Post on 05-Sep-2020
transcript
Improving Technology Access in HealthcareMichigan Lean Consortium Annual ConferenceActive Learning Session (ALS) #2 Wednesday, Aug. 7, 2019, 2:30-4pm
Dewayne Freeman & Heather Strickland
Agenda
Who We Are
Request
Problem
Approach
Reaction
Impact
Lessons Learned
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Agenda
Who We Are
Request
Problem
Approach
Reaction
Impact
Lessons Learned
4
locally governed, not-for-profit, integrated health system,
based in Grand Rapids,
31,000 employees,
14 hospitals,
230 ambulatory and telehealth offerings,
4,200 physicians and advanced practice providers
a health plan serving 1 million members.
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Spectrum Health is…
Who We Are
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Agenda
Who We Are
Request
Problem
Approach
Reaction
Impact
Lessons Learned
7
Our RequestThe process for requesting access to our medical system and then fulfilling the request is cumbersome, time consuming and contains far too much waste.
There are multiple hand-offs between educators and analysts resulting in delayed processing of access.
This can cause delays in patient care and frequently causes request escalations at all hours.
The process is unnecessarily consuming resource hours, resulting in an increased backlog of requests, further exacerbating the problem.
(Submitted June 20)8
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Exercise #1
How would you respond to the request?
Our Response
“Yes, I am willing to be the Executive Sponsor for this PI effort. I would also suggest we use our internal IS PI resources to spin up an effort to quickly look at this problem. Dewayne Freeman and Heather Strickland are available to meet with you and the Process Owner to discuss the PI approach, this particular problem, and map out a quick action planto conduct a PI event for this problem. As soon as that meeting can take place, we can take the next step of conducting the PI event and make progress to solve this problem.” (Executive Sponsor, June 21)
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Agenda
Who We Are
Request
Problem
Approach
Reaction
Impact
Lessons Learned
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12
Exercise #2
How would you learn about the problem?
Problem: What we heard…
My educators continue to share concerns with delays in medical system access post successful completion of the coursework and assessment. They put in help desk tickets when this occurs but the delay/turnaround doesn’t seem to be improving. There are nurse techs and nurses on the clinical units as part of their orientation without access to the medical system. (Nursing Education Director, June 19)
Medical system access requests continue to fall behind, the contractors have left and the fulfillment team is not able to keep up with the current manual provisioning process [even] after implementing the new medical system. (Medical System Director, June 19)
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Problem: What we heard…
Neuro ICU – [Two] RNs have been on Neuro ICU 2 weeks without access. (Nursing Education Director, June 21)
Kelsey Wilson: “She told me on week 3 of orientation that she still didn’t have access).” (Nursing Education Director, June 21)
Every new hire that I had on 6/11 reached out to me last week stating they had taken the class and did not have access. (Nursing Education Director, June 21)
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Problem: The Numbers
440 open requests
Oldest open request was opened on May 9.
Access requests coming in today can be expected to take 3 to 5 weeks to fulfill.
EVERY request requires hours of follow-up by the requestor, i.e. first-time quality = 0.
575 access role templates
85 different training classes
Problem: The Numbers
440 open requests
Oldest open request was opened on May 9.
Access requests coming in today can be expected to take 3 to 5 weeksto fulfill.
EVERY request requires hours of follow-up by the requestor, i.e. first-time quality = 0.
575 access role templates
85 different training classes16
Agenda
Who We Are
Request
Problem
Approach
Reaction
Impact
Lessons Learned
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Exercise #3
How would you approach the problem?
Our Approach: Major Steps
First: who are the players?
Second: what are the major moving parts?
TALK TO THE CUSTOMERS!!!!!!!
Bring everyone together to get everyone on the same page, & to better understand the Current State.
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Our Approach: Players
Customers
• Unit Secretaries
• Admin Assistants
• Nursing Operations
• Nursing Education
• Medical Providers
Participants
• Medical System Access Fulfillment
• Medical System Support
• Medical System Training
• Service Catalog Team
• HR Talent Acquisition
Our Approach: Current State #1
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Our Approach: Current State #2
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Our Approach: Current State #3
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Our Approach: Current State #4
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Our Approach: Current State #5
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Our Approach: ADKARWhile there are many useful Change Management methodologies, Spectrum Health has chosen ADKAR as the backbone of its processes.
For any significant change, impacted people should be led through a series of deliberate, planned activities designed to drive:
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AwarenessOf the need for
change
DesireTo participate in and support the
change
KnowledgeOn how to change
AbilityTo implement
required skills and behaviors on the job
ReinforcementTo sustain the change
Our Approach: ADKAR
Our Approach: ADKAR
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What percent of projects meet or exceed their
objectives when change management is
used effectively?
What percent of projects succeed when there’s
poor or no change management?
94% 15%
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Exercise #4
How do you know when enough is enough?
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Point of Cause
Actual = Standard?Current = Ideal?
Large Vague Problem
Go SeeProblem Investigation
Cause Investigation
Why?Why?Why?Why?Why?
Root Cause: Why it happened
Root Cause: Why it was passed
Test C/M
Who & What
Where, When,& How
Why
Plan
DoCheck
Act
Our Approach: Point of CauseYou are looking for a specific set of conditions.
Start where problem is found and work upstream.
Investigate! Investigate! Investigate!
Get as close as possible to point of cause before testing countermeasures.
Problem solving requires patience and persistence – skills are developed through practice.
Agenda
Who We Are
Request
Problem
Approach
Reaction
Impact
Lessons Learned
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Exercise #5
What reactions would you expect? Use the ADKAR model to predict the teams’ response to your approach.
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Our Reactions
Customers
• Unit Secretaries – Frustration.
• Admin Assistants – Frustration.
• Nursing Operations – Frustration.
• Nursing Education – Frustration.
• Medical Providers – Frustration.
Participants
• Medical System Access – Anxiety, Resistance, Retreat.
• Medical System Support – Change.
• Medical System Training – Change.
• Service Catalog Team – Anxiety.
• Talent Acquisition – Frustration.
Agenda
Who We Are
Request
Problem
Approach
Reaction
Impact
Lessons Learned
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Exercise #6
What characteristics of the Future State would you aim for?
Impact: Our Future State
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Impact: Our Major Countermeasures
Fulfillment team stopped double-checking credentials & checking training (requirements for system access).
Added an information page to the Intranet to help requestors know what & how to request.
Fulfillment team stopped notifying customers manually when access was fulfilled, notifying the customer automatically, sending the user-name, password & login instructions, once access was fulfilled.
Granted access by default, revoking only if the employee didn’t meet the criteria later.
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Impact: Our Data
36%
50%
35%
65%
78%
93% 90%
81%87% 90% 89%
66%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Jun-
18
Jul-1
8
Aug
-18
Sep
-18
Oct
-18
Nov
-18
Dec
-18
Jan-
19
Feb-
19
Mar
-19
Apr
-19
May
-19
% Tickets Closed <= 1 Day
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Agenda
Who We Are
Request
Problem
Approach
Reaction
Impact
Lessons Learned
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Exercise #7
What have YOU learned today?
Our Lessons Learned
“Ah hah!” moment with huge shortcut to Future State.
“Ah hah!” moment during first meeting with Improvement Sponsor. We learned that the mess originated from the new medical system implementation. There wasn’t time to build automated access so they “kicked the can.”
Because the people who made the decisions that got us into this mess weren’t around any more, we lost all of the tribal knowledge available to us later.
Just because participants are told to change their process doesn’t mean that they WILL change.41