N.+Knight+Page

1. Organizational structure of IT- In my organization the Chief Information Officer reports to the Executive VP and Chief Operating Officer, who thens reports to the CEO, who then reports to the Board. There is a Chief Medical Information Officer who reports to the Exec VP and Chief Operating Officer as well. There is a combined IT oversight committee that oversees IT for both the Hospital and the Clinic and is responsible for ensuring ongoing operating stability, incorporation of new technology, and recommendation for new purchases to the hospital and clinic board. 2. Who manages IT budget? The IT budget is developed by the IT department, is overseen by the IT oversight committee, and then goes through the hospital budget review process with the CFO and the Exec VP and COO, and then goes to the CEO for final oversight, and then on to the Finance Committee of the Board, and then to the Board for final approval. IT has its own budget, but each department has an allocation for capital items, and IT capital items comes out of those dollars. Each department director or VP has to go through the Budget approval process to justify their requests. Decisions about IT projects that cost more than $25,000 must go to the Board for Approval, and projects that are less than that and are budgeted through the capital allocation process can be approved and authorized by the director or VP for purchase. 3. Do they outsource IT functions? We in the hospital contract with the clinic for IT services, and use the combined IT oversight committee for oversight. There is no outsourcing of IT functions unless we do not have the expertise in-house, or a critical project is needed and we cannot do it in house. 4. In thinking about an overview of a successful IT projects, I would have to say that one of our biggest successes was the implementation of our Epic electronic medical record. This was an $18 million dollar cost to the organization, minus some hardware and installation costs. It was implemented on time and on budget, and has made us one of about 4-6% of hospitals in the country to implement physician order entry. An example of a failure brings to mind on implementation of an electronic documentation system in our ED about 10 years ago. The system used templates, and was sold to us with the understanding that it would save us about $ 400,000 dollars a year in transcription costs. The system unfortunately did not work as billed, as it had multiple software bugs, and it went down frequently. When it did the on call tech would want the physician to stop seeing patients, and do trouble shooting on the system. Our IT department did an evaluation of the system, but did not load the software program with the number of patients that it needed to handle simultaneously, and so were not able to apppreciate the impact on the system in use. We did not do a good enough job in our contract with the company to ensure performance levels and support of the system. 5. What are IT projects that are planned for the next 2 years? We will be implementing OpTime which is the electronic health record that will be used in the perioperative and operating rooms in the hospital. We will also be implementing an enterprise wide registration system. These will be implemented out of necessity, as the OR needs to be electronic, and the enterprise registration system is necessary as we are using a legacy system with poor support and recurrent downtime issues.
 * __Questions__**

Here are the top ranking from the two individuals that I talked with: 1. Ensuring that hardware and software that is critical for patient care and safety is in good working condition. His staff rely on this equipment and don't have time to trouble shoot if there are equipment malfunctions. 2. Having an IT call center that is able to effective support staff when there are issues with the equipment. Again, they do not have the time to do this as they are involved in patient care. 3. Non-standardization of software throughout the organization, which causes difficulty in communications at times.
 * __Interviews__**
 * Nursing Manager Intermediate Care Unit**

He did not have any issues with the way that IT was governed in the organization.


 * __Director, IT__**

1. System redundancy, and uptime (ensuring critical systems have redundancy so in the event of a component failure, system switches to backup automatically. This also includes a secondary data center with alternative power grid, generators, etc.) 2. Data backup (ensuring that all systems have the data backup in the event of data loss. Backup includes having data off site as well in the event of the loss of the data center) 3. Disaster recovery 4. Data integration (within the organization where we have multiple disparate systems) 5. Data exchange (external to the organization where we want to share data with or from other facilities and providers. This includes outside images) 6. Server consolidation through virtualization. As we continue to grow applications which require more horsepower, power/cooling/space requirements become evident. Virtualization is designed to mitigate that.

IT Governance 1. Having a single IT department with a single CIO for both the clinic and the hospital is advantageous in terms of policies and strategic planning. 2. Given the growth in the IT department and dependency of operations on IT systems, it may be that an Asst. CIO is required to support day-to-day operations while the CIO devotes time to strategic planning. 3. Policies are in place regarding the prioritization of various IT services and projects, but we find that waivers and exceptions are more the norm and thus, we end up with resource constraints because of competing departmental initiatives. Each believing theirs is the most important.

Cisco Case Review Did he think that line managers should get to make //all// IT decisions? He wanted IT investment decisions on application projects pushed out to the line organizations and their respective leadership, but the central IT organization still executed them. How well did Slovik's model of IT governance work? How did Cisco itself in such trouble with regard to its internal IT in 2001? There were multiple order-status tools. The tools used different definitions for key terms, redundant systems were being created. Why didn't the single ERP system help? Due to the large amount of customization and lack of standardization that it led to. They wound up with multiple systems performing similar functions. It also led to extreme difficulty when the time came to upgrade its most important enterprise-wide system. Why didn't it ensure more consistency? There was not consistency in data sources and the core architecture, and IT decisions were being made in functional silos, with no centralized group checking for conflicts and redundancies. What is 'Shadow IT'? Describes IT systems and IT solutions built and used inside organizations without organizational approval. Why should a CIO want to control / minimize it? The proliferation of these projects can lead to increased costs, use of IT resources that the company may not have, waste of resources if the projects are abandoned, and loss of IT focus. Are there effective ways to do so? If there are committed resources, and there is leadership support for experimental projects than I think it can be successful. It needs to fit within the construct of the IT strategic plan and funding structure. Do you think Boston's amnesty program will work? The success of the changes that he made was a testament to the fact that it did. Making it clear to the employees that he knew that it was going on, yet being willing to take the time to uncover them, which may have led to some interesting learning on his part, was an important way to support the employees, yet corral the activity. It was also an example of good leadership. Does it stand a good chance of uncovering all or most of Cisco's shadow IT projects? Yes it does. Most amnesty programs allow a period of time to "confess" without penalty, but then have a punishment of some type on the backside. What is BPOCs role? The role, in short, was to function as a high-level advisory committee, with senior representation from each of the major functions. It was set up to set and drive corporate priorities for the company, as well as making key operational policy decisions, aligning initiatives across the company, developing the corporate business process framework, and enforcing decisions with attention to execution and accountability. They also made recommendations that afffected how the company allocated its IT spending. How much formal authority does it have? As above, they had a great degree of authority with respect to policy creation, aligning initiatives, developing frameworks, and enforcing execution and accountability. Given that they made recommendations with re: to IT spending, this would add to the clout of the group. Would you approve call center project? Yes. Why? a. The customer advocacy group had already successfully proved the concept in a European pilot so there was proof that it could work. Given the number of countries and cultures that this likely involved, many cross functional barriers that would need to be overcome would already have been shown to be possible. b. Given the customer centric nature of their business, a proven program that would lead to further enhancement and improvement of the customer experience would be of extreme importance for the company. c. Given the relatively new role of the BPOC, this project, if successful, would give further support for the BPOC in the eyes of the employees and the Board. d. It would also allow them to pool resources, which would likely lead to lower costs and better efficiencies as well. Do you think that Cisco can easily transition to a more horizontal, process-oriented company as described on pages 8-10. Why? I don't think that they will be able to do it easily, but I think that eventually they will be able to get there. Given the structure and success of the company in its current state, there likely is not a burning platform that the employees can see for making the change. In order to make this happen, they will continue to need strong leadership from the top, clear delineation of the importance for the change, continued examples of the change and the success or improvements that it will bring, and how it will benefit the employees. I think one of the main reasons is Brad Boston. He seems to have a good analytical mind, seems to be able to push the organization in directions that they need to go, and has made some important and necessary changes which I don't think he would have been able to do without significant leadership and communication skills. ||
 * What was Pete Solvik's to IT decision making at Cisco? 1. He changed the org chart such that IT moved from finance to the customer advocy group. 2. He reallocated the majority of the IT budget so that each function and department controlled the money, rather than having all of IT spending clustered together under general and administrative expenses. 3. He disbanded a central IT steering committee and replaced it with a structure by which IT investments decisions on application projects were pushed out to the line organizations, but still executed by the centralized IT organization. His thought was that this would help to change the perception of IT as overhead.


 * __Analysis from reading and interviews__**

Do business and IT managers have different views? Are their views aligned? Are the views about IT strategic or tactical? From my interviews and reading it appears to me that there is a difference in my organization and others in the way that IT is viewed. Business managers tend to look at IT from a day-to-day survival perspective. How does the technology enable me to do my work. How does IT allow me to achieve my goals. How do the people in IT support me and my IT functions so that I am able to deliver what is required for the organization and my department. IT managers tend to think longer term with regard to functionality of applications, security, advances in technology, and their ongoing struggle to maintain operational efficiency, as departments continue to change their priorities, and thus those of the IT department. The strategic decision making with regard to direction of IT and how it continues to support the business seems more top of mind the the IT managers as well. One other critical difference was the importance of system security, with IT managers understanding the threat to systems and the organization much more that the business manager.

Does the way IT is governed or the organizational structure impact the way managers view the role of IS/IT? They way that IT was governed did not seem to make much difference to the manager in my organization, but was more appreciated by the IT director. The focus on the part of the manager was much more on making sure that the technology being used by their staff was working and adequately supported by IT. They truly did not seem to worry about the governance issue at all. The IT director thought that our current structure was adequate for now, but may need to be addressed in the future. In organizations other than health care I don't think this discrepancy would exist as widely, as IT might play a larger role in departmental functions, with resulting internal politics driving the ability to steer IT support or projects to individual departments. Does the industry or size of business have any impact? I think the size of an organization plays a huge role. In organizations that are geographically spread, that may have a larger reliance on IT functionality, it is more likely that the governance issue is a problem. As the company tries to prioritize the various competing needs of the organization, which may be impaced not only by geography, but a variety of cultures, this issue can be a significant problem. In a smaller business these concerns may be fewer, but their may be other issues such as having the capital to fund the technology needs of the organization, and to support the technology with an adequate staff as well.