S4E12: Measurable Clinical Impact: IT as a Strategic C-Suite Partner (ft. Rob Adamson, RWJBarnabas Health)

Jordan Cooper   0:59
So many of our listeners are still in the midst of doing that or have recent traumatic memories of that. Lots of budget there. Also, last time three years ago, you were going strong with Siesta Fiesta. How has that been continuing?

Rob Adamson   1:15
So we still do some version of that, and we tie that to basically where upgrades are going to be or something substantial so that we don't allow people off when we desperately need them, but at the same time, give them the latitude to enjoy all their paid time off.

Jordan Cooper   1:32
So for our listeners, that's just about blocking time and ensuring that there's time on and time off, and we try to separate the two at Robert Wood Johnson. Anyways, let's get down to it. Today our conversation is going to be what happens when you stop treating IT as a support function and start treating it instead as a strategic partner.There's a campaign at Robert Wood Johnston Barnabas Health called the Driving Early Awareness and Partnership for Innovation campaign. So before we jump into the mechanics of all this, do you want to give an overview of the campaign?

Rob Adamson   2:05
Yeah, sure. So one of the things we did is when I took over as CIO, I asked a very simple question to my coworkers in our IT executive council. I said, I want you to look at every meeting that you attend, all of you collectively, and I want to see, is it early awareness?mid-awareness or late awareness in the strategy. And what we actually found when we did this is in 2023, 70% of the things that we attended was late in the cycle, late awareness. A little bit on the mid-awareness and then 10% was early awareness.

Jordan Cooper   2:38
Mm-hmm.

Rob Adamson   2:43
We feel advocacy is an offensive sport. And I said, let's go out there and let's get rid of the things that are late awareness and get ourselves on those things that are early awareness. And in 2026, that same group, 80% of all the meetings we attend now are strategic and are early awareness.and only about 5% is left at late awareness. And you may say to yourself, go ahead.

Jordan Cooper   3:06
So...Okay, so no, keep going. You may send yourself and then...

Rob Adamson   3:11
Yeah, so what I was going to say is you may say to yourself, what does that actually mean? So as an example, in 2022, we were on 2 early awareness councils, the Chief Medical Officer, the Chief Nursing Officer. Now in 2026, I'm a member of the Board of Trustees, the CEO's Executive Leadership Team.We're on the construction and space planning, the COO council, mergers and acquisitions, quality and patient safety. Very, very different complement of what we're on. And why is that important? Because when a goal, a strategy, or an initiative is being started, who's at the table? IT.What was happening is we would be informed of something and nobody on this call is going to ever remember something like this, but just go with me. Hey, we're opening up a building and we need a network spun up by Monday. Even though you've been planning this project for a year and a half, so early awareness gets you away from reaction

Jordan Cooper   3:56
Yeah.Yeah.

Rob Adamson   4:07
to proaction and that's when we became not a division, but a service line that is thought of the same as cardiovascular, oncology and the like.

Jordan Cooper   4:17
I can't tell you how many of our listeners are often, one, are asked to go through fire drills that are preventable, and two, are asked for a band-aid solution that in reality doesn't address the root business cause and use case that you need to solve for, which just leads to a new request for a new solution

Rob Adamson   4:29
Okay.

Jordan Cooper   4:37
a few months down the road, and it keeps going until somebody does the root cause analysis. So before we go deeper into exactly what you've been doing the past few years in this early awareness and partnership campaign, I'd like to bookend this conversation with a thought that I'm then going to mention again at the end of this conversation.

Rob Adamson   4:39
Correct.Mm.

Jordan Cooper   4:56
So and that thought is about measurable clinical impact. Ostensibly, IDNs, integrated delivery networks, or large healthcare delivery systems are all about, yes, they're businesses. Yes, you need to be in the black instead of the red, but ostensibly, you're there to deliver healthcare in order to improve health outcomes for patients. Sometimes you're managing at a population level.A lot of times we're managing at an individual level. And so I just want to bookend the conversation like with why we're doing this. What are the implications of having the IT team separated from the business owners, the service line owners? And I just want to ask you to speak for a moment about where you started in terms of your inpatient mortality index.And then we're going to go through the awareness, the strategic IT governance, the executive share goals, and then the impact of all of those mechanisms, those tactics on the strategy of having where you ended up with measurable clinical impact. So would you please guide us through that journey, Rob?

Rob Adamson   5:44
Hussam.Yeah, sure. So, and I think you talked about shared goals, which I think is the secret sauce to get to the clinical measurable outcomes. If you take a look in 2022, 9% of all of our executive goals were shared with some business, operational, or clinical owner.

Jordan Cooper   6:08
Mhm.Okay.

Rob Adamson   6:16
In 2026, as well as 2025, every single executive in IT has a corresponding shared executive goal with an owner. The one you're referring to is a project that we're incredibly excited about, and it's called the Auto Clinical Documentation Improvement.scenario. And essentially what this is, is we know when a patient comes into our facilities, there's something called the mortality index. And what that basically means is if your mortality index is 1, that means if you came in and you actually succumbed to your disease,

Jordan Cooper   6:43
Mhm.

Rob Adamson   6:53
That was expected. A1 means it's expected. If it's 1.3, that means 30% of people are dying more than we expected. And then if it's less than one, less people are succumbing to disease than we expected. And what we found was we were doing amazing clinical care, but some of the problem we have is documentation in nature. And then we were underappreciating how sick

Jordan Cooper   6:56
Mhm.

Rob Adamson   7:18
our patients were. So the Auto CDI program, when launched, which is an AI platform, gets launched into Epic. It actually goes and finds about 15 to 16 different diagnoses, as well as things that are already in the chart, surfaces them for our clinicians to say, oh my goodness, I forgot to document these things. They get documented, and now we're getting credit.

Jordan Cooper   7:26
Mm-hmm.

Rob Adamson   7:42
for people and how sick they really are. So what happened was is...

Jordan Cooper   7:45
No, hold on.Just to jump in there, you say services information that clinicians forgot the document, but of course, you can't service information that doesn't exist in digital format. So are you talking about discrete data elements as opposed to unstructured text?

Rob Adamson   7:56
Correct.So yes, so for instance, I'll give you a very clear example. We know when someone's potassium level is very, very high or very, very low, this could have a major detriment to people's mortality. And so it's in a lab, we see it's high, but nobody wrote it in the actual note.

Jordan Cooper   8:12
Mm-hmm.Uh-huh.Got it.

Rob Adamson   8:22
Somebody forgot to document it. It's all there, it just never got documented. Now it gets surfaced so that it becomes part of the note, so that when you go through this, it goes into the overall index. And what's wonderful is we were starting at 1.25, meaning 25% more of our patients look like they were actually succumbing to disease when they shouldn't have.

Jordan Cooper   8:27
Okay.Mhm.

Rob Adamson   8:44
And in fact, now we're down to a 0.6, which means it's 40% less likely you're going to succumb and have mortality. And it's because we're actually doing two things, the amazing clinical workflows that are being done by our clinicians, and at the same time, making sure that we're appreciating just how sick our patients are.

Jordan Cooper   9:04
So before we get into how you accomplish that, and that's going to be very exciting, just to understand the number between 1.25 and.6, I can think of at least two ways that you might explain that. One, the care being delivered is better. More information is being available at the right time to the right person to make better informed decisions.

Rob Adamson   9:24
Correct.

Jordan Cooper   9:24
or maybe it never really was 1.25. Maybe it was closer to like 1.0 or 1.1, but now you're better able to capture the accurate clinical diagnosis. Can you speak about the different explanations for how to interpret the first, where you started?Mm-hmm.Yeah.Mhm.

Rob Adamson   10:03
sick really are you? And so what we did is clean up the bottom as well as the remarkable job on the top. And when you put them both together, you're right, it's probably maybe a little exaggerated at 1.25. Nonetheless, what we saw is an accurate representation. And now what we see ourselves is we're now a top quartile health system in the United States.

Jordan Cooper   10:26
Now, I think that will capture the attention of a lot of our listeners. I think everybody already knows the answer, but would you mind explaining what the financial implications are to the business of being in a top quartile? Very brief, high level.

Rob Adamson   10:39
So what's interesting is the reason I'm not going to do that is because we don't actually talk about that. What we talk about in our health system is the quality of care and that and then the patient experience. Now there is going to be financial benefit to obviously documenting more in those kinds of things.

Jordan Cooper   10:51
Mhm.

Rob Adamson   11:00
I will tell you that the back of the napkin math is in the 10s of millions of dollars, like 40 to $80 million in additional revenue that goes out. Now, what we actually get paid is a little bit different. And I don't want to go into the specifics because then it's kind of, hey, how'd you get that arrangement with your commercial payer? But the idea is, is that at least

Jordan Cooper   11:00
Mhm.Mm-hmm.Mhm.Right, right, no.Yeah.

Rob Adamson   11:23
We know it's been an uplift in terms of the revenue in a large magnitude.

Jordan Cooper   11:28
Right. So basically what you're saying is you try to, there's a bunch of programs to have a measurable clinical impact on more closely integrating IT leadership with the rest of the business lines. So, and there's financial impact, there's improvement in patient experience and quality of care. So let's dive into exactly how to get there. Now that we're convinced that there's a pathway to get where we want to go,

Rob Adamson   11:50
You.

Jordan Cooper   11:51
You said, first of all, about the meetings. The meetings need to be early awareness instead of late awareness. I think our listeners may be interested. How do you designate early, late? And then more importantly, once you designate and have a standard definition, how did you get, how did you change those meetings? A lot of times people,

Rob Adamson   11:59
Ohh.

Jordan Cooper   12:10
They're just, how do you cancel meetings? Everybody has too many meetings that they can't extricate themselves from. How did you do that?

Rob Adamson   12:17
So I wanted everybody to do what I call a, I said, let's do hygiene for your calendars. Tell me what would happen if you don't show up to this meeting. Explain to me what horrible event would happen if you don't come to this meeting. And 90% of the time I got, I

Jordan Cooper   12:17
Yeah.

Rob Adamson   12:35
I, nothing. Correct. Then why are you going? I've always been going. Okay. Then I said, where do you think you should be? And they were very, very articulate in why they should be at these other meetings. They couldn't give me a good reason for staying at the meeting that they were currently having on their calendar.

Jordan Cooper   12:53
Mm-hmm.

Rob Adamson   12:54
The way we actually define it was early awareness is simply IT is engaged before the strategy, the decision is actually made. You can't deshape it. On the other hand, mid awareness is the direction is largely set. They bring us in the end and then say, hey, why don't you give this a look?So there's at least something, but all that does is it basically preserves value, doesn't create any. On the other hand, late awareness, there's a risk, a cost, rework, all of that's done because we're woefully too late. And so I said, let's categorize all our meetings along those lines, because if

Jordan Cooper   13:14
Mhm.Mhm.Mhm.

Rob Adamson   13:33
Again, early awareness happens. This is where advantage actually gets created if you're part of the strategy up front. As an aside, the way you take those meetings now and then operationalize this to get great outcomes is those shared goals. And I'm talking about incentive goals, not just a goal.

Jordan Cooper   13:47
Mm-hmm.Mhm.

Rob Adamson   13:52
Can you imagine your IT leader having the exact incentive goal is your business owner, your chief medical officer, your chief nursing officer. Those are the kinds of people who have a shared goal with, let's say, our chief medical information officer or our CNIO, or in my case,I have shared goals with business owners. So such that you definitely align, it's shared, and the same person we all report to approves the goals to be cascaded amongst two and three different people that we all share them together. Suddenly you can unlock lots of things because you can't work in a silo. It's not in your best interest.

Jordan Cooper   14:13
Mhm.So I think, I mean, it makes a lot of sense from a common sense perspective, but obviously, if this is something that is new and novel, then it didn't make enough common sense for it to just already exist and not require this intervention. What have been some of the challenges to getting a CFO and a COO on the same page as a CIO? Are theyThey're used to thinking about doing something on their own, maybe having more independence. What kind of pushback is there? Oh, if we involve it, it'll slow us down. What kind of objections did you encounter, and then how did you overcome those objections?

Rob Adamson   15:06
Yeah, so the strategy around that was knowing that I was not at the right table to advocate for myself and then advocate for the colleagues that I represent. And so the challenges that I first overcame was IT is woefully too slow, you take too long, things never get done on time.

Jordan Cooper   15:17
Mhm.

Rob Adamson   15:26
so on and so forth. So what we did was I took three or four projects, superimposed when everybody else knew about all of it, and when we were brought in. And I said to them, it's interesting that this 14-month project, all of you had 14 months, and we were given.

Jordan Cooper   15:31
Mhm.

Rob Adamson   15:44
four weeks. And I was just wondering, why did everybody else get so much more time to actually do this? And you're telling me we're a major dependency and we had the least amount of time. And no one said a word and they looked at me and said, wait, I got another one. And I did the next project and then the next project. And they said, well, maybe you need to be right at the table when we're making these decisions. And I said,

Jordan Cooper   15:46
Mm-hmm.

Rob Adamson   16:06
Yes, I do. So they said, well, why don't you start joining the COO council? I said, sounds good to me. Hey, you should be a member of the board of directors. Sounds good to me. And so by educating them that, listen, I'm not throwing aspersions at everyone, but if it's a 12-month project and you're giving me two weeks to do it and everybody else,

Jordan Cooper   16:16
Mhm.

Rob Adamson   16:27
gets 52 weeks, how do you expect us to not do the same kind of quality and checks that you all had because you were afforded a different level of opportunity? And so educating people with cold hard facts and pictures work, and you basically show them a picture of, here's everybody else's timeline,And you see that little thing at the end there? That was our timeline. And you're telling me we had the most complicated part of all of us.

Jordan Cooper   16:53
Was it difficult to do discovery on when other C-suite executives first had knowledge about a project? I'm sure, did you have to go through their admins? How did you know about that if you weren't, if you didn't know about that?

Rob Adamson   17:06
So I have good relationships with my colleagues. I just said, when did you get aware of this? He goes, well, we started talking about this last, I'm making this up, for instance, last May. I'm like, oh, when was that? He goes, I don't know, first, second week in May. Good enough. I found out about it in April, the following year, not good. And so we had this discussion and he says, that doesn't seem fair. I said, no. He goes, you know, you're a critical part of this. I said,

Jordan Cooper   17:13
Yeah.Yeah.Yeah.Yeah.

Rob Adamson   17:30
You don't say, I have to look out for that. And so I would, you know, just have a good conversation with my colleagues. And at that point, I think Epic also helped when we rolled out Epic and they saw just the value of being on the front end. I leaned into that and said, now let's take Epic as a microcosm of

Jordan Cooper   17:44
Mhm.

Rob Adamson   17:49
all the things we do in this health system.

Jordan Cooper   17:51
So I think you've spoken a lot about awareness transformation. You spoke about getting on the same page with these other executives. Now, how do you align your goals in the IT stack, the CIO vertical, with the rest of the organization?

Rob Adamson   18:06
So the rest of the organization has a strategic plan and strategic priorities. What we did in our IT group is I said, guys, it's always going to be ever changing. So let's simplify what we need to do as an IT team. So perhaps maybe, you know, Jordan, another.call maybe one day is how we organize the strategic plan of IT into 4 words. And those 4 words are real simple. And we brought that back to them, which was organizational enablement, organizational resiliency, and modernization was the other one. And so I said, and then people, and then

Jordan Cooper   18:30
Mm.Mm-hmm.

Rob Adamson   18:48
customer experience. And when you think about that, everything we do lumps right into those four things. And so as they were getting facile of what they were trying to do as an initiative, we could become very organized because we had a very simple 4 words that we can, or 4 themes that we can tuck you in under. And that made us much more nimble.

Jordan Cooper   19:05
Mm-hmm.

Rob Adamson   19:09
The same thing is true as we brought back what we wanted, back to the board of directors or back to the COO council or brought back to the right C-suites to say, here are the things we're thinking of doing. And then we did a reconciliation of those.

Jordan Cooper   19:23
So in terms of defining incentive goals, I think some of our listeners may be listening to this episode and thinking, how do I replicate Rob's success at my IDN in the Midwest, the South, the West Coast? When you say incentive goals, can you define them more clearly and concretely? Because I'm sure there are many KPIs on everybody's dashboard.Which incentives are you aligning?

Rob Adamson   19:49
So it could be something as simple as the overall budget to the health system, the overall budget, you know, in your department. One of my shared goals with the CEO of our medical group, as an example, is to increase the referral footprint with our joint venture partners.

Jordan Cooper   19:57
Mhm.

Rob Adamson   20:09
increase the referrals within our own group because we have friction in some of the workflows. And by working together, we would then say, we want to increase referrals by X. And so that as the CEO, he's going to see that benefit. As the CIO, I'm going to enable that benefit.

Jordan Cooper   20:15
Mhm.Mhm.

Rob Adamson   20:28
And so we do those goals together. Another one is looking at our labs, our lab operator. We were able to shave $5 million out of labs we just didn't need or we were ordering them too frequently. Well, the person who, the vice president over our clinical service line was with the senior vice president of the lab service line and bothboth of these ladies share that goal, and both of them share the exact same goal for their incentive program. So it's those kinds of things where they're trying to do an efficiency that they're doing on the front end or the workflow, but in the end, you can't do anything unless it's been built, enabled, and tested in the IT system, whatever that system may happen to be.

Jordan Cooper   20:52
Mm-hmm.So we're approaching the end of this podcast episode, and there's still one more important bookend part that we need to address. So we've addressed, we started with the measurable clinical impact, talked about awareness transformation, aligning incentives, executive shared goals. We spoke a little bit about the strategic plan,and strategy, making sure that you're at the right table at the right time and getting out of meetings you're not supposed to be on. Now we're at the end of this journey. We've implemented all of these interventions where you're driving the mortality index down to.6, meaning 40% better than expected when they presented at the hospital.you know, thoughts on where you are now and exactly how aligning all these incentives, perhaps with one quick little anecdote about how you, how do these changes led to that.6 score?

Rob Adamson   22:06
So these changes, and so I don't want it to seem like IT drove this whole thing. IT was just one of those groups that did this together. However, having said that, if I just enabled something in IT and nothing changed on the clinical side, maybe the numbers would have been marginally better. If the clinical team did something, but we didn't enable things on the documentation side, maybe it would drove marginally better.

Jordan Cooper   22:11
Mhm.Mhm.Mhm.

Rob Adamson   22:31
What this is, is we think of this as a shared responsibility and that everybody owns this. One of the great things about the health system is in the last several years, everybody in the C-suite has a cadre of about 9 goals that are pre-prescribed to us that we all have to get behind. And one of them is mortality. So everybody who has a C in front of his or her name

Jordan Cooper   22:42
Mhm.Mhm.

Rob Adamson   22:54
has the exact same goal of mortality. So we all share that as one large group because this one clearly takes a village. And so what we did is help expedite things from a technology standpoint, but everybody leaned in to do this.

Jordan Cooper   23:03
Mhm.Yeah, you can't improve what you can't measure. You got to measure and an incentive drives behavior and leadership drives the behavior of their team. So I really do appreciate your time with us today, Rob. Any final parting words, perhaps to yourself, two years ago,

Rob Adamson   23:13
Black.

Jordan Cooper   23:29
After our first podcast, but before you started implementing all of these changes, any kind of suggestions to a Rob from 2024?

Rob Adamson   23:39
So you have a lot of ideas and always make sure you have patience because whatever you do in a large group like this is going to take time and you can't measure it on a daily basis. You have to make sure you do check in periodically, but just know that there's a great expression that says,10 pounds of constant pressure will eventually move the Queen Mary. And so the idea is it has to be constant, always be vigilant, but always make sure you have the level of patience to watch things mature over time and don't get discouraged.