A Discussion with Steve Weiss:
Strategies to support technology projects in reaching their greatest value potential
We recently sat down for a conversation with Steve regarding his perspectives on barriers to organizations reaching their value potential. As an 18-year veteran of implementing, maintaining, and optimizing clinical health records, Steve has leveraged 12 years of clinical experience establishing workflows that drive clinical quality and operation values, to create numerous optimization and governance groups. A proven leader having served in the C-suite for a multi-hospital health system and expert Meaningful Use project director, he has established post-live support and training teams, developed and managed clinical build teams, and provided business intelligence solutions for inpatient and outpatient quality reporting, Meaningful Use, and hospital dashboards. From a business intelligence perspective, this included implementing a decentralized model of report creation with centralized support.
Q: What are some of the biggest reasons new technology projects do not reach their greatest value potential?
A: I’d have to say there are three key areas:
- Lack of business alignment
- Competing priorities
- Lack of change management
First, a lack of alignment with the business can lead to the technology not matching the need. Some organizations get pulled into “magical thinking”, where solutions are presented based upon a vendor promise that is not always delivered. If IT challenges these, it can be seen as creating barriers and can generate a lack of trust between their department and the business operations. If they don’t challenge them, the organization may be purchasing technology that has problems providing value, and IT will be accountable after the fact. Additionally, when IT does not have a good understanding of the change impact, they may not spend enough time engaging stakeholders, or miss key stakeholders altogether. They may miss some small point within a workflow that snowballs downstream creating afterwork and confusion. Focusing on the technology rather than the business opportunity from the start, can lead to expensive implementations that do not live up to the hype. “Shiny object syndrome” can keep an IT department busy with projects where there may be an existing solution that meets the need.
The second key area is creating competing projects and priorities and not understanding the IT workload. Organizations need to consider their project portfolio in its entirety, leveraging portfolio management, to understand its impact on day to day operations. This entails purposeful project prioritization, demand management to reduce opportunity costs, project management, and business outcomes (measurement of success). At times, you can decide to do more than capacity, but need full awareness of impacts of the load after the work is completed, such as deferred maintenance will need a period of time to be caught up, while protecting your heavily extended project resources from burn out.
Third, is a misunderstanding of the true change disruption and not having a communication and change management plan. All change is disruptive and creates change trauma whether that change is for the good or not. Preparing end users before a change can often make the difference between a technology that supports an organizational goal, and one that is seen as a burden, imposed on them by the IT department.
All three of these can be fixed with some short term and long-term strategies.
Q: What short term strategies have you found to help?
A: A good start is to have requestors focus on the business need at the beginning of an intake process. They may have a solution in mind, but that solution should line up with a reason for implementing. Focus on WHY they want a change. What problem or need are they trying to solve? This will help decision-makers understand the value of the business need, determining if the cost or work effort exceeds that value. Capturing this will also help to line up the value with the organization’s strategic direction or to negotiate partial solutions available to them aligning better with the value they provide.
A recent example was an interface project needed to provide lab results to a long-term care facility. The project went well up to one small part requiring manual intervention. The project went on longer than anticipated to try and automate the last piece of workflow, when the executive team could have intervened because the value of automation did not outweigh the work required. Another example was an expensive solution created for a department planned to be downsized. This was not only an expensive waste of resources but created opportunity costs preventing work on projects providing more value.
Project work assignment overload can make it prohibitive for resources to simultaneously support maintenance requirements. Understanding maintenance activities and optimization need to occur concurrently with project work is key to avoiding a backlog that is expensive to correct or required heroics to keep issues from impacting user satisfaction. And finally, having a routine report out and executive oversight structure for technology projects keeps the business in line with IT and the technology. In providing a regular cadence and requirements for status reporting of project work, including oversight for long term maintenance as well as future optimization, the business keeps up to date on activities and can more easily be engaged for decision-making.
Q: You mentioned long term strategies as well. Can you share those?
A: Again, there are a few key areas I consider to be of value in supporting successful alignment between the business and IT, generating more value out of your technology. I’d start by looking at the maturity of your informatics program. How are you developing a leadership pipeline, managing the super users through informatics, and keeping a program in place and active? Your super user program is a great pipeline for optimization; an army of super users can be leveraged to develop optimization and change management programs.
Who are you partnering with to develop informatics? Nursing clinical education, med staff, HIM, quality are great partners. Those relationships help to expand the outreach of informatics without having to expand the team. Some examples include quality leveraging the EHR for MIPS and other regulatory quality programs, HIM with the management of information, maintaining nursing education skills also supports documentation requirements within the EHR. Also, Med Staff uses quality measures and efficiency/proficiency measures that can be leveraged to improve physician documentation, reimbursement, and more. If there is consistency in the message they have when they reach out with the message informatics has when they round, behavior change leading to value occurs much more quickly.
I had mentioned project portfolio management earlier in our conversation. A transparent decision-making process organically creates alignment and educates other departments on informatics or IS processes, demand requirements, and prioritization. Cross-contamination between departments can create leaders who understand both operations and informatics. Having informatics representation at the C-suite, driving and advising the vision and strategy, helps to define IS as a strategic differentiator rather than just a cost center.
These strategies must be well thought through and purposeful with a multi-year progression and require leadership with vision.
Q: What role do you play when brought on as a consultant?
A: Great question. I am typically brought in for a specific project and issues that come up can be addressed with a mature governance process. Challenges with business operations engagement and approaches to change management are common barriers to achieving value realization. Seeing the gaps, I can offer solutions for the client. They may have these programs in place but have opportunities to resolve existing gaps that can be identified and resolved. It is more difficult to “see” portfolio management, governance, and informatics as a need until pieces are brought in as part of a project and the benefit is realized in that context. I work to develop and gap-fill within the project constructs and start to introduce some of these above concepts, but a maturation process does take longer than a typical project does. So, I am often kept on to continue building or enhancing an IT governance structure, a project portfolio management process, or an informatics program.
If you would like to dig deeper into any of our discussion topics with Steve, he may be reached at HSi@hsi-corp.com.