When Luis Taveras took over as CIO at Barnabas Health in December of 2013, the goal was simple: help transform the 9-hospital system into a high-performing organization. How to make that happen, however, wasn’t so straightforward. And so before he took any action, Taveras asked for 90 days to get to know the organization, the people, and the processes.
What he found was a health system that acted as a collection of separate entities, and an IT department that existed in silos. After identifying this as one of the key challenges, Taveras worked with leaders across the system to craft a long-term strategy that would enable the organization to achieve operational excellence, which required three pillars: standardizing process and tools, enhancing knowledge management, and consolidating operations.
Of those, the most difficult was to create a unified IT organization built on the ideas of centralized decision-making and frequent communication among team members. The first step was to establish a governance model in which each individual hospital has a site director who acts as an advocate for that facility. “We needed clearly defined roles and responsibilities,” said Taveras. “It was a major cultural shift.”
Next came a formal submission and evaluation process to help IT leadership more effectively track service requests. “Now, business and clinical owners present the business case for IT products — not IT,” he noted. “There’s no more shadow IT, and I’m not surprised anymore.” With the new procedure, if a product or service is IT-related, the requestor must show that it was approved. As a result, Barnabas has been able to transition out of “fire-fighting mode” and into “planning mode,” said Taveras. “We’ve made huge progress in the last 18 months. We went from being a reactive organization to moving much closer to operational excellence.”
With the early challenges out of the way, Taveras and his team can now focus on increasing efficiencies, driving down costs, and most importantly, leveraging IT to improve care quality and the patient experience.
Q&A With Luis Taveras, SVP & CIO, Barnabas Health
Gamble: You talked about having 90 days to develop a plan. How did you come up with that concept?
Taveras: I spent a lot of years in the consulting world, so I’ve done this a few times for other organizations. The difference is that as a consultant, you set these plans and you walk away, and other people are left holding the bag and implementing it. In this case, it’s my plan, and I have to implement it. That’s a big difference.
Gamble: Coming into the organization, you knew there was going to be a big transformation. What were your feelings about taking such a complex project?
Taveras: I knew it was going to be a challenge, but that’s what I love. What would drive me crazy was if I had to sit here with nothing to do. I wanted a thousand things to do, whether it was IT or other things.
Gamble: You talked about creating longtime operational and strategic plans. Based on your past, it seems like something you feel fairly comfortable with as far as putting together a road map.
Taveras: Yes, very much so. This is very similar to the situation I worked in at Hartford HealthCare, and in so many places across the country when it comes to health care systems, because we’ve all been down the same path with transformation; we’ve all taken disparate entities and tried to put them into a system. And typically what you see is a federate model where they have 10 hospitals, but they all operate as individual hospitals. The value comes when you operate as a single integrated system, and you change the model from a federated model to a real integrated model where everyone is working toward a common goal, and you build these organizations — IT, financial and HR — into a central services organization. That’s where you’re going to get the leverage to behave like a system. A lot of people say ‘we’re a system,’ but they don’t behave like a system. This is what you have to do to behave like a system.
Gamble: Is that how Barnabas was before as far as having different CIOs and acting as individual entities?
Taveras: It was very much a federated model, like many organizations. They weren’t getting the value of being a system.
Gamble: How did you approach that role of coming in and introducing so much change? I imagine it was difficult.
Taveras: The key to that is making the changes, but making people feel like they’re making those changes with you. If I went around and told people, ‘from now on you have to fill out this form and you have to do all this,’ it wouldn’t work, because people would feel like I’m imposing things on them. Instead you have to go around, get everyone to collaborate, explain to them the idea — but don’t put anything on paper yet, even though you know what you want. Don’t go with it like it’s baked. Make sure they’re engaged in the process of developing what the plan is, because then people have a sense of ownership. It encourages collaboration and it encourages informal communication — all the things you want. So you can’t come in and try to change something by forcing it on people. It really is working with people to make those changes together. And that makes it a lot easier, and a lot more enjoyable.
Gamble: You implemented a 7 a.m. roll call that is held every morning. Why did you feel this was important? And was it met with resistance at first?
Taveras: Oh yes. When the message came that I was going to start 7 a.m. calls, at first, people said, ‘What? No way!’ But now they’re all used to it. As a matter of fact, one of the things we’re emphasizing now is that if you’re taking the day off, don’t call at 7, because it’s your day off. People think they need to call even if they’re not here. So I’m trying to set an example — when I take the day off, I don’t call. And we’re making good progress with that.
Gamble: Let’s talk about the CIO role, which is continuously evolving. I read an interview where you compared it to being a general manager — that’s an interesting concept, and I wanted to get your thoughts on that.
Taveras: It very much is. I look at it as a general manager with a specialty in IT. I can step into a lot of different roles in the organization, but my specialty is IT. But it is that general manager concept — I can’t know the nth degree of everything that’s going on in the organization. I have to trust that I’ve put the right people in place to do that, and I strongly believe I have. We have a strong leadership team, and that filters down to the rest of the organization.
The feelings of people in the organization today are much different that they were when I got there 2 years ago. We do a lot of things. We have picnics to get people more involved. The first Friday in May we have an in-person, all hands on deck meeting where we all get together. That never happened before. They dealt with each other on the phone for projects and they knew who each other were, but they never got together for a day of discussions and planning. We do it now, and it’s two-fold. In the morning we have meetings and in the afternoon we all go bowling, and that creates that sense of camaraderie and teamwork. We do that as much as possible.
Also, I try to keep a pulse of what’s going on in the organization. On a quarterly basis, I have lunch with 10 folks who are randomly picked just to see what’s happening out there. It gives people an opportunity to not only speak with the people they work with on a normal basis, but also to let others across the entire leadership team know what’s going on.
Gamble: Transparency is very important to you, it seems.
Taveras: Absolutely. A lot of people feel comfortable approaching me and talking to me about what’s going on, because they realize there’s not going to be a punishment for it. We need to communicate. We need to understand what’s going on. I have weekly leadership meetings where I go through exactly what’s going on across the organization.
At the end of the month, we include not only my direct reports, but all site directors in that meeting, because they need to know everything that’s impacting the organization. It sounds like a lot of meetings, but it’s really not. These meetings are critical with what we do in that time frame, because everyone has to know what’s going on — what contributions they’re making, and what contributions they need to make.
Gamble: When you look at the push toward population health, one of the big challenges is being able to focus on everything you’re doing now, while also looking at what’s coming down the road. How do you approach that?
Taveras: We need to be thinking 5-10 years down the road and what is healthcare delivery going to be like then. I can tell you it’s going to be a lot different, and I tell my staff that in the next 12 months, you’ll see more changes than you’ve seen in the last 5 years. That’s exactly what’s happening. And every new 12 months brings that much more change — and these are changes that are going to result in better patient care, which is what we’re here for. But it is a major transformation. The line between health insurers and health providers is being blurred — who’s going to be what?
We have to go through that and say, what is Barnabas going to look like 5 years from now and 10 years from now? And we have to do that from an IT perspective and say whatever it is, we’re going to go down that path and support the organization. Because the more these strategies evolve, the more everyone realizes that there’s no accomplishing them without having IT right next to you. We’re becoming such a critical component of the organization going forward — and every day more and more.
Gamble: It’s going to be interesting to watch the patient’s role start to take shape more.
Taveras: That’s the big part. When I meet with the major providers of solutions out there, one thing I ask is, ‘when are you going to start to think differently?’ The way we have designed, developed, and delivered solutions has been very hospital-centric. We need to change that and become very patient-centric. So don’t build strategies and plans and solutions from the hospital-out; think of them from the patient-in.
Who are the big players out there that focus on end users and patients? Those are the folks I’m talking to for a solution 5-10 years down the road, because they’re going to have the best solutions. The patient is finally going to be king — they should’ve been a long time ago, and we need to make sure we address those needs from the patient perspective. It’s a whole different way of thinking for us, but that’s the way we have to think. I’ve been talking about consumerism in healthcare for the last 25-30 years, and it’s actually happening now.
Gamble: Another major item on your plate is the pending merger with Robert Wood Johnson University Hospital.
Taveras: We’re still going through the regulatory approval process, and that takes time. The big difference is we’re not talking about a hospital coming into a system. We’re talking about two major systems having a merger. This is as a true merger of two organizations. It’s absolutely far from any type of acquisition, and you can see that in the name: RWJ Barnabas Health System.
Gamble: Could you have pictured doing something like this a few years ago? It doesn’t seem like the organization wouldn’t been well-positioned for that.
Taveras: That’s the key. We have to position ourselves so that we can handle whatever the changes are, and the stronger the position you’re in, the more you’re able to handle changes. Because those forces may bend you a little, but they won’t take you down. If you’re weak, those forces will take you down. We’re strong financially, we’re strong from a leadership perspective, and we’re strong from an organizational perspective, so we can handle any changes that are coming to us from the feds, from the local environment, from within. We’re in a strong position, and it’s great to be dealing with these issues and these forces from a strong position. We’re fortunate.
And it’s taken a lot of work from key members of leadership to get us to that position. Five or 10 years ago, my understanding is we were not in that position, but there’s been some strong leadership and forward thinking that have put us in the great position that we find ourselves in today. I’m thankful to them because I’m reaping the benefits of the hard work they’ve dome in the last few years.