leanhealthcare_ITcatchballThis is the final blog of a four part series on Lean Led Information Technology.  We have seen some very scary statistics from the Bureau of Labor Statistics and the Office of the National Coordinator for Health Information Technology regarding the staffing requirements necessary to implement and support the requirements of the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act.  The requirements in both studies are scary because in a period of declining reimbursements and systemic over-burden they are, in a word, unsustainable.  In Part One, I proposed a three tiered approach to meeting this challenge:

  1. Leverage Lean tools and techniques to drive waste from key support processes. (Part Two)
  2. Use Lean principles and tools to drive defect-free implementation of new products and services. (Part Three)
  3. Provide the appropriate governance structure to drive strategic alignment and improve management of the IT investment portfolio. (Discussed below)

One of the challenges facing most healthcare IT departments, Lean or otherwise, is that demand exceeds capacity.   This is exactly why excelling in the above items is critical.  However, even organizations that have mastered items one and two can be seriously compromised in their effectiveness due to lack of governance.  Without effective governance, IT investment and project management lose their linkage to the top-level organizational strategy.  This significantly exacerbates a setting of multiple and often conflicting priorities — making it difficult for the IT function to “get it right” when it comes to the order of the lineup.  Worst case, this degrades into an advocacy model with everyone screaming for inclusion of their pet rock.  Those who scream the loudest, win.

Before going into structure, let’s explore function.  The function of the governance structure is to prioritize and fund IT investments in alignment with the organization’s strategic imperatives, including internal and external resource allocation.  This includes understanding the voice of the customer, defining and managing project approval, and defining accountability and measurement of success.  Using the Lean Healthcare approach to strategy deployment (Hoshin Kanri) can be very beneficial in providing a conceptual framework that may not end the screaming but will provide objective evaluation criteria.

This process is illustrated in the graphic.  Within it, the organization’s strategic imperatives are cascaded into IT driver goals.  These are in turn cascaded into IT tactics, and ultimately specific programs and projects through a catch-ball process.  Interlocking accountability and measurement are assigned as well with a corresponding cascade of leading and lagging indicators.  Notice in the heavy arrows within the figure that this catch-ball process is not accomplished through a single team but through a top-level IT steering committee supported by a number of sub-committees.  This allows connection and interaction with all key customer groups.

An example governance structure is presented below for illustration purposes.  Bear in mind that this is not a static structure.  It will change as the organization evolves.  Leveraging this structure and using the catch-ball process illustrated above can take some of the pain out of identifying the correct IT initiatives to support the enterprise.  While it may not end the screaming, it will provide objective evaluation criteria.


Brad Schultz, Vice President for Lean Healthcare and Process Improvement Consulting at HPPToday’s blog was written by Brad Schultz, vice president with HPP. Brad serves as a Lean Healthcare facilitator, business consultant, and executive coach internationally with HPP. Brad has served as one of the leaders in front-line adaptation of the Toyota Production System to healthcare, in particular around the ability of healthcare organizations to sustain and expand successes gained through rapid improvement.

Brad began his career in manufacturing with GE Healthcare and joined GE’s Performance Solutions during its infancy and remained with the business unit for seven years. He provided significant leadership to adapt the firm’s products to the unique needs of healthcare clients and to translate the firm’s published materials into the language of healthcare.

Brad’s educational background includes a B.S. in Business Administration from Cardinal Stritch University in Milwaukee, Post Graduate Certification in Quality Engineering from Milwaukee School of Engineering, a M.A. in Business Administration from Marquette University in Milwaukee, Six Sigma Master Black Belt Certification from General Electric, and Front-Line Leadership Development Certification from Achieve Global.

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