Standards for Healthcare IT - Now!

In discussions with Houston/Dallas based Hospital and Integrated Delivery Network (IDN) CEO's last week the financial outlook for healthcare is bleak and the pressure to perform is immense. Despite promises of billions from the new Obama Administration for technology, costs and the rip-tide of emerging demographics are against maintaining profitability - margins will absolutely continue to shrink if it's business as usual (with little or no innovation).

We must use technology with good governance to leverage the provider position in the marketplace. It will be key to maintaining efficient and high quality operations. Quality is critical...

Along with other mission critical services we provide, InterOPERANT believes in the standardization of clinical operations, functions, and access to key clinical and financial data...

What is the value of standardization?

What does it mean?

The value of standardization is comprised of very simple concepts such as:

Having all or a significant number of the applications reside in common environments which deploy like operating systems and common database types.

Focus IT staff on a limited number of technologies to become deeper content experts limiting reliance on vendor provided resources who may not have the same level of dedication to the institution.

Separate infrastructure contracting from software contracting to leverage better pricing due to volume discounts.

When standard platforms exist in an environment, standard tools for environment monitoring and recovery can be deployed as well as a number of more complex concepts such as:

Can actually achieve reliable, unaltered business performance metrics because the need for data normalization is significantly reduced

Sets a foundation to effectively build an EHR through integration as well as interfacing. When interfacing data across unlike platforms, data is very likely to get changed in some manner to achieve “integration”. This can be insignificant in most cases, but very significant in a few. The data normalization when interfacing can be very complex and require extensive support overhead.

If you achieve integration through interfacing, a significant part of the enterprise becomes tied to one platform which has a track record of being a high maintenance environment with questionable stability.

What will be the exact deliverables from InterOPERANT?

An Application inventory and standards implementation assessment – this would provide an expert pathway from current state to desired end state leveraging the most prevalent current investments and functionality.

Then we roll up our sleeves and help you get it done.

Why hire us to do it? Could you just do it yourselves? How do we co-source partner with you?

The partners of InterOperant have over 75 years of combined experience and have directly been involved in standards implementations in several multi-billion dollar companies. These implementations spanned years in each organization and were accomplished by:

Establishing the proper governance for hardware and software selection and deployment (this involves significant education of the entire organization to the proper guidelines to insure compliance to policy)

Effective auditing of the entire enterprise to identify technologies or platforms not in alignment with the strategy and planning for the mitigation of these within desired timelines

Working with the vendors to transform the implementations of their platforms into compliance with the adopted standards or plan a mitigation strategy which might mean replacement of the platform should the platform not be able to be remediated.

Educating the organizational stake-holders to the importance of a balance of application functionality to platform standardization to achieve an overall standards based environment.
Implementation of enterprise standards is a very difficult task and without continued reinforcement throughout the change process, these initiatives can get derailed or linger on until the initial goals become irrelevant or outdated.

This type of change has to be deliberate and continuously supported until it is completely adopted in the environment in order to shift into the support and evolutionary stages that follow. There will always be continuous change prevalent in computing environments and this change is harder to manage and is more costly in a heterogeneous environment where standards are attempting to be deployed.

What will we build to help them maintain standards after InterOPERANT leaves?

The governance is the key piece to maintaining the implemented standards. There has to be a solid roadmap for departments to bring projects forward, have these projects reviewed and championed in partnership with IT to insure standards are being adhered too. There can be tools constructed to audit and monitor the application inventory present on the network for offending applications to the standards. Some of the tools you already own, the rest we can supply.

Best,

Don Lyons, CEO and Managing Partner

Blenda Shipp, Chief Development Officer and Senior Partner

Governing High Complexity - Verse 2

In late 2002 having been newly recruited from Seattle, and upon entering the halls of one of the top cancer centers in the world, I was presented with enormous challenges. The central IT division was almost equal in size to it's "federated components." These "islands of automation" in most cases were highly effective - but perhaps were not the most efficient from a data integration and cost perspective. They were in many cases highly independent. Although I functioned in the Deputy CIO role, our organization had at least 20 or so "other CIO's." I can attest to the fact that most all of them had the next great idea! In fact, the division of Radiology under physician leadership had built an absolute world-class clinician portal called "Clinic Station." Having spent a number of years with this team, and having had a long career as a leader and a technologist - I would say Clinic Station today has few, if any, equals...it was and is a smashing success (thanks to Kevin, and Chuck)! Clinic Station through leveraging the SOA (.xml) environment continues to improve with new releases. Stay tuned for new developments as "Research Station" rolls out in the near future...


The challenge - the costs of managing this portfolio in a distributed manner were and are absolutely staggering. Also, not all functions could be efficiently integrated such as CPOE, Medication Management, etc. And what about using the data for clinical research? Data was everywhere - it was the land of databases...

Structured decision making, or the lack thereof often led to poor technology choices - the result of which became a very (massively) expensive "de-installation" project for other clinical applications. What the scenario lacked was effective decision making rooted in the technical and user community, managed by a collaborative governance team.

Extraordinary expense levels could not continue, and data integration became the new mantra. So how did we go about managing for results, and leading for transformation in this scenario?

As the Deputy CIO and in conjunction with our team of operational executives and physicians; we formed the Information Services Executive Team (a few consultants were added to the mix). The team began to define the need for:

1. Effective IS Governance.
2. A clear and credible organizational IS Strategy.
3, Well coordinated IS projects.
4. The need to provide substantial value through those projects.
5. Building relationships between central and distributed IS organizations.

From there we laid out the charge, the guidelines, the committee's, participation, etc. Today, and according to Gartner Research, the organization has reached a pinnacle in governing itself around IS technology, people, and related process issues. We were pioneers in tackling these problems with all it's political implications - I was proud to be part of the solution.

One size does not fit all, and we at InterOPERANT can help you design, build and implement the proper solution for your organization. Much of our research comes from Gartner, the CISR at MIT, Sloan School of Management, http://mitsloan.mit.edu/cisr/. Also, see our blog post, "Governance - Verse1." As well, InterOPERANT relies on the work from HITSP, and are commenting members of ANSI, HITSP, http://www.hitsp.org/.

Today, health care organizations are just beginning to understand how to manage the expense and complexities of it's information technology functions. As I have mentioned in prior posts, IT is both a value creation, and service delivery center all tied to core functions and processes at every level of the organization. It is a concept which must be embraced by everyone - and effective, and participative (read collaborative) governance will help create, and deliver real value across perceived organizational boundaries.

Some of you may have friends at Stanford Hospital and Clinics - we do. They have a huge appetite for advanced clinical systems, and an annual capital budget of $40 to $60 million allocated to information systems. Not only are they huge and wonderfully complex, but in 2004 they established a seven year system-wide information technology out-source contract with Perot Systems Corporation. As well, a few large scale consulting firms got involved...2007 found trouble in paradise.

Today, they are well on there way toward implementing an elegant and strong governance solution to manage their commitment to information technology out-sourcing. This is one of the most difficult of all challenges. If they can do it, so can you. We at InterOPERANT will help you achieve your climb to the summit!

Best,

Don Lyons
InerOPERANT
CEO and Managing Partner

Acute Care, Really?

In performing research for Quantum Leadership (American College of Healthcare Executives) on Acute Care, Managed Care, and Ambulatory Care - we found large variations in what was described, world-wide. InterOPERANT continues it's quest to provide a benchmark understanding of the key terms describing the people, process and technology. These are the systems that encompass the delivery of our national healthcare model. We will start with Acute Care, and continue additional posts on other forms of care delivery most prevalent in the US.

Knowledge of Acute Care Sector

Acute Care defined:

A commonly accepted definition is difficult to find in the literature and changes are by author, or organization, or political administration. However, it conforms generally to the following:

· Acute care refers to necessary treatment of a disease for only a short period of time in which a patient is treated for a brief but severe episode of illness. Many hospitals are acute care facilities with the goal of discharging the patient as soon as the patient is deemed healthy and stable, with appropriate discharge instructions.

· The term is generally associated with care rendered in an emergency department, ambulatory care clinic, or other short term stay facility. An important aspect of the current health care crisis in the US is the result of the growing need for acute care despite a decrease in the number of facilities which provide that care. This mismatch has resulted from the dramatic increase in the number of patients who are uninsured or underinsured, and therefore unable to pay for services rendered. Those patients often turn to emergency departments for their acute care needs. That has resulted in overcrowding and made it increasingly difficult to focus adequate resources on those patients who present with true emergencies.

From the “Wikipedia 2008”...simple, and powerful, another more simplistic notion is the following:

acute care
n.
Short-term medical treatment, usually in a hospital, for patients having an acute illness or injury or recovering from surgery.

DEFINITION AND DESCRIPTION OF ACUTE CARE HOSPITALS:

Acute care is a level of health care in which a patient is treated for a brief but severe episode of illness, for conditions that are the result of disease or trauma, and during recovery from surgery. Acute care is generally provided in a hospital by a variety of clinical personnel using technical equipment, pharmaceuticals, and medical supplies.

Hospitals – the essential partner to the physician a hospital is an institution for health care providing treatment by specialized staff and equipment, and often but not always providing for longer-term patient stays. Today, hospitals are usually funded by the state, health organizations (for profit or non-profit), health insurances or charities, including direct charitable donations. In history, however, they were often founded and funded by religious orders or charitable individuals and leaders. Similarly, modern-day hospitals are largely staffed by professional physicians, surgeons and nurses, whereas in history, this work was usually done by the founding religious orders or by volunteers

Financial and Operational Classes:

· For profit
· Not for Profit
· Community Hospitals
· Academic and Teaching Hospitals
· Government Hospitals

Hospitals may have any of the following departments or units:
Behavioral Health Services
Burn unit
Cancer Center
Coronary care unit
Dispensary
Emergency department
Intensive Care Unit
Labor and Delivery and Neonatal
Laboratory Services
Nursing unit
Orthopedic Services
Outpatient Department
Pharmacy
Psychiatric ward
Rehabilitation Services
Physical Therapy
Post anesthesia care unit
Radiology
Respiratory Therapy
Surgery
Urgent care
Non-medical departments include:
Medical records department
Release of Information department
Other such as Legal, Compliance, etc.

Physicians
· Primary Care – primary contact with the patient
· Medicine – referral
· Surgery - referral
· Diagnosis – referral
· Multispecialty Practices
§ Open to fee for service, and managed care financing
· Group Practices
§ HMO financing
· Independent Physician Associations
· Physician Hospital Organizations
§ Fee for service and managed care.
· Government Physicians
· US Army, VA, etc.
· Academic Medical School Faculties
· Government and Private
Other providers and integrators to the system
· Over 50 professional specialties that support the model.
· Hospice
· LTC
· Vendors and suppliers, equipment, Pharma, Bio-Pharma, etc.

Healthcare Networks and Systems, and Alliances – Consolidations

· An Integrated Delivery Network (IDN) is a network of facilities and providers working together to offer a continuum of care to a specific market or geographic area. Developed in the early 1980s, IDNs emerged to address common concerns like capitation, excess capacity, decreased margins, and complaints from patients regarding access.

· IDNs include many types of associations across the continuum of care and one network may include a short- and long-term hospital, HMO, PHO, PPO, Home Health agency, and hospice services, for example. Multi-hospital systems and mergers may be considered limited IDNs in that different entities join forces to provide care.

· Some members of a network provide identical or complementary services to patients. Such associations in which a similar level of care is provided by members of a network is sometimes called horizontal integration or, as opposed to different levels of care, or vertical integration, generally seen in the more traditional IDN model.

During the 1990s and into the next decade many hospitals pursued twin strategies of vertical and horizontal integration. Each type of integration assumed multiple forms:

· Vertical integration. Proponents of vertical integration between hospitals and other health care providers and payers mentioned several goals underlying these efforts. These objectives reflected a range of efficiency goals (manage global capitation, form large patient and provider pools to diversify risk, reduce cost of payer contracting), access goals (offer a seamless continuum of care, respond to state legislation), and quality goals (assume responsibility for health status of local population).

· Horizontal integration. Hospitals’ rationales for horizontal combinations likewise reflected a mixture of efficiency goals (prepare for capitation, reduce excess capacity, strengthen financial position) and access goals (expand the delivery network). In fact, their objective functions for the two broad strategies often overlapped, which suggests that hospitals did not really understand the difference between the two. A major stated objective in horizontal integration was achieving economies of scale. Such economies were believed to flow from several sources, including large patient volumes, sharing of equipment and services, and group purchasing.

· All of these alternatives give the hospital-based enterprise a role, but by no means the leading role, in linking the services that patients receive. What entity will actually control the process of coordination is still up for grabs. Given the strong trends toward outpatient care, even within a hospital structure, we can probably rule out an inpatient-oriented firm as a contender. The hospital will have to be more than a hospital alone. Economic theory implies that organizational structure and control depend on transaction cost, or its mirror image, transaction productivity. It remains to be seen whether any of the current players, or possibly some wholly new entity, will perform best in that role.

Health Insurance Organizations – primary method to finance healthcare in America

· Healthcare Insurance over 2,000 private payors and commercial companies, BlueCross/BlueShield
· Medicare
· Medicaid
· HMO Act 1973
§ Limits on premium covered – employee premium sharing
§ Limits on payments – deductibles, co-payments
§ Limits of provider selection – PPO’s, POS
§ Provider risk sharing – DRG’s, and capitation
§ Pay for performance – behavior change among physicals

So how about a question for our readership:

The best strategic approach for hospitals to pursue most efficient operations:

1. Pursue vertical integration strategies
2. Pursue horizontal integration strategies
3. Monitor the environment and be aware of emerging strategies to best position for short-term and long term viability focused on the needs of patients.
4. Continue every day with business as usual. Healthcare delivery processes will not evolve.

Correct answer: 3. The environment should be closely monitored for a combination of vertical and horizontal integration strategies and projects on an individual basis of merit with a focus on economic returns, patient, physician and employee satisfaction, and operational re-trenchment, stability and growth.

References:

The American Heritage® Dictionary of the English Language, Fourth Edition copyright ©2000 by Houghton Mifflin Company. Updated in 2003. Published by Houghton Mifflin Company.

Center for Medicaid and Medicare Services, 2005

Griffith, J.R., and K.R. White, The Revolution in Hospital Management, 2005.

Griffith, and White, The Well Managed Health Care Organization, 6th Edition, 2006.

Rosenberg, C.E., The Care of Strangers, The Rise of Americas Hospital System, 1989.

Glen McDaniel, MS, MBA, The Gerhson, Lehrman Group, Expert Healthcare, 2008.



Lastly, why might a technology executive have a specific interest in what I have written today? Strategic thinking CIO's, and Technology Director's, Manager's, and Staff must understand these components, and follow the genesis of new delivery structures. You are the enablers, and manage potentially the largest "Value Creation and Delivery Center" in Modern Healthcare...

We at InterOPERANT would like to help you climb to your Summit in creating greater value for your organizations.

Best,

Don Lyons

InterOPERANT

CEO, and Managing Partner

Technology Trends for C"X"O's...

In a series of articles written for the ACHE, I focused on Technology Trends that the CXO's should be aware of. Making the assumption that most CIO's are aware of these and include them in their current leadership practice - this feature article is more directed at the CEO, COO, CNO, etc. I hope you find these selected updates of value...

As pressure increases to raise profits by cutting costs, small to medium-sized businesses (SMBs) that provide healthcare products and services are looking to several technology solutions to increase patient safety, reduce medical errors and improve bottom lines, stated the Information Technology Solution Providers Alliance (ITSPA), a national, non-profit alliance that helps SMBs understand how technology and local technology providers can help them succeed. "Several key drivers are expected to increase healthcare IT investments by 8-10 percent yearly including improving workflow efficiencies, billing and payment systems, revenue collection and management, regulatory compliance, patient records integration and links between financial and clinical systems.

The Certification Commission for Healthcare Information Technology (CCHIT®) has gained substantial momentum since the organization's founding in 2004. As a result, buyers of electronic health records (EHRs) - or electronic medical records (EMRs), as they are also known – the role of this Commision is to certify EMR and Clinical software technology against function, and performance standards.

Chartered by the Office of the National Coordinator (ONC), the Healthcare Information Technology Standards Panel (HITSP) was established to identify interoperability standards that enable widespread HIT interoperability. To achieve this, HITSP works in a collaborative effort with standards development organizations (SDOs). As HITSP leads the effort in systemic interoperability, the Certification Commission for Health Information Technology (CCHIT) ensures that EHR systems support key functional requirements and comply with HITSP identified standards Healthcare is undergoing an historic shift: a shift from one-size-fits-all healthcare to one-to-one healthcare. The mapping of the human genome is bringing about massive changes in the practice of medicine," says Jeff Bauer, PhD healthcare futurist at ACS, a leading provider of business services to the public and private sectors.
All that data brings a need to process and analyze it. "There's more data than any one person can keep in their minds. We can expect a rapid proliferation of technologies at the bedside, in the laboratory, throughout the entire healthcare setting. Imagine information technology fueling personalized predictive medicine," continues Dr. Bauer. "This will require new devices, telemedicine, the ability to transport - if not the patient - then at least loads of data about the patient directly to their doctors or other healthcare professional anywhere in the world." At every level, healthcare, while providing more, also demands more. More data, more analysis, more systems. More money. It's not that technology and innovation alone are driving up healthcare costs, per se. These often require capital investments, but over the long term most end up improving productivity and ultimately reducing costs. At the same time, regardless of the source, healthcare costs nationwide have consistently grown at a much faster rate than the overall economy. In February, the US Department of Health and Human Services reported that it estimates healthcare costs will more than double of the next 10 years, rising from $2.2M in 2007 to $4.3M by 2017.

The quality of healthcare and the safe practice of delivering healthcare services have garnered much attention in both healthcare journals and the media at large. Healthcare’s importance has taken center stage in this year’s Presidential election contest.

Wrong patient and wrong site surgery, medication errors, pressure ulcers, central intravenous line (IV) infections, and antibiotic resistant infections such as Methicliin resistant Staphylococcus aureus (MRSA), are only a few of the high profile issues that have healthcare industry leaders talking. Over the years healthcare regulating bodies such as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and local Departments of Health have spearheaded multiple patient safety initiatives in an effort to mitigate errors and improve patient safety. Even with the advances healthcare.

Unified or enhanced communications is the buzz du jour in our industry, but there are a lot of different ideas out there for what it actually is and what it is good for.What everyone seems to agree on, though, is that there are two key drivers that fuel the need for the application of unified communications in healthcare IT: reducing clinical errors through enhanced communication and improving collaboration across healthcare service providers. The real buzz should therefore revolve around “integrated” unified communications in medical imaging, with a capital. Missing deadlines due to ineffective communications in healthcare can be deadly. According to a survey done by the Joint Commission in 2006, ineffective communications is the primary root cause to sentinel events like wrong-site surgery, medication error and delay in treatment. As a matter of fact, ineffective communications has been the No. 1 root cause to sentinel events for the last 10 years from 1995 to 2005 in the same survey. For example, in the field of radiology, delays and failures in communicating critical patient findings from reporting radiologists to ordering physicians can threaten patient safety.Unified communications also plays an important role in improving collaboration within the realm of medical imaging; expertise in diagnostic imaging is in short supply, and these skill sets are becoming more and more geographically dispersed. Every minute engaged in tracking and locating others introduces a bottleneck in delivering the service and compromises productivity. Therefore, every opportunity in making it easier to communicate, consult and collaborate when delivering a diagnostic imaging service can improve patient care and can increase the competitiveness of the provider’s business. Even as the U.S. health industry has been laying the foundation for a national health information system to electronically exchange clinical and patient information, a parallel movement has been taking shape and focusing on the healthcare supply chain. It represents a historic opportunity to leverage IT to reform the supply chain and yield billions of dollars in savings while significantly strengthening patient safety and improving care outcomes.

Like efforts to use IT in support of the transformation of clinical care, reinventing the supply chain is of strategic importance to every single healthcare participant. To succeed, the supply chain reinvention effort needs visionary leadership and commitment from healthcare senior executives, not only the supply chain professionals they have managing such functions as logistics, purchasing and IT.In some ways, the healthcare supply chain is in more dire need of IT-supported innovation than are clinical processes. The current series of transactions that takes a syringe, an IV bag, a pacemaker, a hospital gown or an ultrasound machine from the manufacturer to the patient relies on product information that is recorded differently by almost every trading partner at each step in the supply chain. It is commonplace for different departments within a single organization to have multiple identification numbers for the same manufacturer or product.

Continuous escalating healthcare costs nationwide highlight the need for change within the United States healthcare system. Many solutions have been proposed and it seems that broader use of health information technology (HIT) is seen as a prime catalyst for transformation. Electronic health records (EHRs), systemic interoperability and automated clinical decision support are the three other key components in the transformation mix. EHR converts paper charts to digital form; interoperability allows disparate systems to exchange records; and decision support provides safeguards and recommendations to clinicians at the point-of-care based on information available from these multiple interoperable systems.Industry theory tells us that full realization of HIT will prevent procedural redundancy, reduce errors, decrease medical costs and yield better patient care. These benefits multiply as the data involved is drawn from a larger array of sources, ranging from a single provider system to larger, interoperable networks such as a regional or nationwide health information exchange (HIE).If the benefits are clear, why is the industry struggling with widespread adoption? It’s because HIT adoption is fraught with challenges. Multiple factors impede success, including competitive friction, regulatory barriers, leadership voids, and lack of funding and sustainable business models. To overcome these barriers and achieve sustainable HIE, industry stakeholders at all levels must innovate and collaborate. Continued focus on formalizing interoperability standards to harmonize systems is imperative in creating a nationwide HIE. America's Healthcare Organizations are building company-wide business strategies designed to sustain security while achieving efficiency and effective improvements. In today's challenging regulatory and healthcare environment, a key challenge is integrating processes and metrics used to monitor adherence to regulatory requirements with those used to understand risks and manage enterprise performance. Database security performance and access is now a mainstream part of the healthcare business strategy that addresses operational practices, from procurement and implementation to delivery of services to the organization. There are more features associated with next generation IT Security than ever before. With the ever changing world of regulatory guidelines comes equally evolving technology. Revitalizing modern solutions is the pinnacle of a quality security initiative, however there's also the need to maintain current solutions that can embrace a progressive technological age.

EMR Adoption ModelSM-

HIMSS Analytics, the authoritative source on EMR Adoption trends, devised the EMR Adoption Model to track EMR progress at hospitals and health systems. The EMRAM scores hospitals in the HIMSS Analytics Database (derived from the Dorenfest IHDS+ DatabaseTM) on their progress in completing the 8 stages to creating a paperless patient record environment.

The Stage ( from 7 to 0) and Descriptions are as follows:

Stage 7. The hospital has a paperless EMR environment. Clinical information can be readily shared via Continuity of Care (CCD) electronic transactions with all entities within health information exchange networks (i.e., other hospitals, ambulatory clinics, sub-acute environments, employers, payers and patients). This stage allows the health care organization to support the true sharing and use of health and wellness information by consumers and providers alike. Also at this stage, HCOs use data warehousing and mining technologies to capture and analyze care data, and improve care protocols via decision support.

Stage 6. Full physician documentation/charting (structured templates) are implemented for at least one patient care service area. A full complement of radiology PACS systems is implemented (i.e. all images, both digital and film-based, are available to physicians via an intranet or other secure network.)

Stage 5. The closed loop medication administration environment is fully implemented in at least one patient care service area. The eMAR and bar coding or other auto-identification technology, such as radio frequency identification (RFID), are implemented and integrated with CPOE and pharmacy to maximize point-of-care patient safety processes for medication administration.

Stage 4. Computerized practitioner/physician order entry (CPOE) for use by any clinician added to nursing and CDR environment. Second-level of clinical decision support related to evidence-based medicine protocols implemented. If one patient service area has been implemented CPOE and completed previous stages, this stage has been achieved.

Stage 3. Clinical documentation installed (e.g. vital signs, flow sheets, nursing notes, care plan charting, and/or the electronic medication administration record (eMAR) system are scored with extra points and are implemented and integrated with the CDR for at least one service in the hospital.
First level of clinician decision support is implemented to conduct error checking with order entry (i.e. drug/drug, drug/food, drug/lab, conflict checking normally found in the pharmacy).
Some level of medical image access from picture archive and communication systems (PACS) is available for access by physicians via the organization's intranet or other secure networks.

Stage 2. Major ancillary clinical systems feed data to clinical data repository (CDR) that provides physician access for retrieving and reviewing results. CDR contains a controlled medical vocabulary (CMV) and the clinical decision support system and rules engine for rudimentary conflict checking. Optional for extra points. Information from document imaging systems may be linked to the CDR.

Stage 1. Laboratory, pharmacy and radiology installed.

Stage 0. Some clinical automation may exist. Laboratory and/or pharmacy and/or radiology not installed.


References:

Lundstrom, Mon, Garretts,http://www.futurehealthcareus.com/?page=its-concept, 2008.
HIMSS Analytics, EMR Adoption ModelSM , http://www.himssanalytics.org/hc_providers/emr_adoption.asp, 2008
Mike Davis, HIMSS Analytics, Trends ppt, http://64.233.169.104/search?q=cache:FrvvCTbHGOEJ:www.chimss.org/downloadlibrary/doclibrary/CHIMSS_June_06.ppt+healthcare+it+trends&hl=en&ct=clnk&cd=29&gl=us, 2006

Best,

Don Lyons
InterOPERANT
CEO and Managing Partner

Knowledge of Employee Satisfaction Measurement and Improvement Techniques

Recently, I wrote a series of articles for the ACHE, American College of Healthcare Executives. If you have not been involved with this organization, they are someone to get involved with. As a Technology Profesional you have many choices, CHIME, HIMSS, etc. I have found this organization to be among the absolute best in examining practices and trends in healthcare delivery and all it's component organizations. ACHE membership provides excellent guidance and education to executive leadership. I hope you enjoy these feature articles submitted to the ACHE through Quantum Leadership.

Healthcare providers are faced with cutting costs while maintaining high quality services. Patients, employers, business groups, health plans, and insurers are scrutinizing the delivery of care from the perspective of quality and cost. Determining what matters most to employees and aligning expenditures with priorities are strategic challenges for HR. “For organizations to be successful at competing for new talent and retaining employees, they have to know what workers want, what keeps them happy, and what makes them stay,” said Susan R Meisinger, president and CEO of Society for Human Resource Management (SHRM).

Addressing the essentials, including fair compensation, valuable benefits, and the ability to balance work and life are crucial components of an organization’s overall retention strategy. Organizations must not only create a mix of benefits that retain and motivate what are often very diverse workforces, but they must also continually fine-tune that mix. Hospitals that know how to create an organizational culture that accommodate the needs of their targeted workforce will have the advantage in the competition for talent.

Research has proven that wholly engaged employees tend to be more self-motivated, reliable, and have higher levels of organizational loyalty. Additionally, studies have revealed that an engaged personnel tends to retain employment and is less absent Besides, these engaged employees have higher levels of customer approval and service quality and they regularly achieve, and often surpass, goals.

Some factors of job satisfaction are universal and consistent. Both employees and HR professionals note compensation and benefits are important to employee job satisfaction. However, research has shown that there are more important factors that contribute to job satisfaction, such as relationships with immediate supervisors, management recognition of employee job performance, and communication between employees and senior management. These factors have more to do with the organizational culture and working conditions in the company.

Determining the need
• The need for such surveys is greater when one or more of the following factors is present:
• Rapidly growing organization: It is critical to find out how employees feel about their jobs, the hospital and their fit and future within it.
• Highly competitive industry: In an industry like health care, turn over minimization and productivity and creativity maximization are keys to success. Staying in touch with employees is necessary to facilitate continued competitiveness.
• Contemplated changes in pay & benefits: To know what needs to be “fixed” and how much “fixing” it needs to maximize return on invested money and people resources.
• Planned or recent organizational changes, including change of leadership: Change can be difficult for many people. If not handled properly, productivity and profits can decline.


Determining what and how to ask
• Organizations usually develop a base questionnaire that contains core questions necessary for substantially all employers. There are three broad types of questions: Factual ones, those dealing with opinion i.e. opinion questions and those dealing with motivation i.e. motivation questions. Classification questions such as date of birth and age, which are a special group of factual questions, are asked at the end of the questionnaire. The majority of questions on a employee satisfaction survey should be answered using a scale.
• Examples include 10-point scales, Likert scales (e.g., five points ranging from “strongly agree” to “strongly disagree”), four-point scales (which force a sided response) and many other variations. Including an open-ended question allows the respondents to give their suggestions and recommendations in writing. While verbatim comments are not easy to tabulate, they will bring meaning to some of your scores. The verbatim responses will help you understand what is behind that score,” “It’s pretty powerful to see exactly what some of your employees are saying about you.” This is then customized to fit it to the particular needs of the department being studied, adding and deleting items as appropriate.
• The area of focus in the current study being front office, the researcher studied and reviewed all the recent projects and trainings organized for this team in order to select the broad dimensions for study. Existing instruments were reviewed and studied. All types of questions were included covering nearly every facet of employee satisfaction.
• All items were to be rated on a four point Likert scale. Each item in the survey was combined with other related survey items to produce dimensions. A dimension is a broad-based subject category which measures an important aspect of satisfaction. Dimensions greatly simplify the reporting and feedback of survey results by providing specific findings for each subject category measured.

Proofing & testing
• This includes checking misspelled words, proper skip patterns, question numbering, grammar and format.
Inviting the employees & obtaining a high response rate
• Certain information is communicated to the employees to invite them for the survey and obtain a high response rate. It may be regarding what and why is happening, assuring the anonymity, how will the results be used in their favor, duration and deadline for completing the questionnaire to thanking the employees for their time and co-operation.
Interpreting the results
• It is astounding how much “data” can be created by a survey. Each scale question has multiple possible answers, each of which is reported along with each item’s average score; there are results for various dimensions, and there is statistical analysis.
• The different approaches for analysis may include:
• Analysis of strengths & weaknesses: In this, the emphasis is laid on the intra-survey strengths and weaknesses, i.e. how the items in the survey compare to each other. This may be done at the attribute (individual question) level as well as on a section/dimension (groups of question) level.
• Leverage analysis: It provides a way of selecting areas to focus on, by calculating each area’s level on a “bottom line” measure – overall satisfaction.
• Comment Analysis: Recommendations/suggestions written by employees as well as patients/attendants generated qualitative data. Simply reading comments can give one a flavor for the types of issues on employees’ minds. However, proper interpretation becomes difficult, if not impossible, for two reasons:
• The reader may tend to give more weight to comments that mirror his/her point of view. The number of comments can be overwhelming. The solution is to “code” the comments, which is done by reading all or a large sample of comments, and creating categories. This yields a table of results showing the prevalence of comments of various types.

• In one study at Rocfkord Hospital, more than 80 per cent of the employees were satisfied with the nature of their job. They acknowledged that their job is challenging and used their skills effectively. However, 35 per cent felt that the facilities in terms of resources provided need to be improved.
• The results also showed a positive relationship between the employees and their immediate supervisor which was a motivating factor for many of them. Nanty per cent of the team members unanimously felt that their head is knowledgeable, cooperative, and he recognizes their contribution. They highlighted that his leadership traits and openness to suggestions play an important role in their job satisfaction.
• The front office department also displayed team spirit and synergy as more than 85 per cent team members expressed that the team is efficient and manpower is sufficient. The organization also reflected a positive work ambience as most of the employees praised the management for giving fair and equal treatment, recognizing their achievements and providing development opportunities. Regular training session, workshops and team building exercises emerged as a key factor in enhancing their team spirit.
• The only dimension on which majority of employees expressed their dissatisfaction was compensation and benefits. Seventy five per cent of them were unhappy with their salary. Sixty per cent said that increments and appraisals are almost absent. Thirty five per cent felt that the HR policies need to be revised and improved in favor of the employees.
• The analysis of the open ended verbatim section revealed that the only demotivating factor or the dimension that might hamper the employee loyalty in this organization is compensation and benefits, absence of promotions, perks and performance based appraisals and lack of information regarding HR policies.

Sharing the results
• It is critical to share results for two reasons’ everyone must know where the hospital and their individual areas stand. Employees need to know that the time spent in completing the survey was worthwhile.

• The basic principles of sharing employee satisfaction survey results:

 Being honest: An organization/hospital should be willing to share both its strengths and its areas in need of improvement.
 Being timely: The sooner the results are released, the earlier can the hospital move towards positive changes.
 Sharing appropriate information at each level: Senior management needs encapsulated results and access to detailed results for the organization as a whole and differences between departments. Department heads need to know how their department compares to the organization as a whole and how different departments compare with each other.
 Discussion: After presenting the results, discussion on future plan of action is needed for improvement.
 Respect of confidentiality: Confidentiality of employee’s responses is maintained.

Acting on the results
• Mostly hospitals fail to communicate the findings of the survey and the plans created to improve weak areas. Distribution of the complete survey doesn’t mean reporting to everyone, but an open and honest discourse of both organizational strengths and areas for improvement at the department level if possible. Admittedly, the method of hospital’s communication and the content of those messages are again, influenced by the hospitals culture. Failing to reveal the results of the survey and to take action to correct shortcomings can prove detrimental.

Examples of improvements offered:

• Empower employees via the Service Recovery program to make a difference
• Tie together employee satisfaction and patient satisfaction initiatives
• Encourage employee feedback by surveys for corporate benefits, ideas for use of funds, and home mailings of all marketing information
• Celebrate successes with food carts and box lunches
• Validation of hard work given through peer-to-peer access to meal vouchers and gift shop certificates
• Customer Service Representatives for each department (Super User/Role Model)
• Provide monthly Open Forums with administrator
• Provide walking rounds by administrative team
• Honor each department with their week
• Encourage informal problem resolution directly with union representatives
• Recognize outstanding staff with the annual STARS program
• Support an Employee Activities Committee:
 Vendor sales
 Annual holiday dinner dance
 Annual holiday dinner in cafeteria served by leadership
• Provide monthly New Employee Orientation with top leadership
• Expanded tuition program
• Quarterly union meetings with administrative team and various union representatives

References:

Bidhan, Das, Dr., Jyoti Gupta, Express Healthcare Management, 30 September, 2005.

Joan Jeffords, RN, MPA, IHI.org, Excellence in employee satisfaction, December 2004

Debbie Cardello, Urgent Matters, Studer Group, 2007

Governance - Verse 1

Governance is defined as a shared process of top-level organizational leadership, policy making and decision making. Although the governing board has the ultimate authority and accountability, the CEO, senior management and clinical leaders are also involved in top-level functions. Thus, governance is not a “board only” activity, but rather an interdependent partnership of leaders.

It is the function that holds management and the organization accountable for its actions and that helps provide management with overall strategic direction, and at an informal level it keeps things "glued together."

Reports to the board need to present measures of the processes and performance areas that are most critical to the organization’s mission, vision and strategic and operational goals. These measurements are frequently reported indicators of the organization’s key strategic initiatives and critical processes. Reports generally include the following major topics: financial position, revenues and costs, clinical quality and appropriateness review, service volumes and environmental changes and progress reports on ad hoc committees and ongoing projects.
Increasingly, boards are also informed of quality outcome measurements, ratings and comparisons that may be reported through the media. Many, but not all, of these measurements are provided to the board prior to communitywide dissemination.

Reports should also include evidence of how well the organization performed in meeting its own expectations. Reported measures should include established expectations, tolerance limits of variation and highlighting of variance that exceeds those limits. This is not necessarily the same information as presented to management (e.g., it may be simplified), and it does not have to be the same as similar organizations (that may have different missions and financial constraints). Reports on these measures are generally made in aggregate since board members have limited time to review information .



Of course there is much more to the substance and the form for each organization. Let InterOPERANT have a look. We specialize in this subject as well as strategic and tactical planning for your systems - Financial, Clinical and the key integration points between them.

I'll follow this verse with some very specific examples of organizations I have worked with in developing their governance processes. Governance won't work miracles, but it can be a very effective tool for all healthcare organizations particulairly as it relates to InformationTechnology, capital management and spending, priorities, and project management.


Bader, B.S. “CQI progress reports: The dashboard approach provides a better way to keep boards informed about quality.” Healthcare Executive, September/October 1993, 8-11.

Shortell, S.M. and Kaluzny, A.D. Health care management: Organization design and behavior (5th Ed.), Clifton Park, NY: Thompson-Delmar Learning. 2006

Griffith, J.R. and White, K.R. The Well-Managed Healthcare Organization (6th Ed.), Chicago: Health Administration Press. 2007.

For more information try this excellent podcast, and link. I feel you will find them very useful:

"Peter Weill, director of the Center for Information Systems Research at MIT's Sloan School of Management and co-author of IT Governance, discusses lessons he learned while researching his book":

http://www.cio.com/podcast/102564/What_Makes_for_Good_IT_Governance

also try,

http://www.cio.com/article/355413/IT_Governance_Tips_Help_to_Improve_Executive_Buy_In

Best,

Don Lyons

CEO and Managing Partner

The Technologies that Empower

InterOPERANT Project Coordination

Information technology has an exciting and fast growing history in healthcare. Its current complexity is the reason for high perceived risk of project failure. In order to successfully employ IT, critical information must be communicated in a way that excels the work of all involved parties. I'll follow this post and share somes experiences and lessons learned in governance. Stanford, MD Anderson, IDN's and Community Hospitals - one size does not fit all. If you are implementing governance, it is crucial to understand the importance of communication, and tools to optomize it. Tools, such as the client portal on InterOPERANT, record, centralize and standardize the communication and related exhibits of the work performed and the relationships that build success.

InterOPERANT’s project management interface allows for remote work to be brought in house with a simple powerful remote meeting environment. A universal, multi-user chat interface makes meetings and even phone calls unnecessary. This interface allows groups of both IT and health care personnel to discuss concepts together, and review auto-transcripts at any time.

InterOPERANT leads with the highest power communication and tracking tools to ensure success. What is measured is completed. Time-tracking Tools, and the ability to review what has been said, the milestones of project progression, and versions of documents collaborated on ensure that no details go without noted attention.


Michael Lyons, InterOPERANT
Director of Client Technologies and Services

InterOPERANT live...

Good morning, and today we annouce a new business unit of Stonewall Consulting LLC known simply as InterOPERANT..

Just before Y2k, we initiated a concept in the Seattle area whereby hospitals could work together sharing some common ancillary platforms such as laboratory, pharmacy, and radiology systems - this gave rise to Insight Healthcare Partners Ltd. In it's early form the actual sharing of production systems was the underlying concept - beyond the sharing of data. Standardization and economies of scale could be acheived. Taking the next step, Stonewall Consulting LLC extended the proposal further with experience from large academic medical centers, and on to western europe with the sharing and provisioning of clincal and genomic data to bio-pharma.

All of this work centered on key constructs that have formed the back-bone of InterOPERANT. Quality and efficiency in healthcare can be delivered by technology with standardization, integration, and interoperability driven by a world-class methdology and a great governance model.

We can help you on your journey to the summit.

At InterOPERANT we call it The 8th Summit.

Best,

Don Lyons

Founder and CEO