You never know where the next big idea will come from.
It’s a talking point often used by leaders seeking to inspire creativity. But at Virtua Health, it’s more than lip service — and not just because the NJ-based organization has its own Center for Innovation. In fact, the idea that resulted in the deployment of intubation boxes to protect both providers and patients during Covid-19 came from outside the organization (and the industry, for that matter).
To Adam Glasofer, MD, who serves as both Chief Innovation Officer and Associate Medical Director of Informatics, it didn’t matter in the least where it originated; just that it had the potential to improve outcomes. “Ultimately, it’s about thinking outside the box and listening,” he said.
During a recent interview, Dr. Glasofer discussed the critical role innovation has played in Virtua’s response to Covid-19, and how the pandemic has “raised the bar” when it comes to digital engagement. He also talked about the organization’s bold plans for l predictive analytics, the challenges they faced in scaling up telemedicine, and what he believes is the “greatest tool” for clinicians.
- About Virtua Health
- Co-founding the Center for Innovation w/ CIO Tom Gordon to “keep a pulse on bleeding-edge technologies”
- Crowdsourcing with nurses – “Some really impressive things came our way.”
- Intubation boxes to protect providers & patients
- Balancing dual roles: “It has become more complementary than ever.”
- Telemedicine’s rapid growth – “We were ready for this”
- Challenges with scaling up quickly
- Adoption of digital tools
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I recognize that I’m in a fortunate position; when I have good ideas, people often listen. But we have 12,000 employees, and among those, not everyone has that same voice.
The perceived benefit by the outsider isn’t always the same benefit seen by those on the inside — that’s what makes this so unique. We learned that the boxes, while helpful with intubation, were even more helpful with extubation.
The effort it took to scale up telemedicine rapidly allowed me to help the digital health and IT teams in getting those things done and getting them in the hands of clinicians. Ultimately, that’s what we’re trying to do; we need to adapt the way that we deliver care for this new normal.
For a standalone provider, it’s easy to set up; but for a large health system with 12,000 employees and over 200 different care locations, it’s not. You can’t just flip a switch. You have to build that framework and that infrastructure.
A lot of our hold-ups previously were on the clinician side. They’re used to the way they do their job, and it can be scary to make such a change drastic. But this has forced them to do just that.
Gamble: I think the best place to start is with some information about Virtua. Can you provide a brief overview?
Glasofer: Virtua is a comprehensive, suburban community health system with expansive offerings. We have five hospitals, as well as two freestanding ERs, multiple urgent cares, and a very large ambulatory practice with health centers and surgical centers. We really span the gamut of providing full care for our community.
Gamble: What about the Virtua Center for Innovation — how did that come about, and what does it aim to do?
Glasofer: The Center for Innovation was founded by myself and our CIO, Tom Gordon, a little over three years ago. The intent was two-fold. One, to keep our pulse on innovative, cutting-edge and bleeding-edge technologies out there, and two, to look for ways in which we can use them to improve the delivery of care for our patients.
In terms of my vision of the center, I recognize that I’m in a fortunate position; when I have good ideas, people often listen. But we have 12,000 employees, and among those, not everyone has that same voice. I’m certain that there are some great ideas out there; we’ve already seen some great ideas from nurses and providers. We’re really trying to keep our eyes and ears open for things that might improve what we do.
Gamble: Have any initiatives come out of the center that really stand out to you?
Glasofer: Yes. Probably our biggest crowdsourcing initiative is our nursing innovation challenge, which was launched approximately a year and a half ago. We had two finalists, and we’re moving forward with both projects. I believe we had about 20 to 30 entries from nurses across the health system, with varying ideas from solutions that could be commercialized to technology innovations to process innovations — some really impressive things that came our way from nursing.
Gamble: When you hear the word ‘innovation,’ there’s still an instinct among some that it has to refer to some type of technology or a cutting-edge tool, things like that. But it can also be presenting different ways to do things more efficiently.
Glasofer: Yes — now more than ever, especially in response to Covid-19. In general, I hate the word ‘innovation.’ It’s such a buzzword. But to me, it’s relative to who you are and what you do. And ultimately, it’s about thinking outside the box — and listening. A lot of what I do in my role is listen. Not everything is the greatest idea. But sometimes I might listen and think something’s not a good fit, and then ultimately we realize it does have a significant benefit.
And an interesting example is the intubation boxes we recent deployed. That’s the true spirit of innovation. I could sit here and take credit, but honestly, all I did was listen. I listened and heard a story I thought might help with what we were trying to do. I connected outsiders from outside of healthcare with our health system, and ultimately, helped them do something that they thought was a benefit. So for me, innovation is a very relative term.
Gamble: It is. Let’s talk a little more about the intubation boxes — what do they do, and how did it come about?
Glasofer: I’ll start with how it came about because it’s interesting and funny. A friend of mine who I knew from nursery school through high school growing up, had posted something on Facebook about the work his father was doing with their art studio since it was closed down. I sent him a message saying, ‘Hey Brad, this really seems like a great idea. Can you connect me with your dad?’ I then spoke with his father, David Ascalon, and told him my ideas for how we could deploy this. We brought one over to Dr. Emilio Mazza who is the Medical Director of the ICU at Virtua Memorial Hospital. He tried it out, gave us some advice, then had some of the anesthesiologists look at it and provide their feedback. That’s how of all this started.
The interesting thing is that the perceived benefit by the outsider isn’t always the same benefit seen by those on the inside — that’s what makes this so unique. We learned that the boxes, while helpful with intubation, were even more helpful with extubation. When you’re intubating a patient, there’s certainly a risk of aerosolizing infectious particles throughout the room. But when you’re extubating a patient, the risk is much higher, and the spread of aerosolization is also much higher. And so when we brought it, our clinicians were like, ‘Wow, this is really great. But it’s going to be even better for extubation.’
That hadn’t occurred to David and his team, because again, they’re not clinical. But for them, it was very gratifying to know it had an additional benefit from what they perceived.
Gamble: Very interesting. It goes to show that you really don’t know where an idea is going to come from. What were the next steps in rolling this out on a larger scale?
Glasofer: One of the benefits I have is between my role as chief innovation officer and my other role as associate medical director of informatics, I work with all areas of the health system and operations. And so, when something comes in, I usually know the people to connect with in order to find out, is this worthwhile to roll out? Is the interest there? Then it’s putting together some tangible next steps.
With this initiative, my first move was to reach out to Dr. Mazza. My clinical location is Memorial, and I knew he was going there on this particular day, so I called him and told him about the boxes. I sent some pictures and asked if he would be interested. He was, so I brought it over to him. Once we realized it was a viable solution, I reached out to the rest of our clinical leadership team in critical care and pulmonary, and they all wanted some for their ICUs.
Gamble: That’s a good example of how your two roles complement each other. But is it challenging at times balancing the two roles?
Glasofer: It depends on the project, to be quite honest. Often it’s a juggling act, but the roles definitely complement one another, and allow me to connect with people that I have a regular working relationship with.
Gamble: Right. Now, when the organization was starting to put together a COVID response strategy, were you more involve on the associate medical director side? How did that work in terms of prioritization?
Glasofer: Specific to COVID, it’s really become a melding of the two roles for me. One of my previous projects I had worked on was to create our telemedicine program from the ground up. Over time, it had taken a bit of a backseat. When Covid-19 hit, I took on a more active role to help us rapidly scale up what we had been working on over the previous years. And so it’s really become a melding of the two roles. I’m keeping my eyes and ears open for things like intubation boxes or artificial intelligence algorithms that might help our clinicians, while rapidly scaling telemedicine or other connected tools that might help deliver care. It has become more complementary than ever. It has also forced us to put some of our projects on the back burner.
Gamble: Once it was decided that the telemedicine program was not going to be on the back burner, how did you get it up and running?
Glasofer: It really was an amazing effort by the digital health and IT teams. They partnered together to listen to our customers and our operational areas, and figure out what they needed. That’s where my roles become complementary. A lot of what I do is to serve as almost a liaison to the clinical and technical worlds. I am employed by IT, but I work with our medical staff, our clinicians, our nurses, and our interdisciplinary care teams. The effort it took to scale up telemedicine rapidly allowed me to help the digital health and IT teams in getting those things done and getting them in the hands of clinicians. Ultimately, that’s what we’re trying to do; we need to adapt the way that we deliver care for this new normal.
Gamble: Because of the work that had previously been done, I would imagine you didn’t have to start from scratch when ramping up telemedicine.
Glasofer: We didn’t. We had been working on building and scaling our programs for about six years prior to this, and had put a lot of time and effort into building those programs. And to be honest, there were some small successes, but we had challenges with widespread adoption.
Fortunately, we were ready when Covid-19 hit. All the work we had put in previously really set us up well for this, because now the appetite was there. That’s part of the reason why we were able to scale these services. A lot of people have been saying they made more progress in 10 weeks than the previous 10 years. But in reality, we really have made more progress in the last two months than we had in the previous six years. The work we did leading up to this allowed us to have that success.
Gamble: Sure. Without the groundwork in place, you can’t just roll out something to that scale.
Glasofer: You can’t. And actually, that’s where a lot of people have misconceptions and confusion about telemedicine. For a standalone provider, it’s easy to set up; but for a large health system with 12,000 employees and over 200 different care locations, it’s not. You can’t just flip a switch. You have to build that framework and that infrastructure. I’m sure this is a challenging time for organizations that didn’t have the work done ahead of time.
Gamble: In general, has the feedback been positive in terms of telemedicine?
Glasofer: Yes. The feedback has been overwhelmingly positive. It has allowed our clinicians and our patients to get as close to their normal processes as they can right now, and I think it has been very well accepted.
To be honest, I knew the patients would adapt. A lot of our hold-ups previously were on the clinician side. They’re used to the way they do their job, and it can be scary to make such a change drastic. But this has forced them to do just that. We’ve seen amazing adaptation by the clinicians. We have a medical staff of close to 3,000 doctors; when you have a staff that size, technology adoption is going to be a bell-shaped curve. You’re going to have laggards and people that do fine, and then people who excel. And I have to say, our doctors have done an amazing job adapting to these times, which is not something we typically see.
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