Since she started at Summit Health in 1993, Michele Zeigler has witnessed significant change, and learned that the only way to navigate a journey as complex as electronic transformation is to follow a roadmap. In this interview, Zeigler talks about the long-term IT strategic plan her organization recently formulated, which includes new data and IT governance, and how her team is leveraging lean processes to improve not only the selection but also the utilization of new technologies. She also talks about the importance of leadership buy-in, hitting restart on ICD-10, the Summit Health app store she hopes will increase patient engagement, and why volunteering is more than just a hobby.
- 90-plus interviews to improve strategic planning — “50 percent talked about data.”
- Data & Analytics Governance Committee
- Creating dashboards — “It’s an exciting journey.”
- Plan, Do, Study, Act
- The art of customization—“We only have so many resources.”
- Taking Aspen’s model & ‘Summitizing’ it
- Patient & provider engagement survey
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What we really wanted to know is how do you use our tools, what do you want from us, what are we doing well, what aren’t we doing well, and where do you think the needs are? I think 50 percent of the interviews talked about data.
You can actually drill down, twirl around, and get to subsets of the data or look at it in different ways. It’s an exciting journey to see people have real-time or near-time data at their fingertips, because that’s something that we struggled to do.
We weren’t going to have them look at a patient and say, ‘Well they’re inpatients, so let’s do it electronically. This one’s outpatient, so let’s do it on paper.’ We went 100 percent live. And that took a lot.
It’s not all about technology. Sometimes it’s about a process or a common phone number to call for information for all sites, or something as simple as that.
Zeigler: As we went through the IT strategic planning process, we did over 90 interviews of groups and individuals and we even did patients. Because what we really wanted to know is how do you use our tools, what do you want from us, what are we doing well, what aren’t we doing well, and where do you think the needs are? I think 50 percent of the interviews talked about data.
Senior leadership approved the new governance process and included data governance. It’s called the Data and Analytics Governance Committee, and actually reports into the Summit Senior IT Steering Committee — they’ve been meeting for about six months. And we’ve identified our key performance indicators. Senior leadership assigned them to do a senior management dashboard, and we have a new board committee for quality, and they assigned us a quality indicator dashboard for that committee.
In the last two or three weeks, we’ve been doing a little dog and pony show to a couple of the committees to say, here’s the draft of what it’s going to look like. But we found that not all the data we collect and need to report comes out of our core systems. Some of it is stuff that people manually capture, and we’ve had to go through a process to validate the accuracy of the data — how it’s being collected and how it’s being stored. And we’ve really created some efficiencies for folks so that we can collect things in an efficient manner and store them in consistent areas so that we can automate the reporting process.
We’ve also create a lot of standardization with how our dashboards look, how our meta data repository is documenting, where is our source of truth for each key performance indicator, and the data elements that make up that key performance indicator.
It’s been an interesting new journey. We started out with one process that we thought we were going to use in the data and analytics governance committee for problem-solving teams, and as we got our first couple of problem-solving teams established around these two dashboards that we were assigned, they quickly determined that our process needed to be tweaked a little bit. It’s been neat to see it evolve.
There’s a lean activity called Plan-Do-Study-Act. You plan it one way, you do it, you study what worked, and then you act on the things that didn’t. That’s really what we did. What we started out with has now morphed into something that’s even more efficient. If we didn’t do the Data and Analytics Governance Committee, I think our dashboard and our QuickView tool would have been stuck. Because it really establishes who’s your process owner or your business owner for your key performance indicators, and the whole process of validating and testing data before it’s published; ongoing ways to review key performance indicators and to add them.
Right now we have so many requests for dashboards, and they almost become many applications because of the analytics that you can do on top of that. On top of just having the data presented to you, you can actually drill down, twirl around, and get to subsets of the data or look at it in different ways. It’s an exciting journey to see people have real-time or near-time data at their fingertips, because that’s something that we struggled to do without this tool for many years.
Gamble: That is really interesting. It certainly seems like it’s an evolving process and that you’re open to say, let’s change what we have to do to make it better. Do you ever get worried that there can be almost too much input coming in and do you have to draw the line as far as what you’re going to tweak and what you’re not going to tweak?
Zeigler: Yes. You do have to have some stabilization, and that’s where we said let’s try this process with our first three problem-solving teams. And the problem-solving teams were around our key strategic initiatives of improving the patient experience, affordability, and quality. They use the process. That was the agreement. Use this to develop your key performance indicators, and while you’re doing it, keep in your mind how does this work and how can we make it better.
But we weren’t constantly tweaking it while they were doing it. You try it for a cycle and then we give input. We took it, we talked as a group about what we wanted to change, and then I worked with the data analytics group and we modified the process based on their input. And so we’ll take it to the committee and say, ‘this is what you said. This is what we interpreted. This is the process that you want to use going forward.’
The challenge that we’re having now is that so many people, as we’re starting to show this to committees, before I get back to my office there’s another request. What the senior IT steering committee is going to do this week is just take a look at all the requests and prioritize them based on the business and strategic needs of the organization. I guess that’s a good thing. People want it, but we just only have so many resources, and it’s not just IS resources. As we are learning, it takes time from the process owner side to make sure their metrics that they want to collect are being collected in a efficient fashion and it’s a repeatable process that we can automate and provide some efficiency to that process as well. So that takes time.
Gamble: What you just said about making these repeatable processes is key because the object is not have to reinvent the wheel.
Zeigler: Right. One thing we identified is these things were being stored all over the place. So what we did was create on our Intranet called Inside Summit a single location where all of this data is maintained. Now, because it’s on our Intranet, we know it’s backed up and we have the ability that if it gets pulled to a dashboard, what is also published on that dashboard is the last date that data was updated. If you look at something, you’re like, wow, that looks off, and then you see it hasn’t been updated this month. We go to our meta data repository and we look at who is accountable for that data and we do follow-up.
Gamble: In looking into some of the lean tools and techniques, what do you think has been the biggest benefit or the biggest takeaway from looking into that lean and maybe making some of your processes more efficient?
Zeigler: I think it provides us a common language that everybody understands. We have a core group of senior management or VPs that have the certification from Virginia Mason and then we have Summit lean system leader training which is pretty extensive. We have probably about 40 or 50 folks that have already gone through that, and we’re continuing to have those education classes. And we have a 3-hour overview session that we’ve provided to all the staff. I think it provides a common language, and so when we talk about documenting a process, it’s not a foreign topic to folks, where before we would really have to help people and then you could tell sometimes the folks that didn’t get it. We have no way of knowing everybody’s process, but you could tell at the point of go-live or shortly afterwards who did a really good job with it and who didn’t.
With certain implementations that had a high risk like CPOE, we made sure a lot of that was done, and we spent a lot of time on it. It took as three years to implement CPOE 100 percent — that’s in the ED, etc. When we took the surgical area live, it was inpatient or outpatient, because we weren’t going to have them look at a patient and say, ‘Well they’re inpatients, so let’s do it electronically. This one’s outpatient, so let’s do it on paper.’ We went 100 percent live. And that took a lot. We had to work through the anesthesiology process. We had to work through the surgical process. We even had to work through a process for those things that are ordered from the office or scheduled from the office. There are a lot of processes involved, and so it provides us that common set of tools, common language and framework to work with it. So it’s been good.
Gamble: Okay. You briefly mentioned Aspen before. What is some of the work you’re doing with them?
Zeigler: They did our initial IT strategic plan, and then they helped us with the actual data analytics committee and the governance of that, and some education on what’s a key performance indicator. They’re the ones that brought us their model for the problem-solving team. That’s what we started with, and then more or less we just Summitized it or made it our own.
Recently they started an assessment of our external website and our Intranet, and we did an internal Survey Monkey survey of our staff and all the associates about our Intranet. I was really pleased that we got probably a 30 to 40 percent response rate because this was over the holidays. I didn’t know how many people and plus our census was very high, but they just had really good input to how to make it better. Aspen is facilitating that process for us.
Shortly after we approved the IT strategic plan, one of the areas — patient and provider engagement — we determined that we needed more information about and more understanding of what some of that meant to different constituents. We engaged Aspen to do some additional interviews to take a look at some best practices to measure us against them. Based on that assessment, they helped the Senior IT Steering Committee see the things that we did have, but then looked at the things that we didn’t have. We prioritized the ones that were important to us and then turned them into about 16 projects, 14 of them were IS but two were just totally business process projects. So it’s not all about technology. Sometimes it’s about a process or a common phone number to call for information for all sites, or something as simple as that. And I say that’s simple but it’s not necessarily simple to do behind the scenes.