Texas Scottish Rite Hospital for Children

I have the privilege of serving as a part of an outstanding organization and team at Texas Scottish Rite Hospital for Children in Dallas, Texas. Scottish Rite Hospital is one of the nation’s leading pediatric centers for the treatment of orthopedic conditions, sports injuries and fractures as well as certain related arthritic and neurological disorders and learning disorders such as dyslexia.

Over the last five years, Scottish Rite Hospital has implemented several complex programs which brought substantial operational change. Our latest accomplishment is the successful implementation of Epic’s Electronic Health Record system. While addressing this milestone helps us tackle some of the operational changes impacting our industry, of vital importance is preserving our unique culture and ability to deliver exceptional care and service to patients, families and the communities we serve.

Mitigate Risk by Taking Time to Effectively Plan

There’s a time-honored saying that goes something like this: “If you don’t know where you are going, any road will take you there.” As an area of increasingly significant investment and associated risk, this is especially important in programs which require substantial financial and operational commitment in information technology and resources.

"Communicating early and often, offers an opportunity to initially address risk management and culture impact by eliciting the concerns of board members"

A recommendation for those who don’t have a formal IT planning methodology or tools, is to consider engaging a third-party consultant. This provides a planning model and associated toolset reflecting the organizations culture and approach to planning. Executives can benefit from this support, as they will assume ongoing responsibility for execution and support throughout the IT planning cycle. Taking time to effectively plan significantly increases the likelihood that value delivered will equal value expected.

Clearly Define and Communicate the Value Expected from the IT Investments You Make

Unfortunately, some programs are launched without the organization clearly defining and communicating desired value. If implementation is rushed and values are not effectively outlined, while the completed program may technically work, the processes, tools and services may not be developed or managed in such a way that expected value is met.

Value can be defined in a variety of ways, such as supporting organizational expansion goals; strengthening community relationships and engagement with the organization; reducing operating costs; avoiding additional operating or capital investment; or addressing compliance, quality and patient safety goals.

Providing the desired value-added specifics at the initial phase of a program, helps an organization better plan and evaluate alternatives, and increases the likelihood of intended value being delivered at the project’s completion (Benefits Realization phase). A suggestion would be to set the “value expectation” for the organization as a whole, and enforce that guiding principle consistently.

Formalize Governance

The goal of governance is to create a clear, easy to understand framework for making decisions, setting priorities and managing investments.

As many may know, a project or program typically gets off track by inches not feet. A combination of several seemingly small, insignificant things, when combined together have the power to derail programs. A formal, proactive project health assessment allows you to intervene when necessary. When properly managed governance model, adapted to reflect the culture and approach to planning noted above, offers the organization the ability to better understand the health of a program and to intervene quickly and effectively as issues arise.

Acknowledge and Promote Change at the Front-end of the Program

Acknowledging and promoting change during the investment planning and evaluation cycle gives an organization more confidence in communicating what change(s) may occur throughout the progam. The key messages are able to be refined as the program moves through different phases of the execution.

Starting early enables the organization to frame the purpose and benefits of change for patients, families and communities we serve sooner, rather than later. Additionally, communicating early and often offers an opportunity to initially address culture impact by eliciting the concerns of board members, providers and staff.

Collectively sharing and participating in a formal change process will help everyone navigate difficult situations effectively. Finally, as a practical matter, we all know, organizations “digest” change at different rates. An early understanding of how entities in an organization (particularly multi-hospital or multi-entity) will be impacted, offers an opportunity to proactively prepare them for the magnitude and pace of change.

Building the Program Team

1) Operations Impact to patient care and operations. How will clinical and ancillary resources needed to fill out the team be provided without adversely affecting patient care staffing?

2) Risk Acknowledging the organizations culture and level of comfort with varying degrees of operational and financial risk.

3) Skills and Experience Understanding the depth and breadth of internal staff skills and experience.

4) Budgeting Constraints on capital and operating budgets and the organization’s overall staffing model/plans.

5) Other Current Initiatives What other priorities has the organization identified and which will be concurrently pursued? What is the resulting impact on staff availability?

Decision making framework for building the team:

1) Use internal staff as much as possible and always in key leadership roles. This approach ensures responsibility for program success remains with the organization and team. It also makes sure the team is prepared to take charge of ongoing support requirements, and remain otherwise self-sufficient. Finally, this model supports the organization’s employee retention strategy, providing a tangible example of interest and willingness to invest in and grow staff.

2) Experience matters Place experienced internal resources in key areas of the program. If they are not available internally or externally, consider engaging external resources to work alongside less experienced internal staff. Be sure to include knowledge transfer to internal employees and always check references of prior clients. Cultural fit is a very important factor to team success.

3) Everyone on the team has an equally important role to play in contributing to program success. Acknowledge individual contribution personally and often.

From my leadership experiences at organizations differing in terms of governance, culture, size, complexity, etc., the suggestions and recommendations noted above have proven to be effective guidelines in planning for, and executing, new programs and initiatives (IT and otherwise) of varying size, complexity and risk.

Whether you are a seasoned executive, someone new to leadership or a staff member aspiring to serve in a leadership role, it is my hope that these guidelines and suggestions prove helpful to you in planning for and operating your organization.