Will Walders believes one of the most important things an organization can do, especially now, is to become “brilliant at the basics.” At its core, it means making sure clinical systems are functioning properly and users can access their email without issues. In doing so, teams can create “an excellent foundation” to accomplish the more complex tasks.
This philosophy has served him well at Health First, where Walders has served as CIO since June of 2019. Since that time, the organization has cut $16 million in waste and significantly reduced the number of applications in use, and he doesn’t plan to stop there.
Recently, Walders spoke with Kate Gamble, Managing Editor at healthsystemCIO, about how his team is leveraging visibility and shared accountability to decrease legacy debt; the “holistic, predictive approach” he has taken to IT business management; and why capturing “low value work” is so critical. He also talked about how they’re working with partners like RelayOne to create a “frictionless experience” and what he believes healthcare can learn from the Domino’s Pizza Tracker.
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- In addition to the team’s resiliency and ability to “wax and wane resources,” a critical takeaway stemming from Covid was the discovery of “blind spots where we were underutilizing technology.”
- With 60 percent of hospital revenue coming from surgical services, Health First “had to get creative” to avoid significant financial losses. One way was by leveraging ambulatory surgery centers.
- Sweet spot: leveraging technology such as automation in the perioperative space to “capture some of the headcount we’re seeing with staffing shortages” and help increase occupancy rates.
- Inspiration for improving efficiency can come from anywhere — even the Dominos Pizza Tracker, which provides a “level of transparency and visibility” that can be leveraged in areas like the OR.
- The best way to incentivize staff to find opportunities for cost savings? By reinvesting it into the “solutions and resources they want.”
Q&A with Will Walders, CIO, Health First, Part 1
Gamble: In terms of Covid, are you at a somewhat manageable level in terms of cases and hospitalizations?
Walders: We are, knock on wood. We passed our Delta spike just before Thanksgiving and started on a downward slope that at one point may have been considered to be high numbers, but we’ve become so desensitized to it and so good at managing Covid itself.
Gamble: When you were dealing with surges in the summer and fall, were you able to apply some of the lessons learned during the first go-around with Covid?
Walders: Yeah, absolutely. We didn’t stand up with full-time command center like we had. We had a virtual one and emergency management and a couple of folks always at the ready. Our numbers were triple what they were with the initial spike the first go around. We were looking at each other amazed at how well the team responded; how we were able to wax and wane staff and resources in order to support whatever was needed most. It was ridiculous how well the teams performed.
Of course, we know that comes at the sacrifice of work-life balance, and I think we did a good job of managing that, but it was a struggle. We took it in stride and the team has been very resilient. It’s good to walk through our halls — virtual and physical — and see people finally taking 5 days off in a row as opposed to being tapped on the shoulder and told to go home. It’s good that they’re taking the opportunity to get some much-deserved rest after all this. Let’s hope we don’t have to deal with that again, much less another variant, for a while.
We’re certainly facing a different time in healthcare when it comes to talent management and work-life balance. It has shown us a few things: one, how resilient the team is and how quickly they can respond. Moreover, it let us in on some blind spots where we were under-leveraging technology, to be selfish in the IT world. We were able to quickly implement some ways to save time and staff. It showed us where we really need to focus on covering some gaps so we can prevent something like this in the future, particularly in the perioperative world and the nursing world.
Gamble: I can imagine that was a challenge, especially when you’re talking about the fluctuations with elective surgeries.
Walders: We had to be creative. A large portion of our revenue comes from surgical services. It accounts for about 60 percent of revenue for the hospital division, and probably about 25 percent of total revenue for the IDN.
I think we missed some opportunities in terms of prioritizing. Like other organizations, we were cancelling elective surgeries and putting emergency surgeries in the forefront. We were doing that for a lot of reasons, including to gain back headcount. But then we got smart and started leveraging some of our ambulatory surgery centers.
The “sweet spot”
I’ve seen systems that are doing this really well. A system in North Carolina has been able to leverage technology in the perioperative space to improve scheduling, automation, and care coordination, which is something we’re looking into. We really see this as a sweet spot — not only in the perioperative space but also clinical areas, to capture some of the headcount we’re seeing with staffing shortages. Our occupancy rate for nursing is around 76 percent; that’s almost 3,000 nurses in our IDN. That means 24 percent of spots aren’t filled. And so, we’ve taken a SWOT approach to where we can capture some of that vacancy rate back through solutions like care coordination and virtual.
In the perioperative space in particular, we started a committee around insuring that our surgery product line takes a relentlessly consumer-centric approach: how do we engage with you? How do we make sure you’re ready? How do we provide scheduling in a manner in which we’re all used to dealing with scheduling anything else in our day to day lives?
Pizza tracker for health IT
Take the Domino’s Pizza Tracker for example. It can tell me exactly when the pizza will be at my house, who’s going to deliver it, and when it was in the oven. You can follow their trucks using the Pizza Tracker; I love monitoring it.
I want to build a pizza tracker for health IT. Think about the level of transparency and visibility that we get in our everyday lives — and yet, it’s still such a mystery when it comes to healthcare, and particularly the OR. Patients get a referral to the OR from their doctor and have some pre-surgery communication with the doctor or care team. They might get a call a few days before the surgery reminding them where to go and where to park and providing some care instructions. But there’s a lot more efficiency that could happen there, and there are ways to make the whole experience much more consumer-centric. Those are some of our priorities post-Covid based on blind spots we saw. And that’s all on the patient-facing side.
Care team coordination
In terms of the care team, I counted nine unique personas who are interacting directly with the patient in the OR. That doesn’t include support services like environmental services who turn the bed over and clean the room, and supply chain who puts the trays with all the surgical gear in place. You have anesthesiologists, diffusionists, surgeons, and surg techs and nurses who may or may not work for the health system, who are often third-party contractors or providers who all have to coordinate and communicate in a critical way that not a lot of people do well in terms of changes in surgery. That’s an area we’re focused on: scheduling the patient and the care team.
I think this is a blind spot for a lot of folks. Somehow we’ve been doing surgery in modern medicine for probably a century, and we still can’t get the anesthesiologist to the room on time or get everybody to the right room if it changes. There are lots of opportunities there.
Gamble: In terms of your responsibilities, supply chain management falls under you now, right?
Walders: Yes, as of about a year. We have great supply chain leadership. We’ve had some great foresight around having supplies in place. As an IDN, we also have some ways to creatively harvest supplies from each of these elements. I want to be clear: it has not been easy. There is a ridiculous amount of opportunity to improve. Covid has shone a light on inefficiencies in supply chain and a lack of customer service.
At Health First, we’re pursuing the relentless pursuit of customer centricity. With the pandemic happening and me taking over supply chain in the past 12 months, it really showed some opportunities where we can do this better. We’re overhauling the supply chain at large and we’re hiring a senior vice president of supply chain. We really want to take a consumer centric look at how we provide a frictionless experience for those we serve. It could be the physician in the OR. It could be the staff at bedside or across the IDN. It could be our patients and how we sell them things like durable medical equipment and retail pharmacy and other things.
Cutting out waste
Really, it’s a reckoning as we take this consumer centric approach to all things in wellness at Health First. I’m approaching supply chain with that same level and holding on to the same standard that we all expect our IT systems to be, as well as clinical systems and personnel.
When I got here, I cut $16 million of waste out of our budget and reinvested that in new solutions. I’ve got a $22 million target this fiscal year. We’re finding opportunities for better efficiency and better coordination. My favorite use case is IV sets. Due to poor administration or complacency on either our part or our partners, we pay three times the price for the same IV set at the outpatient setting as we do in the inpatient setting.
We have an opportunity to better understand the system and to rationalize our contracts. I have a $12 million target that I know we’re going to exceed. We’re going to take those resources and reinvest them in all things wellness; in creating a frictionless experience for our patients, our customers, and our consumers.
Gamble: I’m sure going through contracts can be a pretty laborious process. Obviously, there are savings there, but it’s a lot to go through.
Walders: It’s no different for my IT peers. It’s the same as application rationalization; if we could only cut legacy applications out, right? We had 1,283 applications when I got there. We’re now down to 400. That’s where the $16 million in IT savings came from.
It’s similar with contracts. You’d be surprised when you open the file cabinets and double-click those contract management systems and see what you’re automatically paying for. We’ve taken this approach a lot. There’s an expression in Latin that basically means that if you can find way or an opportunity, you get a percentage of the savings. That’s the mindset I’ve been trying to bring here. And while I’d love to give big golf tournament-sized checks like I used to in government, we don’t do that.
This is an opportunity for driving legacy issues out of your systems — I use the term ‘system’ generically, but it can be anything — to gain innovation. We’ve empowered the staff with the ability to hunt these things down, get credit for them, and, in a sense, get credited back to their cost centers.
To give you an example, we’ve been automatically paying for a bunch of licenses for a certain type of software. And so, someone picked their head up and said, ‘We don’t use this as much — certainly not to the scale of having 10,000 licenses when maybe we only need 200.’ And voila, half a million-dollar cost savings.
Feeding the flywheel
It’s easy to just renew it. The same goes for instrument sets in procedural areas and scopes for endoscopies and colonoscopies. We’re using that same IT mindset in the operations world and empowering the staff on the supply chain side, process improvement side, and PMO side, as well as other areas in my purview, to go hunt those opportunities. It’s understanding that they’ll be reinvested, not just for our growth margin as a not-for-profit health system, but real opportunities to reinvest in the solutions and other resources they’ve wanted. It’s like the expression, feeding the flywheel; we’re gaining those efficiencies and reinvesting them back in the flywheel to make it more efficient.
Gamble: That’s a great way to improve engagement, by helping people see the benefits.
Walders: Exactly. We’re doing this through partnerships as part of our supply chain rationalization. We’re looking at why it costs so much for total joints and spine and cardiac rhythm management. We’re partnering with our provider partners to give them an opportunity for cost savings.
I have a real-world example where we’re saving a significant amount of money on orthopedic surgery and some cardiology surgery, and we’re reinvesting that back in OR modernization. We’re buying a robot for the surgeons so they can be more efficient at procedures and purchasing one for our hospitals where physicians could leverage those new technologies. The ‘what’s in it for me’ aspect is ridiculously important, not only with our internal team, but our partners as well.
Gamble: So a lot of emphasis on cost savings and automation in 2022.
Walders: Yes. We’re trying to capture — and I hate this expression — low-value work and have people operate at the top of their discipline. You hear a lot of talk in medicine about people operating at the top of their license. You don’t want a highly credentialed nurse filling water pitchers with the bulk of his or her time. You want them to operate at the top of their license and reduce the amount of low value work.
We’ve done a good job of that in IT; and in particular as a health plan, we’ve learned the power of automation with claims processing. In the old days we had teams of people processing claims; robots do that now. It was our first entry of toes in the water with what automation looks like.
Like many organizations, we’ve looked at revenue cycle and registration. And now we’re looking into clinical areas to see how can we capture back hours that are crucial to our nursing staff? We’re looking at things like tele-sitting, virtual nursing where it’s appropriate for a lot of the administrative areas. We’ve got EVP level staff — our hospital division CEO, our health plan CEO, medical group CEO, our chief administration officer — all speaking the language of automation and where we can go target these opportunities to capture back this low value work. We’ve spun off a product team for this. We’ve got a multi-disciplinary approach to how we’re finding these.
Again, it’s kind of what’s in it for me, we’re celebrating these wins in very public ways as people identify opportunities to automate.
I think there’s great ones again around the perioperative space, how do you automate the scheduling, the care coordination, coordination and collaboration of that care team, and something we’re targeting early ’22 is to do that around scheduling, bringing those disparate resources together around the OR, which is our number one revenue generating business line on the hospitalization side. That’s what we’re targeting first, and we’re finding some successes there.