In a previous blog, I defined the digital health system that delivery systems need to implement in the next three years in order to function, thrive, and fulfill their mission. In another blog, I listed some of the attitudes and activities systems will need to get there. Here I will discuss governance for demand management, data, information, knowledge, and innovation – the critical decision-making infrastructure that systems need to ensure a successful transformation.
Governance is not an exciting topic. The degree to which it is done well, however, determines how effectively and efficiently an organization will function. Governance defines an organization’s decision rights and can improve communication, collaboration, and coordination (the 3C’s) to produce more reliable and sustainable outcomes at a higher quality and lower cost.
An easily understood lightweight governance framework should include a set of principles, policies, and procedures that define how an organization will operate and how individuals in that organization should behave. Governance creates trust. Trust impacts behavior. Behavior impacts operations. Operations creates value. Value improves sustainability. Governance, therefore, anchors the value chain.
In a mature health system, you’ll find dozens of governance structures. I’ll cover a few of the key ones for IT.
Demand Management Governance
Demand management governance is critical to determine what can and should be done. Demand will always outstrip supply.
In the systems where I served as a CIO, we consistently measured the ratio of demand to supply. The lowest ratio was 6:1 meaning we got 6 times more requests than we could complete. That is on the low end according to a survey I did of my peer CIOs. To survive as the leader of Digital Services (what IT should become), you have to learn how to say “No.” My favorite phrase to communicate “no” is simple: “We can do anything. We can’t do everything.” Though not always happy with this message, when said diplomatically and with the weight of the governance process in place, the requestor is almost always accepting. And please note that “no” is not equivalent to “not now.” You have to avoid creating a backlog by putting every request in the work queue. Backlogs destroy morale. The workloads must be limited to what can be achieved with the resources you have or the resources you will be getting.
In a digital world, as users get more sophisticated, demand will increase. Demand management protects your resources and your people.
Data fuels your decision-making engines. Data governance can help ensure that the fuel for those engines produces the greatest energy. Use data governance to assign data owners who are accountable for the quality of the data. Set up processes to monitor the quality of the data and ensure that it is consumed in compliance with your own policies and regulations. Create common definitions, provide context, and ensure that consumers of data understand it. Patients and families place a sacred trust in providers – trust that what they share with a provider will be safeguarded. Honor that trust by making sure their data are accurate, safe, secure, and that the patient’s privacy is protected.
When data are converted into actionable information, you need a process to manage it throughout its lifecycle. AHIMA, the American Health Information Management Association created a useful framework. They note there are strategic, operational, regulatory, legal, risk, and environmental requirements for information. Information Governance establishes policy, determines accountability for managing information, and ensures this strategic asset is used properly and protected.
Unlike most physical assets, the more information assets are shared widely the more valuable they become. Knowledge governance is a means for deriving meaning from, managing, and most importantly, securely and appropriately sharing an enterprise’s information assets according to established principles and policies. Sharing knowledge improves the performance of the individual and the organization. For patients and families, knowledge improves and saves lives.
Knowledge inspires. Coupled with imagination it fuels innovation. Governance is essential to innovation. Without it, innovation will likely falter due to a lack of focus, support, funds, vision, or resources. To increase speed and decrease time and costs, innovation requires disciplined communication, coordination, and collaboration. Innovation governance encourages an organization to examine and challenge the status quo in a deliberate, disciplined way while protecting operations. It is a means for constructively disrupting processes and improving operations to achieve better outcomes.
Governance is the fabric that ties all elements of an organization together. With the challenges and opportunities ahead, digital health systems need to be agile, flexible, protective of resources, well-coordinated, and resilient. Governance is essential. Choose your approach wisely and adjust as the enterprise evolves.
There are numerous models of governance for each of the areas listed above. For a practical and pragmatic approach to governance for your organization as it transforms into a digital health system, StarBridge Advisors has the expertise to assist you in that effort.