As healthcare CIOs, our lives are filled with change in almost every aspect of our job. Most of the changes we deal with, however, are about inflicting change on others as new systems come online and upgrades wreak havoc on our organizations.
Despite the constantly changing environment to which we’ve become accustomed, stepping into a new organization brings with it a completely new type of change; a change that strikes at the foundation of what we have become comfortable with, and requires us to develop a strategy for getting the new organization up and running to meet the challenges we’ve been tasked with. As I have recently made a change, I wanted to take the opportunity to write about my transition process and the approach that I took.
As with any transition, getting to know the leaders and staff was the critical first step. Through this process, everyone had an opinion, and information flowed like the proverbial water from a fire hydrant. If I made any attempt to act on all of the free advice, I’m sure I would have been run out on a rail, simply because of the vast disparity in the information I received.
As I assimilated the data and got my arms around the culture, five logical steps quickly surfaced as the road I needed to take: 1.) Structure, 2.) Staffing, 3.) Governance, 4.) Process, and 5.) Metrics.
Structure: While every IT department around the country has a different structure, and job titles vary, there is a relatively logical structure that accounts for Information Security, Technology and Applications at the highest level. Below each of these are common groupings that account for the various technology and application functions that need to be addressed. It became clear to me that I needed to validate the structure and take into account the gaps we faced. While structure, in and of itself, doesn’t really fix anything, it certainly positions the department to take on the various roles and functions required by the organization.
Staffing: Once the structure was set and gaps were identified, I needed to address the staffing needs to fill those gaps and position us to take on the various projects that the department was expected to work on. Since one of the most significant gaps in structure was the lack of a Project Management Office (PMO), getting a handle on the projects was a project in itself. Without a clear understanding of the project demand and resource requirements, staffing needs became somewhat of a ‘gut-check’.
Governance: The lack of project demand that I spoke to above was a clear sign of problems at the governance level. This can be a systemic problem and is one of the most challenging to address as a CIO. Changing the culture of an organization so that they realize that the projects we lead must be prioritized by the organization, and not simply thrown over the wall to be completed by IT on a timeline, is unrealistic. While the PMO began pulling together the project list and estimating the resource requirements and balancing against the resource reality, I formed a multidisciplinary Enterprise Governance Team to take responsibility for prioritizing projects against the operational strategies and initiatives of the organization. This can be an uncomfortable process for an organization, since it’s so much easier to simply throw things over the wall and expect miracles to occur.
In addition to the Enterprise IT Governance, I put together an EHR governance team to address the numerous ‘optimization’ and project requests specifically around the EHR, as well as a Physician IT Advisory Committee to engage physicians on IT initiatives and technology. Simply having Governance teams in place doesn’t accomplish much without processes in place.
Process: With Governance in place, the processes for capturing work, quantifying it, and presenting it was critical. I started with the framework as Governance was being formed so that there was a method to the madness as we began to meet. Other departmental processes are also critical to success, including “Change Control”, Helpdesk ticket handling, Escalation, and On-call, to name a few.
Metrics: As kids we are measured by report cards in school, but somehow, once we get a job we find it an inconvenience to be asked to place metrics on our work. With as much money as we have responsibility for within the IT budget and as integral as we are to the operations of our health system, we owe it not only to our organization, but to ourselves to develop dashboards and metrics to measure our work.
Along with these metrics, we need levels of service that meet the needs of the organization. Service levels shouldn’t be randomly set or unrealistic, but rather, set based on the data. Developing a baseline is critical in order to establish meaningful measures. I’ve got each of my managers currently working with their teams to come up with measures that provide meaningful information by which they can be measured. These will go to the IT Governance for approval for ongoing reporting.
So, this has been my world for the past six months. I’ve developed a presentation outlining the five key areas of focus and will continue to update it as we make progress. It sets a vision and common ground for discussing progress. Communication is a foundational component in everything I do, so getting on every possible agenda to provide updates has been critical to showing progress.