There are not enough resources to complete the work in front of us for 2011 and beyond. Before Meaningful Use became “meaningful” we already had a full plate. We now have a buffet of plates that are overflowing and we are forced to bring a renewed sense of prioritization to the problem. We are challenged to deliver an elegant way to tell our customers “while that project/support request sounds great, we just do not have the resources to complete it in a timely manner”. No matter the governance structure, priority matrix, leadership or gadgets that allow you to prioritize your workload, the elegant “No” is a tool you better have in your tool belt ready to use. Without it an awkward “No” can create a long lasting tarnish between you and your customer that takes longer to correct than actually saying “Yes” to the original request.
Here are some of my suggestions in developing an elegant “No”:
- Your elegant “No”, no matter how eloquently stated, will only be received well after your customer has heard “Yes” many times before. An elegant “No” travels on a road paved with successive yeses.
- It should be definitive. A soft “No”, or a delayed “No” will just defer the inevitable conversation which wastes valuable time for everyone.
- It should be honest and transparent. You should give a considerate amount of time and thought to the request before lurching to an easy, yet awkward, “No”. If a customer knows that you put consideration and thought behind the request while giving them the real reason for the “No”, I have found that they are more willing to accept the answer.
- It should be consistent across your department, and not just the “No”, but the elegance of the “No”. Having one of your team deliver an awkward “No” generates inconsistent communication in your ranks – the customer will just move through your department to get a better answer, even if it is a more elegant “No”. This wastes time and frustrates everyone involved.
- It should NEVER be delivered by / through your governance structure. While it is important to leverage your governance structure for appropriate prioritization of work, hiding behind that structure to communicate a “No” is disastrous. Your governance structure will help you when the customer tries to go up the chain or around you, it shouldn’t be used to communicate for you. Go face to face with your “No” whenever possible.
- It should not stop the conversation with your customer. Realize that even with the most elegant “No” your customer may not be happy. Be prepared to funnel the request through another channel. If you are part of the solution, even if you or your team is not doing the work, then you are part of the solution, not just another road block.
May all of your “No’s” be elegant…..
Tuesday, September 14, 2010
Celebrate the current pace
Much has been written about the impact of meaningful use on the healthcare CIO, but it is worth digging a bit deeper in the organizational chart and outline how our management teams will need to adapt as well. A tremendous strain has begun to take hold within our departments as we thoughtfully charge forward to achieve meaningful use, brace ourselves for ICD-10 and become a strategic partner with the organization in navigating healthcare reform. As CIO’s become more engaged in physician relations, community healthcare IT strategy, and countless other tasks our management team is caught in the same job redefining era that we are. Here are three suggestions for your management team to stay ahead of the curve in this new era:
Celebrate the current pace. The current pace will not change in the foreseeable future and this should be celebrated not lamented. I see no end in sight to the amount of work on our plates, and the grass is not any greener at other healthcare institutions. Realize that trying to manage the project load, support requests and compliance tasks the way we have previously is truly the path to, and definition of, insanity. You and your management team must find innovative and different solutions to manage the work. Our managers need to examine the way they organize themselves and their team’s workload and settle into the current pace. If the leader is perceived overwhelmed that has a multiplicative negative impact to your team.
Pull back, plan and reengage. While sometimes counter intuitive your management team should mentally pull back from the front lines, get organized, plan and reengage on a regular basis. While being on the front line is right where the action is, and it demands so much of our attention, without getting out of the details we risk heading into a wrong direction and rarely correcting our course. I am encouraging my management team to get out of the office for a few hours a week, turn off instant messaging, don’t answer emails, just organize and bring fresh thinking to some of the most difficult problems we are facing. Much of the anxiety we face can be resolved by pulling back, planning and reengaging into the situation.
Prepare mentally and operationally for staff transitions. Competition for talent and expertise will be heavily fought over. You and your management team must be providing an exceptional work environment to keep your best talent engaged. Even if you have the best work environment, there will still be transition in times like this. Prepare for staff transitions and new staff. As transitions take place and community colleges create new curriculum for students interested in Health IT, a new approach for new team members will need to be developed.
“The key to success is often the ability to adapt” – anonymous
Celebrate the current pace. The current pace will not change in the foreseeable future and this should be celebrated not lamented. I see no end in sight to the amount of work on our plates, and the grass is not any greener at other healthcare institutions. Realize that trying to manage the project load, support requests and compliance tasks the way we have previously is truly the path to, and definition of, insanity. You and your management team must find innovative and different solutions to manage the work. Our managers need to examine the way they organize themselves and their team’s workload and settle into the current pace. If the leader is perceived overwhelmed that has a multiplicative negative impact to your team.
Pull back, plan and reengage. While sometimes counter intuitive your management team should mentally pull back from the front lines, get organized, plan and reengage on a regular basis. While being on the front line is right where the action is, and it demands so much of our attention, without getting out of the details we risk heading into a wrong direction and rarely correcting our course. I am encouraging my management team to get out of the office for a few hours a week, turn off instant messaging, don’t answer emails, just organize and bring fresh thinking to some of the most difficult problems we are facing. Much of the anxiety we face can be resolved by pulling back, planning and reengaging into the situation.
Prepare mentally and operationally for staff transitions. Competition for talent and expertise will be heavily fought over. You and your management team must be providing an exceptional work environment to keep your best talent engaged. Even if you have the best work environment, there will still be transition in times like this. Prepare for staff transitions and new staff. As transitions take place and community colleges create new curriculum for students interested in Health IT, a new approach for new team members will need to be developed.
“The key to success is often the ability to adapt” – anonymous
Beacon Communities - Just do it!
Based on the conference calls that I listened to on the Beacon Community Program from ONC, many communities around the nation submitted great proposals. While those communities are anxiously awaiting the award announcement in March, I am hopeful that we all are taking advantage of the platform that was created to submit the proposal.
For some, the process to create the Beacon proposal was a new platform to get caregivers, community members, legislators and patients together to discuss how health information technology might positively impact care coordination and specific community health concerns. To submit a successful proposal the program required you to set your competitive nature aside and focus on some really difficult care issues. Not only did the Beacon program force us all to develop a coordinated effort to address those though issues, but it also demanded a strong financial and sustainability plan. For those of us who submitted proposals – the process was very challenging but incredibly rewarding.
The reality is that only a dozen (plus or minus) communities will be awarded. That will leave many communities with great plans but with little or no capital to implement those plans. Each of those plans took amazing effort and collaboration to put together. I challenge these communities to not waste the opportunity OR those great plans! The hard part, outside of the financial aspects, was getting competitive players together to talk about improving the health of your community by leveraging Health IT. A good proposal required looking at intricate details around care coordination and health improvement, don’t lose this forward momentum. If you planned on creating a consortium, CREATE IT. If you planned on sharing information, training, space, data, etc. see what opportunities exist now and if you are awarded the Beacon Grant, congratulations you can really ramp up your efforts and implement the full plan. If you are not awarded, you still can make a positive, albeit potentially smaller, contribution in ways the Beacon program made possible.
The Beacon Program is one of those unique times in history that provides a platform for great organizations to move beyond the everyday rhetoric and potentially change the health of community. Since the door has been opened and the players are talking, don’t miss the opportunity to do something with it NOW!
For some, the process to create the Beacon proposal was a new platform to get caregivers, community members, legislators and patients together to discuss how health information technology might positively impact care coordination and specific community health concerns. To submit a successful proposal the program required you to set your competitive nature aside and focus on some really difficult care issues. Not only did the Beacon program force us all to develop a coordinated effort to address those though issues, but it also demanded a strong financial and sustainability plan. For those of us who submitted proposals – the process was very challenging but incredibly rewarding.
The reality is that only a dozen (plus or minus) communities will be awarded. That will leave many communities with great plans but with little or no capital to implement those plans. Each of those plans took amazing effort and collaboration to put together. I challenge these communities to not waste the opportunity OR those great plans! The hard part, outside of the financial aspects, was getting competitive players together to talk about improving the health of your community by leveraging Health IT. A good proposal required looking at intricate details around care coordination and health improvement, don’t lose this forward momentum. If you planned on creating a consortium, CREATE IT. If you planned on sharing information, training, space, data, etc. see what opportunities exist now and if you are awarded the Beacon Grant, congratulations you can really ramp up your efforts and implement the full plan. If you are not awarded, you still can make a positive, albeit potentially smaller, contribution in ways the Beacon program made possible.
The Beacon Program is one of those unique times in history that provides a platform for great organizations to move beyond the everyday rhetoric and potentially change the health of community. Since the door has been opened and the players are talking, don’t miss the opportunity to do something with it NOW!
Electronic tasks?!? Are you serious?!?!
I recently finished reading “Checklist Manifesto” by Atul Gawande and “How Doctor’s Think” by Jerome Groopman. I would highly recommend them to anyone in Healthcare IT. Because each book touches on how doctors contemplate change, it got me thinking about how physicians may be thinking about all of the upcoming changes in Health IT. While more physicians are accepting of Health IT as time goes on, I still run into physicians who are very hesitant to move to electronic orders and progress notes. I wondered if there was something that would elicit a similar hesitancy for me.
What if someone asked me to significantly change the way I worked on a daily basis, yet expected me to be as productive, or more productive. What if someone asked me to change the way I dealt with my task list – something that I’ve standardized over the course of the last 10 years.
“Wait a minute Huffman – are you comparing your task list with CPOE and electronic Progress Notes” you may be asking? Not really; I’m trying to get a better understanding of what a physician might be thinking when I ask them to change what they have done for years, to a new way of doing it, even if they don’t believe it will be an improvement. Stay with me for a minute…..
People are very passionate about their task lists. If you ask someone how they track their daily tasks you will get a varied response, some paper, some electronic. Some use systems like “Getting Things Done” by David Allen or “Seven Habits” by Stephen Covey. Some keep their tasks in applications like Google Calendar, Remember the Milk, Outlook or Omnifocus. There are hundreds of applications and dozens of iPhone apps to manage your tasks.
I’ve used the same methodology for tracking my daily tasks for the last 10 years – a standard composition notebook and a pen. I use the same system to track which items are done and which items I need to follow up on. I pride myself in rarely loosing track of an issue or task. I can pull one of my old composition notebooks out from 5 years ago, review it, and get the essence of what was going on that day or week. There is emotion on the page – it isn’t just “12 point Times New Roman” staring back at me. (sound familiar?)
I have had numerous conversations with team members about my “system” and why I use it. While I have tried suggested improvements and different systems they never seem to stick and I move back to a notebook and pen. I’m convinced, for me, that the mighty pen and paper work the best! (again a familiar argument).
The next time I’m struggling with a physician conversation about “change” I can now compare that to someone asking me to forever change how I deal with my task list…..and I’m staying on paper…..unless someone wants to pay me $44,000 over five years to go electronic.
What if someone asked me to significantly change the way I worked on a daily basis, yet expected me to be as productive, or more productive. What if someone asked me to change the way I dealt with my task list – something that I’ve standardized over the course of the last 10 years.
“Wait a minute Huffman – are you comparing your task list with CPOE and electronic Progress Notes” you may be asking? Not really; I’m trying to get a better understanding of what a physician might be thinking when I ask them to change what they have done for years, to a new way of doing it, even if they don’t believe it will be an improvement. Stay with me for a minute…..
People are very passionate about their task lists. If you ask someone how they track their daily tasks you will get a varied response, some paper, some electronic. Some use systems like “Getting Things Done” by David Allen or “Seven Habits” by Stephen Covey. Some keep their tasks in applications like Google Calendar, Remember the Milk, Outlook or Omnifocus. There are hundreds of applications and dozens of iPhone apps to manage your tasks.
I’ve used the same methodology for tracking my daily tasks for the last 10 years – a standard composition notebook and a pen. I use the same system to track which items are done and which items I need to follow up on. I pride myself in rarely loosing track of an issue or task. I can pull one of my old composition notebooks out from 5 years ago, review it, and get the essence of what was going on that day or week. There is emotion on the page – it isn’t just “12 point Times New Roman” staring back at me. (sound familiar?)
I have had numerous conversations with team members about my “system” and why I use it. While I have tried suggested improvements and different systems they never seem to stick and I move back to a notebook and pen. I’m convinced, for me, that the mighty pen and paper work the best! (again a familiar argument).
The next time I’m struggling with a physician conversation about “change” I can now compare that to someone asking me to forever change how I deal with my task list…..and I’m staying on paper…..unless someone wants to pay me $44,000 over five years to go electronic.
Staffing and Meaningful Use - It's not just a vendor issue
Looking at my project load for 2010 and the upcoming requirements to keep our existing applications fresh, as well as trying to address meaningful use (in a meaningful way), has created capacity issues for all of us. While I hear a lot about how vendors may not have enough staff to implement all of the new functionality that is required to meet meaningful use, I still have to keep a few hundred applications up and keep thousands of users happy. WHAT ABOUT THE HOSPITAL IT STAFF? Coming off of a very difficult budget cycle in 2009 and with many people hesitant to add staff, a modified approach to “how much can our existing staff really take on” comes into play.
I realize that you can only get so much done with a team without pushing them “over the limit”, but I continually try to ask the question and push the boundary related to knowing our limits. Do you really know what your capacity is? My team is currently working on more projects at one time than we have since 2001 and we have almost 20% less staff than we did from five years ago. I can say that we are more productive and more successful than we ever have been even though we are fitting more into a day.
There are a few principles that have helped our team achieve the ability to pile more on, successfully.
Your team needs to know that you are trying to eliminate work that “isn’t smart”. If you look at your programming queue or project requests I can imagine that you can find a few items that you know are not going to pay off for the business in the long run. Instead of plowing through those projects or writing those programs because the end user or governance team approved it I personally go back to the project owners / requestors and have a conversation about workflow, utilization and really challenge them to prove results and quantify the need to expend the effort. We have cancelled some substantial projects and “rush” jobs by our management team in I/S being diligent about our work queues. When we do cancel those or resize them we make that very public to the I/S team.
Understand and cleary communicate the business need in terms that your team will understand. Because our Hospital is community owned and independent, one of our advantages is being extremely nimble to market conditions. There are requests that we get that really make sense to push through ahead of other tasks and projects. In a formalized structure these tasks can frustrate your I/S team. If they don’t understand, at a fundamental level, why these requests jump ahead in the queue it will be a continual point of frustration that you may not be hearing about. We try to ensure that when these items come up that our managers clearly explain why we are reprioritizing work and how the business will benefit from it. This not only fosters better communication between teams, but creates better outcomes. Information Systems requests can get very transactional and it is easy for your team to become disconnected from how they are really impacting the business.
I used to work for a CIO that said if you worked 40 hours a week you were considered part time. Times have changed and while almost all of my team puts in more than 40 hours a week the expectation to work longer no longer is the expectation. We are trying to instill a “work smarter” attitude that includes planning your day before you start your day (i.e. don’t answer emails as your first activity of the day), write things down in a journal to ensure you don’t forget anything, and significantly reduce distractions. Working smarter has created good dialogue with my team and has allowed some of them to reprioritize how they looked at their day and are able to “work smarter”.
While these three things won’t allow us to double our workload it does provide a simple framework to accomplish more with less. We all are going to wrestle with achieving meaningful use while providing support to our users and existing applications. I don’t know about you but that doesn’t equate to hiring a lot more staff – you will need to find a way to work smarter, not necessarily harder. (It also helps to have the best team in the world to work with!)
I realize that you can only get so much done with a team without pushing them “over the limit”, but I continually try to ask the question and push the boundary related to knowing our limits. Do you really know what your capacity is? My team is currently working on more projects at one time than we have since 2001 and we have almost 20% less staff than we did from five years ago. I can say that we are more productive and more successful than we ever have been even though we are fitting more into a day.
There are a few principles that have helped our team achieve the ability to pile more on, successfully.
Your team needs to know that you are trying to eliminate work that “isn’t smart”. If you look at your programming queue or project requests I can imagine that you can find a few items that you know are not going to pay off for the business in the long run. Instead of plowing through those projects or writing those programs because the end user or governance team approved it I personally go back to the project owners / requestors and have a conversation about workflow, utilization and really challenge them to prove results and quantify the need to expend the effort. We have cancelled some substantial projects and “rush” jobs by our management team in I/S being diligent about our work queues. When we do cancel those or resize them we make that very public to the I/S team.
Understand and cleary communicate the business need in terms that your team will understand. Because our Hospital is community owned and independent, one of our advantages is being extremely nimble to market conditions. There are requests that we get that really make sense to push through ahead of other tasks and projects. In a formalized structure these tasks can frustrate your I/S team. If they don’t understand, at a fundamental level, why these requests jump ahead in the queue it will be a continual point of frustration that you may not be hearing about. We try to ensure that when these items come up that our managers clearly explain why we are reprioritizing work and how the business will benefit from it. This not only fosters better communication between teams, but creates better outcomes. Information Systems requests can get very transactional and it is easy for your team to become disconnected from how they are really impacting the business.
I used to work for a CIO that said if you worked 40 hours a week you were considered part time. Times have changed and while almost all of my team puts in more than 40 hours a week the expectation to work longer no longer is the expectation. We are trying to instill a “work smarter” attitude that includes planning your day before you start your day (i.e. don’t answer emails as your first activity of the day), write things down in a journal to ensure you don’t forget anything, and significantly reduce distractions. Working smarter has created good dialogue with my team and has allowed some of them to reprioritize how they looked at their day and are able to “work smarter”.
While these three things won’t allow us to double our workload it does provide a simple framework to accomplish more with less. We all are going to wrestle with achieving meaningful use while providing support to our users and existing applications. I don’t know about you but that doesn’t equate to hiring a lot more staff – you will need to find a way to work smarter, not necessarily harder. (It also helps to have the best team in the world to work with!)
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