Sisters of Mercy Health System

Chapter 20: Health Care 247

however. If a doctor ordered something or created a prescription, she would write it out or dictate it.

Mercy’s service desk operation needed to become more efficient to address the increased IT load from new clinicians and physicians utilizing the EHR. Additionally, in 2006, consultants examined Mercy’s service management performance and found that poor processes and human error were leading to down time and other quality-of-service issues. Changes that weren’t well planned or were rushed often resulted in problems. The trouble-ticketing system, which didn’t distinguish among different types of problems and requests, was also causing problems: Nonurgent requests were sometimes resolved more quickly than urgent incidents.

Both senior IT and business executives agreed that they needed to strengthen the IT infrastructure and services quickly to support the project with the rocksolid availability it needed to succeed. IT leaders began talking about required uptime, planning for “3 nines” (99.99 percent availability of systems). Even at that high level, those that used Mercy’s most important systems would still experience 8 hours and 46 minutes of down time per year. Additionally, it became clear that technology alone would not save the day. Equal focus on creating stronger processes was essential. Mercy needed to adopt service management and processes to ensure success. Mercy’s deployment goal was very aggressive. Service desk, asset, incident, problem, change, and release management were all included in the initial six-month design period. The hospital system had many requirements for its service management solution, which had to be modular, flexible, and streamlined across different areas and processes.

Prescribing a service management solution

Mercy leaders decided on an integrated solution to meet high availability needs. With so much infrastructure and so many applications, the team needed information to flow seamlessly from one process to the next. If an end user created a service request that then became an incident, Mercy wanted data from the request to populate the incident record automatically. If the incident required a change, Mercy wanted the system to feed the incident and change action automatically through the approval and change-authorization process. In case the fix failed, Mercy’s IT staff would have clear documentation to identify changes that could have caused the failure.

To meet its six-month deadline, Mercy “wanted to affect cultural change within our IT organization, so we did a big bang,” said Will Showalter, chief information officer for Mercy. With strong executive sponsorship, he

recruited business-process managers and owners to help evangelize the initiative and organized “synthesis sessions” to let everyone see design and provide input. All managers attended ITIL foundations courses, and the rest of the IT crew participated in a lighter version of ITIL training before they were trained on the new tools and processes.

248 Part V: Real Life with Service Management

Providing a service management makeover

Michael Zucker, director of process and quality for Mercy’s IT division, led the service management effort. He would have liked extra time for testing, of course, but he didn’t have that luxury. Mercy’s IT staff not only had to be trained in the use a new tool, but also had to adopt a more disciplined

approach. With the clock ticking, Zucker knew that the initial live deployment was bound to face some hitches. “We tried to be very proactive in our communication,” he says. “Executive sponsors were saying, ‘We are going to do it, so accept that — and once you accept that, here’s a plan to handle it.’”

Setting expectations

Setting expectations became a top priority. Zucker’s organization supplied end users and service desk staff information about potential problems and armed the service desk with guidance about how to address those problems.

This strategy helped the team navigate the inevitable bumps of the initial rollout in early 2008. Some IT staff members found the more rigorous service management process a bit cumbersome at first, but they got the message that it was important to “make sure they are thinking about it twice before taking action,” Zucker remarks. Still, the time crunch took a toll; the January 2008 live deployment of the new application and processes was rough on many of Mercy’s IT teams. But Mercy has been working steadily to smooth out those initial rough edges. “We might not be where we want to be yet, but we are heading in the right direction,” says Showalter. “Continual process improvement and a focus on quality will always be with us.”

The system now supports both infrastructure and clinical applications, serving as a single system recording work done by any of Mercy’s 700 IT people. “Everything is recorded and managed here. It’s our vehicle to communicate and make sure the work gets done,” Showalter says. The integrated service management dashboard provides a much better reading on the health of systems and services, enabling IT to track more processes and metrics than before.

Refining the tracking system

Currently, Mercy is concentrating on refining the system through better discipline and additional metrics. Mercy already tracks availability at the network level and is working to measure availability at the individual application level. “All the support processes are interrelated, and we can look at them,” Zucker says. “If something breaks down, it could be any number of things. Now if a user complains about slowness, we can more easily identify the root of the problem and direct it to the right service group to get it resolved faster.”

Better discipline and visibility have helped Mercy improve accuracy, deliver higher availability, and respond more effectively when an issue does arise. Staff members can now distinguish between an incident (which requires immediate attention) and a request (which isn’t urgent), and apply different metrics to each.

Chapter 20: Health Care 249

Mercy’s IT division also introduced policies and metrics regarding standard and unplanned changes, and tracks these changes with specific key performance indicators. Improved metrics and tracking help identify processes that aren’t compliant. If the metric mandates that all priority-one incidents need to be resolved within eight hours, the tools enable staff to spot any metrics that look suspicious and take remedial action.

Conducting customer and user surveys

Mercy conducts regular broad customer satisfaction surveys across the organization, uses a link from the system that provides feedback and ratings on service for individual incidents, and surveys users about specific incidents. User satisfaction and other key metrics improved in all categories from January 2008 to the same time the following year.

Achieving a healthy prognosis

In late 2008, Mercy installed an additional component that can move its assettracking functions to a configuration management database (CMDB). Currently, Mercy is adding new service-catalog functionality for different IT services to the CMDB, with 20 IT teams using the catalog management function to define individual service lines and the discrete services that they can provide to end users (and to one another). With this capability, IT staff members and users can view and order services as they would from an Internet-based retailer. Requests for infrastructure services (such as network or voice) and for clinical and business services are logged. The service catalog helps users throughout the organization find the services they need quickly and determine the right team for the job.

Going forward, Mercy’s strong, consistent, and ongoing executive commitment will drive continuous improvements. The original implementation team, consisting of both business-process managers and IT personnel, now serves as a process board, discussing, prioritizing, and authorizing process changes. The application itself also helps enforce more discipline in processes and provides metrics that flag areas that are out of compliance.

Given that Mercy Health accomplished its service management transformation in record time, Mercy’s IT leaders are often asked how the health system managed to get so much done in such a short time. They attribute its success to a few key factors:

Strong executive sponsorship that established service management as a critical corporate priority

Thorough evaluation and selection of comprehensive solutions that provided the necessary tools up front, as well as the ability to integrate additional components on Mercy’s own schedule

Set expectations up front, and established proactive, open, and collaborative processes to facilitate change