26 Mar Visions with Frank Byrne, Part I: Hospital exec says culture devours strategy
Editor’s note: This is Part I of our Visions interview with Frank Byrne of St. Mary’s Hospital in Madison, and it’s the latest in a series of healthcare IT articles that will be published in advance of WTN Media’s annual Digital Healthcare Conference. The conference will be held May 7 and 8 in the Fluno Center on the University of Wisconsin-Madison campus.
Madison, Wis. – During Michael Leavitt’s January visit to Madison, the Health and Human Services Secretary was asked a question about the importance of business process in the drive to accelerate information technology adoption in healthcare settings.
His answer provided acknowledgement to those who understand the importance of best practices in workflows, but left some question about how much the federal government, in setting standards for the use of patient data and healthcare quality reporting, would link process transformation with healthcare IT implementations.
Frank Byrne is not in a position to soft peddle process transformation. Byrne, president of St. Mary’s Hospital in Madison, is reaching the end-stage of an Epic Systems’ electronic medical record implementation, but he understood that technology and process improvement were embedded long before he joined St. Mary’s in 2004.
“They are twin processes; they are intertwined,” he said.
Byrne, who has served as an administrator and has practiced pulmonary and critical care medicine, recalled an experience he had with another organization as it made the transition from manual to automated scheduling about 15 years ago. All the rules that were embedded in what he called the “suboptimal” manual system were then embedded in the automated system that replaced it. Having computerized the same process, imagine the organization’s surprise when automation did not result in better outcomes.
“The answer is that [the old] software was not the problem,” he explained. “It was a fine software scheduling product. It was the fact that we did not embed process improvement in the technology implementation.
“Technology implementation and process improvement are intertwined and need to be looked at together.”
The process journey
St. Mary’s is a 440-bed tertiary care facility that is part of SSM Health Care, one of the largest Catholic healthcare systems in the country. As the hospital proceeds with the implementation of Epic’s EMR, which will “go live” on May 31, it is evaluating everything it does with respect to workflows and process steps – not just to document how things get done, but for the purpose of continuous improvement.
The EMR will help St. Mary’s make further improvements once the implementation is completed, but the hospital is not waiting for the EMR to make upgrades. As part of its new bedside registration, enabled by wireless Internet access and an investment in laptops, it has evaluated both process and the use of hospital space.
Byrne’s advice to healthcare CIOs (and CEOs for that matter) is that IT and process alignment is more of a continual journey rather than a destination.
“The sweet spot is the combination of technology implementation with process improvement, and understanding that the attitude of `we’ve always done it that way’ is not the right answer to any question,” Byrne said.
Streamlining door-to-doc
The new emergency department now implements bedside administration with the help of the aforementioned wireless laptops, a technique designed to get the patient into a room as quickly as possible and get their care underway. At St. Mary’s, one of the key emergency department metrics is “door-to-doc time,” which is the time it takes for a patient to come through the door and see a physician or other caregiver. St. Mary’s is trying to focus on that metric and compress it, which in theory leads to better patient satisfaction.
“We also think it leads to better resource utilization because by getting the care started more quickly, the cycle time from start to finish of an emergency visit can be compressed,” he said. “Frankly, we believe it’s going to lead to better outcomes.”
As time goes on, Byrne sees other technology applications that help compress door-to-doc time, including expanded imaging capabilities in the emergency room. While he is hesitant to focus excessively on speed of service, he noted that St. Mary’s has a CT scan in the ER to provide the appropriate care in a compressed time frame. It’s not only about rushing people through, he said, but other industrial process improvement techniques are evaluated in terms of reducing the total cycle time and eliminating waste and downtime.
“By increasing imaging capabilities in ER, we’re taking out the part of the cycle where they have to be transported up to the fourth floor, have the image taken, and then come back,” he explained. “With digital imaging, which has been implemented here with PACS (Picture Archiving and Communication Systems), they can have image acquired in ER and read by the radiologist wherever he or she is. It takes time out of cycle, and it provides a better experience for the patient and their family.
“While I can’t prove it at this time, I just have to believe that by paying attention to these types of details, we can also improve the outcomes.”
Cultural appetite
In Byrne’s view, the cornerstone of business and technology alignment is to make sure benefits are communicated to staff, including physicians. St. Mary’s has a multi-faceted partnership with the physicians of Dean Health System, and serves as host to the University of Wisconsin Family Medicine Residency, so cultural considerations are not limited to its Brooks Street walls.
St. Mary’s has undergone some process change in the way its groups the IT team. Even though employees still were coming to work at the same place, they may not be having lunch with the same people they have eaten with for the past 25 years, so it still was a major change that needed to be communicated and respected.
In general, Byrne said organizations don’t do enough to acknowledge transitions, and healthcare is even worse. Healthcare organizations typically expect people to simply plow forward, sacrificing all-important change management in the process.
He quoted the late Peter Drucker, who famously said “culture eats strategy for breakfast.” That means you can have a sound technical plan and a great strategy for implementation of a new technology, but you also have to respect, appreciate, and honor the cultural environment in which change occurs.
“I think we have to recognize transitions, celebrate what needs to be celebrated and, frankly, grieve what needs to be grieved,” he explained. “In every change that we make in life, with the possible exception maybe of our first steps as a toddler, no matter how positive overall a change is, there are also elements of loss to every change.”
For Byrne, it was great to see in writing what he’s always believed in Michael Watkins’ book titled “The First 90 Days,” which is about leadership transitions. One of key thrusts in the book is the assertion that the failure to respect organizational culture is one of the key causes of leadership transition failures.
Healing heritage
The culture at St. Mary’s started nearly 100 years ago when two Catholic sisters came from St. Louis at the invitation of the community to start Madison’s second hospital. If Byrne is having a tough day, all he has to remember is the example they set back in 1910. They took a risk, and they were leaders and pioneers in many respects – the hospital they ran in St. Louis was among the few to allow African American doctors and nurses to practice their profession.
In St. Mary’s culture, expressed in a video titled “Heritage of Healing,” not changing what needs to be changed would be heresy. It is a culture of inclusion, especially when key decisions must be made. As a result, a consensus decision-making process compels it to gather input from caregivers and staff, especially on implementations like Epic’s EMR and physical upgrades like the hospital’s recent expansion, the largest expansion since the facility opened in 1912.
“They key participants were the frontline caregivers,” said Byrne, who holds a bachelor’s degree from the University of Notre Dame, an MD from the State University of New York Downstate Medical Center, and a master’s degree in medical management from Carnegie Mellon University. “The people who were at that sacred interface were the people who were providing care to others.”
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