Q&A with Houston Methodist’s Michelle Stansbury: “It’s All About the Problem You’re Trying to Solve.”

At Houston Methodist, innovation isn’t a novel concept or a trend; it’s part of the fabric of the 8-hospital organization, according to Michelle Stansbury. As such, she and her colleagues have learned quite a few things over the years. First, the key to creating a culture of innovation is to create a separate entity — but to have that entity staffed by leaders throughout the organization. That way, they’re able to develop solutions that address the organization’s unique needs and workflows, and quickly implement them, said Stansbury, who serves as VP of Innovation and IT Applications for Houston Methodist, as well as VP of the Center for Innovation.

Another critical component? Sharing knowledge about innovations throughout the organization, which enables leaders from other departments to identify potential use cases. This type of collaboration “speaks to the heart of our 30,000-plus employees and how they truly believe in what we’re trying to do.”

During a recent interview with Kate Gamble, Managing Editor and Director of Social Media, Stansbury shared her thoughts on what has made both Houston Methodist — and the Center of Innovation — successful; how her team invests in “sweat equity”; what it takes to form a “true partnership” between IT and operations; and the hard line leaders need to draw when it comes to ROI.

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Key Takeaways

• On creating the Center for Innovation: “There was an obsessive focus on how we could transform our institution utilizing digital technology” to help improve patient care and enhance the user experience.
• On IT and operations: “There are no IT projects. There are operational projects with IT partners involved to ensure that it goes smoothly.” An IT-driven initiative, on the other hand, will “never get the operational impact that it needs” because key people aren’t at the table.
• On having R&D capabilities: “It allows us to pilot new technology within that space, work with vendors on their solutions, and allow clinicians or executives to come in and see the technology in real time.”
• On co-development: “We don’t look for companies with alpha products. We’re looking for companies that have a product that’s somewhat working, but they’re looking for more expertise from health systems to help them further develop it.”
• On reducing clinician burnout: “We want to make it as easy as possible for our clinicians to do what they do best, which is take care of our patients. If we can reduce the burden on them, or even the burden on patients… that’s important.”

Q&A with Michelle Stansbury, VP of Innovation and Applications, Houston Methodist

Gamble:  Hi Michelle, thanks so much for taking the time to speak with us. Let’s start with a high-level overview of Houston Methodist.

Stansbury:  We are one of the leading health systems within Houston and the surrounding market. We’ve got our large academic center, and we have eight hospitals in the area. We have a little more than 30,000 employees and have been in existence for over 100 years. We actually celebrated 100 years as the pandemic was starting, which was interesting because the whole Methodist system started during the Spanish flu pandemic.

I’ve been at Houston Methodist for 30 years. Sometimes it’s hard for me to believe but it has been a very rewarding career and couldn’t imagine being at any other health system except Houston Methodist.

 

Gamble:  I’m sure in some ways it feels like it’s only been a few years, which is a good sign.

Stansbury:  It is. I have seen many changes and have absolutely enjoyed my time seeing how the health system has evolved to meet the needs of our patients.

 

“Obsessive Focus” on Innovation

Gamble:  Let’s talk about the Center for Innovation. How did it come about and what are some of the core objectives there?

Stansbury:  It started about 4 or 5 years ago, as digital technology was gaining ground across the nation, and we were seeing many other incumbents who felt they could solve healthcare. There were a few of us that were keeping track of everything that was going on. It really came down to the fact that either we were going to allot these other incumbents trying to disrupt our healthcare system or we were going to disrupt ourselves.

Clearly, healthcare has its own problems that we need to solve within our institution. But it started with a few individuals keeping track of all the different innovations that were out there. We started meeting on a weekly basis and asking questions like, what have you seen? What have you heard? What are the things we really need to look out for? It really proved to be beneficial. And so, like any work group, we started by naming ourselves.

We called ourselves Digital Innovation Obsessed People (DOIP). There was an obsessive focus on how we could transform our institution utilizing digital technology to take care of patients and help our clinicians. What started as a small group formed our Center for Innovation.

What makes us unique is that everyone who sits on the Center for Innovation holds dual roles within the organization. For example, our chief innovation officer is also the CEO of our largest hospital within the Texas Medical Center. I’m vice president of IT of all of our applications as well as Vice President for the Center for Innovation.

Having dual roles

We did this purposely. Even though we all have full-time jobs, and this is another one, we were extremely obsessed with making sure we could do this transformation. By having these dual roles, we know where all of our problems are, because we live it on a daily basis. And when we find solutions that work and we pilot for our organization, we are quickly able to turn around and put on our normal hat. For me, being within IT, I’m able to roll things out with my application teams, and then operations.

A lot of times, we’ve heard that other organizations who had separate innovation centers were able to come up with some really great ideas and pilot these ideas. But t when they needed to hand them off to be fully implemented across the institution, many times they heard ‘we’re too busy,’ ‘we don’t have enough time,’ or, ‘it’ll be 6 to 8 months to a year before we can fully implement.’ With the structure that we have, we’re able to quickly turn it around and implement it across our organization to gain the benefits that we had seen through the pilot.

It’s been extremely beneficial for us. We’ve been able to do things very quickly. As a matter of fact, a lot of organizations reach out and ask how we did it, and we tell them that it’s because we hold these dual roles. As our innovation center has continued to do well, some people have asked if we think we’ll ever change that. We won’t, because it has worked so well for us.

 

IT and Operations working “hand in hand”

Gamble:  That speaks to what you were saying before about some of the outside companies that may have really great ideas but without inside knowledge of healthcare, or of the organization itself, and that’s where you can really run into issues.

Stansbury:  One thing that’s important is that we have a true partnership between operations and IT; we work hand in hand. There isn’t a meeting that we aren’t at together because we realize one can’t do anything without the other. Everything we do is seen not as an IT-led project, but as an operational project with IT partners involved to ensure that it goes smoothly. That’s the best scenario you can have, because things that are IT-driven never really get the operational impact they need, because you don’t have those leaders at the table with you.

 

Leveraging Houston’s scaling capabilities

Gamble:  When the Innovation Center was created, was the goal early on to get some quick wins and build on that? What was the approach?

Stansbury:  We did have some quick wins, particularly looking at patient access. When we’re looking for vendor partners, our strategy is to look for companies that maybe have a product being used in a smaller institution, but they’re really looking for a large health system like Houston Methodist to help further develop their products. That way, they can then turn around and partner with other organizations.

A “huge patient satisfier” with texting

We brought in several solutions to be able to do that, one of which was a text-based solution. What we had found in talking about smart technologies is that most people have just become accustomed to texting. And so, instead of using telephone reminders for appointments, we gave the option to be able to text those individuals. It was a huge hit; everyone loves to text. As a matter of fact, it was so successful that patients were texting us back because we offered a bi-directional texting. They were sending emojis. They were asking different questions. It really helped to reduce our no-show rate very quickly. And so, that was one, but it was a huge patient satisfier.

We’ve continued to work with those vendors. And while texting was the initial use case, we’ve very quickly been able to roll it out for many other things. We’re now looking at rescheduling appointments and things like that.

Creating care pathways

We also reached out to a vendor with whom we had partnered to help develop care pathways, and we found that utilizing this technology can improve outcomes, because it communicates information about the services you’re going to get. For example, if you’re coming in for a procedure, you’ll be contacted via text, email, or phone — whatever form of communication you prefer — to remind you of the things you need to do prior to coming into the hospital. After discharge, you’ll receive information on what you need to do.

This has helped reduce readmissions, reduce length of stay, and increase our HCAHPS scores tremendously in these areas, because patients felt like they knew exactly what to expect before coming in and what they needed to do. We’ve continued to expand that across our organization.

Covid’s virtual push

Another important initiative is our virtual ICU. It started out as a project we were going to roll out to all of our hospitals within probably a year and a half or two years. We already had it in place at our main hospital within the Texas Medical Center, where we had created a virtual command center to help with deficiencies within our ICU and the lack of hospitalists.

When Covid hit, we had already been doing virtual health, but on a small scale. We were toying around with it, but of course, like everybody else when COVID hit, we had to shut down all of our clinics. The virtual ICU project fully expanded across our organization — we were able to do it within 6 to 8 months.

It was interesting; when Covid hit and we had our very first community spread, our Chief Innovation Officer [Roberta Schwartz] sat us down and said, ‘okay, which of the technologies we have in place can help us?’

From tech hub to training hub

We had recently created an R&D space, which we call our Innovation Technology Hub. That allows us to be able to pilot new technology within that space, work with vendors overall on their solutions, and allow our clinicians or executives to come in and see the technology in real time, instead of doing a PowerPoint presentation or a demo. Having that in place helped us. But the key was that we were able to quickly convert that tech hub into a training space. We were able to train all of our physicians how to do virtual visits and how to utilize the technology within a very short timeframe.

That helped us overall as well as during Covid, because it was so difficult for everyone having to gown up to get into rooms for just a quick visit, and family members had no way to come in and visit their family that was in the hospitals. And so, we put iPads in every single room to enabled that, and to allow clinicians to be able to do a quick video visit with a patient without having to get gowned up. It also allowed the patient’s family members to communicate, and it helped us streamline and move things forward within the organization during Covid.

Leveraging chatbots in the call center

We’ve implemented intelligent automation and RPA with high success within overall the organization. During Covid, we also implemented chatbot technology, which we’ve continued to use as Covid has died down. We really look to create efficiencies within our organization. With that technology, we’ve been able to reduce our call center staff. Our goal is to have at least 75 percent of calls coming into our lines to be able to be handled by the technology that’s there. We’re looking at efficiencies gained from utilizing the digital tech from the voice vendors to the virtual ICU, as well as the care plans that we’re looking at. I will tell you, we don’t do any kind of innovation solution unless it has a true ROI for us. While there are a lot of technologists to get excited about, if it’s not solving a problem and giving us a solid ROI, we won’t do it.

 

Investing in “sweat equity”

Gamble:  It sounds like you’re talking about co-development with vendors, and not taking a fully-baked product, but instead, using your own knowledge in-house to work with it and make it something that’s going to be as useful as possible.

Stansbury:  That’s exactly what we do, and we have found it to be beneficial for us. We don’t invest dollars within other smaller companies; we know other health systems that do that, but it’s not the approach we want to take. What we do invest in is our sweat equity. We share knowledge and expertise with these companies to help them further develop their products.

What we have found is that they may be bringing in one solution to solve one problem — we help them realize a lot of times that they can further develop other solutions based on the core product they’ve developed, and that can help us solve other problems. It’s really a true partnership with these organizations that can help grow their company while also helping to solve the problems that we want to solve.

Ultimately, when you get that win-win partnership, there’s a trust that comes along with it. I don’t know if it would work for other organizations, but it has been a win-win for us, and we will continue to do it that way. We don’t look for companies with alpha products — that’s not something we want to develop. We’re looking for the ones who have a product that’s somewhat working but they’re looking for really more expertise from health systems to help them further develop it.

 

Care redesign

Gamble:  One thing I imagine can be challenging is prioritization. There are so many needs that need to be met, and innovation can help with a lot of those, but what is your strategy when it comes to prioritization?

Stansbury:  Again, I think it all comes down to what’s the problem you’re trying to solve.  I think you get hit with different problems at any given time. The biggest one we’re working on right now is our care redesign process, which had to do with the staffing challenges that we’re all facing because of Covid. The mass exodus out of healthcare is a reality. If you look at the stats, there aren’t enough nurses out there to hire. So we thought, what can we do within our institution to be able to help overall with the staffing challenges? Our Chief Innovation Officer is constantly being asked when we’re going to get more nurses, and the reality is they’re not there.

One thing we’ve realized is that sometimes it isn’t about looking at new technology, but thinking about how to do things differently. We already had the technology in place that we were using with our virtual ICU, with tele-sitting, and other virtual services. We had iPads in every room. And so, she did a short time study on our nurses to see if they were doing things that weren’t part of direct patient care. She found that it was taking as long as 40 minutes to get through admit and discharges. And so, the question was could we utilize the technology in place and assign a few nurses to do virtual nursing, at least on our admit and discharges? Again, no net-new technology — we already had everything in place. The iPads were already in the room.

I will tell you the nurses were a little apprehensive about it. They said, ‘what do you mean you’re taking this away from us?’ But after about a week, the nurses absolutely loved it. Our patients absolutely loved it. It cut the time down from 40 minutes to 13 minutes to be able to do these activities.

With this initiative, we’re taking time away from those tasks and allowing our nursing staff to focus more on the things that they need to do to be in front of patients and take care of them. That’s part of what we’re looking at overall from this care redesign. Now, that’s quickly rolling across our institution and has been a big, again, time savings for every one of us.

The other thing that we’re looking at is instead of having iPads, which need to be wiped clean after everyone leaves, what if we put camera and speaker technology in every one of our rooms? We’re also looking at a product for ambient intelligence using cameras that can show you different use cases like fall prevention. It provides an outline of the room and an outline of the patient so that if a patient presents a fall risk, the technology can detect that movement and send an alert into the room asking the patient to remain in bed. It will also alert the staff to let them know somebody needs to have a direct conversation with the patient. Again, there are multiple other use cases with this vendor that we’re working with. We’re starting out with fall prevention; there’s about six other use cases that we’re further developing with them that we have high hopes for.

Biometric & biotech data – “The next big thing”

We really believe biometric data and biotechnology is kind of the next big thing. We all use smart watches, and we’ve seen other technology that you can attach to yourself. We’re partnering with a vendor right now that has a patch, about the size of a half dollar, that sticks on to the patient. Whether they’re coming into the ED or they’re coming in as an inpatient, it collects vital sign information and all types of different vitals that can immediately go into the EMR. If you think about it, how much time is being spent by staff having to go rounding and taking vitals off of our patients? By having this, maybe we can stop Q4 vitals and gain efficiencies from that as well. That is our whole goal in looking at this technology — how can we gain efficiencies from it? That’s a really big piece.

If you look at what ambient intelligence is providing these days, there are other efficiencies that you can look at within operating rooms. We’re working with a vendor right now that has cameras that are rolling all the time. If the staff is coming in to set up an OR and getting everything prepared for a procedure, certain things are blurred out for privacy. Once the case is finished, it looks at how long it’s taking to get the OR cleaned up and ready for the next case. We can quickly determine by looking over all this data where we can gain efficiencies, and what are some things that can allow us to turn over those ORs much faster.

We’re also looking at voice technology; we believe that’s the wave of the future as well, from the Alexa devices that we have in all our rooms to allowing our physicians to use voice technology to help with documentation. We’re also exploring ways to help our nurses. Physicians need help, but nurses need help as well. It would be great if all they have to do is be able to speak to get all of their documentation done without having to spend hours going back and trying to complete the documentation that they did not get to do during their rounds or with patients. It’s sad to think about, but nurses are still writing things down and then going back and trying to document them into the EMRs, and we need to get rid of that. Our CEO’s prime objective is to get our clinicians back in front of the patients and not in front of the computer.

“Know me” strategy

Gamble:  I find it really interesting, the idea of leveraging tools like ambient intelligence to get clinicians in front of patients. It seems like that’s a big driver for so much of what you do.

Stansbury:  It is. This obsessive focus that we have in our Center for Innovation is all about our patients and our clinicians — how can we make it easy for patients to get services at our facilities, or in way that they prefer. We have a ‘know me’ strategy focused on ensuring we know our patients and we know how they prefer to get services at Houston Methodist. Do you want to do everything by phone? Do you prefer the old way of calling us? Because certain people do prefer that. We want to make that as easy as possible.

And we want to make it as easy as possible for our clinicians to do what they do best, and that is to take care of our patients. If we can reduce the burden on them or reduce the burden on our patients by making it as efficient and convenient as possible to get those services, that’s what we believe that is important for us to overall transform our overall operations.

 

Culture of innovation

Gamble:  It seems like you’ve really been able to establish this culture of innovation at Houston Methodist. Can you talk a little bit about what it takes to build that?

Stansbury:  Innovation is not new to Houston Methodist. We’ve had many innovations even back to when we started the research institute. But when it comes to digital technology, we have an overall culture of innovation. We have great pieces on different units and in different clinics. We have physicians and nurses that are so engaged with us and are willing to try these things. And look, sometimes they fail; sometimes they don’t go exactly as we would have hoped. We have started and stopped a few times with different solutions, but they’re very much engaged with us, because they know at the heart of what we’re trying to do is to help them and our patients.

Patients “at the heart of everything”

Our CEO will say this all the time, and you won’t find any employee at Houston Methodist that doesn’t believe this: the patient is at the heart of everything that we do, and that’s the reason we have such great engagement. We’ve held shark tank events and other different types of innovation events so that we can hear about potential solutions from people across the institution.

The other thing that we’ve started doing is going across different leadership huddles and explaining some of the innovations that we’ve done so that people can look at that and say, ‘that’s a potential use case for something else that I’m doing.’ We’ve got a running list of things that we’ve already done, and we have potential other use cases for us that we’re learning from. To me, that speaks to the heart of our 30,000-plus employees and how they truly believe in innovation and what we’re trying to do.

 

Reflecting on 30 years

Gamble:  As you stated earlier, you’ve been with the organization for a while and have seen so much change. Can you give some thoughts on what it’s been like to be with the organization and to be part of that evolution?

Stansbury:  It has been my honor to be at this institution. I can’t imagine being at any other place. Everyone is so dedicated to taking care of our patients. But in terms of the evolution, what really stands out is the growth of the institution. I’ve seen tremendous growth in my 30 years here. I was here when we created the research institute and created our own physician organization, and it’s a credit to the commitment from our leadership for us to do the right thing.

Even during our Epic implementation, our CFO was spearheading a lot of that work with the organization. He used to tell us all the time: when you’re making decisions about what to do, think of the patient first. Because if you think of the patient first and make the decision based on that, you’re probably making the right decision.

That speaks to the heart of Houston Methodist and our desire to make sure that we’re doing the right thing. It’s that overall commitment from leadership and the staff as we continue to grow. I’m just amazed that we’re at 30,000 employees now. We’re building our newest hospital in Cypress which we’re dubbing our smart hospital of the future because we’re using a lot of this technology in that institution. It’s that commitment from leadership to do what we need to be doing for Houston and the surrounding community, and our patients.

 

Gamble:  It’s great. It’s clear that you really have a passion for what you do and a belief in the organization.

Stansbury:  I feel extremely fortunate. I don’t think anyone, especially these days, goes into an organization thinking, ‘I’m here for life.’ But I see the obsession we have to be able to drive the things that we’ve been able to do and make the changes that we’ve been able to make to transform, and it’s exciting. It’s exciting to come to work every day and see the things that we’re working on.