using a kanban approach to manage workload in it 4/13/13 · concord hospital 3,000+ employees 295...
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Using a Kanban Approach to Manage Workload in IT
4/13/13
Josie Bendiks
Dan Venecek
Understand how a Kanban process can be applied to manage service requests and projects
Describe the challenges encountered when implementing a Kanban process
Understand the benefits that can be realized by implementing a Kanban process
Learning Objectives
At the end of the session, the attendee will be able to:
CONCORD HOSPITAL
3,000+ employees
295 licensed beds
60,000 ED visits
17,500 admissions
143,000 primary care provider visits
Concord Hospital Medical Group: ~225 providers
30+ locations
Environment
Centricity EMR 9.5 SP3 on Unix
IBM P550 live and standby servers
Citrix XenApp 6.0
1400+ users per weekday
90+ XenApp servers in farm
25 XenServer servers in farm
4 PVS servers in farm
60 Published applications / Desktops
EMR licensed for 435 concurrent users
Environment
Most practices have 1GB fiber connections
13 Primary Care & 20 Specialty office
locations throughout South-Central NH
158,664 patient electronic records
Accessed “in-hospital” with focus as med
reconcilliation & communication tool
122 providers qualified for Stage 1 MU
Physician Information Services Team
EMR IMPLEMENTATIONS
APPLICATION SUPPORT
PROJECT MANAGEMENT
FORM DEVELOPMENT
CRYSTAL REPORTING
WORKFLOW DEVELOPMENT
INTERFACES
Working as a Team (connected)
Team Work
Shared Goal
Defined Process
DB Merge
MU Stage 1
Centricity Rollouts
Keep MU1 going
Prepare for MU2
ACO
Patient Portal
Increasing number of employed providers
HIEs
ACA
New World
Working in Silos (disconnected)
•Projects previously “On Hold”
•Numerous smaller and divergent projects
•Challenge keeping team members aligned Projects
•Reports backlog
•Form Development
•Other Requests
•500 calls/month
•Often need input of other team members HelpDesk
Ongoing Commitments
# hrs/ week times /yr Total Hours
HelpDesk Coverage (2 Staff) 2 40 52 4160 4160
Form Development
Joanne 1 15 50 750
Cathy 1 8 50 400
Sarah 1 5 50 250
1400 1400
Report Writing
Joanne 1 10 50 500
Cathy 1 8 50 400
Pam 1 5 50 250
1150 1150
Interface Support
Joanne 1 1 50 50
Sarah 1 4 50 200
Pam 1 1 50 50
300 300
Meetings Meetings # hrs/ week times /yr Total Hours
ARUP conversion 1 1 13 13
Centricity OB Collaboration 1 1 12 12
Back Pain Task Force 1 1 12 12
Centricity Pediatric Group 2 1 12 24
Centricity Technical Meeting 3 1 12 36
Change Management 1 1 12 12
CHMG Clinical Leader meeting 1 1 12 12
Clinical Reporting 1 1 12 12
Clinical Practice and QI 2 1 12 24
CHMG Triannual Meeting 7 1 3 21
Clin Team All Staff 7 1.5 12 126
Clinical Decision Support 1 1 12 12
Form Committee 3 2 26 156
GE Site Visits 2 5 12 120
GI Centricity Monthly Meeting 1 1 12 12
iDoc (Documentation) Committee 1 1 6 6
Informatics 2 1 12 24
Interface/PhIS Team Meeting 2 1 12 24
IT Process Improvement 2 1 12 24
IT Providers with Megan 1 0.5 12 6
ITS Divisional Meeting 7 2 4 56
Managing Anti-Coags at CHMG 1 1.5 12 18
Medication Reconciliation 1 1 12 12
Patient Connect Advisory Committee 2 1 12 24
Pharmacy Anti-Coag Subcommittee 1 1 12 12
Phis Analyst 7 1.5 26 273
Practice Operations 1 1 12 12
Program Office 1 2 50 100
Provider IT 7 1 12 84
Report Committee 3 2 26 156
Service Team 1 1 12 12
Service Interruption 2 1 12 24
1434
Work not visible within our team (work generated from emails, projects, etc.)
Work not visible to our clients
Large backlog
Team members working in silos (not aware of what each other is working on)
The problems
No way to prioritize requests
Small issues not addressed become large issues
Difficult to quickly adapt resources to changing demands
The problem
Author: Douglas Thompson, May 15, 2012
Inventory management
Focus on one task
Daily attention
Make work visible via a board and “tickets”
Principles of Kanban
Professional, expert, knowledge workers
All our work is unique – we are “artistes”
What is the inventory unit in our environment?
Not an obvious match – a bit of a square peg/round hole
Will this work for us??
3 Planning Sessions Established vision and goals for process
Kanban Board Created Started with request board Added project board
10 Minute Daily Huddle Scheduled Built in Plan-Do-Study-Act (PDSA) cycle
Making Kanban a Reality
Kanban Tickets
Kanban Board: Phase 1 Reports
Tasks Analyst In Process Complete
1
2
3
Cathy
Joanne
Garvin
Christine
Megan
Sarah
Pam
Client Pending
Escalated
Kanban Board: Phase 2
Legend:
Gold = Tasks Hot Pink = Problems Green = Training
Purple = Reports Dk. Blue = PhIS Project
Pink = Forms Lt. Blue = Non-PhIS Project
Tasks Analyst On Deck In Process Complete
Unassigned 1
2
3
New:
Problems
Assigned
1
2
3
Cathy
Joanne
Garvin
Christine
Megan
Sarah
Pam
Client Pending
Escalated
Kanban Board: Projects
MU Pt Connect eForms – SK – Q4 - B
MU SP3 CHMG – CB – Q4 –B
MU ACM EOV to Pt Connect – MR – Q4/1 – B
Win7/Win7 – PA – Q4 – B
Win7/Citrix – PA – Q4 – B
MU SMPP DHC – CF – Q4/1 – P
DHC ADT/EIUD (HIE) – SK – Q4 – R
Centricity Test Systems – JB – Q4 – R
Dragon Citrix/Housecall/Exam Rms – GE –Q4 – R
CPS Imaging Solution – SK – Q1/2 – R
Delirium – MR – Q4 – P
“The BOARDROOM”
Daily 10 minute huddle provides TIMELY
information
Allows team to react quickly to changing
circumstances
Benefit of group input to problem solve Items not discussed still
VISIBLE
Management has to provide some parameters
There needs to be trust alongside the accountability
Proved its value – staff wanted to add more to it – one-stop shopping
Have the huddle every day no matter who is missing
Work was made visible
Resistance - a challenge to overcome
Early Lessons
“You’re making us work on the least important things”
“we aren’t capturing all of our work”
“what the heck goes on the board?”
“how does this help us prioritize?”
“why duplicate a perfectly good electronic process?”
“fear of micro-management” “perceived lack of productivity” “trust”
Challenges
PhIS Kanban Board (Oct, 2012) Work was made visible
Report writers focused on reports Team focused on all other tasks Report requests became obvious
PhIS Kanban Board (Dec, 2012)
Modified intake process
Report Requisition Form
More detailed information at start of process
Approval process
Practice Manager
CHMG Directors
Help desk call logged after approval
Actions Taken
CENTRICITY REPORT REQUISITION FORM
REQUESTOR:
OFFICE: TODAY’S
DATE:
Please circle when needed: 2 weeks 2-4 weeks 4-6 weeks
1. PURPOSE /REASON - What are you trying to
accomplish with this report? What is your business case for
needing/wanting this report? Why is the report important?
2. If report contains PHI (personal health information) whom
will this information be shared with?
3. FIELDS - What data fields (information) do you want to
include on the report? For example PT NAME, PTACCT #,
DOB, SEX, PCP, INSUR, etc....
4. INCLUDE - for example include only patients with Last
Date of Service after 1/1/2012 or pts with LDL > 130, etc.
Please specify date range if appropriate.
5. EXCLUDE - Should there be any exclusions? Such as
exclude patients who are inactive or exclude patients who have
not had a visit in the last 2 years.
6. SORT – How do you want the report sorted? For example:
sort first by Provider name, then by patient name, then by
appt date, appt time.
1st sort by:
2nd sort by:
3rd sort by (if necessary):
4th sort by (if necessary):
7. SUMMARY COUNTS or TOTALS – for which fields do
you want totals or a count?
For example, count all patients who have Medicare Insurance
and Dr. ABC as PCP
8. OUTPUT – Please circle the format in which you would
like the output.
PDF FILE (spreadsheet) LABELS
9. FREQUENCY – Does this report need to be run on a
regular basis? Should it be set up to autorun and auto e-mail ?
Is report needed on a regular basis? ___Y es ___ No
Should report be set up to auto-run? ___Yes ___ No
Should report auto e-mail to someone? ___Yes ___ No
If yes, who should receive the report?
Practice Manager Signature / Date:
Practice Manager: Please route to your Director for final approval.
ADMINISTRATIVE USE ONLY:
COMMENTS:
STATUS: ____ Approved ___ Not Approved
APPROVED BY: DATE:
** Please keep a copy of your completed request for your records**
Client Pending queue addressed (5 day limit)
Stated goal of 2-4 week turnaround time
Continual process improvement is necessary
Daily huddle enables us to address issues
Actions Taken
Service Level Agreements
Respond SLA
Close SLA
Monthly Calls
Month/Year Number of Calls Duration of Call (# of Days)
Oct-11 519 4
Nov-11 536 4
Dec-11 469 6
Jan-12 500 4
Feb-12 517 5
Oct-12 676 2
Nov-12 433 1
Dec-12 360 1
Jan-13 507 2
Feb-13 319 1
Mar-12 502 6
Apr-12 535 4
May-12 589 4
Jun-12 577 2
Jul-12 544 3
Aug-12 536 2
Sep-12 473 3
PhIS Requests Time
Global view – requests, reports, forms, projects, coverage Team more informed and connected Better communication
Easier to anticipate and plan for work Project tasks viewed well in advance by entire team
Daily 10 minute huddle
Small issues addressed BEFORE they become big issues Less interruptions during day. Not blindsided by work. Keeps entire team informed
Benefits
Identified bottlenecks in process Eliminated report backload by adjusting resources
Informed new report request process
More flexible in sharing of work
Easier to align resources
Changes dynamic of PhIS Team staff meeting
Benefits
“On a daily basis, I am more informed about issues and what other team members are working on”
“There is a feeling of accomplishment every time I complete a ticket!”
“Communication is improved”
Staff Feedback
“Biggest benefit is the daily 10 minute huddle”
“I understand the workload of the team”’
“We more often share ‘best practice’ for handling specific types of calls”
Staff Feedback
Establish vision, goals, and objectives first
Build Kanban with input from all team members – iterative process
Make time for a 10 minute daily huddle
It takes time
Keys to Success
Thank You
Questions