Using Strategic Management Tools to Support Your Electronic Health Records Deployment

Managing the deployment of Electronic Health Record (EHR) system is an extraordinarily complex task with many interdependencies both within the IT department and across nearly every aspect of a hospital’s operation.

Because of the complexity of these interdependencies, and because nearly everyone involved with the process of selecting, defining, implementing and using an Electronic Health Records (EHR) system also has a “regular” job to do, these EHR projects are notoriously difficult to manage. The amount of change and the number disciplines impacted by EHR deployments make it almost impossible for the broad spectrum of people involved to “get their minds around” the implications of choices or interdependencies that need to be addressed. As the projects extend over multiple years, those challenges multiply. Fortunately, the use of state-of-the-art strategic management tools can provide the support to streamline the process and manage the information more easily.

The University of Utah Hospitals and Clinics in Salt Lake City, also known as University Health Care (UHC), had a full plate of healthcare IT projects when Jim Turnbull took over as the CIO in 2008. As a board member of the College of Healthcare Information Management Executives (CHIME) and as a fellow and past president of the Healthcare Information and Management Systems Society (HIMSS), Mr. Turnbull was very familiar with the difficulties that hospitals often face in their efforts to deploy large IT projects. The 340 people in the UHC Information Technology & Systems (ITS) division were being pulled in many directions by the myriad of demands that come from being an academic medical center. As the ITS leader, Mr. Turnbull felt the pressure to improve the alignment and efficiency of his team and to make sure that a long list of IT projects were implemented successfully so they delivered the desired value to the organization. His experience with strategic management tools when he was CIO of The Children’s Hospital of Denver, Colorado convinced him that these tools could play an important role in addressing these pressures.

According to Mr. Turnbull, "The scope and complexity of many healthcare information technology projects often requires that they span several years. Too often the original goals are forgotten, and our project management tools and methodologies get too focused on a successful 'go live'... while achieving the benefits of the system becomes secondary. Strategic Management tools that include Balanced Scorecards and strategy maps keep us focused on addressing the business problem that we are trying to solve, rather than the technical challenges of successful technology implementations."

When at The Children’s Hospital, Mr. Turnbull had hired Insightformation, a consulting and software company based in Minnesota, to help the hospital improve its ability to manage and measure strategy execution on all fronts – starting with Quality and Patient Safety. One of the primary tools that Insightformation has introduced to the hospital was that of developing “Strategy Maps.” The concept of Strategy Maps grew out of the Balanced Scorecard methodology as a powerful and valuable tool for understanding and communicating the details of a strategy, clearly defined in a series of strategic objectives that are linked by cause and effect logic. Each strategic objective includes supporting detail to articulate details of the desired change and the factors that need to be addressed to successfully accomplish that change.

The Balanced Scorecard (BSC) methodology, created by Harvard’s Robert Kaplan and David Norton, is considered the “Gold Standard” for strategic performance management and strategic governance. The BSC gets its name from the initial concept that organizations should not just measure financial performance. Instead, they should examine and measure – or balance – their performance across multiple “perspectives” such as the customer perspective, the internal process perspective and their organizational capabilities (which Kaplan and Norton called “Learning and Growth”). The BSC approach has matured and evolved significantly since it was introduced in the early 1990s. Today, if best practices are followed, the Balanced Scorecard is much more than a system of measurement. It is a powerful framework for strategy execution, alignment and successful change. A good Balanced Scorecard is built on a well-designed set of strategy maps, adding performance measures, targets, and initiatives. Instead of just providing the monitoring of operational measures, it serves as a management system for strategy implementation. In addition to the balanced set of performance measures based on the strategy maps, a Balanced Scorecard system includes the prioritization and tracking of strategic initiatives (projects that are critical to strategy execution).
Insightformation has developed an approach to designing and deploying Strategy Maps and Balanced Scorecards called “Strategy-Aligned Management.” This approach builds Strategy Maps around “Strategic Themes” and engages cross-functional “Theme Teams” that bring multi-disciplinary viewpoints to each Theme Strategy Map. For hospitals, Strategic Themes are the agreed-upon organizational priorities, such as “Improve Clinical Outcomes” or “Enhance Patient Satisfaction” or “Lead Community Public Health Improvements.” Each theme will usually have a clear gap between where things are today and where the hospital aspires to be, and there should be a set of high-level choices that define the strategy for closing that gap.

The Theme Strategy Maps (structured based on the “Perspectives” of the Balanced Scorecard methodology) provide a logical framework that clearly describes about 12 to 18 supporting Objectives that reflect the choices and the causal drivers that must be addressed to successfully execute that strategy. Once the Theme Strategy Maps have been agreed upon, they provide a valuable framework that greatly eases the task of understanding both the “forest” and the “trees.” These strategy maps provide the structure for developing the rest of the Balanced Scorecard system that can be both summarized up (for top-level monitoring) and cascaded down (for executing the details that deliver the top-level benefits).

Shortly after starting at the University of Utah Hospital and Clinics, Mr. Turnbull again brought in Insightformation to introduce the Strategy-Aligned Management approach to his team. This time, the focus would start with the ITS Division improving alignment, strategic performance management and execution. After a half-day kickoff and facilitated discussion, it was agreed that the Strategic Themes should be:
•  Enhance Quality Outcomes
•  Improve Patient Satisfaction
•  Provide Healthy Operating Margins

By defining the themes in terms of UHCs organizational goals, rather than the major IT projects, Mr. Turnbull set the stage for the process to broaden his staff’s viewpoint and think more carefully about the relationships between the projects they were working on and the high-level organizational goals. Bill Barberg, Insightformation’s president, facilitated the process of creating the strategy maps for each theme. “When guiding the process of building strategy maps,” Mr. Barberg explains, “the goal is to pull together the knowledge that is usually fragmented between many parts of the organization and end up with a picture that they all can understand and agree on.” If there is a reasonably-strong consensus on the strategic themes, then the logic of cause and effect helps people working in different areas come to a shared understanding of what it will take to reach that theme’s destination. “I always warn people that it gets ugly before it gets pretty,” Barberg shared--“but the process really works.” The Theme Strategy Maps clarify the most important set of strategic objectives for each theme, and they provide the framework for managing strategy execution rather than isolated projects.

When hospitals use Strategy Maps and Balanced Scorecards to manage Electronic Health Records deployments, the clinical, financial, safety and research benefits that are usually used to justify a large investment remain clearly visible to everyone involved, and the many different changes and drivers that are needed to achieve the benefits can be proactively managed throughout the process. This framework makes it much easier for the various people to productively engage in every aspect of EHR design and deployment, and it supports the on-going performance monitoring of a broader set of success factors than just IT project deadlines. It helps the stakeholders in different parts of the hospital’s organization understand their important role in achieving the benefits. When those roles are not clearly understood and pro-actively managed – as is typically the case – the EHR software may get “deployed” by the IT team, but the other important drivers of may be neglected. For example, a member of the EHR deployment team at a different hospital where the EHR had been largely implemented prior to the introduction of strategy maps commented on how valuable it would have been to understand the strategy and drivers the prior year when the key EHR decisions were being made. The use of strategy maps helps overcome that fragmentation of understanding that contributes to less-than-expected benefits.

Nearly anyone who has been through an EHR deployment will emphasize that the “people changes” are at least as challenging as the technological details. Strategy Maps and Balanced Scorecards can help physicians, nurses and other important stakeholders see how their role combines with the new technologies to accomplish things that they care about. By explicitly connecting the dots between things like the hospital’s core values, clinical care transformation and financial performance, Strategy-Aligned Management tools help these key partners understand and appreciate their roles and the ways they will benefit from the strategic changes enabled by the EHR deployment. That understanding helps motivate higher engagement which then results in greater benefits for all.

Strategy-Aligned Management is enabled by having the right technologies to support the information needs of the process. The strategic management processes, supported by the InsightVision software and the templates built into the software, helps capture the understanding and decisions in a way that makes it much easier for people to retain their understanding of the choices and decisions as the journey progresses. At both The Children’s Hospital and UHC, Mr. Turnbull brought in InsightVision, the strategic management system developed by Insightformation which is also being used at other healthcare systems like St. Mary’s/Duluth Clinic Health System – one of the first healthcare providers inducted into the Balanced Scorecard Hall of Fame. InsightVision software allows objectives to be defined at multiple levels as the strategy is cascaded throughout the organization. There may be top-level objectives in each Strategic Theme that address things like “Improve Clinical Outcomes” or “Enhance Patient Satisfaction.”  Those objectives can be further cascaded to the various departments that will be responsible for more detailed objectives that will play an important role in accomplishing the higher-level objectives. By explicitly mapping out this “cascading” of objectives among the various departments, a powerful information structure is put in place to enhance understanding and to structure projects as well as performance measures in ways that support strategy execution. The InsightVision software, like Google Maps, allows any user to zoom in or zoom out to see the objectives, measures or projects that are most relevant to his or her work, without being overwhelmed by the other details. The interdependencies are mapped out, and the desired changes, obstacles and intentions are easily seen.

The InsightVision software is not just a dashboard. It is a strategic management system built on the best practices of the BSC methodology. It is designed to support the journey – starting out with goals and strategies that need refining and mapping, and gradually adding details, clarity, measurement and data. Unlike most other scorecards or dashboards, InsightVision is not centered on data analysis and reporting capabilities. Instead, it is focused on managing the information that is so critical to complex strategy execution. The software provides different stakeholders – from Boards to executives to front-line project manager and IT staff – with a heightened sense of understanding and accountability. Since both performance measures and project status are communicated on-line on a 24x7 basis, far less time will be wasted in trying to communicate what is going on, and more time can be spent working on how to improve progress going forward.

Since most organizations attempt this multi-year journey to deploy EHR technologies with little assistance from the information management tools and techniques that could assist them, the process itself usually proves to be frustrating and inefficient – often undermining the support of key stakeholders. Mr. Turnbull, for one, is a believer that the right techniques and tools can play an important role in making sure that the potential benefits from Electronic Health Records are realized. He explain, "Strategy management tools (such as InsightVision) help us answer the question of whether we are getting value from our I.T. investments. At the executive level this is a much more important issue than whether or not a project was brought in on time and on budget."

To learn more about How Insightformation can help your hospital deploy Electronic Health Records (or other Healthcare IT) by leveraging strategic management tools, visit www.insightformation.com/ehr.