Kristine Terrio calls it being “Zenned.” The vice president of rehabilitation services at Capital Region Health Care (CRHC) is referring to what the health-care organization’s IT department used to do: Push new technology such as Novell’s ZenWorks desktop management tool on users without a word about possible service interruptions. The IT department was known to not even pass on routine system updates. One of the worst “Zen” incidents occurred a couple of years back. The department’s beeper system went down, and IT, while working to fix it, never alerted Terrio’s group of the problem. As a result, 30 therapists weren’t beeped when their noon appointments arrived, and no one noticed the lull until nearly 20 minutes later.
“Thirty patients missed treatment, all had to be rescheduled, and everyone was upset because no one told us,” recalls Terrio, who heads the hospital’s departments for physical, speech, occupational, pulmonary and cardiac rehabilitation services. “IT was waiting to know what the answer to the problem was, but we just needed to know there was a problem [in order to institute an alternative communications system].”
Incidents like this one were the wake-up call for Deane Morrison, CIO of CRHC, a Concord, N.H.-based integrated delivery network of health-care organizations that provides IT services to its members as well as other surrounding hospitals, visiting nurse associations and physician practices. Beginning more than two years ago, Morrison started a journey to change the culture of his 80-person Information Technology Services (ITS) group from a primarily technology-focused shop to one steeped in customer service. Although the ITS group had received high marks from users for keeping the health-care organization ahead of the curve technologically?by being early adopters of such technologies as an electronic medical record system?it was also perceived by CRHC’s top managers as being out of touch with the needs of its user community. There were ongoing complaints about ITS employees’ sometimes disobliging demeanor when assisting users and a general dissatisfaction with how the group communicated?or rather, failed to communicate?with users.
Morrison, like so many cios in health care, was at a crossroads. He knew that a major change was in order, but orchestrating a cultural shift away from a technology-centric IT organization to a more responsive and customer-focused group was no small feat. More important, Morrison realized that any sustainable change was going to have to start with him. Simply talking to employees about the problem was not enough?he was going to have to dig in and modify his own behavior. “The first thing I was doing wrong was talking about it and expecting others to do what I was saying, but not doing by example,” he recalls. Morrison then set out to do what many IT leaders fail to do: He embarked on a formal campaign to embrace and promote a customer-service orientation, leaning on outside training and new technologies such as internal paging systems along the way. ITS also met its goals in part by leveraging its substantial project management expertise. With this approach, ITS was able to tackle a potentially unwieldy problem?customer service?with the familiar tools and skills honed on technology projects. This plan yielded concrete results, which in turn fed the enthusiasm so crucial for sustaining the initiative’s momentum.
But instituting the changes wasn’t easy. Along the way, Morrison had to handle sticky morale issues, mediate cross-departmental conflict and deal with employee turnover when some staffers, disgruntled about the changes, opted to leave. Morrison also had to work at overcoming the general consensus among his group that the problem wasn’t theirs, but rather the result of uninformed and unappreciative users. “We had to deal with people who didn’t believe that any shift would make a difference,” he explains. “They felt they were giving all they could and it was time for the client to change.” Morrison’s active participation in the process was crucial in bringing about a successful cultural shift, says Dan Roberts, president of Ouellette & Associates, a consulting company in Bedford, N.H., that provided the customer-service training to CRHC’s IT staffers. “Every CIO in corporate America knows that having a service culture is critical to their success,” Roberts says. “But most pay only lip service to making such changes.” What the project management approach did [for CRHC] is to take something nebulous like customer service and break it down into bite-size, achievable chunks.
At Your Service
The realization that the ITS group needed to become more client-friendly came about gradually, says Morrison. Initially the ongoing problems were brought to his attention by staffers like Terrio who would walk into his office and try to brainstorm ways to improve user relations with ITS. Things came to a head when CRHC President and CEO Mike Green mentioned that he wasn’t getting a very supportive response from ITS the few times he called for help. “If I couldn’t get better support, I thought, God help anyone else in this organization,” Green says now.
That kind of feedback began to eat away at Morrison. He realized he needed to enact change before upper management mandated change to him. “Even though we had been talking about the shift, I realized we needed help getting the staff to understand why we needed to develop a service culture,” Morrison recalls. “We needed to approach it in a more structured way.”
The first step in Morrison’s systematic approach was to implement an outside training program. On a recommendation from Tom Moran, director of ITS administration and planning, who was hired by Morrison around that time to provide a fresh, outside perspective, Morrison marched 12 of his top managers into a two-day, Ouellette training course titled IT as a Service Culture. The seminar resonated so well with that group that Morrison decided to make it a prerequisite for all current and new ITS staffers. He also invited representatives from various user groups within CRHC to the training so that they could get a feel for some of the pressures on the other side?a process he continues each new session. “We think of the Ouellette training as a jump start,” Morrison says. “Now, our own staff does a better job of introducing the culture, but [the classes] regenerate enthusiasm and are still important.”
Based on the initial round of classes, Morrison quickly determined that the root of ITS’ problems was tied to poor communication with users. He assigned groups to brainstorm different initiatives, and project leaders were picked from within those groups. The effort became a regular agenda item on ITS’ Tuesday project planning meetings. As ideas gelled into actual project plans, the management team gave the various groups deadlines for their initiatives, and project leaders made sure everything stayed on track and that the right people were informed about any changes in schedule or scope. “The idea was why not use something we’re good at, project management, to implement something we’re not so good at, customer service,” Morrison explains. “We didn’t improve our culture with project management, but with it we got visible results that reinforced that service was important.”
Attacking the problem in such a way where ITS staffers could appreciate each incremental improvement was a critical part of getting them to buy into what was initially viewed as an unpopular assignment, Morrison says. For instance, as his group began to deliver more status information on system problems?even if they hadn’t yet been resolved?users became more understanding and willing to work around the problem instead of blaming ITS. With each positive reaction from users, ITS staffers became more willing to change their behavior or to embrace the new systems and customer-service processes.
Lines of Communication
Two of the first projects ITS tackled were a new paging system that keeps ITS staffers informed about system problems as well as a stakeholder system that alerts the appropriate staffers by e-mail to problems via a standardized report. Communications were further enhanced by setting up a Web-accessible calendar where ITS publishes planned events such as a scheduled system upgrade, allowing users to make backup plans so that system downtime doesn’t affect their schedules.
This kind of formalized communication is a welcome improvement over the vacuum in which ITS used to operate, says Abby Strople, information systems specialist in surgical services. Strople is one of a dozen IT employees on the payroll of a specific department, and he functions as a liaison between ITS and that department. “The culture change has really had a huge impact on how I do my job,” notes Strople. “Previously, systems problems were not communicated to us at all unless we made contact with the help desk to find out if a system is down. Now, during the last six to eight months there are pages to notify us of system downtime, planned or unplanned, all the time. That’s a huge help because it’s my responsibility to keep my department informed.”
There are other changes helping to promote open communication and attention to customer service. Among them is a new lexicon for ITS, including a switch from the term user, which has technical connotations, to the more service-oriented word client, as well as a client bill of rights. The latter, available on the ITS website and soon to be stenciled on mouse pads and given to all CRHC clients, specifies 10 commitments that the ITS team makes to its constituents. In keeping with ITS’ emphasis on project management, the bill of rights also includes links to specific projects addressing each commitment. For example, under tenet four?which is a right to receive computer education and training necessary to meet the requirements of your job?CRHC users can click directly on the ITS education class schedule and sign up for a specific offering.
Morrison has made better customer service his personal mantra: promoting the issue at every staff meeting; talking one-on-one with employees on a regular basis; and hosting lunches where ITS employees can casually gripe about their fears and concerns associated with the cultural shift over pizza or sandwiches. Morrison even goes a step further: He attends every Ouellette training session with each new batch of employees. So far, he’s participated in six. “It’s essential that the CIO be personally committed and involved,” he says. “It’s too large a cultural shift to delegate.”
The fact that Morrison shows up at every seminar?no matter how busy his schedule?speaks volumes to his staff on how important customer service is. It also helps staffers get over the frustration of being asked to learn a new discipline when they’re already feeling overloaded, says Tracy Cote, help-desk representative at ITS. “At first [the process] was frustrating because we felt whatever we did wasn’t good enough,” she explains. Morrison’s participation in the training, she says, makes ITS staffers feel like their feelings and frustrations are being taken into account.
Morrison’s commitment to instill customer-service values is slowly starting to pay off. Impromptu surveys left for CRHC clients to fill out and return via interoffice mail show that ITS is now getting high marks for responsiveness, and hallway conversations are more encouraging. Recently, CRHC’s chief financial officer told Morrison that he was getting better information than ever before, and Terrio joked that the messaging was keeping her too informed, almost to the point of overkill.
Morrison says that seeing his department getting recognition and respect for the culture change makes what he calls a painful and still ongoing journey well worth the trip.