Digital Transformation. Begins with... Primum Non Nocere

Unplugged. A blog at the traffic circle of professional, personal,
technical and healthcare. Opinions my own.

Leading technology in healthcare is privilege. Absolute privilege. We are a member of the care team. Taking care of people at their most vulnerable time. Our leadership impacts patient safety and quality of care. While virtuous, the honor comes with a price. A significant commitment. Absolute excellence. Consummate professionalism. A never-event execution mentality.

Top patient safety and quality organizations have much in common. Transparency. Accountability. Process. Passion. Relentless commitment and drive to perfection. Technology leaders must emulate these practices to achieve the same. Imagine. When technology services equal their high performing clinical counterparts. Pow. Outcomes improve. Lives are saved.

We struggled with technology performance. The number of Major Incidents were so common, customers accepted as normal. In the technology cross-industry best practice known as IT Infrastructure Library (ITIL), Major Incidents are defined as having one or more of the following attributes; impacting multiple customers, costly to the business, impairing critical work, and the large time and effort to resolve. In healthcare, Major Incidents adversely impact patient care. 

As a member of the organization executive team, I marvel how our chief quality officer routinely shares data showing year over year improvements in patient safety and care quality. I reflected. I wanted two things. I desired to share similar data demonstrating technology services continuous improvements. I desired to emulate my colleague and redesign our processes to match her teams. So we did. We cut Major Incidents in half. Each year aiming for another half. This is how the team did it:

Language. We adopted the language of our customers. While we held to our ITIL best practices, we dropped tech jargon. We adopted clinical terms. Instead of Major Incidents, we called them Serious Safety Events (SSE). Instead of After-Action Reviews, we called them Root Cause Analysis (RCA). Our efforts and resulting measurement immediately resonated with the executive team and the entire organization.

RCA. In-depth reviews are conducted and completed within 48 hours. We model the same forms and processes as the enterprise. Identifying the underlying cause, the documentation focuses on improvement. RCA are led by our ITIL practice leadership. Responsible individuals are identified and actively participate in the process. 

Accountability. All SSE are reviewed by the leadership team. Those responsible for the event present using the RCA template. Difficult conversations flow. Reviews are non-punitive and focused to advance learning and eliminate repetition. That said, there is ample incentive to avoid a return visit. 

Tracking. SSE and associated RCA are catalogued. All tasks are timeboxed. If the accountable party said they will have a new process or technology in place by end of month, we test. If they are going to stand-up new hardware end of quarter, we look. Commitment to timelines enforced. You are what you review and measure.

Sharing. The RCA are shared with all technology leaders to include customer facing business relationship managers (BRM). BRM share these with business unit leadership. The objective is for everyone to benefit from the learnings and apply across functional areas. Iron sharpens iron. The greater the share, the greater the improvement impact.

Transparency. We publish our SSE and all related documents for everyone to see. The splash page is simple. One metric. How many days since the last SSE. The second visual is a graph showing trend by month. We committed to a 50% reduction. You see the baseline and current reality. Your customers know your performance so why hide it. Transparency is key to trust. Key to improvement. Customers wanting a deeper experience can double-click and find RCAs and related documentation. Nothing is sacred.

Present. My executive team doubles as the technology governance committee. We review the SSE graph quarterly. Rain or shine. No umbrellas. My hope and goal is negligible differentiation between a clinical quality division SSE presentation versus technology. Same format. Same process. Same outcomes, ideally.

Operations. We adopted ITIL throughout technology. As a condition of employment, each professional was trained and certified. No exceptions. We incorporated daily huddles. Each day leaders reported on and addressed metrics or items of concern, in real time. Uniformity of practice improves quality and safety.

First, Do No Harm. I have no paper in my office except one. The graph. I circled September. That beautiful September. In the recorded history of our organization technology services, our first month of zero SSE. Zero. If you knew where we started, you would appreciate my joy. We finished the year with a 50% overall reduction. That was my scream you heard. Now for the next 50%.