Tag Archives: lessons learned

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 →

COVID-19: Health IT collaboration and best practices

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We are an industry that shares best practices and continually learns from one another. As we all deal with uncharted territory, that sharing is needed more than ever before. In conversations with healthcare CIOs it

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

is obvious that the amount of work currently being undertaken by health IT teams is extraordinary.

In that spirit, this week I’m highlighting several resources that might be useful to health IT teams:

Through ThisWeekInHealthIT Bill Russell has produced valuable podcasts for health IT professionals for the past two years, interviewing healthcare executives and IT leaders across the country. Last week he pivoted to focus on COVID-19 with two new services:

COVID-19 Resources is a page dedicated to COVID-19 resources during this time. It’s a resource site for health IT teams when they are asked to stand up a relevant technology or implement a technology enabled process. Visit the page now to see what’s already been shared. And you can help him help others. Just forward any resources for health IT that you are willing to share to Bill at hello@ThisWeekinHealthIT.com

Podcast interviews with health IT leaders on the front lines of the pandemic who are willing to share some of their preparedness challenges, lessons and best practices:

COVID-19 Prep with Baptist Health KY

  • Standing on the lessons of the past
  • Protecting the care providers during COVID-19

COVID-19 Prep with Asante Health OR

  • Establishing communication in crisis
  • Preparedness huddles
  • Prioritization of IT work
  • Leadership skills needed

Continue reading →

Healthcare providers on the front lines of Covid-19

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In my blog last week, I consciously decided to avoid the Covid-19 topic. The situation was evolving day to day and I asked myself what useful insights or comments I could possibly have.

Just 11 days ago, the cancellation of HIMSS20 conference was announced. Many of us were hoping for this as we worried about being in a convention center with 45,000 people from not just around the country but around the world. With the cancellations of major sports, Broadway, closure of Disney, limits on the size of large gatherings, and school closings, the times have changed drastically in a matter of days.

We are being encouraged to practice “social distancing”. People who can are working from home.

But hospitals remain open for business as they must. Our nurses and doctors are on the front lines. IT teams and all the hospital staff who support the clinicians are doing what is necessary to ensure that they can deliver care.

While all healthcare organizations have emergency preparedness plans in place for a variety of incidents, this is uncharted territory that tests the limits of those plans. There will be much to learn and share when we get to the other side of it. But in the spirit of we’re all in this together and the culture of sharing best practices we have in healthcare, here are a few links that might be of value in the days ahead.

UW Medicine CIO’s advice: Prepping IT systems for COVID-19 – by Eric J. Neil published in Health IT News, March 12. UW Medicine was one of the first health systems on the front lines of the pandemic in the U.S. Their insight and advice are invaluable to IT leaders around the country.

While you may question the value of Twitter, it is yet another forum where lessons are being shared from the front lines. Dr. Kira Newman has worked in the ICU in Seattle the past week and posted a 10 part thread:

In one part Dr. Newman provided the link to their Covid-19 Resource Site for other hospitals to use.

17 Coronavirus (Covid-19) Actions for Healthcare CIOs – by John Lynn in Healthcare IT Today, March 11. John is continuing to collect info from IT leaders and will share as he does.

Healthcare IT News is maintaining a list of trusted resources that can be found here: Key resources to keep track of the coronavirus pandemic.

Most of my readers probably work in healthcare organizations and fully understand the magnitude of this pandemic. For those of you who don’t and need some convincing, remember that science and math do matter. Here are two of the best articles I’ve seen:

Why Outbreaks Like Coronavirus Spread Exponentially and How to Flatten the Curve – by Harry Stevens in the Washington Post, March 14.

Coronavirus: Why You Must Act Now – Politicians, Community Leaders and Business Leaders: What Should You Do and When? – Tomas Pueyo, first written March 10 and updated on March 13. The author closed with this message: “This is probably the one time in the last decade that sharing an article might save lives. They need to understand this to avert a catastrophe. The moment to act is now.” So, I share with all of you.

And if working from home is new to you, here’s a good resource to check out:

Work in the time of Corona – a blog by Alice Goldfuss on March 11th.

My paternal grandfather died in the 1918 flu pandemic. He was young but married with three small children. My father and uncle were sent to an orphanage and my grandmother and aunt went to live with friends. Yes, it’s not 1918. Healthcare has advanced significantly. But we are an even more global and mobile society. The most important lesson from 1918 is the impact of social distancing which is shown in this graph:

In closing, I want to express a huge thank you to all who work in healthcare. The strain on our healthcare system is real. The stress on our healthcare workers is real. Let’s all do our part to #SlowTheSpread and #FlattenTheCurve.

Major implementations need experienced leadership

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What CIO hasn’t worried about a major EHR or ERP go live? Despite the years of work by your dedicated and talented team alongside your software vendor and possibly an implementation partner consulting firm, you still worry. The Go Live Readiness Assessments (GLRA) at 30-60-90 days have level set all involved on what is complete/ready, what is on track to complete, and what needs help.

It’s that last piece – what needs help or is significantly behind schedule – in bright red on the status report that requires attention. There could be many reasons it’s red, but bottom line it is red. Do you have enough of the right resources and enough time to get it done? Do you have to adjust scope? Do you have to put more money into it? You certainly don’t want to sacrifice quality. And with the scale and complexity of most major implementations, you don’t want to move the go live date. Any good project manager knows that those are the only four levers you have – scope, quality, money, and schedule.

Everyone who has done this before tells you that there will be some yellow and red areas yet at the 30-day GLRA. But they should be minimal and able to be addressed in time for the go live.

If you have a major implementation in 2020 and don’t have an implementation partner or lack full, unbiased confidence in your implementation partner, you might consider a little more help in those final 90-120 days. And not just more staff resources. As the CIO, you may need to bring in an experienced senior IT leader who can assist you by doing a quick project review and risk assessment. Someone who can identify the key areas you need to focus on and if needed bring the expertise and leadership to address them in time for a successful go live. Someone who, at a modest cost, will help you sleep better at night.

At StarBridge Advisors, we have a team of senior IT leaders serving as advisors who have significant experience leading successful implementations in all sizes and types of healthcare organizations. We know what can go wrong and how to avoid it. We know what it takes to be successful. And we will tell it to you straight. Our approach is practical, unbiased, open, and plain speaking. We offer you frank and honest opinions based on real-world experience.

If you have a major implementation in 2020 that you are worried about, let’s talk.

Related Posts:

Plans, processes, people: lessons from a successful EHR implementation

Epic Go Live – report from the field

9 Tips for Go Live support success

10 best practices for project success

10 Go Live Command Center lessons from the field

Crunch time and why IT matters

Most popular blogs in 2019

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It’s the new year and time for top 10 lists and countdowns so I’m adding mine to the mix. These are my most read blog posts in 2019. If you missed any of them first time around now is your chance to check them out.

I am a practitioner and always willing to share experiences pulling lessons from everything that I do. I continue to cover a range of topics from leadership to women and work to technology and healthcare. It looks like my readers appreciate the variety. Here are the top 10 as measured by total views:

A passion for health care – a classic one from previous years about why we do what we do

6 tips for successful huddle boards – another classic from previous years that doesn’t go out of style

“We’re at meeting norms” – this one is about best practices I learned from my IT colleagues during my interim CTO engagement at University of Vermont Health Network (UVMHN) this past year.

10 best practices for project success – another one from my experience at UVMHN as we approached the November Epic Go Live.

Where do new ideas come from? – another back to the classics from a previous year.

Develop women leaders, transform leadership – at StarBridge Advisors, we launched a new service early in 2019 call C-Change focused on developing women leaders in health IT. Continue reading →

Conducting project “lessons learned” as continuous improvement

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As I caught up on my industry reading this past weekend, I saw several implementation best practices articles – advice from experts on EHR, Telehealth, Pop Health, and Medical Device implementations. These kinds of resources are always helpful to think beyond your organization’s experience, get a different perspective, and learn from others.

At the same time, conducting lessons learned sessions internally after major projects is critical. While it’s still fresh in your mind, being able to look as a team at what worked well and what didn’t work well over the life of the project is an important step before moving on to the next project or next phase of a multi-year project. This should be done in the spirit of continuous improvement. Ask yourself, what can be learned from this project that can be applied to future projects. And be sure to document that in a way that is referenceable in the future.

We are just over 3 weeks post go live for Wave 1 of our Epic project at the University of Vermont Health Network (UVMHN). We start a series of lessons learned/debrief sessions this week. IT managers have been asked to think about three questions and submit them in advance so they can be compiled for review and discussion:

  • What worked well?
  • What didn’t work well that we should modify?
  • What didn’t work well (or was unnecessary and we should no longer do)?

As we planned for the sessions, I suggested that we have a few guidelines – no blame, assume positive intent, and ensure everyone is heard. UVMHN has a very collaborative and team-oriented culture so that shouldn’t be difficult.

Often, it’s easy to go right to what didn’t work well. Those examples may be top of mind. But there is so much in a project of this magnitude that is done well. Capturing those points and making sure you repeat them in the future is important.

Wave 2 planning started before the Wave 1 go live. Certain lessons have already been looked at as part of that planning. But the upcoming sessions will be an opportunity to look more broadly and get the input of all areas involved. Given I’ve been interim CTO since late May, my involvement did not span the entire project but rather certain aspects in the last few months including the go live. I look forward to hearing everyone’s perspective on how we can do better and build on the successes to date.

Related posts:

10 Go Live Command Center lessons from the field

Epic Go Live – report from the field

9 Tips for Go Live support success

Plans, processes, people: lessons from a successful EHR implementation