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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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


Creating a Necessary Dependence – An IT Business Alignment Whitepaper

May 6, 2009

 

Over the past several months, I have written several posts about the issues facing IT Business Alignment, a need to create a dependence between IT and the Business, and an emphasis on taking a process centric approach to the issue.

I decided to consolidate that into a white paper, which is now available. 

It’s not sponsored by a large software or hardware company, but does present an approach offered by my company (New Age Technologies) to help an organization move toward IT Business Alignment by focusing on a process to be improved, then understanding how it’s infrastructure and technology can help that process.

Please feel free to leave any comments about the paper at this post, or you can email me at the address on the paper.

I hope you enjoy!

Whitepaper:  Creating a Necessary Dependence: A Process Centric Framework for IT Business Alignment

 

Thanks!

 

Glenn Whitfield


Want IT Business Alignment? Change Your Approach and Create a Dependence

April 14, 2009

 

What’s wrong with your approach to IT Business Alignment is your approach to IT Business Alignment. For over 30 years, organizations have been wrestling with the IT Business Alignment issue, and according to the annual Society of Information Management survey it remains a top issue today. 

Why is this so difficult to get our arms around?  I’ve written previously about how defining IT Business Alignment has been an ongoing issue, and how our organizational structures make it very challenging (here).  We have spent so much time struggling to figure out the right approach that perhaps we have lost our way.

Part of this struggle is due to the definition itself.  ITIL v3 defines Business/IT Alignment as:

An approach to the delivery of IT Services that tries to align the Activities of the IT Service provider with the needs of the Business.

The problem with this definition is it defines Business/IT Alignment as an approach. Other definitions call it an “ongoing process” (Wikipedia).  While there may be a process to achieve it, Business/IT Alignment is not an approach or process, it is an outcome.

It is the outcome of many different approaches and processes which will vary by organization and will involve varying levels of technology.  Defining it as an outcome:

IT Business Alignment is the delivery of IT Services that does align the IT activities to the needs of the business.

Now looking at it as an outcome, how do you know when you’ve achieved it?  Well, it’s just like in the movie Goldfinger, when James Bond is asked, “What do you know about gold 007?”  His response was, “I know it when I see it.”  IT Business Alignment is like this in many ways because there is no “one size fits all” solution; each organization is unique, and alignment will look different in each.  This is what makes it so challenging.  An attempt by Company B to replicate the alignment results at Company A will likely be disappointing, because Company B is different than Company A.

However, to achieve this outcome, there must be some fundamental pieces in place in order to drive the approaches to meet the outcome of IT Business Alignment.  Fundamentally, IT and Business must be dependent on each other for success, and this dependence must be mutually recognized and acted upon.

Creating this dependence starts with creating a relationship and establishing common metrics.  Many will say this already exists in their organization.  Before you do, ask if the actions back it up?  Remember, not only does the dependence need to be recognized, but it must be acted upon.

 One way to act is to take the initiative to engage with the business in helping improve their operation.  This is where taking a process based focus to the operation can provide real benefit.  Using techniques like Business Process Management, or the one we’ve developed like the IT2x FrameworkSM, can help IT and Business create the necessary dependence and become aligned.

Once aligned, continue to move IT and the business closer.  Whether you call this Synchronization, Convergence, or Fusion, doesn’t matter.  What does matter is the continuous process of moving toward these goals. 

Change your approach to IT Business Alignment.  Stop treating it as an approach, and start looking at it as an outcome.  Then act toward achieving this outcome, by creating a dependence on each other through relationships, common metrics, and a process centric approach to improving operations. 

Let me know your thoughts!

 

Glenn Whitfield

 

 

 

 


Lean & IT

January 26, 2009

 

Forrester Research recently held several “jam sessions” the first of which was one that focused on the topic of creating a leaner IT, and has followed it up with several discussions on lean, declaring, “lean is ‘in’ right now.”  This scares me.  Not because the folks at Forrester are wrong, precisely the opposite.  They are right on in declaring that lean is a mindset and culture.  What scares me is how organizations and consultants will respond to this declaration.

Now, I am a huge proponent of Lean, having been involved with it my entire career, but organizations need to tread carefully when embracing Lean thinking.   Many will start with declaring they are starting a new ‘lean initiative’ and will hold kaizen events, use Value Stream Mapping, send people to training, study the Toyota Production System, and, yes, they will get results (this stuff DOES work).  After a while, however, they will start to stagnate.  The ‘lean initiative’ will start to seem stale, and will eventually wither on the vine, becoming yet another initiative that failed to sustain and meet expectations.

Why do they fail?  Because they did not implement Lean, they implemented the TOOLS of Lean.  Kaizen is a tool, Value Stream Mapping is a tool – in and of themselves, they are not Lean.  Lean is a culture of the continuous pursuit of the elimination of waste in everything the organization does.  Toyota does not care that companies (even competitors) come study their production systems, because they know that by the time the competitor is able to implement what they observed, Toyota will have moved on – that is the way their corporate culture works.  Toyota does not have a ‘Lean initiative.’ Toyota does not ‘do’ Lean, they ‘are’ Lean.  It’s just the way they do business.

Implementing the tools of Lean will get you results, and will help move you toward becoming a Lean organization, but Lean is bigger than the tools.

So, as IT organizations move to embrace Lean thinking, the question becomes, “Are you going to ‘do’, Lean, or are you going to ‘BE’ Lean?”

 

Glenn Whitfield


IT’s Responsibility to the Business

January 6, 2009

 

When implementing a technology project, whether major or relatively minor, it is easy to forget the value and insight IT leaders and project managers can bring to the process being impacted.  This is something that is often forgotten not only by business leaders, but by IT leaders as well.  Much of this can be attributed to the “that’s the way we’ve always done it” attitude.  This must STOP!

As stated in previous posts, IT is in the unique position to see the impact of changes across the organization, not just in the primary area impacted.  But, while it’s one thing to see it, it’s another to actually DO something about it.  How often does this happen?  A business leader makes a decision.  The IT staff follows orders and provides the IT solution that does what the business leader said he wanted – all the while wondering why such a “bonehead” decision was made due to the implications on the business further down the process.  The thoughts often go like this, “Hey business leader, you asked for a solution; I gave you what you asked for.  Not my problem if there were other issues because of your decision.  That’s not part of my job.”  IT leaders will cringe at the thought of their staffs thinking this way, and will swear up and down it doesn’t happen in their shop – but it happens, more than we would like to know.

Here’s a way to avoid it.  When I was working with a $1 Billion regional healthcare organization with multiple IT systems, the IT project manager came to me with a problem (one core system solves the problem, but that’s another issue).  The organization wanted to launch a branch of the rehab hospital inside of one of the existing acute care hospitals.  His job was to get the IT systems up and running.  They had just had a meeting where the acute care hospital president stated he wanted the rehab branch on the same IT system as his hospital.  To him, it made sense to have all the patient information on his system (primarily for accounting purposes), since the rehab branch was in his hospital.  The problem was, as the project manager explained to me, that the rehab hospital and all its existing branches were on a different system, and the physical therapists staffing the branch could come from any of the branches, so they would have to learn and know 2 core systems.  Also, it was planned that patients would transfer from the rehab branch at the acute hospital to other less specialized branches as their condition improved, creating duplicate entries when the patient went to another branch.  And, to top it off, the additional work to write and test the multiple interfaces put the project’s timing at risk.  But, the president said he wanted the rehab branch on his system, so that’s the direction the team was taking.  I asked a simple question, “Does he understand the consequences of his decision?  Did anyone explain them to him?”  The answer was, “No, he’s the president.”  My advice, “Then you need to.  He’s a reasonable person, lay it out and make sure he is informed.”  And he did.  The president realized the implications of his decision, and quickly reversed it, keeping in mind what was best for the organization as a whole. 

 When a business leader makes a decision about the direction of a project, and you know there will be unintended consequences, speak up.  No, not in front of everyone, but in a one-on-one session (always remember to use tact – never intentionally, or unintentionally, embarrass the boss in front of others).  Collect the information and what you believe to be the consequences of the decision and present them in a logical, concise manner (keep your boss informed as well – whether or not your boss attends will depend on your organization’s culture).  Then if the business leader still makes the same decision, at least they have done so with full knowledge of the consequences, and you have done all you can do to keep them informed.  Then, you may sleep better at night…. or want to update your resume.


Holiday Alignment Wishes

December 22, 2008

 

As we wrap up a year that many would like to forget, let’s at least be grateful for the good things that have happened.  Come on, there had to be at least one….

 

The holiday season is a great time to think about the past year, and get ready for the new one.  With that in mind, here are some Holiday Alignment Wishes I have:

 

o   IT Leaders will stop whining about how Business leaders “just don’t get it” and will actually go DO something about it.

o   Business leaders will stop blaming everyone (including IT) for their problems and look deeply at their own processes.

o   CIOs will step up to the plate and show how they can add real business value to the organization

o   CEOs/CFOs/COOs  will listen to their CIO

o   EVERYONE (CEOs, CIOs, IT leaders, Business leaders) will get over themselves and start working together to figure out how to improve their organization and make it successful.

 

This is a great time to take a look in the mirror and ask a simple question, “Am I part of the problem?”  Then ask yourself one more, “What am I going to do about it?”

 

Here’s to hoping 2009 is Happy, Health and Safe!!!