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Wag the Dog

May 1, 2007
by Pedro Rivera
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Is your IT department running the business operations or is your business operations running the IT?

Today's information technology (IT) seems to change every year from one user conference to the next. Your staff attends these professional conferences and comes back energized with the latest software updates. Why does it always seem that your healthcare organization is the only one that has been doing it the same way for the last 20 years and everyone else is so far ahead of the game?
Pedro Rivera

Aligning business strategies to IT is a challenge for both IT and business operations. You hear of new systems and technologies and wonder if it's a good fit for your organization, and you turn towards your IT department for guidance. Most often, IT will give you sound advice about the technology, but also information on limited resources, training curve, and how many projects they have on the table.

You're left satisfied that you got your answer, but wonder if you got the right answer. Far too many times, the IT department has its hands in every aspect of the business process and, as such, becomes the driver for any major business change. Unfortunately there are some IT departments that start saying what can't be done instead of trying to figure out how to get things done. The tail starts wagging the dog.

Turning corners and making maps

Have you noticed how many times software updates or new installations are conducted and IT states that you must change your workflow or the way you do business because it's the way the information has to be entered? Maybe you just got funding for a technology project and you hand it over to your IT department to come up with the best use. Either way, you just turned a very important corner in the operations of your business. You have empowered your IT department to make business decisions.

The primary reason why IT projects fail is because the users were not involved early in the design process, or they come in too late and realize that it will not fit the workflow, and demand costly changes. The lesson here is that there is no such thing as an IT project. Rather, it is a business improvement project. Radiology imaging (PACS), physician order entry, electronic health records and practice management software should be treated as business improvement and not an IT systems installation.

What about server operating system upgrades, application upgrades and network upgrades? These all involve the backbone of your operations and although you may not need to be intimately involved, you should have representation at all project milestone meetings.

The key is to manage your IT department from a service standpoint. The same metrics used for your front-end patient representatives can be applied to your IT support staff. Remember your old Total Quality Management training? Customers can be external or internal to your organization. Certain tools can be used or services contracted that will help capture IT performance. Having concrete performance data for IT helps you determine if they are below, meeting, or exceeding business expectations. If you hear providers complain that the system is too slow, how do you measure that? Is it user impatience or truly a system response issue?

For years, businesses have operated like computers, in that they are too complicated and too technical to try to understand. It's easier to leave the bits and bytes to the "techies." But the reality now is that business and IT are intertwined. You can no longer afford not to have a basic understanding of information technology. Most business management programs have information technology courses as part of the curriculum for this same reason. How many of your business operations staff have gone back to obtain either IT business certifications or attend software user conferences? Are you looking for MBA's with an IT minor?

Likewise, what certifications or graduate level work does your senior IT staff hold? Your healthcare professionals are required to go back for training and obtain CEU's to keep pace with changes in the healthcare industry. How many technology changes have taken place in the last three years? Has your IT staff kept up?

Does your organization have an IT project committee or an IT department review process that is managed by business operations? IT projects are managed in the same way that any project is managed. You use the same methodology and often the same project tracking tools. The key is to have business drivers, senior vice president champions and key users providing the directions for the project. The IT staff is only there to help determine how to make it happen.

Does your technology department get report cards on how software or hardware installations are conducted and if milestones are met? Part of the committee review process is to help close out projects and provide "Lessons Learned." This review time can also be used to provide a report card on how well IT was able to meet business requirements and how accurately the software changed to meet business "best practices."

Conversely, you should conduct periodic quality checks during the project to make sure input is provided for business requirements. Don't wait until the demo before go-live to raise concerns.

Continuing education essential

Has your senior staff pursued Six Sigma, project management or CIO professional development courses? The worse case scenario typically occurs when you have senior IT staffs that were "home grown" from operations or clinical departments with a degree not even close to information technology, and have been with your organization for many years. Often these IT managers think that they know your unique healthcare operations or clinical operations well enough to answer and decide for the users. They feel empowered to drive installations and business processes since they know both sides and have seniority. Projects tend to take longer, you get a slow response to requests from IT and you get the sense that you're not in the loop because someone is making decisions for you. Warning bells should be going off if this sounds familiar.

Often these managers/directors are far removed from operations and medicine and they have not kept pace with changes in the workflow. They also lack the technical knowledge required to help guide the IT project.

You want your technical staff to stay technically proficient and your business staff to stay technically knowledgeable. That is to say, super users belong in the business or clinical departments and they can help liaison with the IT staff. Your technical staff needs to have IT training and stay current with changes to help drive the technology infrastructure.

Budget and be prepared to send your technical staff and senior IT personnel to continuing education courses or provide incentives and recognize those that pursue advanced degrees on their own time.

Conversely, encourage your business staff to take "management of information services" type courses and attend conferences. Your staff will be better prepared to embrace technology and enabled to weave through the tech talk to make informed decisions. At the end of the day, it will be the business/clinical departments that generate the revenue and wag their own tails.

Pedro Rivera is a senior healthcare consultant with Hayes Management Consulting, Newton Centre, Mass.


Unfortunately there are some IT departments that start saying what can't be done instead of trying to figure out how to get things done.


You can no longer afford not to have a basic understanding of information technology.

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