There are few things more daunting than dealing with a natural disaster; especially when you’re new to the organization, and the storm headed your way is a category 5 hurricane. It’s the type of news that would send any leader into a panic — unless the individual in question has quite a bit of experience with disasters. Like, say, being in a submarine during a tsunami. Or providing relief after a devastating earthquake. Or, perhaps most terrifying, having to testify before Congress.
Once you’ve weathered those types of storms — as William Walders has — it’s hard to be rattled. And so when Hurricane Dorian threatened the Florida coast (and ended up veering in another direction), he was ready. And Health First, which impressed him with its high level of disaster preparedness, was ready to focus on building a framework to enable better care, and a better overall experience.
Recently, healthsystemCIO spoke with Walders about his team’s core objectives, why effective communication is the basis for pretty much everything, his approach to professional development, and how his military career prepared him for the CIO role.
- New EHR as “a huge recruiting tool.”
- Top priority: “Creating discipline around IT business management”
- Data plumbing
- Goal to “support the IDN from an IDN level, not a point solution level”
- Competing with Amazon, Harris & others
- “What if we don’t train folks and they get complacent?”
- His early career as a submarine engineer with the Navy
- Seeking advice from former military folks on the “drastically different” landscape
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Standardizing that environment and creating discipline around IT business management has been my number one priority. And that means building a framework for basic blocking and tackling, having IT speak the same language, and providing transparency of the services that we provide.
We’ve increased the size of our enterprise architecture staff from three to 14 so we can build a framework, have a clear understanding, and support the IDN from an IDN level, as opposed to a point solution level.
I had started operating as a commercial hospital early on, which proved to be really helpful. I think that differentiated me from my peers.
What better way to understand what you own, and what you have, than by pulling every contract and looking at it? I spent a lot of time reading contracts and was able to have some big wins. If something doesn’t look right, you need to ask, ‘What is this?’
Gamble: I would imagine having an ambulatory solution that’s almost turnkey, as you said, can definitely be a physician satisfier.
Walders: It absolutely is. The new system has not only improved satisfaction among our existing physicians, but also the independent physicians in our community. It’s been a huge recruiting tool and is paying dividends by allowing physicians to gain access to the tools we offer in their practices.
Gamble: What are some of the other big objectives from an IT standpoint?
Walders: There are a few. We’ve grown immensely, and it’s been organic. We partnered with a health plan, we had an acquisition for a medical group, and we acquired hospitals, and everything got bolted on. As a result, IT came along with it — that’s the environment I inherited. Standardizing that environment and creating discipline around IT business management has been my number one priority. And that means building a framework for basic blocking and tackling, having IT speak the same language, and providing transparency of the services that we provide so that we can articulate to finance folks what we’re doing with the funds we’re entrusted with.
From a leadership perspective, it’s making sure we’re properly managing resources and having folks understand how they work together with services that are dependent on others. That’s number one — getting that framework in place.
The second is all things data. When I got here, data was in disparate locations. And, much like what happens in IT when people struggle to get a service, they’ll build it themselves or try some faction they deem to be the best way. I was blessed with the opportunity to aggregate all the disparate data and analytics cells. I say ‘cells’ because they weren’t as mature as departments at that point; they were more like centers of excellence among the IDN. And so we’re working to aggregate those.
Right now we’re in the assessment phase, or ‘data plumbing,’ which involves mapping where everything is and how it interacts, getting a clear understanding of that, and then creating a single visualization layer from where everyone can consume services. In the current state, they’re getting data from disparate sources and through inefficient means, the data is going out through different channels, and it may not be timely or even accurate by the time it gets done, just due to the disparate nature.
We’re also doing a lot around information governance and management. We have document management. We have a lot of legacy systems that need to be modernized, and all these things need to be compiled in enterprise architecture constructs. I’m calling it enterprise archaeology. We’re discovering a lot; we’ve increased the size of our enterprise architecture staff from three to 14 so we can build a framework, have a clear understanding, and support the IDN from an IDN level, as opposed to a point solution level. We’re really excited about that. Thankfully we were able to get funding. It was almost fortuitous timing; I came here right as we were having these conversations and was able to get the resources needed to do it.
Rationalization is another priority, particularly when it comes to applications. I cut my teeth early on in my military career as a comptroller or CFO type, and then flocked to IT. As a result, I have a pretty good discipline when it comes to finance accounting and contract management. And so one of the first things I started doing when I got here was contract rationalization; I immediately saw some opportunities for cost savings, which was great.
Last but not least from a priorities perspective — and probably the most important, I believe — is professional development for the staff. In my experience, it costs about $5,000 per person each year to maintain the IT certifications needed to stay relevant in our field. There was initially a little pushback on that. If you run the numbers, we have a staff of almost 400, so that’s a $2-million-dollar budget line item for something that can naïvely be seen as sending people to conferences.
So we had to dig a little deeper. We’re in Brevard County; which is an area that competes highly for talent. Blue Origin is building an enormous facility, Amazon is here, and you have the entire Space Coast. There’s also Harris, a big defense industry contractor that recruits IT talent, so we’ve got to do what it takes to retain these folks. But it is sometimes met with resistance.
I was at a meeting with leadership where someone asked, ‘What if we train these people and they leave?’ I said, ‘what if we don’t train these folks and they get complacent and stay?’ Needless to say, I was able to secure the resources we needed, and the staff were enthusiastic about where we’re going from a professional development perspective.
Gamble: Really interesting. One thing I want to touch on is what you talked about with reworking contracts. I imagine that’s a good place to get some quick wins and maybe win over some support.
Walders: Absolutely. Some places call them positive variances — we call them good guys. Where can we find some good guys? I’ve always done this as CIO. What better way to understand what you own, and what you have, than by pulling every contract and looking at it? I spent a lot of time reading contracts and was able to have some big wins. If something doesn’t look right, you need to ask, ‘What is this?’ And when they say, ‘Oh, we haven’t done that in six years,’ and yet the contract keeps being renewed, you settle it, and it’s a quick win. When you have a couple of hundred contracts, like we did, you need to look at them right away. You can gain a pretty good understanding of what services are consumed, and you quickly start to do some rationalization in your mind’s eye. That gave me some great perspective upon starting.
Gamble: When you’re the new CIO and there are so many things you want to do, can it be a challenge to prioritize and figure out what needs to be done now, and what can wait?
Walders: I approached it as short, medium and long term. It starts with discovery and assessment, which is phase 1 and 1a, then goes to phase 2, which is planning, and phase 3, which is execution. We’re at various levels of maturity for our FY20 priorities; I have a medium range plan and a long-term plan. All these things are aligned with our priorities as an organization: ease of access, customer satisfaction, decreasing costs, improving convenience for our staff, and delivering an exceptional product.
Thankfully, time on the pond is how you figure out how long these things take. I always joke that you can do anything with enough people, time, and money. When time is constrained, if you throw enough people and resources at it, we can certainly get it done, but it’s a balance. Like I said, in the near term, we need to address the disparate data source problem and create a single source. We need to put a framework in place from an IT service management perspective so that we can intake a customer request or service request, articulate what IT does from a resource perspective, and build a common lexicon for the staff to communicate with each other. And so we’re looking to improve service desk, asset management, and incident management with tools like ServiceNow, Ivanti, or Salesforce. What we have now is woefully deficient, to be kind, and needs a significant improvement in terms of maturity.
Gamble: Right. So, looking at your career, you’ve had some different experiences, a lot of which was with the military. Can you talk about how your background helped prepare you for this role?
Walders: That’s a great question. I’ll go even further back to when I was a nuclear engineer on a submarine 22 years ago. Submarine systems were converting things like magnetic tape, paper tape and vacuum tubes — which you’re familiar with if you know anything but computing from the 1960s and 70s — into commercial, off-the-shelf solutions. Things like rack-mounted servers.
I found out I could earn an extra $150 a month to manage the entire IT infrastructure for a submarine, on top of my day job, so I volunteered. That’s how I built a foundation for IT. At one point, that got boring to me, as strange as that may sound. The Navy had an opportunity for me to pursue healthcare IT at any of our 400-plus hospitals and clinics in Defense Health, so I took it, and grew up from there.
When I made that transition, the Navy actually paid the costs for me to get my MBA and MHA, which was tremendous. I was able to earn my salary, and those two years counted toward my pension. What was also great was during that time, I would go to HIMSS and talk with guys like Rusty Yeager, Drex DeFord, and Wes Wright, all of whom are Air Force retirees, about their experiences. I remember asking how they made the transition and what it was like, because I knew this was what I wanted to do. Sometimes the military has different ideas; they want you to accept more responsibilities and eventually lead troops into battle or a sea, but I loved being a CIO. And so after going from small hospitals to a medium hospital, to a hospital ship, and then to our largest hospital, Walter Reed National Military Medical Center, I knew I had capped out of the CIO roles and it was time to retire from military service.
During most of that time, I was working with the ex-military folks to understand what it looked like on the other side, and I can tell you, it is drastically different. I knew it was going to be different, but I had no idea of the extent of it. Thankfully, I had started operating as a commercial hospital early on, which proved to be really helpful. I think that differentiated me from my peers. In the Department of Defense, to be quite honest, folks can sometimes get complacent on the amount of resources that are available. When I worked on the Cerner project, we had a budget of $12 billion. And so I had been preparing for a career in commercial hospitals by working with HIMSS and CHIME and seeking out mentors.
When I retired at age 41, I started looking for jobs in Florida for several reasons. I have family here and I love the climate. So when Health First came up, I jumped at the opportunity, and here I am.
Going back to your original question, I believe all of those experiences prepared me for my role. The jobs were almost identical, except for the fact that I had zero experience from revenue cycle perspective; we did things very differently in the DoD. I felt like that was a bit of fatal flaw when I was interviewing that I had never dealt with Epic. For some reason, several folks really seemed to focus on that, and I joked that I didn’t want to work in an organization that needed an Epic subject matter expert as the CIO. But aside from that, I felt like I spoke the same language as the people I was interviewing next to and sitting across from.
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