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Today on This Week Health.

 One of the first things I tasked my old team when I got out to the care network sites and said, We have all these kiosks. They're not turned on. , what's going on? And so we've been working hard to say,

yes, maybe the kiosks were the thing eight, six years ago, but now we can do everything through a phone. You wanna make your team members their lives easier, not harder, and you don't want the clinician suffering in silence.

Welcome to 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 dedicated to keeping health IT staff and engaged. For five years we've been making podcasts that amplify great thinking to propel healthcare forward. We want to thank our show partners, MEDITECH and Transcarent, for investing in our mission to develop the next generation of health leaders now onto our show.

 Hello, I'm Sue Shade, Principal at Starbridge Advisors and one of the hosts of the Town Hall Show on the Community Channel Today my guest is Keisha Hortman Hawthorne. Keisha is SVP and Chief Operating Officer at Chop Care Network. I got to know Keisha a little bit when she was CIO at CHOP through the Children's Hospital Association CIO forum.

So I'm really looking forward to our conversation today, hearing about Keisha's work and her journey as she moved into the COO role earlier this year. So welcome Keisha.

Thank you, Sue. Excited to be here.

Great, great. This'll be good. Let's start by you introducing yourself, sharing a bit about your current work at chop, and maybe even a little bit about CHOP for people who may not know what it is.

And it's an acronym, so you're gonna have to explain that. .

So, Children's Hospital of Philadelphia, as we lovingly refer to as CHOP here in this local region and area. Has been providing pediatric care for 165 years. We are a quaternary level academic medical center. We are the pediatric department for the University of Pennsylvania, and we treat patients from all over the world as well as we take our care and our education to places.

All around the world such as Botswana, Dominican Republic, The list goes on and. I am currently in a position that I oversee our ambulatory network, which consists of 50 plus locations. So I have all of our primary care centers, urgent care centers, specialty care centers. I also have our behavioral health.

We're opening up a new behavioral health hospital, which I'll bring that back to. Light in some further conversations. And then also we have an affiliate network with other hospitals where we staff and take care of patients in their NICU as well as we have some inpatient medical units and hospitalists that staff eds at eight hospitals in this area.

So, like I said, 50 plus locations, we probably have about 1200 staff. And we'll have more when we open up that new behavioral health hospital.

Right. And you are busy, as you said when we were getting started here. Recording.

Yeah, I'm very busy. So,

record,

Yes.

You've been busy than being a cio.

Yes. So coming from the CIO role I think it's, some of it's the same stuff.

Some of it's new but it's definitely just as busy. I don't miss the information security piece at all. That's the thing that used to keep me up at night, but now I'm wondering do I have enough doctors to cover shifts or nurses? And we have a phenomenal team, so I've spent a lot of time in this first 12 months just traveling the network.

Mm-hmm. . Putting lots of mouths on the car I should have stock in Panera for as much lunch as we've brought people. But it's been great to go out and meet with clinicians and staff and hear from them what's going on toward our practice sites, see what the problems are, and also understand the positives and the wins.

Each of these sites have their own culture, and so how do we make sure that we bring that chop culture to those sites and that local culture bath to chop.

Yeah, that's great. So you're talking about the listening tour, which new leaders need to do in that, first period of time. That's great. Can you tell us a little bit about some of the specific challenges that children's hospitals like chopper facing these days?

So we all are facing workforce staffing shortages and not just. In terms of filling open positions, but as we look into the future, what's the opportunity to get specialists, subspecialists even nurses and clinicians post covid? I think people are reevaluating their work life balance and some people are reeva waiting their.

Careers and choosing to leave frontline caregiving. So for us, that's something that we're working on in a few different ways. We've also had to, you know, do some compensation changes and use staff and agency in other ways. But also we've done a marketplace where when we had folks that maybe their units were slow for covid, we rotated them out to other places that were still busy.

And we've seen some great wins from that in terms of picking up, you know, maybe a nurse who worked in inpatient unit for four or five years that now wants to work in primary care and hadn't had a chance to see that different setting. We also just have burnout, and so that has implications on our growth as well as just the post covid demand.

We did a really good. With tele visits and telehealth and I think those are still great opportunities that we'll talk about. But post covid, a lot of our patients wanna come in and have their children seen by our clinicians in our community. We also have pretty significant payer shift as more and more people may have been impacted by not having a job and having.

To public assistance. And so that, changes some of the financial models in terms of what we can reinvest back into our organization. And then specifically in this Philadelphia region, Sue and I think other cities and people will resonate with this, just some of the societal factors. We have high levels of poverty.

Areas that are, really struggling with violence, gun violence in particular. And then behavioral health is the number one thing I hear no matter if I'm here in the city, if I'm out in New Jersey, if I'm in, more rural areas behavioral health has really taken, its.

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 Thank you. Those, those sound like common challenges that um, not just children's hospitals are facing, but probably all hospitals are facing at this point. And certainly the last point you mentioned about societal factors and gun violence and behavioral health, I know is a particular concern in children's hospitals with You know what I saw when I was at Boston Children's Hospital as the interim CIO last year I heard a lot about what was happening in terms of ed visits for kids with mental health issues and you know, capacity issues as well for getting those kids in to see someone and get the care they need. On that note, in terms of the challenges, can you talk a little bit about how technology maybe helping address any of those challenges at this point?

Or could?

 Yeah, so it's been great to come in  as a, we were joking earlier, recovering cio, I still have a CIO hat. Some days and look at where the technology's working and where we have opportunities to make improvements. So one of the big places where focus is access. How do we get people in for appointments when they wanna come in?

How do we create opportunities that you didn't check in four times before you got there? Then you stood at the desk. So we're doing a lot of work and doing a pilot of a pre-visit tool that's all digital. It can work within our emr. Personal health record or it can work just via text. So that's something that we've been very successful with and we're hoping to implement in all of our outpatient centers this fiscal year.

We've also been working with another tool for provider scheduling and, room utilization. This is a bolt on to the electronic medical record, but this really helps give us a good assessment of, you know, when are the rooms being reserved? Do we have specialists coming from the main campus to fill up those rooms?

If not, is there another service? But also some details that link it down to the physician level so we can see how that physician is tracking in their patterns. So that's again, something we're looking to do in all settings of outpatient. Some fun things. We changed to clinical communications this year.

That was one of the hangover projects that I didn't get to finish, but got to celebrate with the team when we went live last summer. And that is connecting everything now using Epic, our e EMR platform to allow us to do alarm. Alerting calling on call schedule. It's all integrated in a cell phone.

That nurses and respiratory therapists and physicians, all kinds of folks carry around the house. And that helped us because with people with multiple devices, we were starting to get a tool belt in addition to their badge and their stethoscope of other things that they were We're taking those learnings and the improvements to workflow and bringing some of that out to our offices as well, especially our specialty care centers.

Two others are Epic. Secure Chat. You would think such a small thing. Would not have such an impact, but just bringing that to the network, that's the number one win I hear about anytime I make a site visit. Out is just the ability for folks to talk to each other and have a tool when sometimes you may be in the room, you and the patient, or you and the patient and the doctor and you need a little bit of help, or something gets delayed on the front end and you can give a heads up to say, Hey, we're delayed.

How do we shift this around? So that's been a good thing. And then what I'd love to see a continued resurgence is telehealth and tele visits. So our opportunities definitely still exist and the majority of our visits are happening for behavioral health, but we'd love to continue to see some of those during pandemic numbers when we were relying heavily on these systems.

Prove that they can work. We'd like to see people utilizing those systems more, and we're trying to build it into some of our workflows. For example, if you call our nurse triage and it's more appropriate for you to get a tele visit, how do we switch somebody to that visit right away versus putting them on hold or waiting to schedule an in person?

So those are just five different technologies I think, that are helping to.

There's five. That's great. .

I'm sure there's more too, but that's great. When I think about telehealth for pediatrics, , two factors. One, you've got young parents, young families who probably are more willing and looking for those Virtual options and open to it.

You also have young families that may have several kids, but Right. One kid needs the visit and you've gotta manage all that to get 'em in the car or somewhere else to be cared for while they get to a physical location. So, telehealth, virtual visits when they can work in the pediatric space just seem to be a huge benefit to.

Yeah, and we've had a pretty successful partnership with one of our districts that's outside of the city limits just right outside in the next county. And so the opportunity to do that and keep parents at work and see patients and families at the school, that would be great. Dallas Children's has a wonderful program that they've had for years, so that's something, we look at what other health systems are doing and try to say how do we fill that gap?

So that's one thing we'd love to explore and expand.

Great. That's great. And I know that the, network of CIOs in pediatric healthcare providers is strong and there's a lot of learning and sharing between them. That's great. Let's switch to you a little bit your journey as a CIO to the coo.

Seat is an interesting one. Many CIOs seem to take on operational areas over time and kind of broaden their role, but to actually move into the COO seat talk a little bit about that, your journey and advice you would give to CIOs who want a broader role in their organizations.

Yeah. So a couple of things that I would say is explore opportunities outside of your comfort zone.

I think that there are missed times when people say they don't wanna do something or they're not interested, that you may miss out on something that may turn into something else. So, that's the first thing I would share. As a cio, really keeping an enterprise mindset. It is so easy to chase bright shiny objects, the latest cool tech that's not gonna cut it long term.

And that's gonna be a failed strategy in the long run. Also partner and build relationships with clinical and operational leaders. If people don't take anything else away, you have to have those partnerships in order to make the leap to any role, but you really need it as a CIO to function well and to have effective projects and strategies happen.

Implement technology and supporting with supporting workflow changes. One of the first things I tasked my old team when I got out to the care network sites and said, We have all these kiosks. They're not turned on. , what's going on? And so we've been working hard to say, Hey, technology has changed.

Yes, maybe the kiosks were the thing eight, six years ago, but now we can do everything through a phone. So we're making that shift and saying, Let's get the kiosk out and let's do a digital based tool. And you wanna make your team members their lives easier, not harder, and you don't want the clinician suffering in silence.

And then pickup operational duties. Sue, I think as things come along I had health information management, which included medical records and coding some people, and we had biomedical engineering something that was a part of my assignment, but it could be as easy as things as, doing a shift as administrator on call.

Leading special projects early on in my tenure here at CHOP when we had the Ebola outbreak, I was the IT lead for that project and got to meet a lot administrators and then, you know, work your network internally, make it known that you're interested in other opportunities so that as those projects or those opportunities come along people can give you that.

chance

Great advice, excellent advice. I've often said in terms of reporting relationships, that if the CIO's not gonna report to the ceo, which many CIOs want to or insist on that reporting to the COO is probably the best placement. because the COO has that broad view and is dealing with all parts of the operation and CIOs Do as well. We talk to everything as CIOs, so, I can also see that that can be a good path for CIOs who wanna take that path to the COO seat so That's great. The last question I wanna ask you is you were recognized in 2019 by HIMSS as one of the most influential women in health it. So what advice do you have and Congrat.

Three years later. What advice do you have for next generation leaders?

Yeah. So I have a couple things that I always say, or if you read anything I write or consenting presentation these are the, nuggets that I share no matter where you're at with your career, but The first one is education is the key to success.

If you don't know something learn it. You can go back to school, you can go to a course, you can shadow. That learning can happen in different ways. So as I jumped into the technology space officially I'm not, and I'm not. Please do not folks run and get your PhD. I read that about my PhD in information science cuz that was always a goal that I had to complete that terminal degree.

But it was a great partnership because we have such great schools here. So just, it can be a conference, it could be different things, but just making sure you're focused on educating yourself. The other thing I tell people is study and work hard, but play harder. Work life balance is key. it's very important to your teams and to the folks that you're serving. We've all, I think, taken a step back and that's been a great silver lining in this covid crisis is we've had a chance to spend more time. forced Time with family and friends and, getting back to doing some of the things that we, I think have lost track of Mentor. You have to pay it forward. Someone mentored me, someone is gonna benefit from me mentoring them, then they'll mentor. And so that's something that was instilled in me early in my career by my first. boss Network, Network, Network. So Sue, you and I are definitely our connection is through our network , the pediatric CIOs.

We are a tight crew and we work well together and partner with CHA and Chime and just some other groups, and we still stay connected. People still ask me questions. I'm, working with our new CIO to say, Hey, you gotta know these. folks Plug in. So whatever that network is, whatever field you're in, make sure you're doing that.

And then the final thing is celebrate your wins and successes. Even if it's something small, a thank you card, a gift card, a pat on the back you can go home early. Tell your team and recognize people and celebrate yourself as well. But that really goes a long way in terms of the work that we are doing every.

day

Great. Great. Those are some great pieces of advice. Is there anything else that you wanna highlight about the work at chop, the work that you're doing at CHOP before we close Keisha?

So, I, CHOP has just been a, a great opportunity For me to be connected to an important mission. I think that's the reason most folks choose.

Mm-hmm. , healthcare. It also has an opportunity especially in this role, I think to leave a lasting legacy to make sure that with the services that we need and our community are there for all populations, no matter their socioeconomic status. And I just appreciate that Chops had a commitment and proven track record related to diversity because that's gonna continue to be something on the forefront as the US becomes more diverse.

And I'm just hopeful that we can continue to make a good marriage of technology. In the clinical settings to help, not only just with quality and patient safety, but also health disparities in inequities. So it's been my pleasure to talk with you, Sue today, and share just some of my highlights and some of my experience.

Well, the pleasure is mine and you're very inspiring as you talk about your work and, the mission of chop and what you're committed to. And yes I think we are mission driven in healthcare. That's why we're here. Very good. Thank you so much, Keisha, for talking with me today. Take care.

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