For many big information technology projects these days, a cross-functional team representing various departments plans and oversees the efforts. This approach is essential to success, says Greg Walton, CIO of El Camino Hospital in Mountain View, Calif.
El Camino in July will reopen recently acquired Los Gatos (Calif.) Community Hospital, extending its information systems to the second facility. Then in October, a new El Camino Hospital will open.
It gets worse. Laboratory, surgical, radiology and pharmacy systems at El Camino are being upgraded or replaced, then extended into the acquired and new hospitals.
So that means there are cross-functional teams within the cross-functional teams that are handling those systems.
With all the issues on El Camino's plate this year, it falls to cross-functional teams of hospital supervisors, managers, directors and senior executives, plus community volunteers and government officials, to make sure all the bases are covered.
For instance, clinical programs at Los Gatos will be the same or quite similar to those at El Camino. That means the policies will be the same, but procedures and workflow processes will differ because of the difference in the physical layouts of the facilities.
And several cross-functional teams need to figure out how to make that work smoothly. "The #1 thing you have to focus on is who's leading what aspect," Walton says. "It's really important to have clear leadership."
That leadership includes project managers leading each team and getting help when needed from vice presidents, with C-level executives coming in if necessary.
Cross-functional teams at other provider organizations have their own share of challenges. Some are working on joint initiatives with other organizations. While larger hospitals typically have several teams involved in an IT initiative, very small hospitals, such as 18-bed Steele Memorial Medical Center in Salmon, Idaho, may only have one team handling all issues. Another small facility, Watertown (Wis.) Regional Medical Center has super-users on its cross-functional teams, each of whom signs an agreement specifying what is expected of them and of the administration.
But all cross-functional teams have one critical mission in common, Walton says. "I have learned above everything else that this is a giant communications and coordination job. If you don't have everybody at the table with an interest in what's going on, ultimately it'll bite you."
And it's a job being made a lot easier these days with collaboration software such as Microsoft Corp.'s Share Point that is used at El Camino, he adds. The software manages business processes, content and the sharing of documents and other information to support a project. "Without these kinds of tools, there's a lot more work involved," Walton says.
Assessing the Landscape
In general, cross-functional teams comprise representatives from various units across an organization that would be affected by any given initiative. They are split into teams that tackle specific issues.
A bedside medication management administration system implementation, for instance, may have separate teams to map out how the system will affect the pharmacy, obstetrics, inpatient, emergency, surgery and IT departments, plus physicians.
Physicians and other clinicians often are under-represented on cross-functional teams unless their supervisors set time aside to let them work on the teams, says Abner King, CIO at Steele Memorial Medical Center in Idaho. "It's very difficult to get physicians because they want to focus on their patients and do their job," he adds.
Team members can work for considerable periods on an initiative, and this work is in addition to their regular duties. To the extent possible, many organizations try to lighten the workloads of physician, nurses and other clinicians on these teams.
But not all IT initiatives have clinical participation in cross-functional teams, says Dale Sanders, vice president and CIO of Northwestern Medical Faculty Foundation, a 600-physician group practice in Chicago. Projects involving clinical applications and how data is managed have significant clinician input. But projects covering hardware, operating systems and networks don't necessarily require clinician involvement, he contends. "If we're going to upgrade data storage, we're going to notify clinicians but don't really expect them to participate," he says.
Who Does What?
Many IT projects have a multi-tiered system of cross-functional teams. Lifespan, a Providence, R.I.-based delivery system, started planning for a new lab system, integrated with the hospital information system and laboratory robotics, for its four hospitals in August 2006. The system went live in June 2008.
One of the four facilities, Newport Hospital, has reached the Stage 6 level of adoption of electronic health records, as measured by Chicago-based HIMSS Analytics, a market research and consulting unit of the Healthcare Information and Management Systems Society.
The executive sponsor group that oversaw Lifespan's four-hospital lab initiative comprised the senior vice presidents of shared services and operations, the vice president of finance, and CIO Carole Cotter.
The labs report to the shared services department, so the director of shared services was the project sponsor.
Cross-functional teams included lab managers, lab builders, lab system managers and IT personnel. Teams had to oversee the building of master files for the new lab system and draw up test plans for various modules of the system. These included blood bank, immunology, toxicology and microbiology, among others. They also worked on integration plans so clinicians could view results in the clinical information system.
Other participants included representatives from pharmacy, nursing, emergency, transplant, critical care, the residency program and infectious disease. Among other duties, they ran integration tests to mimic real-life situations. For instance, Cotter says, the pharmacy needs to consider lab test results when looking for adverse interactions.
The cross-functional teams also included representatives of the lab system vendor, which is a common practice. Sometimes, these vendor representatives can become good advocates for the customer, Cotter says. "They speeded up vendor response to problems," she notes. "Response was not satisfactory at first, but vendor members went back to the company and said, 'We've got to step up.' They were really our advocates back at the home base."
And that's because vendor members of cross-functional teams weren't just hearing about problems; they saw the problems for themselves, she adds.
It's important to interview those the vendor is designating to serve on teams, Cotter says. "We test their knowledge of the product. You would be surprised how often you buy a product and the people who show up are not familiar with their own product."
It's also important to know if these vendor representatives have the ear of their own senior executives, she adds. "If they don't, it shows up quickly in the project team." She recommends asking the vendor project leader how influential the other vendor representatives are.
Working Across Boundaries
Cross-functional teams within a facility or organization handle complex subjects, but the complexities multiply when a project crosses organizational boundaries.
When top leaders of a large group practice, hospital and medical school in Chicago agreed to jointly build a data warehouse, they decided that deans and vice presidents would comprise the group overseeing the initiative.
The data warehouse partners are Northwestern Medical Faculty Foundation, the Feinberg School of Medicine at Northwestern University and Northwestern Memorial Hospital.
"Support for the project was expected and put into our incentive goals," says Sanders, the CIO at Northwestern Medical Faculty.
The physician group does not rely on volunteers to staff its cross-functional teams, he adds. "On this project, we didn't give people the option to participate or not participate. We try to make these decisions from the top down."
Building the three-organization enterprise data warehouse was a complicated task from the moment the idea was conceived. But it was even dicier because each organization, while affiliated, sees itself as autonomous. "The only thing that holds Northwestern together is the brand," Sanders says. "We have separate CIOs, boards and CEOs. So, we're kind of a mini-RHIO."
As a result, building an enterprise warehouse holding data from all three organizations has "really stretched the limit for comfort and precedence," he acknowledges. "There are several layers of cross functional teams."
The warehouse initiative has its own board of trustees-comprising dean or VP-level participants-as its governing body. Each organization has a clinician, administrator and IT representative on the board. Sanders represents ambulatory care on the board; Tim Zoph, CIO at the hospital, represents acute care. The board determines, among other functions, how to allocate the budget in such areas as clinical research, medical quality, compliance and operational efficiency.
Beneath the board level are individual committees, called stewardship groups. These groups determine how their organizations' data will be used in the warehouse. They authorize the use of data and advise on the best ways to use it. "So there's a watchdog side but also a helpful side to their stewardship," Sanders says.
Beneath the stewardship groups are individually assigned IT resource groups. Comprising report writers, application developers, data analysts and others, they execute the project based on guidance from the board, stewardships and researchers.
For example, Northwestern Medical Faculty is implementing a clinical quality program that includes pay-for-performance programs and Medicare's Physician Quality Reporting Initiative. The leader is the group practice's medical director, supported by a data architect, a billing and compliance officer, and a programmer analyst. The clinical quality project includes 150 clinical measures of quality. Clinicians are the "owners" of the measures and will decide how they will be reported.
When Corporate Leads
Some projects are led by cross-functional teams outside a hospital if the hospital is part of a corporate chain of facilities, such as Hospital Corporation of America.
As HCA-owned Lewis Gale Medical Center prepares this spring to open an outpatient diagnostic imaging center, HCA corporate teams have led high level planning of the center and its IT components. That's because Nashville, Tenn.-based HCA is in the midst of an initiative to offer outpatient imaging services in many of its markets. And the corporation's outpatient imaging division owns the project.
But plenty of work remains for hospital personnel, particularly on IT and workflow issues, says Beth Cole, director of information systems at Lewis Gale. The 521-bed hospital in Salem, Va., is a HIMSS Analytics Stage 6 facility.
The hospital's clinical and registration systems had to be interfaced with the imaging center's radiology information system and picture archiving and communication system.
The imaging center will remotely access the hospital's existing PACS, but it will use a separate database that also includes speech recognition software.
Granting appropriate access to IT systems for imaging centers and changing IT help desk workflow procedures when dealing with an off-site facility also had to be tackled. "We did a lot of the detail, but it was nice to have someone else develop the plan and do the due diligence," Cole says.
Still, the project was complex for all involved owing to the multiple cross-functional teams at the division and hospital levels, she adds. Planning started last August. Bi-weekly meetings began in October and were replaced with weekly meetings in December. "You've got so many entities involved in this to make sure it works."
Another twist to the initiative was the use of a division-level marketing professional to help the hospital produce flyers, brochures and prescription pads to educate the community and physicians about the imaging center.
Small Hospital View
Small hospitals also often use cross-functional teams, but their organizational structure is decidedly streamlined. At 18 beds, Steele Memorial Medical Center might be tiny, but it's a Stage 5 hospital under HIMSS Analytics' criteria. The hospital has only one cross-functional team for most projects, and the same employees tend to be on the team over and over. That's a continual challenge for team members because it's a facility where many wear multiple hats and are used to accepting "one more thing" on their plates, King says. The CIO, for instance, also serves as senior laboratory manager.
But there are some advantages to being small. Those on cross-functional teams are familiar faces so they have a comfort level with each other, King says. "You already know their personalities, who is kind of laid back and who is a go-getter," he notes. "So, you don't spend the first three or four meetings feeling everyone out."
Sometimes, however, it still can be difficult to get all the necessary parties to the table for an IT initiative. Steele Memorial, for instance, is struggling to implement computerized physician order entry. The hospital is striving for more physician and pharmacy participation in the project. King and the hospital CEO recently persuaded a physician to join the project team and champion the cause with colleagues.
To help implement CPOE and continue to ensure IT is not a silo isolated from other departments, the hospital has designated informatics professionals in various departments. These individuals, who received a 50 cents per hour raise for taking on the extra duties, spend a couple hours a week doing IT work. They communicate directly to King about their department's issues and needs.
Another small hospital, UW Health Partners Watertown (Wis.) Regional Medical Center, makes extensive use of super-users on its cross-functional teams - and after the new IT systems go live.
The 95-bed facility, which has achieved HIMSS Analytics Stage 6 status, had two teams involved in a bedside medication administration verification system that went live in July 2008. An oversight team comprised senior leaders for pharmacy, obstetrics, emergency, surgery, IT, nurses and physicians.
Below that was a team of super-users that handled vendor selection, building data dictionaries - including formularies and rules for triggering medication alerts, testing and training. If bugs were found, the super-users contacted the vendor to get them fixed. They also communicated with their teams. Now that the system is live, the super-users are responsible for updating the dictionaries and hosting site visits.
Super-users at Watertown Regional sign an agreement specifying their responsibilities to IT and the project. Department directors also sign the agreement, attesting that they support the super-user in fulfilling responsibilities and that they understand that some of the super user's time will be spent working on IT initiatives (see document, page 64).
"The individuals who become super-users are the ones really interested in IT," says Jennifer Laughlin, vice president and CIO. A couple of nurses, for instance, have designed their schedule to work one or two days each pay period in IT.