Kristin Darby, VP & CIO, Vanguard Health Systems, Chapter 2

As one of the regional CIOs at Vanguard Health, Kristin Darby is tasked with guiding the IT strategy for seven hospitals located in the Chicago and Boston areas. It’s a role that requires a lot of juggling, and constant communication — which Darby facilitates through “huddle meetings” with the staff. In this interview, she talks about the work her team is doing to enable data flow between facilities, increase patient engagement, and lay the groundwork for ACOs. Darby, who was named one of Boston Business Journal’s Top 40 Under 40 in 2010, also discusses the key advantages in being part of a large system, the changes she is seeing in physician acceptance of EHRs, and why community involvement is so important to her.

Chapter 1

Chapter 2

• Shared-savings ACOs in Chicago & Boston
• IT as facilitator
• Hosting “get to know you events” for docs
• Managing hospitals in two cities — “We have strong director levels at both locations”
• Huddle meetings & videoconferencing
• Targeting 95 percent CPOE — “Our providers have been extremely receptive.”

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Bold Statements

What we want to do is to make sure that as those relationships naturally happen where patients start to follow from a referral pattern perspective, that the connectivity to support that is there in place.

We’ve found ways to effectively communicate across geographic distance in a way that still makes everyone feel like they’re all sitting together and that the communication is flowing and everyone’s aware of what the priorities are.

That’s really what we want to encourage; making sure people are working to their maximum and feel empowered to not only recognize things but solve them, and continue to move the agenda along.

Who is committed to the project? Who isn’t? Is somebody not understanding? You can see all of that immediately when you’re utilizing video. That doesn’t always come across on a call.

We’ve taken a significant amount of time with the governance and content analysis process prior to go-live to ensure we had buy-in — not only with the provider community, but also making sure nursing and all other support services were at the table and part of everything that was being developed and deployed.

Gamble:  You mentioned ACOs. What kind of work are you doing there? What phase is it in at the different locations?

Darby:  The ACOs in Illinois started a little earlier than Massachusetts, which was just launched in January 2013. They are both shared savings ACOs and I would say still are very much in the infancy of development from a strategic perspective around the data of population management and leveraging that. So far those ACOs have proven to be successful, but I think we have a long way to go toward achieving optimal management of our populations. That really comes into having that strong network of doctors aligned with the hospitals to really share that responsibility for caring for the patient, and then leveraging the data that is gathered as part of that process in a way that positively impacts the population that we’re managing.

What we’re trying to do from a technology perspective is start to increase connectivity between all of our providers and the hospital to make sure that data exchange is happening. Secondly, make sure we have the common elements of storing that data so that we can leverage that information in a way that allows us to effectively manage that population. A lot of the intelligence that are really going to allow ACOs to be successful and differentiate themselves from other ACOs is how they apply that intelligence to the analytics that they’ve gathered through the populations that they’re managing.

Gamble:  Right. That’s a huge part of it. Even with getting an ACO off the ground, which we touched on a little bit before, you really have to have that buy-in from the physicians and the understanding that this is going to take a lot of effort. Are you seeing that physician practices are really willing to put in that work and are looking at the long-term possibilities of ACOs?

Darby:  I think it’s very mixed. We have some physician offices that are absolutely on board and tend to be the leaders in any type of adoption effort, and there are others that are still learning what it means to be a part of an ACO. And so a lot of what we’ve been doing is trying to educate and ensure that providers understand the benefits. It’s also about making sure that providers know each other to naturally build that network of PCP-to-specialist or specialist-to-specialist referrals with trusted colleagues that they know will provide the best quality of care to their patients. We’re behind those efforts trying to make sure that the connectivity supports that. What we want to do is to make sure that as those relationships naturally happen where patients start to follow from a referral pattern perspective, that the connectivity to support that is there in place.

Gamble:  That’s a great point you made about physicians actually getting to know each other. How can you kind of help that along? Are there meetings you set up, or is there someone you’ve put in charge with this responsibility?

Darby:  Our organization has tried to be a facilitator as much as possible. And so we have different affiliations with other organizations where we host dinners, continuing education events, and different things that get providers together and allow them to network and meet individuals and colleagues that they might not have previously had an opportunity to meet, and get to know and understand how they can support each other when the needs arise to address the care of a particular patient that is within their population or at their practice.

The biggest thing is that those relationships and the awareness of each individual allow them to know who the appropriate individual is to refer their patient to. From a technology perspective, I think what’s important to me is making sure that I am there watching those developments happen. So we’re continually prioritizing where we’re putting our efforts from a technology perspective to ensure that the connectivity is there as those natural referrals happen as a result of the awareness and relationships that are being formed across these provider communities.

Gamble:  Now with having locations in two cities, how does that work? If you’re spending more time in Boston, do you have somebody in Chicago who is a go-to person for this? I can imagine there are challenges in keeping track of everything that’s going on with these two different environments.

Darby:  Absolutely. There is a strong director level at both facilities that are there to ensure that day-to-day operations continue to run effectively. In addition to that, if there are any pressing, urgent needs that need to be handled within the market, there are extremely capable individuals that are on site and can be immediately responsive to those needs.

Gamble:  I would think that from your point of view, you have to see things at a high level, but then you also need to know what’s going on at the more granular levels.

Darby:  Absolutely, and there are a few things we do to facilitate that. I’m very big on huddle meetings and getting the groups together to discuss what’s happening at each of the facilities and what our priorities are for the week, and making sure everybody has an opportunity to communicate across the group. Our teams are spread out at multiple physical locations so we tend to do most of our huddle meetings via telephone, and then individuals at each location tend to gather in a conference room so that there is a group together. But we’ve found ways to effectively communicate across geographic distance in a way that still makes everyone feel like they’re all sitting together and that the communication is flowing and everyone’s aware of what the priorities are, because those priorities certainly sometimes shift week to week based on what the business priorities are and the operational needs within each of the facilities.

Gamble:  It makes sense to me just because you don’t want to have meetings just for the sake of having meetings, but when you have these huddles and you encourage people to communicate, they’re more likely to actually pick up the phone and talk about an issue, or if they’re in the same facility to go face to face. I think it’s important to encourage that.

Darby:  It’s critical, especially when people aren’t necessarily sitting next to each other. What’s always important for the teams is to make sure that everyone feels empowered to always speak up and that everyone knows what each other is working on, because frequently there are overlapping dependencies, and communication helps draw all those out. It’s important that everybody is working together in a very collaborative open approach. I think that with those elements, people tend to be much more successful and can solve problems often on their own, without any type of escalation. That’s really what we want to encourage; making sure people are working to their maximum and feel empowered to not only recognize things but solve them, and continue to move the agenda along. As leadership we’re there certainly to support that and facilitate that, but certainly we want to make sure that everyone is able to work at their maximum ability.

Gamble:  It’s amazing how technology has changed the game and made it so much easier to communicate — not just by phone, but using the different methods you talked about, like videoconferencing. It’s a lot more effective sometimes than just putting it down in an email.

Darby:  Yes, absolutely. Quite a few years ago, I worked for a large organization that had a national focus, and I had teams in eight different cities. We started using video at that time; we used to call it the Brady Bunch meeting because we all had our own cube but it was amazing how much you can understand. They say roughly 80 percent of communication is body language. Immediately you start to see that and you understand comprehension. Who is committed to the project? Who isn’t? Is somebody not understanding? You can see all of that immediately when you’re utilizing video. That doesn’t always come across on a call.

In my most recent organization I did a lot of offshore contract work and noticed cultural differences. Oftentimes I found that the staff wouldn’t speak up, whether it was because they didn’t feel it was appropriate to raise that or it was just a cultural difference, but they wouldn’t speak up. We started using video because we were having breakdowns, and this way we could immediately see that the person on the right hand side of the table didn’t understand and drill into that until we had that two-way conversation going that allowed us to confirm that there was comprehension and we could move forward. That was extremely effective, so I’m very supportive of doing that. Nowadays most of us all have geographically dispersed teams, and it’s certainly an effective way to operate.

Gamble:  That’s great. Just seeing the expression on somebody’s face sometimes can save a lot of time if you can pin down right away that this person has a concern, and you can work through it.

Darby:  Absolutely.

Gamble:  Okay, so I wanted to talk about a few more of the many projects you have going on. As far as CPOE, where are you with that? What kind of adoption are you seeing, and what plans do you have for expansion?

Darby:  So within Massachusetts, we are utilizing CPOE across our inpatient areas with the exception of the Center for Women and Infants, OR, Pediatrics, and Behavioral Health. We’re actively in the process of rolling it out for behavioral health, but all other inpatient departments are utilizing it. We’ve taken a significant amount of time with the governance and content analysis process prior to go-live to ensure we had buy-in — not only with the provider community, but also making sure nursing and all other support services such as pharmacy were at the table and part of everything that was being developed and deployed. And with that, we’re somewhere between the 97 and 99 percent utilization rate, which is phenomenal.

Our target within our facilities is 95 percent CPOE utilization — really leaving telephone orders only to those extreme exceptions that are necessary to support patient care. Our providers have been extremely receptive of that. To that end, certainly there are many things we do such as remote connectivity and different types of ways of making it easy for them to get access to support the utilization of CPOE. But we’ve had fantastic adoption rates. In Illinois, we’re utilizing CPOE in all of our EDs, and we’re in the process of planning the deployment across the remaining four facilities at all of the inpatient areas, probably starting in the next two to three months.

Chapter 3 Coming Soon…