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March 16, 2020: In this episode, listeners will hear the CIO of Asante, Dr. Lee Milligan, talk about what they have done (and are still doing) to prepare for the coronavirus COVID-19 pandemic in their IT division. For him, the swift manner in which their teams were able to set up a centralized testing location is a testament to what can be done in times of crisis and show the necessity of having clearly defined objectives. He talks about the point at which the leadership decided to prioritize the outbreak and reprioritize other tasks to determine the percentage of staffing that would be needed to continue providing their services. The problem with a pandemic like this is that, when institutions act too quickly, they run the risk of being perceived as alarmists. Conversely, when they delay acting they are criticized for not doing enough. Finding this balance, Dr. Milligan says, has been a significant challenge for them. Tuning in to this episode, listeners will hear what is currently happening in Asante's IT division each morning, how they go about communicating with the community and guide their IT leadership in keeping in touch with the realities people face, and advice for slow-acting health systems that need to make up for the lost time. 

Key Points From This Episode:

  • What the Asante health system is doing to prepare for the coronavirus pandemic. 
  • A testament to what IT teams can do when there is clarity on what matters. 
  • The point at which the Asante leadership team decided to prioritize the outbreak. 
  • Staffing percentages and the importance of maintaining the services of their core systems. 
  • An overview of what happens each morning in the IT division at Asante. 
  • How they go about communicating important information to the community. 
  • Coaching the IT leadership team in keeping in tune with the reality of the pandemic. 
  • Advice for health systems that are late to the game and in the early stages of preparation. 
Transcript

This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.

 Welcome to this week in Health IT News, where we look at the news that is gonna impact health it. My name is Bill Russell Healthcare, CIO, coach, creator. This week in health it a set of podcast videos, collaboration events dedicated to developing the next generation of health leaders. This week I'm doing a series of interviews with health system executives, uh, who will share their plans around cvid 19 preparedness.

Uh, I wanna thank serious computers, our Sears healthcare, uh, who reached out to me last week and asked me if they could sponsor a series of con of these conversations, uh, to help the industry prepare, and I appreciate their. Their, uh, commitment to the industry, uh, that they serve in sharing these best practices.

So, uh, today's conversation is with Dr. Lee Milligan, CIO of Asante Health in Oregon. Good afternoon, Lee. Welcome back to the show. Bill, thanks very much for having me. You know, I mean, this as usually happens when you and I get on the line. We started the conversation and we were like 10 minutes into what I should have been recording.

Um, but we'll, we'll back up a little bit and I, and I enjoy our conversation. So let, first question, let's, let's get started. Let's sort of set the groundwork. In general, not necessarily health it, but your health system, what is, what are some of the things your health system's doing, uh, for your community to prepare for, uh, for this pandemic?

One of the challenges we had was around personal protective equipment and masks just like the rest of the coun country. And so as we got our heads around how do we possibly. Look at and, uh, and test an appropriate number of people. We can't do that if we're distributed throughout the entire organization.

We've got 30 some clinics. If everybody is dawning and doffing all of this PPE, then we're going through a lot of it. So we set up a centralized location for testing. That's essentially a drive through location, uh, that's adjacent to our contact center there. We have a draw station that we, we literally were able to stand up that draw station.

And telehealth associated with it, uh, in 24 hours. And actually it was kind of a testament to what IT teams can do if we give them the gift of clarity about what matters. They focused on that for 24 hours. The team pounded out everything from the billing to the, uh, to the, uh, workflow engine rules, uh, to the telehealth that we had put in place previously, that we stood up on that location.

And so that's one aspect of it. We also are setting up, um, tens, uh, adjacent to our emergency department where we can do testing, uh, there as well if we need to, depending on the critical nature of the patient. And then internally we're doing a lot in terms of our workflows. We're looking at our operating rooms and asking, I think the right questions, which are, can these be converted to intensive care units?

So stuff like that. That's interesting. You know, I want to, I want to touch on the leadership aspect of that. Um, because a lot of health systems are going through this sort of, you know, is this gonna be a big deal to, oh, this looks like it's gonna be a big deal. Uh, but typically there's some inflection point where somebody steps back and goes, Hey, you know what?

We, we need to prepare for this. It's better to be prepared and hope for the best than to not be prepared. And, and, uh, and, and sort of get, uh, blindsided as you go along. How did you guys, as a leadership team, at what point did you sort of decide, hey. You know, we're, we're, we're all in. We're gonna slow other things down.

We're gonna move the priorities and as you say, make it real clear to people what the priority is. Yeah. I, we started 10 days ago now, uh, with daily standups that we did not have in place, uh, previously. I feel like we're late, to be honest with you. Um, although I'm so grateful that, uh, those pieces were put in place over the course of the last 10 days, and I do feel like, you know, with something like this, like a pandemic, when it's rolling forward and it's, it's building steam, you kind of feel like anytime before it becomes obvious, you're seen as an alarmist if you try to make preparation for it.

And then after it's, it's crested. No matter what you did, it wasn't enough. Right? Right. And so we were trying to strike that balance. And so one of the things that, uh, we were able to do was really connect with our CEO and make sure that we were on the same page and he understood, uh, kinda our perspective on it.

And so we got his backing on making these preparations and moving in this direction. I was also able to engage with our, uh, chief Strategy Officer who directs our PMO. We were able to really hunker down and identify out of the 58 projects, it heavy projects that we currently have in execution. Here are the eight or nine that matter the most to our organization.

And you know, that I, I actually anticipated that to be a really difficult thing to do. But if we think about. , um, you know, putting the health of our community, uh, right at the forefront. And then we, after that we asked the question, okay, what's the financial implications of holding on something? 'cause really nothing is actually being stopped altogether.

It's simply being put on hold for a period of time. For us, we're in the middle of, um, starting to build a, um, $500 million tower. And so as we, as we get our arms around that, we recognize that slowing that piece down, uh, would be really bad. And therefore. Continuing on with that really has to be one of our top priorities.

But it was a good conversation and we're actually able to pare it down significantly. And from my perspective, I would say if we're, if we're 90%, uh, staffed, we're good. If we're 20% staffed, maybe we're not good. But it's pretty clear that our only goal is to focus on maintaining services of our core systems.

It's really when we're in between. If we're 70% or 75% staffed, what are the things we really should be working on? Yeah. You know, we talked about this a little bit, um, last week on, on the, um, the huddles and the things that you're doing, but I'd love for you to go through that structure real, real quick. I think a lot of people are used to lean huddles and those kind of things, and this is a variation of that, but it's really around preparedness.

So give us an idea of what transpires every morning. So within the ITS division, uh, here at Asante, we have four separate departments. Each one has their own, um, um, division or a department leader. And as we kind of decided how we're gonna put this thing together, we wanted to start at the very front and have everything kind of roll up nicely, all the way to the end so we could have information to make decisions with decision.

And so we started with our frontline staff having a standup at 8:00 AM for 30 minutes with their supervisor. There they talk about basic stuff like, you know, how many people are out, how many people are on ETO, how many people are, maybe this is a, um, you know, we have four day workweeks, uh, workdays here.

And so how many people are actually not available? 'cause it's not one of the days they're actually on. And so we can identify how many folks are available to do the body of work that needs to be done. So we start with that. Next, we look at our individual areas that might be hotspots. So for example, I have one director who has 50 people who report to him ultimately, and maybe he only has, let's say, seven people out.

But if all seven of them correspond to a. Integration work or interface work, then that's a problem. So we wanna be able to identify those hotspots best we can. Uh, and then lastly, we wanna be able to focus on prioritization. We want those frontline staff to know, do this and specifically don't do that.

And they're gonna get that direction from their managers and from their directors. So that lasts for 30 minutes. We give them a half an hour to input this data into this, uh, spreadsheet that we have on SharePoint right now that rolls up and then at, uh, at nine o'clock. The supervisors and managers meet for 30 minutes to have a similar conversation, and again, to kind of highlight what to prioritize.

After that, from nine 30 to 10, the managers and um, uh, directors meet similar conversation. And then at 10 o'clock the directors and I get together and all that information rolls to the very top. We can start focusing on what to do with that information in terms of resourcing or decisions that need to be made versus gathering that information in the first place.

So like this morning, for example, when we, when we had ours, I could see we were 92% staffed, which is actually pretty normal when you consider ETO and FMLA and everything else that's going on. We identified a couple of hotspots and we're able to clarify our priorities for the group. Yeah. Communication becomes so, uh, so key in this.

It's, uh, so give us a, give us an idea of, from a, uh. From a communication standpoint, there's, I mean, you just really laid out a, a really well how you communicate internally the priorities, but for the community, the community's looking for you guys as the trusted source for health in your community to answer a handful of questions for them.

How are you getting that message out to the community? Yeah, great question. So we have a daily, a daily steering committee meeting for the enterprise that comes together to make decisions around 11 se separate verticals associated with this. And then on a daily basis, that information is sent out to the majority of folks throughout the organization internally.

In addition, a portion of that is then updated to our external facing website for folks who who come to the Asante uh, website. In addition, we are pushing out messaging through MyChart as well. Um, we previously actually had some town halls scheduled, but due to the concert of folks getting together in the same proximity, uh, we had to cancel those, uh, town halls.

Uh, have you I'll say that. Go ahead, please. No, no, please go ahead. I was gonna say, uh, I will say that one of the most important elements, I think during a time like this is that your frontline staff, supervisors, managers, everybody throughout your division, uh, understand your perspective on this 'cause they do look to you for guidance on this.

I've put out a twice a week email, fairly extensive email, uh, to my staff. My entire staff, uh, just shy of 300. Kind of detailing where we are from a, um, a community perspective, what the projections are, and then what the pieces are we're putting in place internally, uh, to help address this. And I've gotten pretty good feedback on it so far, and I want to continue to do that.

In addition, we set up a SharePoint site. That is actually two of them. One that is for all of ITS staff. They can gain some, uh, perspective on different, uh, elements we put in there, as well as our daily standup rolls up to a SharePoint site as well for ITS leadership, so we can have kind of detailed notes about some of the things we're dealing with.

Then lastly, I would say for all of the work that's coming into ITS, um, not just for ourselves to try to be able to work from home, but also from the organization who are asking for ITS products and services to support their needs associated with covid. We have a visual task board built in ServiceNow that helps us track what's been asked, what's an execution and what's been completed.

You know, the, the thing I appreciate about you former, uh, ER doc and your ability to triage, I just gave you a shout out on the, uh, Tuesday show, which will actually air tomorrow. Um, and when, you know, we were talking about, uh, work from home and you said, you know, it's really easy, bill. I sat down and I told people I want, I want, I want people in three buckets.

People who can work from home today without any adjustment. People who can work from home, but they need x. I wanna know what X is, and then people who will never work from home. But it's, it's those kind of things. This is that kind of environment. It's that kind of, uh, triage, quickly figure out what you need, figure out what you have.

I mean, that, that becomes one of the key roles of the directors and the, uh, and the, the leadership within it. So how are you coaching your, uh, your leadership team? The, the IT leadership team in terms of, uh, making sure that they are, uh, really focused in on the things they need to really, uh, I, I would say, connected to the concerns of the, the people that they're dealing with.

E even though they're in healthcare, even though they're in it, they're still susceptible to all the same things. We still have family, we're worried about, we still have parents. We're, we're trying to, uh, care for, we have, you know, we, we have lives, uh, outside of work, if you will, uh, that we have to deal with.

So how are you making them, you know, how are you coaching them, I guess is the best way of saying it to, to, to be, to be, uh, in tune to that. Yeah, that is, I think that is the question for, uh, ITS leadership. Uh, bill, I think you hit the nail on the head. Uh, these, these are human beings attempting to navigate these uncharted waters with folks who are looking to them for direction as well.

I would say number one, it's really important to be clear with your directors that this is not business as usual, and you will not be held to the same standard of completing some random request as you may have been two months ago. So you're no longer required to, you know, build that smart text for Dr.

Jones, uh, who needs this out in the one clinic by the coast. Um, all that stuff is off your plate and we've clarified really what matters for the moment. And I'm no, I'm not gonna be, um, disappointed in you for not doing other things. In fact, I'm asking you specifically to not do it. Um, and so, you know, just having an honest conversation with them about that I think is important.

I also think it's important to just talk about leadership during this time because people are looking to them for leadership as well. And I, I've, for my kind of real simple, um, er background, I, I put it into a couple of basic buckets. The first is, I think your, your staff and your leaders need to truly recognize that this is a real deal.

This, this is a legitimate. Emergency that has been declared in our state and in our country right now. And the folks who look to them need to know that they get it. Because I'll tell you, if, if, if your leader doesn't quite get it, you, you tend to not trust anything else that comes out of their mouth. And so, you know, I wanted folks to just level set, say, this is a big deal.

We shouldn't be panicking. Panicking only makes it worse, but it is a legitimate deal. So let's start with that. Second, we have to put in place. A reasonable plan that is thought through, includes the right people at the table, uh, and is executable. And once we have that plan in place, we need to communicate it over and over and over until I start getting sick of it.

That's when folks I think are fully on board with it. Um, and then lastly, I do think it's important that we communicate and have confidence in that plan. Confidence in the people who will be executing that plan and they need to hear it. And one of the ways you can do that is with Con during conversations is to reference prior difficult challenges and, and scenarios that your staff has gone through.

Your leaders have gone through and call out where they really brought it. Yeah, absolutely. Uh, I, I know, uh, folks I've interacted with and myself included, um, sometimes I look to that in my own history to, to think how the hell am I gonna get through this scenario? and looking back at prior difficult times and where things have gone well really helps, um, I think, uh, shore that up.

Yeah, absolutely. Hey, last question, 'cause I know we went over and I appreciate, I know how busy things are. I really appreciate the time. Uh, one thing you would telehealth system that might be a little late to the game, in their early stages of preparation, what should they be focused in on? I, the two main things that they can do right now is sit down with whoever does their overarching prioritization and have them create a list of top, I'll say top 10 things even.

That they care about if you are 50% staffed. And I would, I would put it in that simple of terms for them. And the way I, the way, I didn't have to phrase it, but I was prepared to phrase it, was. Either I can do it or you can do it , right? But somebody's gotta do it because my staff's not gonna do everything.

So I'd start with that. And then the second thing is, I can't say enough about how, um, how helpful daily standups have been. The, the level of communication, the ability to get on, uh, in front of issues before they are real issues has been used. So if you can set a framework that cascades up. From frontline staff and supervisors all the way up to the CIO, uh, that allows for great conversations about what that information is, not trying to gather the information, then I think you'll go a long way.

Yeah. You know, actually at some future time when we, when things calm down again and they will calm down again, uh, I wanna come back on and ask you if you're still doing daily standups and if you're able to keep people, uh, focused and that they don't have to do that, you know, that little off project.

Because, because that is the, when you said that, I sort of smiled 'cause I'm like. Gosh, we do that every day a thousand times in in health. It, we get, we get stuck doing these little tasks all over the place. And these kinds, these kinds of events, uh, give us a picture of what it is like to be really focused in health it, and we sort of.

Miss that when after these times go, go past. So I, I couldn't agree more. And yeah, and I would just, I would just add to that, that, um, it's been such a, such a pleasure to watch the team rally around something that is, there's crystal clarity about how important it is. To watch them rally and deliver. I mean, what they delivered on that, um, on that centralized testing location would've taken three weeks.

They did it in 24 hours. And, uh, you know, so I mean, seeing that kind of a, a performance, uh, under pressure, under heat, is it, it's truly beautiful. Um, absolutely. And this is all over with Bill. We're going out to drink and I'm buying the beers looking, looking forward to it. Uh, Lee, thanks again for taking the time.

I appreciate it. Uh, special thanks to our sponsors, VMware Starbridge Advisors, GA and Healthcare Health lyrics and pro talent advisors for choosing to invest in developing the next generation of health leaders. Check out more of these episodes this week, health.com and the YouTube channel. Uh, if you are a health system C leader.

Or, and just have a story to tell about your preparedness. We're gonna be recording these all week and, uh, want to get the word out about best practices. So if you wanna do that, drop me a line, bill it this week in health it.com. Thanks for listening. That's all for now.

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