March 16, 2020: In this episode, listeners will hear the CIO of Asante, Dr. Lee Milligan, talk about what they have done (and are still doing) to prepare for the coronavirus COVID-19 pandemic in their IT division. For him, the swift manner in which their teams were able to set up a centralized testing location is a testament to what can be done in times of crisis and show the necessity of having clearly defined objectives. He talks about the point at which the leadership decided to prioritize the outbreak and reprioritize other tasks to determine the percentage of staffing that would be needed to continue providing their services. The problem with a pandemic like this is that, when institutions act too quickly, they run the risk of being perceived as alarmists. Conversely, when they delay acting they are criticized for not doing enough. Finding this balance, Dr. Milligan says, has been a significant challenge for them. Tuning in to this episode, listeners will hear what is currently happening in Asante's IT division each morning, how they go about communicating with the community and guide their IT leadership in keeping in touch with the realities people face, and advice for slow-acting health systems that need to make up for the lost time.
Key Points From This Episode:
COVID-19 Prep with Asante Health
Episode 201: Transcript - March 16, 2020
This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.
[00:00:04] BR: Welcome to This Week in Health It News where we look at the [inaudible 00:00:06] of the impact of health IT. My name is Bill Russell, healthcare, CIO, coach, and creator of This Week in Health IT, a set of podcast videos and collaboration events, dedicated to developing the next generation of health leaders.
This week, I’m doing a series of interviews with health system executives who have shared their plans around COVID-19 preparedness. I want to thank Sirius Computers or Sirius Healthcare who reached out to me last week and asked me if they could sponsor a series of these conversations to help the industry prepare, and I appreciate their commitment to the industry that they serve in sharing these best practices. Today’s conversation is with Dr. Lee Milligan, CIO of Asante Health in Oregon.
Good afternoon, Lee. Welcome back to the show.
[00:00:49] LM: Bill, thanks very much for having me.
[00:00:52] BR: I mean, this usually happens when you and I go on the line. We started the conversation and we were like 10 minutes into what I should've been recording. But we’ll back up a little bit, and I enjoy our conversations.
Look, the first question – Let’s get started. Let's sort of set the groundwork in general, not necessarily health IT but your health system. What are some of the things your health system is doing for your community to prepare for this pandemic?
[00:01:21] LM: One of the challenges we had was around personal protective equipment and masks, just like the rest of the country. As we got our heads around how do we possibly look at and test an appropriate number of people, we can't do that if we’re distributed throughout the entire organization. We’ve got 30 something clinics. If everybody is donning and doffing all of this PPE, then we’re going through a lot of it.
So we set up a centralized location for testing that’s essentially a drive-through location that’s adjacent to our contact center. There we have a draw station that we literally were able to stand up that draw station and telehealth associated with it in 24 hours. Actually, it was kind of a testament to what IT teams can do if we give them the gift of clarity about what matters. So they focused on that for 24 hours. The team pounded out everything from the billing to the workflow engine roles, to the telehealth that we had put in place previously to be stood up in that location. That's one aspect of it.
We also are setting up tents adjacent to our emergency department where we can do testing there as well if we need to, depending on the critical nature of the patient. Then internally, we’re doing a lot in terms of our workflows. We’re looking at our operating rooms and asking I think the right questions, which are, can these be converted to intensive care units. So stuff like that.
[00:02:52] BR: That’s interesting. I want to touch on the leadership aspect of that because a lot of health systems are going through this sort of is this going to be a big deal to, “Oh, this looks like it’s going to be a big deal.” But typically, there's some inflection point where somebody steps back and goes, “Hey! You know what? We need to prepare for this. It’s better to be prepared and hope for the best than to not be prepared and sort of get blindsided as you go along.”
How did you guys – As a leadership team, at what point did you sort of decide, “Hey! We’re all in. We’re going to slow other things down. We’re going to move the priorities,” and as you say, make it real clear to people what the priority is?
[00:03:36] LM: Yeah. I – We started 10 days ago now with daily standups that we did not have in place previously. I feel like we’re late, to be honest with you, although I'm so grateful that those pieces were put in place over the course of the last 10 days. I do feel like with something like this, like a pandemic when it's rolling forward and it's building steam, you kind of feel like any time before it becomes obvious, you're seen as an alarmist if you try to make preparation for it. Then after it's crested, no matter what you did, it wasn't enough, right?
[00:04:11] BR: Right.
[00:04:12] LM: We were trying to strike that balance, and so one of the things that we’re able to do was like connect with our CEO and make sure that we are on the same page and he understood kind of our perspective on it. So we got his backing on making these preparations and moving in this direction.
I was also able to engage with our chief strategy officer who directs our PMO. We were able to really hunker down and identify out of the 58 IT heavy projects that we currently have in execution, here are the eight or nine that matter the most to our organization. I actually anticipated that to be a really difficult thing to do. But if we think about putting the health of our community right at the forefront and then after that we asked the question, “Okay, what's the financial implications of holding on something,” because really nothing is actually being stopped altogether. It’s simply being put on hold for a period of time.
For us, we’re in the middle of starting to build a $500 million tower. As we get our arms around that, we recognize that slowing that piece down would be really bad, and therefore continuing on with that really has to be one of our top priorities. But it was a good conversation, and we’re actually able to pair it down significantly. From my perspective, I would say if we’re 90% staffed, we’re good. If we’re 20% staffed, maybe we’re not good. But it's pretty clear that our only goal is to focus on maintaining services of our core systems.
It’s really when we’re in-between. If we’re 70% or 75% staffed, what are the things we really should be working on?
[00:05:59] BR: Yeah. We talked about this a little bit last week on the huddles and the things that you’re doing, but I’d love for you to go through that structure real quick. I think a lot of people are used to lean huddles and those kinds of things, and this is a variation of that, but it’s really around preparedness. So give us an idea of what transpires every morning.
[00:06:21] LM: Within the ITS division here at Asante, we have four separate departments. Each one has their own division or a department leader. As we kind of decided how we’re going to put this thing together, we wanted to start at the very front and have everything kind of roll up nicely all the way to the end, so we can have information to make decisions with. So we started with our frontline staff having a standup at 8:00 AM for 30 minutes with their supervisor. There they talk about basic stuff like how many people are out, how many people are on ETO, how many people are – Maybe this is a – We have four-day work weeks, work days here, and so how many people are actually not available, because it’s not one of the days they’re actually on. We can identify how many folks are available to do the body of work that needs to be done. We start with that.
Next, we look at our individual areas that might be hot spots. For example, I have one director who has 50 people who report to him ultimately, and maybe he only has, let’s say, seven people out. But if all seven of them correspond to integration work or interface work, then that’s the problem. I want to be able to identify those hot spots as best as we can. Then lastly, we want to be able to focus on prioritization. We want those frontline staff to know, “Do this and specifically don’t do that.” They’re going to get that direction from their managers and from their directors. That lasts for 30 minutes. We give them half an hour to input this data into this spreadsheet that we have on SharePoint right now that rolls up.
Then at nine o’clock, these supervisors and managers meet for 30 minutes to have a similar conversation and, again, to kind of highlight what to prioritize. After that, from 9:30 to 10:00, the managers and directors meet, similar conversation. Then at 10 o’clock, the directors and I get together, and all of that information rolls at the very top. Then we can start focusing on what to do with that information in terms of resourcing or decisions that need to be made versus gathering that information in the first place.
This morning, for example, when we had ours, I can see we were 92% staffed, which is actually pretty normal when you consider ETO and FMLA and everything else that’s going on. We identified a couple of hot spots and we’re able to clarify our priorities for the group.
[00:08:46] BR: Yeah. Communication becomes so key in this. It’s – Give us an idea from a communication standpoint. There’s – I mean, you just really laid out really well how you communicated internally the priorities. But for the community, the community is looking for you guys as the trusted source for health in your community to answer a handful of questions for them. How are you getting that message out to the community?
[00:09:18] LM: Yeah, great question. We have a daily steering committee meeting for the enterprise that comes together to make decisions around 11 separate verticals associated with this. Then on a daily basis, that information is sent out to the majority of folks throughout the organization internally. In addition, a portion of that is then updated to our external facing website for folks who come to the Asante website. In addition, we are pushing out messaging through MyChart as well. We previously actually have some town halls scheduled. But due to the concern of folks getting together in the same proximity, we had to cancel those town halls.
[00:10:04] BR: Have you –
[00:10:04] LM: I will say that – Go on, please.
[00:10:07] BR: No. Please, go ahead.
[00:10:09] LM: I will say that one of the most important elements I think during a time like this is that your frontline staff, supervisors, managers, everybody throughout your division understand your perspective on this because they do look to you for guidance on this. I’ve put out a twice-a-week fairly extensive email to my entire staff [inaudible 00:10:34] kind of detailing where we are from a community perspective, what the projections are, and then what the pieces are we’re putting in place internally to help address this. I’ve gotten pretty good feedback on it so far and I want to continue to do that.
In addition, we set up a SharePoint site that is – Actually, two of them. One that is for all of ITS staff, so I can gain some perspective on different elements we put in there. As well as our daily standup roles up to a SharePoint site as well for ITS leadership, so we can have kind of detailed notes about some of the things we’re dealing with.
Then lastly, I would say for all of the work that’s coming into ITS not just for ourselves to try to be able to work from home but also from the organization who are asking for ITS products and services to support their needs associated with COVID. We have a [inaudible 00:11:31] built in service now to help us track what’s been asked, what’s in execution, and what’s been completed.
[00:11:40] BR: The thing I appreciate about you former ER doc and your ability to triage. I just gave you a shout out on the Tuesday show, which I’ll actually air tomorrow. We were talking about work from home, and you said, “It’s really easy, Bill.” I sat down and I told people I want people in three buckets; people who can work from home today without any adjustment, people who can work from home but they need X and I want to know what X is, and then people who will never work from home.
It’s those kind of things. This is that kind of environment. It’s that kind of triage quickly, figure out what you need, figure out what you have. I mean, that becomes one of the key roles of the directors and the leadership within IT. How are you coaching your leadership team, the IT leadership team in terms of making sure that they are really focused in on the things they need to really I would say connected to the concerns of the people that they’re dealing with? Because even though they’re in healthcare and even though they’re in IT, they’re still susceptible to all the same things. We still have family we’re worried about. We still have parents we’re trying to care for. We have lives outside of work, if you will, that we have to deal with. So how are you making them – How are you coaching them I guess is the best way of saying it to be in tune with that?
[00:13:13] LM: Yeah. I think that is the question for ITS leadership, Bill. I think you hit the nail in the head. These are human beings attesting to navigate these unchartered waters with folks who are looking to them for direction as well. I would say, number one, it’s really important to be clear with your directors that this is not business as usual, and you will not be held to the same standard of completing some random request as you might have been two months ago. So you’re no longer required to build that smart text for Dr. Jones who needs this out in the one clinic by the coast. All that stuff is off your plate, and we’ve clarified really what matters for the moment. I am not going to be disappointed in you for not doing [inaudible 00:14:02]. In fact, I’m asking you specifically to not do it. Just having an honest conversation with them about that I think is important.
I also think it’s important to just talk about leadership during this time, because people are looking to them for leadership as well. I’ve – For my kind of real simple ER background, I put it into a couple of basic buckets. The first is I think your staff and your leaders need to truly recognize that this is a real deal. This is a legitimate emergency that has been declared in our state and in our country right now and the folks who look to them need to know that they get it, because I'll tell you, if your leader doesn't quite get it, you tend to not trust anything else that comes out of their mouth. So I wanted that folks just level sets that this is a big deal. We shouldn’t be panicking. Panicking only makes it worse, but it is a legitimate deal. So let’s start with that.
Second, we have to put in place a reasonable plan that is thought through, includes the right people at the table, and is executable. Once we have that plan in place, we need to communicate it over and over and over until I start getting sick of it. That's when folks I think are fully on board with it. Then lastly, I do think it's important that we communicate and have confidence in that plan and confidence in the people who will be executing that plan, and they need to hear it. One of the ways you can do that during conversations is to reference prior difficult challenges and scenarios that your staff has gone through, your leaders have gone through, and call out where they really brought it.
I know folks who I’ve interacted with and myself included, sometimes I look to that in my own history to think how the hell am I going to get through this scenario. Looking back at prior difficult times and where things have gone well really helps I think I shore that up.
[00:16:07] BR: Yeah, absolutely. Hey, last questions, because I know we went over and I appreciate – I know how busy things are. I really appreciate the time. One thing you would tell a health system that might be a little late to the game in their early stages of preparation? What should they be focused in on?
[00:16:22] LM: The two main things that they can do right now is sit down with whoever does their overarching prioritization and have them create a list of I’ll say top 10 things even that they care about if you are 50% staffed. I will put in that simple of terms for them. The way I didn't have to phrase it but I was prepared to phrase it was either I can do it or you can do it. But somebody’s got to do it because my staff is not going to do everything. So I’d start with that.
Then the second thing is I can't say enough about how helpful daily standups have been. The level of communication, the ability to get on in front of issues before they are real issues has been huge. So if you can set up a framework that cascades up from frontline staff and supervisors, all the way up to the CIO that allows for great conversations about what that information is and not trying to gather the information, then I think you will go a long way.
[00:17:23] BR: Yeah, you know it. Actually, at some future time when things calm down again and they will calm down again, I want to come back on and ask if you’re still doing daily standups and if you're able to keep people focused and that they don't have to do that little off project, because that is the – When you said that, I sort of smiled because I’m like, “Gosh, we do that every day a thousand times. In health IT, we get we get stuck doing these little tasks all over the place, and these kinds of events give us a picture of what it is like to be really focused in health IT and we sort of miss that after these times go past.
[00:18:09 LM: I couldn't agree more. Yeah, I’ll just add to that that it’s such a pleasure to watch the team rally around something that there's crystal clarity about how important it is to watch them rally and deliver. I mean, what they delivered on that centralized testing location would've taken three weeks. They did it in 24 hours. So, I mean, seeing that kind of a performance under pressure, under heat is truly beautiful. When this is all over with, Bill, we’re going out to drink and I’m buying the beers.
[00:18:45] BR: Looking forward to it. Lee, thanks again for taking the time. I appreciate it. Special thanks to our sponsors; VMware, Starbridge Advisors, Galen Healthcare, Health Lyrics, and Pro Talent Advisors for choosing to invest in developing the next generation of health leaders.
Check out more of these episodes in thisweekinhealth.com and the YouTube channel. If you are a health system C leader and just have a story to tell about your preparedness, we’ll be recording these all week and want to get the word out about best practices. So if you want to do that, drop me a line, firstname.lastname@example.org. Thanks for listening. That’s all for now.