ABOUT A DOCTOR’S PRIDE & RIDING A HORSE

I commented on an online BusinessWeek article entitled “Doctors’ Pride: A Hurdle to Digital Medicine.”

The article’s point was that healthcare organizations should not ignore emotions, specifically the professional pride of a key stakeholder, the physician, in its computerization drive.

The change from paper- and film-based records to digital-based ones is wrenching for most parties involved—the healthcare organization, the physicians and other caregivers, the financial intermediaries (insurance companies), and the government. The best seat in the house probably belongs to the patient who, for the most part, just needs to cooperate and be patient.

The change, in short, is revolutionary. A sea-change like this requires the change managers to factor in the emotional reactions of all stakeholders.

The article recounts the learning experience of one of America’s largest hospital networks. The network, a healthcare organization, forced 4,500 doctors who do business with its hospitals to install—at the doctor’s expense—a specific IT system in their respective offices. This would enable every doctor to communicate with the hospital network and, through the network, with other caregivers. There are several good reasons for this. To name just one, it would improve the coordination between physicians especially between physicians of different specialties.

Technology has sped up the pace of life. Technology brings about change—change in workflows and processes—and, as noted in one of my blog entries (click here), persuading people to change their habits is not an easy task. Even rational reasons will fail. Note how difficult it is for people who live an unhealthy lifestyle to change. Sedentary people typically find it difficult to make working out at the gym a habit. Overweight people typically find it difficult to control their eating.

A Doctor’s Pride

At any rate, the article’s subtitle says it all. “A forerunner in New England found that some physicians would sooner cut ties than see their elite status threatened.” The first comment to this article was written by a doctor.

dan1138
Apr 24, 2009 8:37 PM GMT

As a doctor I find this to be a truly ignorant article. We work in teams all of the time. If doctors are reluctant to give up final authority, it’s because we have ultimate responsibility as well- spelled LAWSUIT. In the case cited, how would like to have a $25,000 system shoved down your throat, even if it negates all the work you’ve done with another system or forces you to change your- day-to-day practice ? I’d tell ’em to get lost, too.

I submitted the following comment in response.

Alex Pronove
Apr 25, 2009 11:18 PM GMT

It appears that the second comment, made by dan1138, justifies the title of this article. The dismissive tone suggests that he wrote it with emotions rather than cognitive reasoning in his mind. A major point of the article is teamwork, as in the example of a diabetic in the penultimate paragraph. Teamwork should improve the outcome and, consequently, reduce the likelihood or severity of dan1138’s concern (spelled LAWSUIT). His attitude seems to reflect hurt pride indeed.

ITIL

ITIL stands for the Information Technology Infrastructure Library. ITIL is a compilation of what businesses call “best practices.” I reviewed ITIL in another blog entry (click here). In it, I remarked at how it pleasantly surprised me. One surprise: don’t be misled by its roots in Information Technology. ITIL’s best practices are applicable to many situations in different fields.

Change Management

One vital piece of ITIL’s framework is change management. That’s correct—change management. Today, change—whether it’s in our work or personal space—comes so frequently and, sometimes, so strongly that a discipline emerged simply to understand and manage it. Change management is the field focused on controlling the risk and minimizing the adverse impact of change. The goal of change management is to facilitate the target’s adoption of the change. Adopt and adapt, you might say.

This is an appropriate definition of change management:

Change management is a systematic approach to dealing with change, both from the perspective of an organization and on the individual level. Change management has at least three different aspects: adapting to change, controlling change, and effecting change. A proactive approach to dealing with change is at the core of all three aspects. For an organization, change management means defining and implementing procedures and/or technologies to deal with changes in the business environment and to profit from changing opportunities.

Successful adaptation to change is as crucial within an organization as it is in the natural world. Just like plants and animals, organizations and the individuals in them inevitably encounter changing conditions that they are powerless to control. The more effectively you deal with change, the more likely you are to thrive. Adaptation might involve establishing a structured methodology for responding to changes in the business environment (such as a fluctuation in the economy, or a threat from a competitor) or establishing coping mechanisms for responding to changes in the workplace (such as new policies, or technologies).

Terry Paulson, the author of Paulson on Change, quotes an uncle’s advice: “It’s easiest to ride a horse in the direction it is going.” In other words, don’t struggle against change; learn to use it to your advantage.

Ride that Horse!

If the healthcare sector is a horse, then the American Recovery and Reinvestment Act of 2009 (Recovery Act) that was signed into law by President Obama two months ago gave it a big kick. According to the Department of Education:

“The act is an unprecedented effort to jumpstart our economy, create or save millions of jobs, and put a down payment on addressing long-neglected challenges so our country can thrive in the 21st century. The act is an extraordinary response to a crisis unlike any since the Great Depression, and includes measures to modernize our nation’s infrastructure, enhance energy independence, expand educational opportunities, preserve and improve affordable health care, provide tax relief, and protect those in greatest need.”

Returning to the original article, “Doctors’ Pride: A Hurdle to Digital Medicine,” I appreciated it more for reporting on the lesson that was learned from the change experience than anything else. As the author’s concluding paragraph notes:

No studies have yet been published to determine whether Partners (the hospital network) has saved any money since going digital. Nor has the network determined whether care has improved. But it now has the data to carry out those studies, and it plans to do so soon.

Now I call that horse riding—in the right direction!

ITIL: MY INTRODUCTION. PART-2 OF 3

Earlier I mentioned how impressed I was with the value that ITIL can bring to any organization. My positive impression led me to research it a little more—just enough so that I would get the big picture.

The beauty of ITIL, as mentioned previously, lies in its customizability. It specifies the framework, which means that while ITIL reveals the main outline of each best practice, it leaves substantial parts of the solution for you to fill in.

It should be possible to implement ITIL’s best practices using nothing more than Microsoft Office and a team of really dedicated evangelists. In order to implement these best practices, an organization needs a software tool, a team of evangelists, and a project plan.

ITIL needs a central repository for the knowledge and lessons learned by the organization. This repository takes the form of a database called the Configuration Management DataBase (CMDB). It is conceivable therefore, to use MS Office’s Access database for the CMDB. Of course, you should at least have a back-end SQL server to support it.

But don’t do it unless you have a small organization like a medical practice that has 10 physicians working together in one, maybe two, locations. Or, to put it another way, don’t do it unless the organization has an IT staff of two or three. I’m titillated by the idea but that would be a shoestring operation and wages may outweigh the cost of purchasing a dedicated ITIL software package. In short, I think it is feasible even though I have never heard of an implementation in such a small scale.

In order to implement ITIL effectively, the organization must maintain that CMDB and leverage it aggressively to share information to everyone in the organization about changes to existing processes, best practices that were adopted, standards that were set, timelines, etc. It is also important for the project team to roll out ITIL’s best practices in a sensible manner. The best practices should target related functions so that the improvements are quickly felt by the user organization. That will make it easier to adopt and, ultimately, shorten the time before the organization reaps the benefits.

WHAT ARE BEST PRACTICES ANYWAY?

If a user’s desktop starts malfunctioning, does the organization have a procedure that the user can follow confidently? In other words, can the user pick up the phone and call a service desk to report that her desktop isn’t working? And, when someone from IT picks it up, will she receive a loaner until her desktop is fixed and returned to her? Will the majority of her files be accessible through that loaner because the staff has been trained to save all of their files to a central server?

Those are all practices. In fact, those are all best practices. Note several things. First, the user has confidence in the procedure. Second, the process of receiving the loaner and setting it up for the user should take an hour or two—a quick response, in other words. And third, the user’s ability to access her files is possible only because of another practice, namely, saving user files to a central server.

None of these practices need special software to implement, correct? But how many organizations can execute this process consistently? Not many, would you agree?

This is why ITIL was developed. It is a compilation of the best practices for each conceivable function of the IT organization. These practices have one common goal—maximizing the value of IT’s services to its parent organization. ITIL accomplishes this by establishing a common language of terms and a set of service standards.

THE BIG PICTURE

The big picture I mentioned earlier consists of five major domains:

Service Support, which includes

1. Service Desk
2. Incident management
3. Problem management
4. Change management
5. Configuration management
6. Release management

Service Delivery

1. Service Level management
2. Financial management of IT services
3. Capacity management
4. Availability management
5. IT service continuity management

Business Perspective

Information & Communications Technology Infranstructure management

Software asset management

See Part-3 of 3 for an overview of the individual components.

ITIL: WHAT SURPRISED ME ABOUT IT. PART-1 OF 3

ITIL stands for the Information Technology Infrastructure Library. I’ve been involved with IT infrastructure for most of my career. After my introduction to ITIL last year, I realized how much better our past implementation of various systems could have been. That is how useful ITIL is, in my opinion.

ITIL is a compilation of what we now call “best practices.” The practices were compiled by a government agency of the United Kingdom. The agency, originally called the Central Computer & Telecommunications Agency (CCTA), began a library in the early 1980s of processes that computer departments should use in order to maximize the contribution of their services to the parent organization. ITIL provides a systematic approach to delivering IT services.

The beauty of ITIL lies in its customizable framework.

I was involved in a subset of the second version of ITIL, namely Service Support. This domain focuses on the process required to keep operations running on a day-by-basis.

It explains how the Service Desk owns and supports Incident Management. It is the foundation for supporting user issues and requests.

Problem Management is the other half of Service Support. It analyzes the root cause of problems to eliminate or mitigate them, once and for all.

Change Management uses a structured process to ensure that changes meet business and technical criteria. This reduces risk and minimizes the impact of change on the organization.

Release Management provides a framework for coordinating, controlling, and physically introducing change to the organization.

Configuration Management provides the foundation for all Service Support and Service Delivery processes. It uses a database (called the CMDB for Change Management Data Base) to track and monitor the organization's software, infrastructure, and documentation. It also documents the relationship between incidents, solutions, changes, and releases.

A COMMON SENSE APPROACH

ITIL uses as common sense approach to delivering IT services. It synchronizes the delivery of all IT services towards the common goal of delivering service value to the organization. ITIL is currently in its third version. Its content revolves around five core competencies:

1. Service Strategy
2. Service Design
3. Service Transition
4. Service Operation
5. Continual Service Improvement.

BENEFITS TO THE ORGANIZATION

ITIL benefits its parent organization in these ways:

1. reduced costs
2. improved IT services through the use of proven best practice processes
3. improved customer satisfaction through a more professional approach to service delivery
4. standards and guidance
5. improved productivity
6. improved use of skills and experience
7. improved delivery of third party services through the specification of ITIL or ISO 20000 as the standard for service delivery in services procurements.

TYPICAL ADOPTION PATH OF ITIL BY ORGANIZATIONS

Gartner is a respected name in the field of technology consulting and research. According to Gartner, most organizations dip their toes in ITIL in the domain of Service Support, as our client did. Its involvement began in the area of resolution management. Managing resolutions, i.e., issues aka problems, has two disciplines: incident management and problem management.

After becoming comfortable with resolution management, companies typically add control processes, namely, change management and configuration management. From there, companies move on to release management, and as the organization matures, it shifts its focus on the processes of delivering services and improving services, i.e., service level management and availability management. This, according to Gartner, is the typical path followed by many companies in their adoption of ITIL practices:

1. Resolution Management
2. Change Management
3. Configuration Management
4. Release Management
5. Service Level Management
6. Availability Management

Companies typically follow an evolutionary process in adopting any new technology or set of practices. It is well worth it. ITIL fulfills an important need. In most organizations, IT processes are chaotic and ill-defined, poorly or not documented, nor standardized. The ultimate reward, as the individual company matures along the ITIL path, it begins using basic repeatable processes to maintain and improve its service delivery functions.