This Week Health

Daniel Barchi, CIO for NY Presbyterian shares stories of where speed can be safer than moving too slow in Health IT. I couldn't agree more.

Transcript

Today in health, it speed can be your friend in healthcare and health. It, my name is bill Russell. I'm a former CIO for a 16 hospital system. And creator of this week health instead of channels, dedicated to keeping health, it staff current and engaged. We want to thank our show sponsors who are investing in developing the next generation of health leaders.

Gordian dynamics, Quill health tau site nuance, Canon medical, and current health. Check them out at this week. Health. Dot com slash today. Alright, this is an article written by Daniel Barchie C I O for New York Presbyterian. It was written on, , October 4th on LinkedIn. Be bold. There can be safety in speed.

I'm going to share this story because it resonated with me. Very much. And then I have a story to share on my own. , company as well. And then we will come back to what, what is the, so what of this. So, this is what Daniel has to share. Be bold. There can be safety and speed and moving rapidly can increase control.

We are accustomed to believe. Going slowly is a cautious approach. And by taking time to evaluate. And weigh options. We reduce risks. I do not think so. In my career, I've found that a willingness to take risks to jump into the unknown, to accept responsibility without asking too many questions. And to move rapidly, dramatically.

Augments the achievement of I learned this lesson first when he was 23 years old as a Naval officer at the house of 600 foot long us Navy guided missile cruiser. I was one of the three officers on a 24 hour watch rotation. And he talks about how, when he was in that watch rotation, he had had the binoculars out and he had to look around and identify ships that were, , in every direction. Right. And so they would have to speed up. They'd have to slow down. They'd have to go to port, they'd have to go to starboard depending on all the other ships that were around

He says

all day long, even during gunnery exercises, helicopter, operations, and underway rendezvous with supply ships, I needed to maintain awareness of all the other ships and hazards on the horizon and constantly adjust for course, and speed. So he goes on my understanding of risk changed for me one night in the Mediterranean sea, we were in the port of.

Toronto T a R a N T O near the heel of the Italian boot. When we received urgent orders to make high speed run, access the Mediterranean and through the Suez canal and take up a missile launching station. In the red sea. We made quick preparations cast off the lines, holding us fast to the pier. And then carefully navigated through the channel and anchored ships.

As soon as we were clear the Harbor and safe out to see the captain had me bring the ship. Maximum speed. As the navigator plot of the course for Egypt, all engines ahead, full flank. I ordered over the noise of the crowded bridge. We all steadied ourselves and held tight. As the 10,000 ton ship, as long as two football fields began pounding through the sea.

At more than 35 miles per hour. At normal speeds. I would have worried about the many shifts within sight of us on the open sea.

What I quickly realized was that. At this incredible speed. I no longer have to worry about the ships on our port or starboard sides or behind us. In fact, unless the other ships were directly in front of us or within a few degrees. , of our bow, we were moving so fast. That they all pass quickly and harmlessly behind us.

Clearly our increased speed markedly improved the performance of the ship as anyone who has driven on highway knows. Only one has to turn the wheel of a car slightly to change lanes. So, so two at flank, three, a mirror, one degree of Rutter rapidly changed the direction of the ship. And those moments cutting through the open. See, I learned there is safety in speed. All right. He then equates us to it projects 20 years after this experience on the Mediterranean

EMR. Our three hospitals and:

And billing system, there was no model for the process to standardize. On a single platform to implement the system on time and on budget called for bold leadership and rapid decision-making. To facilitate a 36 month goal for completion of the project we hired. And trained our project team of 150 within three months.

We set a schedule for the entire length of the project and we never moved any of the go live dates. While it's easy to make bold common decisions within the project and project team holding each of the hospitals and physician practices accountable for shared decisions was much tougher. Academic medicine is known for patient decision-making.

Eh, to achieve consensus, even if it means an initiative slows or even stops. Technology was not the limiting factor in this case, organizational process and culture where. , he goes on to talk a little bit more about that project. , and it's interesting as we talk about it projects. And if you want to read the story, just go out on LinkedIn search for Daniel Barchie. , he has written a couple articles out there and all of them are worth reading. Daniel

A lot of great things to say I was, I was reading this today after we had a similar process. As you know, we've grown it this week health, we are up to 10 staff members. And we hired our first, , it person who I think is doing a great job and really like, but doesn't come from that same environment is more of a cautious person, wants to make sure that everything is, you know, all the I's are dotted and T's are crossed.

And we had a meeting, we had a one-on-one today and we were sort of talking through some of the projects and priorities, and I noticed that a bunch of things were starting to back

And, , so we took one of the items, which was, we had an old domain name. And we were on, , all the Google. , Applications on that domain. And then about a year and a half ago, we switched over to a new domain name. We went from this week in health it to this week health. And, , we needed to do that migration and she did a phenomenal job. She moved all the files from Google drive over to the new Google drive and, , took care of DNS, a whole bunch of other things that she needed to

And I noticed that the end date on the project today was about six months And we started talking about that and she goes, I want to make sure that everything is done right. And we just happen to have a staff meeting following that. And so I got on the phone with the staff. And said, I want to know if we turned off the old domain today. I want to know what the objections are

And we had two objections. One was, as we went through it, it was a minor thing and did not need, really need to be taken into consideration. But then we had something that was a major thing. But it was something that we could take care of in about 15 to And we did. We took care of that 15 to 20 minutes.

And we then shut off. Well, we temporarily turned off the domain and we're going to turn it off for a week. And see what happens and then we're going to shut it off permanently after a week. So we're taking a project that was going to linger for about six months. And we're shutting it down within seven

, and I was reminded of how many times that happened in my it organization as well. Where things were just sort of meandering and, you know, as a CIO, you can't possibly be involved in all the projects at a deep level. And so, so some of which you're at a cursory level, some of what you are at a deep level,

And what you find is a lot of times people will create work. They will create busy-ness and there's a sense in which I am busy. Therefore I am valuable. And one of our core values at this week, health is. , affective, not busy. And I brought that along with me. When I left being a CIO at St. Because I found that people equate their value to busy-ness instead of equating their value to what they deliver for the organization.

Which is the effectiveness of the overall organization. And a lot of times we have to step back and we have to educate people on. The fact that we work for a health system. We should be driven by the objectives of the health system. We should be driven by the metrics of the health system. You know, quality metrics and, , efficiency of the clinical staff.

And we have to do that over and over again because otherwise one of the things that happens is it becomes its own little pool that sits over And they're busy and they supply things and they somehow get augured into the ground just with busy-ness and not affectiveness. , so what's my S my, so what on this.

Give you another story to sort of accentuate the, so what, which is when we were doing our application rationalization We inventoried all the projects and we could not find owners. For, , quite a number of the applications. Like no one wanted to own them. No one knew about them, those kinds of things. And we made the decision to shut them off for a day.

See if we got a phone call to anyone to, the help desk. First of all, so we were monitoring those. And , to other places. I think we turned off, like at least about 25 applications. We got a phone call on one of them. I turned it back on and in the other 19.

Essentially, we never turned back on again. And I think what we will find is we are, sometimes we have so much debt and clutter in it. That, , we think it's all important. We think we need to back up that server and backup that application and keep those things going. When in reality, it's just clutter. It's noise and it's a problem, but we could have taken.

You know, three months to try to figure out those applications, but shutting off for 24 hours. , gave us a great indication of are those applications being used? Now we didn't delete those applications, throw away the data and that kind of stuff. We archived them effectively. Because we knew that for any number of reasons, we'd have to have access to

But those applications were shut off and they stopped using power in the data center. They stopped using space in the data center. And they stopped using time of the staff. And that's probably one of the biggest When the ship that Daniel was talking about was moving fast. We just experienced this through the pandemic. When you have focus. The organization moves quickly. It gets the things Because of that singular focus on the outcome that is right in front of them. Now what's happened. Post pandemic is we've scattered.

Once again. , there are so many things to focus on. Obviously we have the economic situation that's going on around us. We have physician burnout. , we have labor costs going up. We have price transparency. We have a health equity. We have, , the end of the COVID money we have, , I mean, just so many things, alternatives to primary care.

, in other words, new entrances to the market. , there's just so many of those priorities have popped up again. That it's hard to know. What is the most important thing that we should be focusing I, if I'm talking to anyone on a leadership team, it's so important to gain focus. It's not that we shouldn't be working on all those things. And we're going to talk about health equity. We're going to talk about a lot of

, initiatives in the coming weeks. , but at the end of the day, Th the team and the staff, if they're working on a hundred things, they are not going to be able to make that progress. So one of the, , Most important things that a leadership team and a leader can do is provide the focus that is necessary for the organization to move.

At that speed. , the second thing that I would say is it's important to be bold. To say to shut off applications. First of all, I didn't do that in a vacuum. We talked to some people before we shut off those applications. , but, , At the end of the day, that was a bold decision.

To shut those off here. You're going to get you potentially going to get some angry phone calls. , I can't believe you didn't know. I can't believe, you know, all those things. , are going to happen and sometimes you have to be able to make those bold decisions. Sometimes you have to say. You know what we are going to do this project, and we learn this during the pandemic. Again, we're going to send everyone home and we're going to do this new work model and you know what, we're going to do it within two

And we did it. And I think there's so many projects that when you go into healthcare and you look at the timeline, so you just want to scratch your head All right now do this. And a third of the time. Because we can with focus. We can do it in a third of the time. And so if we are going to, , find safety and speed, if we were going to move at that speed.

, we need to, , provide the focus for the organization. And then the other thing is, as leaders, we need to be And that's all I have for today. So if you know someone that might benefit from our channel, please forward them a note. They can subscribe on our website this week. health.com. Or wherever you listen to podcasts, apple, Google, overcast, Spotify, Stitcher.

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