The “Easy” Software Upgrade at Delmar Ortho—Case for Chapters 8 and 13 Tressa Springmann and Sharon B. Buchbinder

Delmar Orthopedics is a 42-physician orthopedic group; its physicians command the local market in terms of the orthopedic specialty—operating in several of the nearby hospitals and seeing patients in their five sites around the city. Delmar works like a machine. The physicians, the structure around their practice, and the employees who support them are extremely efficient and predictable. Recently, their margins have declined due to reductions in reimbursement, but they have been doing a good job of squeezing every penny out of each clinical day. And, they finally smoothed things out after the

somewhat rocky implementation of their electronic medical records (EMR) system the prior year. Everything seemed to be under control. Patrick McCain joined Delmar Orthopedics a month ago as the practice manager. Prior to joining the practice, he'd been managing a bank for 2 years after working his way up through the teller ranks in his college years. A hard worker, Patrick felt relatively comfortable in his ability to manage people and a budget. He was excited about his new job with the challenge of managing a large team—more than 40 people—and having responsibility for all practice administrative functions excluding finance, legal, and information technology (IT). Years ago, the practice instituted a bimonthly meeting of the leadership (management team members and a number of the key physicians) to discuss volumes and patient care issues and announce upcoming activities/events. Yesterday's meeting was Patrick's second since joining. During the meeting, it appeared that a number of the physicians were not paying attention. One played a game on his smart phone during the entire meeting, and another one kept leaving the meeting to take phone calls. Two of the team members had a running sidebar conversation about their weekend plans, and a third one actually fell asleep. Although the meeting was relatively noneventful—and, in fact, this seemed to be the team's usual meeting behavior—there was one item that concerned him. Terry, the practice's IT director, announced to the group that it was time for the annual upgrade of the system. The schedule wasn't yet finalized, but he recommended completion within the next 90 days. This would be their first upgrade to the system and would require five hours of downtime for the vendor to complete. Plus, it had to occur on a weekday, when physicians would be seeing patients. Terry did say that this would be their first time the system had been down since it was installed the prior year; however, he did not provide any additional details or offer contact information for follow-up. Patrick knew this upgrade would be an important chance to prove himself, but he was the “new kid” on the block. He worried that there might be alliances of which he was unaware and “sacred cows” that no one wanted to disturb. He lived through many systems upgrades in the banking world and was painfully aware that these supposedly “easy” upgrades never were. He wanted to alert the practice to the problems that could occur and how to avoid them. As he sat at his desk thinking about all the issues, Terry strolled by, grinned at him and said, “Don't worry, I've got it all under control.” At those words, Patrick's heart sank. As he learned more about the project, it was clear that all of the staff and physicians needed to be retrained. And there had been no accommodations made for testing the changes. He increasingly felt as though Terry had not appropriately informed the leadership team about the scope and risk of the upgrade. Terry appeared to be held in high regard by the practice.

DISCUSSION QUESTIONS

1. How can Patrick address these risks without embarrassing Terry?

2. Why do you think that a number of the team members don't pay attention to this important event? As a future manager, what do you think should have occurred in this meeting?

3. How would you handle the discussion that needs to take place with Terry? What measures might you take to plan for the worst?

4. What research should Patrick do on the prior's year's project that might assist him in assessing the risk in the upgrade?

5. How might Patrick ensure that he understands the impact of the project before putting too much time and effort into it himself?

6. What are some of the questions Patrick should pose to understand how this upgrade would affect his staff? The physicians? Delmar's patients?

7. Are the physicians “team players”? Explain your response.