help desk assessment report.x10

1

Pre-Sales Assessment Presentation

Phase 1 Progress Report October 21, 2005

2

Agenda

• Background• Project Objectives• Approach• Deliverables• Current Mode of Operation & Observations• Next Steps (Phase II) • Areas for Additional Investigation• Critical Success Factors • Assumptions

3

Background

• Project Sponsor• Business Driver• Team

Project ObjectivesApproachDeliverables

4

Background

• Project Sponsor

– Cliff Seaholm (ITFS)

• Business Driver

– Customer HealthConnect, the largest healthcare initiative in Customer history, requires the deployment of highly available IT infrastructure to “enhance the patient care support the Customer Promise” for the future

• PC/Failures Timely Repair

– ITFS investigated potential PC support model alternatives to achieve SLA for restoring a failed PC

– Of options considered, re-engineering of the break-fix process using other smart people will be investigated

5

Background - Team

Customer Project Governance

• Cliff Seaholm – Project Sponsor• Carl Kawaguchi – Acting Project Sponsor/Ops

Manager• Kevin Wheeler – Ops Manager• Sharon Bond – PMO Manager• Larry Faulkner – PMO Project Manager

Customer Subject Matter Experts

• Erik Hildebrand – PMO• John Pho – ITFS IT• Carl Haupt – ITFS IT• Althea Santucci – HelpDesk• Mark Stanley – Software and Imaging• Thierry Guichard – Asset Management• William Bruce – BAP• Lisa Kendrick – Network Infrastructure• Carla Burget – Depot and Change

Management• Marc Hedish – Service Delivery

Inventes Due Diligence Team• Anand Raj –Project Oversight• Dawneen Davis –Project Manager• Charlie Jackson –Project Manager

6

Project Goal & Objectives

PROJECT GOAL:

The overall goal of the Business Process (Break/Fix) Re-engineering Project is to investigate and test reducing restoration time of CustomerHC business functionality for urgent areas within 20-30 minutes and within 2 hours for other important areas

ITFS Strategic Objectives

• Improve ITFS Services through the creation of a continuous improvement culture

• Enhance organizational effectiveness and service capability through proactive workforce planning, optimized processes, and cost-effective technology innovation

• Deliver business value by aligning ITFS services with all business requirements and creating a business partnership

• Reduce total cost of ownership for the distributed environment and be competitive with external service providers

Project Objectives

• Examine and document current Customer IT service processes and their impact on Break/Fix (B/F)

• Assess gaps in B/F service delivery processes, parts management, resources and skills

• Examine methods to achieve new service level agreements (SLAs) for improved response time

• In conjunction with Customer staff, develop a future state process and model the new process as part of the pilot in one Customer facility, provide knowledge transfer for continued operation under revised SLAs and document final findings

7

Current & Future Service Level Agreements (SLAs)

FUTURE REQUIREMENTS• 7x24x365 support for: OR/ICU, ED, Inpatient rooms, Inpatient Rx, Inpatient ADT, Ancillaries (Lab/Rad/EKG)• Extended coverage for: Nurse Stations, Outpatient exam rooms, Urgent Care After Hour Clinics, Registration, Appointment Call Centers• 90% of the time, need business functionality provided in the same physical location. Class A users need their business functionality provided in the exact location.

-Includes cart-based PCs, desktop PCs, and laptop PCs-Printing functionality- Assumption – All workstations are “Managed Workstations”

• The replacement PC has at least the same functionality as the one that malfunctioned. This includes the access rights necessary to do the work needed.

LINK – Current ITFS Severity Level Standards

A 2 hrs .5 hrs B 4 hrs 2 hrs C 8 hrs 8 hrs D 24 hrs 24 hrs

80% yield 90%yield

Current Future

74%

70-80%

Needs additional clarification on A, B, C & D

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Project Approach

• Understand & document Customer IT current mode of operations

• Establish baseline process and service levels

• Identify and analyze opportunities of improvement

• Develop a new modified process to achieve enhanced service levels

• Develop plans for pilot and seek necessary support and resources

• Conduct the pilot / gather pilot data

• Review pilot performance against the baseline and analyze gaps

• Develop final recommendations / success criteria for proposed changes.

• Complete overall project documentation

9

Project Deliverables

• Current Mode of Operation Documentation (Due Diligence Report and Presentation)

• FMO Documentation

• Pilot Project

• Summary Findings and Recommendations

• Project Plan, Meeting Minutes, Test Plan, Knowledge Transfer Plan

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Project Review – Phase I (Due Diligence) Overall Approach

Phase 1: Due Diligence

Milestone MilestonePhase 2: Process Optimization

Present and validate Due Diligence Report

Present final deliverablesAchieve knowledge transfer

Break-Fix Process Re-engineering Program Governance

Outline the scope of services (service stack) for due-diligence Establish governance model & communication plan (wk 1) Identify SMEs Conduct one-on-one interviews with the SMEs Document current state findings

Identify areas for further analysis Design and validate Future State Processes Plan pilot Implement and test pilot Prove/disprove desired SLA and recommendations Transfer knowledge Present final deliverables

11

Project Review – Phase I Due Diligence - Overall Approach

9/19/05 9/26/05 10/19/05

ProjectPlanning

Interviews and CMO DocumentationCMO

Presentation and Findings

Due DiligenceFindings

Presentation

10/21/05

Kick-Off Meeting

Phase 1 - Due Diligence

Break-Fix Process Re-engineering Program Governance

Outline the scope of services (service stack) for due-diligence Establish governance model & communication plan (wk 1) Identify SMEs Conduct one-on-one interviews with the SMEs Site visits and observations Follow-up data gathering Document and validate current state findings including process maps Document new requirements Review IT Governance and Business-IT alignment aspects

Finding report and

presentation

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Process Centric Approach

Customer-IT(NOPS)

CustomerBusiness

Client Services

ITFS ENSHDPatient

CareSite

Support

BAP

IMAC-D

Financial Manage-

ment

SoftwareAnd

Imaging

Desk-sideSupport

Asset Manage-

ment

Break-Fix

Network Infrastruc-

ture

NationalHelp-Desk

Solution Center

DepotManage-

ment

Problem Manage-

ment

Managed Project

Deployment

PMO

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Current State

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Infrastructure“When I turned on my computer today, I received an error message that my Customer HealthConnect couldn’t be found, so I called the National Help Desk and passed over to the Physician’s Help Desk.

CORE ACTIVITIES

OBSERVATIONS

KEY DATA POINTS

• Telecommunications and network infrastructure provisioning

• Continual support for electronic operation and communication

• Database storage, management, and operations

• Backup and restoration

• IT Service Continuity Management

• Establishing OLAs across IT organizations may help to achieve service levels

• HealthConnect – Major initiative that provides a program-wide systems for records and clinical content

• Web access portal

• Enterprise data repository

• 134,000 end-users supported across 430 MOBs and 30+ medical centers

• LAN infrastructure with fiber backbone, WAN

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Help Desk“My call was answered promptly and the Help Desk agent was very friendly. She attempted to help me and asked me several questions but it became clear that something must be wrong with my PC that would require a visit by an on-site technician. ►

CORE ACTIVITIES

OBSERVATIONS

KEY DATA POINTS

• Provide prompt, tiered “1st line” service for assistance throughout the region (Physician’s and General HD)

• Classify incident and attempt to resolve incidents on first call

• Generate tickets for Incident, Requests for Change, and Service Requests

• Improving first call resolution at the Help Desk

• Integrating with Site Support Specialists

• Solution Center piloting L2, L3 for expanded remote problem resolution

• 3 NHD call centers with 211 agents

• 99.9% of incidents reported via telephone

• Calls have increased 50% since early 2004

• 32,347 Incidents per month avg 2005: .04% Critical, .23% High, 74.77% Med, 24.97% Low

• 73% of incidents are resolve on first call

• 199, 207 calls (Aug, 2005)

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Help Desk“The Help Desk agent asked me to verify my location and other information and said to expect someone from ITFS to stop by my desk before noon. I said that I would be on rounds but my assistant would be there.” ►

CORE ACTIVITIES

OBSERVATIONS

KEY DATA POINTS

• Dispatch tickets to the appropriate resolver group

• Provide warm handoff to Solution Center for level 2 and level 3 problems

• Information sometimes entered incorrectly, or not updated, causing delays in service response

• There may be time delays between help desk response and on-site response

• Sometimes tickets may be incorrectly dispatched

• Remedy is primary tool for help desk, dispatch, and SLA management

• Many physicians call the general HD number

• 90% of dispatch incidents go to ITFS.

LINK: Process Flow Diagram

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Help Desk

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Availability Management

“I logged onto my Customer HealthConnect account via a shared computer, checked on the status of my patients and then began my rounds. ” ►

CORE ACTIVITIES

OBSERVATIONS

KEY DATA POINTS

• Ensure that necessary systems and data are readily available

• Assist with training of service personnel and customers, particularly regarding new initiatives

• Total availability of all processes (uptime) difficult to measure

• Support for new initiative sometimes affects SLAs initially

• Availability Management Plan includes provisioning for a 99.96 uptime

• XD General Office – used in personal environment with individual login and data

• XD Shared – used in shared environments with workstation logged into network

• XD Simplified – used in individual walk-up environment

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Break/Fix, Desk Side Support“When I returned to my desk, everything was working again. My assistant said that the ITFS staff replaced my computer because the software needed to be re-loaded and they didn’t want me to be without access any longer than necessary.” ►

LINK: Minutes from Interview

CORE ACTIVITIES

OBSERVATIONS

KEY DATA POINTS

LINK: Process Flow Diagram

• Responsible for resolving any hardware or software issue that occurs and cannot be solved remotely, including hot swaps

• B/F and DSS includes support for printers, PDAs, and other devices attached to computers

• Specialized locations for some computers (i.e. wall mounting) may require additional time

• Locating computers may be difficult if asset and/or CAD systems aren’t updated

• Remedy ticket resolution process may be optimized

• Resource quality/skill sets remain and issue and ramp-up time and training may be improved

• # of RFCs/SRs has increased from 742 in Jan to 1,802 in September. Incident includes h/w and software

•Most projects are July-Dec and via augmented staff

• Approx. 5% of incidents dispatched to ITFS are reassigned to other service providers

• 1/3rd of all sites have technicians in the building. 2/3rds of the sites require tech travel time

• PC hardware failure rate averages 3-5% annually

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Break/Fix, Desk Side Support

Kaiser Break/Fix High-Level Flow

Submission Resolution Closure

ED

SH

elp

Des

kB

usin

ess

P

artn

er

END

Call Help DeskSTART

Resolved?

Classify and Assign Ticket

In Scope?

Re-assigned or

Contact Help Desk

Incident? Yes

No

Close and update Activity

Log

Survey Generated

Yes

Escalation Process

Time Limit Expired

Incident or RFC?

Out of ScopeWhat happens if

it is not resolved?

Break/Fix Detail

Begin trouble shooting

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Break/Fix, Desk Side Support

Kaiser Break/Fix Detail

Resolution Closure

Bu

sine

ss

Pa

rtne

rE

DS

H/WH/W or S/W

Failure?

Swap PC,Install Printer,Note LU Info

Bring a New PC from Depot

Test PC

Verify

Additional Apps

Needed?

No

Install Additional

Applications

Yes

Incident Resolved?

Relate & Modify CI in Remedy

Update Local Access DB

Yes

Follow Broken PC Replacement Process

No

Break/Fix Detail

Break/Fix High-Level

Need to understand process for software break/fix

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IMAC-D“The ITFS technician also left a set a guidelines for our department move next week and said that they would move the computers during the weekend so we wouldn’t experience any down time. ►

CORE ACTIVITIES

OBSERVATIONS

KEY DATA POINTS

• Responsible for managing installs, adds, moves, changes, and disposal of computers and printers.

• Much of IMAC-D work is contracted to external companies

• Procurement process time can be an issue and also impact swap-out depot

• Use of Depot inventory for IMAC creates additional overhead in accounting

• No OLA for IMACs between other organizations

• Communication of the IMAC service levels to business partners will enhance customer experience

• # of IMACS per month: 7,190 in NCAL, 3,260 in SCAL

• Because of refresh, number of Installs has greatly increased

• Current service level for IMAC-D is 5 to 10 business days and varies

• Some Service Area (such as SF) also maintain a separate inventory of about 20 PCs (in addition to break-fix inventory at the depot) for the purpose of IMAC-D


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IMAC-D

Kaiser IMAC-D Process Flow

Submission Procurement Resolution Closure

Sta

rt-U

p

Se

rvic

es

BA

PC

ap

ital C

om

mitt

ee

HD

ED

SB

usi

ne

ss

Pa

rtn

er

Initiate IMAC-D Request

START

Open Ticket

Review Request

Need Procurement?

Schedule Time with Business

PartnerNo

Standard H/W?

Finalize H/W Specs

& Get Approval

Yes

Procure H/W

Close Ticket (Remedy)

Receive Asset, Put Asset Tag, Ship to Depot

Open Install SR (Remedy)

Fulfill Request

Test and Validate With

Business Partner

Business Partner

Satisfied?

Close Ticket

(Remedy)Yes

No

END

Validate

Send Survey (Automatic)

Complete Survey

Escalation Process

Time Limit Expired

YesNo

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Depot Management

“I replaced Dr. Carillo’s computer with one from the depot.” ►

CORE ACTIVITIES

OBSERVATIONS

KEY DATA POINTS

• Responsible for maintaining the required levels of configured computers needed to meet swap out for BF

• Manages returned computers, including provisioning of spare parts and warranty and out-of-warranty supplier communications

• Additional depots may be needed for facilities with enhanced SLAs

• Facilities space issues may need to be resolved

• Spare and whole-unit provisioning not automated

• Depots are strategically located, but not at all sites.

• Approximately 1% of the total population of PCs in that area is kept in the depot inventory

• 10-20 machines are imaged and ready to go at any time, depending on site

• Depots are replenished now by manual process

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Imaging and Software Distribution

“Then, I filled out a work order so that it would be re-imaged and I updated the trouble ticket.” ►

CORE ACTIVITIES

OBSERVATIONS

KEY DATA POINTS

• Responsible for maintaining current image builds, including patches, and new releases

• Images computers for depot and IMACs

• Potential to reduce time spent duplicating and imaging at all facilities

• Training on the processes will be helpful in making sure processes are followed

• Roles and responsibilities between ITFS and vendors related to Depot needs to be clearly defined

• 2 builds for express desktop (Win 2000 and XP)

• Core image includes h/w layer, OS, IE, McAfee, Tivoli, Lotus, Citrix, Health Connect, MS Office (some)

• Images stored on servers at 700 facilities, loaded on-site

• Geography config, and active directory managed by RadioOS Manager

• Merlin used for updates (4 hours), EPO for virus scans


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Change Management

“Dr. Carillo’s assistant asked if they could get some new software installed. I showed her how to access the HUB to submit an RFC.” ►

CORE ACTIVITIES

OBSERVATIONS

KEY DATA POINTS

• Change management system and CABs review and approve RFCs

• Manages SRs

• Some confusion over guidelines for RFCs and SRs

• Process sometimes lengthy

• Sometimes gaps occur between an RFC request/approval and the accompanying SR needed

•Communication is challenging. Technical briefings and targeted communications are more likely to be effective.

• 47,547 RFCs registered at HD (August, 2005)

• Standard RFC SLA: 10 days

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Asset Management“I returned to my desk to update the ticket with, and relate the new asset information then changed the status of the one that I brought back from ‘in-use’ . ” ►

CORE ACTIVITIES

OBSERVATIONS

KEY DATA POINTS

• Maintains the CMDB, appends weekly vendor feeds

• Responsible for tracking all assets and their location

• Perform quarterly audits of locations

• Responsible to audit software licensing compliance

• Touch points between ITFS services and asset management improving but need monitoring

• Better integration between Location Center (assets) and local support services groups might help improve SLAs

• Desktops: 147,041

• Laptops: @30,000

• Monitors/Terminals: @190,000

• Printers: @80,000

• Network Devices: @40,000

• Servers: @14,000

•90% of the IT assets are in the database


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Problem Management“This was the third time during the week that the Customer HealthConnect software was corrupted. I’ll need to see if this is being addressed during my next Problem Management meeting. ►

CORE ACTIVITIES

OBSERVATIONS

KEY DATA POINTS

• Root-cause Analysis

• Develop plans to improve problem resolution

• The mix of High-Medium problems could change dramatically

• Problem management is shared across NOPS but often problems are impacted by shared services

• There are ~ 16,000 PC problems each month (across all of Customers Medical Centers & Medical Offices

• All Customer HealthConnect problems rank “High”

• Local Problem Management teams meet weekly to review data

• Local and Regional teams meet and roll up problems

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Managed Project Deployment

“It looks like the Department is about due for new computers.” ►

CORE ACTIVITIES

OBSERVATIONS

KEY DATA POINTS

• Manages refreshes of computer hardware

• Works directly with supplier teams to schedule deployment services

• Resources issues have impacted refreshes

• Refresh issues have impacted B/F - DSS

• 1/4 of hardware is refreshed each year

• 21,597 PCs have been refreshed, 3,000 still left

• 99% of refreshes are completed at night

•There is no SLA defined for the refresh

LINK: Minutes from Interview LINK: Process Flow Diagram

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Kaiser Managed Project (MWI) Flow

Req. Submission Approve Scope Schedule Implement Close

Cu

sto

me

rR

eq

ue

ste

rE

DS

PM

O

START

Close Project

Submit MWI Request For

Project

ENDReview Project

RequestApproval Process

Conduct Survey

Size the MWI

Finalize the Schedule



Conduct weekly/daily

Project Status Meeting

Deployment Process

Use Existing

Inventory/Procure &

Deploy

H/w

No New H/wNeeded

Managed Project Deployment

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Next Steps (Phase II)

32

Next Steps (Phase II)Service Delivery & Support Model

Service Delivery

Service Support

Infrastructure

Customer

User

BU

SIN

ES

S P

AR

TN

ER

INF

OR

MA

TIO

N T

EC

HN

OL

OG

Y

33

Next Steps (Phase II)Process Optimization Plan

Summary Report Project

Close Out

RE-ENGINEERING PROGRAM GOVERNANCE

Final Deliverables Submission

and Presentation

Pilot Implementation Testing and Validation

9/19/05 9/26/05 10/19/05 10/21/05

Project PlanningInterviews and CMO

Documentation

CMO Presentation and

FindingsFMO Documentation

FMO Presentation and Findings

Pilot Implementation Planning

Due Diligence Findings

Presentation

FMO DESIGN & VALIDATION

ASSESS

PROJECTCLOSURE

PILOT IMPLEMENTAION

PILOT PLANNING

Kick-Off Meeting

Phase 1 - Due Diligence

12/09/0511//30/05 12/16/0511/7/05 11/14/05

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Next Steps (Phase II)Process Optimization Plan

RE-ENGINEERING PROGRAM GOVERNANCE

Project Close Out

Pilot Implementation Testing and Validation

12/09/0511/7/0510/24/05 11/14/05 11//30/05 12/16/05

FMO Design & Validation

FMO Presenta

tion & Validatio

n

Pilot Implementation Planning

Develop implementation recommendations Develop implementation plan Develop risks mitigation planDevelop change management & knowledge transfer plan Review plans and get buy-in from stakeholders Develop measurement & monitoring planAssess current skills and gaps and develop awareness management plan

Implement pilot in Northern CaliforniaUpdate process with the field testing learning Conduct user acceptance testing Execute knowledge transfer plan Document finding and further recommendations

Present Final Deliverables and Presentation

Analyze assessment data Identify areas for further analysis Conduct follow-up interviews to capture additional information and identify gaps to achieve desired business objectives Prioritize gaps Develop “to-be” business process Define roles and responsibilities Define measurable metrics Identify and document risks Conduct review workshop Check for ITIL compliant process mapping Validate and present FMO

35

Next Steps (Phase II)Deep-Dive

1. Integration points, roles, and handoffs between ITFS, Site Support Specialists, Solution Center, and other groups

2. Improved swap process, depot management and automated replenishment

3. Ticket management and additional operational efficiencies

4. Training of key personnel on process improvements

5. Incident classification processes and remote diagnosis

6. Problem management (root-cause analysis) and processes improvements that provide opportunities to reduce B/F issues

7. Other Areas?

36

Critical Success Factors

• Prove/Disprove whether 30 minutes MTTR can be achieved and at what cost for 90% of the time (new model for B/F)

• Pilot Site and Key Site Support Specialists are identified

•Model is replicable, scalable, and sustainable

• Roles and responsibilities are clearly defined and communicated

• Knowledge transfer is achieved

37

Assumptions

• Pilot for NCAL only

• Trained site support specialist team already in place at pilot site

• Pilot site must have sufficient time and resources to devote to the pilot

•The various aspects needed are involved and part of project realization team

• Impacts of other process changes have been considered and adjusted for

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Thank You

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