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Unpacking the Gains in HCA Healthcare’s HIT Governance Evolution

July 2, 2018
by Mark Hagland
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HCA Healthcare executives shared with HIT Summit attendees learnings from the evolution of their HIT governance process

On Friday, June 29, during the Health IT Summit in Nashville, sponsored by Healthcare Informatics, two executives from the Nashville-based HCA Healthcare shared their learnings and perspectives around their organization’s streamlined project governance model.

Speaking at the Sheraton Hotel Nashville Downtown, Karen Thompson, associate vice president, strategy and innovation, and Dr. Edmund Jackson, vice president and chief data scientist, both based in the organization’s Nashville headquarters, told Summit attendees about the complex but successful path forward through healthcare IT project prioritization that they and their colleagues at HCA are pursuing these days, as the demands on everyone’s time and resources accelerate in the current healthcare operating environment, in a dual presentation entitled “Govern Not Squash: The Road to Building a Flexible Clinical IT Governance Model.”

To begin with, Thompson and Jackson referenced the fact that HCA Healthcare is a huge organization, one that encompasses 179 hospitals, 1,800 total sites of care, 240,000 employees, 37,000 active physicians, 80,000 nurses, and 27.1 million patient encounters every year, across 20 states.

That alone has made for a complex, challenging journey. “Many people, when they think of governance, think, ‘hall monitor,’” Thompson said. “But that’s not what this is about. In this space, we’re always talking about innovation; we want to go faster. Governance is not something that helps you do that.” But what it does do, she said, is to help everyone in the organization get on the same page. What’s more, she said, “No, we don’t have it all worked out; it’s an ongoing journey.”

Meanwhile, Jackson said, “The data science” that supports innovation in patient care organizations “moves quickly, fails frequently, and is expected to fail. So the challenge Karen and I took on was, how do we get an agile space built into the business structure?”


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As a result, Thompson, Jackson, and their colleagues came up with a three-phase conceptual solution. From 2008-2011, the focus was on standardizing and scaling the project prioritization and authorization process. From 2011-2012, the focus was on “exploring and innovating.” And, since early 2017, the focus has been on accelerating and on measuring innovation and progress.

“I’ve been at HCA a little over 12 years, the formal governance process has been in place about 15 years, and it has ebbed and failed,” Thompson said. “At first, it was like a franchise model, everyone was doing their own thing. We had to create a standardized foundation,” he reported.

Karen Thompson (r.) and Dr. Edmund Jackson (l.), during their presentation on Friday in Nashville

And, Thompson added, “Edmund and his colleagues came up with great idea, and they said, hey, we’re going to save babies’ lives. How can you say no to a baby?? But what challenged everyone was, OK, what was the priority? What if you have 15 ideas and they’re all about safety and quality? And beyond the clinical, there are other aspects of our business that we also have to pay attention to—things like registration. And things like providing physicians and nurses with the technology they need to do their jobs.” Looking at what faced them, she said, “Since we’ve been able to prioritize more, it’s been, what about quality, speed, and efficiency? How can we get faster and better, but also do it cheaper? Can we do something in 18-24 months? So you’ve got this great idea to integrate a sepsis tool. Well, we’ve got 179 hospitals. But we’ve got this great idea. OK, so pilot it. You want me to go slower? No, pilot it.”

And in that regard, Thompson noted, “We have a gate review committee. It’s like ‘Shark Tank’ with 20 of your closest colleagues! We need to be sure that we’re acting as good stewards with your money. Because sure, you’ve got a great idea. But there are 20 other colleagues who’ve got great ideas, too. So our gate review committee makes sure we prioritize our projects appropriately, and pace them correctly. And people will say as a result of going through this, they end up with a better project. And you can’t keep going to the same markets to test things,” so pilots are launched in a variety of different facilities and local healthcare markets. And, she notes, “Testing is great for us.”

Of course, Jackson said, “That was kind of a hard lesson for the innovative side to take on. Because we operate in silos, though I hate that word. And I might want to take on some kind of innovation project, and I can’t understand why Karen says she’s not ready for my project; but then I find out that there are 20 other projects like mine, and she knows that, and I don’t. and that took me a while for me to onboard and fully understand.”

Indeed, Thompson said, “We are shifting from an annual prioritization process, involving clinical, hospital operations, IT, etc.; and we have x millions of dollars to fund projects this year, and so we look at such elements as breadth, impact, and time and intensity of projects, and then we draw a line after a certain amount. But are we leaving anything on the table that it’s a priority for our company? And so now we’re doing what we call our ‘Evergreen’ prioritization process. You prioritize and integrate across strategies as opposed to just business areas. So we’re trying to look across strategies and not just business areas.”

Thompson said, as a humorous note, “So, someone will show the ‘baby’ slide” in a presentation proposing a project, “and we’ll say, hey, we’ve got three projects saving babies already. And we need to have a bit of a sense of humor around this, too. But it’s about balance and composition. So this is why we have this evergreen portfolio process. But sometimes, someone happens to pass Sam, our COO, in the hallway. And the hallway hit-up is real.”

“Karen’s being humorous, but the issues are real,” Jackson said. “And you have to stick to process. The move to the Evergreen Process was real. And yes, most projects are 18-24 months in terms of their timeframe. They had been of various lengths, with some only three months long.” But innumerable short-term projects had become impossible to govern, he said. “So Karen and I and the CEOs and COOs got together and asked ourselves, how do we work this out? And the Evergreen Process emerged. For many years, we had lived on a yearly funding process, and it wasn’t working.”

What’s more, Thompson said, “The time and amount of energy it would have taken,” would have been overwhelming, had the Evergreen Process not been developed. “We couldn’t give units their own pools of money. So we would test ideas within individual areas. That’s how Edmund and I worked this out. We said, yes, you do need to go faster. And it’s more about an iterative build.” As a result, she said, it’s worked out well to work with the innovation team on specific pilots and tests, while maintaining an overall governance structure.

In that regard, Jackson noted, he and Thompson and others created a Lean Oversight Committee, which meets quarterly for 60 minutes, and includes group presidents, CFOs, and senior vice-presidents across the nationwide organization. “It’s a group of people who understand the full scope of the company’s strategies and work,” he explained. “We review potential projects. And we do a forced ranking. We don’t promise we’ll fund the projects, but we do force-rank them. And designing that process took a little bit of time. We actually had to get some friends to support us.” That approach is working well, he reported. “HCA is big and doesn’t move particularly quickly. So one of the keys to success in this was gathering people and aligning support.”

“What I love about what Edmund’s done is the fact that it’s about educating people and letting them know what’s going on; and not everybody needs to know what’s going on all the time,” Thompson said. “So the composition of that committee was important. We wanted some people from the strategic planning committee. But we also wanted the naysayers, because otherwise they’ll throw rocks from the side. And so the more closely you collaborate with people and build trust over the years. Those are the conversations you want to have. What’s going well and what’s not, and why not? And the lessons we’ve learned here, we’re going to apply to the rest of the portfolio. And we’re going to manage ourselves. And the honesty of those conversations really begets trust among people. When you’re honest about what doesn’t work, you beget trust.” “And Karen’s point about getting the naysayers on the committee is exactly right,” Jackson added, “because those people will buy into the process.”




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The Modern Healthcare CIO, CMO, and CTO

December 10, 2018
by Lori Williams, Industry Voice, vice president of fulfillment, Gigster
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Disruption in the healthcare space comes primarily from the expansion of data’s role in the industry, and the healthcare C-suite’s familiarity with that expansion will help drive company and industry success

For the healthcare C-suite executive, the industry has never been more complex—nor has it ever contained so much potential. Emerging technologies mixed with political uncertainty has created an environment where incredible amounts of healthcare data are revolutionizing how patient care is handled, but patients remain uncertain about the future of their own health. With better data and the means to draw insights from it, healthcare CIOs, CMOs and CTOs are in a position to help address patients’ uncertainties and make hospitals and clinics more accessible and effective than ever before.

Here’s a look at how the role of the modern healthcare CIO, CMO and CTO is changing:

The Modern Healthcare CIO
The modern healthcare CIO’s role has evolved to become more innovative. No longer a title reserved strictly for engineers and IT professionals, today’s healthcare CIOs are focused on information science instead of simply setting up network infrastructure or providing back-end support. The trend towards a more data-centric role began as hospitals rolled out electronic health records, equipping individuals with better access to healthcare provider data. Through enterprise data warehousing, CIOs are becoming masters of data management, governance and predictive analytics, and passing along the many benefits of those knowledge bases to patients.

The Modern Healthcare CMO
The confusing healthcare landscape makes the role of a healthcare CMO more necessary than ever before. Thanks to ongoing regulatory changes, uncertainty surrounding the Affordable Care Act, and shifting consumer expectations for on-demand services, healthcare CMOs are responsible for helping patients navigate their way through a complex and opaque industry. As patients continue to assume the role of consumers, carrying out comparison shopping as they would for any other industry, CMOs must be adept in crafting a healthcare provider’s brand and messaging.

At the same time, CMOs must also ensure that healthcare providers offer a modern online experience, ensuring websites are mobile-optimized and social media accounts are generating engagement. This also means CMOs need to help move marketing efforts into the 21st century, transitioning away from direct mail or billboards towards digital marketing and CRM tools. Because if they don’t, there are plenty of med tech startups that will promptly eat into their market share.

The Modern Healthcare CTO
Unlike healthcare CTOs of the past who remained siloed off from the rest of the organization, today’s modern healthcare CTO is fully engaged with healthcare providers and their technology stacks, utilizing new software and hardware to improve daily workflows. The CTO is enabling the transition to patient-oriented self-service operations, enabling patients to carry out administrative tasks like scheduling appointments or refilling prescriptions over the internet. Because medical data is often stored in a variety of different sources, it’s critical for the CTO to be able to keep these systems interoperable with one another. For hospitals riddled with legacy software, CTOs should expect to continue employing middleware solutions to bridge the gap between old and new.

Members of the healthcare industry C-suite have the power to transform lives, and the CIO, CMO and CTO have roles that directly affect a provider’s ability to carry out positive change. With better data from the CTO’s tech stack, the CIO can use better analytics to help providers determine the best solutions for their patients, marketed to consumers by the CMO through modern platforms in clear, easy-to-understand language.

Lori Williams currently serves as Gigster’s vice president of fulfillment. Prior to joining Gigster, Lori was the general manager for Appririo.

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What Does Your Magnum Opus Look Like? A Few Operatic Thoughts

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I was given the privilege and pleasure recently of presenting, for the second year in a row, a lecture on Richard Wagner’s “Ring” cycle, as the leading opera company in my city, a world-class opera house, has been putting on, in yearly succession, the four operas of the “Ring of the Nibelung” cycle by German composer Richard Wagner (1813-1883). Last year, the second opera in the tetratology, “Die Walküre,” was performed; this year, the third opera, “Siegfried.” After the concluding opera, “Götterdämmerung,” is performed, the entire cycle will be presented in festival format, always a major cultural event. I spoke on “Siegfried.”

I’ve been fortunate to have seen six complete “Ring” cycles in live opera houses in different cities, and I can tell you, it’s a life-changing experience, as this four-opera work (16 hours of music altogether), sits at the absolute summit of western art. Richard Wagner was a hideous human being himself, but spent numerous years working on something that changed the course of classical music and redefined opera.

What’s more, from the summer of 1848, when Wagner wrote a first sketch of the libretti, or texts, of the operas, until their true compositional completion in 1871, more than 23 years were to pass; and it would be another five years before the tetralogy was fully presented, in a purpose-built new opera house in the Bavarian town of Bayreuth. It was a herculean feat to create the entire text of these four long operas, and compose 16 hours of music that would completely redefine the concept of opera. Indeed, when the crowned heads of Europe, the great living composers, and the 19th-century European intelligentsia and glitterati, gathered at the new Festspielhaus in Bayreuth in 1876, many were so overwhelmed by what they saw and heard, that they were rendered speechless. Even now, 142 years later, first time Ring-goers are overwhelmed by the breadth and sweep, the musical and dramatic audacity, and uniqueness of the “Ring” operas, with their story of gods, giants, dwarves, flying Valkyries, Rhinemaidens, one huge dragon, humans, gold mined from a river, magic swords and spears, and of course, a gold ring whose possessor can control the world and its fate.

Even just looking at the third opera, “Siegfried,” Wagner struggled mightily. For one thing, being essentially a grifter and a cad, Wagner borrowed/took money from everyone who would lend/give it, and often had affairs with the wives of the patrons bankrolling his compositional work, leaving his life in constant chaos, as he fled from one city to the next. One such wife, Mathilde Wesendonck, inspired the opera “Tristan und Isolde,” groundbreaking operas that Wagner wrote during a 12-year hiatus in his composition of “Siegfried.” And “Tristan” itself changed the entirety of classical music, its tonality-challenging chromaticism.

Well, no one is expecting anyone to match the unique creativity of Wagner’s “Ring” cycle. But the leaders of U.S. patient care organizations are doing a lot of important things these days, including using formal continuous improvement methodologies to rework core patient care delivery processes in order to transition into value-based healthcare. What’s more, as our Special Report on Leadership outlines, the entire role of the CIO is being rethought now, as the demands for leadership and strategic capabilities are catapulting that role forward; and patient care organizations are beginning to make real headway in advancing equality for women and people of color among the ranks of healthcare IT leaders and managers.

So while no one is expecting anyone to create an operatic tetralogy that will change the face of music, there are plenty of heroic endeavors open to anyone willing to envision the healthcare system of the future. The opportunities are as limitless as the imagination.

Related Insights For: Leadership


Using Performance Management to Scale

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Performance management is so much more than just a year-end performance review
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Performance management and goal setting have always been part of my DNA. It’s like a compass that tells us we are steering the ship in the right direction or gives us a chance to course correct if we wander off track. It’s hard for any organization to determine how they are doing unless there are clear measurable objectives. CIOs and their leaders need monthly, quarterly and annual goals to measure how you and your team are doing against the plan. I also firmly believe they should be S.M.A.R.T. goals: Specific, Measurable, Achievable, Relevant and Time-based.

Once the goals have been established, you need a written plan. I like three-year rolling plans so you can look into the future and describe your vision of what your organization will look like 36 months out. Then you can work back to the second year, and eventually the first year, to give you the framework for what you need to accomplish in the next 12 months. I suggest you do it with your managers. It makes them accountable to the organization since they are involved in the formation of the plan.

Your plan must be a living document to be used frequently during team meetings throughout the year to see how you are performing as a team and individually. This is not a process you invest in to review at year-end to see how you performed. By then it’s too late. It must be reviewed on a consistent basis to make sure everyone is on track. Performance management is so much more than just a year-end performance review. If there are individuals who are not performing against the plan, you can use the plan as a tool to performance manage them to re-engage as an important member of the team. 

I just returned from the Scale-up Conference in Denver and learned so much about taking goal setting and performance management to a whole new level by adopting the "Rockefeller Habits," as written by Verne Harnish. After reading the book, everything changed for me in the way we will be doing our planning, goal setting and performance management forever. It’s so brilliant and easy to understand. Here they are:

Rockefeller Habit #1: The executive team is healthy and aligned

Rockefeller Habit #2: Everyone is aligned with the #1 thing that needs to be accomplished this quarter to move the organization forward

Rockefeller Habit #3: Communication rhythm is established and information moves through the organization accurately and quickly

Rockefeller Habit #4: Every facet of the organization has a person assigned with accountability for ensuring goals are met

Rockefeller Habit #5: Ongoing employee input is collected to identify obstacles and opportunities

Rockefeller Habit #6: Reporting and analysis of customer feedback data is as frequent and accurate as financial data

Rockefeller Habit #7: Core values and purpose are “alive” in the organization

Rockefeller Habit #8: Employees can articulate the key components of the company’s strategy accurately

Rockefeller Habit #9: All employees can answer quantitatively whether they had a good day or week

Rockefeller Habit #10: The company’s plans and performance are visible to everyone

Accountability is no longer hard to measure since the entire plan is visible to everyone throughout the organization. Each part of your team should have key people accountable for every functional part of your organization. No more guessing is required. I’ve read countless books about leadership, performance management and goal setting, as I’ve been an avid student on the subject for decades.

These ten habits, once adopted and measured regularly, can change any organization that wants to grow and scale, and keep everyone accountable along the way.

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