Diagnose Your Inefficiency Potholes

potholesMany employees tend to complain about work-related inefficiencies as much as Wisconsinites bemoan the craters (aka potholes) left in the roads each winter. In response, companies usually acknowledge that making improvements is critical, and do their part in researching Enterprise Resource Planning (ERP) options. But, are all work-related inefficiencies exclusively due to a legacy system? Are people jumping the gun in assuming so, or are they misidentifying a process problem? Could some of these issues disappear by making a few simple process adjustments? Without empowerment and support, all the technology in the world won’t move your business forward.

There is no exact formula to determine if a problem stems from a bad system or a bad process; but asking yourself some basic questions could help you figure out where the problem lies. For example:

  • Would implementing new process improvements really resolve the problem?
  • Could implementing new system functionality resolve the problem and also provide a competitive edge?
  • Do the system benefits outweigh process benefits?

The following steps should aid you in your diagnosis and decision-making:

Create a problem Inventory 

Interview Subject Matter Experts (SME’s) from the various departments affected to develop a problem inventory list.

Identify process-related problems

Identify all process-related issues from your inventory list. Ask yourself: What is the root cause of the problem? Is there a lack of communication, lack of enforcement, or lack of an actual process? If you answered yes to any of these questions, the problem likely stems from a process issue.

Examples of process-related problems include:

  • A customer is upset that they’re getting bounced around
  • Sales Agents aren’t required to track or manage lead information
  • No official process for returns exists. (If an actual documented process cannot be provided, there probably isn’t one.)

These items may also range in severity. While going through this process, consider assigning priority levels or at least identify quick fixes.

Make process improvements where possible

This step is important because it improves overall business processes and productivity by making identified improvements. It also validates problems that can be resolved realistically. This step may take a few weeks to a few months to transpire, but it provides important insight and brings the process to the next step.

Focus on system-related problems

Once process-related problems are identified and resolved, one is able to ascertain that the remaining problems are system-related and decide if a new ERP system would be advantageous.

Examples of system-related problems include:

  • No visibility to inventory availability
  • Multiple customer masters, item masters, and vendor masters
  • Manipulation applied to reports (current system lacks reporting functionality)

This step will not completely resolve a company’s problems and inefficiencies, nor will it guarantee employee satisfaction. It will, however, allow for a more focused approach when considering solutions. It also provides the added benefit of some inexpensive process improvements along the way.

Total Recall: The True Cost of Foodborne Illness

All eyes are on Tyson this week after their recall of chicken nuggets with a trace of plastics. Unfortunately, it’s not just the makers of highly processed foods that are struggling with recalls right now.

As April unfolds, we see that the organic food industry is not immune either:

  • Three purveyors of organic black peppercorns here, here and here have also announced recalls this week.
  • And, the real shocker is this one: Tea Tree Oil mouthwash is recalled because of bacterial contamination, despite the many websites and even an NIH article touting tea tree oil’s antibacterial properties!

Traceability of the root cause is difficult for both contaminated food and hazardous consumer products, as the recent Fitbit Force recall shows. There still doesn’t seem to be an answer as to what material in the wristbands caused so many users to break out in a rash.

As the following infographic shows, foodborne illness is a serious issue, and some companies are better than others at weathering a recall crisis. As we have said in earlier blog posts, social media has been a real game changer during recent recall crises, in ways both positive (providing a way to tap into rising consumer concerns to spot quality issues early) and negative (the viral consumer frustration response at any lag in response or mis-step during a recall crisis).

Total Recall: The True Cost of Foodborne Illness infographic for disaster recovery and product recalls

 

 

The Politics of Data in an ACO

Data sharingImagine the following scenario. You discover that you are the victim of identity theft, purchases have been made in your name, and your personal credit has been ruined. You are saved, though. You have paid a watchdog organization to monitor your credit, and they have information that clears your good name! So, when you apply for a loan with a bank, you request the credit monitoring agency to share the details of your prior credit problems and its resolution with the bank. But the monitoring agency will not share that information because that might help the bank understand your needs and negotiate a better price for their own credit monitoring service that they resell to their customers – i.e., you. The monitoring service won’t release your information.

Would you put up with this conflict of interest? NO!

In healthcare, we routinely tolerate a form of this conflict of interest, and in many different forms. Even though health insurers are not providing the patient care directly, these payers tend to accumulate a very useful holistic view of each patient’s history, including information from the perspective of what care was provided based on payment being demanded by many different care providers. There are numerous instances where, if this information was shared with other providers, it could positively impact the care management plan, doing so in a more timely manner, and increasing the likelihood of improving the quality of care the patient receives and possibly reducing the overall cost of care across an extended episode.

Here is an example- A patient is admitted to the hospital and receives a pacemaker to address his atrial fibrilation. After being discharged, the patient follows up with his cardiologist who has reduced the dose of digoxin, having diagnosed the patient with a digoxin toxicity. However, the patient attempts to save a few dollars by finishing their current prescription only to be admitted to the hospital a couple of weeks later for the toxicity. This is an opportunity where the care manager could have intervened based on the cardiologist’s toxicity diagnosis being submitted to the payer and no prescription was filled within a few days. The care manager could have helped the patient be more compliant with the cardiologist’s instructions avoiding an inpatient admission.

Healthcare provider organizations and payers (and in some cases regulators) are working together to break down these walls in an effort to increase value across the spectrum of care delivery and the industry in general. However, the sometimes conflicting vested interests of these interacting payers and providers can still be an obstacle, influencing the politics of information disclosure and sharing in the emerging environment of accountable care delivery models.

There is great diversity in the participating organizations that collaborate to make up an ACO. This is definitely not one size fits all. Viewed from the perspective of sharing risks across parties without the immediate concern about maximizing volumes, the integrated provider-based health plans, such as Kaiser Permanente, Geisinger Health System, and Presbyterian Healthcare Services, are already inherently sharing this risk and are reaping the rewards as a single organization. That’s great for the few organizations and patients that are already members participating in one of these plans.

Unfortunately, for other organizations there is still much more to be worked out regarding proactive sharing of data both within an accountable network of providers acting across care settings, and with the payer(s). Within the network, hospital systems usually have some of the infrastructure in place and they know how to routinely share data between systems and applications using standard data exchange conventions such as HL7 and CCD. In collaboration with HIE’s these systems can help facilitate active data distribution, and they very often provoke the organization to address some of the more common aspects of data governance. However, even when this routine “transactional” and operational data is being exchanged and coordinated, there is still a great unmet need for the ACO to buy or build a data repository for the integration and consumption of this data to support reporting and analytics across various functional areas.

Many organizations encounter further challenges in defining and agreeing on which are the authoritative sources of specific elements of data, what are the rights and limits on the use of these data, and how can these assets be used most effectively to facilitate the diverse objectives of this still-emerging new organizational model.

An even greater challenge for some ACOs is collecting the required data from the smaller participating provider networks. These organizations often have less capability to customize their EHRs (if they even have EHRs in place) and less resource capacity to enable the data sharing that is required. To get around this, some ACOs are:

  • Standardizing on a small number of EHRs- (ideally one, but not always possible) This provides the potential to increase economies of scale and leverage the shared learnings across the extended organization.
  • Manually collecting data in registries- Although not always timely, this addresses some rudimentary needs for population-focused care delivery and serves to overcome common barriers such as the willingness of a given provider to collect additional required data and complying with standards.
  • Not collecting desired data at all- While this seems hazardous, progress toward the overall clinical and/or financial goals of the ACO can still be positive, even if an organization cannot directly attribute credit for beneficial outcomes or improvements within the organization, and the ACO can avoid the overhead of collecting and manually managing that data.

Regardless of what data is collected and shared within the ACO, the payers participating often have the highest quality, most broadly useful longitudinal data because:

  1. The data is ‘omniscient’ – it represents, in most cases, all of the services received by (or at least paid for) that patient – provided a claim for those services has been submitted and paid by the participating payer.
  2. Some of this data is standardized and consolidated making it easier to manage.
  3. The data is often enriched with additional data residing in mature information systems such as risk models, and various disease-focused or geographic populations and segments.

Consequently, payer data very often forms the longitudinal backbone that most consistently extends across the various episodes constituting a patient’s medical history and is very important to the success of the ACO’s mission to drive up quality and drive down costs. Despite this opportunity for an ACO to improve its delivery of care to targeted populations, sharing of data is still achieved unevenly across these organizations because some payers feel the utilization, cost and performance data they have could be used to negatively impact their position and weaken their negotiations with the hospitals and other provider organizations.

While claims have traditionally been the de facto standard and basis for many of the risk and performance measures of the ACO, more progressive payers are also now sharing timely data pertaining to services received outside the provider network, referrals between and among providers, authorizations for services, and discharges, further enabling ACOs to utilize this information proactively to implement and measure various improvements in care management across the spectrum of care settings visited by patients under their care.

Collaboration between provider organizations and payers at a data level is moving in a positive direction because of the effort given to ACO development. These efforts should continue to be encouraged so as to realize the possibilities of leveraging timely distribution of data for better treatment of patients and healthcare cost management.

When I grow up…a project manager’s path to the future

when you grow upWhen you were young, I bet you said “I want to be a project manager when I grow up!”

Probably not, since most of us plunged into project management the old fashion way – by accident. Someone probably approached you and said, “I want you to manage this project.” I bet you scratched your head and thought, “Ok, what next?”

Typically, companies don’t have career paths for project managers.  Project management is generally not seen as a core competency, so  career paths or training aren’t a priority. This reality leaves the project manager frustrated as their career seems to stall.

Another career conundrum: who wants a “new” project manager running the project? How else can project managers learn and gain experience? They can be mentored by a more experienced project manager, but mentorship is an area lacking in most organizations.

So what do we do? Here are some suggestions.

First, identify what your company CAN do to continue your growth as a project manager:

  • Work with your human resources department to create a career path, including continuing education and certification
  • Expand your sphere of impact by implementing project management methodologies, processes, and governance mechanisms to improve productivity across your company
  • Create a mentorship program. While we share some skill sets that make us good project managers, we can still learn from one another

Second, identify what YOU can do to continue your growth outside of work. Remember, it is our responsibility as project managers to continuously learn and apply this knowledge to our projects. Take charge of your growth as a project manager!

  • Join professional organizations like the Project Management Institute (PMI) which, through local chapters, communities of practice and other events, provides additional learning opportunities and certifications branching across the project management universe
  • Think outside the box and identify other opportunities, such as mentoring, to learn and grow as a project manager

Companies want to hire the best talent, but like other professions the company and the project managers need to share in their career growth and development. This is a win-win all around for the company and the project manager.

So back to my question, what do you want to be when you grow up? Me, I want to be a Project Manager.

Are you ready for Agile?

agileMany companies are moving from the traditional Waterfall project management methodology to Agile.  Why?  Agile fits today’s fast-paced organizations and allows them to easily adapt their project portfolios as business priorities change.  It also allows organizations to better respond to customer needs and stay competitive.

If you are ready, here are five tips for transitioning to Agile:

1.  Perform a readiness assessment of the organization

  • Determine if your organization is ready for Agile
  • Ensure the organization understands how Agile works

2.  Educate the team and the organization about Agile

  • Define roles and responsibilities of the Agile team
  • Train the team on their roles and responsibilities

3.  Provide decision-making authority to the Agile team

  • Ensure the team has the authority and decision-making ability
  • Ensure that team members feel capable to step into decision-making roles
  • Guarantee management support

4.  Start with a pilot project

  • Identify a project
  • Set up the team infrastructure

5.  Have an Agile Evangelist

  • Support the Agile team (and organization)
  • Provide recommendations to the team

Many companies try to jump into agile, get frustrated, and run-away from the experience.   It takes thought and preparation to make the transition a successful one.  Agile just doesn’t happen.  You have to make it happen.  But the rewards are worth the journey.

5 Highlights from SharePoint Conference 2014

SharePoint Conference 2014 wrapped up last week. Microsoft used the big stage to announce some exciting new capabilities and paint a clear picture as to how they see the future of SharePoint.

It starts with their view of the future of work. Not farm labor but information work of course. That future is networked. It consists of individuals and groups collaborating using documents, discussions, chat and video in a fluid setting. People may be working from their office, home, on the road or all of the above and using a variety of devices. They need access and an ability to interact. They need to be productive.

I have to subscribe to this vision as this is exactly how we work at Edgewater today. The future is here.

Microsoft’s vision for the technology that should empower this future of work is a natural extension of their mission of supporting information workers, and with Office 365 it all comes together rather nicely. Your office apps and files, email, chat, video, meetings, groups, calendars, people, social interactions all available and integrated. Available from anywhere and on any device.

It’s not all there yet and as I mentioned in an earlier post, there are quite a few gaps to fill but they are rapidly working on closing it and the speed of cloud deployments will allow them to make it a reality pretty quickly. Unless they find a way to derail things again.

A few things that were introduced this week build on and extend these concepts.

officegraphThe Office Graph: Not a new concept in social networks and a core capability of Yammer, extended to the full Office 365 suite, this is at once exciting and scary. All my activities, connections, interactions are tracked and put into a graph format that allows applications to use this data for a more relevant and personalized experience. It has some great potential applications, some we’ll talk about next with the Oslo interface. On the other hand, not that there is any real privacy in the workplace but any semblance of it will be officially gone. “Did you read my memo from last week”? well, no more white lies as your manager can easily get a report of who exactly read the memo.

OsloOslo: a new tool / interface concept from the FAST search team combines search and the social graph to give you a FlipBoard like experience, bubbling up things you should know. If your close colleagues are all reading the same document, maybe you should too? If a specific blog post is generating a lot of comments, what discussions are very active? Natural language search across multiple data sources. Can definitely be very useful.

GroupsGroups: yes, interesting to think of groups as a new concept. In this incarnation (lovers of public folders rejoice) groups are a cross application construct for discussions. Integrated across Yammer, SharePoint, Outlook and office, the idea is that in many instances, group discussions are a better way to interact than email. The only concern I would have is the proliferation of groups. It may be good for people who are only part of a handful of groups and teams but many of us are part of dozens if not more groups and teams and the interface I’ve seen only included about 6. I hope it scales.

inlinesocialInline social experiences: in short, this recreates a way to have a Yammer conversation on files and other Office, SharePoint and even Dynamics entities. I love this feature. It is such a natural way to interact instead of emailing and allows all people with access to see the discussion.

Cloud Only? Finally, I think the big question on everyone’s mind was what will happen to the on-premise version of SharePoint. With so much focus on the integrative aspect of Office 365 and rolling new features on a weekly basis, will the local server be phased out? The official answer is that the on prem version will continue to be important and get a new version in 2015 and beyond. With such a huge existing installed base they have to. But the future is clear and it is definitely in the cloud.

Why Cloud?

Why CloudIT leaders:

It’s time to take an honest look at the business and business goals of your organization. How does IT drive BUSINESS objectives? Can you honestly say that your IT infrastructure contributes to your company’s bottom line? Or are you still a “cost center?” What you will find is that there are big areas of opportunities to enhance business strategy, free up real dollars in hard savings, and free up soft costs. Although out-of-pocket savings is the current focus of the benefits of the Cloud, it’s the soft costs that may provide the biggest business impact.

Freeing up “facilities”

Moving systems to the Cloud will allow key essential resources to focus on those projects that directly impact the business. Your IT group will better serve the organization as a whole by providing the foundation to grow and expand. So what do I mean by facilities? Think on a broader scale. I am not talking about a couple of racks, I’m talking ALL of your physical facilities. Just think of the benefits of not being tied to a physical space:

  • Production and/or Disaster Recovery: you don’t have to house the majority of your hardware onsite. The Cloud can potentially house both primary production AND disaster recovery. Two different locations in the Cloud, nothing in your building.
  • Utilities: Electricity, phone, wireless connectivity, every square foot has associated costs, and much of it can be Cloud based. No more need for the long term contracts and responsibilities a company’s physical space carries. Your utilities don’t have to change when your address does.

The goal of the Cloud is to provide efficiencies to the businesses, both from a cost and support prospective. So why wouldn’t you want:

  • Quicker turns on IT projects
  • Stability across the application base
  • More efficient use of skilled resources
  • Mobility

Shifting applications and functions only makes sense. Consider Microsoft Office 365 as a starting point. Even if you only use Outlook and not the other applications included – SharePoint, CRM, SkyDrive — consider what you WON’T have to worry about:

  • Licensing
  • Version control
  • Hardware life cycles
  • Facility space and costs

And look at the benefits:

  • Ease of access regardless of location
  • Plays right into  Disaster Recovery and Business Continuity plans
  • Latest and greatest versioning / functionality

The bottom line is that the Cloud does provide significant benefits to any business.  It’s time to take a hard look at how your IT footprint can contribute to your company’s success.

Happy Birthday Office 365, what’s next?

It sure looks like it’s been around for a lot longer, but office 365 is officially celebrating its 1 year anniversary this week.

It’s true that some aspects of earlier MS cloud effort have been around for 4-5 years under different names like BPOS but the new branding and consumer side were introduced last year and SharePoint online took a huge step forward. So how is it doing?

Not bad according to different reports. 3.5 million Consumers have signed up and 15% of exchange users are in the cloud (6% increase over the last year). Microsoft is clearly betting the farm on cloud and the recent choice of its cloud chief Nadella to be the next CEO is a telling sign.

A recent technical summary at ZDNet and a financial analysis at Seeking Alpha both look very positively on the stability and profitability of this model.

We’ve been using the Microsoft office 365 email for a number of years and SharePoint for the last few months and our experience has been very positive. Our customers have been reporting similar satisfaction levels with the reliability and performance. The main advantages we see are:

  • Reduced IT costs: No need to allocate server or VM’s. No need for redundancy and backups. No need for regular installation of patches and updates and all the testing involved.
  • We invested in putting provisioning processes in place that dramatically reduced the timeframe for creating new sites and reduced administrative effort.
  • Mobile and iPad access through Office Web Apps.
  • Social: the new newsfeed, Yammer integration and Communities bring out of the box enhanced collaboration and social interaction.

Looking ahead, there are definitely some concerns and wish list items I’d like to see Microsoft address for office 365 and SharePoint online:

  • Stronger security and privacy commitments. Not that the NSA would have a problem getting to most information anyway but knowing that all corporate secrets are basically available to them upon request is disquieting. Multinationals may not be willing or legally able to make the jump and trust Microsoft with their data. This can be the biggest obstacle for mass adoption for larger companies. Small to midsize companies may care less.
  • More control. From an IT point of view this is scary. An inhouse server you can test, tweak, add memory to, reboot when needed, and install 3rd party add-ons. You now, control. Giving away the ability to jump in and intervene is hard. Even when Microsoft does deliver reliability and reasonable performance our natural impulse is to try and make it better, tweak, optimize. Not much you can do here. I do hope that Microsoft expands the controls given to customers. It will get a lot of untrusting IT guys a level of comfort that is not there now.
  • Support for Web Content Management. If we are giving up a local SharePoint environment, why force users to have one if they want to take full advantage of SharePoint as a content management tool for public website?
  • Add native migration tools. Not that I have anything against our partners the migration tool makers but releasing a platform with no out of the box method of upgrading to it was very odd and the fact no support has been offered since is disappointing. Makes the natural audience of smaller to mid-size businesses with an additional expense to migrate.
  • Cleaner social toolset. I wrote about it earlier in the year, that the Yammer acquisition created some confusion among users. The promised SSO is still outstanding and the small incremental steps like the one released this week are a little confusing.

Part 2: Creating an Editable Grid in CRM 2013 Using Knockout JS

This is the second installment following Part 1, which introduced the editable grid in CRM 2011. Since then, I have upgraded the editable grid to work in CRM 2013.

In this blog, I will first demo what the grid looks like in CRM 2013. Afterwards, I will walk through the main block of code.

Demo

The following screen shots demonstrate the editable grid of opportunity products inside of the opportunity.

MPitts KnockoutJS 2 image 1

The above demonstrates:

  • Editing existing data, including lookup data
  • Adding a new record
  • Deleting an existing record
  • The introduction of the custom option set field, ‘projected schedule’ (new to this post)

MPitts KnockoutJS 2 image 2

Steps

  1. Click ‘Add Opportunity’
  2. The standard lookup appears; select a product and click ‘Add’

MPitts KnockoutJS 2 image 3

3. Choose a ‘projected schedule’

MPitts KnockoutJS 2 image 4

4. Click ‘Save’

MPitts KnockoutJS 2 image 5

5. As a proof of concept, the code takes the count of opportunity products, and updates the parent ‘estimated budget’ field.  This demonstrates updating the parent opportunity.

Code Walkthrough

The following code is reference implementation that you can adapt to your needs.

The following web resources make up this solution:

  • Jquery.js
  • Knockout.js (version 2.2)
  • SDK_REST.js
  • SDK.MetaData.js
  • The below html web resource.

Code Walk Through

Code Comments

What’s next?

In future posts:

  • Resolving the known issue with IE (yes, IE only – sigh)
    • Object Expected with JsProvider.ashx
    • How to integrate this code in CRM
    • Sorting
    • Paging through the grid

BPO hosting: Has the dark side finally been destroyed?

luke yodaWhen Luke Skywalker was being trained by Yoda did he ever think about Hosting vs BPO – well maybe he should have. Maybe there where bigger fish to fry than cutting his own Dad’s hand off, which felt a little cheesy.

So what are we talking about? Well, for years Carriers have sought a way not to spend multi-million dollars on infrastructure and to host or process outsource their core. Now if you have no CSR staff and do not wish to hire them, then process outsource was the only avenue, if you had CSRs but your enterprise infrastructure was poor you looked to a BPO to provide hosting. Breaking it down though, no BPO firm wants to host your policies, it is not in their business plan. Sure, they will but why do you think they will? Because their sales guy will constantly be trying to drip bleed you dry and move over to BPO “let us handle the excess claim volume next month”, “wow billing is such a simple area, we could take that off your hands and your valued staff could be moving into bigger things” – it is all the “camel’s nose under the tent” – you do not notice the nose and soon enough, the whole camel is in.

So where is this going, seeing as there are limited offerings… the world has changed and at last large Policy Admin vendors are looking to the Cloud. With harnessing new models in a way to offer their products the costing and security can seem great benefit, to the big and the small alike. Only last week I sat with a PAS vendor who took me through how they could, cost effectively, host several small carriers on one hosted instance, spreading the cost and achieving a way for everyone to access the latest and greatest software out there. Of course, people have laid claim to this before but no one has ever seemed to make it a realistic business model, until now.

The good news is, it is out there – finally we can see costing and hardware sizing where they should be — which is the best of what you want, when you need it. No longer do you need to size for your month-aversary and no longer does the end of year CPU crunch need to worry you…you can have the best of the Admin Systems and you can strap on power when you need it. I, for one, finally feel that really Insurance Admin in the Cloud is here and it is here to stay.

Admin vendors can worry about their product enhancements; Cloud providers focus solely on the security and fail over (they are the best at it after all); carriers can focus on customer service and product. Amen, we are all where we should be. And what about us integrators? Well that is simple, with any move like this comes a need to not only have your Cloud strategy in place but also the ideal time to review your Enterprise Architecture as a whole. PAS is just one thing, what about Office 365 in the Cloud? The list goes on and on – it is time to see if the Cloud has an avenue for your organization and time to stop letting others control your destiny. Cloud vs BPO hosting /services – a no brainer decision.