Tag Archives: lessons learned

COVID-19 – listen to the experts

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Dr. Anthony Fauci may be a household name for your family. But what about Andy Slavitt?  He is a policy expert who served in the Obama administration first to save health.gov and then as acting administrator of the Centers for Medicare and Medicaid Services. During the pandemic he provided reliable, relatable information and education with his daily tweets at @ASlavitt and award-winning “In the Bubble with Andy Slavitt” podcast.  He quickly became a household name with my family and a trusted resource. Many trusted him and looked to him for insight.

He served as President Biden’s Senior Advisor on COVID-19 for the first 120 days of the new administration. He is now back from the White House and in his chair on the renamed podcast – “In the Bubble with Andy Slavitt: Our Shot”.  As the podcast description says, “Just as he took us through the pandemic, this 10-week series called Our Shot is about leading us out. It’s an insider’s guide for getting closure on what happened, how we emerge, and what must come next.”

Busy as my schedule is, I am trying to keep up with this new series. So far, I have heard his interviews with CDC Director, Dr. Rochelle Walensky, and President Biden’s Press Secretary, Jen Psaki. And I am halfway through Andy’s just released book written primarily prior to his recent stint in the Biden Administration. His book, “Preventable – The Inside Story of How Leadership Failures, Politics, and Selfishness Doomed the U.S Coronavirus Response”, is a must read. Not just to understand what happened but how do we prevent it from happening again.

While COVID-19 may seem to be behind us, it is not when you consider the variants and the percent of the population not yet fully vaccinated. Continue reading →

7 years later

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I started this weekly blog 7 years ago right before our major Epic go live when I was serving as CIO at University of Michigan Hospitals and Health Centers. Given my decades of experience in health IT leadership roles, I decided that I had plenty of lessons and experiences to share. A blog seemed like a great forum to do so.

7 years later, I am still writing. I have shared lessons and experiences that have included my interim CIO and CTO engagements at three other healthcare systems since I left Michigan – University Hospitals in Cleveland, Stony Brook Medicine on Long Island, and University of Vermont Health Network. Since March, I have been serving as interim SVP and CIO at Boston Children’s Hospital.

I often wonder how much longer to keep this going. How much more do I have to share and who cares? The feedback and appreciation I get in notes and comments from readers keeps me going. And the topic ideas keep coming.

I was asked recently how I find time to write each week. Good question. I am pretty busy. I am a full-time interim CIO and am helping my colleagues keep things going at our firm, StarBridge Advisors. My response to the question is that I have a lot of ideas and not enough time to write. With this week’s post I am changing when I publish. I will try to write on the weekends and publish early in the week instead of percolate an idea all week and then finally write it Thursday night when I am exhausted.

And while I have a lot of topic ideas, I am definitely open to suggestions from my readers. I was recently asked by a CIO colleague if he could suggest topics – of course I said yes.

At this 7-year mark you might be interested in knowing which posts have gotten the most attention. In the world of social media, keywords, amplification, and cross linking are key. The top 5 most read posts since I started are:

It is worth mentioning that #6 is “New year, next chapter”. Continue reading →

Career advice revisited

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It seems that I am getting a lot of requests to provide career advice these days. I did formal career coaching for a few people in recent months and am currently participating as a mentor in the Boston Young Healthcare Professionals (BYHP) mentor program. In all these situations, I point people to my many previous blog posts on career advice to supplement what we discuss.

For general career advice, they find these “classics” useful to review:

Career advice in a competitive market

5 job search challenges in 2020

You need to own your own career

Taking control of your life

Make career choices right for you

New year, new job?

Time for a job change?

Stand out at the interview

So you didn’t get the job

In this new virtual world of recruiting, I tell people not to underestimate the power of LinkedIn. It is an online professional directory that recruiters look to for candidates. Optimize your profile. Ensure the one liner under your name is a good description of your role since that is what people see when you invite them to connect with you and when you are found on searches. Use the about section to describe what you offer and how you can add value – don’t just copy and paste your current job description summary. Be active which shows you are current and engaged – that means sharing content yourself and commenting on other people’s posts. And if you are actively looking for a new job, check the “open to work” box – don’t worry, you can control who sees it.

If you are thinking of using a coach, check out these two posts:

When to use a career coach

Investing in you, the value of a coach

Looking for a new job can be exciting and hard at the same time. Hopefully, the lessons and tips in these posts will make it a little easier.

Systems at scale and optimized workflow

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IT teams work at scale all the time supporting thousands of users. Workflow optimization is often a goal for new systems. The mass vaccination sites and events are at scale and depend on an optimized, efficient workflow. With over 2 million doses a day being administered now in the U.S., these sites and events are becoming more prevalent and will continue over the next several months. While there was much publicity of the problems in the vaccine rollout early on, there have been many improvements in the tools to find vaccine locations and schedule appointments, and the administering of shots. In part that has been due to improved technology and better workflow design.

Two health systems doing mass vaccination sites/events have shared their playbooks in recent weeks for others to learn from. UCHealth in Denver is offering a playbook, “COVID-19 Mass Vaccination Drive-Through Playbook”. It is a 59 page comprehensive and very detailed playbook covering organizational structure and partner involvement, pre-event planning, contingency planning, patient communication, staff, provider and agency recruitment, vaccine storage and handling, and media communications. The Atrium Health playbook is a higher-level guide for leaders – “A Leader’s Guide to Safer, Faster and More Equitable Community Vaccination Events”. Both are valuable tools whether you are in the planning stage or tweaking your current operation.

To build on these tools, I recommend checking out two recent interviews that Bill Russell did at This Week in Health IT.

Continue reading →

Ensuring go live success for large scale IT projects

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Since the pandemic, major system implementations at health systems have continued with successful go lives supported by virtual or hybrid remote/onsite teams. Many organizations have “go live” success stories in this new world of remote work. While virtual support may change some things and certainly presents new challenges, the core work of a successful go live is still the same.

In late 2019, I published several blog posts on successful go lives based on firsthand experience with a major Epic implementation. Here they are again with basic lessons and tips:

10 Go Live Command Center lessons from the field

Epic Go Live – report from the field

9 Tips for Go Live support success

I welcome your comments on any virtual or hybrid go live experiences you have been involved in during the past year. If I get enough new lessons and tips, I will write a new blog so all can benefit. After all, continual learning and sharing best practices is at the core of what we do in healthcare.

Why this topic this week? I am currently working with a client who is less than six weeks out from an ERP go live so it is on my mind a lot. We are doing what we refer to as an Independent Verification and Validation (IV&V), a framework that facilitates audits of major IT projects regardless of area and complexity.  We explore 11 categories in-depth.  The topics range from governance and budget to training and QA.  The detailed analyses for each area involve document review and interviews to ascertain the status of the project.  A risk score is assigned in each of the 11 areas and mitigations are suggested based on the findings.  Ideally, over the life of the project there are three IV&V sessions conducted prior to go live and one session after go live to ensure that projects stay on course, make corrections as necessary in a timely manner, and achieve the defined objectives.

If you think an IV&V from my advisory firm, StarBridge Advisors, is something that your organization can use, please contact us to discuss.

When healthcare becomes personal

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When you get a call that your husband has been taken to the ER by ambulance, it is hard not to think the worst. I got that call last Wednesday. The good news is that by late Friday night Tom was OK’d for discharge from the hospital. But we still do not have the answers needed. More tests and results should help us better understand what happened and why it happened so together with his PCP and specialists we can develop a go forward plan.

I have worked in healthcare for over 35 years. Our family has dealt with various minor health issues and been able to access the best healthcare available. I have the utmost respect and gratitude for health professionals and all they do.

Through this experience I have seen healthcare through the patient and family lens in a different way. I have several takeaways worth sharing.

Emergency resources – Know when to call your PCP, go to the nearest urgent care center, call 911 or head right to the hospital ER. Minutes can matter.

Friends and family – I can’t say enough here. Tom was visiting a friend when the incident started. She took him to the closest Urgent Care, they called an ambulance fairly quickly and he was taken to the closest ER. The friend reached out to another friend thinking that person might know how to contact me. Fortunately, he did. We are setting up the Emergency Contact feature on our phones for the future. On the first call with the ED physician, I did a 3-way with my daughter who is a nurse practitioner. I wanted her in the loop from the start – to help interpret what I was being told, help educate me, and advocate for Tom.

Clinician in the family – If you are fortunate as we are to have a clinician in your family, let them help you. They are invaluable. Listen to them, loop them in on calls to ask all the right questions, and let them educate you. Our daughter spent ½ hour on the phone with the attending physician before Tom was discharged while I drove to get him. She then explained it all to me and started doing more research on her own.

Accessible and Integrated EHR – Now we are in my domain. Continue reading →

Healthcare leaders continue to learn and share lessons

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Virtual learning opportunities have increased significantly in the past few months as healthcare leaders are eager to learn from the experiences of others or share their own lessons during this pandemic. There are far more webinars, live sessions, and interviews than I have seen in the past. Most of these sessions are recorded so you can listen or watch when you have time. The trick is to register – if you end up not being able to join at the scheduled time at least you will be sent the archive link. And of course there are always podcasts – so many good ones as I have recommended in previous posts.

This week, there is yet another virtual learning opportunity that I am excited about joining – the HealthIMPACT Live’s Summer Forum. I have participated in their previous in-person forums and found them to be very thought-provoking programs with top-notch speakers on relevant topics. With limited attendance, there is always plenty of opportunity for dialogue. The forum organizers have pivoted and are promising a great virtual experience. The topics are very timely and divided into four parts over two afternoons:

Part I: Your People – Healthcare Workforce Reimagined – From Crisis Management to System-Wide Transformation

Part II: Your Processes – Sustaining Gains in Telemedicine and Virtual Care Delivery- Building on Successes and Lessons Learned Connecting Patients and Providers in Response to COVID-19 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 →

Looking ahead – the “new normal” post COVID-19

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It’s hard to think about anything good coming out of this pandemic. Every story of a life lost is heartbreaking. Like you, I have shed many tears in the past month as I read and heard their stories.

And yet, it is encouraging to consider some of the positive changes we may see when we get to the other side of this crisis and are living and working in the “new normal”. We don’t yet know when that new normal time will come. But there are changes in healthcare and how we work that will hopefully be long lasting. I’m not talking about the overall healthcare system or macro societal and economic changes – I’ll leave that to others.

From a health IT lens, here’s my take on some of the positive changes:

Telehealth – There is no question that this crisis has led to a huge increase in telehealth and new use cases. Some organizations are seeing 50+ times the number of telehealth visits compared to before. With regulations relaxed and no alternative, telehealth is being used in many different scenarios. Training, broad deployment and adoption has accelerated as clinic visits are cancelled and telehealth becomes the primary means to connect with your physician. And on the frontlines of COVID-19 hospital care, leveraging it with inpatients to protect staff and reduce the amount of PPE used has also become common. We’ve reached the tipping point for telehealth and I expect we’ll see it continue to grow in the future. A recent article in NEJM Catalyst by Judd E. Hollander, MD, and Frank D. Sites, MHA, BSN, RN, titled “The Transition from Reimagining to Recreating Health Care Is Now”, covers how organizations need to look at expanded telehealth use post COVID-19.

Rapid deployment – From an IT perspective, supporting the effort to stand up a field hospital or alternate care site such as the 1000 bed Boston Hope Medical Center is like a “greenfield” hospital compared to rolling out a new EHR and the associated infrastructure at an existing hospital. What lessons can be learned and applied from these rapid deployments when it comes to getting all hospitals in a healthcare system on a common platform? Does it have to take years?

Interoperability – I use this term loosely here. New York considers all hospitals statewide as one system to share resources and staff. The Hospital for Special Surgery (HSS) in New York City quickly transitioned from an orthopedic only hospital to take other surgical cases and COVID-19 patients, credentialing physicians and providing access to systems. While state and regional Health Information Exchanges (HIEs) have varied in their successes over the years and physician credentialing is one of the slowest and most tedious administrative processes in healthcare, it gives me hope to see how effectively and quickly hospitals are working together in a time of crisis.

Workflow changes – With EHR systems it can often take weeks or months to identify requirements, reach consensus, make the changes, test, train, and implement. Those changes are now measured in hours or days if it’s needed for COVID-19. IT teams and their clinical partners should ask what processes can be streamlined when we are in the new normal. Continue reading →