HCA International
London England

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A JJWild Experience in London

Clare Smallman, Director of Information Services, HCA Information Technology & Services

Consultants... inviting them in can be nerve-wracking for existing managers, tricky to live through, and hard to evaluate the value for money, especially with a complex engagement. But choose wisely, and the results can speak for themselves.

HCA owns six hospitals in London, England, which operate rather independently from the US-based parent company, as legislation, practices, and scale make remote support difficult. The London sites (HCA International) run a largely MEDITECH shop (23 modules encompassing most applications except for Payroll/Personnel) with a single MPI, a central data centre, and about 700 beds across the group. MEDITECH has been in use since November 5, 1996. (November 5, by the way, is a significant date in the UK, on which we light bonfires and fireworks to celebrate the failure to blow up the Houses of Parliament in 1605.)

During 2004, the organisation identified a number of major business initiatives having significant IT&S (Information Technology & Systems) components. A back-of-the-envelope risk analysis indicated that HCA International had neither the IT&S staff in place nor sufficient knowledge of MEDITECH’s capabilities across the group to proceed with these projects immediately. Looking for assistance, we sent a senior management team to Boston to evaluate MEDITECH developments (which supported our strategy) and to meet JJWild representatives (who impressed us). We had considered two other consultancy groups, but JJWild’s focus on MEDITECH and positive experiences of JJWild consultant performance at MUSE events sealed the deal.

JJWild and HCA International worked collaboratively to identify criteria that would ensure success of the multiple initiatives, the most important of which was the establishment of a self-sustaining MEDITECH support structure within the organization and across all facilities. Together, we developed a three-phase approach that embraced the JJWild “Power of MEDITECH” methodology and supported the direction defined by the hospital. The three phases included:

Power Up
The activities defined in this phase were meant to lay a foundation that would allow HCA International to independently carry out future initiatives. We focused on the current state of IT&S capabilities and the general level of MEDITECH functionality throughout the organization.

Power Ahead
In this phase, HCA International is moving forward with major objectives, such as implementing the functionality we gained in the late-2005 update to MEDITECH version 5.4 (from 4.8).

Power Beyond
This final, and currently future, phase will bring advanced clinical and physician-facing applications to the organization.

First up: Power Up

Our Power Up programme for 2005 had two main components: developing the IT&S department and developing MEDITECH knowledge in the wider business. The first component included initiatives such as IT&S restructuring, staff development, development of principles, standards, and service level expectations, and identification of change control processes. The second reached out to the individual organizations and established roles and responsibilities regarding MEDITECH support outside of IT&S.

IT&S began 2005 with 23 FTEs (including several vacancies) and ended the year with 32 in a new organisational structure. As Director of IT&S, I worked with JJWild consultants on organisational options and job profiles. HCA International then reorganised, recruited, and inducted new team members. The process, of course, is ongoing—but positions are filled, new staff members are becoming productive, and we are braced for the projects of 2006. It hasn’t been easy, and we’ve had our share of classic change curve dips, but the Employee Opinion Survey results just released indicate that the team members are among the most satisfied and motivated staff in the organisation.

Work continues in other areas, as well. Service Level Agreements and revised standards did not get past draft stage—partly because there was simply too much else going on, partly because something was already in place, and partly because I wish to complete these key revisions with my new management team. This work is now scheduled for Q1, 2006.

Developing MEDITECH knowledge across the organisation was a larger undertaking, touching literally hundreds of HCA International staff in a process review and training programme that developed business ownership (executive sponsors and line-management stewards) and local expertise (power users in the business, plus additional skills for IT&S application staff). The immediate achievements included a more self-sufficient user base, the 5.4 upgrade, and some quick win programmes in which the business made better use of existing MEDITECH functionality.

So, was the process wholly successful? Not completely if you expected rapid change. There were some clear process improvements, but not as many as we’d hoped. There were a number of underlying reasons including constrained resources, the complexity of some areas, and other issues which we and JJWild worked diligently to resolve. Some mid-programme adjustments were necessary. Sponsors, stewards, and power users struggled to understand their roles and to find time to undertake them. But bottom line: we were able to address all of these issues and move forward.

Was it worth it?

Decidedly. The real proof of the pudding has been the ability of the entire organisation to engage significantly in the implementation of MEDITECH version 5.4—a big jump from 4.8—in the latter part of 2005. The previous update had been largely run by IT&S. This time, power users and their sponsors and stewards found themselves heavily involved, and they rose to the occasion. We have several of the Power Up Quick Wins appearing as business-wide projects for Q1, 2006 and we are revisiting organisational structure in some areas to ensure adequate resources for our 2006 programme of new strategic developments using the skills and knowledge gained in 2005.

What’s next?

We’re certainly more self-sufficient, the main goal of Power Up (Phase 1). And now that we know so much more about what we are doing, we’re able to be more selective about the outside help we need and apply greater focus in support for our 2006 programme. The upgrade to MEDITECH version 5.4 was a big step into Phase 2, and we’re looking forward—with JJWild’s help as required—to tackling more on the to-do list. Power Ahead!

Clare Smallman is Director of Information Services for HCA Information Technology & Services in London. To learn more about HCA International or this initiative with JJWild, please contact editor@jjwild.com.

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