Here’s why.   In project management, success is probably due less to managing a project plan and meeting deadlines and more to understanding who will be affected and how, as a result of project implementation.  The most poorly documented and managed project can be a resounding success if the key stakeholders are engaged and supportive.  I am not suggesting that projects be undertaken with anything other than a fully professional approach, but I am saying that the best project plan may be doomed to failure if a respectful partnership is not established before the project begins.

The process of determining who need to be your partners can be daunting, and if you are a new project manager in a company or industry, it makes sense to make your first partnership with an experienced project manager who is willing to be a mentor and advisor.  If an experienced project manager is not available, try your supervisor.   At a minimum, before scheduling your first project meeting or developing a project task list, ask yourself:

• Who is going to be my primary business partner among the key stakeholders?
• Who else needs to be involved (departments or individuals) in determining project priorities (particularly important in agile development), scope, specifications, timing, testing, communication, training, post-implementation review, and support?
• What vehicles are available to facilitate project meetings and communication (e.g., email, voice or video conferencing, intranet, project management software, gatekeeper calendar, corporate communication packet)?
• Who is not going to like this project and why?  And how do I overcome their objections and address their concerns?

Once you have the answers to these questions, the next step is to meet INDIVIDUALLY with everyone you now know will be involved.  When requesting the meeting, provide a high level overview of the planned project, indicate that you would like expert advice on assembling a project team, and request that other department members be included in the meeting, as appropriate.  In advance of the meeting, be willing and prepared to answer initial questions as many times as they are asked.  These initial questions should be documented, along with answers, to be used as the source for Frequently Asked Questions (FAQ’s) later.

Generally, initial questions focus on:

• Why are we doing this?
• What is the target completion date?
• How much of my time (or my department’s time) will be needed?
• Do we have the option NOT to proceed?

Your objectives for this initial meeting are to:

• Document any initial concerns and address them on the spot or as soon as possible after the meeting.  If any issue remains open, be sure it is part of your issues list or becomes a feature on your release backlog list.
• Determine who will join the project team, either as an active participant or in an advisory role.
• Establish open communications and a feeling of inclusion and respect.
• Share your list of key stakeholders and ask if anyone else should be added.

Always send a follow-up message to all attendees after each meeting, documenting concerns and responses and clearly stating any outstanding issues.  After you have completed these individual meetings, you are ready to schedule a kick-off meeting with your project team.  You also know initial issues that need to be addressed, and you have a list of people who should be copied on meeting notes, given access to the project plan, provide back-up support to the project team, and provide expert advice, as needed.

Let’s look at a real example of this approach.

Overview of the Project

While they are common now, signature pads were once new technology.  Substantial savings were anticipated by the elimination of “hard copies” of charge sales – not only the reduction of paper but also costs associated with the assembly, transportation, and storage of this media.  More importantly, by capturing signatures electronically, it would facilitate the retrieval of transactions and provide proof of authorization when a sale was disputed.   Because of capital spending requirements, it was critical that the equipment be installed on 3,000 registers before the end of the fiscal year.  The project kick-off was planned for mid-June.

Key Stakeholders

The primary business partner would be the Store Technology team, who were responsible for all customer-facing technology.  Other key stakeholders included Store Operations, Human Resources, the Training Department, the Legal Department, and Visual Merchandising.  The representatives from all of these groups had a vested interest in making sure that signature pads were installed with:

• the least interruption on the sales floor
• the knowledgeable support of sales associates and store management
• an understanding of ADA guidelines
• aesthetics that did not detract from the clean and purposeful appearance of the wrap stand

Individual Meetings

A meeting was held with each group, where concerns and issues were discussed.  These included:

• The need to avoid major sales events and complete all installations prior to peak season.  These restrictions collapsed the installation timeframe, resulting in a need to increase the number of installations per week and the number of technical resources needed.
• A desire to have equipment installed and tested after store closing, which would require scheduling lighting over-rides and on-site security.
• Addition of the Store Maintenance Team to the key stakeholders, since it would be necessary to run cabling from the registers to a countertop where the signature pad would be located.  The cabling would need to be covered and secured to avoid being a tripping hazard, and the cable would need to have some “play,” so that the signature pad could be handed to a customer in a wheelchair.
• Training materials that would need to include information about signature privacy and protection, in order to address customer concerns about their signatures being stolen or electronically applied without their permission or participation.

The Result

New issues and concerns, of course, came up during the course of the project, but these were addressed only if they were considered a priority (“show-stoppers”); otherwise, they were added to the issues list for future consideration.   The project plan, schedule, and assignments, along with all issues, were communicated to the project team and extended stakeholder community via email, as well as being posted on the company intranet.

Because individual meetings had been held in advance of the project kick-off meeting, the project team was more engaged in the process and understood not only their roles but felt that they had significant parts to play in the success of the project.

Hal Macomber has written the following 10 rules for project managers. Let’s call it a top-ten countdown that can help you improve your projects. And, remember, projects are wonderful opportunities to learn.

10. Adopt practices for exploring a variety of perspectives.

We think we see what we see, but we don’t. We really see what we think. Remember the blind men and the elephant. Make it your habit to inquire what others see. You’ll see more together.

9. Stay close to your customer.

Clients’ concerns evolve over the life of a project. Take advantage of that to over-deliver. Stay in a conversation with your client to adjust what you are doing.

8. Take care of your project team.

We’ve come to accept that the customer comes first…the customer is always right. We can’t take care of the customer if we first aren’t taking care of our project team. It’s a challenge. While there are some things we can do for the whole team, it comes down to taking care of each team member as the individual that he or she is. And to make it more difficult, we must bring their various interests into coherence.

7. Keep your eye on the overall project promises.

Project work can be difficult. It is easy to loose sight of what we are doing and why we are doing it. Remind your team and yourself of the overall promises and how you are doing fulfilling those promises.

6. Build relationships intentionally.

Project teams come together as strangers. To do great work—innovation, learning, and collaboration—all take people who like and care for each other. Don’t leave that to chance. Start your projects by building relationships among team members.

There is far more that we don’t know and can’t know than what we can anticipate.

5. Tightly couple learning with action.

Projects are wonderful opportunities to learn. Don’t put that off for the after-project lessons learned. Make it your habit to incorporate learning loops in all your project activities. Your team will appreciate it. Your customer will benefit from it. And best of all, it will make your job easier.

4. Coordinate meticulously.

A project is an ever-evolving network of commitment. Keep that network activated by tending to the critical conversations. See that people are making clear requests, promises that have completion dates, and share opinions that advance the purposes of the project. Without attention to those critical conversations the project will drift.

3. Collaborate. Really collaborate.

Make it your rule to plan with those people who will be the performers of the plan. Don’t wait ’til the project has gone south to get their help. Start out that way. Continue collaborating as the usual way you work through the project.

2. Listen generously.

People are able to say what they can in the moment. For the most part, people are well-intended. Give them the benefit of the doubt. Take the time to listen. Ask questions. Seek others’ opinions. And while you’re at it, don’t be so harsh on yourself.

1. Embrace uncertainty.

Expect the unexpected. There is far more that we don’t know and can’t know than what we can anticipate. Be resilient to what life throws at you. Anticipate that your team will learn something along the way that can and should change what you have promised and how you can deliver on your promises. And when you take a set-back—we all do sometime or another—review the other nine rules for how you can work your way out of it.

Hal has an online magazine at http://www.reformingprojectmanagement.com/. His article is being republished here at TechnologyProfessional.Org with permission.

Business Intelligence (BI) applications are becoming more important within the global corporate marketplace by helping businesses with managerial decision making, streamlining operational processes, improving customer relations, enhancing marketing initiatives, and providing timely access to relevant data to boost their competitive advantage. One company taking advantage of BI to boost its bottom line is outdoor sporting goods retailer Cabela’s.

Cabela’s bills itself as the “World’s Foremost Outfitter®” (Cabela’s Investor Relations, 2009), having built its empire more on catalog and internet sales than on numerous retail outlets. Cabela’s has 30 retail stores across the United States and Canada, with its website announcing future store locations in Colorado and New Jersey. Total revenue went from $1.4B in 2003 to $2.3B in 2007. (Cabela’s, 2008)

To increase market share, Cabela’s has used SAS Business Analytics (BA). (SAS, Customers, 2008) This software application tool provides capabilities in data and text mining, data visualization, forecasting, operations research, and marketing optimization. (SAS, Products & Solutions, 2008) SAS BA is fully integrated with data warehousing capabilities provided by Teradata, which allow data to be modeled quicker with greater degrees of flexibility. This holistic software tool is designed to help leaders at Cabela’s make smarter strategic decisions, drive revenue growth, and make quicker, more informed decisions that will enhance its competitive advantage in the marketplace.

Effective and Efficient Marketing

According to Corey Bergstrom, Cabela’s Director of Marketing Research and Analysis, the primary way that Cabela’s uses the SAS BA tool is to hone and improve on its marketing strategies and campaigns. (SAS, 2008) Bergstrom states,“Using SAS, we create predictive models to optimize customer selection for all customer contacts. Cabela’s will use these prediction scores to maximize marketing spend across channels and within each customer’s personal contact strategy. These efforts have allowed Cabela’s to continue its growth in a profitable manner.” (SAS, 2008)

Cabela’s is already seeing a strong return on investment. According to the SAS Customer Success Story, these benefits have included a 60% increase in direct marketing response rates, the ability to choose better retail site locations, a method for identifying its top clients by tracking catalog and internet purchases, an analysis feature that calculates the profitability of individual promotions, and the ability to use previous customer interactions to create and dovetail ideal marketing offers to client preferences. (SAS, 2008)

Cabela’s is working hard to identify and target potential new customers before its competitors do. With the BA tool, Cabela’s can make each marketing piece unique to the desires and habits of its clientele. Customized data can be used to execute targeted mailing campaigns with seasonal coupons based on buying preferences, and on a broader scale, the data can help management choose new retail locations in areas that will likely yield higher revenues. For example, if you don’t have to mail a flyer to every person in every zip code and can tailor mailings to the most likely to buy, why not do it? If you can build your next store in a geographic area with prospects most likely to buy your products, why not do it? If you can help your cashiers take better care of top clients by identifying them at the point of sale, why not do it? If you can send that guy who buys gloves every October since 2003 a customized marketing flyer on new gloves, why not do it?

The BA tool has allowed Cabela’s to spend more time analyzing data versus managing it. Managerial decision making that results in a competitive advantage requires that kind of thorough analysis. Cabela’s has proven that a tool like this can be profitable in terms of additional revenues and increased market share. Bergstrom added, “These efforts have allowed Cabela’s to continue its growth in a prof­itable manner. We’re not talking single-digit growth. Over several years, it’s double-digit growth.” (SAS, 2008)

References

Cabela’s. (2008, February 26). Cabela’s 2007 Annual Report. Retrieved January 22, 2009.

Cabela’s Investor Relations. (2009). Retrieved 22 January, 2009.

SAS. (2008). SAS.com Products and Solutions/Analytics. Retrieved January 22, 2009.

SAS. (2008). SAS® helps Cabela’s reel in more customers. Retrieved January 22, 2009.

Accelerating software development through reuse has long been a goal of IT. Previously, I discussed that development methodologies tend to encourage development rather than reuse. Because Agile is so focused on quickly delivering to the customer, it could be particularly susceptible to subtly discouraging reuse. Code Conjurer is an interesting plug-in for the Eclipse development framework that is designed to complement Agile, test-driven development by automating reuse of fine grained software components. Though Code Conjurer has the potential to be beneficial, it only addresses part of the total opportunity for reuse.

Code Conjurer is explicitly focused on finding small pieces of code to reuse, which means that many big opportunities are outside the scope of Code Conjurer. Rather than waiting for the team to find opportunities for reuse, IT leaders should increase chances for reuse on a large scale. Creating opportunities requires leaders to move further upstream from individual projects; they must influence the environment in which projects are created. In this article, I will introduce a few ideas to indicate the breadth of the topic and the need for senior IT leadership involvement, but I will also recommend some resources for further details.

Pyramid of Reuse

I will use a pyramid to visualize an approach to maximize reuse. The base is architecture and strategy. The next level is management practices and culture designed to encourage reuse. Finally, at the top of the pyramid are tools such as Code Conjurer, which promote reuse.

The first layer in the reuse pyramid is to ensure that enterprise architecture and standards are in place. Having an enterprise architecture that specifies the major systems at the core of the IT infrastructure encourages reuse on multiple levels. Most obviously, it avoids multiple systems solving the same problem.

If the corporation’s architecture is built around SAP Customer Relationship Management (SAP CRM), the SAP engine is reused for many functions, and the corporation avoids buying Oracle CRM. Likewise, standards for development and integration such as coding in Java or requiring MQ Series for integration provide yet another level of guaranteed compatibility. In Reuse-Based Software Engineering, Mili, Mili, Yacoub, and Addy detail the ways that architecture and standards can support reuse. Having an enterprise architecture and enterprise standards is the foundation of the pyramid and maximizes the opportunity for later, fine-grained reuse.

The next layer in the pyramid is to create development processes and an environment that support reuse. From the concept and requirements gathering phase of each project, a person knowledgeable of corporate standards should assist the business in setting requirements. In many cases, requirements are created from the baseline of a product with which the users have experience–often, it is the product they used in a prior job. If requirements in that context are malleable, using the corporate standards as the baseline will maximize later reuse. Guiding requirements gathering without negatively impacting the team’s ability to establish the “true” requirements requires a sophisticated executive and a corporate culture empowering that executive.

Later in the development process, designs should be reviewed by an architectural committee for compliance with enterprise standards and for leveraging existing systems where possible. Of course, the design should also be reviewed to ensure it presents appropriate opportunities for reuse of newly created objects. The project architectural review should be supported by the employee review process. A project that does not fully leverage reuse opportunities should suffer in terms of project score, and the individuals on the project should feel the impact on their annual reviews. Ultimately, compliance metrics should be tracked to ensure the organization continues to move in the right direction. Jeffrey S. Poulin in Measuring Software Reuse gives an introduction to measuring reuse as well as the financial benefit of reuse. Project processes and development processes should reinforce and encourage reuse.

With those layers of the pyramid in place, the final layer is made of the tools that support the enterprise standards and business processes. At this level, Code Conjurer is a significant addition to our reuse pyramid; it searches for reusable components that are guaranteed to satisfy our test requirements, and it minimizes impact on the developer’s work.

As you can see, there are many aspects to reuse: small and large scale as well as reactive and proactive. Software reuse will not happen by accident. In fact, without focused attention, developers will develop and redevelop. IT leaders must create a pyramid of architecture, process, and tools that actively promotes reuse. The value of that pyramid should be communicated with metrics that show both financial and time savings to ensure the topic remains a priority at every level of the organization.

In this article, I will review UML, domain-specific languages (DSLs), and Microsoft’s “Oslo” initiative. I will demonstrate that UML has challenges, but it will continue to be an important tool for software modeling; at the same time, DSLs are likely to increase in importance, especially given Microsoft’s commitment to “Oslo.”

UML

An important goal of UML and the related Model-Driven Architecture (MDA) is to separate the specification of functionality from the implementation, which reduces work involved when the platform changes. UML also has the potential to serve as the thread that ties the development process together from requirements gathering through code generation. These capabilities should result in significantly increased productivity.

Unfortunately, UML is not capable of expressing specialized concepts; and though UML provides a feature called “profiles” to overcome this problem, it is difficult to remove the parts of UML that are not relevant (Fowler, 2008). In fact, there are a number of common criticisms of UML, including it suffers from language bloat; it tries to be all things to all programmers; and it has a dysfunctional interchange format. The interchange format, XML Metadata Interchange (XMI), is used to integrate multiple UML models.

In May 2005, the Visual Studio 2005 Team System Modeling Strategy and FAQ said, “Many people who read our views on model-driven development assume that our emphasis on DSLs somehow has put us into an anti-UML position. We want to make it clear that this is not true. … But for whatever reasons, the existence of UML and UML-based tools has not significantly changed the way developers build applications. Nor has it significantly contributed to developer productivity” (Microsoft, 2005). Furthermore, the document explained that UML is not a good choice for code generation. In short, there were a number of reasons that Microsoft decided against UML as the foundation for their modeling strategy.

DSL

Rather than UML, Microsoft believed that DSLs were the best choice. “A domain-specific language (DSL) is a programming language or specification language dedicated to a particular problem domain, a particular problem representation technique, and/or a particular solution technique” (Domain-Specific Languages, 2009). Such DSLs have been around for decades; for example, one could describe the DOS batch language of the early PCs as being a DSL for file manipulation and SQL as a DSL for database access.

DSLs have important benefits. Because DSLs do not attempt to cover all possibilities, they are both simpler and also more expressive within their respective domain. Being simpler and more expressive, domain experts (business people) can often understand the DSL code without requiring a programmer to interpret. Furthermore, DSLs enhance quality, productivity, reliability, and portability. Finally, DSLs address Microsoft’s key complaint of UML—they can generate code as demonstrated by Yet Another Compiler Compiler (Yacc).

Yacc illustrates several benefits of DSLs. Yacc, a tool to create compilers for new programming languages, takes as input a high-level syntax, or language description, and produces the C code for a compiler for the new language as output. The format for the input is a DSL for computer programming languages. As an undergraduate in computer science at Purdue in 1985, I used Yacc to create a compiler. It was much more efficient to produce a compiler for a new language using Yacc than it would have been to write the compiler from scratch in C. There were fewer opportunities to make mistakes because the syntax was much shorter than the corresponding C code. It is unlikely that an undergraduate student would have been able to complete the project within one semester without such a tool, but with Yacc, nearly everyone in the class finished the project. This is a clear example of the benefits Microsoft claimed.

“Oslo”

Microsoft initially decided to use a DSL approach to modeling rather than using UML. Microsoft uses code names for products before the products are shipped, and “Oslo” is the code name for Microsoft’s model-driven applications. There is no announced release date for “Oslo;” however, there is a “Customer Technology Preview.”

Two key goals of “Oslo” were to produce the increased programmer productivity that was promised by UML and to serve as the thread tying together the development lifecycle. Oslo consists of three components: the M programming language, the Quadrant visual modeling tool, and the repository. M is a DSL which enables programmers to create new DSLs for their particular industry. For example, there could be a DSL for processing auto insurance applications. M is analogous to Yacc in that it is a tool to create new languages. Quadrant allows for the visual creation of new models and specifies access rights for people accessing the models. The repository stores multiple models for a corporation and enables the models to access data from other models. Note that the repository solves the dysfunctional interchange problem of UML.

On May 26, 2009, in an important development, Keith Short, who leads the Enterprise Frameworks and Tools Architecture Team at Microsoft, announced the creation of an M implementation of the UML “metamodel.” The implementation would initially be a subset of UML 2.0; however, it would eventually be a full implementation (Short, 2009). There were two reasons for the change: 1) to respond to customer feedback that the UML standard was important and successfully being used for code generation, and 2) to provide access to UML models that address the needs of developers. This development gives Microsoft the right to claim standards compliance while also providing capabilities beyond UML.

Conclusion

UML is an important standard that addresses the needs of developers in many industries; because of that broad reach, it is heavy and has opportunities to improve. Microsoft’s decision to incorporate UML in “Oslo” is a powerful tribute to the voice of the customer, the strength of UML, and the likelihood that UML will continue to improve and thrive. At the same time, Microsoft has demonstrated that DSLs have an important role to play and can coexist with UML as part of the solution for enterprise development. Perhaps it should not be surprising that the answer is not “either or,” but “both,” so Microsoft should also be well positioned for success.

References

Microsoft, (2005, May). Visual Studio 2005 Team System Modeling Strategy and FAQ. Retrieved June 7, 2009, from Microsoft Website: http://msdn.microsoft.com/en-us/library/ms379623.aspx

Short, K. (2009, May 26). Keith Short’s Blog. Retrieved June 7, 2009, from Keith Short’s Blog Website: http://blogs.msdn.com/keith_short/archive/2009/05/26/oslo-and-uml.aspx

Fowler, M. (2008). UML vs. Domain-Specific Languages. Methods and Tools, Summer 2008, Retrieved June 7, 2009, from http://www.methodsandtools.com/archive/archive.php?id=71

In 1996, the United States Congress addressed this dilemma via the Health Insurance Portability and Accountability Act (HIPAA). HIPAA consists of two parts—Title I and Title II. Title I provides insurance to those who lose or change jobs. Title II, which includes the Administrative Simplification (AS) provisions, monitors the use of patient information for the sake of privacy. Title II also promotes the use of an “electronic data interchange,” or an information sharing system.

HIPPA—Title I

Title I provides several services. First, it seeks to provide insurance to those who have been affected by downsizing or a career change. Second, “it revised the Employee Retirement Income Security Act, the Public Health Service Act, and the Internal Revenue Code.” The Employee Retirement Income Security Act maintains pension plan and federal income tax activity, and the Public Health Service Act provides certain health services to those in need. The Internal Revenue Code is not an act, but rather it governs the payment of US taxes.

HIPPA—Title II

Title II, with the AS provisions, establishes how certain organizations can use your health information as well as how you can access it. Further, it addresses healthcare laws and what can happen to those who abuse the healthcare system. Finally, Title II aims to streamline the healthcare system via the Privacy Rule, the Transactions and Code Sets Rule, the Security Rule, the Unique Identifiers Rule, and the Enforcement Rule.

Privacy Rule

In April 2003, HIPAA established the Privacy Rule. As its name suggests, the Privacy Rule governs the use of public health information, or an establishment’s healthcare data as it pertains to individuals. The Privacy Rule also emphasizes that establishments should disclose as little information as possible for the sake of treatment, payments, and other such care. The rule also advocates accuracy and confidentiality and allows for disclosure during cases of child abuse. Further still, establishments must stay informed and current on the laws that govern public health information. They must employ a Privacy Official as well as an individual trained to receive privacy complaints. Finally, establishments must train all employees in the lawful maintenance of public health information.

EDI Provisions

On July 1, 2005, after quite a bit of conflict, the Transactions and Code Sets Rule was implemented. The first of those transactions is the EDI Health Care Claim Transaction Set. This transaction specifies the use of most healthcare billing information, except in the case of pharmacy claims. Most often, the data moves from payer to provider, from payer to payer, or from payer to relevant organization. The second of these transactions is the EDI Retail Pharmacy Claim Transaction. This transaction regulates the use of data during pharmacy billing and services.

The EDI Health Care Claim Payment/Advice Transaction Set is another rule, which enables one to make a payment and submit an Explanation of Benefits (EOB). The forth installment is the EDI Benefit Enrollment and Maintenance Set. It allows employers, unions, and agencies to register individuals with a paying organization, including health insurance companies and government programs. Financial organizations use the EDI Payroll Deducted and other group Premium Payment for Insurance Products to deliver payments to recipients.

Further still, healthcare members can use EDI Health Care Eligibility/Benefit Inquiry to acquire knowledge about benefits and eligibility. Upon inquiry, the relevant representatives can answer such questions via the EDI Health Care Eligibility/Benefit Response. Also, payers, providers and agents can inquire about the status of a health care claim as noted in the EDI Health Care Claim Status Request. To inform others of such a status, the same individuals should use the EDI Health Care Claim Status Notification. When appropriate, qualified associates can, according to the EDI Health Care Service Review Information, report, review and certify the outcome of health care services. Finally, the EDI Functional Acknowledgement Transaction Set defines the control structures for electronically encoded documents.”

As healthcare evolves, individual privacy will remain a prominent concern. As such, HIPAA appears to change steadily in the wake of such concerns. For example, within Title II of HIPAA, one could interpret the Privacy Rule in a number of ways. Generally speaking, however, the Privacy Rule of Title II refers to any portion of one’s payment and medical records. As information exchange becomes more complex, it is possible that the parameters of HIPAA will similarly progress.

Dealing with HIPAA can be a complex process. As a result, some healthcare workers may be tempted to cut corners. But compliance from the medical community is absolutely mandatory. Institutions that support Medicare and Medicaid must meet HIPAA standards in order to provide service. To further emphasize compliance, the United States Congress enforces the Clinical Laboratory Improvement Amendments (CLIA), which advocates prompt test results for patients. Furthermore, the more complex the medical test, the more facilities must adhere to the amendment. One can even find additional levels of compliance within State Survey Agencies, who regulate the standards for CLIA and Medicaid.

HIPPA’s Effectiveness

Although HIPAA may have been well intended, it does not always prove to be effective. Oscar May, formerly the chairman & chief business development officer at Quality Surgery Centers, LLC in Atlanta, Georgia, is aware of some of the shortcomings of the system. For example, people can report HIPAA violations to the Department of Health and Human Services (HHS). But, as May states, “Initially the department lacked aggressive enforcement action against hospitals, doctors, or insurance companies for reported violations.” May continues, “It has also been pointed out that clinical research has been negatively impacted where patients have become reticent to respond to follow-up studies when queried, for fear that their personal data might be mishandled.” May suggests that facilities should exercise “strict adherence to the Patient Bill of Rights put forth under the Clinton Administration” and that Congress should reevaluate the way it spends money to “manage processes that appear to be less than adequate.”

Conclusion

Today, healthcare is so much more than doctors, patients, and prescriptions. Medical services entail the use of private information, insurance companies, and program providers. The medical community, in its entirety, must work to respect patient privacy while preventing fraud and abuse. The system means well but is laced with imperfection. Regardless, in the face of its flaws, one must think … you have to start somewhere.

References

US Department of Health and Human Services. “Certification & Compliance Overview.” CMS. 1 Jun 2009 .

Wallace, Flynn. “HIPAA.” msstate.edu. 2007. 21 July 2009 .

Weil, Steven. “HIPAA Security Rule.” SecurityFocus.com. 21 July 2009 .

In the first article in this series, Engaging IT: The Story of One Team, I described the impact of employee satisfaction on team performance. In this second article, I would like to share some insight on transforming solid teams into a high-performance organization. In my experience, an IT organization works best when its leaders strategize effectively, coordinate departments, engage team members, and maintain momentum with communication.

Develop a Good Strategy

An effective strategy is crucial to success. Unfortunately, in IT companies, strategy often suffers from poor development, communication, and/or execution. Several years ago, while leading a client server computing team from ad hoc operations to consistently process-based operations, I discovered that the transition required an inordinate amount of time and energy. However, the time and energy paid off, as I was able to create strategic change that produced more reliable and scalable systems as the business we supported more than doubled in volume.

I learned that a strategy should be relatively simple and clear with a few key components. The strategy must be reinforced frequently over time, or the organization risks losing focus and prematurely shifting to a new strategic priority at the expense of the last one implemented. And, finally, the strategy needs to be embedded into the culture and operation processes of an organization.

Maximize Impact by Integrating Processes

Strategy may make each individual team within the organization good, but to make an organization great, those well-strategized teams have to be coordinated with each other and the business. An important step in moving from good to great is to integrate processes and systems from end to end by disregarding team boundaries. Insisting on the inter-departmental view of efficiency and effectiveness provides untapped potential in most organizations, as I found when I launched an initiative called “One Team.”

“One Team” took an organization of 500 members that senior leadership thought was performing well and helped it perform even better by integrating the IT communication and processes within its departments as well as within the business as a whole. IT employee satisfaction went up, our customer satisfaction scores improved, and projects were more effective because of this effort. At the same time, our organization was more efficient because we didn’t waste effort throwing things over the walls between departments or arguing about whose team was to blame.

Engage the Team Members by Giving Them a Meaningful Role

A clear strategy has been communicated and coordinated among teams, and all involved have a clear objective and focus. However, this is not a guarantee that each team member will feel personally engaged. Employee satisfaction, as I discussed in Engaging IT: The Story of One Team, will significantly impact team performance. Employee satisfaction and what influences it can be difficult to quantify; a good approach towards cultivating it can be found, interestingly, by focusing on its desired outcome—engagement.

People will work hard with creativity and enthusiasm if they believe that they are playing a meaningful part in an important effort. If an organization has both the passion for strategic goals and the strategy to achieve them, it has the foundation for the important effort people are searching for. Integrating teams and departments into larger processes gives you the chance to demonstrate to every employee how he or she impacts the corporate objectives, and you give the team the reason and the motivation to engage. In a wonderful example of win-win, by taking care of the two previous factors of high-performance, you secure the third factor of individual engagement.

Maintain Momentum with Communication

Now that the organization strategizes effectively, operates its departments in a coordinated manner, and engages its team members enthusiastically, how do we, as leaders, maintain the momentum? The most important element is communication—up, across, and within. As the IT leader, communicating up and across the organization ensures that the IT strategy is aligned with the business strategy and lets the rest of the organization know what to expect from IT. Communicating within the IT organization ensures the strategy is consistently understood and consistently prioritized.

A clear strategy that is consistently reinforced across departments and within an organization will provide a foundation for a success. Communicating the strategy across teams and departments helps integrate teams into larger processes and ensures that team members are engaged. Maintaining communication will build and maintain a level of credibility and trust that will become embedded in the organization’s culture. This same communication will help eliminate and reduce problems and pave the way for a long-term reputation of maximizing performance in your organization.

Jeff has over 13 years of experience in financial services, business development, and lending, primarily with community banks. Jeff has focused and specialized in training, branch management, and territory development, as an evangelist of innovation in relationship building and problem solving.

Jeff and his wife, Regina, live in Olathe, KS, with their four children. Jeff and his family are actively involved in several community organizations and their local church.

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In this article, I’ll review the breadth of the problem created by too much paperwork. Then, I will demonstrate how information technology, especially CIS, has transformed the industry, made it less paper dependent, and addressed concerns over safety and accuracy.

Patient Information: Anywhere, Anytime

One of the greatest challenges physicians face is obtaining the most complete and accurate patient information at the right time. A person needing medical care might go to the emergency room, a hospital, an outpatient facility or somewhere else if he or she happens to be out of state. A non-digital file can only be at one physical location. Add to that the patient consent forms, legal forms, compliance forms and insurance, and it’s not hard to see how that can present multiple challenges to healthcare providers. The longer the physician doesn’t have the correct information to make a diagnosis, the longer the patient must wait for the appropriate healthcare solution.

Healthcare providers are increasingly turning towards an enterprise-wide CIS that can provide specific medical information whenever and wherever it’s needed. The CIS encapsulate everything from “nursing documentation and physician order entry systems to laboratory and pharmacy systems.” (Rogoski, “Clinical,” 1) This server-based system enables the clinician to access data from home through a Virtual Private Network (VPN) or within any touch point of the health system such as bed-side, off-site, or back office. (Rogoski, “Clinical,” 2)

Effective Care in a More Efficient Workplace

Clinicians don’t just treat patients; they answer telephone calls, check insurance eligibility, order supplies, update patient charts, schedule appointments, reference audit trails for follow up care and hunt down valuable physical file space for patient data storage. The CIS simplifies this task by creating a “single repository” (Rogoski, 2), whereby every component is linked and accessible from virtually any location within the system at any time.

Healthcare facilities that have implemented comprehensive CIS have experienced significant improvements in efficiency, quality of care, cost savings, and security. Regarding enhanced efficiency, Baptist Medical Center South in Jacksonville, Florida, “reduced time from physician order to medication delivery from two hours to 16 minutes.” (All Digital, 2) Somerset Medical Center in Somerset, New Jersey, was able to decrease registration time by 50%, redundant x-ray costs by $104,000 annually, and administrative nursing costs by $1.2M over six months. (HIT, 2)

With more time to treat patients and less time spent tracking down clinical information, even the doctors are happier. Baptist South reports improved employee retention as a result of the CIS-enhanced work environment with “physicians vying to round at the hospital.” (All Digital, 2) By reviewing and accessing patient information at home, they show up fully prepared to see their patients. CIS also improves HIPAA compliance by streamlining the clinician’s time-consuming responsibilities in this process. (Heise) Integration is the key.

It goes without saying that if a doctor has the clinical information faster, he or she can make quicker, more informed decisions. Overall care quality is improved and the risk of medical errors decreases. Margaret Reed, an RN from Altru Health confirms, “It is less likely that patient information will fall through the cracks.” (Rogoski, “Clinical,” 2) One facility dropped chart pull durations, a very time consuming and expensive process, from 20 minutes down to seven. (Rogoski, “Clinical,” 7)

A good CIS also plays a role in forwarding important documents like lab test results, referrals to specialists, and billing instructions, documents that often got misplaced in the past because they changed hands so much. The CIS closes the loop on these issues and others dealing with what’s known as the five rights—right medication, dose, patient, time, and route. (Rogoski, “Banking,” 2)

Enhanced Security and Safety

Enhanced patient data security is an additional advantage of the CIS. Reed’s system at Altru Health prevents physicians from accessing patient data on other physicians’ patients by using a password protection protocol. (Rogoski, “Clinical,” 2) The Baptist South CIS uses a trusted ID and digital time stamping mechanism to track documentation updates and alert security when records have been breached by unauthorized personnel. (All Digital, 2) Other features of the CIS provide safeguards against fraud and identity theft at the facility or pharmacy level.

Protecting the health and safety of patients is in my opinion the most important function of the CIS. Saving time and money is one thing, but protecting human life is pre-eminent. The pharmacy is one place where the advantages of the CIS are highly visible. “More than 7,000 Americans are killed each year through preventable medication errors, most often illegible prescriptions written by physicians.” (Dart) In that same article Newt Gingrich declared, “Paper kills. It is clear that a paper prescription is dangerous.”

To reduce these errors, technology firms have partnered with healthcare entities to form the National ePrescribing Patient Initiative. The initiative has created a website,  www.nationaleRx.com, where physicians can prescribe their medications electronically. The system has features in place that guard against erroneous prescription choices and dosages. (Dart)

Other providers use a CIS with a pharmacy component that has additional patient safety features. Detroit Medical Center, for example, developed a set of “standard orders [they] believe are best practice for a specific disease.” (Rogoski, “Banking,” 2) The company PAR3 offers RFID chips that change the color of the bottle cap when it’s time to take your meds and notifies your doctor if you don’t. (Schwartz) SureScripts’ system is able to suggest alternatives if a drug isn’t covered by insurance and evaluate how multiple drugs will interact with each other. (Schwartz)

Another way to view just how far CIS has impacted healthcare is to visit the high-risk prenatal room of the local hospital. You might find fetal monitors connected to the CIS providing real-time vital signs to the attending OB. Nurses come and go and make notations in a wireless tablet PC, adding detail and continuity to the growing “electronic” patient chart. A paperless audit trail keeps track of who did what and when, and the OB walks across the street for a burger, occasionally checking his own tablet PC for any significant changes, always ready to rush back if necessary. (Rogoski, “Clinical”, 6-7)

Conclusion

The advances in CIS technology have made healthcare delivery safer, more efficient, and more cost effective. Certainly not every hospital or facility has adopted CIS. Those that do will have a distinct competitive advantage in this rapidly changing industry. CIS technology is reliable, secure, and easy to use. It will impact healthcare for many generations to come in ways that stretch the boundaries of our imagination. A nurse at Baptist South said it best … this technology “has encouraged staff to step forward and be part of something new and exciting in the medical world.”

References

1. Rogoski, Richard R. “Clinical Systems Are a “Go” in Real Life.” Health Management Technology. January 2007. http://www.healthmgttech.com/.
2. “All Digital Hospital Transforms Patient Care.” Cerner Corporation Case Studies. http://www.cerner.com/public/Cerner_3.asp?id=27400.
3. “HIT Transforms Community Care.” Cerner Corporation Case Study PDF. http://www.cerner.com/public/search/default.aspx?ip_text=somerset&ip_server=schqryprd.northamerica.cerner.net%3A8500&ip_searchWithin=off.
4. Heise, Rick (September 2006). “Overcoming Financial Barriers to Healthcare Technology.” Cerner Corporation, PowerWorks in the News PDF. http://www.cerner.com/public/Cerner_2.asp?id=26328.
5. Rogoski, Richard R. “Banking on Safety: Detroit Medical Center Fast Tracks Adoption of CPOE, EMR and Other Allied Systems.”Health Management Technology November 2006, Vol 27 Iss 11. ABI/INFORM Global. ProQuest. Evans Library, Melbourne, FL. 29 January 2007 <http://www.proquest.com/>
6. Dart, Bob. “Web site replaces doctors’ scrawl: Online prescription service should cut down on drug errors.” The Atlanta Journal – Constitution. Atlanta, Ga.: Jan 17, 2007.  pg. A.8. ProQuest Newsstand. ProQuest. Evans Library, Melbourne, FL. 29 January 2007 <http://www.proquest.com/>
7. Schwartz, Ephraim. “Healthcare and IT.” InfoWorld. San Mateo: Dec 4, 2006. Vol. 28, Iss. 49;  pg. 10, 1 pgs. ABI/INFORM Global. ProQuest. Evans Library, Melbourne, FL. 29 January 2007 <http://www.proquest.com/>