In my inbox I received the communication from United Airlines about the changes they are making in response to their recent service failure. I thought it was well written, so I though this would be a good time to review one of my favorite topics. Every organization fails their customers at some point. Whether it be an unplanned EHR downtime, or dragging a paying customer off of a plane in a manner that upsets passengers.

Once the actual event has concluded there is a set of steps an organization should take to recover its standing with customers and to continually improve. These basic steps are the same for an IT team or an airline. In my opinion, United Airline’s initial response to recent events their response was terrible. Their subsequent efforts are on target. They followed the process that I have championed within my organization.

1. Accept Full Responsibility: Accept full responsibility for not living up to your promise. Sure, the actions of others may have contributed to the incident. But, blaming others is deflection and not ownership. Ownership is empowering because it gives you the ability to fix the problem.I actually prefer to avoid apologies. I reserve apologies for personal failures and actions that are true negligence. Instead, I prefer to thank customers for their patience and their feedback and to let them know that we will work tirelessly to improve. A thank-you elevates a customer, it is a gift.
2. Root Cause Analysis and Systemic Change: In United’s recent letter to customers they asked “How did this happen, and how can we do our best to ensure this never happens again?” Bingo. One needs to understand why it happened and make systemic changes to prevent recurrence. Root Cause Analysis (RCA) is a well understood science. Every CIO should understand RCA basics and they should have people on the team that are RCA experts. Finally, it is important to communicate to your internal customers the changes that you have made.
3. Cultural Assessment: The extent to which the United CEO understands the cultural aspect of this situation is impressive. As the leader his language and the behavior will be reflected by the 87,000 United employees. While the team closest to the work should complete the root cause analysis, the leader must reflect with the leadership team regarding how organizational culture contributed to the event. Are financial constraints putting pressure on employees to move to quickly and skip steps? Is the lack of investment in employee development keeping people from meeting their full potential? Are leaders openly making negative comments about customers they should revere?

How does your organization handle service failures? What would you add to this approach?

CIOs need to balance three goals:

1. Advancing the organization’s strategy
2. Engaging the IT team members
3. Keeping customers happy

By customers, I mean the people that your IT organization provides services to. In my case it is doctors, nurses, and other knowledge workers. Some people call these people their “users”, but, as I have written in the past, that is a mistake.

Many IT Organizations Are Blind With Regard to Customer Satisfaction
I would argue these three goals are equally important. But, customer satisfaction is the most neglected. In my experience, most CIOs have all types of project portfolio reports that tell us how our strategic initiatives are doing. And, most organizations wisely survey their employees periodically to measure employee engagement and satisfaction. But, most CIOs do not have good overall metrics about customer satisfaction. Are you doing better than last year? Which IT provided services most need improvement according to your customers?

Sure, you might send help desk customers an after-call survey. But, that is a narrow measure of a single service. And quite frankly, these scores are largely meaningless. But, that is a blog post for another day.

Customer Satisfaction Is Important
An IT division can be completing all of their strategic projects with great success, and still be perceived within the organization as a failure if they are not meeting their customer’s expectations.

My Customer Satisfaction Story
I found (the hard way) that you really don’t know what your customers think of your service until you survey them in a methodical manner. I recommend all IT organizations survey their customers annually. In fact, all internal service providing organizations (HR, Legal, Finance, etc.) should join together to survey customers annually.

I thought the IT organization I led was providing good service until our first customer satisfaction survey: 71% of customers rated our service as good and great that year (ouch). My first reaction was to blame the customer and rationalize the data by claiming how difficult it is to provide good IT services. Once I got over that initial bout of self-pity I got to the business of identifying the area of greatest customer dissatisfaction (as surfaced by the survey and follow-up discussions). Our IT team developed a plan to improve those areas. Every year we would get more feedback and every year we would develop improvement plans.

In our last survey 92% of our customers ranked our service as good or excellent. This year-over-year improvement has been my most cherished accomplishment. It was also one of the greatest sources of motivation for the IT team members. They loved hearing the comments and seeing the scores.

Happy To Help
I am happy to share the survey tools that I have used. I am also happy to share my aggregated results if you want to benchmark your results.

During my time off I have been meeting with folks to see what is new in the healthcare IT space. I got a quick demo of a product called IllumiCare. Their mission is to provide cost information to physicians so they can make informed, cost-effective decisions about plans of care and hospital orders.

To be clear, this is not an IllumiCare endorsement and IllumiCare did not ask me to post this. I just saw a demo. But, their offering is based on 2 principles that I completely agree with. I believe these should be guiding principles for all of us in healthcare IT:

1. Embed everything in the EHR

Illumicare’s information is presented as embedded panes in EHRs such as Cerner or Epic. Illumicare believes (and I agree) that having separate systems kills adoption. Physicians live in the EHR. They don’t want to login to separate systems; re-query their patients; nor deal with different user interfaces. Even if you have single sign-on and patient context management, there is significant inertia that keeps physicians from logging into other systems.

2. Don’t hijack the physician workflow

Our attempts to build alerts into the physician online ordering workflow have been failures. Because these alerts are seldom relevant to the task at hand physicians clear these alerts before they are even observed. It is time to STOP using alerts except in the most critical safety situations.

Instead Illumicare presents cost information on review screens. The idea is that information is imparted when the physician is most open to receiving the information. Over time physicians come to understand the cost impacts of their behavior and modify that behavior over time.

This is a personal update.

For the last 16 years I have been the CIO at Affinity Health System and Ministry Health Care. That run comes to an end this month.

So, now I am going to take several weeks off. Initially I had grand ideas: backpack across Europe, bicycle across the US, or through hike the Appalachian Trail. But, after consultation with my wife, Pam, I have more grounded plans:

1. Spend more time on my numerous community activities in downtown Appleton.
2. Spend time reading about healthcare IT; blog; and network with interesting people in my field with whom I had lost contact (connect with me on LinkedIn and we can catch up).
3. I have also been given a list of things to fix around the house.

When summer comes I will get serious about deciding what I will do next. While I love being a CIO, I also love living near my adult daughters: Amy (Chicago) and Mary (Appleton). So, I may be returning to my consulting roots and hitting the road. Either way, I am eager to share what I have learned in 22 years as a CIO.

Transitions are a time full of different emotions. I have been through them all. At this point I am mostly feeling satisfied with what I have accomplished and excited about starting a new life chapter.

The best thing about leaving an organization is the number of kind notes that you receive and how much insight others have about your strengths and contributions. I cherish the many emails and notes I have received.

For the last couple of years I have been transitioning our IT division to Ascension Information Systems (AIS). A move that is the natural outcome of Ministry’s acquisition by Ascension, the nation’s largest non-profit hospital chain. That transition is complete and the team I was privileged to lead is now following an exciting national strategy set by Ascension’s excellent CIO, Gerry Lewis. Those IT employees are in good hands and I thank AIS for taking such good care of those people and me.

More to come…

February seems to reliably delivers Patriot Super Bowl wins and budget gaps to be closed. I have used these approaches, both as a CIO and a consultant, to manage challenging IT expense reduction efforts:

Get Organized

Every daunting task is more easily accomplished by breaking it up and delegating work into smaller streams of work. Here are the categories that I have historically used for large cost reduction efforts:

IT Expense Management Framework

Here is a PowerPoint version that is more readable. In future blog posts I will write about successes I have had in these different categories.

Generally, I would be accountable for the entire effort, but I would assign a lead for each of the major categories (labor, sourcing, rationalization, and telecom). There is a lot of overlap, so the leaders need to regularly meet as a team.

Keep Score

All of these efforts require tracking tools to tally the planned savings. Smaller organizations can use a spreadsheet. Larger organizations need a mechanism that multiple people can contribute to at the same time; and enforces complex score keeping rules. Sharing the results frequently will build momentum and create the proper sense of urgency. I have some sample tools that I have used in the past, let me know if you would like to see them.

For a larger effort it is a good idea to have an audit role. The people that are good at generating creative IT ideas are not always the best accountants. They need help translating their ideas to actual projected savings.

Execution

Each IT expense initiative is a project. Without regular review and disciplined follow-through the savings will not be realized. Keep the structure in place until all of the ideas have been implemented. Create a dashboard to show leadership and the team their progress to the goal and changes to the expected savings total. Celebrate regularly.

Good luck. Remember, the money you save makes healthcare more affordable.

If our experience at Ministry Health Care is an indicator, enterprises may be transitioning from Internet Explorer (IE) to Google Chrome as the browser of the future.

The problem for IE is not about being an inferior browser (although I am sure that will be argued in the comments). But, enterprises like ours have a lot of early generation web apps that were built to run specifically on older versions of IE. This has prevented us from upgrading IE to more recent versions.

At the same time we are implementing a lot of new web apps (like Workday) that demand a modern browser. Since we can’t upgrade IE without breaking the legacy web apps, we are introducing a second browser: Chrome.

Over time we will have fewer and fewer apps running on IE and more apps running on Chrome.

Yammer is the internal social media platform we use in IT at Ministry Health Care. Recently there was a Yammer thread discussing the effectiveness of the communication surrounding the recent Yahoo email outage. Outage communication has been a focus for us and we like looking at what others are doing.

There were certainly a number of things that Yahoo did well. We thought that a communication from the CEO of the company set the right tone and it was written with a lot of authenticity. Sending an email from generic email accounts like the “IT help desk” would not have created the same level of goodwill.

But, I have two suggestions for Marissa Mayer:

1. Don’t refer to your customers as users. Customers are valued. They are the reason you exist. Everyone has a mental model of good customer support. This Yammer post summarizes it better than I could: “Call me a customer, a client, an associate, a staff member, even just ‘you’ but ‘user’ sounds technical and impersonal.” Even if those receiving your service aren’t the ones paying I believe it is important to constantly remind associates they are the reason we are here and their satisfaction supersedes our own.
2. A thank-you is better than an apology. There were a lot of apologies in the Yahoo communications. I believe it is a better approach to thank customers for their loyalty and patience while recognizing the inconvenience and letting customers know that you are working day and night until everything is fixed. When you thank someone you are recognizing them. When you apologize you are denigrating your performance. Save apologies for intentional acts, not mistakes.