Physical distancing: finding our way

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We saw our grandkids again on Sunday. A small family get together for Father’s Day and our youngest grandchild’s 4th birthday. As we all find our way and do our best to minimize our risks of COVID-19, being able to hug my grandkids brings me great joy and is one of the things I have missed the most these past few months.

There is a reason many people want to refer to this new practice as physical distancing, not social distancing. We need each other. Social isolation is not healthy. Technology has helped but it is not the same. Just ask someone who said their final goodbye to a loved one on FaceTime or Zoom.

Living in Rhode Island, my husband and I have taken the shutdown very seriously. Governor Gina Raimondo got ahead of it early with the shutdown order and then a slow, phased reopening. From mid-March until a few weeks ago, we have mostly stayed home except for the weekly groceries, a few trips to the garden nursery and Home Depot, the occasional takeout order, and the daily dog walks.

We limited family visits to outside spaces at our homes at a distance and no hugs. We are gradually loosening up on the hugs. As we all learn more about how the virus is transmitted, spending time with close family who have also been strict during this period seems reasonable.

My 4-year-old grandson first told me back in April on a family Zoom session that he was going to have a birthday parade, no gifts, and a small cake only for his mom, dad, and sister. It was sad to hear him explain this at such a young age but I thought it was probably a reasonable plan. The idea of a parade was exciting to him. But two months later we decided it was ok to do the backyard immediate family only gathering, which was 12 adults and the 4 young cousins, aged 4 through 7. The grandkids gave us hugs and briefly sat on our laps. It was good to not feel like we were all radioactive.

The slow opening of our own circles is a challenge we all must deal with. I do not take this virus lightly. I read a lot and listen to many interviews and podcasts with experts. I try to be as informed as possible about the science. And I take cues from my sister who has a public health background and my daughter who is an NP and has cared for COVID-19 patients in Boston. Continue reading →

More podcast recommendations – going beyond HIT

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If you are like me, there is no gym time and no commute time these days. But there are still ways to get exercise every day. My long daily dog walks are one of those times when I try to get smarter. And podcasts are the means.

I have made podcast recommendations in the past and still have my favorite “go to” for health IT but I have added a few more in recent months.

ThisWeekinHealthIT – this has been my “go to” podcast since Bill Russell started it in 2018 as a weekly show. In 2019 he went to a twice weekly format. And during the pandemic, he went to daily podcasts with an excellent and very timely Field Report series – interviews with health IT leaders on how they are managing during this crisis and preparing for recovery and the new, better normal. Many great lessons and insights have been shared the past few months. Kudos to all his guests for their incredible work and making time to share with others. And kudos to Bill for his ongoing commitment to developing next generation leaders. My firm, StarBridge Advisors, is a proud sponsor of the show and share in that commitment.

Digital Health Leaders – this is a relatively new podcast series started by the College of Healthcare Information Management Executives (CHIME) a few months ago. Russ Branzell, CHIME President and CEO, interviews IT leaders on a range of topics.

Relentless Health Value – this is a podcast I first became acquainted with when I was asked to be a guest back in 2018 – my episode was “The Evolving Role of the Chief Information Officer”. But IT is not the focus. Stacey Richter, a healthcare entrepreneur and innovator, has hosted the show since 2014. The website describes the podcast this way: “The show that connects you with other health care leaders trying to achieve the quadruple aim of improving population health and patient and provider experience, while managing costs effectively. Our mission is to help transform health care by breaking down silos and connecting disconnected parts of our industry. The first step toward collaboration is simply knowing what others are working on and wrestling to overcome.” So, if you want the big picture on healthcare and not just IT, add this one to your list. And like Bill, Stacy has a special COVID-19 series as well.

And continuing down the beyond IT path, I have recently started listening to a few other ones: Continue reading →

At the intersection of racism and healthcare

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It has been two weeks since George Floyd was murdered by police in Minneapolis. Since then, millions of people have joined protests in major cities and small rural towns around the world to make their voices heard. They have said enough is enough, racism must end and real change is needed.

When the protests end and our national focus begins to shift, we can not go back to business as usual. The statements of support and solidarity made by so many these past two weeks must turn into action.

At the local, state, and federal level we must hold our government leaders accountable for change and exercise our right to vote for those committed to change. With the focus on police brutality, we are beginning to hear some major cities announce planned changes in policing. New York Governor Andrew Cuomo has introduced his “Say Their Name” agenda to reform policing in New York state. House and Senate Democrats have introduced the Justice in Policing Act.

In recent days, we have seen many “white coat” rallies as well – White Coats for Black Lives. My social media feeds are filled with pictures and stories of hospital staff rallies – many of them organized by the residents. Brigham and Women’s Hospital in Boston, UMass Memorial in Worcester, Massachusetts, and Henry Ford Health System in Detroit were just a few of them. And these are hospitals who saw thousands of COVID-19 patients in recent months. Truly our healthcare heroes.

In 2014, after Michael Brown was shot by police in Ferguson, we saw similar support. Students at 70 medical schools around the country organized a national white coat die-in saying it was an “important time for medical institutions to respond to the violence and race-related trauma that affect our communities and the patients we serve”. They lay down for fifteen and a half minutes. Eleven minutes to represent the number of times that Eric Garner said “I can’t breathe” as he was in a choke hold by police in New York City and four and a half minutes to represent the four and a half hours that Michael Brown’s body lay in the street after being shot by a police officer. And yet here we are in 2020.

These hospital staff rallies along with the many statements of support from hospital and health system CEOs are an important show of support but we also need action and attention to health disparities. I want to share two heartfelt CEO statements that were the most impactful for me. They are from healthcare leaders I have worked with and greatly respect. Continue reading →

Be a part of the change

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I have watched with sadness, anger, and disappointment the events of the past week. Amid a public health crisis and a historic level of unemployment that are disproportionately impacting people of color we saw captured on video the death of a black man, George Floyd, at the hands of four police officers in Minneapolis.

I am a liberal white woman. I grew up in a white neighborhood in Northeast Minneapolis. As a young adult, I lived in South Minneapolis and later North Minneapolis – much more racially diverse parts of the city. My sister and brothers, nephew and nieces, and their children all still live in the Minneapolis area. My nephew has lived for over 20 years just off Lake Street in South Minneapolis where nearly every business has been damaged or destroyed in the past week. But this destruction was not limited to Lake Street which you saw on the news. It happened all over the Twin Cities area as people intent on causing trouble and more divisions scattered to set fires and smash windows. As of late Sunday night, 270 businesses had been damaged or destroyed. It broke my heart to see that beautiful, diverse city so broken. And then to see that destruction spread in other cities over the weekend.

I am old enough to remember the riots and social unrest of 1968. I came of age during the women’s movement in the late 1960’s and early 1970’s. I have been to my share of peaceful marches and protests over the decades starting with an anti-war demonstration in 1970 on the University of Minnesota campus with one of my high school teachers and several classmates. In recent years, my husband and I have showed up for women’s rights, gun control, and immigration reform.

While I have experienced sexism, I also experience white privilege. I try to understand racism and its impact on people, but I cannot fully understand what it is like to be a person of color in America.

As a citizen, it is our right to peacefully protest. Thousands of people are in the streets in every major city across this country peacefully protesting racism and police brutality. A small number of extremists are turning these protests to violence and destruction each night.

We are seeing the best and the worst in people right now. Continue reading →

Hospitals too are part of a safe reopening

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This past weekend was the unofficial beginning of summer. After 2+ months of stay at home orders and a few weeks of phased reopening depending on the state you live in, the images of large crowds packed in close and without masks at a pool in Missouri, on the boardwalk in New Jersey and at a race track in North Carolina were concerning. As I hope many others chose to do, we stayed home and had a family visit on our patio at a social distance.

We are hearing stories of super spreaders from Mother’s Day two weeks ago resulting in upticks of COVID-19 cases in many states. We see stories of a hair salon in Missouri where two stylists who were ill exposed over 140 customers. We see stories of no available ICU beds in Montgomery, Alabama where cases have reportedly doubled since that state reopened two weeks ago.

On Friday, the President ordered churches to reopen and threatened to override governors who refused to do so. Fortunately, many faith leaders acted responsibly and outlined plans for continued online or outdoor services until they are certain that they can safely reopen their doors to congregants.

News reports say the virus is still spreading at epidemic levels in 24 states and is not contained. This pandemic is not over. And it may be a long time before it is. So how do we begin to recover and safely reopen? Continue reading →

Knocking on the digital front door

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Health systems are learning many lessons during this pandemic that they will need to carry forward into the recovery and “new normal” phases. One of them may be the need for an integrated digital health strategy, and more specifically a patient focused “digital front door”. The almost overnight shift from in-person ambulatory visits to virtual visits during this pandemic highlighted the need for a more integrated approach for many health systems.

An integrated strategy for a patient centered digital front door has many components including the core website, the patient portal linked to the electronic health record, improved access and scheduling capabilities, call centers, and care delivery through virtual visits. The goal is to meet patients where they are and guide them along the right care pathway with efficient, consistent, and easy processes in the background.

However, these multiple components and functions are often led and directed in an uncoordinated manner by different senior leaders within the organization. The core website is typically owned and directed by Marketing and Communications with technical support from IT. The patient portal is often managed by the ambulatory team in IT partnering with the Chief Medical Information Officer, Ambulatory Services, and Marketing. Improved patient access and scheduling initiatives are often directed by Ambulatory Services or in an academic medical center by the Physician Practice Group leadership. The call center may be managed by Marketing or Ambulatory Services leadership. And telehealth may be provided by a specialized team either connected to or part of IT but be directed by physician leadership.

A successful patient centered digital health strategy needs to involve all these components in a coordinated, comprehensive manner. In some respects, who leads this strategic initiative does not matter. What does matter is that there is buy-in and collaboration from all leaders involved with a common overarching goal to meet patients where they are at and provide an easy, consistent experience to access services. Continue reading →

Year of the Nurse: We must support our nurses

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The first time I cried during this pandemic was March 17 when I read that in Italy people over 60 years old were being left on gurneys in the hallway to choke on their own sputum. Patients with coronavirus had

Message from Brigham and Women’s Hospital OR nurses: #StayHome

exceeded the hospitals’ capacity. I had been watching the news and stories from Italy closely in anticipation of what was going to happen in our country assuming we were just a few weeks behind them in this crisis. I cried then not only for Italy but for myself. I wondered if I was going to be one of those over 60 left to die if our hospitals were also unable to handle the potential number of very sick COVID-19 patients.

The second time I really teared up was when I thought about my daughter who is the Chief Nurse Practitioner (NP) on the inpatient orthopedic/spine service at Brigham and Women’s Faulkner Hospital in the Boston area and reassigned to work shifts in the ICU with COVID-19 patients. I feared the worst for my family. That she would get exposed and transmit it to her husband and five-year-old daughter who both have very bad asthma and are allergic to almost everything. We knew this virus was not just killing elders. People of all ages and especially those with underlying conditions were and are still at high risk.

Most of the times I have had tears since then has been watching a nurse or physician tell their story on the news. Describing what it is like to care for intubated COVID-19 patients, helping their patients’ families understand there is nothing more they can do, and sharing the fears they have for their own families when they go home from their shift. I have also cried when I see the stories of family members dying within days of each other from this virus, many of them people of color who are essential workers who can’t stay home.

I have listened to my own daughter describe the days she was assigned to work an ICU shift with COVID-19 patients. While it was not the overall intensity of what we have seen on the news in New York City hospitals, every individual case she described was just as sad and heartbreaking. And the emotional and physical toll on the nurses, doctors and respiratory therapists was obvious.

On the brighter side of this crisis, I have smiled with joy as healthcare workers in NYC celebrate the 500th or 1000th COVID-19 patient discharged from their hospital. Continue reading →

IT requests increase while budgets decrease

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As hospital systems develop their COVID-19 recovery plans, the financial impact of this pandemic is deep and far reaching. IT budgets are no exception. IT leaders are being asked to take salary cuts, furlough staff, and deal with a capital freeze for the rest of the year. This comes at a time when the demand for technology solutions is only increasing. And at a time when IT teams have performed at their peak in providing and supporting new solutions with agility and in record time.

In a recent Becker’s Hospital Review article, Hospital IT Spend Pivots to Mission Critical Projects: 7 Leaders on the Key Focus for the Next 12 Months, IT leaders covered telehealth, digital transformation, analytics, informatics, and of course the reality of cost reduction facing them and their organizations.

IT leaders have long faced the supply vs demand challenge. And they have long faced the need to reduce their budgets while meeting a growing user base and increased demand for technology solutions. The days of significant year to year budget and staff growth in IT are a distant memory.

As we look to the future after the COVID-19 recovery, some people talk about the “new normal” phase and others refer to it as the “re-imagine” phase. The latter certainly encourages us to think differently. Regardless, it will be with far less resources. So how does IT manage and ensure success in this ever more constrained environment? Continue reading →

What next for health IT?

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Two weeks ago, I wrote about looking ahead to the “new normal” post COVID-19. Since then some states have started slowly re-opening while other states are defining what their phased re-opening approach may look like. Hospitals have started to develop plans to expand their services beyond emergencies and COVID-19 patients – performing elective surgeries and opening outpatient clinics. All of this is new territory. Patient scheduling, workflow changes, and appropriate staffing and PPE to provide safe care must be accounted for and planned for very carefully. This will happen over the coming weeks and months.

Given the financial impact COVID-19 is having on healthcare systems, executives also need to be looking at how to position their organization for not just recovery but long-term success. One of the articles that I have seen on this is a white paper published by the Chartis Group – “After the Surge: Five Health System Imperatives in the Age of COVID-19”. In it they discuss how COVID-19 has fundamentally changed the care delivery landscape. They outline what they consider to be the five imperatives for future health system success:

  1. Engage consumers and other referral sources to recapture patients
  2. Fundamentally reduce the cost base
  3. Restructure the physician enterprise
  4. Transform the clinical operating model
  5. Closely evaluate partnerships, both horizontal and vertical, traditional and non-traditional

Other management consulting firms that work with healthcare providers most likely have a similar analysis and framework. Regardless what they may look like, all of these long-term efforts will require IT support. Continue reading →

Leading through a crisis

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As a leader, you are called upon to lead in good times and bad. At normal times and when there is a crisis. It may be an incident in the community with mass casualties, a natural disaster, or a widespread pandemic as we are living through. Barring any of these truly awful crisis, it might be a system failure and as an IT leader you are front and center. Whatever crisis you may face, it requires the best of your leadership skills.

Here is my list of the needed skills from my own experience and watching the best leaders in our current global crisis.

  • Communicate often to everyone involved and impacted. Be open and transparent.
  • Focus on the facts. Be explicit when you are stating opinion instead of fact.
  • Own the situation. Don’t make excuses. Take responsibility.
  • Be genuine and empathetic. Stay connected.
  • Stay calm and project calmness.
  • Be available and present. Stay close to your team. Provide the encouragement they need.
  • Listen to the input of others, especially the experts.
  • Be adaptable and ready to make quick decisions.
  • Lead by example in all you do.
  • Let your organization’s core principles guide you.
  • When you can, look ahead and past the crisis. Develop a return to normal plan
  • Capture lessons learned.
  • Express gratitude often. There are many heroes in a crisis. Find them and thank them.
  • And don’t forget to take care of yourself.

I have heard many health IT leaders describe the work they are doing in support of their hospitals during this pandemic – some common themes are being nimble, partnering closely with clinicians, staying focused, ensuring the safety of their onsite staff, being responsive with a can do attitude and providing rapid, innovative solutions. I have great respect for all of them as they navigate and lead during this unprecedented time.

Becker’s Hospital Review published a summary of advice from healthcare leaders last week titled “73 hospital leaders in 10 states hit hardest by COVID-19 offer advice to colleagues: If you do nothing else, at least do this”. Respondents are from New York, New Jersey, Massachusetts, Michigan, California, Pennsylvania, Illinois, Louisiana, Florida and Texas. The responses are organized by theme – I focused first on the leadership, communication and strategy theme. Continue reading →