In a keynote address on Aug. 19 at the Marriott Seattle Waterfront Hotel, Nicholas Wolter, M.D., CEO of the Billings Clinic, an integrated health system based in Billings, Montana, told his audience at the Health IT Summit in Seattle that culture, vision, and mission are at the core of clinical and organizational transformation and successful IT implementation. Wolter’s keynote on Wednesday was delivered based on the theme, “Culture, Safety, and Quality: Strategies to Enable IT.” The Health IT Summit in Seattle is sponsored by the Institute for Health Technology Transformation, or iHT2 (since December 2013, Healthcare Informatics has been in partnership with iHT2 through HCI’s parent company, the Vendome Group, LLC).
Nicholas Wolter, M.D.
One of the truly pioneering patient care organizations in the United States, the Billings Clinic encompasses a 290-physician multispecialty medical group (founded in 1917), a 285-bed community hospital, a psychiatric hospital, a long-term care facility, 11 critical-access hospitals, five rural clinics, and other resources caring for patients across a 43-county service area that spans much of central Montana and northwestern Wyoming, and is as wide in geographic area as the distance between Washington, D.C. and Chicago. The organization’s annual net revenues amount to about $550 million. As Dr. Wolter noted, “We’ve become quite large by Montana standards.”
But beyond size and scope, the Billings Clinic organization has for years now been recognized as an outstanding pioneer among U.S. patient care organizations for its care delivery and quality innovations. For example, the organization became nationally known when it joined the Medicare Physician Group Practice Demonstration Project, participating from April 2005 through 2010, along with nine other medical groups. As an important July 2011 report on the demonstration project noted, all ten of the medical groups involved made considerable progress in increasing the efficiency, effectiveness, and care quality of their management of patients with diabetes, congestive heart failure, and coronary artery disease, and in their preventive care efforts.
On Wednesday morning in Seattle, Dr. Wolter reviewed the history of Billings Clinic for his audience, and then articulated how it is that the development of vision, mission, and a culture of safety and innovation have been foundational both for the organization’s ongoing clinical transformation work and for its IT development.
Tried and tested
Things haven’t been all rainbows and unicorns along the way, of course. In 1997, four years after the merger of the medical group and hospital entities, the integrated health system faced significant financial losses, and was forced to do a reduction in force and hire turnaround consultants in order to move forward financially. “We’ve achieved tremendous financial stability,” Dr. Wolter told his audience, and, not coincidentally, “we’ve spent a tremendous amount of time on mission and vision, as well as physician recruitment.” Key to the organization’s current development was the creation of an explicit mission that not only aimed very big, but also was forged through consensus, particularly among its physicians; the organization considers itself to be a physician-led organization, and “The decision-making process really does emphasize physicians,” Wolter noted.
“In 2005, we put on the table that we’d like to be best in the nation on safety, quality, and service,” Wolter noted. “And then in 2010, we decided we wanted to be best in the nation in terms of safety, quality, service, and value.” Were those mission statements ambitious? No doubt about it. But they also reflected where Wolter and his colleagues felt Billings Clinic needed to go. Since then, the integrated health system has received a number of national recognitions, including from HealthGrades, the chief impact of which has been a strong “boost in morale,” Wolter noted.
Among the key areas that Dr. Wolter and his colleagues in Billings’ leadership have focused on include: regularly surveying all staff members to find out where they see patient safety gaps, with the results from those surveys informing senior management and the board as to where to intervene to improve patient safety; focusing on continuous clinical performance improvement and on building a culture of safety and eliminating preventable harm; and actively engaging physician leaders and rank-and file physicians and nurses in helping to lead change management around patient safety, care quality, and cost-effectiveness.
IT as a key facilitator for clinical transformation
When it comes to IT strategy, that strategy is completely integrated with the overall strategic direction of the organization, Wolter told his audience. It is focused on facilitating change, not on technology for technology’s sake. “We have a single EHR [electronic health record] for the clinic, hospital, and all our regional sites, from Cerner,” he said. “We were very early attesters for meaningful use. We’re launching a new revenue cycle management solution from Cerner. And we’re using [the Seattle-based] Caradigm” for analytics. When it comes to vendors, he added, he and his colleagues have been “pushing Cerner hard” to help them customize and optimize clinical decision support and other functionalities for the Clinic.
Importantly, he noted, when it comes to clinical informatics work to support clinical transformation, Billings Clinic employs three different practicing physicians—a primary care physician, a medical specialist, and a surgeon—each working one-third time—as a triad of CMIOs, to help lead their colleagues in moving forward on clinical transformation.
Looking ahead Dr. Wolters told his audience that what is clear, as Billings Clinic continues to move forward, is that the world of care delivery is rapidly changing, and that information technology and data will be needed to help facilitate clinical transformation going forward. And that technology, and that information, will need to be used strategically by teams, no longer by individual physicians working in a care continuum vacuum. “We’re no longer fighter pilots,” Wolter said, reaching for a metaphor. “We’re astronauts on a mission, needing a whole host of support. But this [clinical transformation work] is very challenging, and the electronic health record, while pushing change, is also making many tasks harder.” Vendors need to improve core functionalities and interoperability to support the coordinated care of the future, he emphasized.
He ended by referencing a quote from Charles H. May, M.D., one of the founders of the Mayo Clinic, who in 1913 had predicted “fifty years of advancements in improvements in the organization and team work of how healthcare is delivered.” Dr. May “Might be very disappointed in the pace of change until now,” Wolter said but he added quickly that “I am very hopeful for the future” when it comes to the potential for fundamental systemic change in healthcare going forward.