Mercy Health Partners of Southwest Ohio has completed 36 healthcare IT implementations, within 2.5 years, all on time and within budget. Our clinical informatics goal is to improve patient safety and the quality of care. With my experience as a certified project management professional and wholehearted support of the CIO, I applied project management strategies during a rapid cycle of IT changes in five community hospitals. The success of this standardized approach is part of the reason that we were named one of the nation’s most wired healthcare organizations last year.
The customary project management approach identifies four to five process groups — initiating, planning, executing, monitoring, and closing — and nine knowledge areas — integration, scope, time, cost, quality, human resources, communications, risk management, and procurement. The demands of a healthcare environment require a strong approach on customer ownership and buy-in for an implementation.
The three most critical considerations for us are quality, cost, and time. A thoughtful and disciplined approach preserves quality by acknowledging the realistic costs for a good product and by allowing enough time for each phase. Early tasks like vendor research, contract negotiation, and choosing team members, who serve as owners, were key drivers. One challenge was to resist the pressure to set unrealistic deadlines. Timing could be tricky, since projects had to be planned within the constraints of the corporate budgeting schedule (18-24 months lead time) and the availability of capital dollars (five to six months lead time).
Team building was possible with the chief nursing officers as early allies who helped identify a bedside nurse as the project owner and spokesperson for the hospital. The project owner had to be well respected clinical staff at the hospital and not the IT staff from regional headquarters. Effective team members possessed people skills, presentation skills, and felt comfortable with each other. In selection of either team members, both the potential owner and team leader had the ability to engage or disengage.
The project management ownership model has been very successful with evolving improvements. None of these projects are “owned” by IT, rather they are owned by each facility. For example, the bedside scanning medication administration project was not a regional project but was the “Medication Safety Project for our hospital” as spoken by the site owner at leadership meetings. Clinical informaticists are the supporting team for the owner and are the extra appendage to ensure success. The informaticists provide talking points for presentations and may be present to help answer questions, if requested. The owner is given all the keys to the kingdom to work together as site owners for standardization and building the application, according to clinician needs to support patient care. It is explained to the owners that they have the keys but there is a thick “Wizard of Oz”-like curtain to protect them from other things such as database maintenance and security. Each go-live was supported by the owners who rotated at each site, building cross-facility standardizations and synergies.
The owners were also responsible for workflow assessments, coming to consensus for building the application, writing the curriculum, assisting in training, and owning the go-live for staffing at their facility. Another example of the ownership model was exhibited by the owners deciding on metrics for each of the applications, in conjunction with their site leadership. For example, the metrics of the ED tracking board project included: door-to-bed time; door-to-doctor time; door-to-discharge time; number of transfers per month; number of people who left without treatment; and number of admissions per month.
When PACS was first installed, not many people at Mercy Health Partners were familiar with it. We discovered that the vendor had good experts who delivered excellent training. Future contract negotiation involved assertive requests for these same experts to return for subsequent installations. We requested resumes for every implemented application of vendor representatives, conducted phone interviews, and exercised the right to dismiss a representative several times when the fit was not right for the culture and team expectations at Mercy.
Getting the metrics right is a challenge. In the beginning, we frequently were in a rush and did not remember to do the pre- and/or post-measurements to determine the success of the project implementation. We also discovered that surveys of end-users required customization. Radiologists, technicians, and file clerks all had valuable, but different, information to contribute. There was also room for improvement in communicating and applying what the team has learned. Each new team has a clinical informaticist who also worked on a previous installation as an owner. The overlap aids a smooth and accurate transfer of knowledge.
An unexpected outcome of creating site-owned teams is that 50 percent of the bedside nurses who served on teams have been promoted to other positions. The initial emphasis on site ownership and downplaying the regional IT role paid off in other ways. The benefits of hospital staff ‘owning’ the project were well demonstrated post implementation.
After bedside scanning medication administration was installed at Mercy Hospital Western Hills, a nurse first saw a problem with the reporting of compliance rates. It was quickly fixed, and she shared the information with her peers at the hospital. The CNOs got on board quickly, once they recovered from their shock. One CNO asked, “Don’t you have staff?” They responded affirmatively when I asked the question, “Who do you want presenting to your physicians — me or one of your most respected bedside nurses?”
Mike Hibbard is the vice president of clinical informatics for Mercy Health Partners of Southwest Ohio in Cincinnati. Mercy consists of five acute care hospitals and six long-term care campuses that offer a range of services, from skilled nursing to independent living.