In the U.S., when your hospital caters for those on Medicare and Medicaid, everything is run on a tight budget. That in turn creates a culture where the adage ‘make do and mend’ becomes the norm.
People get used to specific ways of working, even when those ways are inefficient. That’s because for every problem, someone, somewhere has figured out a workaround that appears to overcome the problem of the day.
It doesn’t have to be that way and when enlightened management are brought in, change for the good is possible. Such was the case at Boston Medical Center, a 6,000 person and 498 bed facility that traces its history back to 1873.
Right people, right time
Lisa Kelly-Croswell, Senior Vice President and Chief Human Resources Officer at Boston Medical Center explains how the introduction of a new CEO made the difference:
Her thinking was more around an abundance theory, and questioning that just because it’s always been this way, doesn’t mean that has to be. She was very much of the belief that new technology and new business processes doesn’t always equal more cost. She shifted the mindset away from a focus on cost to one of investment and return on investment.
Identify pain points
Making that work is not a walk in the park. Processes that are ripe for change have to be identified. Ms Kelly-Crosswell cites the example of paper processes for compliance on issues like staff TB shot maintenance. At the very basic level, Boston Medical Center struggled to know who was working for them and on what terms. Fundamental problems of that nature made it a relatively easy sell to the governing finance board.
Once we identified these fundamental issues and what that meant for both our people and those for whom we care, our CEO was then able to present a picture that clearly showed how far behind we were in terms of good practice. That generates an emotional reaction – it was something of a shock.
Even in those circumstances, the management team had to present a convincing case and in this context they settled on three broad business case imperatives:
- Significant reduction in cost associated with manual processing of people related paperwork.
- A requirement to ensure that Boston Medical Center would meet all its compliance requirements.
- Savings from staff ability to self serve their day to day needs such as recording vacation requests, sick day notification, booking for training.
But where does Workday fit in because one would assume that an organization used to operating under tight fiscal control would be less than enthusiastic at the thought of taking on a modern and relatively new system? This is where Ms Kelly-Crosswell’s 27 years’ experience in HR came into its own:
I was one of the earlier users of PeopleSoft, I had a lot of exposure to Oracle, I know a fair bit about Ultimate. I’ve done RFP’s on various systems so you can say I know a good amount about the market. At my last job, I had some exposure to Workday and remembered that it looked promising but because of my PeopleSoft days, I was confident that the same founders would provide a best in class solution.
OK – so I can buy that at an emotional level, but surely there has to be more?
It turns out that the flexibility the Boston Medical Center team saw in Workday meant they did not have to map out every process from the get go but could concentrate on the 80-85% that would get them productive and then go back and make any changes that optimize the system.
So what I really like about the Workday product, number one was the flexibility. I’ll couple flexibility with speed. It’s about taking the whole adage of ‘Don’t let the perfect be the enemy of the good,’ in achieving the right outcome.
Tearing up the paper
Coming from paper based systems turned out to have its advantages because people were not worried about the difference between an existing system with which they are familiar and one that requires the kind of persuasion and assurance that is implied by a normal change management program. But again, those factors alone, while helpful in implementation, won’t get you past the finishing line with user adoption.
I knew that self service would be a big win and sure it was. For managers, there is a lot more built in rigor because you have to follow the digital process but it was just a lot easier to use than anything any of us had seen. When we did demos for the end-users, there was a lot of excitement and a ready understanding of the product. It was so different from past epxseriences where consultants dictated what we got and simply said ‘Here’s what you’re gonna get,’ to which I almost always thought, ‘Really?’
The end user experience is critical to acceptance and adoption and here Ms Kelly-Croswell made a statement I’ve not heard before:
When the demos were being run, they weren’t selling us a product but an experience. It was much less about the technology and much more about the outcomes
That sounds like the sort of thing you’d expect to hear from a CRM pitch but then some of us have long argued that HCM is the mirror to true CRM.
The implementation went as well as Boston Medical Center could have expected but it was not without its dramas.
Every project hits problems and ours was no exception. But we’d been very clear that there was no Plan B so when things did go wrong, we went straight to crisis management mode as a way of pushing through as quickly as possible, recognizing the pain along the way but always looking forward to the gains we knew were waiting for us.
There were some big wins. For example, shifting payroll as part of an expanded HR project is not always easy because even a clunky but functioning payroll is something that many are wary of touching. The CFO’s office is rarely a keen customers.
In this case the organization and IT bought into the fact that Workday’s single codeline meant that payroll and HR can sit side by side with no integrations required. This was viewed as de-risking the project while enhancing the final outcome.
Beyond basic HR admin, Boston Medical Center implemented recruiting, compensation, performance appraisal and benefits administration, al of which is now automated and with less staff.
Even though there are fewer required in HR, we’ve upped our game significantly. The staff are now much more into the role of business advisor rather than administrator.
What about the CFO? He was engaged early for the payroll and was, as expected, highly skeptical about outcomes.
That’s an interesting one. He recently moved to another hospital but the last thing he told me was that he looked back and saw what this project was doing helps HR and finance be more transparent and helps drive the business forward. He just said ‘I’m sold.’
Asked about her advice to others, Ms Kelly-Crosswell offered the following advice:
- Don’t aim for 100% at the first pass. You can always go back and optimize once the basics are in place.
- Spend time understanding the modules and the requirements for implementation. Don’t be mesmerized by the opportunity to do a big transformation but pick those that will meet needs.
- Allow the way in which the system can be assembled and configured to guide your thinking rather than relying upon methods you’ve used in the past. They won’t help you and will likely slow you down.
- Work that into your plan so that you implement no more and no less than the project timeframe allows.
What about the future?
We’ve gotten so much value out of the system there is no longer the difficult problem of justification we had at the beginning. It means we are looking at contingent labor. The flu shots thing is an interesting project that pertains to hospitals so that’s in as well, as are TB shots. That’s led to our developing a My Team’s Health dashboard.
Ms Kelly-Crosswell is clearly enthusiastic and proud of the project deliverables along with the prospect of enhancing it for fresh functionality. Her final words encapsulate this project really well:
I call it ‘being taken out of 1864’ while giving time back to people to do a better job providing the care our community wants and deserves.
Does it get better than that?
Image credit - Bostom Medical Center
Disclosure - Workday is a premier partner at time of writing.