What better time than year end to reflect on our collective progress as an IT team. You will see a lot of “top 10” type stories in December – top trends, breakthroughs, stories, and even top predictions for the coming year. I’ll leave those to people with far more time to research and write. What I’d like to share is the progress my incredible IT team has made in partnership with our many internal customers at UMHS in 2015. These are common journeys for health care CIOs around the country. Continue reading
Tag Archives: process improvement
Keep it simple and visual
The past month has been a particularly busy one for me. I have spoken locally a few times and gone out of town on business several times as well. I’ve been to the CHIME Fall Forum, made a site visit at Duke, and attended an AAMI board meeting. During that same period, I’ve given a talk on “Women in Technology” and participated on a CIO panel at the Midwest Fall Technology Conference in Detroit. I spoke on “High Impact IT” at the 2015 ICHITA Conference sponsored by the Center for Health Information Technology Advancement at Western Michigan University in Kalamazoo. I was one of two CIO guests on the CIO TalkRadio Show last week. And we published our monthly newsletter and held one of our twice a year department all staff meetings.
I have a busy schedule of meetings at multiple UMHS locations every day, so how did all these commitments come off without a hitch? The visual board my support staff and I started some weeks ago has made the difference! The only commitment that I scrambled on at the last minute was the one that hadn’t made it onto the board. That’s telling.
Prior to our visual board, I sometimes scrambled at the last minute to finish a presentation or finalize flight arrangements in time to get a reasonable price. Now, as a team, we can see into all the major events and commitments and take an organized approach to the shared tasks involved. Continue reading
Quality month: sharing improvement stories
Recently I wrote that October was Quality Month and I highlighted Dr. Richard Shannon’s excellent talk, part of our Lean Thinker’s Series. I “teased” that I would comment on the Quality Month poster sessions in an upcoming post.
For two days, 48 quality improvement teams displayed their stories as posters. I spent about an hour checking out the posters and talking with people from the teams. I targeted the ones with potential scalability or an IT connection.
Jennet Malone, a manager at The Briarwood Center for Women, Children and Young Adults, explained how they increased use of the portal.
Here are a few worth noting:
Got Portal? –The Briarwood Center for Women, Children and Young Adults
We rolled out our patient portal more than 3 years ago. Patient enrollment has been fairly successful with over 200,000 active users but this is still not at the level we need. This health center established specific goals for making portal functionality part of everyday clinic workflow and used by patients and families. They increased their marketing efforts and established staff incentives for meeting short term goals. They purchased iPads to help staff sign up patients. They added the portal metric to their daily huddle. The result: Briarwood Center for Women, Children and Young Adults has the highest percentage of patients on the portal when compared to other clinics! Continue reading
October is Quality Month!
Each year UMHS celebrates Quality Month and this year is no exception. Last week as part of our Lean Thinker’s Series, Dr. Richard Shannon, EVP Health Affairs, University of Virginia Health System, gave an excellent talk titled “Patient Safety and Quality: The New Currency in Academic Health Centers”.
It was good to hear how another academic medical center is approaching similar challenges and applying lean. Some of my takeaways from his talk and the lunch discussion that followed:
- Dr. Shannon described their Be Safe initiative – “Our Be Safe initiative is advancing our status as a high performing organization by systematically applying the scientific method (Lean Principles) to improve the safety of our patients and workforce through real time problem solving.” He shared examples of how they have reduced the incidence of hospital acquired infections, a problem for all hospitals.
- Senior executives hold a “situation room” and digital report out each morning. They spend 15 minutes reviewing critical problems that have been reported and then spend the next 45 minutes actually going to the units to understand the specific problems more deeply. And they do it on Saturdays as well.
- Their IT team plays a central role in providing data and reporting in support of their daily management system. They have developed the “Be Safe” reporting system. It is a common platform that supports daily manual entry from any employee and takes automated updates from other feeder systems. He emphasized the importance of having actionable data. All of their A3s are done online and uploaded to a library that can be queried. Patient safety events are documented with an online form as part of the system. I plan to reach out to their CIO, Rick Skinner, who has shared some of their lean stories with me in the past. Having heard Dr. Shannon’s talk, it’s time to get a much better understanding of their system.
Are we ready for the business of the day?
“Huddles, not just another meeting;” I wrote that when we started our twice a week IT leadership huddle in April. How true! And as of three weeks ago, we have another leadership huddle experiment in progress – the daily hospital leadership huddle. 
It is part of our developing lean Daily Management System.
Our Acting CEO and COO for the University of Michigan Hospitals and Health Centers, Tony Denton, runs the daily huddle. As Tony said in his initial communication, “The purpose of the leadership huddle is for senior leaders to have daily awareness of issues that may impede our ability to provide service. The leadership huddle is the “top tier” of a daily management system designed to surface issues and problems, assign leads for pro-active problem-solving efforts, examine trends and track progress. It is a key aspect of developing a more effective Michigan Operating System. If successful, we expect to see continuous improvement in our safety, quality, timeliness and financial results, and enhanced ability to deliver ideal patient and family care experiences through the engagement of our people.”
The value of these leadership huddles was clear the first week. Continue reading
Reducing costs while increasing value
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
So what’s the problem – A3 thinking
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?”
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
Making the tough decisions
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
Make your voice heard
March is Employee Appreciation Month. UMHS leadership is hosting breakfast, lunch or dinner at all our sites as a way to say “thank you.” We also conduct our annual Employee Engagement Survey this month. 
There are only two more days to participate in it.
I’m happy to say the IT department is at an overall participation rate of 66% compared to 48% for all of UMHS. We had a 90% participation rate in IT two years ago. It was my first year as the new CIO and I made it very clear to the people on staff that I couldn’t address problems in the department if I didn’t know what they were. I needed their input!
Based on the survey results two years ago, we established four workgroups to focus on several key areas. Some areas we were definitely weak on and others we were OK but knew we could improve – recognition and appreciation, employee development and training, service excellence and teamwork.
While we’ve made good progress in all these areas, I’m the first to admit there is still far more work to do.
I have been encouraging our IT department staff to “Make Your Voice Heard.” There are multiple channels for staff to give me and the entire leadership team input and feedback. In addition to Continue reading
Leadership huddles: not just another meeting
It’s huddle time! No, I’m not joining a sports team. But along with my leadership team, we are taking the next step on our lean journey. In a few weeks we’ll be starting twice a week 30 minute leadership huddles. 
This is part of Lean in Daily Work which also includes key visual metrics, visual boards, Everyday Lean Ideas (ELI), and leadership walks.
In a post last summer, I talked about the lean journey. It is important for leadership to set common expectations throughout an organization. So if we’re going to practice lean thinking as a department, our leadership team has to set the example.
The goals of this lean experiment include the following:
- Create a common understanding of what our performance is compared to what we want it to be so that we can understand the gaps and improve
- Make our work visual and actionable
- Understand our business more deeply by asking questions and looking at trends
- Surface, track and trend problems
- Gain experience and practice with lean