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.
Bill Russell: 00:09 Welcome to this week in health it where we discussed the news information and emerging thought leaders from across the healthcare industry. This is episode number 25. It's Friday, June 29th. Today we looked at the CIO playbook. The aha's response to cms. Cms's 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 the knot of applications? We've been in your shoes. We've been moving health systems to the cloud since 2010. Find out how to leverage the cloud to new levels of efficiency and productivity. Visit health lyrics.com to schedule your free consult. My name is bill russell, recovering healthcare cio, writer and consultant with the previously mentioned health lyrics. Before I get to our guest and update on our listener drive, we've exceeded 200 combined new subscribers between our youtube channel and a 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.
Bill Russell: 01:11 I've hired their graduates and their stories are really inspiring, really good stories of second chances. We hAve seven more weeks in which our sponsor has agreed to give a thousand dollars for every additional hundred subscribers, a two wins for the price of one. You get to listen to great content and support the community while you do it. So join us by subscribing today. Tell your friends, uh, we actually post a new video to our youtube channel every single day. Um, and uh, I, I, I've been told that 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, a veteran, I guess we'll call him a veteran healthcare cio. He's been around the block a and a good friend, Patrick Anderson as the cio of hoag hospital out of newport beach, California. Patrick, welcome to the show.
Patrick Anderso: 02:06 Hi, welcome. Great to see a bill. So it's always good to talk with you.
Bill Russell: 02:10 Yeah, I mean we, we actually got to work pretty closely together for a little while there because uh, we, our two health systems formed an affiliation and, and uh, so I got to see you got to see you in action and I was there when you guys started the conversations about moving hoag to epic. So we'll hear a little bit more about that later. But for, for our listeners, tell us, uh, tell us a little bit about hoag hospital. I guess first of all, it's not really just hoag hospital, it's much bigger than that, but give us a little idea of what hoags about.
Patrick Anderso: 02:42 Sure. Hoag is a top 50 hospital. We really want to be a health destination, top 50 means your in the top one percent in the country for quality and safety. So we, uh, we really try to drive advanced medicine. We have a campus in irvine, a campus in New Port and then we have health centers all around our geography that provides primary care and other specialty with imaging and so forth. It's an exciting time to be in hoag because we, we continue to grow our, our goal is to allow people in orange county, California, the coastal communities and inland, to not have to leave this area for advanced health. You don't have to go to los angeles. We have several institutes that are, um, just um, uh, with, with advanced medicine, ortho, women's, neuro cancer, and we really try to drive the advanced medicine with our amazing board of directors. Our community is very hands on with Hoag the philanthropy community really helps us drive this advanced medicine. So it's really the, the destination that we're after.
Bill Russell: 03:56 Yeah. And I would say that, um, our, our family utilizes the, uh, the clinic over here and um, you know, just great doctors, great service, uh, you know, a couple things to call out in terms of a destination hoi, the hoag orthopedic institute, uh, throughout orange county is the destination to go a knee, hips, and at any orthopedic needs. The other thing I found 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 can deliver while overlooking the ocean. You guys have just one of the premier locations in terms of, uh, just views of a newport beach and the ocean. It's, it really is something else.
Patrick Anderso: 04:52 Yeah, it's amazing. We have a very active of ob operation at hoag. Absolutely.
Bill Russell: 04:59 Yeah. So, uh, one of the things we like to do with our guests before we get started is to ask them, what's one thing you're excited about that you're working on today? So it can be anything.
Patrick Anderso: 05:09 Sure, sure. Bill I think it's our accomplishments is What really excites me at hoag. You know, last year we launched the project to move to epic. We went live 60 days ago and then it's just been, it's just been a marvelous, marvelous transition for the clinicians and it's just been an amazing work. We partnered with providence health care out of seattle are our affiliates and it's just been, it's just been tremendous bringing all of these advanced advanced, capabilities on a very stable, stable ehr has just been phenomenal. They've deployed it in 50 hospitals, so it's, it's proven and we've, we've just had a lot of great synergy with them.
Bill Russell: 05:54 Yeah, I, uh, actually rod hochman, uh, president ceo will be on the show in I think two weeks. So looking forWard to a conversation with him that's just shout out for that now you guys, you guys sort of got stuck. I mean, you were, you were on a pretty antiquated ehr and were really struggling to make that move and then you came in there and uh, really set that up and have the conversation. I mean, was it a pretty easy conversation to make the transition? I mean, where the doctor's ready. Was the health system ready and you just sort of laid it out and everyone said, yeah, it's time.
Patrick Anderso: 06:27 Or was it art? It was a little different. When I arrived at home, I found a couple of dozen departments still on paper. Right. And that was very challenging, so obviously I looked at what is going to be the scope and cost to bring them onto the, onto the ehr and to be compliant. And when I looked at the price and I looked at the time it would take to do that with the, with the legacy systems. I thought, you know, this, this just doesn't make sense. I have a lot of experience with epic, community connect ed and different licensing and affiliation, uh, 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 turned out pretty well because, you know, we've gone through the concept all the way through the delivery and now we're reaping the benefits. Everybody is, everybody is online now. We don't have any more departments on paper and we've met that objective.
Bill Russell: 07:30 Yeah. And I'm sure, I'm sure it was flawless. No pro having done emr implementations myself, you know, you just, those 60 days, we're probably a couple of sleepless, sleepless nights I would imagine. Um, you know, which gets us to a, gets us to the show. So, uh, you know, show is three things in the new sound bites 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 ehr install going live by 2020. So this is your story. So go ahead and set it up for us.
Patrick Anderso: 08:03 Sure. It's a 10 year project, about 15, $16,000,000,000 and I think Washington is really concerned about that spend, you know, uh, the house of representatives have been challenging the va on, on the oversight and the governance. I think one of the, one of the big challenges with the VA, what the representatives are saying is there's been such a turnover at the top with the veterans administration. How are they going to manage this through right now? They don't have, they don't have a secretary of va, they don't have an under secretary for health. They've been trying to recruit a cio for, gosh, I don't know how long. And you know, that in itself is going to be challenging. You know what the pay is for the va cio.
Bill Russell: 08:52 No, I'm, I'm curious though, it's about
Patrick Anderso: 08:56 $225,000 in the Washington dc area or potentially the austin Texas area, but for a, for one of the largest health care delivery system in the world, and that is the pay and that's why they can't seem to recruit that recruit a cio. But the challenges is, you know, 10 years, $15 billion, uh, how, how has the oversight gonna occur? We all know an ehr declinement is not really an it project. It's an enterprise wide project that, that drives everything. It drives workflows, it drives financial modeling and decisions, population health. It's, 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 consistency of that leadership to see this through. What do you think?
Bill Russell: 09:56 All right, so let's, let's do this. Let's, uh, let's put us in their shoes. I've done this before with, I did this with Ed Marx. We talked about specifically, we talked about the va project, so from a little different angle, but I'm going to put you in charge. I'm going to make you cio making $210,000 a year. We're going to move you to dc. And by the way, that's, that's, that's really absurd. I having knowing what my salary is, knowing what yours is, and quite frankly, most of them are nonprofit so that it's, most, most of them are a matter of public record. you can 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, in the project that you're looking at here, they're going to have to use contractors significantly, uh, to, to, uh, to do this because the talent is not going to leave where they're at to do this project.
Bill Russell: 10:51 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 just not enough to take on that kind of scrutiny in that kind of thing. Sorry, I, for whatever reason, you're, you're at retirement and you're saying, hey, I'll take on the role for 210. Here we go. So, uh, let's start with the timeline. So you're going to do a pilot, you're going to do the Washington market, which I think is selected for a reason. It's probably their most advanced or their most cohesive. So you have a group, you have a group of ready hospitals that maybe have some good workflows. They're ready for an implementation may. They may even have an epic implementation. Who are, I'm sorry. It's cerner implementation already in place at one of their hospitals. So, uh, so they're ready to go. That's the pilot. Twenty 20 now you just did a pretty aggressive. Is 2020 enough tiMe? It's the middle of 2018 to do this pilot for let's say 15, 10 hospitals in the greater northwest area.
Patrick Anderso: 12:07 No, I think they're going to do three hospitals up in the Washington state area, they have to gain consensus on that clinical bill across the va system and it's really that, that build of order sets and workflows that will support the rest of the deployment across the country so they have to gain that consensus and that is what is time consuming, gaining that consensus on clinical Bill and then, um, and then pRoving it out in pilot sites and preparing that build for scale ability and distribution.
Bill Russell: 12:44 Yeah. And that's where I was going to take you. So you don't want to do regional builds, you really, especially in that clinical workflow and the, uh, the ontology in the terminology 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 going to build in the northwest and we'll figure out what we're gonna do and in the northeast, uh, you really do have to drive that consensus across the board. Um, I just know in our process that consensus took and now, all right, so before I go there, one thing to point out is there is no billing within the va, so that was a significant challenge in building out the ehr because it's, you just have so many financial and a 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 they going to be able to do that? Uh, that consensus build by by 20 slash 20? I would, I would say my gut tells me that's going to take a year in and of itself to drive that clinical consensus.
Patrick Anderso: 13:53 Absolutely. And then it's going to take longer than a year to do that build. Once you gain that consensus. So if they can, 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 for home monitoring, you know, care management and with, with home monitoring care management is needs to be integrated so they have a tremendous build and doing that in two years looks very, very tight for those pilots sites in Washington state.
Bill Russell: 14:34 What are the other thing I would say is, you know, the representatives pressed them on the staggering costs of the project. uh, my gut feel on this is um, I mean it's, So here's our response to the congressman. My gut feel would be to look at the congressmen and say, I'm not sure it's enough money given the number of people we have to bring together the consensus. We have to drive the number of bills we have to do the number of contractors. We're going to have to do a $16 billion. A 16 hospitals was roughly a billion for what I was looking at to go to epic. A $16 billion for the va doesn't, doesn't strike me as a not. I mean, it might Be enough, but it strikes me as either the right number or not enough. How about you?
Patrick Anderso: 15:16 Well, you know, obviously 16 hospitals, this is a billion dollar deal and maybe cerner cut them a really good deal because they already have the dod, but then 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 going to get higher and demand is going to get higher and the technology is being changed during that 10 year period. So there's gonna be change orders and adoption of new technologies and adoption of new regulatory interoperability and so forth. So with all of that being said, it's really tough to forecast 10 years, don't you think?
Bill Russell: 16:02 Yeah, I agree with that. Let me ask you this. I think this might be a softball for you, but, uh, we put you, as the cio, we put you in charge what are the most important roles you're going to need to fill a in order to ensure success for that ehr implementation at the va.
Patrick Anderso: 16:20 Well, obviously gaining, uh, gaining councils and governments buy in. And then also that consistency of leadership. Again, there's no consistency of leadership across the va and I know that they want the, uh, the gao to get quarterly governance reports and somebody is going to have to go up on the hill on a recurring basis to show how well that that spend is going and is it staying on track. So, so for me, I would, I would focus on the governance, finding out who those key stakeholders are across the organization, maybe get some regional leadership from the va to find some way to, uh, to expedite the, uh, the adoption of workflows and technologies. I think it's all around the leadership and governances and right now it looks scary because they just don't have it.
Bill Russell: 17:15 Yeah. And 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 across the board. I think they need to be looking at alternative models. So maybe a digital officer as well as a part of it. Uh, and you're right, that consensus building a 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 formed consensus. And so it's, these are special people. Whoever's going to run this project, uh, these are special people. I mean, there's enough stories about failed ehr implementations, uh, to, to fill multiple books.
Patrick Anderso: 18:00 They're late out of the gate, if they have a commitment to, uh, to the house of representatives to deliver, to deliver those pilot hospitals in 20, 20, they're going to have to shortcut the governance and we all know when you shortcut the governance, you out, you pay for it later, right?
Bill Russell: 18:19 Uh, yes. Um, so anyway, I, I will give everyone patrick's phone number at the end of the show so that they can call him and make their, uh, their offers for him to be the cio for the va should be fun. All right, so let's kick off to my story is the aha strongly opposes interoperability as a medicare requirement. A pick this up from fiercehealthcare, Aha has come out against the policy, floated by the center by cms to make interoperability requirements to bill medicare, medicaid. Uh, in a proposal, a hospital payment rule issued in april cms included a request for information regarding the revision of hospital conditions of participation, a cop, uh, and medicare conditions of coverage cfc a and would require hospitals to share data electronically with other hospitals, community providers and patients if possible. And, uh, it goes on to say some other things.
Bill Russell: 19:16 Um, Aha 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 in communities. Um, the group argue that it's premature to consider building interoperability into cops and medicaid cfcs until the barriers of data sharing had been fully addressed, noting that post acute care providers in particular are often behind the curve with ehr implementation. Uh, Aha also argued that compliance would be difficult for surveyors to measure and providers can deliver care safely without a interoperability. A, instead the aha urges cms to focus its attention on resolving problems created by the lack of fully implemented exchange framework, adoption of common standards, incentives for ehr and other it vendors to adhere to standards. AHa said, pointing to the, a to Tefca, um, by the onc for health it earlier this year.
Bill Russell: 20:23 um, so, you know, this is one of those things that I, I've been very passionate about. I've had people in the show to talk about interoperability. Um, you know, I, I think the aha is just wrong here. Um, I'll let you rebut me or, or whatever on this, but I think they're just wrong here because, uh, you know, I, it's interoperability is, we all agree. Interoperability is critical in terms of getting the data to the point of care so that the clinicians have the greatest amount of data at the, at the point of care interoperability. is the only way to ensure that the only way to ensure interoperability is to start to incent it, not incent it, like, like meaningful use has, but to start to really incent it and say, look, if you're not going to share your data, you can't take medicare patients. well, that gets everyone's attention and I understand why the Aha is coming out against it because there's, there are some health systems that their data sharing capabilities are lacking in their ehr.
Bill Russell: 21:29 Implementations are lacking, but at the end of the day, at this point, if you're on epic, you already have a extremely robust mechanism for sharing data center. Same thing. Actually, all the major ehr have a robust way of sharing data Tefca may not be the best mechanism. Fire is, is moving forward, but we still have a, you know, we still have a ton of ways to share data. It's not perfect yet. Today. We ended up in pdf hell with too many pdfs going back and forth or whatever. I mean xml really, but essentially just these, 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 just going to 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 aha is against this. Who are they protecting? Who are they? Who, who do you think they're, uh, uh, who do you think within the hospital community is against this?
Patrick Anderso: 22:43 I think the aha is supporting the issue that the hospitals have with those post acute providers. Bill, why would we want to hold the hospitals accountable to connect to post acute providers, home health agencies and other providers that, that do not want to follow meaningful use, when I was at Oschner in new orleans, we actually hosted for the entire state, the electronic mail boxes of everybody, the entire state. I pulled all the cios together from the entire state and 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 directory and at Oschner for the entire state so that we could all meet meaningful use transition of care, no electronic delivery because those post acute providers refused to comply with meaningful use. Putting that burden on the hospital is, I think the aha's position is then they don't like that because it's going to, it's going to impact the hospital's ability to comply and the cop, the condition of participation that has big teeth. Right? So I think that's the Aha's position we have to figure out how to get those smaller post acute providers, those rehab units, rehab hospitals, wherever they are, get them online so that it is the interoperability issue somehow. We have to break that.
Bill Russell: 24:19 Yeah. But we, we, when we saw this with bundled payments and the, uh, the programs were, which have actually been ratcheted back recently. But, um, in those models we were required to take responsibility for the, uh, 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 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 post acute care providers a aligned, um, you and I both know there's, there's just no money in home health. I mean it's, it's at least today and it's typically a pretty starved group of a, of organization. So how do you get them to share that data to move that data around?
Bill Russell: 25:20 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 post acute care facilities, but 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 them 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 mechanism for driving that change, it becomes very, 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, across that entire spectrum.
Patrick Anderso: 26:17 Sure. Incentives seem to help, I think better than penalties. So maybe if we could develop an incentive way for these post acute providers to get online, maybe there could be some potential there, but the 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 just the beginning to the end.
Bill Russell: 26:41 Cool. All right, well, um, yeah, we'll have to see how that one plays out. So let's get into the soundbite section, soundbite section. a of questions go back and forth. Typically one to three minute answers. Uh, we're going to do something a little different here. We're going to go. you have shared with me your cio playbook, so you've gone into new, gone into health systems on several occasions, inherited it shops, and you have some principles here that you go by. So I'm going to share some of that as we go through and just ask questions around it. So the first principle is you run it as a leadership team. That team runs it. Tell us about that. Tell us what that looks like.
Patrick Anderso: 27:23 Years ago, I couldn't keep up. My time was, was just, I was buried, I was working every day, every night, every weekend. And I thought, gosh, am I delegating enough? Do I have enough leadership resources in the organization to, 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 principal 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 too, 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 a rigor is, was really the key. And, and what, what was the real benefit of this is everybody's well informed. Everybody is accountable to uh, to meet their, their service levels and their dashboard deliverables and, and then it provides bandwidth, provides bandwidths for me and it provides bandwidth for the leadership team. So we have, uh, we have a regiment and a rigor that we go through.
Bill Russell: 28:47 Cool. So let's, let's go through this a little bit. So 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 formed that leadership team.
Patrick Anderso: 29:00 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 want to see that. So I start mentoring my subordinates to give and to continue to give and support because when you give you get you get it back. And so, so I look for highly collaborative people, but I bring in a multidisciplinary team, bring in hr and finance and we literally operate as a team. And as we, as we work, I want to make sure that we're cohesive and I, I'm highly sensitive. Matter of fact, I have a high level of awareness, so 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 and you literally have to. You have to mold these people and if they don't want to 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 the key leadership attributes.
Bill Russell: 30:29 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 create the shared accountability, but you're still the cio. So, uh, is there a sort of, uh, uh, 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, a, a decision to be made and the group can't come to consensus that you sort of step in and say, okay, this is what we're going to do.
Patrick Anderso: 31:04 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 am, let's say I have two direct reports that want to go into different directions 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 you have to have no ego in this work. So it's not about egos, it's really about objectivity and trying to find them the least path of resistance to move progress forward effectively. so the buck, the buck does stop.
Bill Russell: 31:50 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 a service delivery metrics, hr dashboard, financial performance contracts dashboard, which was interesting, a outages challenges of the week, uh, just a audit and compliance 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 effective?
Patrick Anderso: 32:34 Well, you know, I developed this from my lean learnings, you know, five, 10 years ago as I develop this over over the last 10 years. The real situation is it's accountability. If people know that they have to, they have to talk about their oldest tickets because oldest tickets drive executive escalations, so people know they have to talk about oldest tickets. They want to get their tickets out of their environment, completed quickly. They don't want age tickets because they'd have to talk to me. So when I looked at any dashboards, we have tuesday, thursday huddles and their scheduled, right? The first tuesday of the month is the hr dashboard. Where are we with, with hiring and recruiting and getting offers and, and delivering on the resources that we needed and, and backfilling with contractors as struggle in certain areas. So 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, so you have to focus on resources and you have to have your hr partner there. So as we look across all these various dashboards, I want accountability. I want accountability from hr. I want accountability from all the hiring managers. I want accountability from everybody. So every tuesday and thursday of week one, two, three, and four of every month, we have presentations by those various dashboard owner's walking us through the health of those operations. Accountability is the key.
Bill Russell: 34:14 I can't tell you the number of times sitting in the cio's 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 and this will show me the numbers. You should look at the numbers. You're like, really? The rest of the industry is this bad. And they just go, wow. 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 because we're gonna we're going to take action and uh, you know, taking action on concrete numbers. Metrics is always better than the stories. Um, give us an idea of how you handle competing priorities within your team. staff organization. So I get this question a lot from cios. You have competing priorities, you have limited resources. How do you, how do you determine which you know which one's going to get funded, which ones could get the resources, those kinds of things.
Patrick Anderso: 35:12 I think the key is, first of all, you build budgets based on a plan and you build that plan with the business. 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 going to have to partner with me to go find contingency dollars if they're not budgeted. So working with, with competing priorities is really more about competing resources and if you can, if you have, if you have a pool of resources and some, some professional services partners that you can trust to bring in A plus resources on, on, on 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, the demands are typically, uh, the 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 there, they take much more consideration and they're ad hoc demands.
Bill Russell: 36:33 That's really true. That's where a lot of the constraint comes on. It is a, 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 it decisions. So I'm 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? How do you reestablish trust and collaboration? Because it will break down from time to time. Uh, you know, there will be stress on the organization. You will have a massive project. You have something go wrong. Uh, so it breaks down. How do you, how do you reestablish it? How do you get it back to where it needs to be?
Patrick Anderso: 37:16 You know, they, they, they break down often. We have over a hundred projects in flight at any time. 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. Are there surprises, especially when you're doing pioneering type projects things break people also, uh, uh, sometimes they don't understand requirements and sometimes that may lead to some designs that are not appropriate for that, for the project. So things breakdown hardware breaks down software breaks because of, you know, volumes were unexpected or whatever it is. You have to be able to have a cohesive leadership team that that can draw upon the entire organization for help. That's why we do one of my principles is the monthly project review and 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 going to offer help.
Patrick Anderso: 38:33 And when you build that culture of collaboration you help each other when, when things are going left and right, you know, I get to the point bill where we borrowed 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 will share, leaders will 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 a big deal.
Bill Russell: 39:14 Yeah. In that budget, that budget mechanism you talked about is key. And when I came in to be the cio, 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 uninstalls cisco switches? And they said, well, you know, it's end of the 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 budget. It's one budget. We will meet as a group and we'll determine how we're going to 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?
Bill Russell: 39:57 This is critical. Uh, we need to, we need to move money in this direction and it wasn't like, hey, we're going to take money from you and take money from you. It was essentially a, you know, we had this, this, this budget to get a certain amount of things done, is it, and because we had a big picture of, of that really ended up working. and so that's, that's a great model. your fourth principle is to foster a great work environment. I love acTually what you, what you say here, so you have a great place to work committee, uh, and tell us a little bit about that. So it, 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 or. So tell us about it.
Patrick Anderso: 40:40 Well, you know, the results of our work is double digit increases in employee satisfaction a year over year. That's the goal. And we 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 into this committee. I meet with them once a month and there's no managers, directors, vice presidents. That's none of them are. It's me and an admin person and this great places to work committee. They become ombudsman. What I asked them to do, bill is I asked 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 they need this mechanism to work with these ombudsman and find out what are the issues.
Patrick Anderso: 41:45 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 struggling and maybe not hitting the baseline. And then let's take the ombudsman group or the great places to work committee. Let's go out and round and let's talk to 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, we've fixed up a pto policies in the organization, overtime policies. We 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 happy progressive workforce is an effective workforce.
Bill Russell: 43:02 Absolutely. And I think the wisdom in that is you give, uh, you give the staff a voice and the reality is they know what, what a good work environment looks like. They know what they want it to look like, a, they're already talking aboUt it, but what you're doing is giving them an outlet to actually create the environment that they want to work.
Patrick Anderso: 43:23 We had bad, bad, bad tasting water out of a faucet we got, we got that fixed. You know, it's whatever it takes, that's what It, that's what the goal Is.
Bill Russell: 43:32 Yup. So you create all this bandwidth and uh, so now, so gIve us an idea of how you're using that band. Was he talked about rounding with executive leaders and uh, digging into the mission and those kinds of things, uh, how has rounding with the executive leaders really changed your perspective as a, uh, as a cio?
Patrick Anderso: 43:52 You know, it's phenomenal. You understand different challenges, deeper challenges of business units, for example, or a example, the cancer center, you know, working with 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, um, with the genomics lab and with another quantitative analysis organization that I learned about from health management academy. We put all this together and we deployed it. We hired an it nurse with some oncology experience and we also, uh, we also brought in more, more oncology precision medicine leadership to operate it, but the medical director and I, we literally did a lot of the architect work on a whiteboard. That's because I was just interviewing him and asking him what kinds of, um, you know, visions does he have that he liked to see in the know. Another example is, um, you know, our, our brain tumor program and, and understanding why are they losing all of these patients. They only like a 30 percent consult to surgery ratio after we, uh, after we deployed virtual reality and show patients exactly what, what the surgeon is going to do inside their brain with, uh, with, you know, with, with, with virtual reality goggles on now. It doubled their conSult to surgery a ratios and I think it tripled their revenue for that year. 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, but the building that bandwidth through the playbook.
Bill Russell: 45:44 Yeah. And actually that's a great vr. People are asking me about vr and how pr is going to be used within healthcare. That's a great story. We'll come back to that at another time. So we are, we're at the end of the show, how we, how we typically closes just a social media close, to be honest with you. I forgot a social media close last week. So if you don't have what I understand,
Patrick Anderso: 46:06 I had one, but I didn't want to 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'd have all this rich information that we need and we want, we want to follow you and share that information with our team.
Bill Russell: 46:24 Wow, that's a great question. Let me do my social media close and we'll come back to that. So my social media clips real quick is just, just I, you know, I feel like an old man because I find this stuff. I'm like, 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's just sort of popped up. The old spice, a marketing team wrote a you, why is it that fire sauce isn't made from real fire? Seems like false advertising, which fire sauces from taco bell, taco bell responded to old spice and said, is your marketing teams old spices your deodorant made from really old spices? And I love it when marketing teams go back and forth. You have some of the most creative peopLe within the organization.
Bill Russell: 47:10 Dueling with words and pictures. It's a lot of fun. Uh, you know, so getting, getting to your, uh, getting to your question, um, you know, we now have that youtube channel that youtube channel has 180 videos. Questions like 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 Ais can be applied to, uh, to pediatrics and, and those kinds of things. we've talked about cloud, we've talked about machine learning, we've talked about a cio playbook. I mean, that's how this, this episode, we cut down into multiple videos where we'll talk about the cio playbooks so people can, uh, within it, organizations can pick it up. I, uh, you know, patrick, it's one of the things, you know as well as I do, it's very challenging for a cio to keep their staff current and uh, you know, that's, that's the genesis for this show was to help cio is to keep their staff current. So I'm just going to keep interviewing great people like yourself, uh, creating content, putting it out there and then, uh, hopefully people can utilize it to your staff current. So hey, I want to thank you again for coming on the show. Is there, is there a way for people to follow you
Patrick Anderso: 48:37 LinkedIn, I published things often in linkedin? 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.
Bill Russell: 48:48 Yeah, that's what I'm finding in healthcare. There's only a certain, a certain subgroups tends to use twitter a lot, but linkedin tends to be the place we all sort of connect. So if you guys wanted. So here's some of the ways. Follow me. You follow me on twitter @thepatientscio. Follow the show on twitter @thisweekandhit website is thisweekinhealthit.com. Uh, the videos, uh, a shortcut to the videos thisweekinhealthit.com/video that'll take you to the youtube channel. You can describe on itunes or google play. And dOn't forget to come back every friday for more news, information and commentary from industry influencers. Thank you very much. That's all for now.