Six Steps to Lead IT Transformation

in Healthcare Organizations
Authored by:
Alan Cudney, RN, CPHQ, PMP, FACHE

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Multi-hospital integrated delivery networks (IDNs) are,
by nature, complex organizations. At the same time,
most Information Systems (IS) departments in healthcare
organizations have long lists of implementations, upgrades
and other worthy projects without enough staff to make them
all happen. When we add federal deadlines for Meaningful
Use, ICD-10, and even accreditation into the mix, we have
the ingredients necessary for missed deadlines, failed
projects and burnout.
There is so much activity going on within the scope of
healthcare IT that it has become crucial for healthcare leaders
to take bold steps necessary to lead through the swirling
winds of change that are engulfing their organizations. Staff
are getting tired, and it is not just the IS staff who are having
trouble coping. Nurses, physicians and other members of
the patient care team feel it, too. These members of the
patient care team face growing expectations and may
perceive a lack of control over their environment that leads
to further stress. Sometimes this results in demonstrations
of frustration, anger and disengagement from their work
which can also affect patient safety and quality of care.
Some of this tension can be relieved by getting back
to basics, remembering what it takes to successfully
implement clinical systems in the dynamic environment of
patient care. All too often, top-notch IT staff revert back to
the simpler days when implementing or upgrading a system
was an IT project and checked off the list when completed.
What clinical staff are telling us is that they feel controlled
by the technology, rather than feeling like they are valued
customers who are receiving new and more powerful tools
to assist in patient care.

1. Communicate Leadership Support

Figure 1 illustrates the basics. These are the time-honored
truths that leaders in healthcare technology have known for at
least the last decade and have been established in numerous
publications. First, leadership support is a necessity. To
some, this has become a trite statement, but we feel that it
deserves further consideration. Leadership support requires
visible advocacy and demonstrated support to all groups
who will be asked to use the technology in the live patient
care environment. In a recent CPOE implementation, staff
noted that the Chief Medical Information Officer (CMIO)
was not seen using this new technology. In another largescale vendor migration, an IS manager remarked that senior
leaders were afraid to be viewed as supporting the project
in case it failed.

Managing the Transformation of IT

1. Communicate Leadership Support

2. Create Engaged Governance

3. Integrated Project Management Approach

4. Develop Detailed Communication Plan

5. View End-User as Customer

6. Foster Ongoing Program Management

Figure 1

Whether it is a barcoding system, CPOE, entire EMR or a

mobile device deployment, the full scope of patient care at
your organization may be impacted by these systems. This
does not let any hospital or health system executive off the
hook. Clinical information technology, with all the component
software and hardware, is simply a tool for delivering patient
care that is safer, more efficient and more effective than it
was previously. If the organization has decided to purchase
and implement the technology, executives must prominently
embrace the technology, speak about it publicly and work
with peers to deliver consistent messaging about the
associated implementation projects.

2. Create Engaged Governance

The term governance sometimes evokes anxiety
producing images of the organizations governing board.
We use the term in reference to the processes and roles
related to policy decisions that govern the successful
implementation of clinical and business systems. We often
see project managers and system analysts working diligently
to fulfill their assignments, while major questions such as
who will use the system and how will the technology adapt
to the needs of the end-user customers, are left undecided.
We also see steering committees in which everyone is
trying to grab the wheel or hang out the windows and look
2

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around, while no one is steering. A study by the Clinical
Advisory Board recommended shared accountability for
the success of IT across the leadership team and steering
committee.
This may take the form of incentive compensation that is
tied to a successful outcome of the implementation. The
Advisory Board Company publication, In Pursuit of Clinical
Transformation, Volume II: The Planning Imperative makes
the point for shared accountability and sponsorship (Figure
2).1

Cheerleading is a necessary but insufficient
component of executive involvement; although hospital
leaders are often reluctant to assume ownershipand
rarely required to do soit is critical that they not only
sponsor IT-related projects, but also have some skin in
the game.
Figure 2

3. Integrated Project Management

Approach
Many hospitals have embraced the idea of using seasoned
project managers who are assigned to IT projects, as well as
significant non-IT projects involving building and renovation.
Some have initiated project management organizations
(PMOs) that serve as administrative entities supervising
activities of the various project managers. However, the PMO
must develop the ability to manage the cluster of projects,
or the IT program. This program management role should
include an aggregated view of all relevant projects, taking
into consideration all the interdependencies, proactively
managing risks and keeping a watchful eye on the critical
path, i.e. delays that may cascade throughout multiple
projects, impacting achievement of strategic objectives. It
is very easy to allow individual project managers to perform
successfully within their individual assignments, but senior
leadership needs to ensure that the aggregate is effectively
planned and executed to fulfill organizational goals.

4. Develop Detailed Communication Plan

Developing a comprehensive, stakeholder-focused
communication plan is a hallmark of project success. So
often it is viewed as something that is done when time
allows. Assuming that the project facts will be consistently
communicated to the right people at the right time is nave
and may eventually contribute to project failure.

A critical component of a successful clinical

systems implementation is a planned
communication strategy that:

Considers views and needs of all

stakeholders, both internal and external to

the organization

Assigns accountability to all members of the

project steering committee, leadership team

and project staff

Provides planned messaging that reflects

the goals of and contributes to success of

the project

Measures success and revises communication

approaches to be more effective

Emphasizes two-way dialogue and

perspective of the end-user as a customer

5. View End-User as Customer

Project interviews often reveal a perception among those
who are expected to use the systems, that they are on the
receiving end of the technology. Successful implementation
and adoption of information systems is achieved more
quickly when formal and informal leaders feel that they are
full partners in successful implementation of the technology.
Granted, there will always be naysayers, vocal resistors
and passive-aggressive responses, whether or not your
organization has implemented a solid communication
plan. However, establishing a partnership so that endusers
understand the whys and why nots and feel that their
input is given consideration is a key part of managing the
profound changes the technology is bringing.
6.
Foster
Ongoing Project Management
The earlier days, when a system was simply a project to
check off ones list, are gone. We are transforming patient
care through the implementation of complex, integrated IS.
Instead of a group of projects, successful organizations will
view this as establishing a new level of capability to become
an information-driven healthcare delivery organization.
Projects may come and go, but the work required to fuel this
transformation and to ensure optimal use of the technology
will continue indefinitely. Successful healthcare leaders will

1 In Pursuit of Clinical Transformation, Volume II: The Planning Imperative,

The Advisory Board Company, 2006, pg. 40.
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recognize and embrace the need to manage change and get
in front of the transformation. It is our hope that an increasing
number of hospitals and care delivery organizations will
embrace the visceral aspects of leading the transformation
to an IT-driven healthcare delivery system.

Summary
Healthcare delivery organizations are complex enterprises
with the physical well-being of human lives at stake. As the
sophistication of IS has grown, so has the understanding
that successful implementation and use of the technology
involves non-technical changes that fall within the
disciplines of leadership, project management and change
management. These changes become important attributes
of successful organizations that spill over into other types of
projects and healthcare programs as the organization seeks
to fulfill its mission and strategic objectives. Savvy healthcare
leaders will give as much attention to these details as they
do to the traditional steps of technical implementation.

About the Author

Alan Cudney is an executive consultant with over 30
years of experience in healthcare. In previous leadership
roles Mr. Cudney improved the coordination, efficiency and
effectiveness of patient care through process re-design,
effective change management and appropriate utilization
of clinical information technology. As a registered nurse,
Mr. Cudney is thoroughly acquainted with the very heart of
healthcare delivery. He effectively leverages his graduate
business and healthcare management degrees to provide
in-depth, realistic solutions.

Beacon Partners is one of the largest healthcare management consulting firms in North America. We focus on helping organizations
improve operational, clinical, and financial performance to deliver the highest level of patient care. For 25 years, healthcare leaders
have chosen Beacon Partners to optimize clinical productivity and financial performance, ultimately leading to improved quality,
safety, and patient outcomes. Our team of industry executives, physicians, nurses, administrators, allied healthcare professionals,
and analysts brings a unique, multi-disciplinary approach to the challenges healthcare organizations face today.
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