The healthcare system has its share of issues, some of which will take years to fix, and some — like the amount of inefficiency embedded into processes — that can be solved much sooner, according to Chuck McDevitt, CIO at Self Regional Healthcare. McDevitt sees a great deal of potential in implementing Lean methodologies to drive down costs and boost patient satisfaction. In this interview, he talks about how his organization is using evidence-based medicine to streamline processes, the challenges of straddling the ACO and fee-for-service worlds, and the cultural change taking place within Self Regional to improve employees’ health. He also discusses integrating the acute and ambulatory environments, his device management strategy, and how he is applying lessons learned from working in other industries.
- The benefits of strategic planning retreats
- The HIT workforce shortage and staff management
- Bringing lessons from other industries into healthcare
- Leveraging Lean to streamline processes
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We get together and look at all the issues that are facing the industry and the hospital and set our strategic plans for the next three years, and then we try to use that from an operating perspective each year as we do the budget and the goals.
It’s hard to get people to move here. Having to sell your house seems to big issue for a lot of people in terms of migrating, but we have seen the same thing that every other hospital has seen. It’s taken 60 to 90 days to find the right candidate.
I think if you’ve always worked in healthcare and never been out of that space, it’s hard to see. We’re so patient-focused that we want everything to be an individual event and yet at the same time, we’re actually doing a disservice to people by not trying to streamline it and look at it from a perspective of, ‘Would a customer pay for this?’
If you can take the variation out of it, at the same time you actually get people in and out of the hospital faster, which makes sense because they don’t want to be here — and you can make it better without taking away the individual care.
Lean, Six Sigma, everything associated with Baldrige — all of that is really trying to improve quality, and I think that’s what the government is really trying to do with Meaningful Use. If you look at it, they’re trying to standardize care.
Guerra: You mentioned going on a strategic planning retreat. Tell me what that’s about. Do you think that’s very common or is it maybe not as common as it should be?
McDevitt: I’m not sure how common it is. I know it’s something that we’ve always done. Every three years we get the administrative team, we get our board and probably about 10 of our physicians in terms of medical leadership and then we spend basically a Thursday night dinner, a Friday and half a day Saturday together. Just to keep the cost down, this year we’re going to Greenville which is about an hour from Greenwood. And we just get together and look at all the issues that are facing the industry and the hospital and set our strategic plans for the next three years, and then we try to use that from an operating perspective each year as we do the budget and the goals.
Guerra: Do you think that’s much better than trying to do it in the normal workflow at the hospital? Do you think getting away really helps?
McDevitt: Yes I do. And I think I’ve only been with Self Regional for the last six years, so for me, the last one I went to was roughly three years ago and it was pretty successful. That document has actually held up in terms of what we’ve used it for during the last three years in terms of our goals. We didn’t get everything right but we got a big part of it. I think it’s probably even more important now with everything we’ve got coming at us in terms of having a consistent strategy.
Guerra: Do you think three years is good or do you think it could be an annual thing, maybe if it was streamlined a little bit?
McDevitt: I think we could do it annually too, but we do update and refresh it every year as part of our annual budgeting. We’re a Studer hospital, so we focus on people, growth, service, finance, and quality — the five pillar goals. We tie those goals to our strategic plan and then our projects are tied to those pillar goals.
Guerra: How many people do you have on your team?
McDevitt: About 68. I’ve got nursing informatics, biomed, and telecommunications, and then probably have another 60 people in health information management. Medical records also reports up to me, so I’ve got probably 120 all total, but about 68 on the IT side.
Guerra: One of the things that the industry is facing is a workforce shortage, especially IT folks who’ve got some clinical experience and knowledge. Do you have open positions you haven’t been able to fill? Is your staff kind of strained? A lot of CIOs tell me that their staff is getting overworked and there’s going to be some burnout and they’re going to lose some people, especially to other opportunities in the vendor community or with other providers — mostly the vendors and their consultants. There are salaries out there that can be paid that hospital can’t match. But what are your thoughts overall touching on those things in terms of managing your workforce?
McDevitt: Sure, it is a challenge these days. We do have a couple open positions, and being in a rural setting with a beautiful lake nearby and a lot of people that were born and raised here, it helps retain people to this community. But it also hurts us in trying to get folks to come to the community in terms of not knowing much about us, and so it’s hard to get people to move here. Having to sell your house seems to big issue for a lot of people in terms of migrating, but we have seen the same thing that every other hospital has seen. It’s taken 60 to 90 days to find the right candidate and typically it’s somebody from another organization that has a job today, so it’s a challenge.
Guerra: Right. I guess it’s easier to sell your house if you don’t mind taking a loss.
McDevitt: Yeah, that’s for sure.
Guerra: Let’s talk a little bit about your past work. You had mentioned that you come from manufacturing. I looked at your Linkedin profile; you were at a place called Synovus for a couple of years, which it says is financial services, and then you worked at Goodrich Aerospace for seven years, which is kind of interesting. Tell me a little bit about those roles and what, if anything, you were able to bring that you learned in those other industries to healthcare?
McDevitt: Sure. I was with Synovus Financial for about three years in Columbus, Ga. We managed the technology operations for a group of about 41 banks and about 350 branches across the southeast. We had the network operations center and the servers and all that technology. It was an interesting opportunity; banking is a little bit ahead of healthcare but not much. And then in manufacturing I worked at a plant level with Goodrich — the wheel and brake division — in Ohio for five years before I moved down to the corporate offices in Charlotte. And there I was in charge of any of the technologies that basically crossed divisions. Goodrich Aerospace at the time had 26 divisions around the country, so it was a lot of rapid change as we tried to consolidate and streamline the approach to technology, intranet and Internet in terms of common look and feel.
And so I think the thing that I can help bring that to healthcare is the lean background and the cost savings on the process side, because I think if you’ve always worked in healthcare and never been out of that space, it’s hard to see. We’re so patient-focused that we want everything to be an individual event and yet at the same time, we’re actually doing a disservice to people by not trying to streamline it and look at it from a perspective of, ‘Would a customer pay for this?’ ‘What’s value added and what’s non-value-added?’ ‘What’s non-value-added but necessary?’ and trying to use evidence-based medicine. You can make processes consistent and more streamlined where there is evidence-based medicine and actually do a better service by taking some of the subjectivity out of it, but without losing that individual care — the care of a physician and a nurse that is watching that. But if you can take the variation out of it, at the same time you actually get people in and out of the hospital faster, which makes sense because they don’t want to be here — and you can make it better without taking away the individual care.
Guerra: So the goal, you would say, is too, as much as possible, put the templated approach; that streamlined, assembly-line approach onto things, as far as you can take it without sacrificing care and without eliminating the customization and necessary variability.
McDevitt: Yeah I think assembly line is probably not the best choice of words, so I think evidence-based, standardized processes — Lean, Six Sigma, everything associated with Baldrige — all of that is really trying to improve quality, and I think that’s what the government is really trying to do with Meaningful Use. If you look at it, they’re trying to standardize care; they’re not trying to keep people from being treated better than the standard, but trying to make sure that we’re all adhering to the standards and looking at the same care.
Guerra: So when you look at it from the beginning of the experience to the end, there are some areas that are sort of removed from the care process — just moving patients from one floor to the next, doing the billing, checking, etc.
McDevitt: Sure, registration and everything — there is so much opportunity there that wastes time and frustrates patients. That’s more the stuff that I’m talking about. So you have more time to spend with the patient on the individual care.
Guerra: And that’s where you can apply a lot of Lean principles, right?
McDevitt: Yes, definitely.
Guerra: Chuck, it’s been a great conversation. Is there anything else that you want to touch on in addition to the stuff we covered?
McDevitt: No. I was hoping to talk about ACOs and some other stuff, you gave me a lot of chance to talk about that and our strategy there, and I think we actually managed to make a good circle through most of healthcare. It was a good discussion; I enjoyed it.
Guerra: Well thank you so much, Chuck. I appreciate your time today and I hope to work with you again in the future.
McDevitt: Sure, if I can ever do again, let me know.
Guerra: Have a great day, Chuck.
McDevitt: You too.