Avoiding the Iceberg: Technology's Effect on Operations

Cynthia Centerbar, for HealthLeaders News, May 10, 2007

Over the past 20 years, healthcare information technology has improved dramatically (remember when a 14K speed modem was considered fast?). Likewise, healthcare managers have become more sophisticated technologically-speaking. There is no shortage of meticulous IT implementation plans replete with specific objectives, critical success factors and detailed timelines. However, more often than not these plans neglect a crucial element that can determine whether the entire project fails or succeeds: The effect of the technology on operations.

Role call
I was called in once to fix the damage created after a large physician group implemented a billing system designed to help centralize the registration process. The implementation group had developed a comprehensive plan, closely monitored the project's progress, and actively addressed issues as they arose. Everything had gone according to plan.

When the system went live, however, registration errors piled up until there were hundreds needing attention. Furthermore, there was no one with clear responsibility for handling registration errors. This delayed thousands of revenue dollars until the organization clarified whose responsibility it was and developed the needed processes, policies and procedures.

What went wrong? Like many organizations implementing a new computer system, this physician group focused solely on the technology. They failed to plan for the ramifications of the new IT system on business processes, workflow and staff. They had not, for example, changed staff roles and responsibilities or developed procedures to take advantage of the new system's features. Moreover, since operational considerations were not part of the implementation plan, the team never even noticed they were off course until it was too late.

30 minutes to checkout
Another example that comes to mind was when a small specialty practice was trying to improve its patient check-out process by installing a new practice management system. Their detailed plan was extensive, and included newly designed staff roles. Just before going live, this practice's leadership was assured that staff was fully trained on the new system, and expected a seamless transition.

But by the end of the go-live day, patients were waiting more than 30 minutes to check out. The wait times were worse than they had been with the old system. Staff scrambled to make due as neither the old nor the new technology working correctly. Needless to say, this created patient and staff dissatisfaction and delayed the organization's return on investment until the problem was rectified.

In this example, although the plan included staffing changes it did not analyze the effects of the new technology on patient flow. Had they studied this area more closely, the project managers would have discovered that one complex patient--someone who takes longer than average to process--would cause a bottleneck at the checkout desk, which only snowballed over time.

Steering clear
Planning for technology itself is only the tip of the iceberg. To ensure the success of an IT system implementation, you must look beyond system requirements, testing and staff training. Project plans must include the effects of the new system on business process and staff.

To do this, the implementation team should roll out two implementations simultaneously: An operational plan alongside the technological rollout. It has been my experience that getting everyone affected by the technology together up front is crucial. Designate a sub-team to study patient and data flow, analyze what will change as a result of the new system, and come up with an implementation plan that will be ready before the technology goes live.

Here is a checklist of things to consider in order to help your planning group assess the operational impact of new technology implementation:

• Operations-- Who will touch or be affected by the new IT system?
  
• Personnel-- What skills will be needed to perform each step in the new process?
  
• Physical elements-- Where will each step in the new process be performed? Is that physical space appropriate to the task, i.e., will the space accommodate the needed hardware, personnel, office supplies and equipment?
  
• Inputs-- What inputs are required at each step? Does this mechanism for obtaining information change? What is the effect of this change? For example, the transition from a paper ticket charge sheet to an electronic charge sheet may require changes in who inputs information, where the electronic sheet can be accessed, how sign-offs are handled, etc.
  
• Policies & procedures--What policies and procedures are affected by the new process? Are changes needed?
  
• Outputs-- Will output elements change? Will these changes cause additional alterations? For example, if paper charge capture is replaced by electronic charge capture, who will have responsibility for monitoring the charge interface error log? What will the process be for resolving the errors on the log?

Unless healthcare IT implementation project managers take the time to fully understand how the technology weaves into the organization's business process, the technology cannot be optimized. In fact, the outcome may be worse than the current state. It is imperative to assess not only the system's requirements but also the changes in workflow, staffing, and other operations that will be required or affected by the technology. From experience, I can tell you that it is much more cost-efficient to plan up front than it is to fix the damage after "hitting the iceberg."

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Cynthia Centerbar is a healthcare consultant with Hayes Management Consulting, Newton Center, MA. She may be reached at ccenterbar@hayesmanagement.com.