Originally published on EpicShare.
By Mark D. Amey, MBA, Chief Information Officer at Alameda Health System
Alameda Health System (AHS) is a public, integrated health care provider that delivers equitable, compassionate, and culturally sensitive care to the most vulnerable populations in Alameda County, regardless of social and financial barriers. As a safety net health system serving patients who often have nowhere else to go for health care, AHS has a critical responsibility to provide excellent care.
When I was considering joining AHS as their chief information officer (CIO), I was influenced by the film, The Waiting Room, a PBS documentary set at Highland Hospital, which is one of the three acute care hospitals that AHS operates. The Waiting Room is an unvarnished look at the inequities and true suffering that some of our patients experience. It also portrays how our clinicians manage to provide exceptional care despite an imperfect system, and how our staff live up to AHS’ mission — caring, healing, teaching, and serving all — even in difficult circumstances. The AHS mission lines right up with my personal values, and I thought I could make the system work better. I was raised to want to leave the world a better place than I found it, to give more than I’ve consumed — and I decided that working at AHS would allow me to do that.
Over the course of my time at AHS, I’ve navigated the unique considerations of caring for a diverse population — our patients speak over 20 different languages — while also pioneering new initiatives and ensuring that our clinicians and staff have the tools that they need to provide high quality care to all the patients who walk through our doors. Based on these experiences, I have five lessons that I’ve learned along the way.
1. Be a fast follower and fail fast.
At AHS, we generally don’t want to be on the leading edge. We don’t have the resources and bandwidth. Instead, we want to be a fast follower. When I’m considering trying something new, I want to see someone else demonstrate that it can be successful first and then quickly iterate on what they’re doing. This way, we can learn from other organizations’ experiences and implement the same thing better, faster, and cheaper, while hopefully avoiding the pitfalls.
Similarly, learning from our own experiences is important. I make a lot of decisions as CIO, and when those decisions don’t work out, I make a point to acknowledge what went wrong and make a plan for change. A common phrase in the Bay Area is “fail fast” — if you’re going to make a mistake, do it quickly so that you can learn from it and succeed on your next attempt.
2. Go back to basics and sweat the details.
After resolving every operational and clinician’s IT ticket, we send a satisfaction survey. We call back every individual who provides less than 100% satisfaction with their feedback. Responding to user issues might sound basic, but it’s not always executed well. Having basic customer service is important for our IT department to run smoothly, which gives us a solid foundation so that we can focus more on strategic projects. I also sweat the details — I make some of those calls myself, and I regularly check my dashboard for helpdesk tickets so that I’m aware of what’s going on in our department.
3. Measure so you can manage.
Particularly because many of our patients don’t have a choice of where to go, we have a responsibility to measure the quality of the care that we provide and to benchmark that against other organizations. We look at areas where we aren’t performing well, investigate the reasons, and make a plan for improvement.
One example of a current project is our overhaul of the bed ordering workflow. Having a streamlined process for ordering a bed has a big impact on our patients, nurses, and finances. However, the benchmarks showed we were lagging in this area — the ordering process was inconsistent, and the system for returning the beds to the rental company was time-consuming and costly. With the new process, nurses have one consistent way to order a bed in Epic. When the patient using the bed is transferred or discharged, our system automatically discontinues that bed order, which sends a notice to the rental company and stops the charges. We measured the times and costs involved in the workflow six months before implementing the project, and we’re going to measure those same metrics again now that we’ve made changes. Overall, patients receive better care because they receive the correct bed in a timelier fashion, and we’re confident that it’s properly cleaned. Nurses have a consistent and simplified ordering process, and we save money by stopping the charges from the rental company as soon as the patient is no longer using the bed.
4. Hire good people and support their growth.
I agonize over hiring decisions because I want to hire the best possible talent — a diverse workforce who are experts in their domains. Then, it’s my job to empower them, support them, and, ultimately, get out of their way and let them perform.
We take our employee engagement survey very seriously. Our managers take ownership of this survey for the members of their teams to ensure that they are satisfied with their jobs.
We’ve also made continuing education a key part of our culture. We expect every member of our Information Systems team to have the Information Technology Infrastructure Library (ITIL) Foundation certification, and to achieve the Lean Yellow Belt certification.
5. Lead with humility.
Finally, be humble. You need to be prepared to fail, acknowledge your mistakes, and be willing to pick yourself back up. As I mentioned before, we view our failures as learning opportunities.
We’ve received several accolades, including Epic Gold Stars Level 8, Chime Most Wired Level 7, and HIMSS EMRAM Stage 6. But we don’t consider these to be IT achievements — they are organizational achievements that involve IT, clinical, and operational teams. Moving forward, we’re aiming to achieve HIMSS Stage 7. To do that, we need to partner with our nursing teams to plan the best ways to use technology to support exceptional care for all of our patients.
We don’t work on projects to gain recognition — we do them because they’re the right thing to do for our patients. Our mission compels us to put the patient first, which means implementing technologies that do that. For example, one of the projects is to improve our ambulatory scheduling, which is the right thing to do to help patients receive the care they need in a timely fashion.
On a note of humility and gratitude, I learned these lessons from the best! There’s a wealth of knowledge that you can access through other people. Much of my own knowledge comes from having a tight network of colleagues, mentors, coaches, old bosses, and friends who are gracious enough to invest in me. I regularly share ideas with a community of CIOs and other professionals, including our Epic BFF, who I consider a crucial extension of our leadership team.