Anticlue

Outcomes - The tactic to get to the strategy

Top-down is one of the easier ways to go when placing new processes and procedures in place. My level is middle management. At times I marvel on how the concepts grow into strategies and are brought into existence by my influence. It is enlightening to see how someone can have a concept grow into strategy in an afternoon right before the plane ride home. Concepts and strategies are the same. However discussions gaining consensus, agreement and educating would take about a quarter for me. We would get there, just not in an afternoon, optimistically about a quarter. For an executive CIO with presence and purpose, an afternoon.

If you can't have the CIO discuss openly with the CEO and CFO the need for IT governance. Maybe you don 't even have a CIO. How does one get there the business to the same place?

Outcomes are the answer. Depending on organizational structure, there is one truth with IT demand always outstrips supply. Having the ability to do what you agreed to, when you agreed to it, and having it done when agreed to is powerful. This should be standard operating process, but unfortunately its not. With the overloading of requests, and reactive nature, basic execution is lost. IT is all about the execution.

What happens when one is executing well? Well first the priority is clear. What needs to be done, is actively being worked upon. What isn't on the plate, isn't there. Discussions and planning is done by management for what is next on the plate. Our customers will begin to believe we do what we say we will do. As a department we will begin to have credibility. Afterall Gartner's five credibility / relationship levels are:

1. Uncertainty
2. Skepticism
3. Acceptance
4. Trust
5. Respect

It is up to the IT department to attain acceptance, the lack of acceptance is skepticism, and the lack of acceptance and skepticism yields uncertainty. If you can't forecast when and how, then you are in trouble. Can't really blame the organization being uncertainty with whatever is stated.

Being able to execute on the needed systems and enhancement helps grow credibility to acceptance. It also helps the entire healthcare organization with managing expectations and delivering to strategies.

Nurse Call, VOIP, and Wi-Fi: Its just cool when things come together!

In early September, we integrated our wireless phones with our nurse call system in the new surgery center. Elevating application and technology integration to the next level, our Nurse Call System is connected to our VOIP Phones via the WPA2 encrypted 802.1x Wireless Nework and Nortel's WLAN Application Gateway 2246, an Open Application Interface (OAI).

As we all know on the floors, time is precious. With our current systems, the patient can request assistance by pushing a button and talking. The unit clerk enters the message into our nurse call system which appears on the Nurse's assigned VOIP Phone. The nurse dials 9 to respond, and is immediately connected to the patient via the intercom. Having this instant response is a key benefit to our clinicians and patients. Our patient's needs are addressed quickly and clinicians are able to respond instantly. It is a win-win raising patient satisfaction and enabling clinicians at the same time!

Contract Closure Process

When you have a contract, the Contract Closure process is just common practice. Contract Closure puts the finishing touches on Project Procurement Management. The four inputs to the Contract Closure Process are:

• The Procurement Management Plan – The Procurement Management Plan is the play book for how to manage the Contract Closure process and to interweave it with other processes.
• The Contract Management Plan - The Contract Management Plan details how to manage the contract on significant purchases, throughout the life of the contract. A project team commonly refers to the Contract Management Plan for any contract closure guidelines surrounding a purchase. By providing information for the necessary documentation, delivery, and performance requirements, the team can assure the seller has met all obligations necessary for the contract to be closed.
• Contract Documentation - Contract documentation encompasses the contract, requested changes to the contract, approved changes to the contract, schedules, seller-developed technical documentation, and seller performance reports. Teams review contract documentation to ascertain what was in the contract originally and how that changed overtime. Additionally the team will use contract documentation to determine how the seller is reporting its performance. If the seller has met its agreed to obligations, then the contract can be brought to closure.

The contract closure procedure commonly occurs during the Close Project process. The contract closure procedure drives the process detailing all activities required by project team members, customers, and other stakeholders to settle and close any contract agreement established for the project, as well as define those associated activities supporting the project's official administrative closure. The contract closure procedure involves product verification and administrative closure. The contract terms and conditions can also appoint specifications for contract closure that must be included in this procedure. In project management, there are two common tools and techniques to close contract.

• Procurement Audits - A procurement audit consists of a structured analysis of the procurement process from the Plan Purchases and Acquisitions process through Contract Administration. Procurement audits identify successes and failures that project managers should take note of when preparing or administering other procurement contracts for the project or other projects within the performing organization. The audits bring successful practices to light which can be used in the future. Additionally, procurement audits identify any related project failures during procurement processes which can be avoided in upcoming projects. The procurement audit includes examining activities related to requirements definition, tendering, bid evaluation, contract award, contract examination, and contract closure.
• The Records Management System – The records management system is a set of processes, related control functions, and automation tools that are condensed as part of the project management information system. Project managers use a records management system to manage contract documentation and records. The organized system helps index and store contract documentation, records, and correspondence created during contract closure. It also assists with archiving project procurement documentation associated with contract closure so project managers can retrieve it in the future.

Procurement audits and records management systems are the two tools for the Contract Closure process. Procurement audits are used to identify project successes and failures so that best practice is ensured when contracting. Records management systems are used to manage documentation and records related to contract closure. The system helps with maintaining an index of contract documents and correspondence, and archiving and retrieving that documentation. After you have done the due diligence the out puts of the Contract Closure process are:

• Closed Contracts - Closed contracts provide formal notification to assure everyone agrees that the deliverables have been successfully achieved and that the contract has been closed. It is the project manager’s responsibility to ensures that each seller receives a formal notification of completion. Closed contracts are also used is to provide documentation in the case of unresolved disputes. Future unresolved claims could arise, related to contract closure and conditions, that are subject to litigation. To be prepared for this possibility, make sure that all closed contracts are filed and kept in order.
• Organizational Process Assets (Updates) - Updates to organizational process assets are the second output of the Contract Closure process. They consist of a set of documentation that includes the closed contract, the buyer's official notice of acceptance or rejection of the deliverables, and recommendations from project experience to use in future projects. The project manager puts project documentation in the contract file and stores it for future accessibility. The project manager may need to refer to the contract file later for litigation purposes and to review prices if there are ongoing pricing contracts for provision of products or services. Check with local and state authorities for specific record retention requirements before destroying any documents.

Reasons for Initiating a project

We in the industry all know, there is a plethora of reasons for initiating a project. Before we had a structured request method for project at one place, several ITers never lunched in he cafeteria because it just created a long streaming request pool of which was unprioritized. So let's discuss structured decision criteria aligned with strategic directives. According to PMI, organizations typically have 6 prime reasons for initiating a project:

• Market Demand


• Business Need


• Customer Request


• Technological Advance


• Legal Requirement


• Social Need

I think it would be an interesting exercise to relate these needs to the five pillars of healthcare: Services, People, Financial, Growth, and Quality. As sometimes technology is necessary to be in existence, I'd like to suggest agreeming upon an infrastructure category. For example, having smart infusion pumps require an 802.11 wireless network, but not an RFID functionality (if the tracking is being offered via 802.11, sometimes the RFID component of this just doesn’t pay for itself) So a wireless network is a required technology building block for a smart infusion pumps deployment.

An example of decision criteria with semi-fictious descriptions and examples.

Aligning this with PMI standards would be as follows:

So what was the purpose of this exercise? The 6 prime reasons for initiating a project can be used as a part of project selection criteria, and again aligned with the strategic relevance. Although I strongly recommend having the discussion of strategic goals and cascading those throughout the decision criteria. The important point is that the decision criteria must be applicable across the project request pool and without exception before project selection. This standardizes the process and implements a best practice.

Organization Prioritization: A couple steps forward

Started rolling out the prioritization criteria for the project in the Liaison meetings this week, overall it was a good start. I have a couple liaison meeting responsibilities -Radiation Oncology and Cardiology. Items I’ve learned from past experiences, is that honesty is the best policy, and honest communication is necessary.

First, we discussed the structure and roles of the organization and reviewed the new process.

All project requests coming into IS will be via a standard form to be posted on the intranet. They will need to be agreed to by the project sponsor and executive sponsor upon submission.

Here is a sample of our current project request form:

The key point is as a part of the request process to have a strong understanding of business need, and how success will be measured as a part of the request. To link the tactical requests to strategic planning, we have the current decision criteria. As the process matures, this criteria is linked to our strategic goals. The section on strategic relevance is an opportunity to articulate the decisions behind the ratings. I’m currently finishing up a guideline on a baseline of the criteria. The benefits realization plan is a way to clearly identify the improvements being offered by our solution.

The next key activity was to review our prioritization criteria and walk through the exercise of prioritizing our current work. A couple of questions and outcomes arose, which were insightful and I’d like to share.
Question: What happens if the strongest departmental request is not rated higher than the others?
Answer: Based upon the rating scale and weighting, we should be in good shape. Let’s walk through that request. The key in this request was it had the required application maintenance, and technology building block criteria.

Question: What number do we need to reach to assure this gets done?
Answer: Honestly, I don’t know. We have to establish a well founded decision which can be supported when asked by our executive leadership. If the project is simply not rated with enough priority, I’ll be happy to work with you to present it to our evaluation council (murder board) to help gain resources for the project.

Organizational change is the fine art of explaining the sense of urgency, sharing the vision of the future, listening to other’s concerns, and engaging in a dialogue which fosters a shared understanding. The good news was with this customer base, we have successfully started the process.