For Sajid Ahmed, the chance to build a new hospital and provide care to more than a million underserved patients was too good to pass up. But it wasn’t going to be easy. In order to succeed where the previous facility was (very publicly) shut down, MLK Community Hospital would have to do two things: expand care outside the four walls and leverage technology to improve outcomes. In this interview, Ahmed talks about what it will take to achieve those goals, why he believe culture is the most important innovation, and the challenge of going big bang with an EHR before workflows were established. He also discusses his “no fax machine” policy, the trap many hospitals fall into, and the one thing he would’ve done differently.
- Best practices for hospital design
- The silo trap
- Creating a new care management model
- Chief Innovation Officer — “I want to build a culture of innovation.”
- Blurring the lines between health and IT
- “We begged, borrowed and stole best practices.”
- 5 value words
I would’ve brought in people who had nothing to do with hospitals, maybe people from the technology side that are outside of healthcare. I would have brought in someone from Google, someone from Facebook, and someone from social work. I would have brought in different types of people to help expand our thinking design and see what else we could have done to support the hospital.
We are habitually siloed in our design; that’s how healthcare and hospitals think. They think in silos. They think, ‘biomed does this,’ ‘nursing does that,’ etc. They design the hospital with puzzle pieces that have been developed in siloes, and then try to put it together.
I’m trying to blur the lines so it’s not just, ‘here’s a computer, fix it.’ We’re part of that delivery of care. We’re part of that thinking. We’re part of that management. It’s not just some doctor saying, ‘I think we should do analytics; let me help you out.’ We’re part of the decision making. We’re partners in the delivery of care.
In opening the hospital, we begged, borrowed, and stole best practices from anyone and everyone. We cut, posted, and modified their policies, and now we’re going through another cycle updating and refining those policies as our workflow and our culture develops.
I think it will be one of the great innovations if we’re able to embed the right culture. Because at the end of the day, people and culture drive everything. You can have the most antiquated hospital, but if you have the best people and the best culture, they can any technology, any facility work.
Gamble: Can you offer any best practices for leaders are building a facility from the ground up?
Ahmed: Sure. I’ve done this a few times, and when I reflect back and think about what we might’ve done differently, I really believe that we did the best we could with what we knew at the time, which was nearly four years ago. When I came on board in February of 2013, all we had were plans.
Our strategy was good, our intents were good, and our execution was great. But if I could do anything differently, I would’ve been more involved in innovation and design thinking, both of which are passions of mine. Being an entrepreneur, I was interested in innovation long before it was the ultimate buzzword. I would have expanded the pool of people who were tasked with coming up with the strategy and the design of the hospital — both from a technology perspective and a clinical perspective. Specifically, I would’ve brought in people who had nothing to do with hospitals, maybe some people from the technology side that are outside of healthcare. I would have brought in someone from Google, someone from Facebook, and someone from social work who has nothing to do with technology. I would have brought in different types of people to help expand our thinking design and see what else we could have done to support the hospital.
I think I missed that opportunity for a few reasons. I know the folks at Kaiser’s Innovation Center and I did get to involved them in the process, but not as early on as I wanted to. Outside of Kaiser — which really has innovation down — the healthcare industry, especially the hospital side, falls into a very basic trap.
Around the time I came on board, there were already 30 consultants hired by the interim CEO, who had been hired by the seven-person volunteer board that had been in place, and they had been working at this for about a year. I inherited the technology group and the construction group, and I looked at the group of consultants and how they were put together, and there were siloes. We are habitually siloed in our design; that’s how healthcare and hospitals think. They think in silos. They think, ‘biomed does this,’ ‘nursing does that,’ etc. They design the hospital with puzzle pieces that have been developed in siloes, and then try to put it together.
When I came onboard and as we added a CMO, CMIO, CFO, etc., we changed the model so that when we designed Cerner, as an example, we designed it for care coordination and care management so that nothing was done in siloes and no data was siloed. We created the first model in California that had care managers for every patient type, for every acuity. We had the opportunity to do something brand new and said, let’s push the barrier. No one outside of Kaiser was building brand new facilities with all the support. No one had designed a brand new delivery system with a brand new organization in probably 40 or 50 years.
That was the initial handicap that I didn’t recognize. So in hindsight, if I did it now, I know exactly what I would do and how I would do it. I would open-end the whole thing and bring in people from Kaiser and outside of healthcare. I think we still have the chance to do that the outpatient clinics. We’re really now masters of our own destiny, with a mission to support the community. So I think more innovation is possible, both on campus and in the community.
Gamble: And you actually have ‘innovation’ right in your title.
Ahmed: Yes, that’s by design. There are a few of us now. I met Jake Dorst, who’s the chief innovation and information officer at Tahoe Forest Hospital District. A lot of people are curious about the role. What it means is that I’m highlighting innovation. I want to bring a lot of innovations on campus, but I also want to bring a culture innovation to the hospital with my colleagues and staff. So when I wrote my job description, I made that title. I didn’t want to just be the CIO of a hospital, which in and of itself, is very challenging. I’m new to the hospital administration world, and when I went through the CHIME Boot Camp, I learned a lot — they do an amazing job. One thing I learned is that CHIIME found that less than 25 percent of hospital CIOs reported to the CEO. Most of the CIOs and directors of IT reported to the COO or the CFO, in part because they thought of is as purely a support function or a cost center. I think you know that healthcare is one of the last industries — and hospitals are a subset of that — to really embrace health information technology.
I don’t have an IT department; I have a health IT department. That’s what I call it, and one of the reasons is because I’m trying to blur the lines that we’re not just ‘here’s a computer, fix it.’ We’re part of that delivery of care. We’re part of that thinking. We’re part of that management. It’s not just some brilliant doctor saying, ‘I think we should do analytics; let me help you out.’ We’re part of the decision making. We’re partners in the delivery of care. But I think for CIOs at some hospitals — not all, of course, some are doing amazing work far beyond my availabilities — it’s been a challenge to get noticed.
At Cleveland Clinic, for example, all of the C-suite members, with the exception of the COO, are physicians. That’s the mindset, and I’m not disparaging it at all, but it’s not for everyone. I like to think of myself as both an insider and an outsider — I spent a lot of time outside of healthcare but always had a foot in the door. I was part of the dot-com era when startup companies could get $10 million with a business plan on a piece of paper. I’ve gone through the immature days to the structured, mature best practices days, and so, clearly, we’ve seen a lot of change.
Going back to best practices, once we put together a full-time, dedicated leadership team, we scoured best practices. We visited a number of facilities, both locally and abroad. We went to Fisher Titus in Ohio to look at their all-digital hospital and learned lessons from them. In opening the hospital, we begged, borrowed, and stole best practices from anyone and everyone. We cut, posted, and modified their policies, and now we’re going through another cycle updating and refining those policies as our workflow and our culture develops.
Opening the hospital was phase one. Arriving at the one-year mark this past summer was another phase, and I think we’ve got another year before we reach full maturity. I feel very excited about the opportunities.
Gamble: It’s a great story, and I think it’s going be fascinating to see what you’re able to do, both in terms of improving population health in the community, and making innovation part of the organization’s culture.
Ahmed: Actually, one of the greatest innovations that we’re still working on, and probably will be working on for a while to come, is culture — building and sustaining a strong culture. When we reflect on the old hospital, we believe what killed it is culture; bad culture, or lack of a consistent culture. And we don’t blame everyone. A third of the staff population were truly great workers. Another third were people who did their job but didn’t quite excel, and the remaining third were people who either polluted or colluded with a negative culture.
So when we were laying out plans, we devoted a lot of time to basic behavior and culture. What is the culture we want at the hospital? And we’re still working on it. We’re still defining it. We’re still refining it. We’re still figuring out how we can sustain it. We have five value words that apply both to our goal of providing high quality care to our patients, and our goal of supporting our staff. We hone in on those five words — caring, collaboration, accountability, respect, and excellence — by commending the behaviors that fit within those words, and managing the behaviors that are in conflict with those values. I think it will be one of the great innovations if we’re able to embed the right culture. Because at the end of the day, people and culture drive everything. You can have the most antiquated hospital, but if you have the best people and the best culture, they can any technology, any facility work. That’s what it comes down to.
Being a technologist, I’m all into the cool gadgets and devices. And biomed reports to me as well, so I’m into the medical technology side too. But at the end of the day, it’s the teams and the people that make it all work.
And so if anyone asks what our greatest innovation is, I can mention all the cool technologies, but the innovation we’re working on most is our own culture. And that includes a culture of innovation as well — the broad culture. It’s all about high quality, high touch, high tech care. High quality refers to the delivery of care, and high touch means making sure we gauge the patient at a personable level and treat them as our customers. And of course high-tech means we’re not shy of technology and we want to figure out how to use it to support those first two.
Gamble: Great. Well, it sounds like you guys are building something incredible, and I look forward to hearing more about your journey in the future. Thanks so much for your time, and best of luck going forward.
Ahmed: That sounds great, I’d love to speak again down the road. Thank you!