This is the fifth in a series of columns that explore what it takes to design, implement and sustain technology projects that produce results as promised for stakeholders. In the previous column we began a discussion on leadership, using Ken Kizer's work in turning the Veteran's Administration hospital system around as an example of the difference leadership makes.

More on Leadership at the Level of Executive Sponsor

Leaders at the level of executive sponsor consistently exhibit the following characteristics:

  • They hold themselves personally accountable for customer satisfaction.
  • They hold themselves personally accountable for creating career opportunities for the people in their organization.
  • They have a proven track record of sponsoring initiatives that produce measurable results for customers and internal staff.
  • They have a proven track record of managing both formal and informal teams to produce measurable business results.
  • They lead rigorous review meetings to design, plan, implement and review key initiatives and these weekly review meetings are focused upon measurable progress toward measurable objectives.
  • They can and will go get the money, the people and the approval for anything that could substantially improve customer and employee satisfaction.
  • They say "I don't know" on a regular basis.
  • They are often angry and vocal about things that don't work for customers and employees, and they take personal and effective action to fix what is not working.

Dr. Ken Kizer's work with the Veteran's Administration (VA) hospital system is a case study in leadership, and how a leader at the Executive Sponsor level can use technology to engineer a transformation of an organization.

Leadership and Technology: Central to the VA Turnaround

According to an article in the May 11, 2006, edition of Fortune magazine:

" . . . Tech is at the heart of the transformation. A networked software program - dubbed Vista - runs a powerful electronic medical record-keeping system that acts as the VA's brain. Through Vista, doctors submit prescriptions electronically, minimizing errors that stem from illegible handwriting. They are notified when their patient needs a flu shot, a chest X-ray, or other follow-up care. (In a pilot program, many vets also get reminders over home computers.)

"The improved care at the VA hasn't been lost on veterans. This year the agency expects to treat 5.4 million patients, up sharply from the 2.9 million people it treated a decade ago. Customer satisfaction with the veterans' health system, as measured by the University of Michigan, has exceeded that for private health care in each of the past six years.

"'The care is second to none,' says Tom Bock, national commander of the American Legion, the nation's largest veterans' organization . . . "

How did Kizer do it? Where others saw a hopelessly bloated and ineffective government organization, Kizer said, "I thought that it had great potential." One of the areas of greatest potential was in the management of information, because the VA system administered its own patient claims process and was not held hostage to a plethora of health care insurance programs. In addition, over the years the VA information technology staff had built a suite of programs to assist the staff in making headway in the process of standardizing and digitizing patient records and the patient care process. However, in 1989 only 169 of the hospitals in the system had the Vista system with two dozen applications running.

To make the Vista system really work, it needed to be enhanced and expanded; to do this Kizer needed funding. He negotiated a special arrangement with the Federal Office of Management and Budget that returned any proven cost savings back to the VA. He then worked with pharmaceutical companies and other medical industry suppliers to lower the costs of goods and services sold to the VA - to the tune of hundreds of millions of dollars annually. A significant portion of these savings went into new Vista software applications, new computers at every VA installation, and a network infrastructure that was fast, reliable and had the bandwidth to support the upgraded infrastructure.

By 1999 Vista was up and running throughout the VA system. All patient records are now held within a nationwide digital system and available over secure Internet connections to VA staff members throughout the country. This in a $1.9 trillion industry (accounting for 15 percent of the U.S. gross domestic product) where 90 percent of the 30 billion health care transactions completed every year are done by paper mail, telephone or fax machine. This breakthrough in technology to take care of patients has been done within a system that has kept the annual cost per patient at around $5,000 over the past decade, while the average American spends $6,300 each year.

The devastation wrought by Hurricane Katrina demonstrated the possibility of digital health care record keeping: VA patients records were intact and available throughout the United States, helping to maintain service for people as they struggled to live in the path of the hurricane or moved to other parts of the country.

In addition to the Vista system, Kizer encouraged individuals to come up with solutions to technology problems and took the point of view and did not pretend to have all of the answers. In 1988, during a regular review meeting Kizer was told about an initiative at a VA facility in Kansas that was reducing medication errors through the use of bar code scanners to reconcile and verify that patients were receiving the proper medications as prescribed. A nurse at the Kansas facility had observed a bar code scanner in use at her rental car agency when she returned her vehicle and wondered if such a system would work for the VA. Ken Kizer went to Topeka, and what he saw there convinced him to explore the possibility of expanding such a system for nationwide use. In less than three years an enhanced system modeled on the one in Kansas was in use throughout the VA hospital system.

The turnaround at the VA is proof that the right people and the right technology can make a difference in any organization, public or private, large or small.

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