Q&A with CIDO Tom Barnett, Part 1: “Process Is Always Upstream from Technology.”

In healthcare, the terms ‘large organization’ and ‘agility’ typically don’t go together. In fact, most have come to believe that the bigger a health system’s footprint gets, the harder it becomes to introduce change.

If that’s the case, then Baptist Memorial has achieved unicorn status. Despite its size — 22 hospitals spread out over three states — Baptist has consistently demonstrated a willingness to take on new technology, according to Tom Barnett, who serves as Chief Information and Digital Officer. Case in point: it was one of just a few organizations selected to implement Epic’s new integrated video platform last year. “That type of agility for an organization of this size is extremely gratifying and exciting to work with,” he noted.

What makes that possible, according to Barnett, is Baptist’s methodical approach to change management, and its unwavering focus on process and workflow before technology. During a recent interview, he talked about the multifaceted strategy his team uses when planning an initiative, how they’ve adapted lessons learned from other industries to improve efficiencies, and how to differentiate a vendor from a partner. Barnett also discusses his team’s goal when it comes to improving patient experience, and why he believes the most important thing a leader can do is to make himself or herself available.

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Key Takeaways

• The CIO role is no longer just the “keeper of operational systems.” As digital technologies become more pervasive, it’s becoming reflected in the role.
• Merely introducing technology and assuming it’s going to drive organizational change is naïve. “You have to focus on streamlining a workflow and a process.”
• By leveraging metrics, organizations can establish specific objectives and figure out how to get there. “What is your target condition, and what are the activities you need to affect or improve or redesign or streamline that are going to move the bar?”
• Even if it’s something as simple as taking a page from Chick-Fil-A’s line expediting strategy, “there’s a lot to learn” from other industries, especially now.
• The keys to getting to know a team that’s mostly remote? Using small focus groups, making yourself available, and listening.

Q&A with Tom Barnett, Part 1

Gamble:  You’ve been with Baptist Memorial since May of last year, correct?

Barnett:  That is correct.

 

Digital as “the next progression”

Gamble:  Your title is Chief Information and Digital Officer. What does that mean to you having digital in the title? Do you approach it differently, or do you think the role itself is evolving in that direction?

Barnett:  From my standpoint, I think for a lot of C-level leaders in technology, the role is morphing into that. It’s almost like the next progression. Historically, the CIO has been the chief keeper of operational systems, so to speak. The CIO is usually responsible for the uptime, for the major applications, for enterprise level applications and hardware, and so forth.

Now, however, there are two things happening. One is that we’re beginning to embrace more cloud technologies. It’s not so much about being able to go into the building and make sure the server is nice and safe. Healthcare has been driven in a different direction.

Over the past decade — and particularly with Epic, I see the fusion of a few things. It’s no longer just software; it’s workflow intermingled with software. And that title of being keeper of the data center, so to speak, has definitely evolved as we’ve embraced digital. Of course, digital is technology, but now we’re also thinking about how do we find our customers, how do we engage with our patients, and how do we work internally from a streamlined perspective? And the keyword there is streamlined.

Invariably from my point of view, a digital initiative, is going to be mostly about workflow. Inherently, it’s obviously going to deal with technology — particularly new and innovative types of technology — but I believe process is always upstream from technology. You can’t introduce technology and assume it’s going to drive fundamental corporate change or organizational change. You really have to focus on streamlining a workflow and a process, and making sure that fits neatly with, and is in turn reinforced by, the software. I think it makes sense to view the chief information and digital officer role as being encompassing of a lot of those different activities, particularly transformational types of activities.

 

“Methodical” approach to change management

Gamble:  And the organization has to be there, right? It has to have the mindset of moving toward streamlining workflow and processes, and not just about IT itself.

Barnett:  Absolutely. One thing that was intriguing to me about Baptist was that they do have a focus on process improvement. They have a chief improvement officer, and they have a very methodical approach to how they affect change through what’s known as the Baptist Management System. Whether they’re improvement initiatives, change initiatives, or transformational initiatives, it starts with defining your current condition, particularly with metrics or measurement. What is your target condition, and what are the activities you need to affect or improve or redesign or streamline that are going to move the bar. And there’s a time limit between your starting condition and your target. It’s a very systematic approach to how they evaluate change and how they’re data-driven; that approach lends itself to a perfect marriage with digital strategies and workflow redesigns.

 

The power of metrics

Gamble:  So there’s a lot of focus on process improvement. I imagine that comes through in so many different aspects of what you’re doing and what your team is doing.

Barnett:  It absolutely does, and it’s not just within IT. It’s organizationally driven.  Our chief operating officer, Dr. Paul DePriest, has a long background in working with, and trying to analyze, what can be learned from the manufacturing industry, specifically Toyota — what are some of their quality practices, and how can they be adapted and applied in a healthcare setting?

One of the things we’ve seen nationwide is that healthcare is patient-centered; you’re trying to improve the condition with a patient, but there’s a lot of variability in how that care can be applied. It’s particularly true when you’re measuring outcomes and measuring the condition at the starting point: what works best, what reduces the variability you’re dealing with, and how do you standardize, not only to improve outcomes but control costs and make things more predictable? It’s a marriage between those approaches.

For example, the Toyota model leverages Kata, which are targeted teams focused on improving a specific problem. It utilizes the method of establishing a starting condition and ending condition, and measuring your progress.

In fact, one of the first teams I was introduced to in the IT department are the Kata teams, which are focused on things like first call resolution at the help desk. What was it before, what do we want to get it to, and what can we put in place to help close that gap? It’s very much part of the culture.

 

Learning from Chick-Fil-A

Gamble:  Very interesting. Can you talk about what it was like to come to a new organization during the pandemic, especially the early weeks? What was the focus when you arrived?

Barnett:  I had a unique situation of having started during Covid. The pandemic had taken route first in New York, where I was [at University of Rochester Medicine]. And so I saw the front end of the pandemic and worked through that, and then when I got to Baptist, the Memphis area hadn’t yet peaked. When I arrived, the Covid cases had really began to increase; the first plateau took hold in June. That gave me the unique perspective of seeing how two different organizations approached it. I also spoke with a lot of folks who had been dealing with it.

The first priority was to make sure we’re caring for our patients. We saw an increase in telemedicine and video visits. Although there had been a spike prior to my arrival, it was in the April-May timeframe that they started to increase to a level they had not seen here previously.

Additionally, the workforce had just begun to work in a remote capacity for jobs that allowed it. They were still in the process of rolling out and fine-tuning some of that; fortunately it had been addressed at the front end of the pandemic. A lot of the workforce that could go remote was already operating in that mode; the organization was very focused on that. Senior executive meetings were occurring three times a week, which enabled leaders to watch bed availability and monitor the patient mix and acuity levels, as well as ramp up some of the ancillary services that would need to be performed, one of which was Covid drive-through testing.

We had three different sites; we ramped up over the summer as more and more individuals needed to be tested. The drive-thru lanes we had set up were beginning to have longer and longer waits — that’s when we started working with Skip Steward, our Chief Improvement Officer. We really like the idea of looking at what industries and doing and adapting what we can within healthcare. And so Skip drafted a plan based on what Chick-fil-A does; as the drive-through lines get longer, they have people walking around with tablets taking orders so they can streamline the process.

We quickly pivoted in a few of our locations by extending cellular data coverage, and leveraging a setup where registration staff used tablets to pre-registered patients. That helped us improve throughput. We were also able to take those learnings and apply them as we began ramping up our vaccine distribution.

 

Gamble:  That’s really important to be able to apply lessons from one initiative to another.

Barnett:  Absolutely. That speaks to the improvement culture we have at here at Baptist. Even with something delivering mass vaccinations, it’s a matter of putting processes in place that will continually improve our processes.

 

Gamble:  I think there’s really something to be said about the willingness to learn from other industries. That has always been the case in healthcare, so I think it’s a positive step.

Barnett:  Absolutely. There is there is a lot to learn from other industries. Even if it doesn’t line up perfectly, there may be a pearl of wisdom or a nugget or a really interesting aspect that you can take and see some huge benefits.

 

Out-of-the-box thinking to engage with staff

Gamble:  With the team working remotely, how did you get to know them? That’s a different situation you walked into with starting the CIO role during a pandemic. How did you approach it?

Barnett:  Most of leadership and management were onsite, but a lot of the staff positions were working remotely. When I did the initial meet-and-greet with the organization, a lot of those folks were here. But because we were in the middle of the pandemic, almost all of the meetings were done by video conferencing, even though we were in the same building.

It was different. I had to change my approach because now you’re making those first impressions and establishing those new relationships through a different model than I had done before. Meeting with peers in leadership and many of the directors and managers worked really well; the challenge was in deciding what to do with the staff that was remote.

It depended on the team. Some teams were exclusively working remotely. Some teams were doing rotations where they might be here one week, and remote another week. It depended on the size and the needs of the team. We’d have different combinations, and so I met with my executive assistant and we tried to think out-of-the-box a little bit and adopt some ideas I had used in the past. Typically, when I’m with a new organization, I try to meet with the entire IT shop. I’ll pull small groups of maybe 6 to 8 employees, randomly selected — nobody from the same team — and meet with them in small focus groups where I’ll answer any question. Anything is fair game. We can get to know each other, and talk about my observations and their observations. I’ve found that you definitely get more insights from listening than from speaking.

 

Becoming 100 percent available

For the folks that were on site, we did that in large conference rooms where everyone could be socially distanced. For the rest, we handled it through Zoom, WebEx, or any of the video technologies that are out there.

There was one other element we added to it. Because there were so many changes going on last summer as the pandemic was progressing and information was coming out, we did something I had done in the past with my direct reports and the IT division, and that was to set up virtual drop-ins. I was used to people stopping by the office with a question or asking, ‘hey, do you have a minute?’ that type of thing. In the Covid world, that was missing, because everybody was keeping their distance. And so I’d set up a video call every Wednesday at around 10 or 11 a.m., and open the video session. If no one was there, that’s fine. But I’m here you have questions, need clarifications, or want to give me a heads up about something — I’m making myself 100 percent available.

It worked out really well with my direct reports. It became almost like a virtual huddle, where we could do quick clarifications and so forth. We then extended it to the entire IT division. I would give a few updates, maybe do a 5 or 10-minute introduction of a concept, and talk about some things that will be coming up in the next 4 to 6 months. And then for the next 20 minutes, either through texting, through the video platform or taking yourself off mute to ask a question, anything is fair game.

I think that went a long way toward helping me answer any of the questions that were top of mind as well as making myself accessible. They knew where they could find me. If you have a question, every Friday morning, I’m on that Zoom call. We’d have anywhere between 170 to 230 people on that call.

 

Gamble:  That’s amazing.

Barnett:  It became a really great way to communicate as well as answer any questions. What I heard from the staff is that it also gave everybody a chance to consistently hear from me, learn my style, and learn more about me as a leader. It definitely went a long way. We’re still doing it on a bi-weekly schedule now.

Part 2 Coming Soon…