Question

I need help with my very last assignment of this term PLEASE!!, and here are the instructions: After reading Chapter Two, “Keys to Successful IT Governance,” from Roger Kroft and Guy Scalzi’s book entitled, IT Governance in Hospitals and Health Systems, please refer to the following assignment instructions below.

This chapter consists of interviews with executives identifying mistakes that are made when governing healthcare information technology (IT). The chapter is broken down into subheadings listing areas of importance to understand critical issues and processes for successful IT governance.

Communicate

Meet Regularly

Do Not Be Afraid to Rotate Members

Do Not Allow Gaming

Have an Expedited Process for Smaller Projects

Recognize the Importance of Good Staff Work

Align What You Are Dong with the Organization and Its Culture Recognize That IT Should Not Own the Process and Make the Decisions Keep IT Simple and Transparent

Create a Level of Trust and Credibility

Prepare the Organization for the Governance Process

Socialize the Need

Actively Design Governance

Involve Executives in the Governance Process

Engage Clinical and Management Leadership

Engage Physicians and Nurses

Assign Ownership and Accountability for IT Governance

Provide the Right Incentives

Assess if the Governance Process is Effective

Mistakes and Lessons Learned

Pick at least three of the areas identified above and compose an essay (minimum word count for your essay is 250 words). Be sure to include two outside references and list at the end of your essay.

Chapter 2 Keys to Successful IT Governance The literature on healthcare and corporate IT governance identifies keys, or critical success factors, for effective IT governance. Healthcare executives interviewed for this book have added their own judgments, which are success include the careful definition of who is responsible and accountable for deci- sions. For example, IT staff should not be the primary sponsors of projects, so clinical and management sponsors must be involved from the beginning. as well as the people who will actually use the systems implemented. quoted in this chapter. The keys to The executives interviewed for this book also identified mistakes you can make in IT governance, including ignoring critics, especially physicians, rather than engaging them and even putting them on governance committees so they can understand the issues and processes better Critical Success Factors in IT Governance Communicate The CEO needs to communicate the governance process to the organization. A char- ter should be prepared and widely disseminated from the CEO. The CEO commu- nicates that the process must be followed and that projects are not to be submitted to the CEO or the board directly. Deadlines for submission of proposals to the advisory committees and the governance committee are defined. You need to be out there with the customer and not sitting in your office. You are going to have difficult times in governance and you need the personal relationships Jim Burton, Senior Vice President and Chief Information Officer, East Jefferson General Hospital, Metairie, LA Closing the feedback loop causes people to do things a different way. You have to get back to them after they propose a project. If you don't get back to them, they will find another way to get the project done. Janice Kishner, Vice President and Chief Nursing Executive East Jefferson General Hospital, Metairie, LA IT GOVERNANCE IN HOSPITALS AND HEALTH SYSTEMS 12 Meet Regularly The governance committee needs to meet regularly and follow the finance commit- tee calendar for submission of proposals. Do not be afraid to cancel meetings when no decisions need to be made. Committee members will stop coming if they believe that they lack real authority and that meetings are just for updates or presentations. Meetings are for considering new projects, setting priorities and reviewing existing and completed projects Do Not Be Afraid to Rotate Members Senior managers and clinicians do not have to serve on every committee for every term. Allow them to nominate others to the committee, but do not allow substitu- tions for individual meetings. Senior managers and clinicians must be able however, that the person nominated speaks for them. For example, the medical direc- tor might appoint a medical department head to a committee. That person has to commit to serving for a specified term (e.g., a year). Members who cannot attend a meeting are not allowed to vote on that meeting's issues, nor are they allowed to send a substitute. Explaining the committee's tasks and processes to one-time attendees would waste too much time. to say Do Not Allow Gaming As stated earlier, the CEO needs to communicate that the process will be followed and that no IT project will be allowed to proceed unless it has gone through the gov ernance process. Moreover, it should be impossible to skirt the governance process by breaking a project into pieces, each of which falls below the threshold for submission. To avoid this, the threshold for review can be set at a very low level (e.g,, 80 hours of work for IT and $10,000) Some project sponsors may also try to circumvent the governance process by under- stating their budgets. For example, they may include the cost of software but not the data conversion or hardware costs. To avoid this, the project managers in IT who review smaller projects need to carefully consider each proposal to identify needed components and a realistic budget. The facts of a proposal may be verified by speaking directly to vendors There's going to be conflict and the person at the top needs to be able to enforce the gover- nance process. Governance is about trust. If you have people gaming the system and win- ning approval for their projects, the governance process loses all credibility - Jim Burton, Senior Vice President and Chief Information Officer, East Jefferson General Hospital, Metairie, LA Senior-level people need to tell people who have tried to go around the process that they are aware of what has happened and should remind them that the governance process must be followed. For example, if a project got to the governance committee without being reviewed by one of the subcommittees, a senior manager should find 3 of 12 13 out how that happened and then tell the proposal's sponsor that such a shortcut must not happen again. We need to use those moments for education. Janice Kishner, Vice President and Chief Nursing Exccutive, East Jefferson General Hospital, Metairie, LA Have an Expedited Process for Smaller Projects The governance committee should establish an expedited review process for smaller projects. Doing so will reduce the concern that the governance process will cause sig- nificant delays. It will also help to trim the work load created by setting thresholds low enough to discourage gaming. When an expedited small-project process is in place the governance committee will not feel they are wasting time looking at insignificant projects Recognize the Importance of Good Staff Work Staff need to support the process by thoroughly reviewing the projects. IT staff and the governance and advisory committees need to define the questions to be answered (e.g., what is the project's return on investment?) to avoid repeatedly returning pro- posals for more information. If cach proposal is expected to be accompanied by a completed form, then staff should ensure that each form is complete before it is sent to a committee. Minutes are important and should define all the actions that need to be taken after the meeting. The minutes need to be widely disseminated so that every body knows what is being proposed and what has to be done. Align What You Are Doing with the Organization and Its Culture You want to make sure your process supports your organization's overall goals and strategic plan. You have to include the organization's goals and strategies in the pro- cess, for example, in the business plan. You can be out in front too far. I've tried to be out in front in developing the proces, for example, in requiring business plans. I try to listen to their feedback. We've decentralized some of the decision-making but now are in the process of moving toward greater central- ization. The incentive program for Meaningful Use has greatly increased the degree to which we work together -Cathy Bruno, Chief Information Officer Eastern Maine Healthcare Systems, Brewer, ME Recognize That IT Should Not Own the Process and Make the Decisions The goal is both a process and outcome. The process should not be CIO dependent. The CIO should lay out the facts and give an opinion, but not make a decision. The business sponsor has to drive the decision. -Jim Burton, Senior Vice President and Chief Information Officer, East Jefferson General Hospital, Metairie, LA IT GovERNANCE IN HosPITALS AND HEALTI SySTEMS 14 Keep It Simple and Transparent Effective governance is simple and transparent. The governance process unambigu- ously defines the responsibility or objective for a specific person or group. How the process works is clear to those who are affected by or want to challenge governance decisions. Everyone should know how the process operates and senior managers communicate that For example, the CMIO (chief medical information officer) can be viewed as a marketing person for IT, explaining decisions physician to physician -Deborah Gash, Vice President and Chief Information Officer, Saint Luke's Health System, Kansas City, MO Be really clear and communicate a lot. Build relationships and make sure they know what you're doing and what your decision processes are. There shouldn't be any surprises Cathy Bruno, Chief Information Officer Eastern Maine Healthcare Systems, Brewer, ME Physicians want to know how decisions are made. They want some processes embedded in policy Physicians and nurses can go online and raise an issue about the EMR and shat issue will be tracked until its resolved. Others will go to the CMIO and CMO (chief medical offcer) and raise the concern directly Erik Steele, Chief Medical Officer, Eastern Maine Healthcare Systems, Brewer, ME Have a clear proces for presenting projects to the governance committee. Determine the cri- teria you should use to determine if a project should go forward. Give the individual entities of work they should be pushing up to the gover- nance committee. The governance committee should have an overall vision of hou the pieces on what theyre supposed to de -Eric Hartz, Chief Medical Information Officer Eastern Maine Medical Center, Bangor, ME of the system some guidance on the amount 'going to fit together and advise the individual entis are A process that does not define responsibilities and objectives allows sponsors to argue later that someone else was accountable. Processes that are complex and ambiguous encourage clinicians and managers to go around them. For example, proposal spon- sors can break projects into pieces that individually cost less than the threshold that requires submission to the governance process. Sponsors will also try to expedite a project by asking for approval from a senior executive rather than going through the governance process, arguing that the project is an exception. Make the process very transparent. Keep track of meeting notes, decisions, ownership and communicate widely. Be as inclusive as possible. Strong representation from ever depart- ment is needed. The process must be driven by the operational owners. David L. Miller, Vice Chancellor and Chief Information Officer University of Arkansas for Medical Sciences, Little Rock, AR 15 Chepter 2 Create a Level of Trust and Credibility Deliver what you promised. People begin to realize that if they are involved in the gover n.ance process, theyre going to get results. Jim Burton, Senior Vice President and Chief Information Officer, East Jefferson General Hospital, Metairie, LA You have to have a plausible approach to governance and how you're organized. It has to be well communicated and understood. You have to have the credibility so that governance is believed and trusted. There has to be some confidence that during the governance process, when decisions are made or directions are taken, it will go well. Eric Yablonka, Vice President and Chief Information Officer University of Chicago Medical Center, Chicago, IL Prepare the Organization for the Governance Process the best governance design in the world, mandated by the highest levels in the organization and championed by a senior management advocate, will not succeed if the participants are not ready for the change or do not participate in the design process. Most managers and clinicians will not read or pay attention to the governance process until they have a project for which it is required. It is stll important to talk with a wide group of managers and clinicians. In some hospitals, the need will be obvious to everyone because, for example, major projects are failing and there are severe cost overruns Factors That Contribute to Organizational Readiness. Many factors can contribute to predisposed organizational readiness for enhanced IT governance: A significant, spectacular and/or costly IT failure attributed to lack of communica- tion, direction or controls An unfavorable audit or regulatory finding concerning IT governance or IT controls. An acquisition, merger or other significant change in direction, visibility or depen- dence of the organization on IT Environmental factors that can cause, or have caused, the organization to be "change ready," such as a return to growth after downsizing or an economic recession. Socialize the Need A frequent error committed here is to just announce the need. This top-down approach invariably leads to resistance and failure in all but the most hierarchical, authoritarian- type organizations. Instead, meetings, work groups and planning sessions in which the symptoms are discussed and solutions sought must precede design efforts for most organizations. This sensitizes the organization to the need, gains commitment and organizational readiness. creates 6 of 12 IT GovERNANCE IN HOSPITALS AND HEALTH SYSTEMS 16 Actively Design Governance Many enterprises have created disparate IT governance mechanisms. These uncoordinated mechanism "silos" result from governance by default- introducing mechanisms one at a time to address a particular need (for example, architecture problems or overspending or duplication). Patching up problems as they arise is a defensive tactic that limits opportunities for strategic impact from IT. Instead, management should actively design IT governance around the enterprise's objectives and performance goals. . . . One goal of any governance redesign should be to assess, improve and then consolidate the number of mechanisms. Early in the learning cycle, mechanisms may involve large numbers of managers. Typically, as senior managers better understand IT value and the role of IT, a smaller set of managers can represent enterprise needs. Multiple IT governance mechanisms are sometimes developed as a result of history. A governance committee may be created after a committee has been developed to oversee the implementation of an EHR system. The latter committee is chaired by the CMO or CMIO, while the governance committee is chaired by the CIO. Because of the size and expense of implementing an EHR system, it may seem like a good idea to create a governance body with broader representation than the IT governance committee. However, the two groups would work on the same issues, resulting in some confusion and inefficiencies. Who should consider infrastructure development, eg, network development and storage? A solution is to create a single decision-making structure by making the EHR committee a subcommittee of the IT governance committee. Involve Executives in the Governance Process Executive involvement is critically important for holding the clinical and business sponsors, as well as IT leaders, accountable for project success. Executive involvement is also vital for ensuring that resources are actually available until projects are com- pleted. Executives must also ensure adherence to the governance process so that the benefits of governance are received. The personal investment of the Chief Medical Officer in the process is key. The CMO has to understand how decisions and resolved. The loop has to be closed back to the initiating physician. The CMIO and the CMO have to be partners. The CMO needs to be involved in key discussions to make sure that the physician perspective is represented. You have to make sure the physician's voice is effective in decision-making are made. CMOS have to make sure that issues get tracked -Erik Steele, Chief Medical Officer, Eastern Maine Healthcare Systems, Brewer, ME Executive and Board Roles and Responsibilities. While executive and board involvement is always cited as important in IT governance, translating that into spe- cific roles and responsibilities is not easy or obvious. Top-level executives and board IT GovERNANCE IN HOSPITALS AND HEALTH SYSTEMS 18 Physicians need to feel they are just as important as the business side. If there are templates, physicians need to know what they are, agree that they will be fanctional, and have signif imput on configuration. cant -George Pagels, Chief Medical Officer, Saint Luke's Health System and Chief Executive Officer, Saint Luke's East, Kansas City, MO Nurses have to trust that I will be carrying their mesage forward. They have to trust the governance structure. It is important to recognize that there are going to be mistakes and be willing to admit them to users -Gloria Solis, Chief Nursing Officer, Saint Luke's East, Saint Luke's Health System, Kansas City, MO Assign Ownership and Accountability for IT Governance Our recommendation is that the board or CEO hold the CIO accountable for IT governance performance with some clear measures of success. Most CIOS will then create a group of senior business and IT managers to help design and implement IT governance. The action of the board or CEO to appoint and announce the CIO as accountable for IT governance per- formance is an essential first step in raising the stakes for IT governance. Without that action, some CIOS cannot engage their senior management colleagues in IT governance. Alternatively, the board or CEO may identify a group to be accountable for IT governance performance. This group will then often designate the CIO to design and implement IT governance. Provide the Right Incentives a common problem we encountered in studying IT governance was misalignment of incentive and reward systems with the behaviors the IT governance arrangements were designed to encourage... . IT gover- nance is less effective when incentive and reward systems are not aligned with organizational goals....Avoiding financial disincentives to desirable behavior is as important as offering financial incentives.... It is hard to overestimate the importance of aligning incentive and reward systems to governance arrangements. If well-designed IT governance is not as effec- tive as expected, the first place to look is incentives. a The IT governance process should reward project sponsors who adhere to the rules by providing them with the funds and support for implementation through a clearly defined, efficient process. If the process instead delays projects or requires effort that prevents other work from being done, an incentive is created for potential project sponsors to avoid the process. If those who are successful in avoiding the governance process are seen as being rewarded by earlier implementation and improved perfor mance, the governance process is undermined. For example, a project sponsor wants approval of an upgrade picture archiving and communication system that would to a Chapter 2 19 allow access to images across multiple facilities. In response, the department chair makes a plea directly to the CEO and board and receives funding for the project. When the department receives praise from physicians for the improved access, other potential project sponsors can see incentives and rewards for bypassing the governance process A hospital had an Operating Room (OR) system that provided the reports it needed but did not connect to the other systems in the hospital. A physician looking patient's medical record could see all services except those in the OR. Clinicians had created 200 reports that would have to be rewritten if the OR module in the hospital's EHR system was adopted. To provide incentive, the CIO offered to engage a consul- tant to write the reports and to add an anesthesia module not in the current system. at a The governance process should reward those who comply with it and propose or accept changes that benefit the organization. The CEO should communicate that projects will not be approved without moving through the governance process Assess if the Governance Process Is Effective In Chapter 1, we noted that Weill and Ross define IT governance as "specifying the decision rights and accountability framework to encourage desirable behavior in IT usage." They go on to say that "governance performance must then be how well the governance arrangements encouraged desirable behaviors and ultimately how well the firm achieved its desired performance goals." Symptoms of Ineffective Governance. Weill and Ross identify the following symp- toms of ineffective governance 1. Senior Management Senses Low Value from IT Investments. Senior managers typically react in one of several ways to this concern. Some managers dive in to learn more about IT, making more IT decisions personally and centralizing trol. Others abdicate responsibility to colleagues such as managers in the IT unit because they are unsure how to act or don't think it's important. Still other senior managers engage consultants or make new hires to "fix the problem." Rather than starting with increasing control, abdication, or bringing in new people, first look at IT governance. Perhaps the wrong people are making IT decisions or the people making those decisions need management education. Good governance will pro- duce metrics supporting or contradicting management's gut feeling. If everyone on the senior management team cannot point to a record of how recent IT invest- ments have been performing, governance is a problem. 2. IT Is Often a Barrier to Implementing New Strategies. Instead of acting as a strategic enabler, does IT often act as a barrier? If IT limits the ability to respond to new market opportunities, the IT infrastructure may be broken. 3. The Mechanisms to Make IT Decisions Are Slow or Contradictory. Effective governance comes from a set of well-designed and well-executed mechanisms that reinforce desirable behavior. Are different mechanisms sending contradictory mes sages to executives?. .. Just as troubling are mechanisms that obstruct rather than con- IT GOVERNANCE IN HOSPITALS AND HEALTH SYSTEMS 20 support project implementations.... If the exception process is not fast and pre- dictable, individuals will be motivated to act outside the system. If renegade excep tions are in evidence, governance is a problem. 4. Senior Management Cannot Explain IT Governance. We know from our research that the more managers in leadership positions there rately describe IT governance, the better the governance performance.... In par- ticular, senior managers know what decisions IT makes and what decisions they must make.. . If fewer than 50 percent of managers in leadership positions can accurately describe IT governance, and the number is not increasing every month governance is a problem." 5. IT Projects Often Run Late and Over Budget. A number of studies over the last ten years in several countries found that the percentage of IT projects completed on time and on budget is typically less than half. Effective IT governance should provide consistency in project management and program design. Project manage- ment should ensure allocation of dedicated resources, a disciplined sequence of stages, and formal project tracking. Good project management leads to predictable project delivery. If 90 percent of projects are not delivered on time and on budget governance is a problem. 6. Senior Management Sees Outsourcing as a Quick Fix to IT Problems. Selec- tive outsourcing of IT capability can be a very effective management strategy... However, some outsourcing decisions result from frustration with IT. Concerned about IT costs or lack of value, managers turn to outsourcing as a quick fix to con- trol the problem.... To be effective, outsourcing should result from a decision that particular competencies or services are better provided externally.... Outsourcing as a quick fix motivated by frustration with IT outcomes suggests that governance is a problem. 7. Governance Changes Frequently. Management is what decisions are made. Man- agement decisions typically change as strategies change. Governance is who makes the decisions, and thus changes less often than strategy. Changing governance every time you change strategy should not be necessary as many of the governance mechanisms, such as committees and budgets, are independent of strategy. Gover- nance should change only when a change in strategy prompts a change in desirable behaviors. For example, a shift from a customer intimacy to a product leadership discipline would signal a change in how much business unit collaboration is valued. This more radical shift in strategy-a change in strategic intent-would be likely to drive changes in governance. Frequent changes in IT governance almost guarantee ineffective IT use. Unable to comprehend or keep up with the changes, managers are likely to completely ignore governance.40 are who can accu Another symptom is bypassing of the governance process. If there are other ways to get projects approved, e.g., a direct appeal to the CEO or CFO, then the governance process is not organizational priorities and are completed on time and within budget. going to be able to assure that projects are successful, are aligned with 11 of 12 21 The governance process should also be identifying important needs, such as infrastruc- ture upgrades and the physicians' need for mobile and remote access. There should not be an imbalance of the IT capabilities and resources berween the business and clini- cal functions of the organization. Are clinicians provided with an EHR system while finance has difficulty producing accurate bills? Mistakes and Lessons Learned Providing Too Much Information Michelle Hood, President and CEO of Eastern Maine Healthcare Systems (EMHS), believes it is a mistake to provide too much detailed information to people involved in governance. Information needs to be filtered. Providing too much information puts them in the role of management. "It's a fine line," Hood says. "They should be involved in issues like Meaningful Use and the use of informatics to support new care delivery systems. Assuming People Understand You shouldn't operate in a vacuum and assume that people understand what the plan is and the implications of that plan. Eric Yablonka, Vice President and Chief Information Officer, University of Chicago Medical Center, Chicago, IL Not Engaging the Critics Remember that the people who don't agree with you are not your enemy. Bring the people who are the loudest crities into the process -Christopher Barilleaux, Chief Medical Information Officer, East Jefferson General Hospital, Metairie, LA Engage nayayers in the process. People who critics can be very helpful. Eric Yablonka, Vice President and Chief Information Officer, University of Chicago Medical Center, Chicago, IL are Do not take criticism personally. Cathy Bruno, CIO at EMHS, believes you should not express frustration and take criticism personally. "You need to engage your con- stituents in a positive way," Bruno says. Having an Unclear Process for IT Funding or Poor Staff Support Erik Steele, CMO at EMHS, believes that having an unclear process in defining how much money IT gets is a mistake. "If there is a lot of variability so that IT gets less money during the year, the IT governance process is degraded. The confidence of the IT governance members is degraded," Steele says. He believes that inadequate staff support for IT governance is also a mistake. "Good background information is neded well in advance. Good minutes that are action oriented are needed to provide cred- ibility," he adds. IT GOVERNANCE IN HOSPITALS AND HEALTH SYSTEMS 22 Not Prioritizing Against Objective Criteria Good prioritization is comparing every application to every other application according the criteria. If the criterion is patient safetry, then every application needs to be compared on that. That's hard work, but if you do that you wind up with something that has face validity. It's acceptable to everyone. to George Pagels, Chief Medical Officer, Saint Luke's Health System and Chief Executive Officer of Saint Luke's East, Lees Summit, MO Other Mistakes to Avoid Jim Burton, Senior Vice President and CIO of East Jefferson General Hospital (EJGH), Metairie, Louisiana, believes there are three major mistakes to avoid: Compromising on what's right to make pressure go away. This dilutes the influ- ence of the CIO. When the CIO is willing to deviate from the process, credibility is lost. Not starting the governance process when you first arrive. Once the spigot of projects has been opened, it is difficult to turn it off. You need to slow down the evaluation process while the governance process develops. Allowing a siloed process that separates physicians, nurses and managers. When Burton arrived at ĒJGH there were to0 many committees. The process was siloed. Physicians and nurses had separate committees and never met together. There is now a weekly meeting where the CMIO, the CNO, the medical director and the CIO meet to discuss changes related to clinical projects. Judy Brown, CFO of EJGH, believes there are two mistakes to avoid Make sure that the IT department does not prioritize projects before they enter the governance process. Doing so could push projects down that should have a higher priority. Do not let departments, including IT, go around the process. Try to get IT involved from the beginning. This helps avoid disappointment because people often do not understand the implications of their project in terms of resources and impact on other projects

Answer 1

IT governance identifies the parameters and the factors which are critical for health care governance. We will discuss three which are ways to communicate, need to meet regularly and do not allow gaming.

To effectively communicate the CEO must establish a governance process in the organization. The governance process will ensure that the communication circle is completed. The communication should be as per process and the projects don’t need to be submitted to the board or the CEO directly. The critical need is to spend maximum time with the customer. The customer feedback will be utilized to maximize the process and to ensure the goals are met. The deadlines for submitting the proposal is clearly defined and adhered.

Meet regularly requires regular review of the proposals and managing the financial calendar. Further meetings which are unnecessary should be eliminated otherwise the committee members will stop attending the meetings. The meetings should be fruitful and conclusive. The meetings should be initiated only for critical matters like to discuss new projects, setting the priorities and for reviewing the existing project5s.

Do not allow gaming discusses the critical need for Ceo to communicate the governance process. He should communicate that the project will not be cleared if the process is not followed. Some people try to circumvent the process by breaking the project into smaller projects. This will result in projects being below the threshold of submission. Others will try to understate the budget.

It is important the managers verify the proposals thoroughly to avoid budget mismatch and discuss the project carefully with the vendors.

To conclude the IT governance process should be communicated effectively by the CEO and followed by the project managers.

References:

"Principles of corporate governance by business roundtable Sept 8, 2016"

"Enterprise development-governance objectives and communication (IT for business) "