Fixing The Car While It’s Zooming Down The Highway

In September 2011, after 14 years of working in our hospitals, I took on a “corporate” job. I didn’t know then, and still don’t know, how long it will take to prepare our organization to meet the new business demands, but I had three areas of focus for the first three years: Performance Management, Process Improvement and Measurement. I also had a few pain points I wanted to solve — “email jail” and our IS Provisioning process.

We’ve made great progress with performance management. In the first year, we asked our leaders to make sure we graded on the intended scale. For example, on a scale of one to five, three meant one was doing their job and five meant one was exceptional. We had grown to giving most people fours and fives, so we wanted to make sure we graded appropriately and provided “headroom” for people to improve performance.

In addition to each person’s annual review, we did a point-in-time analysis on whether the workforce was adhering to our values. This meant that supervisors were trained to consider how their staff members behaved according to stated values around how we get our work done and how we treat each other. This set up the opportunity for supervisors to re-recruit high performers and to ask those who were not meeting standards to step up. Fortuitously, the company also had an overall initiative to redesign its evaluation tool to ensure against grade inflation. Our entire department is adopting the conversations about behaviors, which means we have staff people who are focused on our mission, technically excellent, and can collaborate with others.

Our major process improvement initiative has been around IT Service Management and our new Service Desk website (more about those in my next blog). As mentioned, I had two other specific things I wanted to fix that I had experienced as a CIO of one of our hospitals. Eliminating “email jail” and improving our IS Provisioning process. Like many companies, we had limited the size of Exchange/Outlook mailboxes to control the use of storage. For much of the history of our company, a common lament was that one couldn’t send email because one needed to clean up the mailbox first by deleting or filing emails. Hence, one was in “email jail.” Increasingly, as storage became less expensive, this seemed not only unproductive, but also just plain silly. Other attempts had been made to solve the problem, but always got thwarted by some political or financial constraint.

Happily, my tenure coincided with our CFO’s desire to purge emails and lower costs of eDiscovery. Notwithstanding some pushback about retention periods, we have been able to implement an effective email management platform that provides a virtually unlimited mailbox, archived on our least expensive storage. Once we got going, we migrated over 80,000 email accounts pretty quickly. Voila, the end of email jail! Many commented that this was actually an IS project people wanted, and we had requests from users to go earlier than their scheduled conversion.

In my 14 years of working as an applications person and leader in our hospitals, I was also very frustrated with our IS “provisioning” process. This is what one had to navigate to get a server in the data center with a SQL database, storage, appropriate vendor access and certification on our standard computer workstations. A long time ago, there was a seven-page paper form, then it was 15 pages, then it was posted online, but it was always very challenging to complete. Also, because we are so large, our engineers have very specific roles. Tying all of these pieces together required a conference call with an army of subject matter experts, and losing one could stop the whole process.

This is another area where we can still use improvement, but we’ve come a long way. We’ve had success virtualizing our servers, but the turnaround time was unacceptable. Now, one can get a virtual server and space provisioned in the public cloud in minutes; our virtual server process was taking 30 business days. Along with our ITIL process redesign, we hired an ITSM Manager, who reports directly to me. After taking no prisoners in knocking down silos between my teams, this manager scheduled a daylong session with all SMEs. There was some pushback in getting this scheduled, but once everyone was in the same room, the backlog was removed in one day!

We have made progress. Our efforts at managing leader and staff performance and the process redesign has paid off handsomely with our Voice Over IP Telephony program (over 50,000 phones converted), Windows 7 (over 50,000 computers converted), a new Tier 3 data center, and much more. All of this has been happening as we go through the biggest clinical and revenue cycle transformation program in the company’s history.  Yes, our primary focus throughout all of this has been an Epic implementation, but a close second has been a large investment in information security and privacy.

We are not where I want to be at this point, but we have accomplished much more than I expected to improve our performance and process, even while tackling programs that transform the entire company. In the future, I’ll share more about our ITSM/ITIL initiative and new Service Desk website. Soon, we will be able to publish metrics to demonstrate the effectiveness of these changes and fulfill our goal of measurement.