View from the Bridge

Patients First! Patience Always!

Soon after I began working as a CIO at Presbyterian Healthcare System (PHS) in Dallas in 1992 – 25 years ago – I asked the staff to hang a banner with those 4 words printed with a bold 12-inch font in the data center. It was placed strategically to ensure that all who entered our area had to see it. The Help Desk and Operators could see it from their desks. The intent was to inform or remind everyone who entered where to focus and how to conduct themselves. The everyone included our Information Services (IS, not IT) staff and all our visitors including non-IS PHS employees or any of our numerous vendors. No one could miss it. Based on frequent unsolicited compliments, we knew the banner was easy to understand. It resonated with people on an individual, human basis. We, IS, are about people, not technology.

Why display such a simple banner so prominently? We needed an anchor to help steady us in the turbulence that defines our workplace. It’s that turbulence, however, that creates the energy and excitement that fuels our endeavors. Our employees are confronted and strengthened by the common challenges facing all HIS professionals including but not limited to

• Complexity – We work at the nexus of 2 of the most complex industries – healthcare and information technology. Both produce a never-ending torrent of changes and challenges. As healthcare IS workers, we function as a clutch plate between the 2 industries to ensure our activities stay in sync, to create synergies which further the goals of the Triple Aim. The constant change helps us grow, makes us strong.

By preference and necessity, we became agile, flexible, and nimble, the hallmarks of all successful HIS groups. The best of us welcome and embrace change. Our users recognize us as agents of change, as transformers who use enabling technologies as catalysts to evolve our care delivery model, to improve outcomes and operations, and to improve staff and physician satisfaction (I have evidence of that from employee and physician surveys).

• Demand – The demands from our increasingly sophisticated users grow exponentially. At my next employer, Baylor Health Care System, we consistently documented demands for products and services via our formal governance processes. The ratio of demand to supply was 6:1. When I discussed this with CIO friends, they reported ratios higher than that, one as high as 16:1. Were they bragging or complaining? Most businesses must work hard to generate demand. For us, it’s a blessing to be part of an ORE – opportunity rich environment.

With those kinds of ratios, you cannot meet the demand, only manage it. By our design, the governance council at Baylor was not chaired by me, the CIO, but by a hospital CEO. Again, by our design, IS didn’t have a vote in setting priorities and rank ordering requests. Only 17% of requests were approved. We declined the remainder to manage expectations and eliminate a backlog. That relieved much anxiety for the IS staff who would have been otherwise overwhelmed by the demand, and provided certainty to the requestors. To our surprise, complaints were rare because the process was equitable, and because participants knew we kept a small capacity surplus for emergent projects. I believe this approach to demand management signals our goal to be servant-leaders. As such, our priorities should be determined by and for the people we serve.

• Vigilance – Though we all are users of more and more information technologies, we humans can never be as vigilant as our digital partners. When working properly, our devices are incredibly consistent and attentive. In addition to entertaining us, these ever-attentive technologies can educate, monitor, and inform us and our caregivers. And most important of all, they help us mine, refine, and analyze data, our most precious resource. We are then able to use technology to share observations and learnings, and encourage adherence to care plans with all the involved stakeholders. When patients and families can access and react to pertinent data and information, they are more likely to become active participants and partners in their healthcare journey. That improves the chances of success for everyone.

In regards to patience, everyone knows that the “hecticity” in our lives is increasing and with it, our stress levels. Our technologies are often contributing factors. We know when we’re stressed, we’re not always as patient as we want to or should be. Regardless of our stress levels, we must remain sensitive to the profoundly stressful circumstances of patients, their families, and the care team. When we maintain our cool, we can treat our users with the same dignity, sympathy, and compassion we expect and receive from our own caregivers, with the patience that we get from our families. When shared, patience is a gift.

In summary, we are fortunate to be HIS professionals. If it wasn’t initially, healthcare becomes a calling for us. Once it’s in our blood, we’re hooked for life – striving to model our behaviors on our caregivers by being caring, compassionate, and collaborative.

Is the message on the banner still relevant after 25 years? Absolutely. Should it be changed? Yes. Healthcare is a team effort. We need to add our best, most critical supporters – “and family.” Our life journey starts and ends with “and family.” For the future, let’s commit to

“Patients and Families First! Patience Always!”

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