There's a sign on a UPMC conference room door that depicts the universal circle-and-slash symbol for "No." Inside the circle are the words, "But we've always done it that way!" Subtitle: Organizations that don't change, don't survive.

Variations on the theme "change is good, change is necessary" are plastered all over the hallways because more than anything, the UPMC Transformation Project is about change. And people tend not to like change, particularly changes outside their control.

That's where Marybeth Schwartz came in. Schwartz, the hospital's manager of service level management, scratches her title off her business cards and writes in "org change." It's her job to manage change at UPMC. But when she first got the job, she admits she didn't understand what that would entail. "When we first started down this road, I felt very green. I didn't know what I didn't know," she says.

Although she had IBM to lean on, that relationship didn't get off to a great start, either. "We did have a false start in the beginning, with a different team of people," Schwartz says. The first team "wanted to coach us through it," rather than showing how it should be done, she says, and that wasn't working. "The team IBM sent in on the second go-round is the one we have now."

"They needed some help from folks who had done it," says Dale McClinton, an IBM executive consultant who came in as part of that second team. With more than 40 years of I.T. experience, McClinton has served as a "rent-a-CIO" for other organizations in health care and financial services that were going through difficult changes. He also reorganized IBM's internal headquarters information systems organization. "There is a real question of how much change you ask people to accept," he says.

Mostly, the changes are being felt within the I.T. organization, where UPMC is systematically taking away tools and technologies that application developers and system administrators have grown used to and asking them to learn new ones. That can be disconcerting for people who have built their careers around expertise in specific technologies, McClinton says. Ultimately, they'll realize that the new tools "are not all that different," he says, but meanwhile they'll suffer from uncertainty about their future.

The point of all this change is to create a more adaptable organization where employees are more comfortable with change and a little less wedded to particular tools and technologies, McClinton says: "We want them to be process oriented, rather than product oriented, so that they focus on what is needed to get the job done, rather than the technology employed."

While management believes these are necessary changes, it can't simply ignore negative reactions from the staff, Schwartz adds: "We have to maintain the right levels of service and productivity, so we can't have them be that upset about it."

So, part of her job is to improve communication between management and staff, with regular question-and-answer sessions, a newsletter and a

program of regular e-mail progress updates from Sikora. She has also recruited 24 "change champions," representatives of different employee groups who get regular progress reports and are asked to share that information with their colleagues.

Besides trying to goad employees into accepting change with posters, Schwartz's team has hung "comment caddie" suggestion boxes in the halls, and it publishes a regularly updated frequently asked-questions document with responses. Many of the comments are fairly hostile (suggesting that management is ignoring input from the technical staff, or speculating that the "real reason" for all this change is to take away people's jobs). One note even took issue with those hectoring "But we've always done it that way" posters, suggesting that it would be better to promote a positive message like, "We can be better." The response from management: "Excellent feedback; we will incorporate these ideas into our posters as we create them going forward. Keep an eye on the walls!"

Meanwhile, Sikora keeps repeating that the Transformation Project isn't about outsourcing jobs, and that those whose jobs change out from under them will have the opportunity to be retrained and transferred—for example, to a whole new storage management group that's being established. "That makes them a little more comfortable," he says. "Not totally comfortable, of course. I try to be pretty honest and tell them the one thing I can promise you is that everything we do is going to change."

UPMC is a little more than halfway through the initial three-year leg of the IBM deal, the portion targeted for the most intensive change, but the Transformation Project is much further along in the results it has delivered, according to Sikora. Much of what UPMC has accomplished, particularly in virtualization, could just as easily be applied to organizations in other industries, he says. For health care in particular, the significance is that by minimizing what it spends on basic infrastructure, UPMC can devote more resources to systems such as eRecord that have a direct impact on patient care.

Today, UPMC is a showcase customer for IBM. It has gotten used to hosting meetings and data-center tours, and running through presentations about the wonders of its on-demand, virtualized systems infrastructure. Recent visitors have included Mellon Financial, Del Monte Foods, the Mayo Clinic and the University of Kentucky.

"I think what everyone's trying to figure out is how we pulled it off," CIO Drawbaugh says of the transformation effort. "Instead of dabbling in it, how do you take the plunge?"

Working Together: How UPMC & IBM are delivering technology change

There are 18 people around the conference table when the University of Pittsburgh Medical Center transformation team gathers for its weekly tactical planning meeting on a Wednesday in April. Although about half the attendees are from the health-care company's technology partner, IBM, this is not a meeting with consultants on one side of the table and UPMC people on the other, nor is that the way the conversation flows.

Two years ago, UPMC and IBM signed a huge deal that tied the two companies together. IBM not only plays a big part in helping UPMC transform its information-technology infrastructure, but the vendor is also committed to helping the health-care company develop new medical information systems that could be sold to other health-care institutions.

This meeting exists to deal with the immediate tactical challenges that lie in the way of the grand strategy. John Reed, who was at the time the IBM Systems and Technology Group project director (Reed has since joined EDS), goes around the room, asking for comments on the agenda and what needs to be added to it. Paul Sikora, the executive in charge of UPMC's Transformation Project, sits back and listens until there's a decision he needs to make.

As of 4 p.m. on Wednesday, April 18, the plan is to complete 58 migrations per month, meaning that many applications will be moved onto the new standardized technology platform. "We're moving that out about a month," reports Bob Bowman, the project management office leader from IBM, but he presents it as a minor adjustment in the grand scheme of things. The schedule was altered to squeeze in the addition of Network Appliance storage devices to UPMC's storage architecture, which hadn't been in the original plan.

There is a round of applause for Rey Johnson, the application manager who has just completed the smooth rollout of Hewlett-Packard's ServiceCenter, the service management product UPMC is using as part of its adoption of best practices from the Information Technology Infrastructure Library (ITIL) management framework. The goal is to make ServiceCenter a common platform that service and support personnel will use to deliver speedy resolution of problems and improve system reliability.

Dave Hileman, UPMC process and service team director, reports a couple of obstacles that he is running into, including a "bottleneck in the generation and approval of security plans." Some migrations and upgrades that ought to be routine are being held back for want of a sign-off from UPMC's I.T. security team, he says, and after some further discussion, Sikora agrees these are unnecessary delays.

"We've got to cut some of this bureaucracy down—80% of these should fall into an expedited pattern," Sikora says. In other words, as long as the team submits the required security plan and isn't making any radical changes, the systems ought to be moved into production now and validated later if the security team doesn't have time to review them up front.

Hileman has one other issue: the deployment of HP's PolyServe database clustering technology UPMC is using to improve the efficiency of its Microsoft SQL Server databases. "I'm starting to get requests for non-transformational projects where PolyServe is a fit," he reports. In other words, these are new applications that are outside the focus of the Transformation Project on improving the existing technology infrastructure—and outside the project budget. So, what should he tell the people making those requests?

"We have to serve those requests, but we need to capture the service request process," Sikora says. Eventually, he wants to be in a position to do chargebacks, where other departments will be billed for the information services they receive. At a minimum, he wants to document the process well enough to make sure that his team gets credit for the value it is delivering. "So, we need to capture that," he repeats.

Still, if project managers from elsewhere in I.T. are recognizing the value of the new infrastructure, they ought to be encouraged to take advantage of it, Sikora says, "because changing it later is painful."

Then there are a few issues related to Children's Hospital of Pittsburgh, which was merged into UPMC in 2001 and still has its own data center and I.T. staff. Sikora volunteers to get involved in negotiating the political issues getting in the way of that integration. He's willing to be flexible, but only up to a point. "If we're bringing the Children's systems into our environment, they can't be separate," he says. Given competing priorities in the budget, Reed says he is inclined to push that conversion project into 2008 anyway.

Base Technologies
UPMC relies on an IBM On Demand computing environment to run its operations.

Application Product Supplier Virtualization for Unix AIX in conjunction with the IBM Hypervisor IBM Virtualization for Windows ESX Server VMware Unix server hardware P Series servers, particulary the p595 for virtualization IBM Windows server hardware X Series server IBM Storage virtualization SAN Volume Controller IBM SQL Server database consolidation/clustering PolyServe Database Utility for SQL Server Hewlett-Packard I.T. Service Management ServiceCenter Hewlett-Packard Backup and archiving Tivoli Storage Manager for Mail, Tivoli Stroage Manager for System Backup IBM Health-care management suite Cerner Millennium Cerner Electronic medical records eRecord UPMC custom development, incorporating components from Cerner Financial management PeopleSoft Oracle

*For first nine months ended December 31, 2006. Fiscal year ends March 31. Software AG acquired the company in June 207.

Source: Company Reports

Player Roster

Daniel Drawbaugh
CIO

Drawbaugh became CIO in 1990 and has been a leader of UPMC's I.T. and biomedical technology initiatives for more than 23 years. He also serves as president of BioTronics, a medical technology subsidiary of UPMC. In addition to negotiating the IBM deal, he was responsible for a similar $300 million arrangement with Alcatel (for wired and wireless network upgrades), as well as an $84 million partnership with dbMotion to develop integration and interoperability technologies for health care.

UPMC Participants

Jeffrey Romoff
President and CEO

Since taking over the leadership of UPMC in 1992, Romoff has guided the organization's evolution from a city-based academic medical center to a fully integrated health enterprise, driving a nine-fold increase in revenue in the process. As a top executive of UPMC and its predecessors since 1973, Romoff has driven the organization to solidify its reputation for academic research and specialties such as transplant surgery, while aggressively expanding and establishing for-profit subsidiaries.

Paul Sikora
VP for I.T. Transformation

Sikora leads the $402 million, multi-year effort to transform I.T. infrastructure operations and drive down costs. He also contributes to the management of a key electronic health record project, including its overall architecture and middleware components such as IBM's MQSeries and WebSphere.

Kevin Muha
Enterprise Architect, Transformation Project

Muha is responsible for the planning and design of both technology and supporting processes (such as the process for approving and deploying new servers) for UPMC's I.T. transformation. That means keeping the design and deployment teams integrated, well informed and aligned with business requirements. He also has engineering responsibilities for overseeing UPMC's server and storage virtualization projects.

Dave Hileman
Project Director, Process and Service Team

Hileman holds a master's certification in I.T. Service Management and leads UPMC's effort to adopt Information Technology Infrastructure Library (ITIL) best practices.

Marybeth Schwartz
Manager, Organizational Change and Communication

Schwartz leads the initiatives for organizational design and implementation, communication planning and delivery, human resources and education for the Transformation Project.

Rey Johnson
Application Manager, I.T. Service Management

Johnson has been managing the implementation and administration of systems to support I.T. Service Management. His team recently completed the rollout of Hewlett-Packard's ServiceCenter, which helps the support and help-desk staffs track incidents and problems and the steps taken to fix them.

IBM Participants

John Reed
Project Executive (now at Electronic Data Systems)

A 23-year veteran of IBM, Reed oversaw its contributions to UPMC's Transformation Project, including technical aspects such as virtualization as well as adoption of ITIL best practices for service management.

Dale McClinton
Executive Consultant

He and his Organization Change Management team joined the UPMC project in July 2006 to design a new structure to facilitate the management of an On Demand, service-oriented, ITIL-based I.T. organization. Working with Schwartz, he has helped redefine processes for communication, job definition and skills development within the I.T. organization.

Headquarters:
200 Lothrop St., Pittsburgh, PA 15213

Phone:
(412) 647-8762

Business:
A broad-based, non-profit health-care organization that operates 19 hospitals and employs more than 4,000 physicians.

Chief Information Officer:
Daniel Drawbaugh

Financials in 2006:
Revenue of $6 billion; $240 million operating margin.

Challenge:
Transform information-technology operations, and contain runaway growth in server and storage infrastructure.

Baseline Goals:

• At least double the number of agents who can simultaneously use its reservation system, from 650 in early February to more than 1,300 in six months.
• Reduce I.T. infrastructure spending by 15% to 20%.
• Consolidate the functionality of 786 servers and 40 storage configurations onto 305 servers and 2 storage configurations.
• Whittle down the number of operating systems supported from nine to four.

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