Reengineering an Information Management Help Desk
a quality improvement processMAJ Louis Schwartz, CPHIMS
The process we used to achieve a markedimprovement in our Facilities Information Management Help Desk.
Gathering InformationObservationsBased on your experience and knowledgeInterviews open format they provide informationCustomers, Superiors, Peers, EmployeesStaffing Model do we have enough folks to provide good serviceBenchmarkingInternal AnalysisInformation Mgt. Division (IMD) Needs AssessmentJoint Commission of Accreditation on Healthcare Organizations requirement - where do we stand with the customer Average time for the completion of work orders. how long the customer waits Customer satisfaction analysisInternal process analysisElements that affect service
Staffing ModelTOTAL 45.6531 4Model developed by Booz, Allen, & Hamilton for US Army Medical Command
BenchmarkingComparing your organization against othersWorking with CIOs, Information System DirectorsLook to different businesses but provide the same internal serviceIT help desks in manufacturing, utilities, and service companiesWhat are they doing well and why?Industry StandardsResolution Times, How to Support, Products to assistEmployees Flextime, Education Opportunities, Stability, Promotion Potential
Information Mgt. Division (IMD) Needs Assessment
Average time to complete IM office automation requests JAN- JUL 99 prior to start of projectSnapshot in time
Old Customer Resolution Time Graph
Helpdesk Aging Report 25JAN 01
4hours1 day2 days3 days4 days5 days
Total Help Desk Aging Report11 Jan 01
4hours1 day2 days3 days4 days5 days
Total Help Desk Aging Report18 Jan 01
4hours1 day2 days3 days4 days5 days
Helpdesk Aging Report 25JAN 01
Happy with our quality of service but our response time is slow
IMD Customer Satisfaction Survey by Section
Systems Admin Services
Help Desk Support 1.68 Information Desk 1.71 Systems Ordering 2.07
End User Computing 1.93 Telephone Service 2.17
Systems Support (CHCS)1.75 Medical TV 1.5
IMD Sponsored Training 1.95 Photographic Service 1.64
Forms, Printing 2.26
Video Teleconference 1.75
1=very satisfied 2= satisfied 3=somewhat dissatisfied 4=dissatisfied
How to get service from IMD Customer request is completedType of requestMultiple methods of problem and support, tracking, analysis, and resolution:manually, telephonic, and computer assistedInternal Process Analysis
limited home grown databaseOffice Automation (OA) help deskmanual processesAdmin. Servicemanual closeouts not done by service providerOA help deskNo trackingDOD Systems trackingWork order Assignment inefficientOA help desk, Admin. Service, DOD SystemsNo consolidated knowledge baseDOD Systems OA help deskNo automatic trend analysisAllanalysisMultiple phone numbers to callAllLimited Information for customerAdmin, DOD Systems, OA help deskreportingmultiple pieces of equipment & software to serviceOA help desk DOD Systemslimited cross-trainingAlltraininglimited numbersAllpersonnelSlow Resolution TimeRoot Problem five elements that effect customer service
Defining the ProblemGather a group of folksStudying your findingsObservationsInterviews Staffing Model BenchmarkingInternal AnalysisDevelop an Opportunity Statementfocuses on the positive and keeps the team on trackmuch like a charter
ManagementSection LeadersComputer AnalystsOutside AdvisorStaff MembersCivilianContractorsMilitaryTeam Members
We want to be able to providesuperior support to ourcustomers as well as anyservice organization in the IM/IT businessDevelop your StatementStudying your dataBrainstorming
Make a Tentative PlanList Action ItemsDefine requirements and priority for eachDevelopment timeline and critical points
Action ItemsBased on our analysis the Team determined areas for improvement to make our opportunity statement a reality.ObservationsDocument Business ProcessesLarger Workspace and Updated EquipmentInterviewsFaster resolution times Need training for specific applicationsStaffing Model Need more personnel in specific areasBenchmarkingAutomated Problem Management SystemResolve customer problems within an hour remotely.Internal AnalysisOne number to callFaster resolution times Streamline customers ways to get support
Defining Requirements and PriorityAction Items require different activities by type and need. We prioritized and grouped action items based on funding requirements, required outside resources and impact on quality improvement.
Action ItemFundingOutside ResourcesImpactPriorityA. Document business processes A. Streamline customers ways to get supportNoneN/A3B. Technicians need training for specific applicationsNoneN/A5C. Larger workspace and updated equipmentC. One number to call24KNoneInternal funding to DivisionN/A2D. Automated problem management systemD. Resolve customer problems remotely132K upfront10K reoccurring Information Mgt. Guidance Council (IMGC) thenExecutive Committee4E. Need more personnel in specific areas88K reoccurringIMGC thenExecutive Committee1
Development Timeline and Critical PointsABCDEImmediateProvide in-services presented by staff5 monthsAppoint teams; define goal; ensure deliverables; publish SOP 12 months12 months12 monthsFind the space; Bargain with section that has the space; Space committee; Union notification; Move; Number SetAnalysis; Selection Process; IMGC Recommends; Executive Committee Approval; ImplementationIMGC Recommends; Executive Committee Approval; Contract
A. Document business processes A. Streamline customers ways to get supportB. Technicians need training for specific applicationsC. Larger workspace and updated equipmentC. One number to callD. Automated problem management systemD. Resolve customer problems remotelyE. Need more personnel in specific areas
Implementing the PlanNew officeOne number to call Server upgrade/PCs & phones/Problem Mgt SystemReorganization and additional personnelNT and Magic SoftwareDocumentation and streamline processesIntranet and management marketing
Analysis, Survey, FeedbackInternal AnalysisIMD Needs Assessment Metrics
Interviews - One complaint in over a yearObservations -Users call back after departing to say they miss us! Less than a 8 hourAverage
New Customer Resolution Time Graph
Total Help Desk Aging Report19 Sep 02
4 hours8 hours16 hours24 hours
Total Help Desk Aging Report19 Sep 02
Why this topic?As a new director of Information Systems I was given a requirement to improve the ability of our hospital staff to get prompt service from our two help desks, clinical information systems, and our administrative information systems help desk. Though the entire process took over a year, I learned many valuable lessons which are important in solving not only information technology problems, but, systems process problems in any type of service organization.
Having served as the plans and resources officer, within the Information Management Division, I luckily had some insight as to the process and methods the Information Systems Branch used to resolve customer problems. In addition, the Chief Information Officer wanted some immediate resolutions, so I made the decision early on to modify the problem solving process I chose by limiting the number of personnel involved in developing and gathering data, and making a tentative plan. I chose this to speed the process, but I took some risk in that they would not have as much say in the plan (buy-in). Another variable was I was the new boss, and many employees were not yet comfortable with my leadership style.*Although the process as depicted on the slide is recommended, the slide doesnt depict the amount of time spent on each step. Based on my experience, I believe that gathering information is the most important step because all other steps come from what your team or individuals find. Therefore we spent the majority of our first few months just gathering data, so we could truly define our problem - which set the scope of the project.*Again, I believe this is the most important step. From our analysis, the problems - or should I say, - the opportunities clearly stood out and really determined our course of action.From the staffing model and benchmarking a baseline of where our organization should be was established. Observations, interviews, needs assessment, and analysis products produced where we actually were. *Our higher headquarters provided the medical facilities within the Army like us, a staffing model to compare our organization. Although the definitions of the components did not always exactly match our organization personnel job descriptions, it did show, without question, the need for more help desk support personnel. I also realized, I had to get management involved in resolving customer problems. The chart illustrates we had four management personnel that provided little support to the customer. Although it is not part of this presentation, we realized later that we needed another mail administrator. Then we cross trained all of our System Administrators to be mail administrators. This has significantly decreased the time it takes to create new email accounts.
*Benchmarking was an eye opener for me. I had worked with an individual that moved from an IS shop at an energy plant to our hospital. He had a vast amount of experience and loved to share his knowledge. From him, I learned what a help desk must have to be successful. Such things as remote seat management, a web based problem resolution system, a multi-phone system. We also learned the industry standard for customer resolution at the time was one hour.In addition, I looked to a major Information Management magazine that ranked organizations based on employee satisfaction and cemented in me the four areas under the employees bullet above: Flextime, Education Opportunities, Stability, Promotion Potential.*We used our I.M.D. Needs Assessment to gauge our customers satisfaction. We post this survey on our intranet annually. This assessment is a J.C.A.H.O. requirement. (If you would like a copy of our entire survey please email me) *The C.I.O. took data from our customer problem access database to devise the pie chart above. This information was critical in seeing where we were. The industry standard is one hour, so when we saw we were at 5.4 business days, we truly realized we had a problem (Houston we have a problem) . This showed us where we need to be but not how to get there. We took the information from bench marking and the staff model to figure out how to get there. *This slide depicts where the organization was early in the project. We publish this graph every week so our staff can see where we are so they could try and positively effect it. This graph shows the opposite of what we wanted. The red bars are the total number of open requests and the blue are the age (time opened) of the customer requests. We wanted the majority of customer problems opened between 4 hrs and 1 business day and few to none after that. This graph depicts about 40% of our work was still opened after 5 days. Later in the presentation you will see where we currently are.
*This data was generated by our I.M.D. Needs Assessment. The data told us our staff could do its job (for customers PCs), but we could tell it was taking too long for our work orders to be completed based on the research we did with our own problem tracking database. *From our Internal Process analysis, the need for stream lining how a customer gets service jumped out at us. We had numerous methods to resolve customer problems; everything from word of mouth, and or manual processing to a limited automated process.A prime example of this type of problem was : was getting a wall plate to be activated. A helpdesk technician had to hunt down a network engineer to activate it. This required the technician to stop his work, go and find an engineer and activate the wall plate. Through the process of streamlining, we assigned a Network Engineer to provide a beeper number to the help desk technicians in order to dispatch the network enigneer. The idea state which we incorporated in our system later was the process of referring the work through our web based system to the network section. With little work and straight forward solutions we dramatically decreased the time required to perform simples processes. *We performed a root problem analysis on slow resolution time, what we found where their we common problems among numerous areas within the branches of the resolution tree which effected many of the same areas within the organization. So if we could find a product that addressed multiple areas we could address multiple opportunities with one item.These like areas, shown above, validated our benchmarking specific product type we were in search of, a web-based problem resolution system.
*Because we spent a lot of time gathering data, and a lot of our opportunities jumped out at us during the first phase of the process. We were able to make a very relevant opportunity statement. We looked for people to be on the team that would foster the process.
*Not only did we want to bring in members from different levels within the organization, but also different types of people. This is particularly difficult in a military healthcare organization because of the wide variety of folks. *At this point we developed an opportunity statement as depicted above. Although we had a very good idea of what our problem was, we wanted and needed buy-in by the folks that were going to be doing the work and using the system. In order to get that buy-in we showed them our gap analysis motivating them so they could develop the statement above. This statement was our vision and a charter for the Information Technology Branch. It caused us to focus on root problems so we wouldnt stray from the goal.
*In making a plan we used the following: Semper Gumbie always flexible. Based on our analysis our team knew which way to go, but because we are an operation shop we had our daily workload and projects which affected the timeline and priority for our action items. Therefore, its important to know timeline and priorities might change but the opportunity statement of the group shouldnt. *We listed the action items. The things we need to do, the honey do list. Then we combed the list for redundancy and missing items. *This to do list had to be prioritized. Priority is generally dictated by funding and the need for approval for outside resources. We placed the highest priority on things we could do with our own funding and items that didnt require higher authority approval. If we could use our internal funds and did not require approval from a higher level of authority those items went right to the top except for more personnel. I took that on as my most important action item, because regardless of technological advances, streamlining etc., we would never really improve until we have sufficient staff. *In hindsight, we developed formal time lines for item A and item C through E after we completed the re-engineering because of our operations tempo and funding approval requirements, which affected the ability of our organization to accomplish the actions items. We knew the steps required to complete a request for funding, but bargaining for space and the union negations were beyond our control.
*Through the use of team leaders within our organization, we assigned action items or parts of action items to each. They lead the change. Several action items, specifically the problem resolution system and streamlining processes, had numerous parts to complete in order to complete that entire action item.As an example: In order for our organization to field our web based problem resolution system, we required new workstations for our technicians, another server for the Oracle database, a system administrator for the system, the documentation and grouping for our work procedures, and the upgrade of our current servers hardware. All of these tasks had to be completed prior to installation of the web based problem resolution system. *We used the same methods of gathering information that we used previously to see if we had made improvements. We could do more to search for additional opportunities to improve on our process, but we are still working on two major issues, client standardization and the combining of our help desks. *Here we are today. This report is a snapshot which we can create at any given time from a canned report within our problem management system. An individual can discern that we no longer report out to five days, but only to 3 business days. In addition we resolve over 1500 customer problems a month so a majority of our current workload is closed during the call which is our new goal. When we started, we had at any given time anywhere from 200-300 open calls as compared to our current level of only 40-50. What this means is if we open 50 calls per day and we have closed 26 we are resolving 50% of our calls on the phone.