“Transparency has always been very important to me.”
It’s not exactly a rare thing for an established healthcare IT leader to say. But Jeff Buda doesn’t just talk about being transparent; he has walked the walk throughout his 30-year career. For example, when Floyd Medical Center joined Atrium Health in June of 2021, his team was notified months in advance. And not just notified, but told in candid terms what it meant in terms of realignment, restructuring, and converting IT systems. “I’ve always had an open door so that if people had concerns, they could come in and feel comfortable expressing those.”
As the organization has continued to undergo changes — most notably, the merger of Atrium Health and Advocate Aurora Health, which created a 67-hospital system across six states — Buda has made communication a key facet of his strategy, whether it’s through asking questions, sharing observations, or the ‘Stump the CIO’ initiative that enables staff to ask questions anonymously.
Recently, Buda spoke with Kate Gamble, Managing Editor at healthsystemCIO, about his leadership philosophy — particularly when it comes to change management; how Floyd has leveraged Atrium’s resources and experience in rolling out and optimizing Epic; and why he’s a big believer in remote work.
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- Floyd Medical Center joined Atrium Health in June 2021, then experienced more change when Atrium merged with Advocate Aurora in 2022. “It tossed our salad again and put some things on hold as everybody figured out, what does this mean?’”
- Floyd went from having a “hodge-podge of systems” to implementing Epic and being able to deliver “a better patient experience from a portal and billing perspective” as well as virtual care technologies.”
- Buda’s team announced the decision to join Atrium to the staff “well before the transaction actually took place,” he said. “We were very transparent with our teams about what that means.”
- “Everyone is looking at AI with one eyebrow raised and trying to figure out, is there a place for it? Is it safe? What are the best places for it? How can it help us the most?”
- Buda’s key piece of advice for CIOs? “Ask a lot of questions. My philosophy has been for many years that we hire professionals to do a job. I’m not a micromanager. My approach is to let them do their job.”
Q&A with Jeff Buda, VP of Operations & CIO at Atrium Health Floyd
Gamble: Hi Buda, thanks so much for your time. Just for some background, can you give an overview of Atrium Health Floyd — what you have in terms of hospitals and where you’re located, things like that?
Buda: Atrium Health Floyd has three hospitals: two in the northwest corner of Georgia and one across the state line in northeast Alabama. The main campus is about 304 beds; the others are a 25-bed critical access hospital and 60-bed facility. A little over two years ago, we joined Atrium Health, and then about 8 months ago Atrium combined with Advocate, and so, we are now part of the fifth largest health system in the US.
Gamble: That’s big. Now, does that work in terms of the reporting structure? Do you report to Atrium’s Health IT office?
Buda: So, a lot of things are changing right now. I report to Andy Crowder, who is CIO for the Southeast Region of Advocate, and he reports to Bobbie Byrne, Advocate’s Enterprise CIO. I actually have a dual reporting relationship where I report to both Andy and our local CEO.
Going live on Atrium’s systems
Gamble: Being part of a large network, how does that work from an EHR standpoint? Are you on the same system?
Buda: We are. When we joined Atrium two years ago, we immediately started implementing some of their enterprise systems and migrating our technology. We went live on Atrium’s version of Epic in August of last year; just before that, we went live on their ERP solution, which is Oracle.
“It was intense”
Gamble: Can you talk about what that process has been like, starting with the Oracle rollout?
Buda: Upon joining Atrium in June of 2021, we started migrating our active directory structure, including Outlook, almost immediately, and then we began the Oracle implementation. Atrium had been working with Deloitte, and so we followed their roadmap when we moved to Oracle. It was a pre-requisite for Epic. Because of some of the supply chain integration in the OR, we had to go get our technology migrated first then go live on Oracle followed by Epic. All three of those things happened within roughly a year and a half. It was a pretty intense time, to say the least.
Gamble: I’m sure. Once you got through the initial implementations, what were your biggest priorities?
Buda: Epic brought a lot of capabilities that we didn’t previously have, and so we’ve also been working to implement some of Atrium’s virtual care models. We’re starting the process now to go live on their eICU and be able to do virtual patient observation as well as some other telemedicine enhancements.
The integration with Advocate has really tossed the salad again and put some things on hold as everybody sort of figures out, what does this mean? What further consolidations might there be with Advocate’s systems? It has slowed things down a little bit, but we are still pursuing some of the virtual care models. That’s really key for us in our market and with some of the things we’re doing. It’s been a benefit to our patients as well.
Gamble: It seems like it has really propelled the organization forward.
Buda: It has. We were previously on Cerner for the EMR in our acute setting, and Greenway in ambulatory. We had different billing systems sitting on top of both of those. We were kind of a hodgepodge and somewhat limited in what we could do in having a really integrated system, but Epic was going to be cost prohibitive for us as an organization to move to independently.
By joining Atrium, we were able to bring that to bear and deliver some of the capabilities that integration allowed for, such as a better patient experience from a portal and a billing perspective, virtual care technologies, and having a world-class EMR.
“We were in a box”
Gamble: Did the fact that migrating to Epic was a prerequisite make it easier for you to build buy-in?
Buda: Our organization recognized some of the shortfalls of the systems that we had. But again, we were somewhat in a box because we had legacy investments, and so, moving to Epic was going to be quite expensive from a capital perspective. Organizationally, we were going to struggle.
We looked forward to it. And in fact, as we looked at suitor organizations, one of the expectations was that they would bring Epic into the equation and bring us up on it. That was one of the things that we were looking for.
Not Atrium’s first rodeo
Gamble: Right. What was your approach to getting started and getting the teams and training set up?
Buda: Thankfully for us, this wasn’t Atrium’s first rodeo. They already had an implementation model, and so, they really helped us identify the teams that we were going to need. We aligned our people into those teams and quickly got about the implementation work. We partnered very closely with Atrium who already had a support and implementation structure.
Transparency during change
Gamble: One thing you’ve had to deal with frequently is change and leading through those situations. I can’t imagine that’s easy. What has been your strategy in guiding the ship when there is uncertainty or a major change?
Buda: We announced internally that we were going to be joining Atrium well before the transaction actually took place, probably a good 6 months. We were very transparent with our teams about what that means — that it’s going to bring about change, and we’re going to have to convert a lot of systems. We communicated to the teams that organizationally we’re going to restructure and align so that the people who previously had been Floyd IT department employees are ultimately going to be aligned with the larger Atrium Enterprise model. It was going to be okay.
Atrium had committed that people were not going to lose their jobs; their jobs may change a little bit, but they would have a voice in what they wanted to pursue. I think that transparency helped a lot. I think the reassurance helped a lot. We provided open forums. I’ve always had an open door so that if people had concerns, they could come in and feel comfortable expressing those. We worked to address any of the concerns they had that were within our collective power to address.
I’ll be honest. In the two years since joining Atrium, and really the six months leading up to that, I think we’ve had less than 5 people leave the Legacy Floyd organization. And many of them left for different and broader opportunities; it wasn’t because they were dissatisfied. Again, that transparency helped a lot and that open door policy helped a lot.
Atrium was very welcoming. I think their culture was very much like ours; not identical, but very similar in many ways, and so I think it was an easy transition. Maybe not easy, but it was an easier transition for a lot of our people than it might have been with a different organization that had a different culture.
Gamble: I would imagine that by being transparent and having open door policies, you’re able to build trust so that as more changes happen, you can draw from that level of trust that’s been established. That’s important. So at this point, what do you consider to be really your key areas of focus?
Buda: We continue to work to really stabilize and improve the Epic experience. It was less than a year ago that we went live. In some regard, we were still on the back side of the learning curve, but still on the learning curve. We’re continuing to pursue some of the virtual technologies that are key to our market.
We recently announced a collaboration with a local physician group that is the largest independent multi-specialty group practice in our region. That will happen at some point in the future. It’ll be good. We’re looking at growth opportunities to continue to expand our footprint.
“We all row in the same direction”
Gamble: In terms of stabilizing Epic, what’s the strategy there? Is that done in phases?
Buda: We went big bang with Epic using Atrium’s model. And so really, it becomes more of an enterprise decision for Atrium, and we follow along. We’re implementing some of the new capabilities within Epic. They were recently awarded the Epic Gold Stars Level 10, and so, they’re pretty advanced as far as that implementation goes. We’re in a position now where part of one large happy family and we all row in the boat in the same direction.
Gamble: What about updates? What has been your approach there?
Buda: We’re on a cycle right now. Epic delivers quarterly updates. Atrium has chosen to do them bi-annually, and so, we’re on that cadence and rolling out some of that functionality twice per year.
Spacing out Epic updates
Gamble: That makes sense given the amount of time it takes to adjust and account for all the factors.
Buda: There’s some logic in Epic’s rationale. If you have a number of smaller updates, the lift isn’t quite as heavy. They do deliver a lot of functionality and fixes and things like that. But to do it more frequently keeps people in that groove where they’re always looking to the next thing, always ready to update. It’s not as much of a shock; you don’t have to go through as extensive of a training or retraining effort. The communications are a little bit easier because you have a regular cycle of communications and people look out for those.
Gamble: I see what you mean. There’s something to be said about not wanting to change too much at once but like you said, you want to stay on top of it. I guess it’s striking that balance.
Buda: Yes. Previously with Cerner and then with the billing systems that we had connected to that, we were on a cycle of taking updates pretty much every two years. They were significant projects, 6 to 9 months each, with lots of training and lots of communication. We had a team of project management resources helping us through that.
With Epic doing the updates twice per year, there is a series of email communication. Our clinical informatics team works with the physicians and the nursing staff to do education on some of the new features or how they’ve been reorganized. To my earlier point, it’s really not as significant a lift and it happens in a much more condensed timeframe.
Gamble: You mentioned virtual care being a priority. What are you doing or looking to do in the way of homecare or things along those lines?
Buda: We’re not doing it; the Atrium Enterprise is doing more than we are. That’s something we’re looking at and there is interest, but as we’ve looked at priorities for our organization, getting the eICU up was a top priority, as well as patient observation.
Like a lot of organizations, we struggle with staffing, and in particular, nursing staffing. We have a lot of contract labor and when we have to pull nurses out of clinical duties to be a sitter for a patient, it keeps those costs high and it adds to the burden. Getting patient observation in place is a priority. Atrium already has the infrastructure; they have the central monitoring station that they’ve been expanding, which will really help alleviate some of the constraints we face with the nursing labor situation.
Virtual care offerings
Gamble: That’s something we’re hearing a lot more, especially for rural organizations. The idea of virtual nursing is really interesting.
Buda: And the pandemic helped telemedicine a tremendous amount. If there is a silver lining, that would be one of them. We had done very little with telemedicine prior to the pandemic. We did some virtual behavioral health and some tele-stroke with a partner in Tennessee, but we really weren’t doing much from a primary care perspective. The pandemic certainly changed that.
Now, we do offer telemedicine through our primary care. We’re looking to integrate some behavioral health into that model at some point in the future. We’re looking at some of the things Atrium is doing. We actually have a telehealth program working with our local schools. Again, we’re looking at all of the offerings that Atrium has. Hospital-at-home is one of the things that they do; that’s probably a good couple of years out for us while we focus on some other things.
Leveraging Atrium’s “large pool of resources”
Gamble: Right. What types of things are you doing to improve staff efficiency and automate some of the tasks that are taking up valuable hours?
Buda: It’s hard to single out one thing. Part of the reason I say that is we’ve had a strong lean Six Sigma performance improvement focus for longer than I’ve been with the organization, which is 11 years. That’s interwoven into our culture. We’re always looking for opportunities to make improvements. Some of the virtual care work we’re doing is focused on patient observation.
From an automation perspective, we’re looking at leveraging staff differently. We’re now part of a large enterprise that has a lot of resources, and so, we’re looking at how we can leverage those resources to maybe free up our local team to focus on other things. That’s another opportunity for us; how do we utilize the economies of scale of being a much larger organization? In the past, we’ve had to build capabilities on our own. Now, we can rely on some of those capabilities from the mothership, so to speak.
Gamble: Right. So, if Atrium is looking at something like robotic process automation, that can trickle down. Is that the idea?
Buda: Absolutely. We were doing some RPA before joining Atrium. With Atrium, that has continued. I think everyone is looking at AI with one eyebrow raised and trying to figure out, is there a place for it? Is it safe? What are the best places for it? How can it help us the most? I think we’ll see some continued interest in that and maybe some investments at some point in the future, but it’s hard to say. People have been talking about it for years. The hype has really grown, I would say, just within the last 6 months to 12 months. I think it still remains to be seen what the real benefits are and what the risks are.
Rise of remote work
Gamble: Definitely. Let’s talk a bit about the workforce. Obviously Covid led to some dramatic changes, but what has been your approach to trying to retain people and keep them happy?
Buda: Prior to joining Atrium, our IT team had about 80 people. It’s still pretty close to that — like I said, I think we’ve lost less than 5 people. It’s a unique market. Most of the people have been with the organization as long as I have, if not longer. We’ve not had a high turnover.
One of the things that the pandemic brought about was remote work. Historically, Floyd was always a place where work had to be done in person. People were expected to come into the office. I was a little bit of a rogue and allowed our team to work remotely one day a week at their manager’s discretion, prior to joining Atrium and prior to the pandemic.
Then the pandemic hit, and everybody shifted to team meetings. One day our CEO came up to me and he said, ‘You know, these virtual meetings work really well. They start and end on time. We’ve had great participation and engagement. People are paying attention. We don’t seem to be suffering from work not getting done.’ I saw my opportunity and I said, ‘What do you think about letting our IT team work remotely 100 percent of the time?’ I said, ‘we can work from anywhere; all we really need is an internet connection. Our data centers are in remote locations, and we can travel to those when needed.’ He looked at me for a second and said, ‘Sure.’ And so, we’ve been able to work remotely since the early days of the pandemic.
A “large pool” for recruiting
We actually had one of the first COVID patients in the state of Georgia at our facility. It started early for us. Not only did we not lose productivity, but it also allowed us to be able to recruit from a large pool. Our facilities are in a fairly rural part of the state in northwest Georgia. But we can recruit from the metro Atlanta area where previously that would have been a bad commute. We were now able to recruit from a broader area.
Then when we joined Atrium, they had already embraced remote work. The IT team can pretty much live almost anywhere within the southeast, and with permission, live elsewhere in the country. That opened up some doors for people to change their lifestyle.
Staying engaged with remote teams
Gamble: What do you do to stay in touch with people and make sure you’re checking in on them? It doesn’t seem like you’ve lost that aspect.
Buda: No, we really haven’t. But it was a little awkward at first. We did a lot of things that organizations did with virtual team meetings and get togethers. We do virtual happy hours and game nights. We have a tradition in our Floyd market to have an IT picnic in the summer where the management team will cook the burgers and dogs and people bring games. We do that to ensure there are interpersonal connections.
Gamble: It has been a difference-maker. Even something simple as doing one-on-ones and check-ins can make sure people stay engaged.
Buda: Yes. The other thing we’re doing is leveraging the chat feature in Microsoft Teams so that workgroups can chat with each other all day long. It’s very efficient. Work is done fairly quickly. You don’t have to get up from your desk and walk over to somebody else’s desk to have a conversation; you just put it in the chat and go. The team has really embraced it.
Gamble: It really is a quality-of-life issue. People are going to work harder if they’re happier.
Buda: Right. Atrium had already embraced remote work. I’m not sure what Advocate’s position is, but within Atrium, the IT teams are permanently remote. There is no plan to return to the office. There is office space and hoteling space if people want or need it for some reason, but the cord has been cut, so to speak.
Stump the CIO
Gamble: Right. In terms of your leadership philosophy, how would you characterize it? Has it changed since Covid?
Buda: Not that much. I feel like I interact with the team similarly to the way I did before. Transparency has always been important to me. We still have a monthly staff meeting. Even though our team now reports to different people within the Atrium leadership, we still have a local team meeting for those 80 people. We communicate what’s going on in our market and swap stories — it helps maintain that connectedness.
One of the things that I had been doing for several years as part of that team meeting is ‘a stump the CIO’ session where people could anonymously submit any question they wanted, and my commitment is that I will answer it as honestly as I can. In some cases, if the information is sensitive or confidential, I’ll tell them I can’t answer that at this point. But I will try to answer anything. I’ve had some questions that were difficult to answer and some normal things people wanted to know. Again, I think that has really helped foster trust, connectedness, and a certain amount of loyalty.
Adding operations to CIO
Gamble: That’s great. And so, you’ve been with Floyd itself for about 11 years. You started in the CIO role but then took on some operations roles as well, correct?
Buda: Yes. As part of our combination with Atrium, there has been a lot of realignment. Our chief operating officer retired, and our CEO decided to redistribute some responsibilities. And so, I got operations in addition to the CIO responsibility. I have quite a number of non-IT areas that report to me, including some clinical areas as well.
“A learning curve”
Gamble: Do those roles mesh together well? I’m sure it was an adjustment.
Buda: It was definitely an adjustment. A good bit of our leadership team has been with the organization for a while, and so, I had interacted with a lot of people fairly regularly prior to the realignment. It has been and continues to be a learning curve for me. My sweet spot is IT, although I’ve been in healthcare for 30-plus years and I know how hospitals work, but to have that level of oversight and responsibility was a little bit different. There’s a lot that I’ve had to learn and continue to learn.
For me, it’s been fun. And I think it’s been good for the leaders that now report into me — at least, I’d like to think so. One of them in particular told me that she felt like she had won the executive lottery when she was realigned to me. I think that’s pretty telling.
“I’m not a micromanager”
Gamble: Is that part of your approach to situations like this — to take your time and learn about the different responsibilities that are under your purview?
Buda: Yes. And I ask a lot of questions. My philosophy has been for many years that we hire professionals to do a job. I’m not a micromanager. My approach is to let them do their job. I maintain regular one-on-ones with each of those leaders so they can keep me apprised of what’s going on in their areas. We can bounce ideas off one another. I can share some of my observations. For example, if there’s something that I think needs to be improved, we can have that conversation. It’s really been a continuous ongoing dialogue of what’s happening in the organization.
“A cog in the wheel”
I learn through that, and again, I ask a lot of questions. I’ve gone to different areas and just done a lot of observation. ‘Let me watch how you guys do this.’ And it’s been fun. I’m glad the transition happened because through our realignment with Atrium, the CIO role is not what it was. I used to be the decision maker; now I’m more of a cog in the wheel of a much larger organization. A lot of the strategy work is done elsewhere. I have a voice at the table but I’m not driving it. I’m not necessarily making those decisions; I’m participating and contributing where I can. It’s a little bit different, and so, I’m thankful to have some of these additional opportunities and some things to dive into and learn about as well.
Gamble: So there aren’t too many boring days for you?
Buda: No two days are the same, that’s for sure.