For healthcare IT leaders, prioritization and resource allocation can be challenging under normal circumstances (that is, if there is such a thing). But when a global pandemic hits, it graduates to a new level. As teams log 100-hour weeks to ensure patients can receive care, whether it’s virtually or at converted clinics, CIOs must decide which projects — if any — can be postponed, and how to proceed.
Sometimes the answer is none, as was the case for the Northwest region of OptumCare. If the “massive conversion” planned to bring up an organization on Epic was delayed, it would have resulted in a snowball effect, according to CIO Jason Wood.
Recently, Wood spoke with healthsystemCIO about the approach his team has taken with project planning, his team’s initial response when Covid-19 hit, and how they’re dealing with the ramifications. He also shared lessons learned, and discussed the keys to leading through a crisis.
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- For OptumCare Northwest, 2020 was already projected to be a busy year, with several “massive projects.” Pushing them back to deal with Covid simply wasn’t an option.
- An important component of crisis management is evaluating what worked well and what didn’t, and what can be replicated.
- Sometimes just explaining the ‘why’ isn’t enough; leaders have to cite examples. In OptumCare’s case, it was a patient whose life was saved when a monitoring tool alerted caregivers to the fact that they had to access to insulin.
- Don’t underestimate the role of communication, particularly during difficult times. And that means offering reassurance, while also providing as much information as possible about impending changes.
Q&A with Jason Wood, Part 2 (Click here to view part 1)
Gamble: Is it challenging trying to get the right messaging out to consumers, especially when they’re being inundated with Covid information?
Wood: Yes. It was pretty interesting; we got to a point where we were telling patients, ‘Don’t come see us. Don’t come in and get care.’ We absolutely were at that point. We would see models coming out of analytics, and I can recall sitting in these huddles, looking at the data, and the hairs on my arms were standing up. I was getting goosebumps just looking at charts. We were looking at what week in March the hospitals were going to hit capacity, and the graph kept going up, which means a lot of people weren’t going to get into the hospitals. And we know, based on what we saw in Italy, that’s when the death rate just skyrockets. It was pretty intense.
Gamble: Did leaders from other organizations reach out to you to learn how you were dealing with it? With Washington being the first hot spot, I imagine you had some leaders from East Coast organizations contact you and get whatever knowledge they could.
Wood: Absolutely, mostly within Optum. We have groups in Boston, New York, Texas, and Florida — we’re scattered throughout the country. We had huddles throughout the week with colleagues from those organizations where we shared what was going on here and how we were converting those FURI clinics. A number of folks on the calls, especially my counterparts in New York and Boston, were very inquisitive, because their case counts were rising during that period.
Gamble: You mentioned that there were initiatives that had to be pushed back or postponed. What has your approach been as far as reprioritizing or rescheduling those?
Wood: For us, 2020 was going to be busy as can be, notwithstanding COVID. We had signed a major contract. We had plans in place where we were set to do at least 18 to 24 months of work during a 12-month period. That was the plan; we knew that coming in. We knew we were going to get help from the outside to do some of it, but that was the plan. Then Covid hit, and some of those things slowed, but did not stop. When you are heading toward big contracts and major events kicking off January 1, 2021, you can’t unwind or pause those, but you can’t do everything either. And so they slowed down.
When you look at things like Vivify, video visits, and moving our team offsite, you can imagine what kind of pressure that puts on the service desk and the field service desk — they weren’t ready for that. Normally you would say, ‘This unplanned work popped up, and so we’re going to have to go look at what can’t do.’ In our case, we’re bringing the Polyclinic onto our Epic instance in September; we couldn’t move that date due to some other projects.
We have a risk transfer and some payer movement scheduled for January 1. We’re now pivoting back to those and trying to squeeze all that work in a short amount of time. You sprint for maybe a mile; you’re going at a 50-meter clip — and all of a sudden, you realize you’ve got 10 more miles to go and this isn’t a mile pace. That’s Covid. And so my big concern is burnout and taking care of the team.
Gamble: Right. As IT teams are working so hard and were able to accomplish so much so quickly, there’s concern from some that it’s going to raise the bar too high and create unrealistic expectations. What are your thoughts there?
Wood: There’s a lot of talk about that. What came up at some of our meetings was, ‘Wow, we were able to work so efficiently. Let’s figure out how to bottle that up and just do that from now on. We were able to deploy telemedicine to all these folks in three weeks; let’s make that the new standard.’ The idea was, let’s try to capture some of that — not necessarily mirror that. It goes back to the sprinter analogy. We ran a 50-meter pace at breakneck speed. Folks were working 100-hour weeks. I had many 100-hour weeks. I simply can’t keep a 100-hour week pace for a year, and our teams can’t do that. It’s not possible.
And so we’re looking at what worked. We had tried to deploy telemedicine this broadly for the better part of a decade and we got next to nowhere. We had deployed it here at Everett Clinic throughout behavioral health and we’ve had some decent success, and so we want to reach into that and ask, ‘What did work well? What allowed us to make this transformational change, and what can’t we replicate?’ What we can’t replicate are 100-hour work weeks, or skipping the vetting of solutions, or anything that reduced the risk.
Gamble: I’m sure that can be a tough conversation. You want to really lift up your team and show what they’ve done, but at the same time, you want to be clear that it’s not sustainable.
Wood: I agree. Our leaders are pretty receptive to that. They’ve been very supportive. And we realize that we need to do this for the patients, and for the staff. This is going to protect people from getting infected if we’re able to deploy it. They understand that it’s a sprint and we have to get back to some semblance of normalcy.
Gamble: Certainly. What are some of the priorities you’re focused on now?
Wood: We started this year with probably a year and half or two years’ worth of work to do, and we’re squeezing it in. We’re doing a big claims system transition for the two different companies. At the Polyclinic and the Northwest Physicians Network, we’re employing a brand-new care management/utilization management system in Epic Tapestry. We’re bringing Polyclinic onto our Epic instance, and that has myriad sub-projects within it.
We’re standing up an Epic Connect program where we bring affiliate groups onto our instance, some of them this year. We’re standing up a whole new company, a risk-bearing entity, with a full technology stack to support them. We’re deploying a new call center system for the network and the risk transfer that we’re doing. We’re deploying Optum Performance Analytics, which is a full data and analytics solution.
As far as Epic Beacon, we finished up at the Everett Clinic, and we’re now deploying it to the Polyclinic, as well as a clinical suspecting tool and a point-of-care tool. We’re also putting in a brand-new provider portal for pushing out care gaps and HCC suspecting codes.
In a normal year, you might do two of those things. That’s your roadmap, and then there are a few others you want to get to. We’ve got about eight of those things that are all hitting this year. They’re all massive, and in many cases, they’re interdependent.
Gamble: That can be daunting, I’m sure.
Wood: We get support from the national organization through various methods. On one of the national CIO calls, I was speaking with one of my colleagues from another market about some of the projects we’re working through. And the comment was, ‘We just have to figure out how to do four years’ worth of projects in six months.’ That’s how it feels.
Gamble: Right. Can you talk about some of the other attributes that are important when leading through a crisis?
Wood: Sure. One thing we did was to huddle up. We huddled seven days a week — sometimes even three times a day — and of course there are meetings in between. As a leader, you need to make sure you’re providing the right communications out to teammates, especially when there’s that much change happening. When you’re taking things day by day, and there are critical changes and information that need to be disseminated, you need to get folks together. You need to let them know, ‘This is going to be tough. We’re in it together. Here’s the information you need.’ It’s a big change, and you need to talk it through collectively. You need to tap into everyone’s expertise to make sure we do this thing right. Because when there’s no playbook, you might come up with an idea, but there are subject matter experts who will get on that call and tell you the five reasons why that’s not going to work. So it’s really tapping everyone’s expertise.
Another think I observed is that everyone here did a fantastic job of explaining the why. When you’re in month two of 90-hour weeks or 100-hour weeks, you’re going to get weary. When you’re on a call at 9 p.m. on Sunday night and your first call was at 6 a.m., you’re going to get weary. Folks start to think, ‘Is this right for me? What are we doing here? I can’t sit through another WebEx.’
You really need to focus on why we’re doing this. Yes, we could have taken Sunday off, but if we don’t get a project deployed (like, for example, telemedicine) patients aren’t going to get the care they need, and they could die. If you have patients with multiple chronic conditions, they can’t go three months without care in some cases. It’s tapping into that and highlighting back to people what they already intrinsically know to be extremely important.
We’ve shared a story of how Vivify triggered the symptom checker for a patient. It wasn’t Covid, but through the application, we figured out that patient was stuck at home with no insulin for weeks. And so the triage nurse was able to coordinate with the pharmacy to mail it to them, and it saved that person’s life. Sharing those things really enforces that everyone is in this together. This isn’t a fun way to live and to work, but when you feel that you’re doing amazing work and helping people, it makes it a heck of a lot better.
Gamble: It’s so important to be able to tie the work IT does to the clinical mission, and I would think that gets amplified during a time like this, when people are exhausted.
Wood: For sure. Early in my career, I remember thinking that IT isn’t part of the business — ‘whatever the business is doing, is has nothing to do with me. I make the servers run.’ This is a whole different model for folks, especially when you get the opportunity to work in an industry like healthcare, where you can see that when we go out and deploy video visit software, or set a clinician up with a solution, here’s the impact it’s having. Or, in our case, we can look at the projected Covid case counts and point to a huge flattening and a crest downward because of the work IT has done.
Gamble: I guess if there’s any positive with all of this, it’s that we know more about how to keep the numbers down.
Wood: Yes. The big concern, of course, is that we’ve had a pretty individualistic society cultural-wise. And so we know what science tells us about what we need to do; it’s a question of whether that will happen.