In 2010, Randy Gaboriault left an industry that thrived on innovation to answer the call of another that “had not incurred disruption in decades.” Healthcare, he believed, offered him an opportunity to “reshape it from my backyard,” and he accepted. Five years later, Gaboriault is leading a top team at Christiana Care that is focused on creating a ‘true community health record’ and harnessing the power of predictive analytics to improve outcomes. In this interview, he talks about the major IT plans on his plate, what he believes are the core competences of health care, what leaders should mean to their teams, and what surprised him most about the CIO role. He also discusses the innovation challenge that was issued to his team, and the trend that CIOs must work to reverse.
Chapter 3
- Transitioning to an “entirely new business model”
- Core competencies of healthcare
- The “Holy Grail” of patient engagement
- Identifying the “ticking time bombs”
- Background in manufacturing — “I don’t fit the mold whatsoever.”
- Biggest challenge for CIOs
- His role as “energy source and the communication leader.”
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Bold Statements
It’s building an entirely new business model on top of a business model and an operational engine that has to continue to perform and perform very effectively.
If you’re really driving in value-based medicine and pushing hard-wired science through a process, a core competency of the organization becomes, ‘we have to be able to very quickly assess, digest and diffuse science through a process totally different than the way medicine has been practiced in the past.’
As we think about really the large ecosystem of information, about how we can actually help people and identify them at risk and earlier, and then use engagement tools to help them and help us accomplish a shared outcome?
Healthcare is an industry that has a lot of information, but it’s one that necessarily hasn’t integrated, put together, and leveraged the information that has available. So those factors all were very energizing for me to say, ‘I can come in and actually reshape the industry from my backyard.’
We should be very focused on delivering an exceptional experience for people as they move through, and we should be generating an organization that has strong vitality and that’s able to reinvest in capabilities, competencies, and talent to be able to continually produce that in a very consistent way.
Gamble: As far as some of the other big priorities on your plate, I know you’re looking at a lot of analytics and some of the other things we talked about. Anything you could think off of the bat that’s something that’s very big on your plate right now?
Gaboriault: Clearly for us, as probably with a lot of organizations, it’s the transition into building the new capabilities to perform very effectively in a value-based commerce framework. It’s building an entirely new business model on top of a business model and an operational engine that has to continue to perform and perform very effectively in today’s model. So that squarely clearly falls into the number one priority as an organization and a lot of these things fall in an orbit thinking about analytics, information integration, HIE exchange, patient engagement—all these other components start to become what I define as the new core competencies that we actually have to create in healthcare.
An example of that is thinking about really hard-wiring the best known science into health pathways or specifically a care pathway, and how do you begin as an organization when there’s published literature. Historically, it’s up to each individual provider to effectively catch up with peer-reviewed literature, individually assess what might be clinical findings, and make a determination of whether to embed those types of changes into their practice. So when you think about the new core competencies, if you’re really driving in value-based medicine and pushing hard-wired science through a process, a core competency of the organization becomes, ‘we have to be able to very quickly assess, digest and diffuse science through a process totally different than the way medicine has been practiced in the past.’ I find that incredibly energizing for us, and IT falls directly at the center of enabling a lot of those new core competencies.
Gamble: You mentioned patient engagement — that’s another model we’re seeing really transform as far as the patient’s role in his or her care, and the change that’s going through.
Gaboriault: I totally agree. It’s the holy grail of getting someone to effectively engage, understand, and effectively be able to have some degree of self-management or active participation in defining what’s the important outcome for themselves, but actually helping navigate with a set of tools and a set of partners of themselves to that intended destination over some period of time. And it becomes really important when, from my standpoint, you start thinking, okay, we’re going to take on a population of patients in a risk-based model. You start to even think about engagement at a really basic level, which is if I own a patient population, maybe a commercial population or a Medicaid or Medicare population — if I take on a population of people and I now own your risk, I am responsible for your healthcare dollars, whether you actually ever engage one of our providers or not, whether you ever cross the threshold into one of our facilities or not. If you’re taking a trip to Florida and you’re in an auto accident on the way in South Carolina, we are incurring 100 percent of your cost.
So it really begins to challenge your thinking about how do you start to engage patients from an awareness perspective of 1) we’re here and we’re paying attention to what’s important to you,’ and 2) we’re going to engage and have a different level of conversation about health. And then that same model means how do you begin redesigning the provider tools and the capabilities they need to have and what become different core companies for them and how do we redesign their care and the care teams and the people that supplement the provider. It’s really energizing to think about how you begin to drive a tremendous change to a totally new business model.
Gamble: That’s a good way to think about it, because I’m sure it can be daunting, but it’s also exciting to be part of this type of transformation.
Gaboriault: Yeah, and obviously there will be lots of interesting technology components, and we’ll push a lot of these technology components and lots of things will take place outside the four walls. Effectively, the perimeter of the four walls of the hospital or the provider office are dissolving. When you start to think about engagement as well, a huge piece for us is going to be using the analytic information to actually help us figure things out. If you look at it from a couple of dimensions, you have a set of population or people that when they’re sick, they really do engage and they become consumers and they research information. They’ll make very active choices about the provider.
And then you have others that as they get sick don’t have even awareness — how do you start to identify where those people might be, because they’re the ticking time bombs that effectively are going to disclose their illness through an acute episode. And so as we think about really the large ecosystem of information, about how we can actually help people and identify them at risk and earlier, and then use engagement tools to help them and help us accomplish a shared outcome?
Gamble: These are really interesting times, for sure. In terms of your career path, you’ve been at Christiana since 2010, correct?
Gaboriault: Right. I’ve been here five years.
Gamble: And then prior to that, you had some experience on the vendor side?
Gaboriault: No. I came from a completely different place — highly atypical for what would come into health services. I came out of global manufacturing engineering and distribution basically producing products, and so I have a history of working in a handful of different industries, everything from the manufacturing of aircraft engine components to medical devices, all on a global scale. And so coming into health services, I am absolutely atypical in terms of processes and variation reduction. When I look at a readmission, I look at that as a process of something that in other industries could be, ‘Is that a warranty issue that’s taking place?’ So I have a completely different background coming into health services. I don’t fit the mold whatsoever.
Gamble: When you mentioned about units for thousands before thinking that does sound like a different perspective. What was it that made you get interested in taking up on this kind of role?
Gaboriault: Obviously, it was a few different components, including having a young family and ideally looking to reach a point where my travel was not as intense as it was for many years. But the big factor in moving into a role in health services is that this is an industry that effectively has not incurred real disruption in decades. For me, I’m energized by the big mega change and industry shift and moving an industry and an organization to a very different place as well. Health services was not disrupted for a long time. The fact that it was going to be absolutely driven, enabled, and powered by information technology makes it very exciting.
All businesses, if you really think about it, are information management businesses. Healthcare is an industry that has a lot of information, but it’s one that necessarily hasn’t integrated, put together, and leveraged the information that has available. So those factors all were very energizing for me to say, ‘I can come into this industry and actually reshape the industry from my backyard.’ It’s really powerful that you can have the ability to do that in healthcare, just reshaping industry from your seat. You don’t have to be sitting at a national level to be able to do this, and that’s really empowering for me and for my team and everybody that I’ve recruited to work with me here.
Gamble: Did you have any moments early on where it hit you how different healthcare is than other industries you’ve worked in?
Gaboriault: Yes. There are additional layers of complexity that exist. I came out of very highly regulated manufacturing industries when you’re producing medical devices, when you’re producing aircraft engine components, when you’re producing transportation-related stuff. The quality of the product has got to be very high, because if there is an issue, the scale of which when you have products distributed throughout the world can be very significant in a material way. So yes, there’s a lot of complexity.
Obviously, HIPAA is one component of something you need to power through when you’re really thinking about how do we innovate and do things in a different way when it comes to lifting patient generated data and how are we going to move that information. What probably hit me the most is the amount of accepted variation that exists in American healthcare, and realizing that the answers lie often within the information that’s there and the ability to think about how healthcare’s configured where you got free agents, the reimbursement structure that exists — how to actually generate a platform for change and get all of the participants aligned. There’s additional levels of complexity there. All of these are important components as we all get around and look at the same problem. Everybody can sort of get behind in realizing that got to navigate for each individuals or politics as well, but I look at the examples of building up and standing a statewide health information exchange in place.
There are a lot of differences, but at the core, if I’m a patient and I’m entering a system and all of us have a one-on-one chance of interacting with healthcare system — and I’m at a point in my life where I’m also having to navigate through eldercare challenges, as well as having a child that has a chronic disease and having to navigate that — when I enter a system, I absolutely want, and demand, frankly, that we should be getting the best science. We should have a shared objective in terms of understanding what is the optimal health position for that individual, whether it’s me, my child, or my parent. We should be very focused on delivering an absolutely exceptional experience for people as they move through, and we should, along the way, be generating an organization that has strong vitality and that’s able to reinvest in capabilities, competencies, and talent to be able to continually produce that in a very consistent way.
In American healthcare we still have a long way to go, but as I think about things, I think about how are we starting to build these capabilities now, realizing that we’ll be in a likely 100 percent value-based model of care here in five to ten years. What capabilities do we have to create and begin to straw-man now and then become really exceptional at defining what become the strategic, differentiating, competitive things that we will do better than anyone else, and then how do we actualize those and then scale them.
Gamble: Right. Always looking down the road, but then at the same time, you’re looking at every experience from the eyes of the patient and the caregiver too. It’s really interesting how you have to keep that all tied together.
Gaboriault: That’s true, but it’s an ensemble of bringing things together, and that’s where architecting clear strategy plays a role in an organization; that you create a shared set of challenges and a shared destination that’s aligned. Effectively, as a leader, driving and activating the belief throughout the organization to be able execute on those, and then being the energy source and the communication leader to constantly navigate the organization and the resources to that destination.
Gamble: I can’t really think of a better way to wrap things up. Unless there’s anything else you wanted to touch on, this has really been so interesting. It’s been great to hear about all the work your organization is doing, as well as some of your own experiences. So I want to thank you so much for your time.
Gaboriault: Great, Kate. Thank you and I appreciate the time.
Gamble: Sure. I know that our readers and listeners are going to enjoy this. Hopefully, we can connect down the road and possibly even meet in person at some point.
Gaboriault: Superb. Thanks, Kate. Have a great day.
Gamble: Alright, thank you. You too.
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