David Williams: The 2004 to 2006 standardization initiative is very impressive. A lot of organizations probably thought that that would be useful but probably didn’t see how they could do it.
Can you provide a perspective on how organizational culture, psychology and technology interacted to get you moving in the right direction?
George Conklin: I joined a predecessor organization of Christus in 1998, just months before the formation of Christus. At that time we were primarily a two-vendor shop from an HIS perspective. We looked carefully at the culture of the organization at that time, which very much held the belief that health care has to be delivered locally (which is obvious), and therefore we need to manage and operate our institutions and deliver health care services at a very individual kind of level, which is not necessarily the truth. Science and technology is taking us in pretty much the opposite direction.
So my associate CIO Chris Blakemore and I evaluated where we stood from a systems perspective and from a cultural perspective and made the recommendation that we not touch anything with information systems at the time at which Christus was formed. We did not make a recommendation that we try to move to a single information system because we realized that culturally we were not ready for that.
I’m from the Northeast –originally from outside of New York City– and so I got a laugh out of seeing the bumper stickers that you see around here: ‘You’ll peel my 357 magnum out of my cold, dead hands.’ Well we felt it was the same sort of thing with information systems here. ‘You’re going to peel my Meditech or my McKesson or Cerner system out of my cold dead hands’ was the attitude that we saw in parts of the leadership of our regions. That was frankly just not a battle that we in senior leadership wanted to fight in the early days.
Instead, we established what we call our four Directions to Excellence. We focused in four areas; clinical quality, service quality (which included patient satisfaction, physician satisfaction and associate satisfaction), business literacy, which is the financial performance and then community value, which has historically been one of the fundamentals of our organization. We are the safety net provider in many, many of our communities.
And those four Directions to Excellence formed what became our balanced score care, which we have published online since 2001. That set up a very subtle competition among the regional leadership teams. Over time that moved us toward greater and greater standardization and betterment of performance.
In the 2004 time frame it was actually the regional CEO’s who came to us and asked if it would make sense for us to move to a single information system. Like my daughter would say when she was a teenager, “Duh, yeah, of course it was going to be a savings to us to do that!” But we came back and said: only if we approached massive standardization across the organization. Our regional CEO’s response to that was: that was exactly what we were expecting to have occur.
So the platform was established at least from a regional management perspective. At the same time, because of the focus on the clinical measures and the clinical quality segment of the balanced score card, there was a major focus of our medical staff around increasing clinical quality, obtaining external validation of that through the Top 100 or other kinds of certifications. Louisiana has a grading system for hospitals; most of our hospitals there are gold or platinum providers of services. Our focus became increasingly on obtaining these higher level kinds of recognition.
We then worked more and more with physicians, asking questions such as: How do we provide treatment better? How do we lower our costs? How do we become a better overall provider of care in our communities? We really defined a model that couples the cost of care and quality of services that are being delivered.
The organization itself was much better positioned when we started that project. We had very little push back about the concept of standardization as we began to move forward with it. As I presented what we’ve been doing here to many of my peers in the Catholic Health Association CIO group, most of them back in the 2004 time frame thought we were crazy. But they said, “I wish we could do that same sort of thing.”
Now what’s happening is that many of the peer organizations are having to pull out a lot of work that they did to implement systems individually in each of their locations and now move toward greater standardization. We avoided that cost and huge effort of rework that many other organizations are now having to go through.
Williams: We’ve talked a lot about culture change and technology change within the enterprise. I’m wondering what you’re seeing on the consumer engagement side, something which of course you don’t control directly. What changes are you seeing, what role is Christus taking in influencing consumer behavior?
Conklin: As I mentioned, one of the four Directions to Excellence, service quality, has patient satisfaction as a component. That is one segment of the consumer marketplace that’s out there.
We also have employers, we government, and payers as constituents. Obviously government is becoming far more engaged with what’s going on in health care IT. It’s still questionable whether something is going to happen with reform but I believe a lot of reform can be driven through what’s going on in the IT area under Dr. Blumenthal.
So we have been increasingly engaged. We’re having payers getting engaged in almost a defensive kind of way particularly around health care reform. Employers, because of the larger and larger chunk of their profit getting eaten by health care costs, are very much focused around low cost, high quality providers. And obviously patients, since they’re being made responsible for a larger and larger portion of the health care costs want to get the best quality of care at the lowest possible price.
So we’re seeing a lot of focus on the dimensions that line up with a strategy that we’ve developed over the last 11 years of Christus’ existence. Our focus is really around the patient and the individual and reaching that goal of being a low cost, high quality provider of care.
Williams: I’ve been speaking today with George Conklin. He is Senior Vice President and Chief Information Office at Christus Health. George, thanks so much.
Conklin: You’re very welcome. I enjoyed speaking with you.March 15, 2010