Organizational Structures for Clinical Transformation

Transcription

1 OrganizationalStructures forclinicaltransformation By:MaryStaley Sirois,PT,MBA&ColinKonschak,MBA,FHIMSS,FACHE The healthcare industry is in the process of transforming itself using technology. These transformationeffortsfocusonmovingfrommanualprocesses,oftenbasedonhistoricalpractices, to technology enabled or even automated processes. The overall effort involved in such a transformation creates a tremendous amount of disruption to all aspects of the organization, creatingtheabsoluteneedforacommitmenttomanagingchange. This paper explores, through case studies, the clinical and cultural considerations in implementing andmanagingworkflowchangesatthreelargehealthcaresystems. 1 Introduction Thescopeofclinicalandculturaltransformationinhealthcaretodayisprofoundandall inclusive.it requirescollaborationbetweenallclinicalandtechnicalareasofahealthcareorganization, necessitatingnewgovernanceandorganizationalstructures. Thetransformationismulti dimensional,takingonmedical,clinicalandculturalimplications.onthe medicalandclinicalsides,effortsfocusondeterminingandimplementingbest practice,evidencebasedprocessesthatsupporttheadoptionofclinicaltechnologies.ontheculturalside,theclinical transformationeffortsrequirehealthcareorganizationstoworkcollaboratively,bringingtogether groupsofphysicians,nurses,pharmacists,ancillarycareproviders,andinformationsystempersonnel tochallengethewaythingsaredonetoday.theresultsofsuchcollaborationarenewcareprocesses andpractices,aswellasdatastandardsandintegritythatbettersupportapatient centricapproachto care.thesedevelopmentswillensurepatientsafety,qualityofcare,workflowefficiencies,care timelinessandeffectiveness,andoverallcaregiverproductivity. Theoveralleffortcreatesatremendousamountofdisruptiontoallaspectsoftheorganization, creatingtheabsoluteneedforacommitmenttomanagingchangeateverypointalongtheway. Becausethescopeofthisclinicalandculturaltransformationissoprofoundandall inclusive, organizationsmustcreatenewgovernanceandorganizationalstructuresthatensurecollaboration acrossclinicalandtechnicalareas.tosucceed,organizationalchangestructures,committeesand teamsshouldensure: Leadershipalignmentattheseniorexecutivelevel,includingboard levelsupport Participationofmulti disciplinaryend userworkteams Sponsorshipbyclinical,operationalandphysicianleaders

2 2 FacilitationfromITpersonnel Recurringtheme Thecasestudiesthatfollowexplorethreelargehealthcare systemsthataretransformingclinicalcarethroughthe implementationofworkflowchangessupportedbytechnologies. Therecurringthemeinalloftheorganizationalstructuresisthe presenceofphysicianandnursingchampionshipalongwith carefulalignmentoftheorganization soperationalentities. Essentially,thoughthegoalappearstobetheimplementationofa technology,theorganizationsdefinegoalsthatalignwiththe utilizationofthetechnology.thus,theirendgoalsarethe adoptionofthetechnologyintheprovisionofhighqualitypatient care. Essentially,thoughthegoal foreachorganization appearstobethe implementationofa technology,the organizationsfocustheir goalsonstepsthataffect useofthetechnology. Thus,theirendgoalsare actuallytheadoptionofthe technology. Finally,inadditiontoaddressingorganizationalclinicaltransformationmodels,effortsweremadeto provideexamplesofclinicaltransformationdepartmentreportingwithintheoverallorganizational leadershipstructure.today,trendsrevealreportingoftransformationdepartmentsthroughthechief InformationOfficer(CIO);however,commentsfrommanagementindicatespecificchallengeswiththis structure,namely,alackofclinical/medicalprocesschangeimpactingleadership,understandingand appreciation. Alignmentmustprovideclearandhighlysupportedlinesofcommunicationbetweentransformational leadersandclinical/medicalstaffoperationalleadersatalllevelsoftheorganization.sowhile healthcareorganizationscontinuetolookfororganizationalalignmentbestpracticeforpositiveclinical transformation,theleadershipofclinicaltransformationalignedwiththeciocouldputthetechnology implementationgoalsatrisk.itisimperativethatclinicalinformationsystemimplementationsare championedbyseniormedicalandclinicalleadersworkingincompletealignmentwiththecio. CaseStudyOne:ReorganizationAroundaNewClinicalApplication HealthcareOrganizationOne(HO1)isa12 hospitalhealthsystemthatisimplementingaclinical centerpieceapplicationthatwilladdressscheduling,access,emergencydepartment(ed),orderentry, andclinicaldocumentation.ho1begantheirclinicaltransformationeffortsbycreatingadepartment ofclinicaltransformation(ct).thectdepartmentreportedtothechiefoperatingofficer(coo),who inturnpartnerswiththeinformationsystemsdepartment(is).atthestartoftheirclinical transformationjourney,ho1hadnoseniormedicalornursingofficer;andthelackofalignmentofthe CTdepartmentandIScreatedsignificantissues.

3 3 Eventually,aChiefMedicalOfficer(CMO)andChiefNursingOfficer(CNO)joinedwiththeChief MedicalInformationOfficer(CMIO)toreorganizetheCTdepartment.Thegoalsincluded: TobetteralignwiththeworkofIS;and, Becomeabridgebetweentechnologyandclinicaloperations. Undertheneworganization,theCTteamreportstotheVicePresidentofApplications(VPA)through thedirectorofcaremodelintegration(cmi)(seechartbelow).thecmiroleincludesadottedline reportingrelationshiptothecmio.inaddition,thetechnologyimplementationprojectmanager reportstothevpa,creatingacohesiveandcollaborativeteamunderasingleseniorleader. HO1 soperationalleadershipstructure,reportingtothecio TwodistinctgovernancestructuresnowfunctionunderthedirectionoftheCIO ISandclinical informatics. ISgovernanceforthe organizationis overseenbyanis GovernanceCouncil (ISGC).Chairedbythe COO,membershipon theisgcincludesthe C levelleadersatthe systemlevelaswellas

4 4 thecioandhisseniorleadershipteam. TheExecutiveCommittee(EC)overseesclinicalinformaticsgovernancefortheorganization.This includesthedataandworkflowthatwillbeimpactedduringimplementationoftheelectronichealth record(ehr).thecmochairsthiscommitteeofseniorclinicalleaders,includingphysicians,nursing, quality,patientsafetyandis.inputtodiscipline specificdataandworkflowcomesthroughthe system level,interdisciplinaryand/ordepartmentalclinicalcouncils,witheachcouncilco chairedbya physicianandanoperationalleader. Hospital levelgovernanceforis(aswellasclinicaldataandprocessstandardizationthatisaresultof theehr)occursthroughfacilityimplementationteams(fit).thefitisco sponsoredby:asenior hospitalexecutive,aphysicianleaderandrepresentativesfromvarioushospitaldepartmentsandthe medicalstaff. CaseStudyTwo:Enterprise buildlocalizedat22hospitals HealthcareOrganizationTwo(HO2)isa22 hospitalhealthcaresystemimplementingaclinical centerpieceapplicationthatwilladdressscheduling,access,ed,orderentry,medicationmanagement, andclinicaldocumentation. Inaddition,theyareimplementingasystemstandardRIS.LikeHO1,theyarecreatinganenterprise buildwithlocalizationattheaffiliateorhospitallevel.theoverallprojecttimelineissixyears. HO2CommitteeStructureforEHRProject

5 5 TheCEOchairsthesystem levelehrandprocesstransformationsteeringcommittee,with membershipincludingthec suiteleaders.reportingtothiscommitteeistheehrintegrated LeadershipCommittee,whichismadeupofoperationalleadershipfromthefouraffiliatesthatare targetedforgo livefirst.reportingtothiscommitteearetwolinesofwork thetechnicalbuildand operationalstandardization. Thetechnicalbuildisconsideredtheorganization sarchitecturalmodel.duringbuildsessions, operational/clinicalfrontlineleadersandstaffaddresstechnicalconsiderationssuchasnavigation tools,headersandtheoverallapplicationlookandfeel. AnIntegratedRevenueCycleCommitteeandtheIntegratedClinicalCommitteeoverseeoperational andclinicalstandardization,includingdatacontentanddefinition,documentationflowsheetsand workflow. Thesearechairedbykeyoperationalleadersandalthoughintegrated,arefocusedonspecific functionalareas. SimilartoHO1,HO2hasaCTdepartmentreportingthroughtheCIO.Itisthroughtheprojectstructure abovethattransformationalprojectactivitiesoccur. CaseStudyThree:TwoClinicalInformationSystems,OneImplementationTeam HealthcareOrganizationThree(HO3)isa43 siteorganizationfocusedonimplementingtwomajor clinicalinformationsystemvendors.whiletheyareusingdifferentvendors,chosenbasedoncurrent businessneedsandpractices,asingleprojectteamleadsthetransformation.inspiteofthedifferent clinicalapplications,theorganizationiscommittedtoassimilaraspossiblecareprocesses,practices anddatastructures. HO3 shigh levelorganizationalstructure

6 6 TheprojectreportsthroughtheCIOviaaVicePresidentofClinicalImprovement,whoisresponsible forthetransformationaswellastheapplicationimplementationareas.theseteamsworkwith hospital basedprocessandapplicationdesignteams. TheTransformationLeadisresponsibleforoverallprojectgovernance,changemanagement,process redesignandstandardizationanduserreadiness.theseeffortsareparamounttothesuccessofan EHRimplementation.ItissignificanttonotethattheTransformationLeadthatinitiallyreported throughthecmowasrepositionedwiththearrivalofanewcio. Becauseoftheimportancefortransformationdepartmentstobetightlyconnectedtoclinicaland medicalstaffgovernance,ho3establishedadottedlinerelationshipbetweenthevpofclinical ImprovementandtheCMO.Thisthenpresentsitselfthroughalignmentwiththeclinicalinformatics structurethatexistsateachofthesystem shospitals. HO3OrganizationalStructure AtHO3,thehospitalimplementationsteeringcommitteeconsistsoftheclinicalinformaticistalong withanexecutivebusinesssponsorandaclinical/medicalstaffleader. IndustryDiscussionwithHIMSSAnalytics AttherequestofDIVURGENT,theleadershipofHIMSSAnalytics, knowntrendsinhowthectdepartmentandclinicalapplicationsisstructuredwithinhospitalsand healthcaresystemstoday.dependingontheorganization,thectdepartmentreportstois,nursing leadership,medicalstaffleadership,andhighleveloperationalleadershipsuchasthecoo.himss Analyticsexpertsagreedthatnospecifictrendsnowexistconcerningthisreportingstructure. Theydidnote,however,thatnomatterwhatthereportingstructure,bestpracticewouldsupportclear alignmentofstrategy,goalsandworkactivitiesbetweenthectdepartmentandtheclinicaland

7 medicalstaffleadership(cnoandcmo).infurtherdiscussingthefutureofthectdepartment,they indicatedthatitcouldevolveintoonedepartmentwithoverallresponsibilityforaformalinformatics strategy. Thisgroupaswellasleadersofthethreehealthcareorganizationsfeaturedhereforcasestudies, expressedsomefrustrationoverallwithhospitalleadershipteams.theyexpressedthathospital leadership,includingthecio,didnotfullyappreciatetheneedtoconsidertransformationalprocess andpracticeactivitieswellinadvanceofthetechnologyimplementation. Finally,weassumethatthegoalofatechnologyimplementationisnottheimplementationitself,but theadoptionofthetechnologyintoclinicalandmedicalstaffpracticeandworkflowprocesses. Therefore,thehealthsystemsdiscussedheremaintainedsignificantfocusontheimportanceofawelldefinedandwell supportedchangemanagementstrategyandplan.thisissomethingforwhichact departmentisuniquelyqualified. Conclusions Whilehealthcareorganizationscontinuetolookfororganizationalalignmentbestpracticeforpositive clinicaltransformationoutcomes,themovetoplacementunderthecioputstheappreciationfor,and supportof,theimpactonclinical/medicalprocessesandpracticeatrisk.alignment,ifreportingtothe CIO,mustprovideclearandhighlysupportedlinesofcommunicationbetweentransformational leadersandclinical/medicalstaffoperationalleadersatalllevelsoftheorganizationinordertobe successful. AboutTheAuthors: MaryLawrenceStaley Sirois,PT,MBAisPresidentofResurgenceConsulting.Ms.Siroishasnearly20 yearsofhealthcareoperationalandstrategicplanningexperienceacrossawidespectrumofprovider andacademicenvironments.asaphysicaltherapistbyclinicalbackground,shehasworkedwithlarge andsmallhealthcaresystemsontheplanningnecessaryforclinicaltransformationasaresultofan EHRdeployment,organizationgovernanceandchangemanagement,medicalandclinicalstaff collaborationonbestpracticeandevidence basedprocesses,regulatorycompliancereadinessand issueresolution,organizationalbudgetdevelopmentandrelatedbenefitsrealizationprojection,and detailedprojectplanning. Ms.Sirois workisfocusedonleveragingtheskillsandteamofthehealthcareorganizationinthe deploymentofstrategicinitiatives fromproductdevelopment,tooperationalmanagement,to transformationofclinicalprocessandpractice,toehradoption.ms.siroisiswell publishedonhipaa complianceandisapublicspeakerinhealthcareoperationsandregulatorycompliance.inadditionto herworkinthehealthcareprovidermarket,ms.siroisworkscloselywithinternationalorganizations forthedevelopmentofoperationalandeducationalprogramstoimprovehealthcareindeveloping countries. 7

8 ColinB.Konschak,MBA,FHIMSS,FACHEisaManagingPartnerwithDIVURGENTandleadsthe AdvisoryServicesPractice.Heisahighlyaccomplishedexecutivewithover17yearsofexperienceand recognizedachievementinqualityservicedeliveryandprojectmanagement.mr.konschakhas extensiveexperienceinhealthcareoperations,p&lmanagement,accountmanagement,strategic planningandalliancemanagement.hisbroadhealthcareexperienceencompassespharmaceutical, provider,payer,informationtechnologyandconsulting. Mr.KonschakisaregisteredPharmacist,possessesanMBAinhealthservicesadministration,isboard certifiedinhealthcaremanagement,andisasixsigmablackbelt.heisanadjunctprofessorwithold DominionUniversityleadingclassesintheirMBAprogramonPerformanceImprovement,Negotiation andbusinessethics.mr.konschak scommitmenttothehealthcareindustryisevidentinhis participationinsomeoftoday sleadinghealthcaretradeorganizationsincludingservingasthe immediatepastpresidentofthevirginiahimsschapter,andachievingandmaintainingfellowstatus inboththehealthcareinformationmanagementandsystemssociety(himss)andtheamerican CollegeofHealthcareExecutives(ACHE). AboutDIVURGENT: Foundedbyateamofconsultingveterans,DIVURGENTisanationalhealthcareconsultingfirmfocused solelyonthebusinessofhospitalsandotherhealthcareproviders.divurgentprovidesadvisory, interimmanagement,revenuecyclemanagement,projectmanagement,andmodelingandsimulation servicestohelpimprovepatients lives. Wearecommittedto: ProvidingThoughtLeadership ProvidingExceptionalValueforourServices FacilitatingKnowledgeTransfer EnsuringClientSatisfaction GreenvilleAvenue Suite144 Dallas,TX GreatNeckRoad Suite1272 VirginiaBeach,VA23454 (877) [email protected]