Gut Check Time: What It Takes to Maintain Continuity During A Major Change

It’s no secret for those inside or outside of our company — Partners HealthCare System is going through significant change. Like all healthcare providers, we are adjusting to the changes in the payment system and our local market demands. Two years ago, we signed a contract with a systems vendor, ending a long era of developing our own clinical systems, although we’ll build extensions to the system and continue our history of academic innovation. To date, we have two hospitals live with our new revenue cycle system and are working toward our first clinical go-live at one of our AMCs in May 2015.

We have always taken pride in all levels of our technology stack, but CIO Jim Noga made it clear: “It was hard enough when one of our hospitals had a problem in the past. With this enterprise system, we’ll have the ability to take out all of our users at once.” In response, we have built a dedicated environment for our new vendor product and its complementary applications. We also built a second complete replication for disaster recovery and plan to run for six months in one data center, then six months in the other to exercise the equipment and our cutover processes. We have been blessed with capital for this. In addition to the systems, we are also replacing one of our 30 year-old data centers (on Boston Harbor, near a LNG terminal) with a state-of-the-art facility west of Boston.

That’s the context. All of that is terrific, but we can’t provide consistency for our clinicians and patients without our employees. Many of us have worked at one of the hospitals or for Partners HealthCare for decades. These changes in the external and internal environments required a gut-check. Would we maintain status quo, which arguably served millions of patients well, or would we raise the bar to another level?

It’s not like operating budgets are expanding — particularly with the capital expenditures I’ve described above. Employees, managers and leaders have had to look inside ourselves and ask whether we we’re prepared for these new challenges. I’m happy to say that, with few exceptions, people have risen to the occasion. In addition to day-to-day operations, we have built the new vendor environments and kept our technology refreshed.

IT professionals know that change management is key to high availability. We certainly had change management processes in place; in this new world, we have change management on steroids. I’m not saying we are perfect, but that we have the attention of all ranks of the organization. When it comes to the new EHR platform, our CTO, Steve Flammini and I approve every change. Steve is brilliant and has deep technical command of our myriad systems and infrastructure. Our staff people are monitoring every layer of the technology stack proactively and raising the flag, even if the infrastructure is expected to handle compute or I/O spikes. We are in continuous process improvement mode.

At the beginning of the year, Brigham and Women’s Healthcare hired a new CIO, Cedric Priebe, MD. Cedric is the consummate professional who brings experience, a calm demeanor, and toughness. He suggested that we commence a “daily operations call,” where our IS Administrators On Call spend 15 minutes or less each workday reviewing Major Incidents from the previous day along with any major changes expected in the coming 24 hours. We are a month into this practice and it has not only raised awareness of change, but also fostered collaboration amongst teams.

I began my current role at Partners three years ago. Like any new job, it’s been a learning experience and has kept me extremely busy. I’ve been in more meetings and have spent less time with front-line staff than I would have liked. I learned the discipline of “Leader Rounding” from Quint Studer of The Studer Group. I’ve spent a lot of time over the last three years feeling guilty that I was not meeting the best practice of rounding on staff, finding out what’s going well, giving rewards and recognition, and asking if there are tools they need to get their job done.

Fortunately, I have been able to re-establish this habit over the last quarter and have been very pleased. When I get the chance to interact with front-line staff, I find people who are incredibly dedicated to our mission. Their job function requires many of them to be awake or at least on call at all hours of the day, night and weekend. At least some benchmarks would say that we are understaffed in some of these areas, but I see cooperation and support amongst the staff. It’s clear that there is not only deep technical expertise, but also good humor and genuine appreciation of each other.

We are still maturing on the ITSM/ITIL framework, but it’s clear to me that our staff are deeply engaged with our mission and connect their work to the outcomes of our patients. We have great hardware and software, but this staff commitment is the linchpin of making sure our systems are there for caregivers and patients.