The Way to Right-Sizing

Kathryn Mackenzie, for HealthLeaders Magazine , October 13, 2008
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Determining the proper resources for the IT department is often a difficult proposition amid changing technology needs and tightening budgetary constraints. But it can be done.

Early in his career as chief information officer at North Shore-Long Island Jewish Health System, John Bosco performed an assessment of the Lake Success, NY, system's IT infrastructure and made the decision to virtualize as many of the system's servers as possible. Server virtualization is generally thought to save money while conserving energy and securing data by requiring fewer servers to handle more applications.

About a year and a half after the virtualization project was complete, Bosco made another decision: to hire an outside consultant. Although everything seemed to be running smoothly, Bosco wanted to ensure he was getting optimal performance out of the new virtualized server environment. The consultants studied the system and found much that was being done correctly—along with some things that could be done better.

The ultimate result, Bosco says, was a smoother, more effective server system. Such reassessment of IT department projects has helped 13-hospital North Shore-LIJ keep its IT department "right-sized," Bosco says. "Determining whether you have the right processes, the right number of people, even the right infrastructure in place takes constant reassessment. If you can do that internally, good, but we've found it helpful to bring in outside experts to understand where we might be deficient and what to do about it."

A common sentiment among hospital CIOs is that they understand the need to remain vigilant about the how the IT department is operating; many CIOs say the department should undergo a thorough assessment once a year, or even more often. But setting IT priorities and determining the proper resource allocation can be a challenge as technology needs shift, competitive pressures grow, and internal stakeholders offer sometimes conflicting assessments.

JoAnn Klinedinst, senior director of healthcare information systems for the Healthcare Information and Management Systems Society, says any IT department assessment should consider how the department supports the system's overall mission. Klinedinst recommends performing a periodic perception survey of the entire executive team. "It's important to understand how they see technology contributing to the broader patient care mission. The tricky part is to do the survey in a way that doesn't penalize those who make comments or suggestions you may not have been expecting. In the end, you want the process to be objective and helpful, leaving the entire organization feeling like the IT department is a partner in the mission," says Klinedinst.

Once the CIO understands how the department fits into the organization as a whole, she says, the next step should be intermittent analyses that determine the IT department's strengths, weaknesses, opportunities, and threats (SWOT). This type of analysis, she explains, is designed to identify specific attributes that assist in objective setting and developing specific strategic objectives. "Performing the SWOT analysis on a periodic basis helps you determine gaps or surpluses in service, compliance, and personnel. It's especially important for IT because the systems are so complex and regulatory issues do change," she says.

A case for outsourcing
Regular assessments and an organizational emphasis on quality and patient safety helped the 319-staffed-bed St. Clair Memorial Hospital in Pittsburgh become one of a handful of hospitals in the United States to receive a "Stage 6" designation on the Healthcare Information and Management Systems Society Analytics EMR Adoption Model—a method of rating hospitals on their progress toward a paperless patient record environment. But Richard Schaeffer, St. Clair's vice president and CIO, says the hospital also employs another tactic: outsourcing many of its IT functions.

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