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Move from Traditional Change Management to Agile Methodology

Session #139, February 13, 2019

Sherri Hess, MS-IS, BSN, RN-BC, FHIMSS Chief Nursing Informatics Officer, Banner Health

Jean Palazzetti, MSN, MBA, RN, Sr Dir Nursing Informatics, Banner Health

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Sherri Hess, MS-IS, BSN, RN-BC, FHIMSS

Jean Palazzetti, MSN, MBA, RN, HCM

Has no real or apparent conflicts of interest to report.

Conflict of Interest

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• Pre-Agile Landscape at Banner Health

• Why agile

• Agile principles

• How to implement agile

• Benefits of agile

• Data to support

• Retrospective

Agenda

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• Explain the importance of moving from traditional change management to Agile methodology

• Explain how to implement a governance model to support an agile, rapid methodology

• Describe the importance of a data driven approach, using analytics to lead design

• Identify three principles in Agile methodology

• Describe three benefits of Agile methodology

Learning Objectives

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Banner Health System

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Dare To Dream

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Polling Question

How long from request for an enhancement to implementation?

Responses

1. 0-3 months

2. 3-6 months

3. 6-9 months

4. 9-12 months

How many requests are in your backlog?

Responses

Under 100

100-300

300-600

Way too many to count

Are your end users satisfied with your enhancement process?

Responses

Delighted by the process

Saddened, needs improved

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• Significant growth

• New venues of care delivery

• Essential Clinical Data Set

• Clinician satisfaction

• Patient Obsessed culture - Sofia

• Minimal data used to drive changes/enhancements

Landscape For Change

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• Enhancement process long

• Unclear on decision making process

• Metrics unclear

• Large meetings – poor decision making

• Education was “one size fits all”

Why Agile?

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Waterfall Change Management

– Converted large academic system

– Enhancement request was complex

– Large backlog of requests

– Adoption low

– Communication was challenging

– Rarely went back to measure success

Pre Agile

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Which Landed Us Here

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18,000 Nurses

Done

Done

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Agile Principles

• Satisfy customer-early and continuous delivery

• Welcome change

• Individuals and interactions over processes and tools

• Working software over comprehensive documentation

• Customer collaboration over contract negotiation

• Respond to change over following plan

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• Training

• Assemble the teams

• Start-DO SOMETHING

• Scrum meetings

• Grooming sessions

• Retrospectives

How To Implement

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Benefits Of Agile

• Whole team & stakeholders (SMEs) at the table real time

• Simplicity

• Reflection & Fine Tuning

• Team size

• Work broken down into manageable units

• Focus on quality

• Frequent delivery

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Capabilities Completed

Average:

• 23 Capabilities per Iteration

Total Counts:

• 362 Complete

• 17 Ready

• 86 In Progress

• 299 Backlog

1 2 2 2 3 2 3 2

79

5 48

12

1

1 11 2

2

1

6

1

2

11 5

108 5 5

12

6

8

9

10 15

24

1

1

4

3 2 2

2

33

3

1 1

2

6

1

2

61

6

5

1

6

6

31

1

2

31

4

3

2

5

84

10

9

7

7

7 8

7

3

0

5

10

15

20

25

30

35

40

45

Iteration01

Iteration02

Iteration03

Iteration04

Iteration05

Iteration06

Iteration07

Iteration08

Iteration09

Iteration10

Iteration11

Iteration12

Iteration13

Iteration14

Iteration15

Iteration16

Ambulatory Consumer/Portal Cross Venue Operations

Hospital Based Medicine Lab Meds Process

Procedural Specialty Medicine

Break/Fix

Only

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Orders to Scheduling

Decreased the turn around time from procedure order to actual scheduling time by 36.4%

Equated to 2 days and 4 hour reduction

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• Baseline

– 25.40% of the orders were scheduled within the first 24 hour of the order being placed

– 10.31% of orders were scheduled between 24-48 hours

– 35.71% of orders were scheduled within the first 48 hours

• Comparison

– 43.12% of the orders were scheduled within the first 24 hours of the order being placed

– 11.22% of orders were scheduled between 24-48 hours

– 54.34% of orders were scheduled within the first 48 hours

Increased the amount of orders scheduled within 48 hours by 52.2%

52.2%

Baseline: February 2018

Go Live: September 5, 2018

Comparison: October 2018

Excludes: Orders with a turn around time greater than 28 days

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Prevented 534,532 mCDS alerts for all users6.4+ million projected prevented mCDS alerts over 12 months for all users

Data Source: Millennium

Baseline: 3/1/18 – 3/31/18

Comparison: 8/8/18 – 9/8/18

534,532 prevented mCDS

alerts over 1

month for all users

6.4+ million projected prevented

mCDS alerts over 12

months for all users

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ED Physician Efficiency Metrics

Adjusted Time in EMR per patient reduced from 19 min 42 seconds to 11 min 59 secs. Total of nearly 8 minutes!

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• Interdisciplinary team

• Triad approach

• Feedback Loop

• Dedicate resources

– Support

– Education

– IT

– Informatics

Aligning Support To The Work

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Banner Comprehensive Approach

Agile Governance

ECD Clinically

Driven

Data

Utilization

Efficiency

Analysis

ECD/Model

Subjective

Survey

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• What went well

– Hit the ground running

– Teams engaged and Leaders supportive

– Stakeholders on board

– Large amount of work done in a short amount of time

– Clinicians eager for optimization

Post Agile Retrospective

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• Lessons Learned

– Not all pieces have to be done in one iteration

– Review usage and efficiency analytics before and after

– Take time to address poor adoption

– Put all projects in one place

– Don’t bombard one group with too many changes

– May be too agile

Retrospective, cont’d

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• Are you ready to adopt agile and two-week sprints?

• Responses

• Bring it on!

• No way!

Polling Question

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Sherri Hess MS-IS, BSN, RN-BC, FHIMSS

Chief Nursing Informatics Officer

602-747-7288 | Sherri.Hess@bannerhealth.com

Jean Palazzetti, MSN, MBA, RN, HCM

Sr Director Nursing Informatics

602-747-7538 | Jean.Palazzetti@bannerhealth.com

Questions