Avoiding “Automated Dysfunction”: What to Know When Incorporating Automation into the Strategy

In recent years, we’ve seen the potential of automation to make healthcare processes more efficient, which in turn can improve outcomes. But as organizations look beyond areas like supply chain to leverage automation, there are several points that need to be considered — and questions to be answered.

“We’re all trying to meet the needs of our customers, but are we actually solving the problem or are we throwing technology at it?” noted Karen Marhefka, Deputy CIO at RWJBarnabas Health. “We need to make sure we don’t automate our dysfunction, which is something all of us do.”

Rather, the decision to automate — and if so, where and how — is one that should be carefully planned out and executed. During a recent discussion, Marhefka, along with co-panelists Ash Goel, MD (SVP & CIO, Bronson Healthcare) and Ross Stoddard (Chief Strategy Officer, Simetria Health) shared best practices on how to incorporate automation into the overall strategy and why they believe strong communication and governance are just as vital as the technical components in ensuring a successful implementation.

12 hospitals, 12 strategies

At RWJBarnabas, one of the areas Marhefka’s team has targeted is patient engagement; specifically, using automation to improve the call center experience. “It’s solving our access problem,” she said, noting that the ability to provide help more quickly to patients can benefit staff as well, making it a win-win. “It’s an area of the business where automation really makes sense.”

Expanding it across the organization, however, could prove challenging, as RWJBarnabas has grown largely through mergers and acquisitions. With 12 hospitals, Marhefka stated, comes “12 different ways of doing things. We’re a very well-functioning, robust health system, but we’re still working through the nuances of those differences.” One way is by ensuring all technology requests are being funneled into a centralized location, which can foster productive discussions.

To that end, RWJBarnabas has established councils to ensure requests align with the organization’s strategic goals and technology stack, and fit within the confines of the budget. “Who is going to pay for it? Has the capital already been determined? If we can’t pay for it, we can’t have it,” said Marhefka. “We’ve been able to funnel requests into that structure and it has worked very well.”

Process matters

At Bronson, patient experience has also been a key driver in leveraging automation, according to Goel, who hopes to dramatically reduce the number of contact centers. “We have about 85, and each one of them has its own unique version of phone trees,” he said. And although “the technology works great,” patients aren’t necessarily getting the same experience across the system, which is far from ideal. “Even if we have distributed call centers, we want to have the same information available to patients so they can make the right decisions.”

And that means ensuring the right pieces are in place. “You can’t foster technology when the area or the business processes aren’t ready,” he said. “You don’t want to have a solution looking for a problem.”

That’s why the vetting process is so important, stated Goel. His strategy? To identify subsets of portfolios, which are then segregated into clinical, corporate, and digital solutions, and moved up the ladder. Another key is the use of intake specialists, who work with individual requestors to gather more information in the areas they’re investigating, and curate a single source for ideas. “That is then escalated through our governance structure in a way that allows us to bounce against the different sets of solutions and portfolios that we manage,” he said. “We have capacity and resource constraints, and so we need to recognize what value these ideas can generate. That’s how we look at user-requested services.”

The process for internal (IT) requests is more agile, Goel said, as Bronson uses a run-grow-transform model and conducts monthly reviews to determine which opportunities need improvement and which can be baked into the planning cycle.

The challenge is that they’ll never realistically be able to meet all the demands,” he noted. “We’ll never be able to serve them up in the order of priority that we identify, because as soon as soon as we add paint to the collage, there’s a request to change the color.” And although it creates chaos, “we manage through it, and we adjust to the business needs and tie it back to the strategy for the organization. That’s where my role comes in– trying to navigate through that to highlight areas which are important to the organization.”

“We have to be mindful”

Of course, before any request can be escalated, there are several points to consider — starting with the absolute basics, according to Stoddard. “How feasible is the automation opportunity? Who’s going to pay for it? Where are the dollars coming from? What’s the uplift to keep the system maintained and plugged in?”

However, before those questions can be answered, it’s critical to understand the why behind the request. “Typically, it comes from some pain point,” he said. For example, “a provider can’t do X, Y or Z, or it takes them too many clicks to do it and they have to hire another FTE.” By having those discussions, leaders often find they’re able to optimize core systems to improve processes — and further, avoid bolt-ons or additional purchases that can lead to a lack of integration. “It often comes down to, are you utilizing all the functionality that’s available? Yes, we can automate, but we have to be mindful and ask if it’s going to achieve what we want it to achieve,” Stoddard added.

“We try to be very thoughtful about what’s the expected outcome and be very explicit about that outcome,” he continued. “What are we going to save? What are we going to fix, whether it’s money, time, errors, or patient experience? Be very explicit about that mission statement.”

Learning from losses

Once that has been established, and the technology has undergone an “intensive security assessment and fit review” — and passed, of course — the next step is to conduct a pilot, said Marhefka. At RWJBarnabas, that entails not just implementing a solution in a specific area, but observing, testing, and providing at-the-elbow support throughout. It also includes a great deal of communication across the organization about what is being piloting and how it’s performing. “Nothing works without transparency,” she added.

The feedback, however, isn’t always going to be positive. For that reason, it’s vital to be willing and able to “back out of the process,” according to Stoddard, whose team is engaged in a pilot with RHQ around automating workflow. “That’s another key component.”

Marhefka agreed, noting that the losses are just as valuable as the wins in helping leaders understand whether a solution is viable and how to proceed going forward. “We learn so much from the losses,” she said. In fact, “we communicate those in the same way we communicate successes,” something she attributes to the culture set forth by Robert Adamson, who was promoted to EVP and CIO of RWJBarnabas in December 2021. “He has helped tremendously to change the tone of how IS responds and works with our customers.”

When a pilot does meet the mark, the next phase is to develop a strategy around how to deploy it, Marhefka said. “Now, let’s tackle the hard stuff. We work all that out and it becomes very iterative as we complete the implementation. It’s exactly how we did our big EMR transition.”

“Clear directives”

Communication is always important, but even more so with automation, which can invoke feelings of anxiety, especially without understanding of how it will be utilized. For this reason, Goel highly recommends involving IT right from the start. “We try to put in place very clear directives to our teams to be partners with customers and make sure they run requests up the chain and are part of the discussion right up to when it is essentially a ‘yay’ or ‘nay,’” he said. And if it is a ‘yay,’ his team will create a timeline and share it across the organization.

Stoddard concurred, adding that it’s also important to establish clear expectations and manage them accordingly. “We encourage every interaction with the end user to provide a quick win. Maybe you can’t solve their entire problem or maybe you can’t achieve exactly what they’re requesting in the first call resolution or that first engagement,” he said. “But do something to show immediate value.”

Finally, and perhaps most importantly, it’s imperative to set the tone from the beginning that although ideas are certainly welcome, they need to get the green light from the CIO. “We can be responsive to our user base,” said Marhefka. “But at the same time, we know what will be helpful and what will work technically. That’s where me and my IT executive peers become pitchers instead of catchers. Think of it as the executive operations whisperer in terms of what’s needed to solve a problem.”

To view the archive of this webinar — Reducing Costs & Improving Service by Implementing Use-Case Specific Automation (Sponsored by Resourcing HQ) — please click here.