When asked why they chose to pursue a new role, leaders often say they needed a challenge. Although sometimes it can be code for another reason, it certainly seems fitting in Jonathan Goldberg’s case. A year and a half ago, he left St. Peter’s Health Partners in upstate New York to serve as CIO at Arkansas Children’s Hospital, the only facility of its kind in a state that ranks 49th overall in children’s health. While that might have some people running for the hills, Goldberg views it as a “huge opportunity to make a difference.” In this interview, he talks about the learning curve in transitioning to pediatric care, the challenge in juggling multiple big projects at the same time, the innovative work his team is doing with telemedicine, and how they’re leveraging technology to stay lean.
- ACH’s Epic project — “We tried to stay skinny & do projects ourselves.”
- Small vs large rollouts
- The leap of faith with workflow planning
- Leveraging analytics to forecast staffing needs
- “Labor is your most significant cost.”
- Recruiting challenges in Little Rock
- “The more we can use what we have, the better.”
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We really believed we could do a lot of things quicker and easier in relating to decisions and process changes than with some of the other implementations. So we tried to stay pretty skinny as it relates to projects and do more ourselves.
I can’t say it hasn’t been an exercise in having people learn and have some faith in their decisions, because there are some things they’ve been asked to decide on that they won’t see until the final product is done.
It enables you to start forecasting staffing needs. And so as you connect the dots, it allows you to really understand where you’re going to need more staff in certain areas based on the workload, and you can be very smart with your resources.
We have very high expectations of our staff, but at the same time, you want them to enjoy what they do. If people enjoy what they do, a lot of times they’ll forget about the things they don’t like.
Gamble: Going back to Epic rollout, did you have somebody heading up that implementation? How did that work as far as governance?
Goldberg: Our VP of Applications is considered the project executive or project director. He took that role on and he’s been the lead from our side. And then Epic brings their project director to the table as well to manage the project from their end. The two of them, in combination, become the project management team. And we certainly have a steering committee, as you would expect from a project this size, which includes a lot of the senior leaders and operational leaders from the organization.
So far it’s gone very well in terms of being able to make decisions. Nothing has been that controversial. One of the benefits we have — and it really did dictate how we implement it — is we try to do more in-house and less outsourcing. A lot of the Epic implementations in recent years have been multi-site organizations that had multiple leadership teams, multiple CMOs, CNOs and CFOs, and different physician groups that practiced in each of those organizations. That was the type of environment I came from.
When you reach the point of implementing a system that requires standardization of content, workflow, and process, it requires a lot more governance than what we had in a single entity with control of our physicians and only one leader for each area. We really believed we could do a lot of things quicker and easier in relating to decisions and process changes than with some of the other implementations. So we tried to stay pretty skinny as it relates to projects and do more ourselves.
So far, I would say it’s been fairly successful. We’d like to have some more help — we always could use some, but I think there’s a cost benefit piece as well that we had to take advantage of to try to keep this project at a reasonable cost.
Gamble: Right. There’s something to be said for having the expertise stay with you after the go-live.
Gamble: Now, you said that you just wrapped up the build as far as workflows. Let’s talk about that — obviously a workflow can be created in this type of environment, but it still has to be tested in a live environment. How do you deal with that?
Goldberg: The good news is that from a workflow standpoint, we’ll have all of our operational folks helping us with the testing and going through the various day-in-the-life scenarios. So there is end-to-end testing that happens. We were live on a lot of clinical functionality — we currently are. The good news is a lot of our leadership and our subject matter experts we have consulting with us know what they want and what they need, based on either what they have or what they don’t have. And then of course we factor in what the system can bring to bear.
It has been an interesting exercise because certainly every system you implement is different and has some uniqueness to it. Just looking at how we function today versus how we’re going to function down the road, I can’t say it hasn’t been an exercise in having people learn and have some faith in their decisions, because certainly there are some things they’ve been asked to decide on that they won’t see until the final product is done. They will certainly get to see it during the testing piece, but they’ve made decisions six months ago that they may not see for another month from now. Of course we hope they’re the right decisions, because there’s not a lot of turning back at this point.
Gamble: Right. Now, had you worked with Epic in the past?
Goldberg: No, this was my first time. I came from organizations that had Siemens, Cerner, and Meditech. I’ve touched almost every EHR except this one. It’s a new system to me, so there is a lot of learning on my end going on as well.
Gamble: Sure. Looking at some of the other projects on your plate, you said you’re using API for labor analytics. Is the goal there to make sure resources are being used as efficiently as possible?
Goldberg: Yes. It’s known to most that labor is your most significant cost, and so we certainly want to make sure we have the right people in the right place at the right time. We use API for time and attendance, and we’re also implementing it for staff scheduling — mostly clinical staff scheduling. When you take time and attendance and scheduling, and the ability to take all of that data and model it, as well as inputting other data such as census and acuity, it enables you to start forecasting staffing needs. And so as you connect the dots, it allows you to really understand where you’re going to need more staff in certain areas based on the workload, and you can be very smart with your resources.
It’s hard to get good staff these days to come to the table. We don’t have a lot of people moving in to Little Rock, and certainly we have great staff that we want to make sure we keep — and keep them productive. From a retention standpoint, the more we can use what we have and not have to bring in agency nurses, for example, the better off we are. Nursing is certainly the biggest pool of people, and we still struggle with trying to get enough nurses.
But now, we’re growing our own. We have a great program for that and lots of retention programs. But still it’s not an area where there’s a lot of people and it’s not very transient, which means we have to hold on to our own. In terms of labor and analytics, we’re looking at how do we use our resources and maximize it to the best we can, and that should be a win for everybody.
Gamble: Right. What are some of the things that you do to improve retention rates?
Goldberg: We spend a lot of time trying to make sure people are having a good time at work. They spend a lot of time with us here, and we want to recognize that. We learned a long time ago that the more you can engage staff, the more they feel like they’re having a great time at work. And having a great time doesn’t mean you don’t take work seriously. We have very high expectations of our staff, but at the same time, you want them to enjoy what they do. If people enjoy what they do, a lot of times they’ll forget about the things they don’t like, because they’re not going to dwell on that.
We have a lot of opportunities. I do breakfasts with the staff; once or twice a month, they can have breakfast with me. I’m not sure if they like having the breakfast more than they like talking to me, but if they don’t want to talk to me, they don’t have to. There’s no formal agenda. We just get to hang out and enjoy some good food. Probably every month or two, we have different lunches for different events that we throw. Earlier this spring we had a Final Four party and a barbeque, and the staff were able to come and just enjoy a little bit of time.
We just put up our clipboard walls — this is something I saw when I was on vacation over Thanksgiving. There was a company on one of the islands that had thousands of picture frames all over the walls — it was all pictures of their employees, their family, their pets, their kids, their vacations. It looked really neat, but the same time, it looked like a lot of fun.
So we decided that we were going to put up a clipboard. So we have a few walls — we have them in different buildings because we had to make sure we covered all of our staff. It’s a wall where each staff member gets an opportunity to put what’s meaningful to them up on the clipboard and it’s in the hallways where people see it. You can change the pictures or sayings, or you can put up your latest vacation photo. We have one employee who just had a baby and they put up a photo the day the baby was born. That was cool to see. It’s just different ways of engagement that we try to promote.
We try to encourage all of the managers to have retreats at least once or twice a year from a work-related standpoint while also weaving in some fun. Some have gone bowling, some have done other things. But it’s all about communication. It’s about having a good time. And while nothing is perfect, I think we’re doing a pretty good job at trying to promote that.