“We’re focusing on the real issues.”
Since Bradd Busick arrived at MultiCare Health System two years ago, his core objective has been to find better ways of doing things. Not because the organization wasn’t on the right path — it was, and continues to be. “The vision for transformation is real,” he said during a recent interview with Kate Gamble, Managing Editor at healthsystemCIO.com. “It’s palpable. And frankly, it’s now an expectation.”
What the 11-hospital, Pacific Northwest-based system needed was someone who could help steer it in the right direction, whether that means ensuring Epic is fully optimized, leading an infrastructure modernization effort, or making customer service a key priority. Busick, who spent several years with the Gates Foundation, seemed like the right candidate for the job.
In the interview, he spoke about what it was like to begin his first CIO role in “firefighter mode” as the organization dealt with Covid; the huge importance of having “an incredible leadership team and business partners”; why he’s optimistic about the next generation; and the many lessons healthcare can learn from outside industries.
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- One of the first Epic shops in the country, Multicare is constantly focused on being the latest version of Epic and ensuring the system is fully optimized.
- Stepping into the CIO role right when Covid-19 hit meant having to jump right into firefighter mode. But it also helped Busick quickly develop relationships and drive change.
- Rather than relying on a long-term strategy, MultiCare can pivot every 90 days based on the most pressing needs. “The magic in this process is the fluidity.”
- Being a high-reliability organization is about more than just patient safety (although that is critical). It’s implementing processes “where we crosscheck each other to say, ‘let’s stop the line. We have something that looks out of the norm.’”
Q&A with Bradd Busick, CIO, MultiCare Health System, Part 1
Gamble: Hi Bradd, thanks so much for taking some time to speak with us. I’d like to talk about the work your team is doing, as well as your career path. Let’s start with an overview of Multicare Health System.
Busick: Multicare is located in the Pacific Northwest, which we define as Washington, Oregon, Montana, and Idaho. We have 20,000-plus people, including employees and providers. As of December, we now have 11 hospitals between eastern and western Washington. We have a pretty aggressive growth strategy; not only from an expansion perspective, but also in terms of capabilities. We have an urgent care platform via Indigo with a few hundred clinics scattered around eastern and western Washington as well. It’s been a great time to come into healthcare, as we’re scaling at a pretty rapid pace.
Gamble: Definitely. And in terms of the EHR, you’re on Epic, correct?
Busick: We’re an Epic shop. We actually were one of the first shops in the country to put in Epic. As you know, these systems require a ton of care and feeding. We’re in the process right now of optimizing and moving to Epic Foundation so that we can take advantage of the capabilities, as opposed to admiring them and watching them sit on the shelf. We’re embracing them more than we have in the past.
Gamble: Right. So, Epic has been in place for a while. But as you said, so much goes into the care and feeding.
Busick: Absolutely. We have a team that’s focused on that aspect. But if you think about the depth and breadth of a system like Epic, there’s a lot to say yes to; there’s a lot to embrace. And if you don’t stay on top of that, you get behind pretty quickly. We started implementing Epic in 1997. So, when I say we were one of the first in the country, I really mean it. And now, we’re actively scaling to get to Foundation level.
Gamble: What exactly does that entail?
Busick: It’s taking advantage of everything it offers. For example, with an iPhone or Andriod, if you’re not on the latest version, you can only take advantage of a certain percentage of capabilities that get rolled out. It’s the same with Epic, whether it’s eCheck-In, Epic native telehealth, or any of those things. Because of different priorities and leadership changes we’ve had at MultiCare, investing more in Epic to stay current or stay on the latest version hadn’t been a priority. With our new leadership team, however, it is. That’s one of our main areas of focus in 2022.
Gamble: Can you talk about the leadership changes that were made?
Busick: Sure. I joined in March of 2020. On my first day, March 16, I got pulled out of new hire orientation. They said, ‘Are you Bradd?’ I said yes, and they said, ‘We need you up in the command center,’ and so I went to this thing that was being assembled.
What was really interesting is that doing that 100-percent bypassed the traditional onboarding process. We didn’t do any of that. It was 100 percent focused on Covid — we have thing, and we don’t know what it is, but it’s here in our hospitals. How do we support the system and our community? That really was my fast track to developing the relationships that were needed in order to scale the way that we have.
Fast-forward to today, my experience at Multicare has been 100 percent steeped in putting out fires, whether it was moving 6,000 people to virtual or setting up a command center focused on patient orchestration for the entire system. It’s been a really awesome way to bring change, whether that’s telehealth or an IVR for self-service — things that weren’t possible without the urgency of COVID.
Gamble: Really interesting perspective. You’ve only been a CIO during Covid — that’s what you know. I’m guessing at some point your strategy will change.
Busick: That’s actually an interesting topic. When we talk about strategy, we’ve implemented a pretty rigorous process that I brought with me from the Bill & Melinda Gates Foundation. We call it A3; it’s a plan, do, study, adjust model. Every 90 days we actively look at all of our capabilities. We’re bringing in our business partners as well as our IT team to measure those capabilities and articulate what we’re studying about a certain focus area, and then make adjustments as needed.
“Pivot and be fluid”
For example, one of our PDSAs might focus on self-service capabilities. During Covid, we needed a way for patients to be able to self-schedule. We would have had to hire 163 FTEs just to handle the volume of phone calls and people showing up for our Covid response. So, we simply rolled out a technology solution that allowed people to self-serve, and more than 100,000 people downloaded the app and made appointments. No one even had to speak to a human being. And it was about a $7 million cost avoidance.
Those are the types of things that have allowed us to pivot and be fluid as opposed to having a document that just sits on the shelf somewhere, which a lot of systems have. It looks really pretty, but it’s not executed. That’s absolutely not how we’re operating our IT shop here at MultiCare.
Gamble: Can you talk a little bit more about the process of looking at capabilities every 90 days? What does that look like?
Busick: Sure. We call it an A3 because that’s the size of the document when it prints; that’s the paper tray size. And so, if it can’t fit on one page, it probably isn’t strategy worthy, at least for this format. We look at every single one of these focus areas, whether it’s technology infrastructure, applications, clinical informatics, security, or data orchestration, and we say, how are we looking with regard to our predictive capabilities, or how can we enhance security in micro-segmentation? We have an owner for that capability who can articulate what we’re learning and observing. We’re on track for our measurement to roll that out.
Getting real feedback
Everybody gets the chance to provide feedback, and we do it digitally. You might have 60 sticky notes from your colleagues in different parts of the organization who know nothing about security but have questions or feedback like ‘when you turn this on, it stopped my VPN from working,’ or ‘when you guys turned this on, it stopped our Phillips pumps from talking.’ This cross-pollination of ideas has frankly been one of the ingredients that has allowed us to really scale, and help IT earn the trust of our business partners.
Gamble: That’s interesting. We’re seeing that the 3, 5 or 10-year strategies are going by the wayside because it’s just not practical. If anything, the last two years has shown us that.
Busick: We would go out 18 months, and even that is questionable. The magic in this process is the fluidity; the ability to pivot every 90 days. We do, and we have. There’s no ego in coming to the table saying, ‘I’m behind in this area and I need help.’ Or someone might say, ‘that’s actually not important anymore.’ It was important 90 days ago, but it might not be important now. Let’s repurpose those resources and go focus on our cloud migration or enterprise data warehouse, etc.
Gamble: Okay. So, I read an article where you talked about having a high-reliability strategy. That’s a really interesting concept. Can you talk a little bit about that?
Busick: So, at a 50,000-foot view, when you talk about high reliability and combine that with a retail experience, let’s say you went to an Apple Store, but you didn’t know it was closed. Or you walked in and grabbed your iPhone and took two steps out the door and it stopped working. That would leave a fairly bad taste in your mouth. I don’t know that we apply that same level of retail or consumer thinking to healthcare, at least in the way that we should. And so, the premise and the idea of high reliability goes beyond patient safety. As we think about it from a technology perspective, can I apply predictive capabilities to keep our equipment up so that we actually know it’s going to down before it happens, or that we deploy the right tech to the right place at the right time to fix that CT or that MRI.
The same is true for our buildings. When I think about patient comfort, what if the HVAC system is really struggling and our patient rooms are really hot? That’s a big deal; patient comfort is really important. And so, there’s technology and rigor we can apply to make sure people view Multicare as a reliable system. They know they won’t get stuck in a CT machine because it’s been taken care of. That might sound far-fetched, but it’s not. That type of equipment is really fragile.
The premise of that argument supports our HRO journey. We want to be highly reliable and we want to put processes in place where we cross check each other to say, ‘Let’s stop the line. We have something that looks a little bit out of the norm. Let’s talk about it and see if it’s isolated or if in fact it’s a system-wide issue.”
Gamble: You mentioned analytics, which certainly plays a role in this. Can you talk about what needed to be in place?
Busick: More than any point in industry, we have a lot of data. We have more data than we know what to do with. So, how do you take data and turn it from something that’s interesting to something that’s actionable, with the analytics we’re gathering from our equipment — particularly in this use case? This is a $126 billion dollar industry with a compound annual growth rate at 24 percent over 7-year period. This is not a small space. And in this space, it’s one thing to gather the data; it’s another thing to actually do something with it.
Back to the strategy conversation, we knew this is a capability around predictive that we needed to grow, particularly in the clinical space.
And so, we invested in both the people and the infrastructure to be able to capture that data, analyze that data and then do something with it. I think a lot of systems stop short of the last two. They’ll capture the data because that’s probably the easiest piece, but then they don’t do anything with it. They admire it. We are not in the admiration game. We actually go and do something with it and that’s been a really fun journey Multicare.
Gamble: That is a big piece and something that has been a challenge. I know there’s no easy answer, but what enables organizations to next that next step? What does it require?
Busick: I think it’s the investment in people. It’s one thing to have a vision for what the technology can do. It’s another thing to bring your team along with you to go and execute it. Let’s take smart equipment as an example. When we decided to invest in the infrastructure to monitor our critical equipment, such as MRIs and CTs, we brought our staff along to say, ‘this is a new way of thinking about it,’ rather than being reactive and waiting until the machine is down and you have a really unhappy patient that’s either in the middle of a procedure or needs to be rescheduled. What would it look like for you, for your spouse, for your family? Everyone one could conceptually get behind that, so we decided to try it.
We rolled it out to a really small subset of data with a team of five people. We said, let’s monitor the equipment. Let’s change our processes to strategically look at these alerts that are going to come, and then let’s cut all the data, and carve out the noise so that we know when a tube filament is going to burn out or when a magnet monitor is going to freeze over. Since we’ve done that, not only has the team seen the fruit of this, because now we’re actually focusing on the real issues that could actually take a machine down and fixing it at night or over the weekends, but the win comes back to the HRO piece for our patients. Because in some cases, we’re saving patients from unnecessary X-ray exposure due to multiple scans or the first scan getting stuck in the middle. We’re avoiding all of that, but more importantly, we’re avoiding downtime. If I can go and have a staff member fix a machine that saves me, in some cases, three plus days of equipment being down, that has patient implications. It has a revenue implications.
We are really thoughtful about that. And because of the success we’ve had in the first nine months of doing this, we’re actually growing that team and also growing that platform.
Gamble: That’s huge being able to point to those metrics, which can help build support for it.
Busick: Absolutely. The really interesting part is that it isn’t IT out there banging the drum saying, ‘Look what we’ve done for you lately.’ These are hospital presidents saying, ‘We’ve had some pretty incredible uptime for this piece of equipment, because of the cool work IT has done.’ And in most cases, they don’t care how it’s done, but the end result is better patient experience, higher reliability.