ITSM Applied to Healthcare

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ITSM can be applied across many different areas from healthcare, government, private business as well as Healthcare.

This panel discussion will take a deep dive into how these principles are being used in at several large Healthcare companies in North America.

The discussion will be applicable to those just starting out on their journey as well as those who are well on the way to program success.

Companies on the discussion panel:

Welcome to today’s webinar. It’s a pleasure to host this panel of distinguished ITSM specialists. My name is David Mainville and I'm on the co-founders of Navvia. At Navvia, we are very passionate about helping our clients improve their business outcomes through robust repeatable processes. If you are so inclined, you can follow me @Mainville on Twitter or you can email me directly,

I’d like to go ahead and introduce the panelists. I'm going to ask each panelist just to take a moment to just give a little bit of background on their ITSM experience and a little bit of background on the organization they work for. The first panelist today is Bob Seffler, and Bob is the service operations manager for Baptist Health. Bob, can you give us a little background on yourself?

Bob: Here we go. I'm currently the service operations manager for Baptist Health. I've been with them for about four years and came from the banking industry to the healthcare industry. I was with the banking industry for about 15 years and was responsible for bringing IT into the organization that I was in there and doing the same thing here. Baptist Health is a community based hospital that’s in northeast Florida. We have a main campus that is our children’s hospital and our adult hospital, and then we have three community hospitals and about 48 primary care offices in the northeast Florida. We have both the for profit side and not for profit in the healthcare side of things. We recently, in the past three years, have opened a data center, so we've moved our IT department out of the various hospitals and consolidated into our data center.

That’s fabulous. Thank you for that background, Bob. The next panelist is Rob Marti, and Rob is the administrative director and information security officer for Integris Health. Rob, can you give us a little background on yourself and your organization?

Rob: Sure. As you can see, I have a varied role. I have been the information security officer for Integris for six years and recently increased by accountability to assume responsibility for the IT project management office as well as our newly formed service management office. I have intermediate certification and ITIL for the service strategy and bring about 15 years worth of highly technical background and expertise to the table through engineering services that I first offered as an employee of Integris Health. Integris Health is Oklahoma's largest healthcare system and hospital network. We’re not for profit; we have 50 clinics, 9 hospitals and continue with a very robust merger and acquisition strategy. Our service management team consists of six folks who are all with varied ITIL experience that are really chartered with driving forward process improvement tied with a very robust Lean organization and these two things have proved successful over the last 18 months or so in terms of moving our ITIL and our IT service management programs forward.

David: Thank you, Rob. That’s really interesting how you're doing that combination of both Lean and ITIL. I've seen that work successfully in other organizations as well. Thanks for that background. Now I’d like to introduce an old friend of mine, Anthony Salvo, senior director of IT service management at New York City Health and Hospital. Anthony, could you give us a little background on yourself and your program?

Anthony: Sure, David. Hello, everyone. Welcome. I actually been at New York City Health and Hospitals for about four years now and in this role I have, just a little about New York City Health and Hospital Corporation, it’s a municipal hospital corporation for the city of New York. We have 11 or so hospital, major medical centers, spread out through the five boroughs of New York and we have dozens of rehab and health facility clinics sprinkled throughout the five boroughs also. We have about 50,000 IT users out there spread everywhere and I actually work for Central Office IT and my role as senior director is in the service management organization and I have ownership for enterprise wide asset and change and release management. Basically, our team is about 12 people or so and we work in the model of if there are lots of matrix resources into the service management organization to actually deploy, execute, and support the service management model that we’re pushing across the enterprise.

I came from the financial sector so I have a lot of software development background and IT operations and things like that; I actually bought that to the table when I joined HHC about four years ago here.

David: That’s fabulous. What we’re going to do is we’re going to ask the first question and I’ll start with Bob. Bob, how, in your opinion, does ITSM differ within healthcares compared to other sectors of the economy?

Bob: I would say what I've seen coming from another area in the industry and the challenges that I've seen within the healthcare is from a clinician perspective, they're all about the service that is needed and IT is more of an enabler to them and they don’t really get as much about how partnering with IT is absolutely necessary in our environment. On the technical side, you’ve got your technical folks that are all about the technology and don’t get the service focus. Getting the two extremes to be able to work together for the same thing is really unique within the healthcare industry. The healthcare industry is all about the patient and the service that is there for that. With all the healthcare change that’s going on in the environment today, there's not a whole lot of time for people to think about what business model am I working under or what should I be looking for, or how should I be partnering; I just need this, I need to get it in now.

David: That’s interesting. Do you see your team as the bridge between those two extremes?

Bob: Because my team is the main customer facing areas, we obviously are the ones that are interfacing the most, but I think that what I see is a need to have a group that is able to be the ‘go between,’ to be able to facilitate that service perspective and ITIL helps bring that into reality. When you use the words ‘service catalog’ with a clinician, they don’t get that; that’s just a word to them. When you give them the idea that if you were going to go purchase something from Sears or something like that, you can look in a catalog and select what you want type of thing they start to understand. I look at the role of ITSM as helping provide that commonality and put the structure around it.

David: In terms that they understand as well. Rob, what's your perspective on this?

Rob: I think organizations that are focused on delivering value regardless of sector can use definable processes based off of industry standards like ITIL and I think the primary difference is more process nuanced. I agree with what Bob said around value being more nuanced to clinicians and healthcare, but at the end of the day, we were supporting their deliver of clinical services and if we can align IT services and our support around value seeing from their eyes as with any other sector, as that point I think we achieve the goals of IT service management and I think those goals are likely the same for finance, government and other sectors of the economy.

David: I like the way you put that, ‘through their eyes.’ I think that was a very good way of saying it. Sometimes I personally believe ITSM is about improving business outcomes regardless of the business and helping people see it. Thanks, Rob. Anthony, what are your thoughts on this? I know you came from a very high availability, highly demanding IT organization and moved. I'm not saying it isn't demanding where you are, but a different type of pressure and a different type of organization. I’d be interested to hear your perspective on this.

Anthony: I think you hit it right on the head. Coming from a financial sector, that user community or that [unclear 0:11:10], IT is expected to be a service. It has to be highly available, they never want it to go away, if it does go away it’s away for a very short period of time, their expectations of IT being embedded in what they do and how they do things are at that level. In my time here in healthcare, I came into this thinking ‘healthcare, life and death stuff,’ but I was surprised to see that even though IT is everywhere in healthcare and it’s a backbone of many things, the user perspective of it is not a critical type of thing. They don’t demand those services. When something goes away, that’s down for now or that sort of outlook on it. Nobody really ever speaks of high availability, although some of these applications need to have high availability, what services and things like that. I think for me and the user community in healthcare, for them it’s a paradigm shift to actually see IT not as just a thing that’s around and we use it and we need it, but really challenging us IT providers to actually step it up and actually provide the services they need, listen to the customer, have the customer challenge us to produce IT or better availability.

David: That’s very interesting. Early in my career, I did have an opportunity to provide some ITSM services into a number of healthcare networks, and one of the things that struck me was that IT was extremely distributed in many of those organizations. Do you think that some of what you were talking about, not seeing it as a high priority service, you think that maybe stems from the fact that maybe IT was more departmental?

Anthony: What we’ve been going through here at NYC Health and Hospital Corporation, just because historically the way this hospital system came together, every hospital, every region was its own island. They have their own network and CIOs. They had their own clinical administrative that they report to. The last several years, what we have started about four years ago, they consolidate 32 helpdesks into one centralized helpdesk. We’re consolidating a lot of physical service into two central office distributed data centers. It’s been a challenge as far as that goes because one of the things I recognized, and they look at central office like the evil empire somewhat, within six months of that is the people who run IT out of these hospital locations, they are the closest to the patient to delivering the services. I found out very quickly that in their areas when IT isn't available because of compliance, they go back to paper; they do things manually.

They're well versed in those standard type of operating procedures to get the job done. Now we have this whole consolidation thing to central office and the people in central office, like any central office, pretty much know everything about everything. I'm, for one, that I'm learning so much and I'm trying to bring back what these people who deliver healthcare at these locations, their expertise into the central office realm of running things because they are more aligned with these local people supporting IT like the world that I came from; upfront, in the pits, that user who’s not getting a service is right across the hall from me or is knocking on my door.

David: Rob, Bob, does that resonate with you guys? Are there some similarities in what Anthony said in your organizations?

Bob: I think for me there is a similarity there. We have three community hospitals in our central main hospital and we are 100% EMR as of a year and a half ago. What we've seen is the traditional campus driven, because they're in different communities, initiatives that now have to take on a system perspective because what they do in one has to translate across the board in terms of practices and so forth. I think there's been a challenge in that arena for understanding. We've recently gone through a whole nursing model of care change based on the fact that with the affordable care act coming into play, we've had to make some operational changes and I think it was a significant change for them to change their model of care based on the delivery of EMR to them and the efficiencies they expected to get from it.

It adds a little bit of uniqueness in the fact that they're used to having the autonomy and their ultimate thing is take care of patients; they don’t need a computer to take care of a patient. That used to be the case and that no longer is the case because there's no paper. It changes their whole perspective on what's being bought in and system perspective comes into play.

David: Very interesting. How about you, Rob? Any similarities in your organization?

Rob: Yes. We actually see those challenges. To go back to Anthony’s earlier statement, these processes in IT are really about the value proposition and value for a clinician is that these technologies and tools that are applied via the application of information technology enable their clinical processes that are evidence based that they adopt and then subsequently apply technology as a tool. I think that’s a real challenge; the adoption of standard processes and the ability for an IT organization to go deliver against those processes in such a way that the technology isn't an inhibitor to care but an enabler, then the value becomes self evident and aspects of service management of disciplines like project management and information security management are actually valued and are services that are desirable in those settings and not necessarily seen as a blocker to patient or to taking time away from the clinician’s focus and allow them to focus on the patient and less on the computer and [unclear 0:19:17].

David: To listen to you folks speak, what I'm getting from this is while there are some nuances perhaps with culture, the way your organizations evolve, the central office, the distributed camps, the goal remains the same. It’s really supporting the business outcomes and it’s really providing value in a way that the users understand and can resonate with.

I'm going to stick with you for this question, Rob. The next question is could you tell us a little bit how you’ve organized to support ITSM? For example, is it very grassroots? Have you got some executive support? Is there a program office? Are you doing it off the corner of your desk? Can you give us a little sense of how you're structured for your supplemental program?

Rob: About 18 months ago, we formally structured an IT service management organization. It’s got a relatively small team, it’s got dedicated management from a highly certified professional in [unclear 0:20:23]. At the outset of that initiative, we chartered the group and set job descriptions that were very specific towards the activities and oversight that we wanted that group to have. We subsequently engaged our executive leadership team in approval of the program and repurposing some resources to support that, and during that process, came to the realization that an ITSM program taking and applying best practices and continual process improvement really ties nicely with our organizational Lean initiatives in the process improvement initiatives there. In my experience, many organizations have adopted Lean as a process improvement and management process across their organizations through clinical and business sides of the house and basically to get the support and continue to drive with the support.

We believe that the ITSM program, the application of best practices, is how we will achieve the Lean IT organization and it starts to give us a common taxonomy to speak to the organization given that many of our executives, managers and directors, including senior directors, have all been trained in Lean.

David: That’s really interesting. I've seen in the past organizations who are getting into service management for the first time benefitting by, I don’t want to say writing the coat tails, but basically by working along with other programs that might be within the organization such as Six Sigma or Lean or maybe a certification initiative like ISO20K. Those things can be a great way to buy additional support and to combine some resources towards a common purpose. It was interesting to hear you say that because I've always thought that that was a great way to help embed service management into an organization.

Rob: Given that these are both process management improvement frameworks, it gives those executives who already have their stump speech on Lean, a real easy way to integrate a conversation around IT service management.

David: Well said. Did that make it easier to get support for your organization? I was going to ask the question, was it hard to get the support or did you find that the fact that there was a lean program going on make it a little bit easier?

Rob: The fact that the Lean program existed and was well adopted and politically on track and supported all the way from the CEO’s office down to the line level leadership and staff made the adoption and subsequent maturation of the ITSM program very successful in my opinion.

David: I think that’s a great takeaway for everyone in the audience. If there is a program out there that seems to have similar objectives, it shouldn’t really been see as an adversary or someone competing for resources, but it could be a great opportunity to further enhance what we are trying to accomplish because they are common goals.

Anthony, how about yourself? You talked a little bit in your introduction but can you just give us a brief summary on how you're organized and some of the challenges and struggles that you might have faced?

Anthony: Actually, this service management journey began in 2008 at NYC Health and Hospital. It was pretty much not recognized as an ITSM thing then, but they knew they had a need to, at some point, start to consolidate helpdesk and things like that and ITs and move the many dozens of data centers we had to two main data centers. With that, they brought a consulting [unclear 0:25:05] in Accenture that did this big requirement gathering and they listened to everybody and everybody thought they had their own specialized requirements, but when you boiled it down at 100 requirements like 97 and we’re all just about the same. If they decided on a framework, which was a best practice framework, they decided on ITIL and they decided on the ITSM model moving forth and they also decided on a technology where pretty much a BMC shop here. What they also did that was good, that was fortunate for me at the end of 2009, they recognized that we just can’t have consultants running this because some of the additional feedback they got after 18 months was we have all these consultants coming in and they tell us about all this stuff and then they just disappear.

It was decided by executive management to start to have a permanent service management organization and that’s when my vice president was brought in the end of 2009 and he started building a team of more IT eccentric people because we had project people and finance people take over initiatives because they were here to do it. The team that came in 2010, everybody on our team and our new CIOs team is pretty much, we've been doing IT for a very long time. It became more structured, all my staff are permanents now, and now when we go out to do things, I'm a type of guy where telling you which way we got to march and receiving feedback, I’ll actually roll up my sleeves and through demonstration we were able to build confidence that we’re not acting like consultants just telling them what to do and coming back and checking on them; we’re actually moving ahead with the service desk consolidation, we started incident, we started change, we started asset and then it’s a whole confidence building thing.

I think one of the most important things that I recognized was everything about hospitals. As I was walking around hospitals the first year I was here, I noticed on the board they had dashboard graphs and all kinds of clinical process improvement stuff. The program we have here that’s still ongoing is called Break Through. It’s about standard clinical processes to reduce infection rates and reduce things in healthcare. I said to myself ‘what a way to have clinical people understand IT service management.’ We all learned about the scientific method when we took biology 100 years ago. Whether it’s the scientific method a repeatable process is or that example I use is how 22- or 20-year-old kids, young adults, are able to run aircraft carriers. I actually give those examples and it makes a good connection from them because what we’re trying to do here is a best practice, standard process for the things we did in IT. That’s a little about the organization and my learning curve to get comfortable with the healthcare in general.

David: One of the takeaways I took from your comment, I call it ‘baby steps,’ but the fact that you built confidence through success. Programs that I've seen implode upon themselves were programs that promised the moon and delivered very little. To build that confidence and taking those nice baby steps, showing success and then getting buy in to move on to the next thing; that’s pretty cool. Bob, how about your organization?

Bob: Like Rob, on the clinical side, we have a Lean organization, and it actually became the impetus for us to have to look at something structure wise on the IT side because of all of the Lean projects that were coming. The business side didn’t know when or how to engage IT or if they even needed IT when they ran these projects up and it was created in havoc in the ad hoc environment that we were struggling with. We became a very siloed IT department driven by the various ad hoc technologies that were coming in via these process improvements and things of that nature.

I’d seen the organization for the last 20 years because my wife was on the clinical side of it, so I had a pretty good idea of where some struggles were and where I might able to bring some help. That’s when we started our ITSM journey looking at a framework that would align well with their Lean process improvement and compliment it and also give the technology side of the house a way to be successful at delivering on these processes. I started that journey 2 ½ years ago with what used to be IT Optimizer, which is now Navvia, and started with looking at what our processes were around the core things; incident, problem, change management, and how mature were we. We started with that and once I did that then presented a plan to IT leadership about how we could start on a path to make ourselves better and laying out the processes. We've done that and its already showing tremendous results in how we’re being able to operationally support the healthcare side of the house.

David: That’s really a great way of showing how these processes can actually provide direct benefit for the business. There's a question that came in from Bob from Pittsburgh. The question is ‘has anyone ever used ITSM to assist folks in facilities maintenance or housekeeping do their jobs?’

Anthony: I know where I came from in my old world. We very tightly align with facilities because of building operations and we had data centers in the building. I think since I own enterprise change control, my interactions with facilities and engineering has everything to do with I really need to know when they're doing things at hospitals as far as generate a test and coordination with OEM services and the maze office for all these plans they have for hurricane or things like that.

We’re starting to develop more of a consistent relationship with them to knowing what's going on with the facilities and what they plan to do so we can actually work that into our change control process and everybody can have that situation all the way and it’s about their generated test this weekend that’s going to happen at Belleview and half of our ORs are going to moved over to UPS and such.

David: I'm looking at the question and how I interpret it is, what about a service request to clean up a room or a service request because there's a problem, maybe the toilet’s overflowed in one of the facilities? Has anyone maybe looked at using the systems, be it a remedy or a service now or whatever you like to be using, that also-

Rob: Sorry to interrupt but we've actually have looked at that and I hate to say that ITSM starts with process view, but that said a lot of the processes that the facilities do align nicely with the ITIL model and in terms of providing a framework for asset management, providing capability to define and document PM schedules to be able to respond to a request or instance because an incident is something that wasn’t serviced, that is no longer; a broken toilet could very easily be classified as an incident in our opinion. We’re not mature enough in our processes today from an IT perspective to branch out to that degree yet, but we are having those conversations.

We’re also having those conversations around our HR helpdesk and transfer center. There are a lot of areas where there's similarities and inability to be more efficient with our dollars and our resources by taking a look at where those processes could be applied to gain that efficiency.

David: Very good. One of our senior consultants, Darcy McColin, when I first hired Darcy, one of the things that really intrigued me was about how he was using ITSM outside of the IT world because as you said, ‘an incident is an incident,’ ‘a request is a request.’ Capacity could be defined in a number of different ways. When we have to be IT capacity, they could be human capacity or capacity of any resources. I really truly believe that ITSM is very much applicable and that organization’s matured, they’ll be able to take advantage of what the ITIL has built to leverage it in those other areas. Very good question, Bob. Thank you for that.

I'm going to ask Anthony this one. What are some of the most significant challenges you're facing right now in respect to service management?

Anthony: We have a lot of cultural challenges. Since we were very distributed, every hospital was its own island, its own data center and so on. We have a lot of cultural challenges to the extent where we've been doing it this way for 25-30 years so why do we need to change things now. One example would be change management. Nothing that I tell them about change management is going to be new to anybody running data centers and running IT operations. What really is new to them and why we have an enterprise change process is because I need everybody to do change management the same way across the board and across the enterprise. Once that defenseless posture is diffused and they recognized there are efficiencies of putting everything into one database and having a standard process and a standard way to categorized and report and make the data into useful information and prioritize and such, then it becomes a whole lot better. That’s one challenge.

The other challenge is, with regards to asset management, we don’t have policies, the creation or updating the policies keeping pace with what we need to do as far as deploying process, executing it and supporting governance activities. Although just recently, some of the pressures put on us over this hurricane Sandy business and receiving feeble money and such, there's more attention on a more consistent asset management end to end, whether it’s the financials and everything in between and the sun setting. Now I have somebody from the policy area actually playing catch up with us with my assistants having those policies. It’s a really talked down, everyone’s marching to the same drum beat sort of thing.

David: Bob, what are some of the challenges you're facing? They could be anything; organizational, push back, cultural, maybe you can give us some insight.

Bob: I think one of the biggest challenges that I'm facing in our organization is ITSM in its scope is very broad. What we have started with is just a small piece so the challenge here is, where do you go next in service delivery, how do you get the technology side aligned with the business side in that direction? We've been throwing about the service catalog and request fulfillment. On the technology side, we’ve been throwing about capacity and asset management. Which do you go and then again how do you keep it to where you can manage it in that incorporation of it, because it can become pretty significant in how you execute on those things, and  where's the return on investment going to be the greatest and aligning those so that you get the greater return for the effort. I think that’s probably where we face the biggest challenges looking down the line.

David: That’s interesting. One thought that I have on that is, if anyone remembers their basic psychology 101 with Maslow and the hierarchy of needs, I think there's a set of processes that are right there foundational, and for someone to come along and say ‘we’re going to do service level management but not have good change and incident in place,’ are going to find themselves in a very difficult situation. One thing I always recommend to anyone starting out on an ITSM journey or even someone who’s mid way through one is to really work on the foundational things. They might not always be the coolest ones or the most visible ones but getting that infrastructure, getting that foundation in place, is so critical.

How about you, Rob? What are some of the challenges you're facing?

Rob: I will say they're similar, to carry on that theme around those foundational processes. We spent, as an organization, about six months working with the knowledge that we had plus resources external to our organization to really determine what those dependencies were and to lay out a high level plan that says ‘these are the disciplines we’re going to pick up in these orders because history has shown that these things that are in the later years are dependent on these things in the early years.’ Part of the challenge with building that timeline is now we have awareness of the work ahead of us and we can track against that but we also have a lot of pressure to shrink that timeline, which means that we got a lot of tenure in our IT organization which requires a significant investment in training and awareness to create a common taxonomy, a common vernacular, so we can go build these things together. I would say that’s probably one of the most significant challenges we face. It is that cultural component; we’re moving people’s cheese, we’re taking to steal from some of the Lean language, we’re forcing people who have been in their stove pipes for 20 years, we’re now asking them to look horizontally and say it doesn’t matter how well the server is running at layer seven if there's something wrong with the application layer, because what's valuable to the customer does have to do with the individual component pieces but those pieces in totality that come together to deliver the service, that’s what we’re measuring.

David: It’s interesting listening to all of you provide that response. There is a common thread there of the culture of understanding where we should go next on the road map, getting people to look at things horizontally, even determining some of the challenges of what you have to do from an asset or configuration perspective. It’s ultimately all about people what we’re doing here and that’s always going to be one of the most difficult challenges.

Rob: I was just going to say we really found a way for people to start to grasp the concept of service management and the changes we’re trying to make is simply to say that we’re going to shift IT from a focus on optimizing technology in individual components to one that is based on the idea of optimizing value and the only way we know what that value is, is to go engage with the business and to really understand what can benefit them in their day to day workflow.

David: We’re all here to do one thing and that’s to support the business.

The next question, I’ll pass this on over to Bob, what aspect of ITSM do you think will provide the best results to your organization and why?

Bob: I would say probably the structure and methodology. With using ITIL and [unclear 0:45:14], it brings process into play and forces you to define process in order to be effective with it, and once you define process, it then becomes a new point as to what's going to deliver for you because your processes, with good definition, will support just about any procedural methodology. I think going from an ad hoc environment to the structured managed environment makes it predictable and I think that’s the thing that the organization needs, especially in this day in time, is the ability to be more predictable for delivery and on support and operation.

David: I love that answer. It’s the whole practice really that the benefit is opposed to any specific aspect, like incident problem or change. Rob, how about you?

Rob: That’s funny, the notes that I took to answer that question parallel Bob’s a lot. For us it’s really the end to end process definition and that definition really helps set a common practice and expectation not only for the service delivery teams, but also for the organization and the ways that we interact with them.

David: Anthony, how about you?

Anthony: What Bob and Rob rings true to me also. Since we were so diverse and now we’re consolidated, just having a best practice framework, a standard way of doing things and also the demonstration of that there is value to this. There was certainly value recognized when we condensed 31 or so individual helpdesks that really weren’t 24/7 365 into one enterprise service desk, which is 24/7 365. You can rest assure at any time, any day of the year, when you call that number, somebody is going to pick up and somebody’s going to be very well scripted how to handle this call, route this call, assign this call and there's value provided in that extent.

Another thing is especially with service management is general, a service has many components, everything from your networking facilities to networking infrastructure to computers and servers and software and level zero stuff, DNS, everything in between there, and having the understanding that any of those infrastructure components go away, they will effect that surface and there’ll be a ripple. Of course, on the tail end of that or alignment to that, has everything to do they have realized great value here that having our change with enough lead time to figure out impact and know that you're going to affect other people if you play with this course which that sort of situation or awareness right there is gold. On the tail end of it, you make use of al that data.

We have all types of audits going here. At any given time, I'm four years into it, anybody comes up to me, if they need change data, if they need this or that, with a matter of minutes, we can turn that data around into information and give it to them. Even where I came from, I always embrace auditors because auditors were always my 5000 lb gorillas to get the stuff done, so there's great value in that and the value is being recognized. Besides the IT people, the better thing for me and my organization is its being recognized by the clinical groups out there; the doctors, the nurses, the administrative and practitioners. That’s really good solid results.

David: Excellent. I’ll start with Bob on this one. You’ve been working hard at this for a few years, is there a moment that you can speak to as an ‘aha’ moment when it became clear either to you or to your organization to other members on your team that ITSM was the correct approach?

Bob: I would say probably with the very first process that we implemented as a result of our survey and maturity assessment and taking a look at a snapshot of what the process did to immediately address some of the areas that we were weak in. I think that was probably the telling factor that it was the right thing to do and the right direction to go. It had immediate results and our first process that we brought in place was change management. In any healthcare organization, change management is always about mitigating risk and through your process and so that was probably the one that we did that I think I saw this is the right way to be going.

David: Very interesting change. Very important. If you can’t get changes into your environment with shooting yourself in your foot, you're not going to have time to do anything else; you'll be always picking up the pieces. How about you, Rob?

Rob: For us, we really started to put all the pieces together when our internal leadership came together at the executive workshop to define their vision for the role of IT within our organization, and they used words like ‘engagement,’ ‘partnership,’ it became clear that they wanted to be able to utilize some of the expertise in the IT department to help take the solid acumen that exists in IT and combine that with the technology to help propose optimal technology solutions for the organization. That executive workshop, a theme that came out of that, was that IT must be integrated with the business, meaning we need to be at the table and that we’re invited to the table. Out of that, we determined that to do that, we wanted to move to a value optimizing model. From an asset optimizing state to one that’s value optimizing and then we ask ourselves the question, how do we get there, and we said we need to adopt a service management framework and practice, and so that was truly the beginning of opening the eyes for our organization, which has subsequently led to the adoption of the ITIL process we have to date in the long term plan that we had to move the needle from an asset or technology focused to one of value.

David: Excellent. Whenever you get the executives to come out and really embrace that engagement in bringing IT to enable it, that’s definitely an ‘aha’ moment. How about you, Anthony?

Anthony: I think the area, the ‘aha’ moment, which went well, we have a chief information officer, Dr. Willis Kaponey, his comment some months ago that we had distributed applications, we have them in all these hospital facilities prior to the enterprise service desk, if things happen they may have some connection to one another but they will be reported at Belleview or Jacobi Medical Center and nobody really knew about them. You had many people and lots of cycles being focused on their own little world figure things out. Now that they come into one enterprise service desk, we shorten that mean time to resolve because we see these trends of the issues happening and we’re able to put two and two together. That’s what Kaponey recognizes, he’s hearing from his clinical staff out there, the nurses, the doctors and so on, that there's huge value in that right there.

Another ‘aha’ moment, two others, has everything to do with change management, knowing when you do these types of changes that there's going to impact of the services or could affect other things, especially in the area of consolidation. We’re consolidating where it was virtualizing stuff or leveraging consolidated storage facilities, EMC and such. People don’t understand that we got production development and testings connected to these shared services. When you touch those consolidated components, they can have a ripple effect. Just the whole change management situation awareness and impact assessment of what you're going to be doing is a huge ‘aha’ moment for this community of IT people here.

Lastly, we've been using an EMR for 25-30 years; we’re actually moving to a new EMR product and it’s a seven year project, in excess of a billion dollars and the fact that ITSM and ITIL is being factored in from the start is a wonderful thing because it added a gate in our planning and service designed strategy, decomposition and such. From the start, they already recognize over a few short two or three years that this stuff is working first and its important enough where it should be part of what we’re doing with our new EMR.

David: That’s excellent. Gentleman, we’re just at the top of the hour now and I want to get some closing remarks from each of you. What we’re going to do is combine this last question, which is, if you had one wish in respect to ITSM, but I’d like to combine this question with your closing remarks and I think we do have one more question from the audience as well, which I’ll post at the panel.

I want to thank everyone who’s on the line here today. I know we’re going a little bit late but this is just a great engaging discussion and it'll just be a few more minutes if you can hang on. Bob, if you had one wish in respect to ITSM, what would that be and why, and maybe just provide some closing comments as well.

Bob: I think my one wish would be that it was fully deployed and implemented and we were looking at maturing-

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Rafael Alencar

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