Q&A with CIO Aaron Miri, Part 1: How UT Austin Used “Battlefield Triage” to Weather the Storm

In recent months, some have referred to the rapid adoption of digital health tools as a “silver lining” of Covid-19. Aaron Miri, however, sees it a bit differently. He believes the pandemic has “galvanized and rallied everybody around common causes of humanity,” and has helped increase awareness of healthcare IT’s critical role in care delivery.

“You have to be in the pilot seat,” he said during a podcast interview. “If you’re not, the ship is going to crash.” And that doesn’t just mean being in the trenches with your team; it means ensuring they know the value of the work they do, and that it’s appreciated.

For Miri, that opportunity came a few weeks ago when Texas faced massive power outages and severely cold temperatures, forcing leadership to – once again – pivot quickly to make sure frontline workers received adequate support. Recently, he spoke with healthsystemCIO about the challenges in dealing with a crisis on top of a crisis, the “little things” leaders can do to boost morale, why it’s more important than ever to set the right tone when it comes to work-life balance, and how he hopes IT will be able to leverage the “goodwill” it has built during the past year.

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Key Takeaways

• When the cold snap hit, UT Health Austin went into “battlefield triage” mode by opening up research buildings to provide shelter for those with no heat or power.
• Making a swift decision to administer vaccines to students before they could expire demonstrated the organization’s agility and willingness to help out the community.
• The pandemic has forced IT to become accustomed to working at a “fast, unpredictable pace,” and has shown an incredible ability to adjust to different situations.
• With healthcare teams having run what feels like a marathon for well over a year, it’s imperative that leaders encourage time off. “We need our IT teams. We need our janitorial staff, our engineering staff and our finance and HR teams. We need them.”
• “Healthcare is told in stories.” Leaders need to “bring people together, drive items forward and recognize and see them. That’s humanity. That’s what this is about.”

Q&A with Aaron Miri, Part 1

Gamble:  Walk me through what happened with the recent cold snap in Texas. How was your organization affected, and when did you know it was going to be a major event?

Miri:  It’s interesting; going into it, the weather forecast for the area showed that we were going to have a freeze and possibly some snow and some ice, but it really wasn’t expected to last beyond the weekend. So from our perspective, we were running vaccine clinics during the weekends. Some of ambulatory clinics were open, as well as the hospitals and EDs. But in Texas, it’s par for the course that when we get an ice or snow event, it’s a few days at most. The state is really not equipped to handle ice or snow appropriately. And so we know it may slow things down or delay some appointments but I don’t think anybody had an idea, probably until the end of the weekend or Monday, that it was about to get really bad.

When you’re in single-digit temperatures for a sustained duration, there’s only so much you can do for buildings that were built 60 or 70 years ago and were not designed for this type of climate. We saw a lot of water main breaks, and a lot of people started panicking because the electricity situation became a problem. UT has its own power grid and source of energy, and so a lot of our campus was able to stay open (including the dorms) and we were able to offer shelter to a lot of people who lost power.

I really credit the leaders at Dell Medical Center. We opened up the research buildings and say, ‘If you don’t have power, come sit in the conference room and just try to stay six feet apart from other families. Do what you need to do.’ So it became a matter of battlefield triage. The nurses, doctors, and other care workers were determined to make sure patients were safe, people were taken care of, and operations were sustained. The university did a good job of communicating, especially making sure students who were stuck on campus knew what to do.

In fact at one point, we had a power failure in one of our ancillary buildings that happened to be storing some of the vaccines. We didn’t want to lose the vaccine, and so we immediately offered it to kids who were in the dorms. I think we deployed about 60-plus doses right there. There were some doctors and nurses who trekked out in the snow and ice to administer the vaccine. That was the idea: let’s not waste a shot.

 

A city-wide effort

And I will say, UT was very agile like that in making sure that we try to do what we could for the city. It’s part of mission to help out Austin and the state of Texas by doing what we can, and so we did. The hospitals had a litany of different things to navigate, one being water main breaks. Of course they have emergency power and generators, but what about food? You have to get food to the patients and to your staff. You have to get milk to the pediatric hospital.

And everyone needs water, but you can’t have low water pressure, because that can actually lead to a lot of other issues. For example, in the UT Health Austin Ambulatory building, we were working with the city because water pressure was low throughout the area, and we had to make sure that didn’t impact operations. So we relocated patients to clinics that we know could get clean water and at the right pressure. Our facilities team was just amazing; they did whatever they could do to quickly get there.

Some buildings took longer to restore water or operations, but at least we have the capability. That’s what UT does. But the city itself, especially in some areas that we know are lower from a socioeconomic standpoint really struggled.

By about mid-week, we saw so many volunteers coming out to deliver water and take food to people. We saw businesses that were able to deliver food to the hospitals for the nurses and doctors. It was pretty impressive seeing the city come together like that for a historically disastrous event, but we were able to get through it.

 

Battlefield operations

Now, if you look across a state, it’s really sad what happened. There were stories of people who passed away in the night because they were freezing. That’s horrific. Is this the new normal? Is this what we have to expect? 2020 was a doozy. 2021 now is turning out to be a doozy.

It’s one of those things about medicine; you find physicians and nurses, in times of stress, focusing on their patients and doing whatever they have to do — even if it means living at the hospital — to make sure patients are taken care of. That’s something I can’t explain to people in other industries — the level of commitment. If a factory that makes socks goes down, people don’t die. But if a hospital goes down and loses power or water or food, very serious ramifications can occur, and so the clinical staff was determined to be there. And that in turn mean support teams like IT were there with laptops, managing deployments of wireless access points and making sure we were monitoring all of vaccine refrigerators and didn’t lose power. And we were doing all these things side by side with operations. It became sort of a battlefield operation all over again, but we’ve been in this mode now for the past year, and so IT has become somewhat accustomed to working at a fast unpredictable, pace, and that’s okay.

I would say that COVID actually helped set the tone that on your weekends, your evenings, your Sunday nights at 10 p.m., you may be on a phone call, or you may be on a group chat, or you may be in a command and control situation. The teams were able to adjust and be very adept to what they had to do.

 

Gamble:  That’s a really interesting point. As horrific as it has been, dealing with Covid really did create this mindset where people are much more used to being in crisis and being able to adapt. And it seems that IT was able to step into that support role pretty quickly.

Miri:  It did happen pretty quickly. And it happened as it always does, which is with a phone call on the weekend at some strange hour with our senior leaders saying, ‘Okay, this is becoming much more serious, let’s go.’

One thing I’m trying to do is instill a sense of balance. I’m a big believer that, as much as possible in these uncertain times, we need work-life balance. Every time I have cut into evenings or weekends, I know that I am borrowing from a piggybank of patience and of tolerance from the staff. I’m well aware of it and although they’re such great sports, we’re all human and everybody needs a break. And so as we’re looking at the summer time coming up, hopefully as more of the general public gets vaccinated, it’s important to take a break. You can’t mandate someone going on vacation, but you can definitely tell them to turn it off. You can tell them, go recharge your batteries. Go somewhere for a week with a good book or two and just veg out. You need it. We all do.

 

Healthcare’s 15-month marathon

I think healthcare is going to come to that adjustment point in the near future when the pandemic begins to subside because of vaccination efforts, and we really need to take some time and look at all of the healthcare teams and say, ‘You guys and gals have been running a marathon for 14 or 15 months. You have to take a break,’ because we need our doctors and nurses. We need our IT teams. We need our janitorial staff, our engineering staff and our finance and HR teams. We need them.

And healthcare isn’t getting any simpler. Unfortunately, COVID-19 will happen again. I remember Ebola; I was there in Dallas when that happened. I remember   H1N1. These things happen every other year or so, and then there are really bad ones that come around every 5-10 years. But what if that accelerates because of climate change? We don’t know what’s going to happen, and you only have a finite number of healthcare workers.

That’s one thing I think the ice storm here in Austin exposed and forced us to focus on: whatever remaining bandwidth you have, throw it to this to make sure that we get through this unscathed and come out the other side, which we’ve done. Now that’s happened and our attention is fully back on vaccinations. We’re churning out thousands a day, and doing just a heroic job. But how long can that go on? It’s one of those things that I think is top of mind for everybody, but we’re just really looking forward to the day where there’s ubiquitous vaccine availability to start calming the waters so people can breathe again and be human.

 

Gamble:  You talked about physicians and nurses, who have been so amazing in their dedication to patients, but it’s also so important to recognize that burnout happens with facilities and IT and other departments too. I imagine that’s top of mind for you right now to make sure people are okay.

Miri:  Absolutely. I’ll reach out to my staff — especially those who I know are burning the candle at both ends — and send them gift certificates from places like GrubHub and say, ‘Go buy yourself a sandwich.’ Those little tokens show that you recognize them.

At our vaccine hub, I have multiple IT staff there to help if something breaks, or the scanner guns go down, or the computers have an issue or the WiFi goes out. It’s like a war room, and I have a small army of people assisting the nurses and doctors and others administering the vaccine.

 

Make sure people are seen

I was there recently with our chief operating officer, and I asked if he would be willing to thank our teams for their efforts. He was more than willing to do it, and the staff was beaming at the recognition. It’s the little things that we can do as leaders to make sure people are seen. Your desktop technicians, help desk people, biomed people, HIM folks, and others in the trenches with their sleeves rolled up—they’re working just as hard as the nurse administering the jab in a vaccine clinic. These people oftentimes are doing a thankless job, but it’s so important to the whole process. Even if it’s just a quick thank you, that goes so far. It’s incumbent on us as leaders.

Our president at UT Austin is very active on Twitter, and he was sharing some phenomenal stories of what was happening across campus, like people setting up makeshift tents. One of our surgeons turned our ambulatory surgery center into a warming center for folks because we weren’t doing surgeries. It was brilliant.

It’s that ingenuity that makes us human and brings us together as a team, and having leaders see that and recognize that is just awesome. That’s what galvanizes us and makes us human. I have a tagline I like to say, which is, ‘you’ve got to humanize technology,’ and that’s exactly what I mean by that. Healthcare is told in stories. Bring people together, drive items forward and recognize and see them. That’s humanity. That’s what this is about. That’s what healthcare is about.

Part 2