Secrets to Success in a Complex World · Secrets to Success in a Complex World J OSEPH W ERNER,...

HCA | Information Technology & Services – © 2016

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Secrets to Success in a Complex World

JOSEPH WERNER, CPBA – MARCH, 15, 2016IIBA – GREATER ATLANTA CHAPTER MEETING

When Requirements Aren’t Enough

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HCA | Information Technology & Services 2http://healthcareinspired.com/

The views expressed in this presentation are those of the presenter and do not necessarily represent the views of, and should not be attributed to HCA, HCA IT&S, or the IT&S Business Analysis Center of Excellence.

©HCA 2016. All rights reserved. HCA, IT&S and other service marks used herein are the property of HCA and may not be used or reproduced without written authorization.

Disclaimers








This presentation would not be possible without the support of• Susan Kelso• Danny Schunk & Steve Hackney• Marty Paslick• Advanced Strategies, Inc.*

With Sincere Appreciation

*Used with permission. All rights reserved.








• Intention: Provide practical tips for improving attendees’ efficiency & effectiveness as BAs

• Values: fast-paced, practical, spring-board• Focus

• Including: tips, ideas, & overview of techniques

• Excluding: training in techniques• Context: BA attendees of all levels, industries,

& development approaches; less than 1 hour

Session Definition

© Copyright 2016 All Rights Reserved • Advanced Strategies, Inc. Atlanta, GA. • www.AdvancedStrategies.com








Session Topics

Achieving Success

Problem Solving to Avoidance

Professional Services








“Business analysis is the practice of enabling change in an enterprise by • defining needs and • recommending solutions • that deliver value to stakeholders.

Business analysis enables an enterprise to • articulate needs and • the rationale for change, and to • design and describe solutions that can deliver value.”

What is Business Analysis*

* © A Guide to the Business Analysis Body of Knowledge® (BABOK® Guide, Version 3.0, §1.2, p.2.)








“Business analysis is performed on a variety of initiatives within an enterprise.

Initiatives may be strategic, tactical, or operational.

Business analysis may be performed • within the boundaries of a project or • throughout enterprise evolution and continuous improvement.

It can be used • to understand the current state, • to define the future state, and • to determine the activities required to move from the current

to the future state.”

What is Business Analysis*

* © A Guide to the Business Analysis Body of Knowledge® (BABOK® Guide, Version 3.0, §1.2, p.2.)








An individual who works with business users and developers as a business problem solverA liaison between the business and technical worldsSomeone who is

• Not the end user• Not intoxicated by technology

What is a Business Analyst*

* © Copyright 2007 All Rights Reserved ● Advanced Strategies, Inc. ● wwww.AdvancedStrategies.com ● BA R&R v105, p.26.








Analyze the Business

Business Aspects

Models Focus








The Business

“Why”

WhoPeople/

Organizations

What Objects/

Information

HowProcess/

Workflow

WhenEvents/ States

WhereLocation

Business Aspects









Sample Business Model Segments

2.3Order Care(Physician)

EHR

Patient

Symptoms

Signs

PatientIdentifiers

BlankOrder Set

Pt Chart

MedicationOrder(s)

LabOrder(s)

ProcedureOrder(s)

CPOE Order Sets

PhysicianExperience,Knowledge,& Training

Pt Chart











EHR

Patient

Symptoms

Signs

PatientIdentifiers

BlankOrder Set

Pt Chart

MedicationOrder(s)

LabOrder(s)

ProcedureOrder(s)

CPOE Order Sets


Pt Chart











EHR

Patient

Symptoms

Signs

PatientIdentifiers

BlankOrder Set

Pt Chart

MedicationOrder(s)

LabOrder(s)

ProcedureOrder(s)

CPOE Order Sets


Pt Chart

Untreated Patient

Treated Patient

• Assess Patient• Review Patient Chart• Select Clinically Appropriate Order Set• Customize Order Set for Patient• eSign Orders

• Process Orders










Untreated Patient

Treated Patient


• Process Orders











EHR

Patient

Symptoms

Signs

PatientIdentifiers

BlankOrder Set

Pt Chart

MedicationOrder(s)

LabOrder(s)

ProcedureOrder(s)

CPOE Order Sets


Pt Chart

Untreated Patient

Treated Patient


• Process Orders









Define Plan AnalyzeSprint “Zero”

Defining Focus during the Project Lifecycle

Project Focus• Intentions (Vision)• Values (Guiding Principles)• Focus (Scope of Work and

Scope of Analysis)• Approach• Measures

Planning Focus• Purpose• Unknowns• Assumptions• Horizons• Level(s) of Precision• Contingencies

Model Focus• Objective of Model• Breadth/Scope• Emphasized Perspectives• Depth of Detail• Universality• Scope of Integration









Project Scope vs. Analysis Scope







http://search.dilbert.com/search?p=R&srid=S3-USWSD01&lbc=dilbert&w=scope&url=http://dilbert.com/strips/comic/2009-12-07/&rk=8&uid=997215047&sid=2&ts=custom&rsc=RvCpTdXZn-Rwd8Oc&method=and&isort=date%20rev&view=list&filter=type:comic

http://search.dilbert.com/search?p=R&srid=S3-USWSD01&lbc=dilbert&w=scope&url=http://dilbert.com/strips/comic/2009-12-07/&rk=8&uid=997215047&sid=2&ts=custom&rsc=RvCpTdXZn-Rwd8Oc&method=and&isort=date%20rev&view=list&filter=type:comic


“Scope of Work”• Project context• Lists the work that will or will not be done• Typically identified early on• Has direct correlation to schedule and budget

“Scope of Analysis”• Business Context• Must know the objectives/intentions of the project/effort• Areas/aspects of the business that are expected (or not expected) to

change• Requires analysis to define• Directly impacts schedule, resources, and cost to specify

requirements• Typically not intuitively obvious

Project Scope vs. Analysis Scope








Scope of Integration

Universality

Depth of Analysis

Emphasized Perspectives

Boundaries of Analysis

“From” & “To” Points

Sample Scope of Analysis: Elements









Sample Scope of Analysis: Vitals Now

From: A caregiver approaching a patient to collect routine vital signs.

To: The time the data is available in MEDITECH.

In Scope• Any area in the hospital where patients are not hard-wired to bedside monitors,

e.g.o Med/Surgo L&Do ED

• Radiology• Patient Identification• Frequent collection of vitals, e.g., Q15.• Other Vitals Capture modifiers, e.g.

o Orthostatic positioningo BP Cuff location

Out of Scope• Patients that are hardwired to bedside monitors. • Vitals data trending and analysis processes • Assignment Sheet Development ,Communication and Hand-off• Pain Scores• Critical thinking process for utilization of vitals• Staff assignments• Any business process not listed as in scope

Emphasized Perspectives• Nurse• Medical Technician (assigned to collect vitals) • Facility IT Support staff• Biomed Support Staff

Depth• Processes will be high level to support solution-agnostic workflow

descriptions• Clinical data will be at the discrete level to articulate required medical

record information.

Universality (level of generalization)As broad as possible to include future scalability/scope. Workflow should be

applicable to any facility in the enterprise.

Scope of Integration (Products, initiatives, etc. that may be impacted by or may impact the project)

Including• Biomedical Equipment to measure vital signs• Remedy• Failure to Rescue initiatives

Excluding• Evidence-Based Clinical Documentation Project• Telemetry Equipment• Labor & Delivery applications (e.g., GE QS) • Emergency Department applications (e.g., TEV)


Provides a level assurance that your analysis is “done.”








• Easier to review with SMEs• Provides a basis for measuring ROI and the business impact of

the future state• Provides a sound foundation for documenting requirements

for the future state• Opportunities• Pain points• Bottlenecks• What must continue in the future state

• The Future State Model and requirements are likely to be • More complete and more accurate• A better fit to the environment• The end result is higher in quality

Why Current State Analysis?

Problem AvoidanceIdentify problems on paper, before they’re coded or implemented.


Very useful for problem solving.








Nursing Workflow: Vitals Now

Clinical Workflow Action Team

Nursing Workflow








In Sprint Zero• Defining the Scope/Focus of Analysis can help

• Identify what aspects of the business – Are in and out scope– Should be/will be impacted

• Identify what systems/units you need to integrate with

In General, models can help• Provide high-value, “least amount of documentation”• Identify dependencies• Provide a strategic view of tactical work

• Manage functionality across different customer bases• Maintain a view of the solution as it is being rolled out• Identify conflicting functionality before the users do

• Solve Problems

Additional Agile Ideas








• Get & maintain agreement• Plan• Focus and Definition • Iterate! Iterate! Iterate!• Continually improve• Do your homework• Define the Analytical Needs of the project• Get “plugged-in” to the project

Closing thoughts








Session Topics

Achieving Success

Problem Solving to Avoidance

Professional Services









Questions?







Thank you!









Appendix






• Achieving success in the midst of (and in spite of?) chaos, complexity, and ambiguity

• Moving from problem solving to problem avoidance

• Providing professional business analysis services for a projecto Selected analysis tools and techniqueso Agile projects

• Real-life examples (and handouts)

Session Topics








Advanced Strategies Articles• Business Analysis: Asking the Right Questions

Matrix Diagrams• Excerpted from Nancy R. Tague’s The Quality

Toolbox, Second Edition, ASQ Quality Press, 2004, pages 338-344.

Handouts







http://www.advstr.com/

http://qualitypress.asq.org/perl/catalog.cgi?item=H1224


Order Taker• Do what you’re told, when you’re told• Conduct work according to project timeline• If there’s not enough time, work overtime to get it done• Limited options for adding value

Consultant• Know that the business and project desperately need your skills• See yourself as an equal partner with other team members• Proactively plan work => input into project timeline• Provide Value, i.e., valuable analysis services

• Requirements specifications• Wherever clarity or understanding is needed• Collaboratively

• Make yourself the “Best Option” for the business• Continually improve your skills & knowledge

Shift from Order-Taker to Consultant








Context Diagram Example

Patient’s Electronic Health Record

MDI

Patient’sMeasuredVital Signs

Patient’sValidatedVital Signs

Medical Device IntegrationContext Diagram

Clinical Informatics and Integration Product Development

Date Created:Last Updated:

Filename: MDI PAM DFDs 20091030.vsd

3/7/20133/7/2013

Notes:

Vital Sign Intervention

User’sIdentity

User’sIdentity

PatientPatient

Identifiers

User

PatientIdentifiers








Analysis Work Plan DFD ExampleMedical Device Integration Pilot:

Phase IRequirements Work Plan DFD

BA Center of Excellence

Date Created:Last Updated:

Filename: MDI RWP diagrams.vsd

2/12/20082/12/2008

Notes:

Align Reqt Priorities with

Capsule Proposed

Requirements

Capsule’s Proposal(RFP Response)

SOW Business Use Cases. – (Joint)

DFDSOW Workflow model of Capsule GA base functionality and HCA

Specific Enhancements – (Joint)

Kelly (& CSG SMEs)

MDI Proposal Score Card

ReqtPriorities

ContractuallyObligated

Reqts

CandidateReqts for

Enhancment(non-obligatory)

PrioritizedContractually

ObligatedReqts

PrioritizedCandidateReqts for

Enhancement(non-obligatory)

Communicate Reqt Gaps to

Business/Negotiate Trade-offs

IT&S & CSG PMs

PrioritizedReqt Gaps

PrioritizedReqt Gaps

Feedback/Negotiation

Capsule

Draft Capsule Process DFD

Refine Clinical Business Use

Cases

Existing Use Cases

Capsule Ops Support SME

Facility Ops Support

TriStar ITSMRefine Support Business Use

Cases

Support Bus.Use Cases

CSG Clinical SMEs

Clinical Bus.Use Cases

Capsule Deck

Ideal State PAM

Analyze Gaps Between GA Functionality

and Contractual Obligations

SOW Gap analysis of Capsule MDI Proposal to Capsule Q4 2009

GA Functionality – (Joint)

SOW Documented Proposed Screen Modifications/

Screenshots– (Provider)

SOW Release Notes & System Documentation– (Provider)

FR/NFR Updates

SOW User Acceptance Test

Cases– (HCA)

Back-End Data Flows(Neuron to MT NUR)

Align Use Cases w/ FRs

Working Forecast

Refine Product-Level Use

Cases

Product-Level Use Cases

PLUC Updates

Review Test Plan & Test

Cases

• SOW Standard User Guide in Word Format– (Provider)

• SOW Train the Trainer Class Materials– (Provider)

• SOW IT&S Training Session(s) – (Provider)

• SOW Pilot User Training Session(s) – (Provider)

• SOW Metrics Plan & Pre-Go-live Metrics Capture– (HCA)

• SOW Support Plan– (Provider)

• SOW Metrics Plan & Pre-Go-live Metrics Capture– (HCA)

• SOW Support Plan– (Provider)

• SOW Wave I Metric Compiled Results– (HCA)

• SOW Wave II Metric Compiled Results– (HCA)

• SOW Acceptance of Provider Interface: ADM to Other Vendor (HL7)

• SOW Acceptance of Provider Interface: NUR Monitor Results from Other Vendor (HL7)

• SOW Completed Environment Setup

• SOW Acceptance of Training Materials

SOW Functional Test Cases– (HCA)

SOW User Acceptance Test Results– (HCA)

QA Test PlanQA Testing

Svcs

TestingFeedback

Define UAT

Strategy

Project CharterSOW

UAT Strategy

Kelly

IT&S & CSG PM

Capsule

Draft UATStrategy

UATStrategy Feedback

Final UATStrategy

Define UA Test

Cases

IT&S Technical SMEs

Product Owner

Product Owner

Plan UAT

UAT Plan

Execute UAT

Users

Support the Delivery of

Technical SMEs

Requirements Management

SOW Functional Requirements Specification – (Joint)

Prioritized RFP Contractual Obligations

Capsule

Unknowns• New Vendor for HCA• HCA has never deployed Neuron• Vendor has never deployed Neuron








Current State DFD Example (Vitals Now)

36

Ptn not id’d

Assignment Sheet

1.0Positively

Identify Patient

(RN/Tech)

AS Ptn Name

RN/Tech

AS DOB AS MedicalRecord No.

Patient

Equipment Source

Vitals Capture Equipment

2.0Commu-nicate &

Educate Ptn(RN/Tech)

Patient Arm Band

Arm Band Ptn NameArm Band DOB

Arm Band MedicalRecord No.

Ptn Stated Ptn Name

Ptn Stated DOB

Other Paper

MEDITECH

Vital Sign Display

Protocol3.0

Apply Equipment(RN/Tech)

4.0Initiate

Equipment(RN/Tech)

5.0Assess Patient

(RN/Tech)

6.0Clinically Validate

Vital Signs(RN/Tech)

7.0Report

Abnormals per Protocol

(RN/Tech)

8.0Record Vital

Signs(RN/Tech)

9.0Manually

Enter Vital Signs

(RN/Tech)

Protocol Desitination

AssignedOrthostatic

Position

AssignedCuff

Location

Equipment

Arm/Leg

for frequentvitals collection

AppliedEquipment

AppliedEquipment

Education

Experience& Training

Ptn Vitals

8.0Physically Find Ptn

(RN/Tech)

abnormal

DisplayedVitals Displayed

Vitals

invalid

• HR• BP• SAO2• T°• MAP(?)

RRVisualObservation

RR

Assignment Sheet

if abnormal

ValidatedVital Signs

ifneeded


AS Ptn Nameno POC


MT UsernameMT Password








Hospital Corporation of America (HCA) Information Technology and Services(IT&S) delivers healthcare IT products and services to HCA's portfolio ofbusiness and other pre-eminent healthcare brands, including ParallonBusiness Solutions, HealthTrust, Sarah Cannon Research Institute, andWorkforce Solutions.

As one of the largest providers of healthcare IT, IT&S offers products andservices to more than 260 hospitals, 830 physician practices, 115 ambulatoryservice centers and 51 imaging centers.

IT&S employs over 4,300 employees across the U.S., operates five datacenters and fifteen division support centers.

Our services include business analysis, systems development and integration,information security, customer support, training and education, andinfrastructure support.

HCA IT&S








Above all else, we are committed to the care and improvement of human life.In recognition of this commitment, we will strive to deliver high quality, cost-effective healthcare in the communities we serve.

In pursuit of our mission, we believe the following value statements areessential and timeless:We recognize and affirm the unique and intrinsic worth of each individual.We treat all those we serve with compassion and kindness.We act with absolute honesty, integrity and fairness in the way we conduct

our business and the way we live our lives.We trust our colleagues as valuable members of our healthcare team and

pledge to treat one another with loyalty, respect, and dignity.

http://hcahealthcare.com/

HCA Mission







http://hcahealthcare.com/


Our mission is to help transform healthcare bydelivering information technology and solutionsthat dramatically improve patient care andbusiness operations.

HCA IT&S Mission








That's why we say we are "Healthcare Inspired."

It's this guiding vision that pervades and positively influences everylevel of our organization. It shapes our mission, defines our values,and brings our leaders and employees together in a sharedenthusiasm for their work, setting IT&S apart as a uniquely purpose-driven company in the IT industry.

We Are “Healthcare Inspired”We are IT professionals and are certainly proudof our technical expertise. But what makes usunique as a technology company is that oursolutions ultimately impact the care of patients.Although our skills are needed in a number ofindustries, we in IT&S apply them specifically tothe noble cause of healthcare.








HCA | Information Technology & Services – © 2016 30http://healthcareinspired.com/

Consulting Business Solution Analyst (10207-17319)

Work Location: Nashville-Corporate Main Campus

Job Summary:The Consulting BSA leverages a robust set of tools and works independently and as a lead to other business analysts on large projects of significant complexity and are responsible for analyzing the business, facilitating solution definition, and successfully integrating business processes, roles and technology to ensure business objectives are met.

Open Position







https://hca.taleo.net/careersection/jobdetail.ftl?job=10207-17319&lang=en


Joseph Werner, CBAPConsulting Business Solutions AnalystHCA IT&S Business Analysis Center of Excellence

Born in Berlin Germany and raised in the New York Metropolitan Area, Joseph has more than 25 years of experience in the US and abroad. He has worked on military projects, non-government organization (NGO) relief and development projects, and healthcare and operations efforts.

In his past 10 years at HCA, he has worked on more than 35 projects and analysis efforts, and he was part of the team that formed HCA’s Business Analysis Center of Excellence. In addition to regular project work, his services are often requested on projects that are highly complex, already in flight, and have unique challenges.

He and his wife, Dawn, now call Nashville home. They are licensed foster parents for special-needs and medically-fragile children, and they are part of Middle Tennessee’s pilot program to support caring for children with complex trauma and Post-Traumatic-Stress Disorder, or PTSD. In his spare time, Joseph enjoys singing, flat-water kayaking, and spending time with his family.

About the Presenter







Secrets to Success in a Complex World · Secrets to Success in a Complex World J OSEPH W ERNER,...

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