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 1
Conflict of Interest Sherri Hess, MS-IS, BSN, RN-BC, FHIMSS Jean Palazzetti, MSN, MBA, RN, HCM Has no real or apparent conflicts of interest to report. 2
Agenda Pre-Agile Landscape at Banner Health Why agile Agile principles How to implement agile Benefits of agile Data to support Retrospective 3
Learning Objectives 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 4
5 Banner Health System
Dare To Dream 6
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 7
Landscape For Change Significant growth New venues of care delivery Essential Clinical Data Set Clinician satisfaction Patient Obsessed culture - Sofia Minimal data used to drive changes/enhancements 8
Why Agile? Enhancement process long Unclear on decision making process Metrics unclear Large meetings poor decision making Education was one size fits all 9
Pre Agile 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 10
Which Landed Us Here 11
Done 18,000 Nurses Done 12
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 13
How To Implement Training Assemble the teams Start-DO SOMETHING Scrum meetings Grooming sessions Retrospectives 14
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 15
Capabilities Completed Average: 23 Capabilities per Total Counts: 362 Complete 17 Ready 86 In Progress 299 Backlog 45 40 35 30 25 20 15 10 5 0 5 3 3 5 4 2 8 9 6 4 6 6 2 1 12 1 2 1 3 1 2 2 4 10 8 5 5 1 11 5 2 6 2 1 2 1 1 1 2 2 1 1 2 2 2 3 2 3 2 01 Ambulatory Consumer/Portal Cross Venue Operations Hospital Based Medicine Lab Meds Process Procedural 02 03 04 05 06 Specialty Medicine 07 10 08 09 7 6 2 8 6 1 7 10 7 6 3 9 9 11 7 8 1 3 3 10 15 1 1 3 5 4 12 13 7 24 8 14 Break/Fix Only 3 1 1 15 16 16
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 17
Increased the amount of orders scheduled within 48 hours by 52.2% 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 52.2% Baseline: February 2018 Go Live: September 5, 2018 Comparison: October 2018 Excludes: Orders with a turn around time greater than 28 days 18
Prevented 534,532 mcds alerts for all users 6.4+ million projected prevented mcds alerts over 12 months for all users 534,532 prevented mcds alerts over 1 month for all users 6.4+ 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 19
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! 20
Aligning Support To The Work Interdisciplinary team Triad approach Feedback Loop Dedicate resources Support Education IT Informatics 21
Banner Comprehensive Approach Data Utilization Agile Governance ECD/Model ECD Clinically Driven Efficiency Analysis Subjective Survey 22
Post Agile Retrospective 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 23
Retrospective, cont d 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 24
Polling Question Are you ready to adopt agile and two-week sprints? Responses Bring it on! No way! 26
Questions 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 27