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Patrick Anderson CIO for Hoag Hospital in Newport Beach California stops by to discuss the VA Cerner implementation, his CIO playbook and the AHA response to CMS interoperability incentives.


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 Welcome to this Week in Health It where we discuss the news, information and emerging thought with leaders from across the healthcare industry. This is episode number 25. It's Friday, June 29th. Today we look at the c I O playbook, the A'S response to cms, uh, CMSs Interoperability Requirement, and Cerner 2020 for the va.

This podcast is brought to you by health lyrics. Are your strategies constrained by infrastructure or are you tied to a nod of applications? We've been in your shoes. We've been moving health systems to the cloud since 2010. Find out how to leverage a cloud to new levels of efficiency and productivity.

Visit health to schedule your free consult. My name is Bill Russell, recovering Healthcare, c I o, writer and consultant with the previously mentioned health lyrics. Before I get to our guest, an update on our listener drive, we've exceeded 200 combined new subscribers between our YouTube channel and uh, podcast outlets, which means we've raised $2,000 for hope builders.

Which provides disadvantaged youth, the life skills and job training they need to achieve, enduring personal and professional success. I've hired their graduates and their stories are, are really inspiring, uh, really good stories of, uh, second chances. Uh, we have seven more weeks, uh, in which our sponsor has agreed to give a thousand dollars for every additional a hundred subscribers.

Two wins for the price of one. You get to listen to great content and support the, uh, community while you do it. So join us by subscribing to today. Tell your friends. Uh, we actually post a new video to our YouTube channel every single day. Um, and, uh, I've, uh, I, I've been told that, uh, people are getting great value out of the content.

So tell your friends, let's get people signed up. Let's blow away that, uh, that number, uh, the 2000 number. Okay, today's guest is a, uh, veteran. I guess we'll call him a veteran healthcare, c i o. He is been around the block, uh, and a good friend Patrick Anderson is the c i o of hospital out Newport Beach, California.

Patrick, welcome to the show. Hi. Welcome. Uh, great to see you, bill. It's always, always good to talk with you. Yeah, I mean, we, we actually got to work pretty closely together for a little while there 'cause uh, we are two, uh, health systems formed an affiliation and, and, uh, so I got to see you, uh, got to see you in action and, and I was there when you guys started the conversations about, uh, moving hope to Epic so we'll about that.

Uh, tell us a little bit about Hogue Hospital. Uh, I guess first of all, it's not really just Hoge Hospital. It's much bigger than that. But give us a little, uh, uh, idea of, of what ho's about. Sure. Hogue is a, is a top 50 hospital. We really want to be a health destination. You know, a top 50 means you're in the top 1%.

Quality and safety. So we, uh, we really try to drive medicine a

around. That provides, uh, you know, primary care and other specialties with, uh, with imaging and so forth. And it's an exciting time to be at hope because we, we continue to grow. Our, our goal is to, um, allow people in Orange County, California and the coastal communities and inland to, uh, not have to leave this area for advanced healthcare.

They don't have to go to Los Angeles. We have several institutes that are, um, just, uh, uh, with, with advanced medicine, ortho women's neuro Cancer, and we really try to, uh, drive the advanced medicine with our amazing board of directors. Our community is very hands-on with hope. The philanthropy community really helps us drive this advanced medicine, so it's really the, the destination that we're after Bill.

Yeah, and I would say that, uh, I mean our, our family utilizes the, uh, The clinic over here and, um, you know, it just great doctors, great, uh, service. Uh, you know, a couple things to call out in terms of, uh, destination, h o i, the Hoag Orthopedic Institute, uh, throughout Orange County is the, uh, destination to go, uh, knee, hips, and, and any orthopedic needs.

Uh, the other thing I. Funny because, you know, we, uh, we delivered a ton of babies, uh, at our hospitals within Orange County. But it was amazing, always amazing to me to see the number of people that drove from their community right past our hospitals, all the way down to Newport Beach, just so they could deliver while overlooking the ocean.

You guys have just one of the premier locations in terms of, uh, just views of, uh, of Newport Beach and the ocean. It's, it really is something else. It's, it's amazing. We, we have a very, very active, uh, o ob operation at, at, at Hogue. Absolutely. Yeah. So, uh, one of the things we like to do with our guests before we get started is to ask them, you know, what's one thing you're excited about that you're working on today?

So, could be anything. Sure, sure. You know, bill, it's, I think it's our accomplishments is what really excites me at Hoag. You know, last year we launched the project to. To Epic. We went live 60 days ago and, uh, it's just been, it's just been a marvelous, uh, marvelous transition for the clinicians and, uh, it's just been an, an amazing work.

We, uh, we partnered with Providence Healthcare out of Seattle, our, our affiliate. And, uh, it's just been, it's just been tremendous bringing all of these advanced stuff. Advanced capabilities on a very stable, uh, stable. E D H R has just been phenomenal. They've deployed it in hospitals, so it's, it's proven and, uh, we've, we've just had a lot of great synergy with.

Yeah, I, uh, and actually Rod Hockman the, uh, president and c e o will be on the show in I think two weeks. So looking forward to a conversation with him. That's just a shout out for that. Uh, now you guys, you guys sort of got stuck. I mean, you were, you were on a, a pretty antiquated, uh, e h R and, and worked really struggling to make that move.

And then you came in there. And, uh, really set that up and had the conversation. I mean, was it a pretty easy conversation to make the transition? I mean, were the doctors ready? Was the health system ready and you just sort of laid it out and everyone said, yeah, it's time, or was it part It was a little different bill.

When, when I arrived at Hub, we, I found a couple dozen departments still on paper. And, uh, and that was very challenging. So obviously I looked at what is gonna be the scope and cost to, to bring them, uh, you know, onto the, onto the E H R and, you know, to be, uh, to be compliant. And when I looked at the price, and I looked at the time it would take to do that with the, uh, with the legacy systems, I thought, you know, this, this just doesn't make sense.

I have a lot of experience with Epic and Community Connect and different, uh, licensing and affiliation, uh, you know, scenarios. So, uh, so I, I put three scenarios together for, for the leadership team and the board, and they, uh, and they chose one of them, and it, and it, uh, it, I.

All the way through delivery and now reap benefits. Everybody is, everybody is online now.

We've. Yeah. And I'm sure, I'm sure it was flawless, no, pro having, having done e EMR implementations myself, you know, you just, those 60 days were, were probably, uh, a couple sleepless, sleepless nights I would imagine. Um, absolutely. Well, you know, which gets us to, uh, gets us to the show. So, uh, you know, show is three things in the news, soundbites and then social media close.

Yeah. So the first story is yours. It's really the, uh, VA to Congress, uh, talking about the first Cerner e H r. Install going live by 2020. So this is your story, so go ahead and set it up for us. Sure that's a, it's a 10 year project, about 15, $16 billion. And, uh, and then, you know, I think Washington is really concerned about that.

Spend. Bill, you know, uh, the House of Representatives have been, uh, been challenging the VA on, on the oversight and the governance. I think one of the, one of the big challenges.

There's such a turnover at the top with the Veterans Administration. How are they gonna manage this through, you know, right now they don't have, they don't have a secretary of va, they don't have an undersecretary for health. They've been trying to recruit A C I O for, gosh, I don't know how long. And you know, that in itself is gonna be challenging.

You know what the pay is for the va, c I o. No, I'm, I'm curious though. It's, uh, it's about $225,000 in the Washington DC area, or, or, or potentially the. For a, for one of that, you know, that's the largest healthcare delivery system in the world. Right? Right. And that, and that is the pay. And that's why they can't seem to recruit, uh, recruit A C I O.

But the challenge is, is, um, you know, 10 years, 15 billion, uh, how, how is the oversight gonna occur? We all know an E H R deployment is not really an IT project. It's an enterprise wide project, then. That drives everything. It drives workflows. It, it drives financial modeling and decisions. Population health.

It's a, it's bigger than just it. And with that being said, it's a, it's a big project that needs oversight. And Washington is really concerned. The VA doesn't have the leadership and the, uh, Of that leadership to see this through. What do you think, bill? Alright, so let's, let's do this. Let's, uh, let's put us in their shoes.

I've done this before with, uh, I did this with, uh, ed Marks. We talked about specifically we talked about the VA project. So, uh, from a little different angle, but I'm gonna put you in charge. I'm gonna make you . The c i o making two $10 a year. We're.

And by the way, that's, that's, that's really absurd. I having, uh, you know, knowing what my salary is, knowing what yours is, and quite frankly, most of 'em are nonprofits, so that's, most, most of them are a matter of public record. You could just go out there and collect the salaries and realize that for, given the magnitude of this job, given the complexity of this job, uh, and the project that you're looking at here, they're gonna have to use contractors.

Significantly, uh, to, to, uh, to do this because the talent is not gonna leave where they're at, uh, to do this project, even though we all agree that the. The, the, the group that you're serving here is so important and that all of us sort of feel compelled to help and we want to help. Um, but, you know, that kind of money in a DC market or even an Austin market is, uh, just not enough to take on that kind of scrutiny and that kind of thing.

So, all right. I, yeah, for whatever reason, you're, you're at retirement and you're saying, Hey, I'll, I'll take on the role for 210. Uh, here, here we go. So, uh, let's start with the timeline. So you're gonna do a pilot, you're gonna do the Washington market, which I think is selected for a reason. It's probably their most advanced or their most, uh, cohesive.

Uh, so you have a group, uh, you have a group of ready hospitals that maybe have some good workflows. They're ready for an implementation may, they may even have a, an epic implementation. Who, or I'm sorry, a Cerner implementation already in place at one of their hospitals. So, uh, so they're ready to go.

That's the pilot. 2020. Now. You just did a pretty aggressive timeline. Um, is 2020 enough time? It's 28. It's the middle of 2018. To do this pilot for let's say, I don't know, 15 ho 10 hospitals in the, uh, uh, greater Northwest area. You know, bill, I think they're gonna do three hospitals up in the, uh, Washington State area.

Okay. But still they, they have to gain consensus. On that clinical build across the VA system, and it's really that that build of of order sets and workflows that will support the rest of the deployment. So they have to gain that consensus and that is what is time consuming. Gaining that consensus on, on clinical build and then, uh, and then proving it out in pilot sites and preparing that build for scalability and distribution.

Right. Yeah. And that's where I was gonna take you so. Um, you don't want to do regional builds. You really, especially on that clinical workflow and, and the, uh, the ontology and the, uh, terminology and, and, and data sharing. All those models, uh, need to be baked for the entire system. I mean, you don't start with, Hey, this is what we're gonna build in the Northwest and we'll figure out what we're gonna do in, in the Northeast.

Uh, you really do have to drive that consensus across the board. Um, I, I just know in our process that consensus took and now, alright, so before I go there, the one thing to point out is there is no billing within the va. So that was a significant challenge in, in building out the E H R 'cause it's, you, you just have so many, uh, financial and, and different billing mechanism.

The VA doesn't have that, so that makes it a little easier. But still that, that clinical consensus is hard to drive, are, be able to. Do that, uh, that consensus build by, by 2020? I would, I would, my gut tells me that's gonna take a year in and of itself to drive that clinical consensus. Absolutely. And then it's gonna take longer than a year to do that build once you gain that consensus.

So if they, if they can do the consensus on, on maybe two or 300 order sets and workflows, then how fast can they configure Cerner and build it? And again, looking at that patient population, it's an aged population. They're gonna need, they're gonna need home monitoring, they're gonna need, uh, you know, care management.

Yep. And with, and with, with, and, you know, home monitoring care management is, needs to be integrated. So they have a, they have a tremendous build to do. And doing that in two years looks very, very tight for those pilot sites in Washington State. For me. Yeah. Well our, the other thing I would say is, you know, that representatives pressed them on the staggering cost of the project.

Uh, my gut feel on this is, um, well, I mean it, or, so here's our response to the congressman. My gut feel would be to look at the Congressman and say, I'm not sure it's enough money. Um, given the number of people we have to bring together the consensus. We have to drive the number of builds we have to do, the number of contractors, we're gonna have to do, uh, 16 billion, uh, you know, 16 hospitals.

It was roughly a billion for what I was looking at to go to Epic. Uh, 16 billion for the VA doesn't, doesn't strike me as enough. I mean, it might be enough, but it strikes me as either the right number or not enough. What, how about you? Well, you know, ob obviously 16 hospitals is, is a, is a billion dollar deal and, uh, you know, may maybe Cerner cut 'em a really good deal because they already have the D o D, but the, the challenge is, is those, those contractor prices to help.

Facilitate and orchestrate that build and then to facilitate and orchestrate the deployment over 10 years, and prices are only gonna get higher and demand is gonna get higher, and the technology is gonna change during that 10 year period. So there's gonna be change orders and adoption of new technologies and adoption of even, uh, new regulatory, uh, uh, interoperability and so forth.

So with all of that being said, it's really tough to forecast 10 years, don't you think? I, I, I agree with that. Let me ask you, I think this might be a softball for you, but, uh, you're, we put you as the c i o we put you in charge. Uh, what are the most important roles you're gonna need to fill, uh, in order to ensure success for that E H R implementation at the va?

Obviously gaining, uh, gaining councils and governance, uh, buy-in. And then also that consistency of leadership. Again, there's, there's no consistency of leadership across the va and I know that they want the, uh, the g a o to get quarterly governance reports and somebody's gonna have to go up on the hill, uh, on a recurring basis.

To show how well that, uh, that spend is going right. And isn't staying on track. So, so for me, I would, I would focus. Uh, on the governance, finding out who those key stakeholders are across the organization. Maybe get, uh, get some regional leadership from the VA to, to find some way to, uh, to expedite the, uh, the adoption of workflows and technologies.

I think it's all around leadership and governance. And right now it looks scary, bill because. Yeah, and I, you know, I think that, I think there needs to be a medical officer who's driving it across the board. I think there needs to be a nursing officer who's driving it across the board. I think they need to be looking at alternative models.

So maybe a digital officer as well. That's a part of it. Uh, and you're right, that consensus building, uh, doesn't mean technologists or even a great nurse or doctor. It means somebody that can really drive those conversations, uh, those decision points. Um, and, and really just form consensus. And so it's, these are special people.

Whoever's gonna run this project. Uh, these are special people. I mean, there's enough. Stories about failed e h r implementations, uh, to, to fill multiple books. Uh, and, you know, they're, and they're, they're, uh, they're late out of the gate. If, if they have a commitment to, uh, to the House of Representatives to deliver, to deliver those pilot hospitals in 2020, they're gonna have to shortcut the governance.

And we all know when you shortcut the governance, you, uh, you pay for it later. Right? Uh, yes. Um, so anyway, I I, I, I will give everyone Patrick's, uh, phone number at the end of the, uh, show so that they can call him and, and make their, uh, their offers for him to be the, uh, c i o for the va. Should be fun, right?

Uh, alright, so let's kick off to my, my story is the a h a strongly opposes interoperability as a Medicare requirement. Uh, pick this up from fierce healthcare. Uh, a a has come out against the policy floated by the center, uh, by C M Ss to make interoperability requirement to build Medicare and Medicaid, uh, in a proposal.

Uh, hospital payment rule issued in April c m s included a request for information regarding the revision of hospital conditions of participation, uh, c o p, uh, and Medicare conditions of coverage C f C, uh, and would require hospitals shared data electronically with other hospitals, community providers and patients if possible.

And, uh, it goes on to say some other things. Um, a h a said the rule unfairly targets one of the sector, one of the actors in the healthcare ecosystem. And that requirements could have unfortunate consequences for some hospitals, uh, and communities. Um, the group argued that it's, uh, premature to consider building interoperability into CLPs and Medicaid, CFCs until the barriers of data sharing have been fully addressed.

Noting that post-acute care providers. In particular, in particular, particular are often behind the curve with E H R implementation. Uh, e H A also argued that compliance would be difficult for surveyors to measure, and providers can deliver care safely without. Uh, interoperability. Uh, instead the HA urges c m s to focus its attention on resolving problems created by the lack of fully implemented exchange framework, adoption of common standards, incentives for E H R and other IT vendors to adhere to standards.

HA said, pointing to the, uh, to oh to teca. Um, by the, uh, O N C for health it earlier this year. Um, so, you know, I, this is one of those things that I, I've been very passionate about. I've had people in the show to talk about, uh, interoperability. I. Um, you know, I, I think the a h a is just wrong here. Um, I'll, I'll let you, you know, rebut me or, or whatever on this, but I think they're just wrong here.

'cause, um, you know, I, it's interoperability is we all agree. Interoperability is, is critical, uh, uh, in terms of getting the data to the point of care so that the clinicians have the, the greatest amount of data at the, at the point of care. Um, Interoperability is the only way to ensure that the only way to ensure interoperability is to start to incent it, not incent it like, uh, like meaningful use has, but to start to really incent it and say, look, if you're not gonna share your data cm, you, you can't take Medicare patients.

Well, that gets everyone's attention. I understand why the a coming out against it because there's, there are some health systems that. Their data sharing, uh, capabilities are lacking, uh, and their e h R implementations are lacking. But at, at the end of the day, at this point, if you're on Epic, you already have a extremely robust mechanism for sharing data.

Cerner, same thing. Actually. All the major EHRs have a robust way of sharing. Teka may not be the best mechanism. Fire is, is moving forward. Uh, but we still have, uh, you know, we still have a ton of ways to share data. It's not perfect yet today we end up with, in P D F, hell with too many PDFs going back and forth or whatever.

I mean, X L really, but essentially just. These, uh, unstructured documents, which are not overly helpful, but they're more helpful than no data going back and forth. So I, you know, again, I'm, I'm just gonna come out strongly against this and say, I think we need to incent it. I think interoperability is key and the only way to get there is to put money behind it.

Uh, I'm curious what your thoughts are in terms of, um, you know, who, who, who would be, I mean the is against this, who are they protecting? Who are they? Uh, who, who do you think their, um, uh, who do you think within the hospital community is against this. I think the a h a is supporting the issue that the hospitals have with those post-acute providers.

Bill, why would we wanna hold the hospitals accountable to connect to post-acute providers, home health agencies and, and other providers that, that do not wanna follow meaningful use? When I was at Ochsner in New Orleans, we actually hosted for the entire state, the electronic mailboxes of. Everybody, the entire state.

I pulled all the CIOs together from the entire state and we, we looked at all of the recipients of our transition of care, meaningful use requirements, and we contacted all of those. We gave them electronic mailboxes and we hosted the, the directory. For the entire state so that we could all meet meaningful use transition of care, you know, electronic delivery because those post-acute providers refuse to comply with meaningful use.

And putting that burden on the hospital is, I think the a h a's position is. They don't, they don't like that because it's going to, It's gonna impact the, the hospital's ability to comply and the c o p, the condition of participation that has big teeth, right? So I think that's the, ah, a's position we have to figure out how to get those smaller post-acute providers, those rehab units.

Rehab hospitals, uh, whatever they are to get them online. So it, it, it is the interoperability issue. Somehow we have to break that. Yeah. But we, we just, we, you know, so we saw this with, uh, bundled payments and the, uh, the programs we were, which have actually been ratcheted back recently. But, um, in those models, we were required to take responsibility for the.

Um, for the, uh, quality of post-acute care. And again, it's the same thing. I mean, if, if we. Um, a majority of the money flows through the hospital, so this is why you, you go to the hospitals and the hospitals do control where those patients get referred to, and so they become the 800 pound gorilla. And it's the way to get those, uh, post-acute care providers, uh, aligned.

Uh, you and I both know, there's, there's just no money in home health. I mean, it's, it's at least today, aved. Uh, of organizations. So how do you get them to share that data and to move that data around? And I think, you know, it has to be financial mechanisms and if the referrals are coming from the health system down into the post care, uh, post acute care facilities, what we started to do was we started to look at each of those.

We gave them quality scores, metrics they had to hit. Most of 'em were below those metrics. And then we gave them timeframes for moving up. So I think it's a lot better than other mechanisms. So the best mechanism is to have local providers working with local post-acute care facilities to drive them forward.

I agree with you. It's, it's a huge burden on the health systems. Um, and if the health system outside of, uh, the referral network, if the health system doesn't really have a, uh, mechanism for driving that change, it becomes very, uh, very hard to do from a leadership standpoint. But I just think it's, it's so important to, uh, uh, to get that data across that entire, uh, across that entire spectrum.

Sure. You know, in incentives seem to help, I think, better than penalties. I. So maybe if we could develop an incentive way for these, uh, post-acute providers to get online. Maybe there could be some potential there, but, but penalties against the hospitals may not be the right approach, but you're, I agree.

Obviously something has to happen and I think collaboration is the, is the beginning to, to the end. Cool. Alright. Well, um, yeah, we'll have to see how that one plays out. So let's get into the soundbite section, soundbite section. Uh, have questions go back and forth, typically one to three minute, uh, answers.

Uh, we're gonna do something a little different here. We're gonna go, you have shared, uh, with me your c i o playbook. So you've gone into new, uh, gone into health systems on several occasions, inherited it shops, and you have some principles here that you, uh, go by. So, uh, I'm gonna share some of that as we go through and just ask you questions around it.

So the first principle is, uh, you run it as a leadership team. The team runs it. Tell us about that. Tell us, uh, what that looks like. Sure. You know, years ago, I, I, I couldn't keep up Bill. I, my time was, was just, I was buried. I was working every day, every night, every weekend. And I thought, gosh, am am I delegating enough?

Do I have enough, uh, leadership resources in the. To handle the demand and, and to support the organization and all of the institutes and all of the activities appropriately. So, uh, so I, I really started working on developing the leadership team principle where all of the leaders know everything that's going on in it, and we solve our issues together and we help each other.

So bringing the leadership team together, huddling multiple times during the week to, uh, to make sure that we're staying on track. And then setting the pace of monitoring all of the critical success factors across the IT organization with, with a rigor is, was really the key. And, and what, what was the real, uh, benefit of this is?

Everybody's well informed. Everybody's accountable to, uh, to meet their, their service levels and their dashboard deliverables. And, and then it, it provides bandwidth. It provides bandwidth for me, and it provides bandwidth for the leadership team. So we, we have a, we have a regimen and a rigor that we go through.

Cool. So let's, let's go through this a little bit. So you, you run it as a leadership team, sort of a fellowship of the ring kind of thing. So talk about the qualities of the people that you invite into the leadership team and how you form that leadership team. Sure. Well, first of all, all of my direct reports are on the leadership team and, you know, they, uh, they all have to be very collaborative.

They have to support each other. I'm looking for cross-functional support. I don't want to have to intervene on one of my subordinates and say, you know, I think you really have a lot to offer this project over here. I, I wanna see that occur. So I start mentoring my subordinates to, to give and to continue to give and support.

Because when you give, you get, you get it back. And, uh, so, so I look for highly collaborative people, but I bring in a, uh, you know, a multidisciplinary team. I bring in HR and I bring in finance, and we literally operate as, as a team and, and as we, as we work. I, I wanna make sure that we're cohesive and I, I'm highly sensitive.

Matter of fact, I have a high level of awareness of, of anything dysfunctional. And, uh, and again, you have to be very careful not to jump in and change people in front of everybody else. You literally have to, you have to mold these people. And if they don't wanna mold into a team, then you really have to help them get there or, or actually help them exit.

So, uh, so basically collaboration, a lot of curiosity and a lot of generosity. Is, is the key leadership attributes. Yeah, those are, those are great attributes. Yeah. I mean, we've all seen the silo approach, which leads to destruction where somebody goes, well, you know, that problem was not my problem. It's that group over there.

And that's just, that's just death. And so you, you, you create this shared accountability, um, but you're still the c I O, so. Uh, is there sort of a, a, you know, the buck stops here, kind of Harry Truman kind of thing, that you have ultimate responsibility. I mean, so that when there's a, uh, a decision to be made and, and the group can't come to consensus, that you sort of step in and say, okay, this is what we're gonna do.

I, I do that Bill and I, and the buck does stop here. But, you know, I, I provide explanations and I provide the reasoning behind that. If, uh, if I have, let's say I have two direct reports that wanna go in two different directions and, and they can't seem to work it out, which is, which is fine. I will work it out for them, but I'll provide the sound reasoning and I will, I will ask them to, uh, to provide feedback to my own reasoning, because yet you have to, you have to have no ego in this work.

So it's not about egos, it's really about objectivity and trying to find that. The, the least path of resistance to move progress forward effectively. So the buck, the buck does stop here. So your, your second principle really is data driven. So, uh, you meet pretty often with your team and you go through dashboards, you go through, uh, service delivery metrics, HR dashboard, financial performance, uh, contracts, dashboard, which is interesting.

Outages challenges of the week? Uh, just, uh, audit and compliance, uh, things, portfolio and project management. So you, you're, you're looking at the health of the organization from a lot of different lenses as you, uh, as you get together multiple times during the week, what, what, what do you think makes that so effective?

Why do you think so many people adopt that kind of model or a lean model or a huddle model where you're looking at those things? What, what aspects of it make it. You know, I developed this from my lean learnings, you know, five, 10 years ago. As I've developed this over, uh, over the last 10 years, the, the real situation is it's accountability.

If people know that they have to, uh, they have to talk about their oldest tickets, 'cause oldest ticket drive executive escalations. So if people know they have to talk about oldest tickets, they wanna get their tickets out of their environment. Quickly, they don't want age tickets because they have to talk to me.

So when, when I look at any dashboards, we have Tuesday, Thursday huddles built and they're scheduled, right? The, the first Tuesday of, of the, of the month is, is the HR dashboard. Where are we with? Hiring and recruiting and, and getting offers and, and delivering on the resources that we need and, and are we backfilling with contractors as we struggle in certain areas?

So I may I maintain a rich resource capability. I don't want to ever hear that. We can't do something because we don't have resources. Resources,

dashboard. I want accountability. I want accountability from hr. I want accountability from all the hiring managers. I want accountability from everybody. Of week 1, 2, 3, and four of every month we have presentations by those various dashboard owners walking us through the health of those operations.

Accountability is the key. Yeah. And uh, you know, I can't tell you the number of times sitting in the c I O chair that people came up and said, well, this is happening. And we hear so many anecdotal stories of, Hey, this is happening or this is happening, and the numbers, the charts, the metrics sort of. You know, blow that away.

You know, we're the best in the industry in this. Well, show me the numbers. You should look at the numbers. You're like, really? The rest of the industry is this bad . And they , they just go, well, you know, I don't know if the numbers are right. Well, let's get the numbers right and let's get our story right 'cause we're gonna, we're gonna take action.

And, uh, you know, taking action on concrete numbers, metrics, uh, is always better than the stories. Um, Give us an idea of how you handle competing priorities within your team, staff, or organization. So I, I get this question a lot from CIOs. You have competing priorities, you have limited resources. Um, how do you, how do you determine which, you know, which one's gonna get funded, which one's gonna get the resources, uh, those kinds of things.

I think the, the key is, uh, first of all, you build budgets based on a plan and you build that plan with the business. And we do this every winter for, for the next year, and we build that plan. Anytime there is any changes to that plan, you know, the business is gonna have to partner with me to go find contingency dollars if they're not budgeted.

So working with, uh, with competing priorities is really more about com competing resources. And if you can, if you have a, if you have a pool of resources and some, some professional services partners that you can trust to bring in, you know, A plus resources on, on a, on a short term and immediate basis.

That's the way for you to be able to scale resources up and down and meet those ad hoc demands. So I'm not really that worried about it because it's a, these demands are typically, uh, they're typically born in the business and the business has to bear some of that financial responsibility. So, uh, so when you, when you put that responsibility back on the business, they're, they take much more consideration in their ad hoc demands, right?

Yeah. Yeah. And that's, that's really true. That's where a lot of the constraint comes on. It is, uh, these things that pop up throughout the year of, Hey, can we do this? Can we do this? Um, and, and making it a business decision rather than an IT decision. So, um, Your third principle is culture of collaboration and support.

So my next question on that is just, I think most people are striving for that culture of collaboration and support. Uh, what do you do when it breaks down? Um, how do you reestablish trust and collaboration? Uh, 'cause it will break down from time to time. Uh, you know, there will be stress on the organization.

You'll have a massive project, you'll have something go wrong. Uh, so it breaks down. How do you, how do you, uh, reestablish it? How do you get it back to where it needs to be? You know, they, they, they break down often. We have, we have . You know, over a hundred projects in flight at any time. They're, they're critical.

They're, uh, they're, they're very complex. They're, uh, they're multidisciplinary and, you know, people, people have to leave for weeks on end, sometimes for family emergencies. These critical resources, other, other things happened or there's surprises, especially when you're doing pioneering type projects and, and thing, things break.

People also, uh, uh, sometimes they, they don't understand requirements and sometimes appropriate for.

Software breaks because of, uh, you know, volumes were unexpected or whatever it is. You have to be able to have a, a cohesive leadership team that, that can draw upon the entire organization for help. That's why when we do one of my principles is the monthly project review and we, we bring in all the managers and above and all the project managers and we go through the health of all the projects and we look for anything that is trending.

And then I look around the room to see who's gonna offer up help. And when you build that culture of collaboration, you help each other when, when things are going left and right. You know, I, I get to the point Bill where we borrow budget dollars from each other. If one group has a positive variance and another group has a negative variance, We'll share dollars, we'll share resources, we'll share managers.

We'll share leaders. We'll pull together and create a small sub management team, whatever it takes to get that project back on track, on time, on budget within the overall IT budget. So the culture of, of no ego, the culture of collaboration and the culture of generosity is, is. Yeah. And that budget, uh, that budget mechanism you talked about is key.

When I. To be the c i o. One of the first things I did is, uh, every department within it had their own budget. And, uh, you know, as I walked around the department, I found these closets full of Cisco switches. And I'm like, why are these closets full of uninstalled Cisco switches? And they said, well, you know, it was end of budget year.

We wanted to make sure we kept our money. So we, you know, you had those kind of just poor behaviors. And one of the first things I did is I said, all right, no more department budgets. All the budgets, it's one budget. We'll meet as a group and we'll determine how we're gonna spend that money. And one of the things that did was gave us that ability that you just talked about, which is as a group, we sat there and said, Hey, you know what?

This is critical. Uh, we need to, we need to move money in this direction. And it wasn't like, Hey, we're gonna take money from you and take money from you. It was essentially, uh, you know, we had this, this. This budget to get a certain amount of things done as it, and because we had a big picture of, of that, it really ended up working and Right.

So that's, that's a great model. Your fourth principle, uh, is to foster a, a great work environment. I, I love actually what you, what you say here. So, uh, you have a great places to work committee. Uh, and tell us a little bit about that. So, uh, sure. I mean, you're not just chasing a, an accolade like, you know, we're a great place to work.

You're actually trying to create something here. So tell us about it. Well, you know, the, the results of our work is double digit increases in employee satisfaction year over year. That's the goal. And we've, we've hit that year over year. So how do you do it? You ask each manager to, uh, to provide a high performing.

Person from each manager's group in into this committee. I meet with them once a month and there's no managers, directors, vice presidents, none of them are. It's me and an admin person and this great places to work committee, they become ombudsman. What I ask them to do, bill, is I ask them to, to round within their team and then round with any of their friends and colleagues across the IT organization.

And let's find opportunities. Let's find ridiculous processes. Let's find other items where, where people are, uh, are just not happy or, or they're, they're, uh, and they, they need this mechanism to work with these ombudsmen and find out what are the issues. We also use this group to look at the employee satisfaction survey results and let's look at some areas that are still good but are sliding and let's reinforce them.

And then let's look at the areas where we are, are struggling and maybe not hitting the baseline. And then let's take the ombudsman group or the Great, let's go out and round and let's talk everybody. And let's validate what are the root causes for those issues. Let's not just take it at face value. So we'll go out and we'll validate what the issues are, and then we will solution them together.

And I bring, I bring, uh, my, my, my leadership abilities. I bring budget, I bring whatever it takes. To solve those problems. We've, uh, we've, uh, we've created new training programs. We've cleaned stairwells, we've, uh, we've fixed, uh, uh, p t o policies in the organization. Overtime policies, we've solved so many things that have just made this a great place to work.

And the, uh, the survey results really show. The value of that work. I have to tell you, a, a happy progressive workforce is an effective workforce. Yeah, absolutely. And I, you know, I think the, the wisdom in that is you give, uh, you give the, the, the staff a voice. And, and the reality is they know what, what a good work environment looks like.

They know what they want it to look like, uh, they're already talking about it, but what you're doing is giving them an outlet to actually create the environment that they wanna work in. We had bad, we had bad tasting water out of a faucet. We got, we got that fixed. You know, it's what, whatever it takes.

Right. Bill? That's what, that's what the goal is. Yep. So you create all this bandwidth and, uh, so now you, so give us an idea of how you're using that bandwidth. You talked about rounding with executive leaders and, uh, digging into the mission and those kind of things. Uh, how has rounding with the executive leaders really changed your perspective as a, uh, as a c I O?

It's, it is phenomenal. You know, you, you understand different challenges, deeper challenges of, of business units. For example, uh, example, the, the, the cancer center, you know, working with, uh, the medical director over there, he really wanted to deploy precision medicine. We got on a whiteboard and we literally designed the precision medicine program with a, with a genomics lab and with another quantitative.

Analysis organization that I learned about from the Health Management Academy. We put all this together and we, we deployed it. We, we hired an IT nurse with some oncology experience and, and we also, uh, they also brought in more, more oncology and precision medicine leadership to operate it. The medical director and I, we have, we literally did a lot of the architect work on a, on a whiteboard.

That's because I was just interviewing him and asking him what kinds of, uh, um, you know, visions does he have that he'd like to see in the future. You know, another example is, um, you know, our, our brain tumor program and, uh, and understanding why are they losing all of these patients. They were only like a, a 30%.

Consult to surgery ratio after we, uh, after we deployed virtual reality and showed patients exactly what, what the, uh, surgeon is gonna do inside their brain with, uh, with, you know, with, with, with virtual reality goggles on, you know, it doubled their consult to surgery. Uh, ratios and, uh, I think it, it, it tripled their, uh, their revenue for that, for that unit.

So that's the kind of things that, that rounding can deliver Bill. And it's just, it's amazing to, to drive that type of program development by building that bandwidth through the, uh, the playbook. Yep. And actually that's a great vr uh, people are asking me about VR and how VR is gonna be used within healthcare.

That's a great story. We'll come back to that, uh, at another time. So, uh, we are, we're at the end of the show. How we, how we typically close is, uh, just a social media close, to be honest with you. I forgot a social media close last week, so if you don't have one, I understand. No, I, I don't have one, but I, but I did wanna ask you, what is the best way for people to follow you, bill?

Because, uh, uh, you know, the, the, the point is, is that you have all this rich information that we all need and, uh, we wanna, we wanna follow you and share that information with our teams. Wow. That, that's a great question. Let me do my social media close and we'll come back to that. So, my social media close real quick.

Is, is just, just, I, you know, I feel like an old man 'cause I. Find this stuff and my, my kids are like, oh, that's so old. And it is old. It's from 2012, but I just found it on social media. You know how that works. It just sort of popped up and, uh, the, uh, old Spice, uh, marketing team wrote, uh, why is it that fire sauce isn't made from real fire?

Seems like false advertising, uh, which fire sauce is from Taco Bell? Taco Bell responded to Old Spice and said, is your, uh, the marketing teams. Old spices, your deodorant made from really old spices. And, uh, I, I love it when marketing teams go back and forth. You have some of the most creative people within the organization, uh, dueling with words and pictures.

It's, it's a lot of fun. Uh, you know, so getting, getting to your, uh, getting to your question, uh, you know, we, we now have that YouTube channel, that YouTube channel has 180 videos. Questions like, uh, Dr. Anthony Chang talking about, um, artificial intelligence, and I'll ask him a question three to five minutes, uh, responses on various things like how AI is gonna be applied to, uh, uh, To, um, pediatrics and, and, and those kinds of things we've talked about, uh, cloud, we've talked about machine learning, we've talked about, uh, the c I o playbook.

I mean, that's how this, this episode will be cut down into multiple videos where we'll talk about the C I O playbooks so people can.

I, uh, you know, Patrick, it's one of the things you know as well as I do very challenging for a c i to keep their staff current. And, uh, you know, that's, that's the genesis for the show was to help CIOs to keep their staff current. So I'm just gonna keep interviewing great people like yourself, uh, creating content, putting it out there, and then, uh, hopefully people can, uh, can utilize it to, uh, keep their staff current.

So, hey, I want to thank you again for coming on the show. Um, is there, is there a way for people to follow you? Uh, yeah, LinkedIn and I, I, I publish things, uh, often in, in LinkedIn, and I think that that's, that's the best way. I have a Twitter account, but I don't seem to find my way to Twitter as often as I would like.

That's what I'm finding in healthcare. There's only a certain, a certain subgroup tends to use Twitter a lot, but LinkedIn tends to be the, uh, the place we all sort of connect. So, um, if you guys would, so here's some of the ways to follow me. You can follow me on Twitter at the patient cio, follow the show on Twitter at this week in h i t.

Uh, website is this week in health Uh, the videos, uh, a shortcut to the videos is this week in health That'll take you to the YouTube channel. You can describe on iTunes or Google Play. And, uh, don't forget to come back every Friday for more news information and commentary from industry influencers.

Uh, thank you very much. That's all for now.


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