S1E38 Delegation in an Epic Conversion (ft. Dr. Rob Adamson, RWJBarnabas Health)

Jordan Cooper 0:36
There's also New Jersey's largest private employer, with 33,000 employees.

Jordan Cooper 0:42
So, Doctor Adamson, I know that you're in the middle of an epic conversion that includes the entire health system.

Jordan Cooper 0:49
Hospital physician practices.

Jordan Cooper 0:51
Also, Rutgers Medical School, if you could characterize how you've been able to organize a team in six words pertaining to this epic conversion, how would you do so?

Adamson, Rob 1:02
Yeah.

Adamson, Rob 1:02
Thank you so much for having me.

Adamson, Rob 1:04
And and what I would say is when I when I thought about the IT NS group, I needed to come up with a way where we can organize everything that we needed to do around six words and we actually have a logo called Aspire and that is stands for a is for advocacy as is for security.

Adamson, Rob 1:20
P is people centric.

Adamson, Rob 1:22
I is innovation R as resources and E is excellence and what's wonderful is if you were to go to an agenda, any one of our IT NS groups, it's organized the exact same 6 words.

Adamson, Rob 1:33
If you look at our strategic plan, same 6 words.

Adamson, Rob 1:36
If you look at all the bowls, whether they're individual goals or shared goals, it's the same 6 words, so it winds up happening is when I do my one on ones.

Adamson, Rob 1:45
Whenever I'm doing anything with this team, everybody knows what other 6 words, what is true north and then how are we gonna organize things?

Adamson, Rob 1:53
One of the things we found with the epic conversion, and as must have you know, a lot of you've probably done this before, but many of you may not have done this through COVID and we were knee deep right into where we needed to activate the project and there was a lot of pressure to actually put the project on hold and pause it.

Adamson, Rob 2:12
So I said, well, I don't understand why we're making such an emotional decision.

Adamson, Rob 2:16
I said we need to do something with a little more scientific rigor.

Adamson, Rob 2:20
So what I basically said was let's go through every work group that we have and there were 170 of those.

Adamson, Rob 2:27
True if half of them are not going to be available during COVID, then sure, we would stop.

Jordan Cooper 2:31
And.

Jordan Cooper 2:36
Mm-hmm.

Adamson, Rob 2:31
But if really we have more than if we have less than 1/3 that are completely unavailable, then I think we should move forward strategically.

Jordan Cooper 2:43
Umm.

Adamson, Rob 2:38
As an example, if you're an interventional cardiologist, they were readily available, but if you worked in the Ed, obviously you were not.

Adamson, Rob 2:46
And So what we did is we went through that and instead of making it a yes or a no question, it became one of what's the availability.

Adamson, Rob 2:53
And then could we actually meet more frequently with the ones who are available and less frequently with the ones who weren't?

Adamson, Rob 3:00
And then what we did is we took the Epic playbook and we redid the entire things that all the people who are out of pocket went last in the decisions.

Adamson, Rob 3:09
All the ones that were available went first in the decisions and by doing that and working with EPIC, I'm proud to say that we went live on time and under budget right through the pandemic without any changes or or any stops.

Adamson, Rob 3:23
All of this was because of a strategic pause.

Adamson, Rob 3:26
Rather than making it a binary question, you can go and say let's ask the question differently.

Adamson, Rob 3:32
I know you can't.

Adamson, Rob 3:32
We meet every week.

Adamson, Rob 3:34
Could you meet at least one hour once a month?

Adamson, Rob 3:37
Just so we can keep advancing and when you give people different choices, you get different answers.

Adamson, Rob 3:42
And then what we did was we were able to thread that needle and the team did a remarkable job with that.

Jordan Cooper 3:48
So yeah, it sounds like you started a 5 year project.

Jordan Cooper 3:53
That was is expected to be completed in 2024.

Jordan Cooper 3:55
So you started in 2019 and your average weekly tasks that were accomplished rose from 33 to 18496 by April.

Jordan Cooper 4:05
I think of 2020.

Jordan Cooper 4:06
You're up to 521.

Jordan Cooper 4:07
You even went up to 13109 tasks accomplished in one week.

Jordan Cooper 4:12
Can you speak about that level of productivity and and how you've sustained it after COVID if you have?

Adamson, Rob 4:17
Yeah.

Adamson, Rob 4:17
So great question.

Adamson, Rob 4:19
So one of the things was there was a high degree of aversion to going fully remote.

Adamson, Rob 4:25
The thought was at the time.

Adamson, Rob 4:27
Now it's sort of something that no one would ever believe moving forward, but back in the day, people are like, wait a minute.

Adamson, Rob 4:32
If they're gonna be remote, how are they going to be productive and what we found that was just the opposite.

Adamson, Rob 4:38
We found that no one was commuting to work.

Adamson, Rob 4:41
No one had time to move around and start talking about different things.

Adamson, Rob 4:45
How did a particular baseball team do last night?

Adamson, Rob 4:48
Those kind of things kind of got devoid and it turned out we actually got more efficient.

Jordan Cooper 4:53
Mm-hmm.

Adamson, Rob 4:53
Well, because we are for the most part fully remote with some hybrid positions.

Adamson, Rob 4:58
Obviously, those that are patient facing, customer facing, et cetera.

Jordan Cooper 5:02
Umm.

Jordan Cooper 5:09
Mm-hmm.

Adamson, Rob 5:02
Those aside, what we found was by keeping everybody remote, we took the same exact playbook and just kept moving forward, which was to do this in an efficient manner.

Adamson, Rob 5:13
We we discovered that people flying in for the week, as an example, rather than doing that, gave them all this availability and we actually got more productivity.

Adamson, Rob 5:24
We had the opposite problem, which was how to get people to shut off and to shut down.

Adamson, Rob 5:29
And So what we did is we did a lot of things that forced function where we said this is protected time.

Adamson, Rob 5:35
You have to take your protected time.

Jordan Cooper 5:43
Umm.

Adamson, Rob 5:38
This is the time we're all gonna get together and celebrate something that has nothing to do with this job and get to know each other.

Adamson, Rob 5:44
And by inserting those kind of points, we've maintained that to this day we do 2 huge events, one in the middle of the year and the end of the year where more than 6 to 700 of our colleagues of the 903 and all of it TNS, we'll get together for unity purpose mission and then celebrations.

Jordan Cooper 6:04
And you're saying, so I noticed.

Jordan Cooper 6:06
I just wanna follow up on what you on both items that you said.

Jordan Cooper 6:09
So epic and estimated productivity would decrease 30 to 40% by people not being in the office.

Jordan Cooper 6:15
And what you actually found was a 43% increase in productivity.

Jordan Cooper 6:18
But what also many of our listeners would identify with is though. They saw increased productivity during COVID. Many of our listeners.

Jordan Cooper 6:27
Other healthcare organizations around the country have also seen increased provider burnout and I think what you just mentioned is that those two events a year OHH allows for more socialization reduction and burnout.

Jordan Cooper 6:38
Would you be able to speak to provider engagement and and burnout and how you've been addressing that?

Adamson, Rob 6:44
Yeah.

Adamson, Rob 6:44
So in essence, what we find is, and I'm sure you understand this and that is when you're home sitting talking into a screen, there is no natural way to tell you to stop.

Adamson, Rob 6:55
And So what we did is we inserted for both providers the people in it and S there were scheduled times that we have protected time and we call it a siesta Fiesta.

Jordan Cooper 7:07
Hmm.

Adamson, Rob 7:07
And so it basically what it said was siesta is essentially when you need to take time away and you're completely out of pocket.

Adamson, Rob 7:15
You're protected so that you don't actually have to have a meeting at that time.

Jordan Cooper 7:22
Umm.

Adamson, Rob 7:19
That's the csta time and then Fiesta is when you were encouraged to take your time away.

Jordan Cooper 7:30
Mm-hmm.

Adamson, Rob 7:26
Obviously with active go lives, there are a couple of periods where we would prefer nobody would be out for obvious reasons.

Adamson, Rob 7:32
You either going up leading up to a go live, or obviously you're supporting and stabilizing after a go live.

Adamson, Rob 7:37
So those are those are times where nobody really can be off.

Adamson, Rob 7:40
But what we do is we use something called Fiesta Siesta and that's what we refer to people to remind people that there needs to be a siesta and then obviously there needs to be an engagement with your family.

Adamson, Rob 7:52
Get back with your family and have a Fiesta with them.

Jordan Cooper 7:55
So you've mentioned about you've spoken so far about this epic together strategic pause and this was for the epic migration, especially within the context of a fully remote workforce due to the pandemic.

Jordan Cooper 8:11
But would like to quote you.

Jordan Cooper 8:13
You said we found out that 70% of the people we needed to build the system were fully available to keep making decisions.

Jordan Cooper 8:20
So I directed the team that put all people who weren't available at the end of the build, and all people were available to move them.

Jordan Cooper 8:25
And move them forward.

Jordan Cooper 8:26
So what I like to ask is the numbers that you have produced due to your strategic approach to prioritization of this particular go live are very impressive.

Jordan Cooper 8:40
I'd like, but of course the the the pandemic is in our past.

Jordan Cooper 8:45
Hopefully there won't be another one.

Jordan Cooper 8:47
You're moving towards the end of this epic implementation and I think a lot of our listeners are saying this is great, but how could I apply these lessons to other sorts of task and strategic initiatives at my organization?

Jordan Cooper 8:59
Would you be able to perhaps tell how you've taken some of these lessons and applied them elsewhere?

Jordan Cooper 9:05
Robert Wood Johnson and and also showing how to prioritize balance and increase productivity elsewhere in the organization.

Adamson, Rob 9:14
Yeah.

Adamson, Rob 9:15
So one of the things we found with IT&S is that I I did an inventory of all the meetings that we were attending as a group and I characterized them in three buckets, early awareness, mid awareness and laid awareness.

Adamson, Rob 9:28
And what we found was the majority of our meetings were laid awareness, which means we were getting this information at the end and then scrambling to get this all done.

Adamson, Rob 9:37
What I tried to do is move the entire team to early awareness.

Adamson, Rob 9:41
So as an example to your point, when I find out that there are three construction delays, why would I want people to keep continue going down that road of wiring a building that doesn't have a certificate of occupancy for us to even get in there?

Jordan Cooper 9:58
Mm-hmm.

Adamson, Rob 9:58
Can redirect those resources to something that's fully ready, ready to go, so that we maximize capacity management.

Adamson, Rob 10:05
The only way you can do that as an it and this organization is to move from the mid and late awareness to the early awareness.

Adamson, Rob 10:13
So something as simple as working in a hospital?

Adamson, Rob 10:16
I asked a simple question, show a hands all of the site directors.

Adamson, Rob 10:20
Which one of you is on the Space Planning Committee and only half of them raised their hand, which means the other half didn't even realize that they were changing spaces.

Adamson, Rob 10:30
Changing new locations, doing these things, the whole hospital.

Adamson, Rob 10:33
New but IT then you wonder why there's this mad dash at the end.

Jordan Cooper 10:37
Mm-hmm.

Adamson, Rob 10:37
And so by moving to taking an inventory of what I call the early, mid and late awareness, I have early awareness which means best information.

Adamson, Rob 10:45
So I can redirect things much the same way Reid did with the strategic pause.

Adamson, Rob 10:50
Obviously when I'm pausing things, I'm not going to focus on that.

Jordan Cooper 10:58
Mm-hmm.

Adamson, Rob 10:53
I'm gonna focus on what's available that I could build during the epic, have built and the same thing is true here.

Adamson, Rob 10:59
Why would I focus all their time on something that I already now know won't be ready for us?

Jordan Cooper 11:11
Mm-hmm.

Adamson, Rob 11:05
And now what do I do so we redirect those people so that project is basically sitting in a pause, but I only know that because I'm at the right meetings and at the right cadence.

Adamson, Rob 11:15
And I know where that information's coming from.

Jordan Cooper 11:18
So you've mentioned that right now Robert Wood, Johnson, Barnabas is involved in restructuring of the ITN.

Jordan Cooper 11:26
S stands for information technology and services function and also governance.

Jordan Cooper 11:31
You've just spoken a little bit about how you're prioritizing meetings.

Jordan Cooper 11:35
Is some sounds almost like a lean Sigma approach, but would you be able to delve deeper into the restructuring of the whole function and governance as well?

Adamson, Rob 11:44
Yeah.

Adamson, Rob 11:45
Great question.

Adamson, Rob 11:45
So, uh, what we had was we had people meeting in silos and in, I would say in lanes of function, you know, security team was meeting as a security team, but there wasn't a broader governance beyond that.

Adamson, Rob 12:00
And so the first thing we established was an IT and Executive Council.

Adamson, Rob 12:04
So I'm proud to say I've 16 Vice President, colleagues that I'm a member of, and those sixteen are in all these different lanes.

Adamson, Rob 12:12
That's the Executive Council that is the final.

Adamson, Rob 12:15
That's the final decision.

Jordan Cooper 12:17
This is.

Adamson, Rob 12:17
So I have underneath that and IT&S steering council.

Adamson, Rob 12:21
They deal with just internal IT things.

Adamson, Rob 12:24
Then we have an IT and S strategic council.

Adamson, Rob 12:27
That's customer facing operations.

Adamson, Rob 12:29
That's altogether those are recommending bodies feeding up to our Executive Council, which is the only Council that can endorse any of those decisions.

Jordan Cooper 12:38
Umm.

Adamson, Rob 12:38
Then sitting underneath these, we have a number of things, but the one I'm most proud of is the Workforce Committee, which is actually made up in three or four lanes.

Adamson, Rob 12:48
We have a ladders program.

Adamson, Rob 12:50
We have a capacity management program, work life balance program etcetera and it's made up of its share and a vice chair of the membership of our actual group and then obviously groups on each one of those committees.

Jordan Cooper 13:13
Mm-hmm.

Adamson, Rob 13:03
All of these will funnel up to the governance so that they can make recommendations, ultimately so that the executive team can either endorse, change, migrate, fix, etcetera.

Adamson, Rob 13:14
Prior to that, there was a lot of email confirmations people saying things like why I spoke to so and so and so and so. I think we're good to go.

Jordan Cooper 13:22
Mm-hmm.

Adamson, Rob 13:22
That's awareness and that's institutional knowledge.

Adamson, Rob 13:25
That's not governance.

Adamson, Rob 13:26
What we wanted to do is to make sure that there was a polarity to it to say hey, I I need a motion to approve going to Robert's rules of order.

Adamson, Rob 13:35
All of those things have made all of our decisions.

Adamson, Rob 13:38
I like to call it durable.

Adamson, Rob 13:40
What we had in the past was decisions that were made and then remade several times, and then that caused scope creep, delays, et cetera by making it an inclusive process with all the stakeholders within itns, you now have plurality and now you also have a multidisciplinary approach, which means once we all agree, you can't come back later and say I didn't know.

Adamson, Rob 14:03
And so once we all have that as a unified voice, our decisions have been very durable.

Adamson, Rob 14:09
Where in the past they weren't as durable because of a lack of governance.

Jordan Cooper 14:14
So I find it interesting there's a theme of prioritizing time and ensuring efficiency in decision making.

Jordan Cooper 14:22
You spoke about the epic together strategic pause and how you identified certain stakeholders at the organization who are available now for this thing and others who weren't, and you affected your schedule accordingly.

Jordan Cooper 14:34
You've and so you've also spoken about different sorts of meetings, meetings that were early, mid, late awareness where a lot of the meetings had been.

Jordan Cooper 14:43
I wanna just ask a general question which is delegation.

Jordan Cooper 14:48
You said there's lots of different subcommittees.

Jordan Cooper 14:51
You said there's a workforce committee.

Jordan Cooper 14:52
There's a a strategy committee, but how have you been balancing delegating committees versus having too many meetings and committees?

Jordan Cooper 15:00
Because again, there's work that needs to be done.

Adamson, Rob 15:05
Mm-hmm.

Jordan Cooper 15:02
You need to prioritize things in order to get work done, so it sounds like there's a lot of structure and governance, and now there's a proliferation of meetings and committees.

Jordan Cooper 15:11
How have you struck a balance between delegating and ensuring that there is a unanimous decision and that we are moving forward with transparency versus too many meetings committees preventing us from doing our work?

Adamson, Rob 15:22
Yeah.

Adamson, Rob 15:22
So what you need is the first thing I decided is what are recommending bodies?

Adamson, Rob 15:28
What are endorsing bodies?

Adamson, Rob 15:30
And So what?

Adamson, Rob 15:30
You don't wanna have is 25 meetings to get to the final decision.

Adamson, Rob 15:34
That's woefully inefficient.

Adamson, Rob 15:37
On the other hand, you can't have no decisions, so it's it's always that thing where you want to have the minimum necessary.

Jordan Cooper 15:44
Mm-hmm.

Adamson, Rob 15:44
And so in essence, what we did is we did an inventory of all of our meetings.

Adamson, Rob 15:48
If you could see my office, I had them all strewn on my walls.

Adamson, Rob 15:52
And then each group had to come in and say I said if we didn't have this meeting, what would happen?

Adamson, Rob 15:58
And a lot of cases, they said nothing I said.

Adamson, Rob 16:00
Well, then, maybe we don't need this meeting and we went through an inventory of what meetings made sense, which ones still made sense, and then what was the gap?

Adamson, Rob 16:09
What were the things that didn't connect these?

Adamson, Rob 16:12
And so we actually deactivated a number of committees that just didn't make sense.

Adamson, Rob 16:16
They weren't really effective.

Adamson, Rob 16:17
And then align new ones that were actually already there.

Adamson, Rob 16:21
They were just realigned.

Adamson, Rob 16:23
This one was sitting by itself, but it led to nowhere.

Adamson, Rob 16:26
I'm like, well, do you make a decision?

Adamson, Rob 16:27
Where does it go?

Adamson, Rob 16:28
And they said great question, don't know as well.

Adamson, Rob 16:32
Let's get that connected.

Adamson, Rob 16:33
So there was two bodies of work I would say.

Adamson, Rob 16:35
We stood up a handful of committees.

Jordan Cooper 16:39
Mm-hmm.

Adamson, Rob 16:38
Net new the majority of this honestly was just realignment to make sure that when a decision was made somewhere, it went in a broad enough audience.

Adamson, Rob 16:48
So everybody knew about a particular project.

Adamson, Rob 16:51
What was the timeline?

Adamson, Rob 16:52
Who owned what?

Adamson, Rob 16:53
Etcetera, etcetera.

Jordan Cooper 16:58
Mm-hmm.

Adamson, Rob 16:55
And one of the ways we do that is through a product called work front, which is a project management tool that we use.

Adamson, Rob 17:01
Everything goes through work front, so everybody now obviously knows who's got what, who's tasks or what.

Adamson, Rob 17:09
And that there are dependencies that are related to governance, but I wouldn't say it's onerous because I don't wanna portray that.

Adamson, Rob 17:16
I stood up 31 new committees.

Jordan Cooper 17:18
Mm-hmm.

Jordan Cooper 17:32
Mm-hmm.

Adamson, Rob 17:18
I would say I stood up probably 3 committees overarching the ones I talked about and then the Workforce committee was to give back to our colleagues giving by the people that were asked to lead a voice back to us in a structured way.

Adamson, Rob 17:33
That's basically what we stood up.

Adamson, Rob 17:34
So it wasn't hundreds of things.

Adamson, Rob 17:36
It was just the opposite.

Adamson, Rob 17:37
Peeling the onion to get to the core.

Jordan Cooper 17:40
Excellent.

Jordan Cooper 17:41
We are approaching the end of this podcast episode, so just to get some high level overviews in terms of setting the the context for this migration to epic you were I guess you know if you were to characterize the the the migration process, you know what EHR did you migrate from kind of how many years of clinical data are you importing into epic?

Jordan Cooper 18:09
How many years are you archiving?

Jordan Cooper 18:11
What are you doing to allow clinicians access to data that isn't being imported into epic?

Jordan Cooper 18:16
Just kind of some of the high level questions that people who are going through a similar epic migration may be facing themselves just quick high level overview.

Adamson, Rob 18:25
Yes.

Jordan Cooper 18:39
Umm.

Adamson, Rob 18:25
So we we had to migrate from three different systems, Allscripts, Cerner and the last one will be meta tech which is next year those those data were actually five years worth of data was brought into EPIC.

Adamson, Rob 18:40
So when you went live with epic, you had five years worth of patient data.

Jordan Cooper 18:44
Umm.

Adamson, Rob 18:44
Anything greater than five years we we archived everything and it was completely retrievable in context when we actually put that into the database.

Adamson, Rob 18:54
So if you're in epic, you can look at your archive and sort it pretty efficiently.

Jordan Cooper 19:14
Umm.

Adamson, Rob 18:59
To find anything greater than five years old, we candidly, as a former clinician, there's very little utility beyond five years, perhaps, maybe legal and maybe research is the only two I could think of other than that really five years we thought was very generous for clinicians, which is what we did.

Jordan Cooper 19:22
Umm.

Adamson, Rob 19:15
So it's five years worth of data came in and we went from 3 disparate systems, three different financial systems, two different labs systems.

Adamson, Rob 19:23
I can go on and on and on, all consolidating into one as third parties we we turned off nearly 153rd parties turned on and maybe about 80 new ones and then maybe needed to upgrade some of the ones to either enterprise or some newer version.

Jordan Cooper 19:40
Hmm.

Jordan Cooper 19:41
Excellent.

Jordan Cooper 19:42
Well, I really do appreciate your time.

Jordan Cooper 19:45
Any closing thoughts that you'd like to offer to somebody listening?

Jordan Cooper 19:48
Perhaps if you had a, you know, one wish, if you had a genie in a magic lamp and you could, and you could rub it.

Jordan Cooper 19:55
What?

Jordan Cooper 19:56
You know what would your one wish be if you could have something solved at your organization?

Jordan Cooper 20:01
Yeah.

Adamson, Rob 20:02
The thing that I wish for as a leader, quite frankly, is I knew all 903 people as much as I wanted to.

Adamson, Rob 20:10
I don't know them all as best I want to know them all because this is my family and I don't know the family members as well as I'd like to because you're just so many of them.

Jordan Cooper 20:20
Hmm.

Adamson, Rob 20:19
And so my wish is to have those interactions to get to know them better.

Jordan Cooper 20:24
Thank you, rob.

Jordan Cooper 20:25
For listeners, just has been doctor Robert Adamson, a pharmacist by training, the executive Vice President and Chief Information Officer of the Robert Wood Johnson, Robert Wood Johnson, Barnabas Health of current operational leader, the Epic EHR implementation, and previously the Chief Pharmacy officer of RWJ, Barnabas.

Jordan Cooper 20:45
Rob, thank you so much for joining us today.

Adamson, Rob 20:47
You're welcome.

Adamson, Rob 20:47
Take care.