For Reid Stephan, however, that isn’t the case — not because he isn’t tuned into the threats that seem to lurk around every corner, but because he has “incredible team members and colleagues who are experts in that space.”
The biggest concern for Stephan is the culture and well-being of the staff, who had been accustomed to working side by side and engaging in water cooler discussions. As the pandemic dragged on, he worried that “the credits of good will and trust” team members built would start to fray at the edges. And so he has made it a key priority to ensure he has “the right touch points and a firm finger on the pulse to measure and assess the culture,” whether that’s done through cross-sectional group meetings, or simply asking managers to check in.
Recently, Stephan spoke with healthsystemCIO about the “incredible work” St. Luke’s has done throughout Covid to make sure clinicians have the tools and support they need, why he thinks it’s time to retire the phrase ‘work-life balance,’ how coming up through IT security has shaped him as a leader, and how he believes the CIO role will continue to take shape going forward.
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- The Covid-19 pandemic – and the subsequent rise in virtual visits – provided healthcare organizations with a chance to “validate the discussions we’ve had” around telehealth’s viability.
- By being able to push other initiatives to the back burner, St. Luke’s demonstrated that “we can accomplish a lot in a short amount of time, and be incredibly effective at it.”
- Stephan’s biggest worry as a CIO? Making sure team members are taking care of themselves, and finding ways to connect with colleagues and feel a sense of community while working remotely.
- Rolling out the Microsoft 365 stack prior to Covid proved extremely valuable, but it was still critical to learn “how to absorb this technology into our operations and establish expectations.”
- The phrase ‘work-life balance’ creates a false notion that can lead to disappointment and resent; what’s much more realistic is seeking to achieve work-life prioritization.
Q&A with Reid Stephan, Part 1
Gamble: Hi Reid, thanks so much for joining us. Let’s start with some basic information about the organization — what you have in terms of hospitals and ambulatory services and were you’re located.
Stephan: St. Luke’s Health System is a not-for-profit based out of Boise, Idaho. We prominently serve the Southwest Idaho area and a little bit of Eastern Oregon. We have eight hospitals; four larger hospitals and four critical access hospitals. We have a children’s hospital, and we have 200-plus clinics. We were founded in 1902; we’re the state’s largest private employer and a pretty visible brand and physical presence in the Southwest Idaho area.
Gamble: And are those hospitals located in both cities and rural areas?
Stephan: Yes. It’s a mix; we have urban locations in Boise, Meridian, Nampa, and Twin Falls. And then we have critical access hospitals in smaller areas, including McCall, Wood River, Elmore and Jerome that serve the rural population. As far as clinics, the majority are in urban areas, but then we certainly have some in rural areas.
Gamble: Let’s talk about how Covid impacted the organization. What were your initial priorities when things first become serious?
Stephen: We’re not unlike many other systems. As I’ve talked with peers, I’ve found a lot of commonalities in terms of what went through last March. We quickly pivoted to address the need to have people work from home, and we scaled up the opportunity and the technology needs to support that. We also quickly pivoted and accelerated our telehealth strategy, particularly for clinic visits.
At that point, other than some pilots, we had not performed any live patient video visits from an external home to a St. Luke’s clinic or a St. Luke’s provider. We went from doing zero to closing in on more than a hundred thousand visits within a couple of months. So we really quickly scaled that.
Again, this was not unique to us. We saw across the board that it gave us a test of change to validate a lot of pontification and discussion that we’ve had — and has been had across the industry — in the months and years leading up to COVID. How effective will this be? Will patients want to do it? Can we replicate the in-clinic experience? What does billing look like for this type of visit?
I think we proved without question that there is a need beyond Covid for this type of patient experience. We’ve had overwhelming positive response from patients, particularly the convenience factor that it provides. And in the case of Covid, a sense of safety in the ability to not have to leave the house. My living room is now my waiting room and my exam room. That’s just a really compelling consumer experience.
Gamble: As you alluded to, a lot of organizations were in the same boat in terms of starting from zero. What was the first priority in getting that off the ground?
Stephan: We had obviously aligned with the providers to understand the scheduling aspect of it and the visit types it would support, and we worked with revenue cycle to make sure the billing pieces were in place. We had some tailwind because we had been having discussions about standing up a pilot to test out what a video visit would look like for a patient at their home. And so fortunately, we had some technology pieces in place that were ready to go, and built in a way that led us to scale really quickly.
We also had to get some more licensing for our video software. Epic is our EHR, and so MyChart was the tool we used to facilitate the actual video visits: both the signup and the experience itself.
It was a very energizing opportunity for the organization. In many industries, including healthcare, there’s always discussion around the fact that we have so many initiatives being launched. We need to land some of these planes and we need to say, ‘no’ or ‘not now,’ to some of these things that come in.
Covid was one of the few times in my career in which I saw that approach being applied widely across the system. And so, unless it was directly related to Covid response, a lot of our initiatives were put on hold or stopped. As a result, we were able to demonstrate that when we’re really focused and when we limit the amount of things we’re trying to do, we can accomplish a lot in a short amount of time, and be incredibly effective at it.
Overall, it was a great experience for the organization and for the community. Just a lot of feelings of accomplishment and pride and satisfaction connected with the work.
Gamble: I guess the flipside is that when you are able to focus on one or two initiatives and roll them out quickly, does it raise the bar to a level that can’t be sustained?
Stephan: That’s a great point. Obviously this isn’t a ‘mission accomplished’ moment, but clearly things are moving in the right direction. And so, as we start to mentally envision a future state, how do we find that balance? Because the reality is we can’t just focus on one or two things. There has to be more than that. But how do we find that sweet spot so that we aren’t taking on too much — and creating that ‘if everything’s important, nothing is important’ environment — but also not swinging too far the other way, and are just focusing on a few things.
And to your point, how then do we guard against that, or set the expectation so that people realize the Covid experience was really unique, and unless there’s an emergent driver like that, we’re likely not going to see that kind of efficiency and execution widely across our portfolio of initiatives.
That’s okay, as long as we have the right measures and the metrics and we understand expectations going into it. I think we can manage that conversation, but it’s a conversation that we have to have so that there’s not a sense of failure.
Gamble: Right. And so, as things changed, whether it was telehealth visits spiking up or down, how were you able to keep people on task, especially with so much uncertainty?
Stephan: I think the best way to answer that is by sharing a perspective I have. As a CIO, I’m occasionally asked, ‘what are the things that keep you up at night?’ My answer is probably different than what you might hear from others. I don’t lose sleep worrying about a cyberattack. When I was a CISO, that absolutely kept me up at night. I don’t lose sleep worrying that Epic is still up, or if our core infrastructure is operating efficiently and smoothly, because I have incredible team members and colleagues who are experts in that space. I know that’s on their mind.
What keeps me up at night is worrying about the culture and the well-being of the team. At this point, probably 85 percent of the IT department is essentially full-time remote. And it’s worked really well, because before that, people were in the office the majority of the time, interacting with colleagues and building relationships and connection points that served them well when we pivoted to an almost exclusively remote work experience.
But as you continue to deduct from those credits of good will and trust that you’ve built up over time, it can start to fray the edges. And so I’ve really watching that as the team continues to execute, perform, and deliver on shifting priorities. A year ago the focus was on virtual visits. How do we scale and support that to make it operational? Now that’s steady state. And then there was an incredible effort around building workflows for vaccines, standing up clinics, and doing EHR builds behind the scenes to support that.
It’s been incredibly rewarding, but it’s also been a huge lift and a heroic effort to get things up and functioning and ready with dynamic influences like, what types of vaccines we’re going to get, how that may change, and what is the public demand for the vaccine. It’s been a really interesting use case for how you manage all of that, and then provide the technology to support it.
I worry about our team members — are they taking care of themselves? Are they still able to form connections and relationships with existing team members? As new people have joined the team, how do we onboard them in a way that is meaningful and helps them feel the sense of community we have?
It’s a long response, but from my standpoint, it’s watching and making sure I have the right touch points and a firm finger on the pulse to measure and assess the culture and well-being of the team. Because if those things are in place, a lot of the other issues become much easier to manage.
I do a weekly meeting in which we assemble a cross-functional group of about 15 to 20 folks from the department to check in, and it’s been helpful. But it will be good to get folks back in the office on a regular basis to add deposits back into that account and strengthen those relationships.
Gamble: I can imagine it’s more difficult to measure someone’s level of frustration through video encounters. How has your team managed that?
Stephan: Interestingly, we had just gone live with the Microsoft 365 stack during the fall of 2019. We rolled out Teams and had a fairly successful launch, and then switching to remote work just accelerated that. And so we’ve had to learn as a system how to absorb this technology into our operations and establish expectations and behaviors. For example, it’s okay to turn off your camera during meetings, especially when you’ve gone back to back to back. When you’re physically at an office, you have time to stand up or move to the next week. But in the virtual environment, you have sometimes just seconds of transition time between meetings.
That’s a new competency that we’re learning and developing as we go. I think there has been incredible appreciation for those collaboration tools. With video, it’s nice to be able to see someone and try to read their reaction and body language more effectively than a phone conversation. But there’s also what I would describe as an ongoing maturation of how we then learn to live with and apply this technology in a way that’s beneficial, and doesn’t become a distraction or a burden on our employees. It’s a learning process.
Gamble: That was good timing with Teams. We had actually transitioned to Zoom right before the pandemic, which worked in our favor.
Stephan: It’s a nice intersection of some preparation and planning, but also some luck. In no way were we anticipating a situation in which we would need to use it to the scale that we have, but we’re glad it’s there. My CEO recently said he couldn’t imagine how we would have done this without the collaboration tools we have in place today to support our virtual interactions.
Gamble: When you’re checking in and you notice that someone is getting to the point of exhaustion, is that handled on an individual basis, or is there a specific process?
Stephan: Everyone is different. And so there might be like a certain pattern that’s followed, but I really try to assess that based on what I feel and hear in the moment. In one case, it may just be a follow-up call with that person after the meeting. In another case, I might reach out to the leader or to a colleague that I know has a great relationship with that employee to ensure someone is reaching out to him or her. We need to take care of the whole person.
I’m not a fan of the phrase work-life balance. I think it’s a false notion. It creates this expectation that you can completely balance the time you spend at work, the time you spend with family, and whatever other commitments you have. It’s the notion that you can stack those in a way that you’re in complete harmony, and you can be all things to all people to whom you have some accountability or responsibility. In my experience, you might achieve that for a nanosecond, then it’s gone.
When you use the phrase ‘work-life balance,’ mentally it sets this idea that I can achieve balance; I can spread myself thin and be all things to all people. Invariably, you’re going to fall short.
And if the message from the workplace is that we support work-life balance, and you continually feel like you’re failing at it, you might start to have self-doubt and question your own abilities. Or, you might get resentful toward your organization and say, ‘you said you support this, but I’m not feeling this in my life.’
I like the phrase work-life prioritization. What that looks like for me is, I wear different hats. I’m the CIO at St. Luke’s. I’m also a husband and a father. I have church commitments. I’m on the school board. In wearing these hats at different times, there’s a timing to how I prioritize. For example, I may came home one day from work and my son wants to go outside and throw the football around. But I may have a commitment for work or the school board that I can’t delegate, and so I’ll explain to my son, ‘I’d love to, but I have another obligation that I have to attend to. Maybe we can do it tomorrow.’ Or, on the flipside, I might have something on my schedule that’s discretionary, and I can adjust some things to spend that time with my son.
I think that’s a viable outcome where people can have some control over their work-life prioritization. And it’s a great lesson for our children to understand that sometimes there are moments in life when you have a responsibility that demands and needs your attention right then. It doesn’t mean it’s more important than your family, but there’s an ebb and flow to what life throws at us; our kids face that in their lives as well.
That’s a guiding principle, and it’s a message we try and convey to our staff: we want to support your work-life prioritization. You understand the job you’ve been hired to do, and you understand the outcomes and the output you’re contributing to. And we trust you as a professional to get that done; to make appropriate work-life prioritization decisions.
That may be, ‘My daughter has a school play in the afternoon, so I’m going to leave at 2 pm so I can be there.’ Or it might look like, ‘We’ve got an epic upgrade that’s really critical for some workflow items we’re going to do. I have to work Friday night, so I’m going to have to postpone a date night or whatever it might be.’ I think giving employees that clarity of how we approach it, and then letting them understand the control and the autonomy they have to make those prior prioritization decisions is key to success. And you’re not going to get it right every time, but to me, it’s a more workable approach than the idea of balance where you can be all things for all people at all times.