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HIStalk Advisory Panel: IT Service Management

April 14, 2014 Advisory Panel 1 Comment

The HIStalk Advisory Panel is a group of hospital CIOs, hospital CMIOs, practicing physicians, and a few vendor executives who have volunteered to provide their thoughts on topical industry issues. I’ll seek their input every month or so on an important news developments and also ask the non-vendor members about their recent experience with vendors. E-mail me to suggest an issue for their consideration.

If you work for a hospital or practice, you are welcome to join the panel. I am grateful to the HIStalk Advisory Panel members for their help in making HIStalk better.

This question this time: Does your organization use a formal IT service management program such as ITIL, and if so, what results have you seen?

Responses indicating no: 4.

[from a practicing physician] No , I am not aware of any formal IT management program used by my now very large company, but that is not to say that they do not need one.

We started with one, but we didn’t have the institutional memory to keep it alive. As new people came, it became increasingly difficult. Some good remnants remain, but only if somebody remembers to enforce them.

Yes and no. We’re a small shop, so we use ITIL and other models as a source of best practices and implement what makes sense for us. We don’t want to reinvent the wheel, but a full-scale implementation in a small organization is not cost-effective. The processes, templates, etc., that we have pulled in are extremely useful and allow us to more efficiently manage a large workload with a small team.

Not at this time. We have evaluated the use of ITIL and COBIT, but our plates are too full at this time to put any formal processes in place. Luckily the management team has experience with ITIL, so we apply the concepts to change management and service delivery as much as possible.

We have begun to install ITIL. It has been challenging given we are short on resources and when busy, people tend to fall back into the old way of doing things. We have had success with incident management, which is a good thing.

I was one of the first to enthusiastically jump on the ITIL bandwagon, many years ago, then I saw firsthand how the ITIL process became the goal, not a means to a goal. After two ITIL implementation attempts with two different teams, in which internal client satisfaction with IS declined and my employees became demoralized drones, I threw away any philosophy to implement the details of ITIL and instead focused on the concepts and the end goals. Those end goals are (1) internal customer satisfaction with IS; (2) IS employee satisfaction; and (3) achievement of both #1 and #2 at the lowest possible IS budget.  Since then, I’ve watched ITIL spread to other organizations and watched the same pattern that I experienced. There seems to be an inverse relationship, or at least a tipping point of inflection, between dogmatic adherence to ITIL and IS success and creativity.

At this time we don’t have a formal service structure methodology. We are beginning to look at this due to our organization growing and that all areas now have a major IT component. We most likely would lean towards ITIL.

Yes, we do. If you agree that using ITIL can be helpful and that every part of ITIL may not apply to your operations, it can provide consistency in support that many organizations need. We have found that it is helpful in many aspects of providing end-user services more consistently and more timely with much fewer variations.

We do not use ITIL formally. We will soon be joining a larger system and they have adopted ITIL and we are comparing our current practices to this framework.

We have been trained in the basics of ITIL and have incorporated several concepts and processes. We have not gone full out at this point.

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Currently there is "1 comment" on this Article:

  1. I’ve now helped three hospital organizations improve their operations using service management best practice (mainly ITIL) as a guide. At least part of the mission in all three cases, was to enable the organization to off-load an ineffective IT outsourcing partner that was failing to keep up with the needs of the hospital organizations as they took on major systems projects, e.g. new EMR platforms.

    In all three cases, the success/failure setup was pretty binary: the old provider was failing according to the terms defined by clinicians and the hospital teams I worked with had to make it better…and did simply from a customer satisfaction point of view, and without increasing costs.

    In all three cases we also began with almost zero performance data and virtually no way to tie support effort back to real world clinical outcomes, e.g. “How well are we doing at supporting medication orders?”. Now all three organizations not only have strong and improving performance data, but they can also increasingly tie their IT effort back to clinical outcomes.

    Those are just the basics…what I’d characterize as “Service Management 101” stuff. Now in one of those hospital networks we’re using service management magic to better support clinical workflow optimization prioritizations, capacity planning, strategic/capital planning, project execution, and change control. Most helpfully, we’re helping build clarity about what specific services we support and how those services do or do not make a difference in the “real world” of care delivery.

    Much of what we’re doing now is also specifically geared to help deal with the extremely rapid growth/change brought on by market consolidation. We’re focused on helping a collection of erstwhile independent practices and hospitals function more and more as a single organization…largely by defining and paying close attention to processes. Service management best practice makes sense because these organizations don’t have time to build from scratch in their highly competitive markets. They need things like best practice to leapfrog forward.

    People who read the history of the patient safety movement know that hospitals really made their most rapid progress on that front when they started taking notes from non-healthcare industries that had quality down: manufacturing, air transport, NASA, etc. Folks like Marty Makary and Peter Provnost went outside to Paul O’Neil at Alcoa and even to W.E. Deming himself to get it right and to get things moving in what really was a fully ossified safety/quality culture until that time.

    Nowadays, I think there’s a similar opportunity available for healthcare vis a vis service management, e.g. in realizing that healthcare is in fact a service industry (the second largest in the US) and that there are actually highly successful and longstanding templates for service management which service providers in other industries rely upon. As with the patient safety/quality thing, there are more similarities than differences between healthcare outfits and service providers in other industries. So, best practices are useful.

    As with most other things, there are plenty of bad ways to do service management, some of which have been rightfully called out by other responders in this thread. “Process for process’ sake” is certainly one mode of failure. But, if you really dig into what services are about (outcomes) and keep that as your guide, you’ll be a good few steps ahead and more likely to find the value that’s there.

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