HT2/LCHQ

I've been noodling about an effective way to bring heightened awareness to a typical event in the transition from implementation to ongoing. I'm thinking about that point in time six to eight weeks after an enterprise go-live when the risk of decay in data quality and integrated process sustainability begins and the transformation can begin the long stallout.  It often happens because the technical team and extended implementation resources either move on to the next client and project or disband completely. Attention of the front line operational support team shifts to the work left undone in the buildup to the implementation event.   Without a clear plan to avoid predictable behavior, sustained end user attention on what they are doing and why begins to taper off and opportunities for continuous improvements are lost.

My observation has been that data quality and process adherence usually continues an invisible decay until the organization reaches the next milestone. That milestone occurs when data are made available for first hand review by stakeholders who spot data gaps or the results of workarounds. The stallout ends because these stakeholders have a vested interest in identifying problems and driving corrections.

Who are these stakeholders?

• Leaders who make collaborative decisions based on the aggregated data and the need to have an accurate single source of truth.
• Consumers who own the data and spot errors because the information is familiar and personal. 

Three phases come to mind to describe how data visibility gets things moving again:

"What gets measured, moves"

"If it is all about me, it better be right."

"Pay me now or pay me later."

In many instances, getting data to these stakeholders doesn't happen early enough in the post go-live time frame to avoid the stallout trap.  Lots of reasons for this but I think one of the biggest is it requires a lot of foresight and funding in planning the post go-live phase to include parallel data warehouse development and end user self-service access months ahead of when the input data are defined and available from the production system.

Can it be done? Sure.

Should it be done? Definitely.

But for many large initiatives, the priorities are to configure the user interface needed for data entry, physical and technical infrastructure and behavior change levers.  Building a data warehouse model, analytic tool training  for leaders or self-service access by customers will unfortunately take a back seat. Often defined as a phase two activity, data warehouses and self-service access might even be delayed if the first phase hits a snag. An alternative solution is required for the immediate post go-live period to mediate the decay problem and maximize transformation.

One solution is to immediately transition the implementation operational front line support group to ongoing support group responsibilities.  This front line support group goes by many names: liaisons, super users, at the elbow support, community of practice, local designees, local experts, coaches or simply department go to people. The key is to have a clear vision and an executable plan for how this group will navigate the phases of the timeline and encourage end user efforts leading to increased teamwork, accurate data and  better decisions.  It won't be a complete substitute for getting data into the hands of stakeholders but it is something that will need to be done anyway so it makes sense to build this community proactively, not reactively when problems in data or process define the need.  Since it means planning with the visible (people), and not invisible (data), it can be easier to formulate this plan ahead of time assuming organizational politics can be navigated successfully.

The slides below are a vision of how to work within a frame of high tech, high touch, low cost, high quality (HT2/LCHQ) to avoid the decay that typically begins at the six to eight week post go-live mark.   The idea is to leverage collaborative technologies to get the high tech and low cost component. This creates a context for success within the scope of a healthcare industry reality: the front line end user support role resides with a knowledge worker who maintains a high utilization rate with limited time for non-clinical skill development and knowledge exchange with peers. The focus on continuing the transformation through key front line people who provide the end user point of need support creates the high touch and high quality components 

These slides are a first pass at reducing this noodling to a couple of one pagers.  From here on, the devil is on the details of execution.

 

 

  

Intuitive User Interface: I really just want it My Way

Reading article by Brigitte Kaltenbacher From Prediction to Emergence in the Journal of Information Architecture.  A nice complement this weekend to the presentation I'm creating on the SharePoint mashup we used for the recent rollout.  Kaltenbacher provides a definition of intuitive from Spool (2005) that defines it as readily transferred existing skills.  Some of what we were successful with in this mashup gave me insight into some of the user's pre-existing navigational skills.  The common denominator across these roles is pretty low:  everyone seems to be able to embrace single signon, click on hyperlinks, follow a flow of logical information chunks to scaffold their experience and use the back button in the browser. Beyond that, comfort and intuition start to vary widely. And, instructions? Pretty much a waste of time.  People don't read them on paper - - they REALLY don't read them on the web.

What they requested as improvements also gave me insights into what needs to go into the next design. The need boils down to allowing personalization options based on simple questions that gets at their web navigational intuition.  What feels intuitive is really based on the applications they frequently use.  I don't think there is a one size fits all common denominator for the whole user interface which makes sense give the variety of activities that people complete on the web in their personal lives and the variety of user interfaces in the medical and clinical products in this industry.  Sure, we can impose one but then we add the burden of learning one user interface to learn how to use another user interface or tool.  Feels like wasting time to me building patterns to just tear them down.

I keep coming back to an idea I had a while back which is to start the learner's experience by asking what they do most frequently on the web: shopping? photosharing? reading news? social media? viewing and loading videos? downloading music? open source development? searching for information? I'm guessing there are probably about 10-12  basic questions representing web UIs that get at 90% of the choices.  I would exclude email as an option since it is typically a time sucking user interface given its stand alone non-contextual nature.  Then, I would present the content in the frequent user interface based on the answers to their questions.  Of course, similar to a preview template concept, if the user is curious about how the content looks in twitter style vs youtube style vs. e-bay style, they could check it out.  I'm thinking that would make transferring acquired skills a lot easier which, of course, is what I'm looking for.  Let the user's limited time in task go into interacting with the new content and processes they need to learn, not the user interface to get at the new knowledge and skills.  I'm tired of trying to chase the holy grail of the intuitive user interface and just create more information overload.  No matter how good it is, it will require time to figure out the pattern. Makes more sense to allow the user to identify their preferences and adjust the content to a familiar pattern

This article is also making me think about acquired intuition when a user interface or experience changes. We complain about something new when it changes - - even if the  change is for the better - - but them quickly set about forming a pattern in our brain of how it works.  Patterns:  our frenemy in the user experience space.  I'm  noodling over the type of introduction and learning experience you want to use when trying to change up aquired intuitions in clinicians.  There will be quite a bit of that going on this year as more healthcare organizations have to rollout enterprise products such as Microsoft 7, Office 2007 and in our case with Epic, a significant user interface change.  With Epic, it is a cleaner user interface and should improve the experience.  The challenge is, how to get people who just acquired a new pattern to trade what they know for what they don't?

I've been experiencing this myself with the copy of MicroSoft Powerpoint 2007 I got for next to nothing a few weeks ago.  The SmartArt tools are well suited for my presentation style so that hooks me into taking the time to use the newer software instead of the older version.  On the other hand, I spend a lot of time looking around for functionality I used to know automatically and still haven't found - - like Free Rotate.

Reminds me of one of the many themes from Big Jake:  changing times requires practice and patience from the expert and the novice. Yeah, I can get just about any theme out of my top ten movies.  

Where did the last two months go?

Success at last: 10 days post go-live implementation of the final phase of our multiyear emr project. It has been grueling but we made it. So many successes from the last six month for our team to look back on:
- 78% completion rate on training across a group of 500+ provider learners in 20+ unique roles with a just in time deployment strategy that spanned three American holidays: Thanksgiving, Christmas and New Years
- acceptance of fully digital delivery via a Sharepoint mashup that includes an online meeting/instant messaging option, discussion boards, self directed role based learning map with online knowledge and skill building courses combined with contextual practice through a fully functioning training environment
- single sign-on accessibility both inside and outside the firewall
- blended learning design that leverages one-on one-coaching support prior to go live with over 100 front line clinicians doing at the elbow support for specific roles after go live
- reusable assets including realistic robust patient situations that will form the basis for customized ongoing scenarios to support new hires and onboarding of academic trainees

The most valuable asset we obtained out of program, however, is the electronic feedback we collected from 500+  users on their readiness to use the system: what worked best for them in the learning experience and what didn't. Still sifting through the data but as is usually the case when you ask users what they want and like, they tell you clearly. While I wish we had something as robust as the itunes app store customer rating system to create transparency within the user community to recommended paths through the learning, any kind of customer feedback, no matter how challenging to work with for analysis, is a gift.

The Proteus Effect

Interesting study from Nick Yee on the impact of avatar characteristics on the real world behaviors. The Proteus Effect

from Health Games Research, 10/2009

Transition: Information Age to Conceptual Age

I agree with the premise of this article from Dec 2009 ACM Communications: Computer science and IT can no longer afford to crank out more "plumbers." Design and user experience perspective as well as a cross discipline, collaborative and creative perspective is required just to get the ticket to play. IMHO, this is especially true for healthcare technologies.
Snippet that sums it up:

"The best way to think about the transition is to make the focus "the big idea or big concept" with a followon focus on how to build the concept and with what technologies."

Reminds me of this:



Direct link to ACM article:

Look Inside >>  December 2009