Anticlue

At this time, we probably have a forming change team. It is now time to scope out the low hanging change fruit for quick and early wins. Early wins build momentum and confidence in the change initiative, but one has to choose an early win wisely. Have you every picked an orange fresh from the tree, peeled and then found it rotting from the core? Didn't want another orange right away did you? Same deal, with the early wins for your change initiative. On the flip side if you did pick a nice juicy orange, wouldn't it be easier to get others to join in next time?

When looking for an early win, keep in mine that it will be the foundational beam of your change. It should be purposefully considered and worth the investment of your change initiative. Here is a quick checklist to validate this is a good early win.

• The win can be implemented within 30 days


• The outcomes are noticeable and will resonate with others


• The outcomes are likely to be achieved, but it isn't no brainer solution


• The win and outcomes lines up with the overall change strategy


• The quick win and outcomes are marketable


• The quick win positions another quick win

Another key consideration is that the quick win must be marketable. Others should be able to hear of the quick win and have it resonate with them. Marketing can be done by word of mouth, champions pointing to the success, and through other standard techniques within your organization.

With our healthcare PMO, the tried and tested first quick win normally is a project dashboard. The executive leadership team provides acceptance and agreement to the information being provided. The IT leadership team provides transparency for their current efforts. It is all around a very good early win for a healthcare PMO.

Further Reading:

• How to implement organizational change - Do we really want it?


• How to implement organizational change - We think we want it, but how do we know?


• How to implement organizational change - We know we want it, but who is going to do it?


• How to implement organizational change - We know who but what is their first step?


• How to implement organizational change - We determined the current state of affairs, but where is our urgency?


• How to implement organizational change - We have a sense of urgency but what is our purpose and strategic vision?


• How to implement organizational change - We know our purpose and strategic vision, but can one change agent change the world?

As one begins to understand the theory of constraints and system thinking, an epiphany enlightens. One has to look to improve the system and all interdependent process as whole, by improving systematically a process here and a process there. Improving without a systematic view, just brings little results often shifting the root problem.

Lean-Six Sigma for Healthcare has four interwoven approaches :

1. A strategic deployment approach - Senior Executive's goals are tied to the strategic plan by category of quality, expense reduction, patient safety, physician satisfication, patient satisfaction. This categorization is extended to six sigma project selection. Additionally a system map illustrating the relationships between all major entities and core processes is developed The C-suite champions the Lean Six Sigma deployment across the hospital, medical center, or health system


2. An organizational cultural change approach - The organization's culture is focused upon improving the status quo.This step kicks it up a notch from performance benchmarking against others of similar facilities and departments. This characteristic is a transformation of the organizational culture from the inert attitude of this is the way things have always been done around here to in this organization we strive for perfection and look to continuously improve our processes.


3. A statistical calculation approachThis approach relates to the categorization of costs as quality and the fundamental usage of statistics to provide proof of problem and control of improvement efforts. Costs can be categorized as a process cost, costs of quality (COQ), or costs of poor quality (COPQ). Imagine the beauty of understanding for IT staff's utilization based upon these categorizations? I think the results would be enlightening for departments viewed as an IT expense center.


4. A project management approach - This approach provides the organization with tools and frameworks to facilitate the implementation such as a DMAIC, PDCA, project management and 100 day rapid change response teams

A key outcome for Lean-Six Sigma for Healthcare is for organization to become proactive and purposeful rather than reactive and un-prioritized.

Further Readings:

• IT Value: Is IT an Expense Center or a Value Center


• Costs of Quality


• Six Sigma - Defining the problem statement

While things are still in draft form, we all are following the EHR meaningful use dialogue with great interest. The stimulus bill appropriates $19 billion in Medicare and Medicaid carrots for physicians, hospitals, and others who utilize EHRs in a meaningful way.

Physicians with approved EHRs up and in use before 2012 will be eligible for the maximum Medicare incentive payments. (This is a reward for all those who have invested themselves) Physicians who have not adopted an EHR before 2015, and are not able to obtain a hardship exemption will see a 1% cut to Medicare pay, that reduction will gradually increase up to 3% by 2017.

The first draft by the Health IT Policy Committee is summarized below and note integration and information exchange is a key foundation:

By 2011:

• Use computerized physician order entry for all order types, including medications.
• Incorporate laboratory tests into EHRs and share results electronically with public health agencies.
• Generate lists of patients by specific condition to use for quality improvement.
• Provide clinical summaries for patients after each encounter.
• Exchange key clinical information among health professionals (problems, medications, allergies, test results, etc.).

By 2013:

• Generate and transmit prescriptions electronically.
• Manage chronic conditions using patient lists and decision support tools.
• Use bar coding for medication administration.
• Offer secure patient-physician messaging capability.
• Record patient preferences in EHR.

By 2015:

• Achieve minimal levels of performance on quality, safety and efficiency measures.
• Give patients access to self-management tools.
• Access comprehensive patient data from all available sources.
• Conduct automated real-time surveillance on occurrences such as adverse events, disease outbreaks and bioterrorism.
• Incorporate clinical dashboards into EHR.

Source:

• Health IT Policy Committee healthit.hhs.gov/portal/server.pt/gateway/PTARGS
  _0_10741_872719_0_0_18/meaningful%20use%20matrix.pdf


• American Medical News First Draft of EHR Definition Unvieled

As a part of our help out a reader section here on Anticlue, every Sunday we will be helping out our followers by answering a reader's question. This week, our question is "Where is the best place to start with a scope control process?" from Valerie.

Our advice to Valerie is to start with a frank discussion with the project sponsor. If you see a need, you will need your project sponsor's support and agreement. Normally, this is a simple discussion as the project sponsor has an investment controlling scope. During the conversation, establish what responsibilities will be needed by the project sponsor, the project manager, and the project team.

The next step will be to establish the process. We have shared a scope management standard previously, which can be leaned down for the basic process. If one is going from no process, be careful not to fall into the trap of too much process. Either extremes yield chaotic project management environments.

If you have a suggestion on another way to approach this common issue, please share!

Otherwise please let us know your questions for next Sunday's ARQ (answer reader questions) We look forward to hearing you ask. As always, all questions and suggestions are welcomed.

Interested in reading more on project scope? Further reading:

• Defining Project Scope


• Scope Planning


• The top ten reasons for Scope Change


• Example of a Scope Management Standard

A while ago, I shared that our logistics team would be giving their first customer service survey ever. The group has been in existence about 10 years, however this was the first survey. I'd like to share some wisdom gained from the process to others who will be giving the survey.

We went with a small focused survey using survey monkey as the distribution tool. Our questions were as follows:

1. Calls to the Logistics Team are answered in a timely manner.


2. Calls to the Logistics Team are answered by staff who demonstrates the knowledge needed to address my concerns.


3. You know who to contact for ordering computer and cellular equipment.


4. You are kept informed and aware of your equipments ordering and installation status.


5. The logistics team fosters open and positive communications with Customers.


6. You feel that you can openly and positively discuss concerns with Logistics.


7. Are you satisfied with the service you received.


8. Please list 3 items which could improve our service.


9. If you would like us to contact you, please share your name.

The survey population was top 10 frequent customers, some directors, managers, administrative assistants; outsource vendor partner's local management, and IT team leads - 83 respondents in total. All in all we did very good, our participation level was 28% which in survey terms means the population was very interested in the outcome. It is a blessing to have fully engaged customers.

A key point of advice is to give the survey and look at the results with the intent to identify a problem. It is good to review the results with the team, and look for suggestions to possible issues. My team reviewed the results, and assumed accountability for improving one key suggestion - our follow-up communications. We are also looking for advice from our quality management department through a process improvement team(PIT) to help resolve our order to installation turnaround time. This PIT team will not only be IT and Quality, but we will collaborate with marketing and some customer volunteers. These areas in need of improvement will be identified as performance goals for the team and myself. With hard work and collaboration, within a year we will have improvement service and new ideas to kick the service up another notch as we climb the Healthcare IT credibility curve!

Further Reading:

• The Healthcare IT Credibility Curve


• Customer Satisfaction with IT


• Measuring Process Problems

Sometimes an idea resonates with you, like the term a Chaotic Project Management Culture. I'll be expanding a little on these later but here are the top ten characteristics of a Chaotic Project Management Culture.

1. Having way too many active projects, going far above what the organization can handle.


2. Having a missing in action work intake and acceptance process.


3. Having priorities which change with the alaskian weather and winds or everything is top priority because there is no priority.


4. Everyone's day staff, supervisors and leadership run from meeting to meeting to meeting - everyone runs a daily meeting marathon.


5. Leadership needs to be involved in the weeds and all the tactical details.


6. Management clings to the latest fad or management trend as the solution too all current problems. (Its also cool that they run from one management panacea to another, each fad having no sticking power).


7. It is a cowboy mentality to processes or process follow through - "I can just do it myself right now rather than enduring that pesky change management process".


8. The gut is the only metric for decisions. Decisions are made without analytics or cost information.


9. The project manager plans by themselves on a schedule which is looked at once, and the resource conflicts are never know except by the fact that staff heros wear the same clothes for a couple days.


10. One only has to walk the halls to hear the dissatisfied customers and stakeholders.

Further Reading:

• Improving your Healthcare IT Credibility by developing your project management maturity


• Levels of Project Management Maturity


• IT Value - Is IT an expense center or a value center?