Up-Front Analysis:
How’s That Workin’ Out For Ya?
Monday, April 14, 2014 – 2:30-3:45 pm
Dr. Victoria W. Grady
President & Principal Consultant
Pivot Point Business Solutions
Jinnie Lee Schmid
Certified Partner, Pivot Point Change Index
Owner & Principal, Change Navigators, LLC
Dr. James D. Grady
Chief Executive Officer
Pivot Point Business Solutions
Up-Front Analysis…How’s That Workin’ Out For Ya?
Opening Activity – Case Study (Your Turn)
In 2011, County Hospital* (in a mid-sized US city) was on the verge of installing a long-overdue software
update to a new coding system. Their existing coding software was no longer being consistently
supported by the vendor, and the number of technological glitches affecting the system was increasing
over time. The new software company had a track record of considerably improved performance in
financial collections in its other clients that were hospitals similar to County.
The coding software initiative was called Project InfoSys. The Hospital Administrator expected its main
impact to be on the Coding (staff who type various codes from medical notes/records into software
system(s), which impact collections from insurance), Information Systems (technology department), and
Medical Records (staff who organize, store and retrieve patients medical information) departments.
Additional departments within his responsibility include Patient Access Services (staff who explain to
patients what services are allowed/paid by insurance according to their diagnoses), Patient Financial
Services (staff who make financial arrangements with patients, both insured and uninsured),
Transcription (staff who transcribe non-electronic medical notes into the system), and Utilization Review
(staff who liaise between doctors, patients and insurance companies to determine discharge dates).
Project InfoSys came on the heels of another recent change initiative. In 2010, Project ManuScript was
an installation of software allowing physicians to enter their hospital notes and medical orders directly
into an electronic tablet at the point of creation (rather than capturing them on paper and having them
transcribed by staff at a later date). The success of this project relied on physicians becoming proficient
in using the tablets, but they rebelled against being mandated to change, and against devoting time to
attend the requisite training. In response, hospital administration modified the mandate that all
physicians use the electronic records system, and provisions were made to allow a “hybrid” data entry
system. In the end, Project ManuScript resulted in severe cost over-runs and time to completion delays,
and as of the current date only a percentage of physicians were using the tablets to record their notes.
As the “cross-over/go-live” date for Project InfoSys drew closer (it was now two weeks away), the
Hospital Administrator became concerned that his target departments would have trouble adjusting to
the changes in coding and reimbursement processes. There were many “water cooler conversations”
occurring which seemed to raise the level of anxiety among several administration departments. In
addition, County’s Board of Directors was expressing increasing levels of concern that the coding
changes would disrupt the hospital’s cash flow, possibly causing s in funds necessary to cover operating
costs. Two weeks ago, both the city and county governments that support the hospital announced an
unexpected proration* in funding that equaled a 25% reduction in funding the hospital had historically
relied upon. (*Emergency measure in which governments reduce funding to all its recipients by an
equal amount – as in “a 25% reduction across the board.”)
The Hospital Administrator began to panic, fearing both a repeat of the last change initiative and the
unknowns surrounding the impending one. He felt it would be important that the hospital experience a
smooth transition to the new coding software and rapid acceptance and mastery of the resulting change
in coding processes. He usually leveraged small Training and HR departments for support on these
projects, but none of his staff had experience in change management. He traditionally relied on his
software vendors to manage “the people side of change.” For Project InfoSys, the vendor was planning
to provide two weeks of on-the-job software training starting on the go-live date.
*Names of people, institutions, projects, and products have been changed, and other editorial license has been
taken; otherwise, this case study represents the essentials (including actual data) of a real client engagement.
© Change Navigators, LLC & Pivot Point Business Solutions, LLC
THE Performance Improvement Conference, www.ISPI.org, 2014
Page 2
Up-Front Analysis…How’s That Workin’ Out For Ya?
Data, Case Study #1 – Hospital
Hospital Level of Instability
Alert
G/G
An/Mr
Fr/LP
RD/Mo
RE/Cf
RP/Ab
Wd/To
AVG.
Instability by Department
Coding
Alert
Information
Systems
Medical Records
Patient Access
Services
Patient Financial
Services
Transcription
G/G
An/Mr
Fr/LP
RD/Mo
RE/Cf
RP/Ab
© Change Navigators, LLC & Pivot Point Business Solutions, LLC
THE Performance Improvement Conference, www.ISPI.org, 2014
Wd/To
AVG.
Utilization
Review
Page 3
Up-Front Analysis…How’s That Workin’ Out For Ya?
Data, Case Study #1 – Hospital
Instability by Job Responsibility
Director Or
Manager
Front Line
Employee
Supervisor Or
Team Lead
Go/Go
An/Mr
Fr/Pr
RD/Mo
RE/Cf
RP/Ab
Wd/To
AVG.
Instability by Yrs of Service
0 To 5 Years
6 To 10 Years
11 To 20 Years
20 Years
G/G
An/Mr
Fr/Pr
RD/Mv
RE/Cf
RP/Ab
Wd/To
© Change Navigators, LLC & Pivot Point Business Solutions, LLC
THE Performance Improvement Conference, www.ISPI.org, 2014
AVG.
Page 4
Up-Front Analysis…How’s That Workin’ Out For Ya?
Data, Case Study #2 – Pediatric Clinic
CDI SCORES
(Avg. of all sub-scales)
Organizational Summary
Baseline-Aug 2010
Calibration-Oct 2010
Final-Feb 2011
CDI SCORES
(Avg. of all sub-scales
Floor Nurses Only
Baseline-Aug10
Calibration-Oct10
© Change Navigators, LLC & Pivot Point Business Solutions, LLC
THE Performance Improvement Conference, www.ISPI.org, 2014
Final-Feb11
Page 5