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How KU transformed its health system with lean ITSM

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Jeff Davis, ITSM Process Owner, University of Kansas Health System

Effective service management can be a major step toward your organization's digital transformation, but tackling improvements around incident reporting, problem solving, and change management is challenging at best and overwhelming at worst—especially if it involves IT and healthcare.

At the University of Kansas Health System, we went from a labor-intensive, manual ticketing system to a high-performing, highly automated one by combining service management and lean production concepts to streamline our process, and to create a path for continuous improvement.

Here's how my team did it.

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From paper to HEAT to ITSM

We started with a system that used paper to record changes and issues, then slowly transitioned to an electronic system we called HEAT. Although our HEAT system was better than paper, it was still manual and labor-intensive. For example, we still had to do all approvals manually, and it took 20 to 25 minutes to complete each service ticket.

Meanwhile, our ticket volume was rising. From 2007 to 2010, it increased by 68.5%, from 2,313 to 3,898. To keep up we needed a more efficient system and an easier way to enter changes and issues. That's when we began to look at lean and agile and how we might incorporate those concepts into an IT service management system.

Our new system proved to be more efficient and easier to use. While ticket volume continued to climb—from 2011 to 2014, it increased by 592%, from 3,898 to 26,987—we cut ticket entry times nearly in half, from 17 minutes to nine.

We engaged with stakeholders up front

We believed that our new system would be a significant improvement over the old one, but we also realized that there would still be issues and pain points we would need to address. To identify those and gain user acceptance of the new system, we launched an extensive feedback and education program.

We scheduled team, department, and all-hands meetings to show what we planned to introduce. For groups that we knew would be using the system a lot, we had more formal training sessions, where we went through test cases so they became accustomed to using the system.

That helped calm the kind of anxiety that typically accompanies any big change, especially among older employees, who often see change as a way to push them out the door. And we emphasized that the system was there not to eliminate jobs but to make doing people's jobs easier.

By the middle of the decade we knew we were going to need to upgrade our ITSM system. We didn't want to carry the pain points and issues we had with the old system over to a new system, so rather than tinkering with our legacy system, we built out a new system from scratch. And during that transitioning we wrote a script to translate the information on the old tickets into a format that the new system could understand.

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The new ITSM rolls out

With our new system, we made even greater strides in using lean and agile to manage our services. For example, we implemented a risk-level system. Managers could approve items assigned a risk level of 1 or 2—typically daily maintenance items. Items in risk levels 3 to 5 had to be approved by both management and our change advisory board (CAB).

That board, which meets weekly, includes everyone in the organization at the assistant director level or higher. Prior to creating our risk-level system, we had no classification system, which forced us to manually segregate tickets for something broken from those that were just work orders for a piece of software or a laptop.

We also implemented change templates for daily maintenance items. The templates had benefits for both users and managers. Key items on a template would be pre-populated with information. That saved users time in filling out a form and also improved the accuracy of the information on it. Pre-populated fields on the form included the categorization sections, which allowed us to run reports with detailed metrics from our tickets.

In addition, we added a problem and knowledge management component. It offers a database of solutions for users entering tickets, as well as service desk personnel. This helped contribute to reduced support times by giving support personnel an efficient and reliable source of information to solve problems. It also enabled users to solve problems on their own, before creating a support ticket. Before the system opens a ticket, users type in their issues and links to recommended self-help articles come up. If none of the articles appear relevant or helpful, users can proceed, and the system opens a ticket.

We had even better results when we upgraded the system and automated more of it. The system works so well that today, both ticket volumes and ticket entry times have declined. From 2015 to 2018, we experienced nearly an 8% drop in ticket volume, from 27,967 to 25,833. Automation greatly contributed to those reductions by streamlining the ticketing process and reducing redundant tickets. In addition, because the system is easier to monitor, support staff can stay ahead of problems and address them before a ticket needs to be created. Meanwhile, during that same period, ticket times plummeted by 66%, from nine minutes to just three.

Lessons learned: Educate, then automate 

By borrowing a page from the lean and agile playbook, we were able to re-engineer our processes on a firm ITIL foundation and rebuild our service management system from the ground up—and save $600,000 in yearly operational costs.

We automated everything we could, but we introduced those changes gradually, allowing tasks to continue to be performed manually before we fully automated them. Most important of all, we invested heavily in education and training. We did organization-wide meetings and team meetings. We did acceptance testing, and you should too. Education can be an obstacle to success if you let be—so don't let it be.

For more on how lean service management transformed University of Kansas Health System, come to my conference session, "How Lean & Service Management Changed IT Healthcare" at Pink20 in Las Vegas. The conference runs from February 16-19. 

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