multiple times, and still not getting the result I needed. In the end, I got it worked out when I contacted the service provider directly.

This not so positive experience reinforced how important it is for us to design the optimal flow and support structure for our command center (a call center on steroids) during our upcoming Epic go live at the University of Vermont Health Network. Customer service encounters in some form are an everyday experience. They should be easy, quick, and have a positive outcome. Continue reading →

“We’re at meeting norms”

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That’s a new phrase for me. One I’m still getting used to at my current interim engagement in IT at the University of Vermont Health Network. Said like that, it means it’s 10 minutes to the hour and time to wrap canstockphoto15517676 (1) meeting normsup the meeting. Time for people to shut down any video conferencing, clear the room, take a bio-break and get to their next meeting. And for others to come in and get set up for the next meeting to start right on time. And start on time they do.

This is a meeting discipline that makes a lot of sense and everyone seems to have adapted to it. As the new outsider, I’m still getting used to it and trying my best to conform. Get there on time and if chairing the meeting, wrap up by 10 minutes to the hour (5 minutes if it’s a 30-minute meeting).

Other meeting norms the IT department has established include all agendas and meeting materials available in advance as part of the meeting invite, not sent around separately as emails with attachments. I was told early on that if a meeting doesn’t have an agenda, you’re free to not attend the meeting. While I’ve seen no specific guideline on this, I wouldn’t be surprised. Another way to ensure meetings have purpose and a plan for the time. Continue reading →

What organization can’t benefit from lean?

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As I start my interim management role at a new organization, I’m learning about pockets of best practices throughout the health network for daily huddles and other lean methods. I’m learning from my team that canstockphoto67324721 lean thinkingidentifying the right metrics to measure in IT is a challenge.

And of course, I’m getting a lot of standing meetings added to my calendar while trying to understand what each group’s unique purpose is and where specific type decisions are made. These are important questions given most organizations have too many meetings and people often say they spend too much time in meetings.

One of my first observations week one as I listened to colleagues is that there is potential for lean methods such as a daily management system, huddles, and visual boards.

I’ve learned a lot about lean and what it takes to introduce new concepts into organizations in recent years. One of the most important lessons I’ve learned is to listen and get to know an organization before making any assumptions.

I will be doing a lot of listening and learning in the coming weeks. When it comes to lean methods, I will share my experiences in previous organizations as it makes sense with my new colleagues and teams.

If you share my passion for lean thinking or are interested in learning more, check out my post “Lean classics worth a second look”. It’s a recap of previous posts covering huddles, visual boards, and gemba walks from my journey as a lean leader in different organizations. And if you have a story on how you have applied lean thinking in your organization, I would love to hear it.

Related Posts:

6 tips for successful huddle boards

Leadership huddles: not just another meeting

Making the invisible visible

Making the invisible visible – part 2

Importance of rounding or going to the “gemba”

Go to the gemba, seek to learn

Celebrate nurses, but more importantly listen to them

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May 6-12 is National Nurses Week. According to a Gallup Poll, nursing has been the most trusted profession for the past 16 years. It’s no surprise.Nurses Week (002)

Those of us with nurses in our family are grateful that there is someone we can turn to with health questions. They help us navigate complex healthcare systems when we have a worrisome condition and need to see specialists and subspecialists. I’m fortunate to have nurses in my family. I am grateful to them and know that I should never take them for granted.

As the President of the American Nurses Association, Pamela Cipriano, PhD, RN, said, “Nurses provide much more than bedside care. We advocate for patients, deliver primary care, meet the complex needs of patients with chronic conditions, volunteer for disaster relief efforts, and are a trusted voice in boardrooms across the country.”

When my daughter first considered a nursing career back in the early 2000’s, I was very supportive. I thought that with her personality, people focus, and an incredible ability to multi-task she would be an excellent nurse. I told her that she could take many different paths as a nurse over time. She already had a bachelors degree in Hospitality Administration/Management with a minor in Business, so she decided to attend a combined nursing/nurse practitioner (NP) program to get her BS in Nursing and her Masters in Science and Nursing.

She worked as a bedside nurse, first on a cardiac surgery stepdown unit and then on a cardiac surgery ICU. Her first nurse practitioner opportunity was working with patients who have atrial fibrillation (known as Afib). She later moved to orthopedics where she is now the Chief NP on a busy and growing inpatient ortho unit.

She balances clinical patient care with administrative responsibilities. And she is always looking at how to improve processes and care. Continue reading →

Walking in a nurse’s shoes

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National Nurse Week begins tomorrow. I’m fresh off a 4-hour shift shadowing a nurse on a busy inpatient unit with cardiac surgery patients. I was taking part in the “Walk in My Shoes” program at Stony Brook Sue in scrubs cropped (2)Medicine where I currently serve as interim CIO.

All the executives were asked to block out 4 hours this week to shadow a nurse. I looked forward to my shift despite the other work on my desk. And as I told the nurse I shadowed, spending time on their unit was more fun than some of the problems I deal with as a CIO.

But I wasn’t there to have fun. I was there to understand what a nurse’s day is like and find ways that administration can help. And as the CIO, I wanted to understand how they use the systems we support and to find opportunities to improve them.

I donned a pair of scrubs, the universal hospital uniform and a fashion neutralizer. It’s amazing how different it feels to be on a nursing unit in scrubs compared to being a “suit” who periodically does rounds with a bunch of other “suits”. The staff seemed more willing to just tell it like it is when I encouraged them to be candid with me.

As soon as got to the unit a nurse realized I was from IT. His first thought was that I was there about a system problem that had been reported in the patient safety system. I introduced myself and my role as interim CIO. I told him that while I was there to shadow another nurse, I wanted to hear about their IT issues.  This was my “gemba” walk with a group of nurses. Continue reading →