University Health Network (UHN) expected to improve its business intelligence (BI) capabilities when it signed on with BI heavyweight Cognos. What it didn't expect was to secure favorable contract terms for its partner hospitals or have the flexibility to choose between technical training and strategic consulting when it came to support. But that's just what it got.
Prior to its recent BI initiative, UHN was using a homegrown data warehouse of its own, but, like anything homegrown, it had been developed in an ad hoc fashion. A network of three teaching hospitals –Toronto General Hospital, Toronto West Hospital, and Princess Margaret Hospital – all located in downtown Toronto, the data warehouse lacked important data from UHN's finance and human resources departments. UHN had also long used corporate balanced scorecards to monitor everything from patient satisfaction to infection rates within its hospitals, but the data was incorporated from a variety of unconnected sources, requiring long, tedious hours of data entry. The result was an unacceptable number of errors and an unmotivated staff. In other words, it was time for a change.
UHN hospitals specialize in transplants, cardiac services, and cancer research, among other disciplines. Like all hospitals in Canada, they are publicly owned and depend on the government for funding. As such, cost is a major factor in any initiative at UHN, IT or otherwise, and its BI project was no exception.
"In Canada, healthcare is public, so we don't have all the money in the world to work with," said Diamond Watson, director of management decision support for the SIMS Partnership, an IT association of 13 local health care organizations of which UHN is a member. "So we're always working on a shoestring [budget]".
In October 2006, Watson's team, along with IT staff and managers from across the organization, worked together to develop a request-for-proposal (RFP) for a new BI system. Getting input from a large cross-section of UHN's workforce was key to getting the funding it needed, Watson said. It was also an opportunity to determine the actual BI needs of the organization and a chance to educate those involved about the process itself, and just how long it would take.
Managing stakeholder expectations
Eight vendors responded to the RFP, which UHN quickly short-listed to two, based on functionality, cost and the vendors' experience with healthcare organizations. It invited the two vendors on-site for separate, weeklong evaluations. Each was given actual data sets and asked to run through its proofs-of-concept. At the end of the week, each presented live demonstrations -- "ran the reports, talked about scorecards" -- and allowed UHN staff to "play" with the results, according to Steve Pevere, UHN project manager.
When the evaluations were complete, the selection team was nearly deadlocked, but UHN ultimately decided to go with Ottawa-based Cognos, since acquired by IBM. Neither Watson nor Pevere would identify the other finalist, but Pevere said it was a "household BI name." Whatever its competition, it might seem Cognos had a leg up from the outset, as one of UHN's partner hospitals -- Toronto Rehab -- was a Cognos customer itself. Watson said this wasn't a factor in UHN's decision, however, and she even instituted a communications blackout with that hospital's staff and their Cognos contacts "so there would be no perception or reality of a conflict of interests."
The implementation process is ongoing, but once completed, the network's finance and human resources data will finally be incorporated into a refurbished data warehouse, its corporate balanced scorecards will draw data from consistent, clean sources and come with built-in accountability mechanisms -- like email notifications with action planning -- and its non-management workers will have a wider array of operational-level, self-serving reports to choose from. The first phase of the project, 15 new human resources-related reports, is expected to go live at the end of March.
Watson said UHN is happy with the job Cognos has done so far, and in fact handling internal staff concerns has proved the more difficult job. The director of human resources, for instance, was initially uncomfortable allowing the new data warehouse access to sensitive employee data. Watson ultimately convinced the director to relent, pointing out that her team had long handled patient data without suffering a security breach and could do the same with human resources data.
An even more daunting, and recurring, task has been managing stakeholder expectations, Watson said. There is a lot of behind-the-scenes work to be done, like upgrading the data warehouse and resolving data quality issues, before any tangible results like new scorecards and reports become apparent -- an unwelcome if not foreign concept to some executives at UHN. Like most executives, they want to see the results of their investment sooner rather than later.
Watson likened UHN's BI project to an Antarctic iceberg, whose small tip is visible above the waterline with the bulk hidden beneath the waves.
"There's this huge piece underneath that's not sexy, not exciting; but the building of the data warehouse, the training of all the technical staff, and all that has to get done before they actually see something on the front end," Watson said. "So it's just a matter of always trying to find creative ways to make our milestones and successes on the back end sound exciting."
To do that, Watson works with a steering committee made up of stakeholders from each department involved in the BI project, to keep the rest of the organization updated on the implementation process. Her team also works with a corporate planning committee to make sure the resulting scorecards and reports actually meet expectations. Though UHN staff members are still eager to start reaping the benefits of the Cognos BI project, they have realistic expectations as to when that will actually happen.
Creative contract negotiating and lessons learned
UHN itself is part of a larger network of Canadian hospitals and was able to turn this partnership model -- and Cognos' desire to extend its reach in the healthcare industry -- to its advantage, Watson said. UHN negotiated with Cognos to allow any of UHN's partner hospitals to purchase Cognos products at similar prices for up to three years, or to share licenses with UHN if it had bought more than it needed.
"We have at least two other partners looking at going down the BI route, and it's not predetermined that they're going to choose Cognos. But we have that as an opportunity," Watson said.
Cognos has also been flexible when it comes to support, allowing UHN to use its allotted support hours for either technical training or more strategy-related consulting.
UHN also learned some valuable lessons from Toronto Rehab, its partner hospital that was already a Cognos customer when UHN began looking into its BI options. Among them, stay away from cubes.
One of our SIMS partners "actually had on the managers' desktops cubes to report from, and that really did not go over well. Everyone hated the word 'cubes'," Watson said. "So the lesson … we took into this is cubes are good for analytical people, but a manager of a department wants to see a nice report with some graphs they can click on…. So we skipped that cube stage."
The BI initiative's 2008-2009 funding has just been approved, and Watson is in the process of planning future phases of the project. Among them, UHN plans to roll out improved financial reporting and balanced scorecards in June. Still, she stressed the need for patience.
"It is a long process," she said. "It's been since October 2006, and we still don't have any pretty, shiny things on the desktop…. There's a lot of work to do under the iceberg before we get to the top."