Posts filed under ‘Management’
The Role of IT Engineering
A couple of years ago we separated our “technology division” into two groups: IT Engineering and IT Operations. The dividing line between the two is the production environment. Any new technology is architected by our Engineering group before it goes into production. Once something is in production it belongs to IT Operations and it cannot be touched without going through the change management process.
Here is an example of the IT Engineering group doing a good job:
All IT organizations are seeing a mounting desire for employees to use their own devices (especially iPads) in the workplace. When I recognized that this demand would be huge, I began advocating to connect Android and iOS devices to our Exchange Server via AtciveSync I went to the Engineering team, who is charged with evaluating new technologies before they go into production.
To their credit they said that the vanilla approach to device connectivity would not meet our security expectations. They told me that the only way we could safely manage employee owned devices would be through a device management system that would sandbox the organization’s data, protecting it from security flaws, malware and poor user security practices. They also told me that this would only cover the Exchange connectivity use case and that any other use cases would require further analysis (and perhaps additional expense).
I was disheartened to learn about the added cost, but I would much rather surface that with our executives so we can make a fully informed decision rather than spring a surprise expense on them later.
Attitude Adjustment
My car was being repaired on Wednesday, so I took the bus home from work. Fortunately, the main bus terminal is one block from our IT offices in Appleton. Unfortunately, the closest the bus gets to my house is over a mile a way.
I jumped on the bus looking forward to getting a little exercise with a crisp fall walk. By the bus arrived at my stop it was snowing hard and snow was accumulating on the sidewalk. I was feeling so sorry for myself I almost didn’t notice the person that got off the bus at the same time. When I did, he was smiling and trying to catch my attention. I returned the smile he went on to tell me that he was so happy to see the snow. It turns out he is a college student, on an exchange program from Guatemala, learning Business and English. He had never seen snow before. We shared much of the same path and time and weather seemed to disappear from my list of concerns as we had a pleasant conversation as we walked. Seeing his joy in what I was dreading completely changed my attitude.
At work attitudes are so powerful. Not only does a manager set the tone with their attitude and non-verbal signals. But all employees’ attitudes have so much influence over how a meeting is perceived. I value every employee’s opinion and when they appear uninterested or disagreeable, I cannot help be affected by that. Luckily, the folks I work with are supportive people.
Being a good listener and bringing a sense of excitement to your work is powerful. When I was relatively new to the workforce I remember listening to a fellow employee present some information. Whenever she missed a fact I would shake my head no. After a while I realized this was having a negative on her presentation (duh). Since then I always try to be a good listener. If someone is presenting and I am not expected to engage them in dialogue, I look them in the eye, I shake my head affirmatively and I smile. I know this puts people at ease which allows them to be their best.
Building Team Skills to Win The EHR War
I had the pleasure of being in a small audience to hear Wisconsin’s own Quint Studer speak. Most healthcare folks will recognize Quint as the guru of approaches to achieve great results in hospitals (patient satisfaction, employee engagement, financial performance and quality).
Quint criticized healthcare organizations that have tried to address financial challenges by reducing training budgets. I have been guilty of this short-sightedness in the past. However it is now clear to me that the only way we can continue to address the continually increasing demand for IT is to better leverage ou
r employees. As we ask more employees to lead more complex projects they need the support and education to be successful.
I am working on several fronts to address this. One small but meaningful effort is to encourage employees to read. Recently I sent every IT team member a Barnes and Noble gift card so they can get a book. The only thing I asked in return is that they post a short book review on our internal social networking site (we user Yammer). Some bought traditional books, some of our road warriors bought audio books and others bought ebooks for their nook.
I love the Dave Ramsey quote: “You are the same today as you’ll be in five years except for two things: the books you read and the people you meet.”
I told my team that the book did not have to be related to their work. I did not want people to buy SQL Server Administrator guides that would collect dust on a shelf next to the Lotus 1-2-3 floppies. As I have have blogged in the past, inspiration will come from unlikely sources as long as you are open to it.
To that end I just finished Operation Mincemeat. This is a wonderful non-fiction account of a British WWII deception plot. Toward the end of the book I was struck by this quote:
“Wars are won by men…storming up the beach with all guns blazing…They are won by planners correctly calculating how many rations and contraceptives an invading force will need. By tacticians laying out grand strategy. By generals inspiring the men they command. By politicians galvinizing the will to fight. And, by writers putting war into words.”
At the risk of being overly dramatic, it strikes me that large IT projects (like an EHR) are similar. They need champions willing to take on risks; great planners; people that envision how the system will serve a larger strategy; people at the top that can motivate the team and the users; and people communicating the right message to the right target audience. Contraceptives are probably not so important.
I am also developing a multi-day curriculum for IT Analysts that will make them more effective project leaders and team members. It is essentially a brain dump of everything our IT veterans have learned (often the hard way) implementing healthcare IT systems. I am thinking about opening it up to people outside of our organization. Let me know if you think there would be an interest.
6 Management Lessons I Learned by Watching Tabatha’s Salon Takeover
I am in the process of a significant IT Reorganization. The goals of the reorganization are:
- make IT Operations more reliable and
- improve the overall efficiency of the IT team so we can complete more projects (the demand keeps increasing).
One of the new IT leadership positions is a supervisor to manage the work of support techs in each of our 5 IT regions. As you would expect, the candidates are primarily the existing support techs. I have had the greatest time talking to these men and women about their interest in the position and their ideas to provide end users with a better service. They are talented, bright, optimistic people. It has been a real energy boost for me.
For all of their raw talent, most are new to management. Providing them good mentorship will be key to their success.
Now there are libraries filled with books on management philosophies. But, that would require me to travel to a library, or to read a book. Instead, I chose to watch some reality TV on Bravo. Tabatha’s Salon Takeover follows “celebrity hair stylist”, Tabitha, as she travels across the country helping struggling salons. It is my guilty pleasure.
The owners of these salons are usually in deep debt and losing money. Much of what Tabatha does is address poor management, including bad employee supervision. The salon employees always have the same concerns, and as such, these have become the basis for my primer for supervising people for first-time managers:
- Employees want their manager to be present. There are various approaches to being present, some more effective than others. As Studer disciples will attest, effective rounding is a great tool.
- Employees want regular staff meeting where managers can communicate the big picture and where things are going.
- Employees want clearly defined, preferably written and measurable, performance expectations.
- Employees want opportunities for growth, including a plan for their continued education.
- Employees want feedback regarding their performance. They want to know when they are not meeting expectations and they REALLY want recognition for good work. Sending employees hand-written thank you notes is a Studer “must-have”.
- Employees want to be treated fairly. While low performers are often the biggest complainers about fairness, it is the high performers that are demotivated when they are treated the same as low performers. The Studer Group has great strategies for determining High, Middle and Low Performers and how to manage each group.
Should I tell our new managers to watch Tabitha’s Salon Takeover? Maybe that is not the best conclusion. I think the real lesson is that inspiration to be a better manager is everywhere. If you are passionate about being better at something, think about it throughout the course of your day and it will find you.
The Magic Answer
Every good geek (and Google) knows that the answer to life and everything is 42. This is a famous line from The Hitchhiker’s Guide to the Galaxy.
But it seems like there is a more sensible magic answer: In order for things to go well, there needs to be a high level of specification.
Yes, ambiguity kills. In fact, it literally kills according to a study by Spear and Schmidhofer that was recently published in the Annals of Internal Medicine. The authors found that high performing organizations achieve results “by specifying how work is expected to proceed—who will do what for whom, with what purpose, when, where, and how—before work is actually done. Then, when anything contrary to expectations occurs, it is immediately identified as a problem.“
Medication errors may be one of the most critical examples where a high level of specification is needed. But, I run into this everywhere.
This year I brought in consultant Kevin Behr to analyze our IT Operations. The single most significant finding is the IT Operations in my organization suffers because of a lack of definition. When everyone is left to define how work gets done there is bound to be mistakes and mis-connects. Our organization needs to dedicate time to evaluating what we are doing and how it needs to be done. All work must be EXPLICITLY defined, otherwise talented people (like I am blessed with) can’t achieve their full potential.
I believe my organizations do a superb job of running large and complex projects. That is because we spend so much time defining the right process, then learning from our mistakes and re-defining our methodologies.
Job descriptions are the same way. If you are not explicit about a person’s role and what they are expected to produce you should expect to get something unsatisfactory.
How many times have your interfaces gone through multiple re-writes because you did not have a high degree of specification when you started working on them?
Is this so basic that it is not worth a blog post? If so, why do I see so little definition of work or processes to a high level of specification?
Managing The Project Pipeline
Annually I work with Ministry’s IT Customer Advisory Board (our IT Steering committee) to identify the IT projects for the coming year. Like all capital budgeting processes, we have a IT capital target that is based upon a number of factors like recent financial performance and competing capital projects (usually new imaging equipment and construction projects).
At Ministry we really have two targets, money and time. As I have posted 
previously, we estimate how much time each IT employee has to work on projects (as opposed to support). We add all of that time to determine the total project time for the year. I am simplifying things, but you get the idea.
If we don’t spend as much capital as we had planned then we can save that money to spend in the future. However, time is different. Every hour that we had reserved for projects is lost forever if we are not using it that way.
We have such a great demand for IT projects, it is important to make sure we do not let that time go unused. In past years we approved projects, then waited for those championing the project to bring them forward. The problem with that approach is that our managers are so busy they tend to wait until the latter half of the year to get things going. In the mean time that time set aside for projects is going unused.
This year we are encouraging our business leaders to getting things moving sooner and telling them the resources are available now. This should better use scarce IT time and reduce the number of projects that carry-over into the next year (which ultimately reduces our capacity for a given year).
I will let you know how that works.
My Management Philosophy on Feedback
Recently, we got a glimpse into internal emails sent by Steve Jobs and Bill Gates. They were both to a large audience and both were critical of internal efforts. I found these to be reassuring in that they seem to echo my own personal philosophy regarding employee feedback: Be candid, tell people (individually or collectively) when they do a good job and tell them when they don’t meet your expectations.
I prefer to give feedback direclty to the people, even if there are levels of management between us. To some people this may be a bit of a shock. In my experience many managers have trouble giving people negative feedback. But I believe people need to understand what is expected and how they need to improve to meet expectations. Hearing it directly from me has additional weight and ensures nothing is lost through intermediaries.
Of course there are a number of amazing things being done at Affinity and Ministry every day. I try to thank people for their extraordinary efforts. It is hard to recognize all of the good work. It is one of the most challenging things in a division of 200+ people.
Failure
My person approach to IT management centers around success. Most IT projects fail. Some quite spectacularly, but most in a quieter way. I believe these are the three leading contributors to failure:
Poor Project Plans and Resource Allocation
My personal experience is that most IT departments do not have a good sense for the amount of time they have to spend on IT projects. All of the data I have collected since I have been studying this suggests that only 15% to 25% of total staff time is available to work on new projects. If organizations take on more work than they can complete, everything proceeds at a snail’s pace and nothing ever truly gets done.
The only way to manage resources in a large organization is to have detailed plans for every project and to look at the resource requirements across all of your plans.
Vendor Performance
Just as IT departments over-allocate their resources, so do vendors. Vendor performance issues are usually more related to them not providing services in the time expected (or not having a common expectation with the vendor) than bad software. However, sucky software is still an issue.
Lack of Clear Expectations
If someone’s goal is just to implement some software than, in my opinion, they have failed by default. Each IT implementation should have clear business benefits and those benefits need to remain insight throught the effort.
Am I missing other common contributors to failure?
Super Users
There is a role for super users to provide just in time training and to serve as moderators of user groups. However, there is a tendency for folks to believe that the super user is the person that handles anything above the most routine use of the technology. Having super users cannot reduce the expectations of the rest of the work force. Every employee must be tech savvy and leverage the tolls provided in order for us to have any hope f achieving a return on our very expensive IT investments.
What do you think?
CIO Job Description
I know that there are folks out there looking for a job description for a healthcare CIO. So, I am posting mine to aid those people in their search. Feel free to leave a comment if you have any thoughts or questions.
POSITION DESCRIPTION
SCOPE OF RESPONSIBILITY
This leader is the Chief Information Officer (CIO) for the Ministry Health Care System and will lead the transformation to a centralized Information Technology (IT) service through an Information Technology Shared Services Organization. The CIO will provide technology vision and leadership for developing and implementing information technology initiatives. This individual is responsible for the planning and execution of an information technology vision, goals and initiatives that support the long term objectives, mission and vision of Ministry Health Care (MHC) across North Central Wisconsin and at each of its sites. This leader will collaborate with leaders at the highest level of the organization and manage a team of professionals who are accountable for the delivery of all information technology services in the System. This position will be located in Central Wisconsin, in Wausau, Weston, Stevens Point or Marshfield. The CIO will report to the Senior Vice President and General Counsel. This individual will work in a manner that is consistent with a tax exempt Catholic health care organization that supports the mission of the Sisters of the Sorrowful Mother.
PRINCIPAL ACCOUNTABILITIES
IT Governance and Portfolio Management
- Lead a governance structure that aligns IT initiatives with business priorities while balancing resource constraints (human and fiscal) to optimize IT investments (The IT Portfolio). This governance process will produce an annual IT plan and budget that is integrated into the system planning and budgeting processes.
- Responsibility for the selection, acquisition, development, installation, maintenance and support of information technology for Ministry.
- Manage, in conjunction with other leaders, the project approval and selection process.
- Ensure that all initiatives in the IT portfolio have clear business goals and success metrics.
- Monitor and report on the performance of the IT portfolio including actual vs. expected results, budgets and project duration.
- Perform an ongoing assessment of IT capabilities of employees and contractors and IT performance on behalf of entities across the System. Evaluate performance and skill against Ministry needs.
- In conjunction with other leaders, understand and establish the working relationship with the Project Management Office or similar business unit responsible for organizing the timely completion of Ministry projects.
- Oversee relationships between Ministry’s IT resources and external entities (e.g. government, vendors, researchers and other health care organizations).
SSO Development, Operations and Technical Support
- Management responsibility for all IT activity under a matrix reporting structure from the date of hire and thereafter in accord with the structure of the Shared Services Operation (SSO).
- Develop the Information Technology SSO and develop a permanent reporting structure and a service delivery model for the SSO. Establish processes and metrics necessary to make the SSO successful.
- Understand application architecture and technical infrastructure (including Marshfield Clinic components) of MHC information systems and regularly assess the MHC vision and direction.
- Develop a strategy and plans for the technical infrastructure and application architecture for MHC and execute the plan. The plan shall include standards and protocols for data exchange, communications, software and interconnection of information systems.
- Develop a service level organization that establishes service standards for corporate office and each entity served by the Shared Services Operation. Capture the service level commitments in a Service Level Agreement between each entity served (including corporate office) and the SSO.
- Establish and maintain a service orientated, customer focused IT function that supports ongoing operations that drive efficiency, quality, customer service and growth. Develop service level agreements and manage to agreed upon performance levels for application availability, response time and network performance.
- Ensure that enterprise information systems operate according to internal standards, external accrediting agency standards and legal requirements.
- Ensure the protection of IT assets and the integrity, security and privacy of information entrusted to or maintained by MHC.
- Develop and maintain a business recovery plan to ensure timely and effective restoration of data and IT services in the event of a disaster.
- Oversee the negotiation of all IT contracts.
- Identify and implement formal training and education as needed throughout IT in conjunction with the Education SSO.
- Complete Talent Reviews and development plan for IT personnel.
Clinical Transformation
- Work with other leaders to identify the role of the Office of Medical Informatics and the roles of the Chief Medical Informatics Officer (CMIO) and other medical informatics leaders and their relationship to the CIO.
- Assess existing efforts, initiatives and successes in working to establish an electronic medical record, lead the initiative to establish a new vision and strategy for a platform to support the provision of clinical services and execute the identified clinical information strategy.
Communication and Collaboration
- Provide advice and counsel concerning IT issues and industry trends.
- Communicate to Ministry’s business leaders the plans for continued standardization efforts of information technology (IT) across the system and collaborative efforts with Affinity Health Care. Clarify their role and the need for collaboration across the system to achieve standardization. Provide methodologies for working together toward standardization. Assign resources to areas where standardization is being achieved. Re-direct efforts that lack a system-wide approach.
- Conduct IT planning in conjunction with the Marshfield Clinic to facilitate co-dependency and appropriate alignment between the organizations.
- Develop positive relationships with MHC leaders by understanding business priorities and IT enablers.
- Participate in the strategic planning process and share in the development of Ministry vision, goals and initiatives.
- Frequently and effectively communicate the IT vision and plans throughout Ministry. Use targeted communications that are appropriate to the various stakeholders. Build excitement around the planned changes and understanding for the selected priorities.
Mission Integration
- Work in a manner that reflects the mission and philosophy of MHC and the Sisters of the Sorrowful Mother, including but not limited to compliance with the Ethical Decision Making Process.
Other duties as assigned.
- Under the supervision of the Senior Vice President, perform other duties as assigned.
EDUCATION AND EXPERIENCE REQUIRED
Education:
- Bachelor’s Degree in Information Systems, Engineering or related area from an accredited institution is required. A Masters Degree is preferred.
Experience:
- Demonstrated experience with IT systems and IT management as a senior level with a sequence of increasing responsibilities in large and diverse business settings. Familiarity with health care or health care related organizations is expected.
- Experience with and understanding of strategic and business planning methods, tools, and processes.
- Experience in working through major organizational change
Specific Qualifications:
- Familiarity with the health care industry – its critical issues and major challenges
- A track record of working in a geographically diverse complex organization
- A track record of successful large project implementations
- Demonstrated business savvy to work effectively with other Executives to achieve key business and technology goals.
- Demonstrated project management skills.
- Lean Six Sigma experience a plus.
PERSONAL AND PROFESSIONAL ATTRIBUTES
This individual will understand and have a commitment to the philosophy, mission, values, and vision of Ministry Health Care. The individual will be able to demonstrate these values with his/her leadership practices. This person will possess personal and professional integrity, strong communication skills and an excellent professional appearance and presentation. Strong analytical and decision-making skills along with considerable tact and diplomacy are important considerations. The individual must possess strong leadership and managerial skills, strong interpersonal skills, a good sense of humor, high energy level and a positive outlook. Other attributes include the following:
- Is respectful, honest and demonstrates integrity and ethics.
- Listens effectively, shares ideas and information openly and facilitates relationship building by establishing trust.
- Experience in building a new model to serve the IT needs of a complex organization
- Has functioned at an operations level and in a complex multi-facility environment.
- Interested in serving as a mentor to others.
- Possesses initiative, good judgment and the ability to problem solve.
- Possesses strong business acumen with proven experience in thinking strategically and implementing tactically.
- Has handled demanding workloads to meet objectives.
- Is customer focused/service oriented, and has effectively affected change.
- Works effectively with physician leaders and, in particular, a chief medical informatics officer.
- Broad IT infrastructure and application architecture knowledge.
- Experience in portfolio management
- Is driven, compassionate, and creative.
- Embraces positive conflict.
- Team player.
PHYSICAL REQUIREMENTS
- Moderately quiet office environment.
- Ability to travel, sometimes overnight, by auto or small plane.
- Occasional lifting of 10-20 pounds.
- Sufficient vision acuity for routine computer use, and moderate to heavy reading and writing responsibilities.
- Position requires walking, sitting and standing at moderate levels.
- Stamina able to be maintained to manage a work level that normally exceeds 40 hours per week.
- Position requires a high level of all forms of communication skills: written, verbal, listening.
