When Jeff Pearson stepped into the CIO role at Trinity Mother Frances, Epic changes were in the air. The organization had started its journey toward an integrated system by selecting Epic, and now it was time to get down to business. Walking into a situation like that, according to Pearson, required a great deal of confidence — both in his own abilities, and in the senior leadership team. In this interview, he talks about what it was like to take the helm during such a “hectic” time, why Trinity opted to go big bang instead of using a phased approach, and the enormous benefits of having physicians who are very much engaged. Pearson also discusses the need for CIOs to be able to talk tech and business, and why he believes in the power of scarcity.
- Collaborating with BS&W on population health
- Leading a staff of 135
- His strong team of directors
- “There’s power in scarcity.”
- Reflecting on the past 2 years — “The organization has absorbed a lot of change.”
- Trinity’s 5-year strategic plan
- Learning from Northwestern Memorial
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We’re not yet under overwhelming pressure to work in an ACO-based environment, and so we’ve got the luxury of doing some of these pilots for ourselves and getting some learnings before it comes crashing down on us in a wave.
I need to be able to speak fluently about technology to my staff and have credibility with them, and I need to be able to speak fluently about business needs and requirements with the management team and translate between the two.
Sometimes the worst thing you can do is have the resources available to you to add a new system or to add a bunch of new people before you really thought through how you want to use them or whether some of your existing systems could do that job.
We’ve worked with consultants who have come in and helped us drive out costs and identify throughput improvements in the organization, but we need to become internally capable of doing that and sustaining those changes.
Gamble: What about accountable care — are you doing anything on that front or are you looking at it in the future?
Pearson: We’re not doing anything that is defined as accountable care, specifically as it relates to a particular pilot program or pioneer program or anything like that. But we have been involved in population health initiatives in general with various payers who have come to us and said we need to manage our providers and we’d like you to pay you per member per month to make sure that our patients are getting quality outcomes. We think there’s some shared savings potentially there. So I think it’s been a bit of testing ground for us on accountable care, as well as for some of those payers. We’ve been doing thosefor a few years.
We’re also trying to do our best with our own self-insured population of our dependents and employees to make sure that we’re keeping our employee health costs down, and we use our systems to help us manage those patients too. We have a collaboration also with Baylor Scott & White in which we’re implementing a product called Explorys. That product was originally intended to give us insights into managing our respective self-insured populations and see how we compare to each other in certain measures, and then see how we can learn from each other’s best practices in order to improve in those areas. It’s certainly not an ACO, but it’s a population health management opportunity for us. We’ve only just implemented it. We’ve only now started to make use of the data, but already we found it to be a pretty powerful tool, and we hope to license it to further leverage it across our entire patient base, not just employees and dependents.
Gamble: Right. It’s a good place to start.
Pearson: Yeah. In east Texas, we’re not yet under overwhelming pressure to work in an ACO-based environment, and so we’ve got the luxury of doing some of these pilots for ourselves and getting some learnings before it comes crashing down on us in a wave.
Gamble: Right. I want to switch gears a little bit and then talk about your leadership style. What size IT staff do you have?
Pearson: Trinity Mother Frances’ overall staff is about 135. Those are the people that work for me. We have a fair amount of what are termed shadow IT and analysts inside the lab and radiology and so forth managing some of those systems, as well as in our surgery system. The bulk of it is within my area, and that’s primarily broken down by applications and technology.
Gamble: Okay. Being at a large organization you have a large staff, so I can imagine that obviously there are a lot of advantages there, but is it also difficult having this really large staff? How often are you in communication, and are you somebody who has to be a little more hands-off? How does that work as far as managing a pretty large staff?
Pearson: My style is pretty collaborative and it’s also pretty delegative. I tend to think my strengths are more on the analytical side and thinking big picture, and synthesizing that big picture — both the IT big picture, as well as trying to make it match up with the organizational big picture. And the other thing I need to be able to do is I need to be able to speak fluently about technology to my staff and have credibility with them that I know what we’re talking about, and I need to be able to speak fluently about business needs and requirements with the management team and translate between the two and be able to explain to them concisely what technological limitations we might have in achieving something that they want to make a high priority or something to be done quickly, and when that’s maybe not feasible. I also need to make sure that my team is always on the same page with the business requirements and be able to explain that to them in a way that’s aligned with their spheres of expertise as well.
I have very strong directors, as I’ve mentioned, so I give them a lot of discretion on managing their teams and managing their work tasks for the week. As long as we’re all very clear on what the organizational priorities are, I think that can really work. My key role is to negotiate the resources that they need to have, whether it’s staff or budget, and of course I also have to bridge that with the fact that we have limitations on our organization’s resources, and I have to keep those in line. That’s the eternal struggle there — trying to balance all of that.
Pearson: I tend to believe that there’s power in scarcity. Sometimes some of our most creative work comes when we’re getting the job done with limited resources. Sometimes the worst thing you can do is have the resources available to you to add a new system or to add a bunch of new people before you really thought through how you want to use them or really thought through whether some of your existing systems could do that job and with a lower level of integration and really get creative and think it through and say, ‘You know, we can really do that.’ Or say, ‘maybe we shouldn’t that now. We’ll do that later, and by then, this system will be in a better place to do something like that and we can do it ourselves.’ And so I don’t think it’s always a necessarily bad thing when you’re constrained. I think it really does make some folks find a way to do their best work. Obviously, you try and do that without stressing people out and pushing them over the edge.
Gamble: That’s a really good point, and I think it’s true in so many aspects of life that when you have less resources, you’re going to get the most out of what you have. You have to kind of fight for every dollar, but then you also have to really get the most out of everything, and it’s not always a bad thing.
Pearson: This is the reality of healthcare spending. Our organization has had its ups and downs, and we’re in a good place now, but last year was a bumpy year after our implementation. We need to build up our nest egg and just have to keep our nose down and do the best we can with what we have until we’re in a better place to find those opportunities for growth.
Gamble: Okay. So now it’s been just about two years, and it’s been a pretty busy two years, and an interesting time for you at Trinity.
Pearson: The organization has absorbed a lot of change, and as I said before, I’ve been very pleased with the extent to which that change has been embraced by the operational folks and the clinical folks.
Gamble: And that’s such a huge part of it too. You can take on all these projects, but you need to make sure that people who work for you and with you are able to absorb all of that. Alright, well, we’ve talked about a lot, and I don’t know if there was anything else you wanted to cover, but it sounds like you’re doing really great work there at Trinity, and it’s really beneficial for people around the country to hear about what you’re doing and how you’re doing it.
Pearson: I guess the one remaining piece to what we’re trying to do where some growth needs to happen within our organization is around the area of analytics. It’s probably the biggest outgrowth of my team necessary for me. Now that we’ve implemented EMR successfully, we need to be able to use the data that it produces, and we need to use that to drive the business and hook it up with other data and get all the insights we can out of it.
We also need to put together a systematic approach to doing process improvement in the organization, and we are working to drive an executive role to sustain some of that. We’ve worked with consultants who have come in and helped us drive out costs and identify throughput improvements in the organization, but we need to become internally capable of doing that and sustaining those changes. The people who are going to come and do that won’t be in IT; they’ll be operational folks, and they need the kind of data that our team can produce in order to identify the right course of action and where our opportunities lay. And so the expectation is that I ramp up that capability to be very responsive to that group’s needs as it gets formed. That’s an area where we are staffing ourselves and trying to organize ourselves to.
At the same time, our organization is undertaking a business strategy engagement to set forth a five-year strategic plan, and I’ve made sure that aligned with that is a strategic IT plan to make sure that we don’t do one of those in the vacuum from the other, and that will help us determine the ultimate right size of the organization and the right size of the IT organization. And in this analytics area in particular, I’m looking forward to using that as a method to really drive the best structure for that, and some of the best tools that we can use for that, because we don’t have an enterprise data warehouse. We have Epic’s tools, and we have this access to this Explorys system, which could potentially really be very useful in understanding our organizational data. But as far as whether we need something more than that, the data warehouse space is still to be determined.
Gamble: Right. Do you talk to the organizations that you partner with or do you get outside feedback from other organizations that are similar to yours just to see what they’re doing?
Pearson: I am open to any conversation. It was a big focus for me at HIMSS this year to spend time in the vendor booths, but also to talk to my peers as I ran across them and hear their approaches and outcomes. We’ve talked to some of these vendors that we’ve been working with and we’ve talked to some of their reference customers as well, so we really are trying to piece together what’s the best option and direction. We spent some time with the folks up in Chicago at Northwestern Memorial Hospital who have a very robust and mature process improvement team in place that we’re really trying to model ourselves after. They have done some interesting things with analytics there as well to support that, and so we’re learning from them too. So yeah, I’m happy to engage anyone I can to give us some insights in this area.
Gamble: Yeah, that’s obviously a common thing. It seems like one of the most helpful things you can do is identify an organization like Northwestern and have those conversation and say ‘Okay, this is what they’re doing — how are they doing it? What’s their strategy?’ I’m sure that’s very helpful in this day and age.
Pearson: Right, and also recognizing that technology changes over time and there are tipping points in which the ability to bring some of this data into memory in a way that was not cost effective in the past has become much more cost effective. There are some tools out there that can really serve as an on-demand data warehouse approach in a way that really was impossible before. What folks had to do was build some very comprehensive data warehouses with some really lengthy lead times and investments; we may end up realizing that we can skip over some of the technology and approaches simply by starting a little bit later. Sometimes there is that advantage.
Of course the old comparison in this area is the infrastructure in Africa and how without having plain old telephone system technology in place originally, a strong mobile telephony and cell phone infrastructure has risen that in many ways surpasses the way we use that as extensively in the United States. So sometimes there are some benefits to being late to the party.
Gamble: Yeah, absolutely. That’s a good example. Well, I’d definitely like to check back with you down the road to see how everything’s going. Obviously, you guys have a lot in the hopper and it will be great to catch up and see how the next year or so has progressed for you.
Pearson: It will be my pleasure. I’m curious myself about how it will turn out.
Gamble: I want to thank you so much for your time, I appreciate it, and it has been really interesting to hear about your journey so far.
Pearson: Great. My pleasure.
Gamble: Well, thank you and I definitely will check back in and see how things are going.
Pearson: Okay, Kate, thanks for your time.
Gamble: Thank you.
Pearson: Take care.