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Building on Success-A CIO's Dilemma

By Jamie Nelson, CIO, Hospital for Special Surgery

Jamie Nelson, CIO, Hospital for Special Surgery

I have the good fortune of being the CIO at the leading musculoskeletal hospital in the U.S., maybe even the world. Hospital for Special Surgery (HSS), located in New York City, was named the No. 1 orthopedic hospital in the country for the seventh consecutive year by U.S. News and World Report (2016-17). Every day, I have the privilege of leading a team that provides technology solutions to clinicians and staff working to get their patients back to doing the things they need and love to do. Excellence is the standard here, and the status quo is never good enough.

"While there is no perfect formula for success, building your team with experts, planning ahead and being disciplined in project management can help get the job done"

And, IT at HSS is a success—in 2016, we implemented electronic medical records (Epic) across our enterprise for both inpatient and ambulatory. As hospital leadership sees it, Epic is the ‘Operating System” of our hospital. We have improved patient satisfaction post go-live, and IT staff engagement, as measured by Gallup, is way up. Most importantly, we have established a single source of truth for our clinical and patient financial information, the data bedrock of the organization. The dilemma? How do we move on from this success to the next set of challenges— fully digitizing the patient experience in an organization that is rapidly growing and transforming itself?

First, here is some context about the future of my organization. We are poised to digitize our care delivery platform, which will allow it to be scalable, to meet the needs of consumers and patients around the country and across the globe. As the IT department, we play a major role in supporting and enabling this transformation.

If past success is a good predictor of future success, here is my ‘large scale project’ best practice list based on our recent Epic electronic medical record implementation:

1. People and Team: building the very best team, whether through external hires or repositioning internal high performers is key. Our IT Team for the project was a combination of existing IT staff, internal transfers from within hospital operations and external hires—a fantastic mix of talent and experience.

2. Planning and Resourcing: spending appropriate time (a year in our case) to plan for the implementation, including developing a detailed cost model that included contingency funds, was critical. Enterprise-wide software implementations and the related operational transformation processes are expensive. The organization must have the necessary funds to support such an endeavor—so clearly identifying all costs at the onset is required.

3. Organizational Buy-In and Imperative: maintaining the organizational focus and sustained energy needed for a project of this complexity would be challenging if everyone was not vested in the process and goals. Starting with the software selection activities, we included a cross-section of hospital staff including doctors, nurses, clinicians, and operational frontline staff. We made sure that there was a shared goal and an imperative to reach that goal. Our rallying cry became “One Patient, One Record, One HSS” signaling the organization’s recognition of the advantages of a single source of IT truth in delivering the best patient care.

4. Discipline and Project Management: an effective execution of a project with the scope of Epic requires an incredible amount of coordination and management. A disciplined project management approach is an absolute requirement, and we resourced a robust, IT-led PMO, which has endured and expanded post go-live.

5. Operational Project Ownership and Governance: a key to the success of project management is effective project governance to set and maintain project parameters—a kind of ‘true north.’ Our governance process was led by the same physicians, clinicians and hospital operations leaders who participated in the selection process. These individuals also helped to create a set of project guiding principles, which were reviewed at the beginning of every project related meeting.

6. Transformation and Training: getting the most value from an enterprise implementation involves boldly transforming hospital operations to take full advantage of the new system functionality and the efficiencies inherent on a single patient record. So, defining where transformation would be most effective, starting those processes early in the implementation and training staff on new, transformed workflows (not just system functionality) are very important success factors. HSS had a transformation team, Operational Excellence, in place for the duration of the implementation. Departmental staff-credentialed trainers created curriculum, led end user training and were also part of the go-live support teams.

How do we now apply these practices to help us succeed in our next set of initiatives around the digital transformation of our organization?

•People: Bring together a non-traditional mix of team members who are true change agents, including digital experts from outside of healthcare

• Planning: Be sure that the financial resources are available, with a very strong emphasis on ROI

•Imperative: Clearly develop and articulate a compelling digital strategy explaining why it is required to support long-term organizational vision

•Discipline: Match the creative, disruptive project resources with team members skilled in execution and outcomes

•Ownership: Once the imperative is articulated, clinical and operational owners must be identified who will serve as key change agents

• Transformation: From the outset of the initiative, a relentless focus on truly transforming the patient care paradigm through digital tools and practices

As our digital world continues to evolve, every organization will experience and undergo change. The IT department will inevitably be called upon to lead the charge in a digital transformation. While there is no perfect formula for success, building your team with experts, planning ahead and being disciplined in project management can help get the job done.

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