EHR & The Ghost of Technologies Past

November 30, 2009

“It’s like déjà-vu all over again” Yogi Berra famously once said, and yes, it is. We’ve been here before.  The promise of a new technology the will create so many efficiencies – too many to count.  It will make everyone’s life so much ‘easier’ and allow the organization to make unprecedented gains.

Enterprise Resource Planning (ERP) systems, and the consultants that sold them, promised us the moon.  While a few (and very few) made their mark, most would fall into the ‘failure to launch’ category.  If they did get off the launch pad, they didn’t make it very far.

While everyone generally accepts the definition of insanity as ‘doing the same thing over and over again and expecting a different result,’ organizations and leaders of organizations continue to repeat mistakes from the past despite warnings from many.  They rationalize it to themselves by saying, “our industry is different.”  The only thing to say to that is, “Yes, you’re different – just like everyone else.”

They then make the same mistakes done by those in different industries, but implementing the same concept, and wonder why the new technology failed to meet expectations.

So now, we have Electronic Health Records (EHR) [Electronic Medical Records (EMR)].  We’ve been told that this will help solve some of the issues that create so many problems in healthcare, and improve patient care, efficiencies, eliminate medical errors, etc.  Sounds a lot like the ‘moon,’ and if any industry feels they are ‘different’, it’s healthcare.

But the question is – what are you going to do different?

The traditional approach to implementing new technologies (like EHR) has been to focus on the Technology, glance at the Process, and be blind to the People.  We have traditionally centered everything we do around the new technology, treating it as a panacea; all we need to do is install it, and our problems will be solved.  To this end, we may take a brief look at how the process will be with the new system (rarely ever at how we currently perform it), and typically ignore the people who actually perform the process (we interview and train them, but do we listen to them?).  This approach has produced less than stellar results, with some pundits claiming up to 75% of technology project fail to meet expectations (this approach being only part of the many reasons for failure).

To approach an EHR in this manner would be doing the same thing over and expecting a different result.  A different approach (which I continue preach) would be to focus on the Process, while involving and engaging the People to prepare for the Technology.

By focusing on the process, we can get a true understanding of the way things really get done – how the people actually perform the tasks that move the organization each day.

With the people engaged, involved, and focused on the process, the organization will get a solid understanding of what needs to be improved, and have created the buy-in and ownership of the people who perform it each day to improve the process.

By cleaning up the current process, the organization will be prepared for the new process the EHR will bring and fully understand how to effectively integrate the technology and the process into a new way of operating.

So, are you going to repeat the mistakes others have made in the past when implementing technology, or are you going to try a new approach?

Let me know your thoughts!

Glenn

Note: This is cross-posted here


Before Process – Define Purpose and Value

October 5, 2009

See Post here:  http://piadvice.wordpress.com/2009/10/05/before-process-%E2%80%93-define-purpose-and-value/


Value People Process

August 28, 2009

See the post here:  http://piadvice.wordpress.com/2009/08/28/value-people-process/


Is Chaos the New Equilibrium?

August 3, 2009

 

“We’re waiting for things to return to normal.”  How many times in the past few months have we heard this?  But what if the situation we are in is now the new “normal?”  Many organizations are holding back, sitting on the sidelines, if you will, waiting for economic conditions to stabilize, to become more in control.  What if the control limits have greatly expanded?  Perhaps, now, we are “in control,” based on the new parameters? 

Listening to Wall Street analysts the other day on CNBC, several were referring to historical data on where they thought the market was heading, it was almost as if they were ignoring the events of the past 10 months.  A friend of mine sold some stock we both had bought because a friend of his, who is heavy into the technicals, told him he should sell.  The stock is up 15% since then.

The purpose of this is not to bash stock analysts or technicians, but to point out that using traditional methods and techniques without modifying them for the current situation may not be appropriate in today’s environment.  When a significant event, a Black Swan, like the financial meltdown in October of 2008 occurs, the rules of the game change.   To continue to apply old rules to a new situation will result in staggered growth at best.  It’s not just in the market where this is happening, it’s all around us.  Take IT organizations and Virtualization for example. 

Virtualization is a transformative technology.  Not only does it allow for an IT organization to cut hardware costs, but it allows for a dramatic change in the way IT does business.  But this does not happen on its own.  The IT organization must recognize the opportunity and change accordingly.  Too often, IT organizations deploy virtualization technology, continue to apply the old rules of server management, and then wonder why things don’t seem to be improving.  The rules of the game changed; they don’t get the full benefits because they’re still playing under the old rules.

Customers and markets, that were once thought to behave very rationally, have shown quite a bit of irrational behavior over the past year.  Whether this behavior continues remains to be seen, but one thing is fairly certain, the economic landscape has changed significantly – e.g. the Government owns two auto companies.

So, are you waiting for things to return to ‘normal?’  Or are you adapting to the new environment and positioning yourself and your organization for success?  What events have caused the rules of your game to change?  Have you adapted?

Let me know your thoughts.

Glenn Whitfield


Where to Focus – Executives, Managers, or Frontline?

July 24, 2009

 

In a Lean or Continuous Improvement Transformation, who is the most important – The Executives, the Middle Managers, or the Frontline workers?

This question often gets asked by many who are trying to understand how to roll out a Lean / Continuous Improvement program (or Six Sigma deployment, etc.).  Some will say the work is done on the frontline, the gemba, so the frontline people are the most important, and should get the most focus.  Others will say the Executives must be on board for a successful transformation, so we need to focus on getting executive buy-in.  Even others will say, no wait, no one ever really considers more than a cursory glance at the middle managers.  So here’s a word of caution – don’t forget the middle managers.

Many organizations start the implementation of a Lean/CI effort with big announcements proclaiming the benefits of this approach, and that everyone will be trained on the new techniques.  It typically starts with the Executives to make sure they are on board; after all, they can kill the program through restricting funding, not releasing resources, etc.  During these executive overview sessions, a training plan is usually developed starting with the frontline workforce – since they are the ones who make things happen.  There is a big push from the executives to see action since it is fresh in their minds and it is costing them “a fortune”, so they want results.  To accomplish this quickly, experts are brought in to help with projects and deployment, and the middle managers are given cursory overview at this time – they will be trained in detail later.  These deployments are typically successful, and show excellent results.  The executives, though happy with the progress, eventually start looking for ways to cut costs, and determine that since there is so much success, the training program can be cut back.  After all, they reason, the middle managers already received the overview training (like them), and they don’t need the details like the frontline workforce.  The training budget is cut, and the middle managers continue on to struggle (often silently) with the transformation.

Over time, the use of the experts is cut back as the executives feel the organization is progressing nicely on its journey, and the middle managers are expected to pick up the slack.  Since the middle managers were not trained in the specifics of some of the tools & techniques, they do not fully understand how to use them, and they are either misapplied, or, because the mangers were never fully engaged (the experts facilitated the effort), they resort back to their traditional management mode – their comfort zone.  Continuous Improvement efforts start to become not so continuous.  The executives reason that this CI stuff was a nice experiment, and although there were some nice results, they just read about the next new thing, so they’re going to try that.  The frontline feels betrayed, and the middle managers continue to muddle through their day.

Having lived through a situation like this, it is not fun.  To see the potential of an organization slip away is extremely frustrating.

Unfortunately, this happens more often than we would like, and on varying scales (sometimes it’s an organizational wide effort, sometimes it’s simply inside a large department).  The key to stopping it from happening is to fully understand, up front, what you are getting in to.  Lean and other Continuous Improvement efforts are more about cultural and organizational change than they are the tools.  It takes time (and investment) to transform from the traditional way of doing things to a Lean mindset.  The investment is primarily in people, and it is a long term investment, not just something to do this year to improve the bottom line.  To think otherwise is a recipe for failure.

So back to the question of who is more important – to me, the answer is they are all important; their relative importance depends on what stage the organization is in its journey.  In the beginning, executive sponsorship is absolutely critical.  Giving middle management an overview then providing details to the frontline workforce is essential during rollout.  Then to sustain, it is imperative to provide middle management the training they need to make sure it becomes the way you do things, and not just another “flavor of the month.”

Last, but definitely not least – don’t forget the ongoing training and education as employees come and go to the organization and as new tools and techniques are refined and improved.  This is often neglected, or worse, knowingly dismissed due to cost issues.  It almost always comes back to bite you later.

Let me know your thoughts!

Glenn Whitfield


Understand the Outcomes, then Focus on the Inputs

July 13, 2009

 

The recent and ongoing debate on Healthcare highlights a problem that is prevalent throughout organizations, governments, and society in general.  The problem is with the thinking process, or should I say, lack of a thinking process, and an almost myopic and emotional focus on addressing only the outcomes of a process.

In Healthcare, we are constantly told that the “system” is broken, it doesn’t meet the needs of patients, and there are too many people who can’t afford healthcare.  People not being able to afford healthcare is a problem, so, as some are presenting, the solution is to provide those people with health insurance (the mechanism which they receive it doesn’t matter), then we will have solved the problem of people not being able to afford healthcare.  But what does this solution really solve?  What is being done to drive the costs of healthcare down?  What is being done to improve the quality of the delivery of healthcare to better meet the needs of the patient?  What is being done to fix the broken “system”? And it is broken.

The issue is the solution proposed does not address the reasons as to why people can’t afford healthcare.  Lack of insurance may be one of the reasons, but it’s certainly not the only reason, just maybe the easiest reason to address to a frustrated public that wants to see “results.”  The problem is that to truly address the reasons healthcare is unaffordable means we need to dive into the system and determine what is driving costs from the moment a patient enters a physician office (or earlier) until they settle their bill (which may be covered by insurance).  If the output is unaffordable care, we need to focus on the inputs that are driving these outputs.  Healthcare is a very complex model, with physicians, providers, insurers, pharmaceutical companies, and medical device suppliers all functioning as independent groups (often times, required by law to do so).  To fix the outcome of our current system, we need to focus on the inputs these entities provide and the interrelations that exist.

Years ago in manufacturing, when an organization had quality problems, the solution was to simply put more quality inspectors in to monitor the product.  Well as anyone who’s been involved in manufacturing knows, “you can’t inspect quality into a product.”  Organizations that tried this quickly found it was unaffordable and not sustainable – they had to go fix the inputs of the process to truly improve and sustain quality.  The logic has nearly universal application, whether it’s manufacturing, healthcare, technology, etc. : to fix the outcome, focus on (control) the input.

The outcomes of a process are very important, and measure how effective the process is performing, but if one wants to improve the process, it is the inputs that must be addressed.

Let me know your thoughts!

Glenn Whtifield


Why Private Equity Needs Performance Improvement

May 15, 2009

 

It wasn’t too long ago, Private Equity firms could purchase a company, do ”financial” engineering, and sell the asset for a nice profit in a relatively short time frame. It provided a nice quick return on their investment.

Well, times have changed. Although many firms would like to sell, they are finding that adequate liquidity does not exist. This presents a conundrum for investors. The traditional method won’t work in these economically uncertain times. Maybe it’s time for a new approach.

Here’s the issue: The P/E firm has an asset, one that it may have had for a while. With the economy, the traditional model won’t work – the asset won’t be sold any time soon. Given that and the need to get some value from the asset, a focus on operational performance improvement should be taken.

Just like many other industries whose traditional operating practices have slowed, it’s time for Private Equity to look to a dedicated and structured Performance Improvement approach, and some firms, like Alvarez and Marsal, have recently started their own internal PI groups to address this need. But, what is Performance Improvement? While there are many definitions out there, I’ll define PI as an approach that evaluates and measures a process, identifies improvement opportunities, provides an improvement plan, and executes the plan to achieve the new process. The process can be evaluated at a strategic or tactical level. The scope will depend on the problems to be solved, and the time available to improve. The key to a successful PI initiative is having top management support and active involvement in the improvement activities by the people actually performing the process.

So why not just hire some consultants to assist with this? Well, a firm can start with consultants, and make quick impacts, but it will not have the flexibility or consistent approach that is needed to address the long term. By having a dedicated internal Performance Improvement group, a firm can has these benefits:

• Dedicated and Flexible resources that can easily be moved to different assets in the portfolio

• A consistent approach to PI that can be communicated throughout the firm

• A culture of continuous improvement can be cultivated

• Additional resources with operations backgrounds that can be utilized to assist in what may be considered ‘non-PI’ activities

• The ability to contract out PI resources to firms that have not made the investment in a dedicated PI group, but need the skill set

With this type of approach, it’s more important that members of the PI group have a broad understanding of business and systems thinking, and be experienced in facilitation along with the tools of Lean, Six Sigma, and Theory of Constraints (TOC) than be experts in the process being improved. This is valuable because by using a Kaizen (or Rapid Improvement Event) model, the process experts are already in the room (the ones who do it every day), leaving the facilitator to be able to apply the appropriate improvement tools and techniques, and be able to ‘ask the dumb questions’ which typically lead to breakthrough ideas and actions.

Those firms that embrace this methodology will find themselves well positioned as economic conditions improve to make substantial gains.

If you want to discuss further how to get going, drop me a line.

Glenn Whitfield