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

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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


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


What IT Can Learn From Manufacturing

May 26, 2009

 Background

A long time ago, or at least what seems like a long time ago, in the U.S., Manufacturing was King. For companies whose primary product was manufactured, manufacturing, along with finance, dominated discussions.  There was little concern for quality, cost, or customer service.  The customers would get what they got (and like it), and any additional costs incurred would simply be passed along in the price of the product.  Life was good!

Slowly, however, things started to change.  As other countries began to emerge from the post-WW II economies, they began to develop their own infrastructure, and were actively seeking techniques to improve quality and productivity.

Meanwhile, back in the U.S., it was business as usual, and many felt these pesky little countries were no match for the mighty U.S. industrial base.  Quality experts like Deming and Juran, seeing the error in this line of thinking, pleaded their ideas to senior management before it was too late.  They were cast aside.

So they went to Japan, whose leaders were hungry for ways to improve quality and increase productivity.  They were able to implement these techniques through diligent work with much success.  Eventually, they began to take a foothold in the U.S. and their products became very successful.

Savvy U.S. manufacturers looked at what was going on and began to change their thinking and their organizations.  The traditional organization’s operations, with its command and control structure, siloed departments, mass-production mentality with its associated lack of flexibility, had to change.  Some organizations made the transformation while others did not, and are no longer in business.

Because of the “sudden” insurgence of foreign competition (not really, but few were paying attention to notice), managers took drastic steps to remain competitive – like outsourcing either entire manufacturing operations, or parts of operations.  Sometimes this worked, sometimes due to supply chain and other issues, it was less than successful. 

Next, and for those whose products and structure precluded them from outsourcing, came implementation of Lean manufacturing / Toyota Production System (TPS) concepts, along with several reorganizing by product or service.  This transformation continues to this day.

IT Comparison

So, what does this have to do with IT?  Well, when you look at IT in enterprise organizations, a lot.

One of many ways to look at it is to ask, “In an enterprise, what is the purpose of IT?  What does IT really do?”  In its simplest form, IT processes data to become usable information so it can be utilized in decisions to help the business.  In this way, IT is much like a factory that processes data and turns it into information.

Of course, the way it processes data varies greatly.  Sometimes it functions simply as a conduit, as in email.  A supplier (user) types a note on an application and presses SEND.  At that point, IT takes the email and processes it to a customer (also a user) who opens the email and makes a business decision based on the information it contained (act on it, do nothing, delete, etc.).  Sometimes IT is a storage facility that stores and inventories products (files) for later use by customers.  A supplier (user) sends a product (file) to IT for storage (server).  When a customer (user) needs the file, they order it from IT (click to open), and IT delivers the product to the customer.  Other times, IT functions as a true manufacturer and creates product.  A supplier has a need to solve a business problem and there is an IT product (application) that can help.  The supplier presents the build specs and IT produces the application either by building it with its own resources (development) or by outsourcing production to a specialist (purchase software).  IT then delivers it to the customer for use, and provides customer service (help desk) as well.

Now, there are a lot of things going on behind the scenes in the IT Factory to deliver these products and services, and the way IT Factories go about delivering these vary by organization.  As was the case in manufacturing during the mass-production hey-days, where factories were aligned by departments (Stamping, Machining, Finishing, Assembly, Shipping, etc.), many IT Factories are aligned by function (Hardware, Software, Network, Storage, Server, Support, etc.).  In the traditional IT Factory, every application has its own server, storage, and support group all within and aligned by each of the functional areas.  Changes and new requests must pass through each of the functional areas before moving to the next, with the occasional concurrent processes.  Since the organization was probably already structured in a hierarchical way, it only made sense for IT to follow this structure.

But things are changing, and changing quickly.  If the rate of change in manufacturing was linear, in IT it is exponential (see figure 1).

Mfg IT Change Rate

However, in a slight difference from manufacturing, the change IT enterprises are experiencing is not necessarily driven by outside competition, but by the technology itself.

Applications have gone from being developed in-house (highly specialized ones still will need this), to being purchased off the shelf and installed on the companies servers, to being available as a service (SaaS).  Storage and Networks (along with Applications) that used to require separate physical machines have gone from 1:1 to 1:many with the implementation of virtualization technologies and the advent of the cloud.  Mini-factories (desktops) that are supported by maintenance personnel (desktop support) who had to be dispatched remotely to solve customer (user) problems or make changes can now be fixed remotely with desktop virtualization technologies.

In essence, IT as we have known it in the enterprise is slowly becoming obsolete unless it develops new approaches and skills to support the business.  It’s not a question of whether the current work that is being performed will still be needed, it’s a matter of scope and scale.  There will still be a need for networking, hardware, storage, etc. personnel, just not as many (in the enterprise).

This leaves two choices for IT leaders.  They can either support these new technologies, figuring out how to best utilize them in their organization, or resist them and continue to maintain the status quo.  The problem with resisting them is they will eventually catch you and your organization.

IT Reaction

IT needs to use these transformative technologies to fundamentally change the way it does business, much in the same way that manufacturing embraces Lean and cellular manufacturing concepts and techniques.  IT needs to transform from a provider of technology to a provider of service that utilizes technology.  It needs to become the de facto expert at applying technology to improve the business and business processes, ensuring all the while its actions are aligned with the overall corporate strategy.

Time is of the essence.  Organizations need to review the technology available and determine not only how that technology will enable them to improve operating costs, but also how it will help them improve the service they provide to the business.  The opportunity is ripe for IT to take a true leadership role in helping change and improve the business.  History has shown us where the consequences for inaction lead.

 Mfg IT Then and Now

 

Let me know your thoughts!

Glenn Whitfield