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


The Importance of Error-Proofing

October 26, 2009

Here is the post on Error-Proofing: http://piadvice.wordpress.com/2009/10/26/the-importance-of-error-proofing/


Lean, Six Sigma, Value Streams – Podcast with Business901

September 29, 2009

See Post here: http://piadvice.wordpress.com/2009/09/29/lean-six-sigma-value-streams-%E2%80%93-podcast-with-business901/


Value People Process

August 28, 2009

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


Lean & Forrester’s Business Technology Forum

August 13, 2009

 

Well, it appears my fears have been realized.  As I mentioned in a prior post, Lean & IT, I expressed concern on how IT organizations and consultants would respond to Forrester’s declaration that Lean is “in.”  Regarding Lean, Forrester’s own blog said to, “consider it more a mindset and a culture than a guide.”  It was interesting then to receive in the mail the other day, from Forrester no less, a brochure on their Business Technology Forum 2009, with the theme, Lean: The New Business Technology Imperative.  However, it went downhill quickly from there.

I became a little concerned when I saw the picture on the cover: a man with a tape measure around his waist with the word “LEAN” repeated.  This conjures up the image of ‘trimming the fat’ or ‘cost cutting’, not a ‘mindset and culture’ as they had espoused in their blog.  My fears rang true when I read this in the introduction letter:

“Everyone wants to be Lean these days, whether it’s when stepping off a scale in the morning or when reviewing the cost of running a successful business, hence this year’s theme: “Lean: The Business Technology Imperative.”

Not deterred, I continued to read the through the brochure (wondering if it could still be useful) and came across one comment I thought made some sense:

“Lean thinking and Lean practices must affect the choices you make as a business technology leader.”

I agree with that line of thinking, but the problem is that as I continued to look at the presentations and the presenters, I did not see anything that would define what the principles of Lean thinking are, and what Lean practices would help improve an IT organization.  In fact, when looking on-line at the Bios of the presenters (all impressive), only a handful (a small one at that) had anything that would resemble ‘real world’ experience in Lean.  They all had lots of IT experience, but if I am in IT and want to learn more about how to apply Lean in IT, shouldn’t there be more emphasis on teaching the concepts of Lean thinking, and less about whether or not an IT application is Lean?

By taking this approach, Forrester is undermining the fundamental truth that Lean is a culture of the continuous pursuit of the elimination of waste in everything the organization does.  They are treating Lean as simply a set of Tools to be used.  At best, they are asking people to ‘do’ Lean without even a clear definition of what Lean is.

They are missing the point.

People are going to spend a lot of money to attend this forum, and, especially those with limited knowledge of Lean thinking will leave with a complete misperception of what Lean is all about (based on the summaries in the brochure and on-line).  Just because the “Forrester” brand is on it doesn’t mean they are experts on the topic.

Take a look for yourself (here) and see if you think it would be worth attending.

And ask yourself again, are you going to ‘do’ Lean, or are you going to ‘BE’ Lean?

Let me know your thoughts.


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