A year into its large-scale EHR implementation, the newly formed Hawaii Pacific Health system was experiencing some serious growing pains. In fact, it appeared that CIO Steve Robertson had an Epic failure on his hands. But instead of killing the project, he and his team reevaluated the situation and decided to focus on driving out waste. As a result, the organization got back on track. In this interview, Robertson talks about the organization’s seven-year Epic journey, their innovative ACO work, how he is leveraging in-house talent to optimize systems, and the core values that guide him. He also discusses micromanaging, what it’s really like to work in Hawaii, and the best advice he ever received.
Chapter 3
- Staff retention
- Using in-house talent for Epic rollout
- Clearing up misperceptions: “It’s not laid-back at all.”
- Work-life balance, accountability & transparency
- “Delegation is the most empowering thing of all.”
- Early lessons learned — “Steady course and speed.”
- Chasing your tail
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They got trained and certified in their applications and they became very knowledgeable. You can just imagine what we’ve been able to get out of that, just through improvements and optimizations of the systems that they now thoroughly understand.
People are always surprised and say, ‘I thought when I came from California to Hawaii that you guys would be laid back.’ They’re caught off guard by our intensity to our mission and getting the job done and holding ourselves accountable.
I tell the staff, ‘You need to spend at least 10 percent of your time managing your boss. If you’re getting micromanaged by your boss, then you deserve everything you get.’
Until you go in and tidy up that house so that the information flow is more consistent — so that you get a more accurate picture and you’re able to get claims out the door and paid efficiently — everybody is going to be chasing their tails.
Stop trying to chase every bit of information that’s coming down the path and just slow down, steady course and speed, and you’ll come up with a more reasonable solution.
Gamble: In terms of your key staff members and the administrative team, has there been a lot of turnover, or have you had a lot of people in place for a while?
Robertson: We have had some turnover that’s a little higher than usual. When I first came to health IT in 1998, the average tenure of an IT staffer was about four years. Today it’s more than 10 years, so that speaks volumes. But for some positions there is a bit of high turnover — probably less than the national average, only because the marketplace here is kind of captive.
At HPH, we really have a strong philosophy of not brining in consultants. When we did our Epic implementation, we had very few consultants. We took people from operations and made them permanent members of the project team. For example, the project manager of the hospital billing group was the operations director for hospital billing. So they became the IT project manager, and then we backfilled those positions. We paired them with formal PMO project managers as well. They got trained and certified in their applications and they became very knowledgeable. You can just imagine what we’ve been able to get out of that, just through improvements and optimizations of the systems that they now thoroughly understand.
Gamble: Right, the philosophy of using resources that you already have and giving opportunities to people — that can really pay off.
Robertson: That’s right.
Gamble: I imagine it’s a different circumstance when you need to recruit positions, being based in Hawaii. I’m sure it has its challenges and its benefits.
Robertson: Hawaii is one of the most expensive parts of the country to live. So as a rule, we try to hire locally as much as possible. We will recruit from the mainland as well on occasion, but inevitably, people who come here realize that the cost of buying a home is significant. I think the medium cost is something like $650,000 — maybe more than that. And most people feel they have to send their kids to private school, which runs about $18,000 a year. It just adds up and it becomes impossible.
Gamble: And then you also have the plusses though of a different lifestyle.
Robertson: That’s right. It really is paradise. I don’t know if you’ve been out here before, but the average temperature is in the high 70s. There are no snakes, there are very few mosquitoes, and there’s always a nice trade wind blowing. It’s always a sunny day somewhere on the island. I intend not to ever leave. I’ve been here a total of about 28 years.
Gamble: Where were you before then?
Robertson: I was pretty much all over, because I was an army brat. My parents and many generations come from Alabama, although I’ve never lived there. But I’ve lived in Georgia, Florida, Louisiana, and even France for a year. I was born in Heidelberg.
Gamble: That is interesting. And you have no regrets, obviously, about going to Hawaii.
Robertson: No, absolutely not. I came here as a nuclear trained submarine officer. I get off the plane to meet my submarine and I got that first blast of air at Honolulu Airport, and I looked around and there were flowers and greenery and I felt like I had just stepped into paradise. It really is like that, and it stays with you.
Gamble: That’s great. I’m trying to get a sense of the culture at your organization. Maybe it’s hard to compare it to what it’s like in other areas, but is it somewhat laid back?
Robertson: No, not at all. I’m sure it’s not like New York or the East Coast, but as I mentioned to you before, I get in at 6:30. We have a culture of family and work-life balance; we really believe that, and we really preach it. We really, truly do. We put a lot of weight and emphasis on our corporate culture — for example, we’re members of Studer, and we’ve earned national awards for being a best place to work. We do Gallup polls. When you look at the leadership evaluations, there’s one part that’s based on how well you’re doing from an employee engagement point of view measured by Gallup surveys, and so we measure our overall level of employee engagement, and we try to drive that needle to the right as much as possible.
In our particular organization, I think people are always surprised and say, ‘I thought when I came from California to Hawaii that you guys would be laid back.’ They’re caught off guard by our intensity to our mission and getting the job done and holding ourselves accountable. I would say that work-life balance, accountability, and transparency are absolutely part of our core values.
Gamble: There’s something to be said, I think, for making sure that when you are work, you have a certain amount of intensity and focus, but then when you’re not at work, you’re able to let go of that. A person who does that can be really productive.
Robertson: That’s right. I tell my managers who constantly work weekends — and I know it’s a harsh thing to say, but I really do believe it — that if you’re working weekends, I can only conclude one of two things. One is that you’re incompetent and you need all that time to do the work that anybody else would take 40 or 50 hours to do, or you’re just coming in to work because it’s your security blanket because you’re insecure about your position here.
Gamble: Maybe it is harsh, but I agree with it. You should be able to get everything done during the week. It’s not always easy, but you should be able to get it done.
Robertson: I’m always amazed at the contradiction that some managers have. They think they need to do a certain level of work, and therefore do not delegate. But they don’t realize that delegation is usually the most empowering thing of all for the staff. Giving staff additional work or responsibilities is always going to be a better play than trying to do it yourself as a manager. It doesn’t mean that you need to be lazy, but the staff will always find a better, more efficient way of doing things than any manager, and any manager left to their own devices who is not doing that or is being managed by the staff will absolutely run amuck over time. I also tell the staff, ‘You need to spend at least 10 percent of your time managing your boss. If you’re getting micromanaged by your boss, then you deserve everything you get.’ Okay, enough soapbox talk.
Gamble: That’s all right, we like that. So the last thing I wanted to talk about is in terms of technology, healthcare is still behind other industries. Do you see that changing? If so, what’s it going to take for healthcare to be able to leverage technologies that other industries are able to use?
Robertson: Yes, I do see that. I know that when I first started, technology was about 20 to 25 years behind the time. Now we’re probably about 10 years behind, but it is improving. It’s like having a cluttered house; it’s a pig sty and a mess. Because of the complexity of the information that hospital systems need to run with, until you go in and tidy up that house so that the information flow is more consistent — so that you get a more accurate picture and you’re able to get claims out the door and paid efficiently — everybody is going to be chasing their tails so much that it’s going to be hard for anyone to really look at newer, cooler, and better technologies. You do see some systems that are able to do that but I guarantee you that you can go to a different part of the organization and spot huge inefficiencies in their supply chain or in their revenue cycle systems.
Our approach is to first clean up the house. Do the work that nobody likes to do; the work that’s not very sexy but has to be done to drive efficiency, so that you can do the cooler things later. As systems begin to drive out costs through accountable care-like activities, you are going to see a lot more technology being applied to patient engagement and out reaching to post-acute care facilities or long-term care facilities. That level of integration is going to require interfacing with glucometers, blood pressure devices — everything you could possibly imagine. I would love to be able to have a complete suite of biomedical equipment in my home enables me to go check up on my health at anytime. I would especially love that for my parents; hopefully they won’t need that kind of assistance, but if they do, I’d like to be able to have that and have the information immediately available in an EMR so that care is really a joint partnership between the patient and the doctor and the family.
Gamble: It’s a matter of cleaning up the waste first.
Robertson: Yes. One of the best lessons I ever got in my life happened while I was a submarine officer on a fast-attack nuclear powered submarine on a special operations mission somewhere off the coast of the Soviet Union. I was officer of the deck, and I thought that I’d been counter-detected by a Russian submarine. I began doing all kinds of maneuvers trying to shake the guy, and no matter what, I could not shake him. So I called the captain to the control room. The captain pops up and he walks around the control room, goes into sonar, looks at the displays, looks at the plotting table, looks at the fire control system, and he comes back to me, looks me right in the eye, puts his hands on my shoulder and he says, ‘Steve, steady course and speed.’
I immediately order steady course and speed, and then he pulls me to the back of the control room and he says, ‘Steve, you are chasing your tail.’ I looked at him and said, ‘But that’s impossible, Captain. I’ve got all these indications.’ And then he said, ‘If something looks impossible and is so complex as this, then it’s not real.’ Basically, stop trying to chase every bit of information that’s coming down the path and just slow down, steady course and speed, and you’ll come up with a more reasonable solution. And he was right. The contact immediately disappeared. It was not real. I think that sometimes healthcare is like that. It’s so easy for us to get constantly distracted. It’s better to maintain the longer-term goal of where you really want to be and then ignore everything else as you hit that target. But it takes a lot of confidence.
Gamble: Yeah, sure. Sometimes it takes someone to help you along and kind of pull you away for a minute.
Robertson: That’s right.
Gamble: This is such an interesting time, as I’m sure you know from spending so much time in the industry, and there are so many opportunities out there. I think it’s going to be really interesting to see what happens down the road.
Robertson: This is absolutely the best time to be in healthcare information technology because of the challenges and how quickly things are changing. I would not change my job for anything.
Gamble: Well, thanks so much for providing your insights. It’s been really interesting speaking with you and gaining your perspective. I appreciate your time.
Robertson: Thank you, Kate. I appreciate the opportunity to talk.
Gamble: Sure thing, and I hope we can talk again down the road.
Robertson: That sounds great. You have a good day.
Gamble: Thank you, you too.
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