“If you thought June was hard, you were right. We had nine significant projects go live in 35 days.”
These were the words of our project management office leader as he summarized our resource utilization model to plan for FY09. Over a very short period of time last summer, we implemented HR, payroll, finance, materials and bed management systems, and moved our department off the hospital campus. In the current competitive environment, our community hospital needed to take on what felt like overwhelming challenges in 2008. In the New England vernacular, it was “wicked hard.” What follows are lessons and illustrations from a year of great change in operations and technology.
Communicate the agenda
Over the past year, our hospital was under imperatives to improve throughput and bed availability, convert to a corporate enterprise resource planning (ERP) system, and begin construction and move projects to meet margin expectations. Turning away from these challenges would mean a decline in fiscal strength, as well as compromising our mission and employee well-being. The 2008 goals meant changes in clinical process, staff moves off campus and yielding control of some functions to our parent company.
A leader must understand organizational direction and commit to goals. Given this, I needed to fully buy in to the agenda for our hospital and the overall enterprise. That provided the platform for selling these ideas to other leaders and staff.
One example was the move of our IS department two miles off campus to make room for the hospital's new Cancer Center. We were the first administrative department to be decanted from our hospital site, but most of the other IS departments in our system were no longer located at their hospital. In fact, our new location was one of the main hubs for our corporate IS staff. As moves go, the new location changed staff commutes very little; parking remained free and other amenities were similar. The technical infrastructure was robust because of existing corporate staff. At every forum, formal and informal, I talked about the change and listened to concerns. I assured our employees that we would continue to perform well and that we would work through any unanticipated issues.
The implementation of the ERP system not only changed processes, but also meant that some functions and jobs would move to a corporate office across town. Local reactions to these changes were, understandably, somewhat negative. The new system dis-integrated our hospital information system, and there were the always-present glitches in software and operations that happen with any new implementation. It was important to help the teams see the overall purpose of this software for the efficiency of our company, and to remind staff that several other hospitals in our corporation had successfully adopted this system.
While we had excellent executive support for all of our change initiatives, I think we could have leaned on them more. I realized that I just didn't have enough time and energy to do all of the communicating and cheering on that needed to be done. Moreover, other people in the department could have aided in that effort had I let them in on more information and asked them to step up. The key is that the agenda must be repeated regularly through multiple channels.
Lean on those who can handle change
Perhaps change isn't easy for anyone, but some seem to be less allergic than others. A number of people on my staff (possibly even half) were energized by the daunting agenda. These folks helped carry the group with their can-do attitude, use of humor and calming presence. Two of our leaders couldn't necessarily see the vision, but they trusted the hospital leadership enough to know that it was our only pathway forward. With that seed of commitment, those leaders became champions for change and helped sooth those who were distraught.
The corporatization of our help desk was one project where a strong staff member brought stability. Because of increasing use of enterprise applications, more demand for technology and our move off campus, it became clear that it was time to incorporate our help desk with the bank of analysts used for the whole company. The upside of this move seemed clear - better call response time, more computer technicians at the hospital and space alignment. For some, however, it felt like a loss of autonomy, and seemed to have several insurmountable barriers. The staff that were willing to push forward with this opportunity carried others and solved each problem.
During our patient throughput project, we were challenged with implementing bed management, bed turnover and transport systems in 90 days. Several extracts were required from these systems and our ADT system to meet the throughput goals.
Although we had lost two of our three programmers before the project started, we asked our one remaining person to meet the deadlines. Seeing the situation as an opportunity to have a large impact and to shine, the remaining programmer met the challenge. After that, he took a long, well-deserved vacation.
In these examples, I should have just expected good things from these people. I could have asked them to work hard, to trust leadership and to remain committed. I probably could have given them a little more insider information and asked them to do even more to keep up the pace of change. In addition, I would have insisted that they take more time off, even if a short time, during the most intense time of change. It's important to identify the high performers, empower and protect them, and pay less attention to those who are not on board.
No way around it, change is hard
Accept that change is going to be hard. It's often more challenging because the path is not linear, and it's unclear how people will respond. I entered my role at the hospital knowing that there was going to be substantial operational and technical change. I had some ideas about what the roadmap would be, but much of the time it has been like those houses of mirrors at the amusement park - you think you know the next move, but it turns out to be an illusion, and the right path is just to the left or right. Some leaders and staff rise to the occasion and contribute more as noted above. Others just can't handle the change and act out with complaints, anxiety, reminiscence of the past, institutional pride or even sabotage.
Plan in advance for those who will jump ship and use the time to make other process and personnel changes. Lean even more heavily on the high performers and don't waste time with those who lag. Extra effort with those who aren't with the program doesn't yield enough benefit compared to the dividends you can get from a high performer - even when you give the high performer regular times off.
Despite the challenges, we came out in pretty good shape. Our staff are settled into the new office and we have adopted new processes for the help desk. Our hospital is overcoming the change to the new ERP system and we have learned how to support the integration to our legacy systems. Our throughput project is yielding additional bed capacity just in time for flu season.
We did lose some staff this year, but those who remain feel a deep sense of accomplishment and are game to take on the FY09 agenda. In some ways, this year is even more challenging, but our group approaches it with a new sense of confidence.