Quelle: CIO, Asia
AFTER ONE WEEK on the job as CIO of Des Moines, Michael Armstrong wasthinking he'd made a big mistake moving to Iowa from Lexington,Kentucky.
He was discovering that the capital city's civil servants thought theywere doing just fine without IT. Many of the 2,100 city workers wereperfectly content to work with paper, pens and Post-it notes--eventhose who had access to the city's antiquated desktop PCs. AsArmstrong strolled past one department head's office in September1997, he noted that his computer monitor served as nothing more thanan expensive frame for his children's artwork. And in a departmentmeeting, he butted heads with the assistant chief of police, whoexplained in no uncertain terms that he did not want the CIO tellinghim how to run his department. Today, Armstrong has moved Des Moinesfrom a mainframe to a distributed environment, installed a fibre-opticnetwork to connect all facilities, and developed the city's firstsystems standards. But winning over busy and technophobic policeofficers, city clerks and administrators was what kept Armstrong up atnight. And in the end, he ranks it as his greatestachievement.
Getting Off on the Wrong Foot
To be sure, Armstrong didn't know how to win his users over rightaway. In fact, his first attempt was a disaster. He wanted toimplement a PeopleSoft Inc. application for financials and HR. Hedecided to do the project in nine months and introduce the financialsand HR pieces all at once, hoping to get the pain over quickly,somewhat akin to ripping off a Band-Aid. But during the course of thenine-month rollout, 40 percent of the employees in the financedepartment's accounting division left; some involved in theimplementation simply got burned out by the long hours while otherswere scared off by the changes to their jobs. The HR department alsolost a few employees. And halfway through the project, Armstrongrealised his staff wasn't going to cut it in the new environment. Hefired 60 percent of his workers.
"The implementation was incredibly disruptive. We pretty much blew upthree departments," Armstrong explains. "I was not prepared for thedepth to which it would affect the organisation." He attempted to easetensions by admitting he messed up. "The best thing you can do is takethe heat," he says. And he learned some valuable lessons in how not tointroduce a huge, new system to reluctant employees. He had rushed theimplementation, promised more than he could deliver and underestimatedthe amount of change the city could absorb at once. Two years later,he applied those lessons as he attempted to introduce technology thatwould automate how Des Moines received, managed and resolved requestsfrom its 200,000 citizens.
You Can Right City Hall
Armstrong knew that he needed buy-in from all 15 city departments tomake the CRM system a success. With that in mind, he plotted hisstrategy. First, two of his project managers spent a year talking tocity workers to find out what they did when they received calls. Thoseconversations led to a useful outline of the more than 1,250 differenttypes of calls the city received--from trash pickup and potholepatching to barking dogs and cats up trees. It also made the usersfeel important.
Based on the city's needs and budget constraints, Armstrong decided tospend US$300,000 on the whole project using Heat software fromFrontRange Solutions.
To alleviate any potential alarm about lost jobs or reorganisation,Armstrong decided against going to a central call centre to operatethe system. "We didn't want people to feel that their jobs were beingthreatened, especially at a time when we're trying to get knowledgefrom them," Armstrong says. "And we didn't want to have to reeducatethe public, many of whom had gotten used to calling specificdepartments or even a specific person they knew by name, when they hada problem."
At the same time, Armstrong worked to demonstrate the value of thesystem to those departments that were less than excited about theupcoming changes. The police did not see what the system would do forthem that their 911 system didn't. Armstrong pointed out thatstandardisation would help with interdepartmental programmes that werenot strictly police activities, such as a project that offeredconcentrated police, fire and social services to distressedneighborhoods.
Armstrong began the implementation with the department where the workwould be most intense: public works. He thought it was a good place tostart for two reasons: It received the most calls, and the departmenthead was an advocate of automating its processes.
But not everyone in public works was thrilled with the system. GregCloe, the department's customer service supervisor, would havepreferred a package solely designed for public works' myriad needsinstead of an enterprisewide system. "I knew it would require asignificant dedication of resources to get it to work for us, and Iwas concerned about that," he explains. To address those concerns,Armstrong and his team worked closely with Cloe to customise thesoftware. "Because of the IT team's cooperation in listening to ourneeds, we're pretty pleased with the overall product," Cloeacknowledges.
Armstrong brought on one department at a time, enlisting key people ineach area to help him customise the system for that department's needsand utilising these "change evangelists" to help drive theimplementation. "That's one of the things we've learned over the lastfew years: Involve people early and often," Armstrong says. "And notjust the department heads and line managers, but the actual peopledoing the work."
Today, the citizen response system is up and running with 12 of thecity's 15 operating departments using it to handle 9,000 calls a monthand automate processes previously managed with Post-it notes. Thesystem provides a standardised way to take a complaint, store it in acentral database accessible by any city worker and track the status ofthe associated task. It also generates automatic alerts for follow-upaction and offers the capability to analyse the data for reports. Infact, the system was named one of the 10 most significant CRMimplementations of 2001 by consultancy Aberdeen Group. But one of thebest indications that Armstrong has tamed his tough users is the factthat the police department has agreed to let Armstrong and his teamtake over responsibility for its information systems. It signed on fora US$5 million to US$7 million IT upgrade covering everything from 911systems and electronic records management to mobile data systems andradio improvements.
Why Doctors Are a Pain
When Michael Jones, corporate vice president and CIO of Children'sHealth System in Milwaukee, Minnesota, wants to get through to hismost demanding group of users (the physicians), he goes to grandrounds. As he joins the residents, interns and attending physicians inthe Milwaukee hospital's auditorium, the topics range fromneuroblastomas to psychological sequelae after pediatric trauma. Butwhen Jones attends, the discussion includes IT.
Doctors are not technophobic.Quite the opposite, says Bradford Holmes, health-care researchdirector at Forrester Research. "When it comes to clinicaltechnology--new laparoscopic technology or a new defibrillator--lotsof them are technology addicts," he says. But when it comes to IT,doctors, Holmes says, "have a limited desire to learn new software andapplications, particularly if it will take them a lot oftime."
So when Jones decided to introduce a computerised physician orderentry (CPOE) system at the hospital last year, "There were months ofgoing to grand rounds, physician directors' meetings, any opendiscussion that we could find," he says. He had already built somecredibility with these users shortly after his arrival in 1996, whenhe upgraded a hospital information system to handle administrativeprocesses like registration and billing.
This time around, he enlisted the help of critical care pediatricianDr. Carl Weigle, a 12-year veteran of Children's Health. Since thedoctors weren't exactly clamouring for automated order entry, having aveteran physician touting the system definitely helped. Getting ardentusers to advocate with their peers is the best way to get buy-in forbig technology changes. But that was just the first step. What drawsdoctors in are features that improve patient care, save time orgenerate revenue. Weigle and Jones found that their best selling-pointfor CPOE was patient safety. According to the National Institute ofMedicine, avoidable medical errors kill between 44,000 to 98,000patients a year, and automated order entry, which eliminates mistakesdue to indecipherable handwriting, offers a powerful solution to thatproblem.
Jones recruited the most enthusiastic users to help in the selectionand implementation of the CPOE system. As the new part-time medicaldirector of information services, Weigle also tried to involve theusers that were the most dubious about the project. Among theunconvinced was Weigle's boss, Dr. Thomas B. Rice, director of thepediatric intensive care unit. "I was skeptical of how the technologycould help me as an end user," says Rice, who has worked at thehospital for 27 years. According to Rice, the flexibility of the ITteam in responding to his and other doctors' concerns was critical."Mike's biggest strength is that he's open," Rice says. "But the keyhas been having [Weigle] involved; he understands the physician end ofit."
Once the interdisciplinaryteam decided to invest US$6 million in the installation of the CPOEsystem from Eclipsys, the next hurdle was training. For the busiestusers, this can be the point of pain. You may have sold them on thebenefits and given them all the right functionality, but if they don'thave time to learn how to use it, all is lost. So Jones decided to cuttraining time. "We limited it to one hour and just trained them in thebasics," says Jones. He also ended up training the most gung horesidents separately from the attending physicians, who were not asmotivated to learn. "We had tried training the old guard and the newguard together in the first training session. The attendings werecomplaining and asking how is this going to work, while it was goingtoo slowly for the residents," Jones explains. "One approach did notfit all."
He supplemented the hour-long intro to CPOE with ongoing support fromusers more familiar with the system. "Doctors learn according to 'seeone, do one, teach one.' You watch someone do an appendectomy, you doone, and then you teach someone else to do it," Holmes explains. "Youhave to ditch the manuals and the long classroom sessions."
Following the launch--half of the physicians were brought on board inJune 2001 and the other half in September 2001--Jones provided 24/7user support the first two weeks after each rollout. Theimplementation has included a great deal of follow-up work. "Someonein IT makes the rounds once a week to all areas of the hospital tolisten to and document complaints," he says.
Adoption rate is now nearly 100 percent, accor-ding to Jones, althougha certain number of surgeons tend to rely on residents to do theircomputerised order entry. He has resigned himself to the fact thatsome may never use the system. But the successful introduction of CPOEhas further enhanced the IT department and the CIO's credibility amonghospital users. Jones is considering several upcoming projects,including a new picture archiving communications system, a move toelectronic medical records, updated operating room systems and apharmacy robot. But he understands that each user group can handleonly so much change. "We would get in trouble if we introduced toomuch change at one time," says Jones.