July 12: Today on TownHall, This Week Health’s very own Bill Russell speaks with the WakeMed CMIO/CIO team of Neal Chawla (CMIO) and Peter Marks (VP and CIO). They talk about how they work together to overcome challenges and understand each other's perspectives. How did they transition to a more data-driven organization? How does clinical transformation evolve out of that work?
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Today on This Week Health.
The people process adoption behavior change is the more important piece, right?
And so our big goal is get the folks into the data and then get them out of the data. Don't make the data so complicated and you can't get to that people process because really our goal has been, in our caveman talk it's we want design needle.
We want to build a needle and we wanna move the needle. We wanna spend the majority of time moving the needle
Welcome to This Week Health Community. This is TownHall a show hosted by leaders on the front lines with interviews of people making things happen in healthcare with technology. My name is Bill Russell, the creator of This Week Health, a set of channels designed to amplify great thinking to propel healthcare forward. We want to thank our show sponsors Olive, Rubrik, Trellix, Medigate and F5 in partnership with Sirius Healthcare for investing in our mission to develop the next generation of health leaders. Now onto our show.
Today, we are joined by Dr. Neil Chala, CMIO for WakeMed health and hospitals and Pete mark CIO.
We actually have a team of people together in the same room, gentlemen, welcome to the show.
Thanks for having us
I'm looking forward to the conversation. We're gonna talk about a lot of things. And one of the things I, I really like is talking about how you guys have linked operations and strategy there, but before we get there tell us a little bit about wake bed.
Yeah. I can start we three main hospitals. We're about 11,000 personnel strong about a thousand beds. We're in Raleigh, North Carolina, the capital of North Carolina. We have like everybody else, tons of ASCs, lots of practices. Really strong community based hospital started. In the mid fifties to take care of people of color that couldn't get care in other locations.
And I think that that sense of caring about community is what carries wake med to this day. I'm a big believer that when you start your business to do one specific thing that carries through and that's carried through here at wake med.
I would add one thing that, I've been around in a few different health systems and hospitals never have, I seen such a strong culture and mission as WakeMed with everyone here, just having such a strong sense of we're here to serve our community and take care of our patients and families.
And that's been. So that I find sets, wake men a bit apart from other places I've seen. Mm-hmm ,
that's fantastic. And I love the area. I love the whole Raleigh area, the you, so from a competitive standpoint, you've got duke there. I mean, you've got all the, majors, but you guys serve specific area within Raleigh.
So we're in the middle of wake county. So Raleigh's in the middle of wake county, the main hospitals for duke and UNC are both kind of west and Northwest of us. They have campuses here in wake county as well, but I would say the predominant player in wake county is WakeMed. Yes.
Fantastic. I, I love the fact that I'm talking to the two of you. This CA we've talked a bunch about the CIO CMIO. Team and how they, how important it's to work together. How long have, the two of you been working together
four and years and
take back. So how did you establish the foundation? The working relationship four and years ago.
Now I I'll let Neil jump in. We both got here about the same time. I've, I've been here almost five years and Neil over four. And so we came at the same time. And so we started to deal with all that change management stuff at the same time.
I think we're quite aligned in. People come to wakemed because they love the culture of helping others. And so people are attracted to Wakemed for that. And so I think a big part of it is Neil and I are built from that Stripe. He's an ed physician by training and I'm an army officer by training.
And you can see that all we wanna do is be servant leaders to others.
Yeah, I would agree. I think, Pete got here about six months-ish before me. And so I think one of his first initiatives was hire a new CMIO Wakemed was going through a CIO CMIO, kind of a is leadership change at the time.
And I think the way Pete has said it before is I had him at Hello. But we I think, I think he's right. We do have a very similar. Philosophy on, the mission of really taking care of our patients and families of the community. And I think that base is it gives us a great base where I think we have a lot of trust and respect for each other, where I think our set of similarities and differences are just so complimentary to each other, right.
That it's led to a great working relationship because we both. Want to get to the same place. We sometimes approach it pretty similarly, sometimes a bit different, but even when it's different, it's in the way that makes us both stronger. And I think the system stronger.
All right. So take me to a point where, what was the most challenging thing where you had to figure out how to work together, maybe where you didn't agree on something and how did you work through that?
I mean it's all the time. I think we see things differently, but I don't, I can't think of anything where nothing pops in my head that says we didn't see this the same way. Because those conversations we always have are maybe we should approach it like this. And then Neil may say, maybe we should approach it like this.
I think the right answer is always there. It's. It's the other person going, oh, I see it from that position. I'm a framework guy, right? I need to see the big picture. I need to see the vision and I need to see the process to get us through. And Neil has that capability as well, but he has tremendous amount of strengths that I don't have, especially around relationships.
And I think keeping a myriad of different details in his head that aren't necessarily in a framework. And my sense is that's a. Thing that we compliment each other. I think the other thing for us is I think we both like to tease each other. We kind, of when something's wrong instead of going, Hey, I think you have that wrong.
We just throw these little gentle teases at each other until one of us breaks down.
well, I, think that the thing that I like about that is. You each have a lens and you're each seeing things through the lens, you have a mutual respect for each other. And so you're listening to each other's lens.
There's a conversation that goes, Hey, here's, what I'm seeing. And then you go, well, from a technology perspective here's what I'm seeing. And then Neil, you're giving him, Hey, from a clinical perspective or from, that specific practices perspective, this is how they're experiencing it.
And then you just talk it through. And I think that is that trust foundation, that communication foundation. Really is what makes that CIO CMIO relationship work.
I think so. I mean, I think we both have, we both use our ears and mouths well together, in a way that we'll both listen to each other, we'll talk in a way that we're both able to understand where each other are coming from.
And that usually even if we start here and here, eventually we kind of get to either if not the same place, a pretty similar place. And so, yeah, I mean, it is hard to think of a lot of places where we. Disagreed. And haven't been able to come together pretty easily. I feel like it usually does. Mm-hmm
All right. Let's talk about linking operations and strategy. We've talked before. And in that conversation, one of the things you drove home to me was the use of metrics and using metrics to drive strategy. Walk us through that a little.
And we might, we might set this up on that conversation.
We're having about framework versus in the weeds doing the details. And so I'll start. And then Neil, I think can pick up on the clinical transformation that we've been going through. So again, we both started here about the same time. We knew that the analytics program here at wake me needed some love and attention, and I won't go through kind of all the manifestations, but what I will.
What I think I may have been able to bring to the game a little bit, was this idea of how important the board of directors is and how important transparency of metrics is to the entire WakeMed team? We set some metrics at the board of directors in terms of our analytics program. And we just use really simple things like the Hymes analytics framework to go to them and put that in as a board goal.
So they said, oh, this is really important now. We've done that with some other things too, but I think this is a nice jump off point to say, I'm gonna try and get the board of directors and the senior leaders focused on why is really matters and how it can make things better. And then Neil is gonna pick up the ball, I think, with the providers and everybody else.
And he's gonna get us deep into the clinical transformation.
So you establish the metrics you. It becomes one of those things that becomes a foundation for the conversation, , with the board and the leadership team to say, you know, we're gonna be a for lack of a better term, a data driven organization, we're gonna be looking at, what are the outcomes we're looking to drive?
And by having those metrics, providing that transparency, that's how you build programs off of that. Is that essentially what I hear you saying?
I'll say it similar, but maybe slightly different. So I think, Pete was here a year and a half. I was here a year by that time, but I would say we realized that our data analytics team was really functioning at a lower level and in a way that we weren't delivering to our system, the amount of data and the robust data that the system was really craving to become a data driven system.
And I think when we realized that, and this is where I think Pete did a masterful job, instead of saying, oh crap, we've got a low functioning data team. We better fix this one on the side. We set the spotlight on it. And a lot of that was because we had good relationships with our other operational leaders across the system and said, Hey, we want to get good at this.
We need to get good at this. Let's make this a board goal. So we're all looking at this the same way in the meantime. Pete. And I will come up with the strategy. We may need some money. We may need help and support, but we will mature and develop our data analytics team to support what with mend needs. And we largely have done that.
And the big piece was setting some goals based on metrics, on how we can mature the team so that we had our senior leaders looking and watching and able to help us, which was incredibly, I.
That's fantastic. So you primarily used the hymns analytics framework to create that framework, as you say, to progress the analytics for the most part
We realized that. We weren't functioning high, but we didn't know what highly functioning looked like. And so as we kind of searched for a map, HES kind of gave us a great map to at least say, this is gonna help us chart our pathway towards maturity. Cuz we have no idea where we are until we found that mm-hmm
Your, your journey in analytics was like my journey in security. When I got there, I said all, where are we at? And people would like, give me anecdotes and talk about things and stuff. And I'm like, all right, do we have. Some sort of chart, do we have some sort of numbers? And there was like nothing. So at some point you gotta go, all right, we gotta establish a baseline here of where we're at and where we wanna go to.
And that's, great. So talk to me about clinical transformation. How does clinical transformation evolve out of this work?
That's your part?
That is your,
so I would say. Clinical transformation is really what helped us justify growing and maturing our analytics program. I think trying to make an argument that, Hey, our analytics and data team are functioning at a low level.
We want to function at a high level. You gotta ask, why is it just to deliver more reports? Is it data for the sake of data? No, not when you're gonna have to invest a good amount of money, time, resources to make it better. So we really had to figure out the reason to mature the data team that was going beyond volume and data for the sake of data.
And really, as we. Research and research the why it really became clear the why was to deliberately and measurably improve patient outcomes. And so that was how we really justified the system. This is why we want to mature the data team. And so as we started maturing the data team, creating a couple partnerships
our clinical transformation initiative with exactly that mission deliberately and measurably improving patient outcomes.
So we've now done 30 plus projects working with different clinical teams across the system, essentially creating pathways and then creating. Analytics solutions so that we can monitor both our adherence to pathways, as well as all our major outcomes, whether it's length of stay mortality, readmissions, you name it.
And that's really how we've at least started our clinical transformation initiatives. So that we put patients on pathways and it's been growing and growing. And now we're at the point where, we're even starting to put this as. Metrics in our physician groups, whether for incentives and administration and other, so.
I think that the system is seeing the benefits and now really giving a bigger commitment to, we want to make these clinical transformation initiatives, even more of a formality here.
All right. I'm gonna have to go back to the beginning cuz this how my brain thinks. Okay. So now I've seen the outcomes and I like it cuz you could kick off another one tomorrow without breaking a sweat because you have a framework in place.
You have the maturity model in place. Now you have a run rate of projects that you can look to and say, okay, this is how we've done it. But back in the day, how clean was your data? How good was your data governance? How did you get to the point where you could develop this level of sophistication around the workflows and the pathways and the metrics?
Talk So I think one of the things that Neil has been brilliant about, and I think these images in this way of speaking are really important. So I don't think we ever tried to boil the ocean. And so Neil says. We're gonna start with a skateboard and we're gonna move through the different modes of transportation until we get to the Ferrari.
So when we were talking about
skateboard to Ferrari, that's a big jump. I can't wait to hear how to get there.
He has an image with a scooter and everything in between, and as part of that, The messaging there is important because when we are talking, one of our first ones was opioid reduction. And instead of saying, well, let's do opioid reduction across the entire organization.
We started opioid reduction in a very specific place in urology with some very specific providers. And so set those clinical pathways out about what should you do? Pre-surgery. Post-surgery in terms of opioids demonstrate the efficacy of that care plan specifically in this case from a farm perspective, and then look at the outcomes when you do it that way, and you start small, then you can go to any department with that model and then say, do you want opioid reduction?
We made it happen in urology. Now we can move to OB and then we can move to this. And. This idea of not trying to boil the ocean with every data and analytics project, but letting it grow helps you in a number of ways. One, you said it, you. To repeat your process over and over again. Two is the people in process are really important as well.
So the people who are interested in that start coming to you and it starts to build right. And so I think this idea of moving from small to large has been really, really super influential here in maturing our program as.
So you don't try to clean up all the data. You don't look at all the data stores and whatnot.
You focus in on a specific area which actually limits starts to bring the data down to something that's manageable and say, all right, we're gonna clean up this data set to get to this outcome.
Right. We do it by the question, the clinical transformation that we're trying to achieve.
That's the data that we focus in on. And it helps us talk again, back to let's say for opioid reduction, maybe back to the providers as well. We may find that there's some free texting going on and we get to talk to those folks and say, Maybe there's a better way to capture this data. Now I just use that as an example, but when you focus in on what's the clinical transformation we're trying to make happen and you focus in on that data, on those people and on that process, then I think you have more success.
Otherwise you'll run the risk of putting so much data out there that people will find fault in the data. And so small to large is our approach.
Yeah, I will a hundred percent agree. And when we even add. We think that the people process adoption behavior change is the more important piece, right?
The data is the less important in that whole grand scheme. Right? And so our big goal is get the folks into the data and then get them out of the data. Don't make the data so complicated that you stay in the data forever and you can't get to that people process because really our goal has been, in our caveman talk it's we want design needle.
We want to build a needle and we wanna move the needle. We wanna spend the majority of time moving the needle, which is really our process improvement team and our people process. So this piece we wanna, we want to be able to get something stood up as quickly as possible, and then really hand over the keys and jump in the passenger seat as
quickly as we can.
Yeah. We use a lot of that imagery that a verbal imagery bill like skateboard and what Neil said, skateboard caveman, just caveman we're like, let's take this down to how caveman would do it in order just to get people to say, oh, I get it right. Healthcare and medicine is really complex, but to do the simple things, you can do those in a simple way.
Focusing on the people in the process. I would say we, and he's right. We completely downplays not the right word, but we don't wanna spend time talking about the technology. We wanna spend time talking about the people in the process and then bringing the technology to help the people in the process along
So, final question here. So let help me understand you gave us one, you said opioid and urology. Give me like a handful of the others that you've been able to, jump off of.
Go my friend. All right.
So, we've really jumped on the Eres train. So enhanced recovery after surgery, and we've now got about 11 or 12 surgical projects based on, pre-op border sets, post-op border sets, education, ambulation.
And if we do these all in standard ways, we can really improve our outcomes. Lemme see if we've done hypertension. And diabetes, both in the primary care space in the pediatric space, we've done sickle cell pathways and pediatric excavation pathways. Mm-hmm we see in the cardiology space, we just finished a non SD segment elevation MI pathway.
And we had done a cryogenic shock pathway, not too long ago. We just did a project in urgent care to reduce unnecessary stroke cultures. So we're really trying to get all areas of the system. See, right now we're actually working on a couple of pharmacy projects to, can we decrease? Unnecessary high cost medication usage.
Let's see, we did one on consult turnaround time. So we're trying to get to as many areas of the system as we can from clinical operational to beyond.
And we're doing nonclinical too, bill. So we're doing a lot of patient engagement. So we spent a lot of time with our patient engagement team. Those are board goals for us as well.
How many times are they logging into my chart or how often are they communicating with their provider? Right. When's the next available appointment and how often are they logging in through the website to make that appointment online? And so we're tending right now. Rightfully so because it's, we're strongest in clinical.
But we have been branching it out into operational and it doesn't take a lot of work from us to branch it out to operational because we go and give these presentations that our senior leader teams, our operation leader teams, and people just start coming to us and saying, look, I I'm in I have these wicked problems that I need to solve. I wanted. Be focused on the outcome. You asked earlier about where, again, we don't really disagree, but I think the only thing that sometimes we talk about descriptive versus outcome data and I'm like no descriptive data. It never makes any sense. And then Neil rightfully comes to me.
He goes, but remember these times we did descriptive data and it really helped change the environment. So there's a small one that came up just cause this conversation, but it's pretty rare.
That's fantastic. Well, gentlemen, I wanna thank you for the work that you're doing. Sounds fantastic. And I wanna thank you for sharing your experience with the community.
Really appreciate it.
Hey bill . Before you go, my friend, I really appreciate you. One of the things that Neil and I and our whole team are always trying to do is talk to other health it systems. We all have the same problems and like I contacted you probably three months ago. And I said, I really appreciate you because I drive in the car every morning and I hear from different.
Health it organizations. And I hear what their struggles are and the things that they're doing well. And you've put us in a position where we're like, Hey, we gotta call this group because they're doing this great. And maybe somebody said they had a struggle and we say, we need to call them and help them with something.
We think we've done a good job in, so I think you provide the opportunity for everybody to play it forward. So thanks my friend.
Appreciate it. Thank you guys.
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