Managing a Legacy Team in an EHR Transition: Success & Serendipity Session #75 February 21, 2017 1 Penny Black, Director Houston Methodist Hospital Alan Perkins, Associate Principal The Chartis Group
Speaker Introduction Penny Black Director Houston Methodist Hospital Alan Perkins Associate Principal, Informatics and Technology Practice The Chartis Group 2
Conflict of Interest Penny Black and Alan Perkins: Have no real or apparent conflicts of interest to report. *All images and graphs are property of The Chartis Group 3
Agenda Preparation: Upgrading the Legacy EHR Transition: Managing a Legacy Team & Supplementing Clinical IT Leadership New Reality and Lessons Learned 4
Learning Objectives Identify potential pitfalls in staffing a major EHR project Define key principles for maintaining employee satisfaction on legacy teams Analyze successful strategies for integrating employee and contract labor into a cohesive team Develop a staffing plan which supports an effective leadership strategy 5
Realizing Benefits for the Value of Health IT Our system will enhance our ability to provide high quality evidence-based care in a safe environment and will enable us to quantify our care and deliver metrics in a meaningful way. Our system will highlight the Houston Methodist experience by connecting our patients and families with clinicians, physicians, and employees. 6
Legacy Systems: Mission Critical Today (and for the next 2 years) Tomorrow 7
About Houston Methodist Houston Methodist comprises a leading academic medical center in the Texas Medical Center and six community hospitals serving the Greater Houston area. 2,550 Total Beds > 4,000 Physicians 1,983 Beds in Service 36 Residency Programs 18,000+ Employees 467 Employed Physicians 260 Residents $3.1B (FY 14) Total Revenue 8
Houston Methodist ICARE Values Houston Methodist employees recognize and support the organization s values, reinforce positive behaviors, and celebrate the contributions of those who exemplify our values. Integrity Compassion Accountability Respect Excellence We are honest and ethical in all we say and do. We embrace the whole person and respond to emotional, ethical, and spiritual concerns as well as physical needs. We hold ourselves accountable for our actions. We treat every individual as a person of worth, dignity, and value. We strive to be the best at what we do and a model for others to emulate. 9
Start with the End in Mind Goals: Replace existing Best of Breed applications Utilize HMH employees (IT and Clinical) for implementation team Ensure resources maintain HMH employment Implementation team transitions Legacy team placement post sunset Maintain Legacy team to maintain current systems 10
Agenda Preparation: Upgrading the Legacy EHR Transition: Managing a Legacy Team & Supplementing Clinical IT Leadership New Reality and Lessons Learned 11
Preparation: Upgrading the Legacy EHR Goals Upgrade EHR to most current version Final version to sunset (3 year plan) Upgrade additional ancillary systems Meaningful Use readiness considerations Hire consultants to supplement team 12
Preparation: Upgrading the Legacy EHR Director Systems Architect Manager Manager Lead Report Writer Lead Periop Team Lead 1 Lead Coordinator Lead Trainer Report 1 Periop 1 Pharmacy Lead Coordinator 1 Trainer 1 Our Initial Team= 51 Team Members Report 2 Report 3 Report 4 Report 5 Periop 2 Periop 3 Periop 4 Periop 5 Senior Rx Pharm Tech Analyst 1 Analyst 2 Coordinator 2 Coordinator3 Coordinator 4 Coordinator 5 Trainer 2 Trainer 3 Support 1 Support 2 1 Director 1 Systems Architect 2 Managers 5 Lead Analysts 8 Report Writers 5 Periop Analysts 3 Pharmacy Analysts 8 EMR Build Analysts 13 Clinical Coordinators 3 Trainers 2 Support Analysts Report 6 Report 7 Report 8 Analyst 3 Analyst 4 Analyst 5 Analyst 6 Analyst 7 Analyst 8 Coordinator 6 Coordinator 7 Coordinator 8 Coordinator 9 Coordinator 10 Coordinator 11 Coordinator 12 Coordinator 13 13
Preparation: Upgrading the Legacy EHR Director Project Manager Systems Architect Manager Manager Lead Report Writer Lead Periop Team Lead 1 Lead Coordinator Lead Trainer Report 1 Periop 1 Pharmacy Lead Coordinator 1 Trainer 1 Report 2 Periop 2 Senior Rx Coordinator 2 Trainer 2 EHR Upgrade Team= 64 Team Members Additions: Report 3 Report 4 Report 5 Report 6 Periop 3 Periop 4 Periop 5 Periop 6 Pharm Tech Analyst 1 Analyst 2 Analyst 3 Coordinator3 Coordinator 4 Coordinator 5 Coordinator 6 Trainer 3 Support 1 Support 2 Support 3 1 Project Manager Report 7 Periop 7 Analyst 4 Coordinator 7 Support 4 5 EHR Analysts Report 8 Analyst 5 Coordinator 8 2 Periop Analysts Report 9 Analyst 6 Coordinator 9 3 Report Analysts Report 10 Analyst 7 Coordinator 10 2 Support Analysts Report 11 Analyst 8 Coordinator 11 Analyst 9 Coordinator 12 Analyst 10 Coordinator 13 Analyst 11 14 Analyst 12 Analyst 13
Preparation: Upgrading the Legacy EHR Key Success Factors Plan the work, work the plan, and embrace Change management and communications Extensive training plan Super users Detailed planning, testing, and mock go-lives Command center logistics and processes 15
Agenda Preparation: Upgrading the Legacy EHR Transition: Managing a Legacy Team & Supplementing Clinical IT Leadership New Reality and Lessons Learned 16
Transition: Managing a Legacy Team Goals Keep core systems running and maintained Limit interruptions for EHR implementation team Keep legacy team turnover low and engagement and satisfaction high Implement new governance model Limit requests to appliance core measures, quality, patient safety or critical business needs Ensure streamlined teams meet customer needs 17
Transition: Managing a Legacy Team Core Clinical (Legacy) Team 2014 Team Members Day five, post upgrade Director Report 7 Periop 5 Senior Rx Coordinator 8 Trainer 1 Report 8 Periop 6 Analyst 9 Coordinator 9 Trainer 2 Report 9 Periop 7 Analyst 10 Coordinator 10 Trainer 3 Report 10 Analyst 11 Coordinator 11 Support 1 Report 11 Analyst 12 Coordinator 12 Support 2 Analyst 13 Coordinator 13 Support 3 Support 4 18
Transition: Managing a Legacy Team New Implementation Team - 2014 Open FTE Exec Admin Project Executive Contractor / Staff Aug Nurse (In FTE position) Champion Clinical Director Epic Systems Director Clinical Systems Director Physician Initiatives Director Revenue Cycle Director Patient Access Director CM/ Comm/Edu Project Director App Mgr. ClinDoc/ Stork/LTAC/ASAP App Mgr.Orders/ Willow/Beacon App Mgr Radiant/ OpTime-Anes/Cupid Mgr Appl Tech Mgr Integration Ambulatory Mgr Reporting Mgr Resolute Billing Mgr Patient Mgmt Mgr n Training Mgr Testing Manager Infrastructure Mgr ClinDoc Stork ASAP Orders Willow Beacon Resour ce OpTime/Anesthesia Resourc e Radiant Cupid Technical Apps Integration Ambulatory Resourc e Reporting Resolute Hosp Billing Resolute Phys Billing HIM ADT/Prelude Cadence Instructional Designers Change Mgt/Comm PMO Testing Infrastructure 19
Transition: Managing a Legacy Team Compassion Strategy Critical Core We embrace the whole person and respond to emotional, ethical, and spiritual concerns as well as physical needs. Strong leadership support Created retention bonus Continued internal promotions Celebrated successes Created work close to home options and remote work alternatives Eliminated primary pager responsibility Continued management support 20
Transition: Managing a Legacy Team Excellence Strategy Critical Core We strive to be the best at what we do and a model for others to emulate. Implemented new governance model Applied new work management model Taught Clinical Coordinators configuration Completed cross training between EHR and Periop. Eliminated on call physician training; published schedule 21
Transition: Managing a Legacy Team Respect Strategy Critical Core Consultants We treat every individual as a person of worth, dignity, and value. Initial participation in employee outings Option to work remote exclusively Occasional one-on-one with director Transparency with SOWs and budget plans Created opportunities for additional training and certifications 22
Transition: Managing a Legacy Team Transition 1: Critical Core Team 2016 Five successful core team transitions to implementation team positions One employee transition to clinical area One consultant resignation Addition of consultants to backfill employee transitions 2015 = 28 2016 = 27 Director Director Report 7 Periop 5 Senior Rx Coordinator 8 Trainer 1 Report 7 Periop Lead Analyst 9 Coordinator 8 Trainer 1 Report 8 Periop 6 Analyst 9 Coordinator 9 Trainer 2 Report 8 Periop 5 Analyst 10 11 Coordinator 9 Trainer 2 Report 9 Periop 7 Analyst 10 Coordinator 10 Trainer 3 Report 9 Periop 6 Analyst 11 Coordinator 10 Support 1 Report 10 Analyst 11 Coordinator 11 Support 1 Report 10 Periop 7 Analyst 12 Coordinator 11 Support 2 Report 11 Analyst 12 Coordinator 12 Support 2 Report 11 Senior Rx Analyst 13 Coordinator 12 Support 3 Analyst 13 Coordinator 13 Support 3 Coordinator 13 Support 4 23
Transition: Managing a Legacy Team Employee Engagement Success Tier 1 Tier 1 4.59 4.79 Tier 1 4.67 Tier 2 Tier 3 Tier 2 Tier 3 Tier 2 Tier 3 Employee Satisfaction Scores 2013 Teams reporting to Penny Black 2015 Teams reporting to Penny Black 2016 Teams reporting to Penny Black 24
Employee Engagement Benefits Willing to go above and beyond, exerting additional effort Energetic and enthusiastic Loyal to the organization more likely to stay Proud of the organization and willing to recommend as a place to work and to receive care More satisfied employees overall Key Drivers Sense of belonging Confidence HMH will be successful Work unit members are honest/ethical 25
Transition: Managing a Legacy Team Key Success Factors What Makes This Work? Leadership commitment to employees that no individuals will be left behind Carefully choose 3rd party resources who compliment and blend in to the team Allow time for team bonding and knowledge transfer Share organization value system and align values where possible Trust and accountability Flexibility 26
Transition: Supplementing IT Leadership Team Goal Ensure that existing core IT systems remain Benefits Productive and effective for business and clinical operations Current with regulatory and health reform requirements Supportive of ongoing operational performance improvements 27
Transition: Supplementing IT CL Team Houston Methodist IT Leadership Retains HR-related responsibilities (annual reviews, promotions) Retains financial authority (approval of invoices, budget approval) Provides feedback for the consultants annual review process Approach Engage a consulting partner firm to provide experienced management resources to oversee core operations (multiple leadership positions) Engaged partner firm to provide experienced leads and project managers to supplement PMO resources Logistics Consulting Partner IT Leadership Function seamlessly as part of the Houston Methodist IT leadership team Manage onboarding and oversight of other third party staff resources 28
Transition: Supplementing IT CL Team Key Success Factors What Makes This Work? Choose the right partner! Quality of interim leadership resources knowledge, experience, interpersonal skills Trust and accountability Bi-directional transparency Ability to function effectively in a hybrid leadership environment with some ambiguity Flexibility 29
Agenda Preparation: Upgrading the Legacy EHR Transition: Managing a Legacy Team & Supplementing Clinical IT Leadership New Reality and Lessons Learned 30
The New Reality and Lessons Learned Goals Support the successful go-lives of the new EHR across the health system Ensure a smooth transition of staff from current roles to future roles on the consolidated new EHR/Core team Establish an IT staffing foundation which will support the needs of clinical IT once the EHR is fully deployed 31
The New Reality and Lessons Learned New System Implementation Timeline Primary Design Complete System Build Complete WFWT Upgrade Testing Starts IP Content Build Complete SPG/PCG Training West Houston, St. Catherine St. John, Woodlands Go-Lives (3/4) 4 Hospital Training Willowbrook, San Jac, Sugar Land Go-Live (6/3) Q4 14 Q1 15 Q2 15 Q3 15 Q4 15 Q1 16 Q2 16 Q3 16 Q4 16 Q1 17 Q2 17 Q3 17 Hospital Go-Live PO Go-Live Project HMH Go-Live (5/22) HMH Training SPG/PCG 1 st Go-Live (3/1) 32 SPG/PCG 3 rd Go-Live (11/1) 3 Hospital Training SPG/PCG 2 nd Go-Live (7/19) 3 Hospital Go-Live 2/19/17
The New Reality and Lessons Learned 2016 Core Team Projection Change freeze, reduced number of change requests Continued successful core team transitions Expect third-party resource attrition New system continued rollout 2016 = 27 s Director 2017 = 15 s Director Report 7 Periop Lead Analyst 9 Coordinator 8 Trainer 1 Report 7 Periop Lead Analyst 9 Coordinator 8 Trainer 1 Report 8 Periop 5 Analyst 10 11 Coordinator 9 Trainer 2 Report 8 Periop 5 Analyst 10 11 Coordinator 9 Trainer 2 Report 9 Periop 6 Analyst 11 Coordinator 10 Support 1 Report 9 Periop 6 Analyst 11 Coordinator 10 Support 1 Report 10 Periop 7 Analyst 12 Coordinator 11 Support 2 Analyst 12 Coordinator 11 Support 2 Report 11 Senior Rx Analyst 13 Coordinator 12 Support 3 Analyst 13 Coordinator 12 Support 3 Coordinator 13 Coordinator 13 33
The New Reality and Lessons Learned 2017 Reality Number of changes requests significantly reduced All core team members have suitable transition plans Third party resource reduction occurred organically Rollouts continue 2017 = 15 s Director 2017 = 4 Consultants Director Report 7 Periop Lead Analyst 9 Coordinator 8 Trainer 1 Report 7 Periop Lead Analyst 9 Coordinator 8 Report 8 Periop 5 Analyst 10 11 Coordinator 9 Trainer 2 Report 8 Periop 5 Analyst 10 11 Coordinator 9 Report 9 Periop 6 Analyst 11 Coordinator 10 Support 1 Report 9 Periop 6 Analyst 11 Coordinator 10 Analyst 12 Coordinator 11 Support 2 Coordinator 11 Analyst 13 Coordinator 12 Support 3 Coordinator 13 34
The New Reality and Lessons Learned Implementation Complete Significant reduced number of change requests All core team members successfully transitioned Consultant colleagues will transfer to new projects New system fully rolled out by mid-2017 2017 Transition Complete Director Report 9 Periop 6 Analyst 10 Analyst 10 35
The New Reality and Lessons Learned Lessons Learned Success Managing a legacy team during a major EHR transition can be done successfully Be true to your organization s values Work with partner firms that share your values Transparency is essential to build trust and reduce anxiety Serendipity The prior success of the EHR upgrade created confidence inside and outside of IT Bringing consulting team members on board in advance gave time for them to integrate Staff adjusted surprisingly well to new roles were able to train up and develop additional skill sets 36
Realizing Benefits for the Value of Health IT Our system will enhance our ability to provide high quality evidence-based care in a safe environment and will enable us to quantify our care and deliver metrics in a meaningful way. Our system will highlight the Houston Methodist experience by connecting our patients and families with clinicians, physicians, and employees. 37
Questions Penny Black Houston Methodist Hospital plblack@houstonmethodist.org Alan Perkins The Chartis Group aperkins@chartis.com Thanks for your participation. Please complete the online session evaluation. 38