It’s day one of the Health Forum and American Hospital Association Leadership Summit in San Diego and Donna Sollenberger (pictured right), executive vice president and CEO, University of Texas Medical Branch Health System, talked with H&HN about how UTMB handled the implementation of a large IT project and why C-suite leadership was critical from beginning to end.
Can you describe the University of Texas Medical Branch IT project and why it was so important to the organization?
We had been talking about making a conversion of all our revenue cycle systems, which includes patient and hospital billing, patient registration and scheduling for some time. Our clinical system was on one platform and our billing was on another. The billing system really needed to be updated. It was a nearly $26 million project, and we’re primarily a safety net hospital, so at the time, we weren’t going to be able to spend that in the near-term. But, with the ICD-10 switch in order for us to be able to effectively bill for ICD-10, we had to convert our billing system. So, really that decision became something that we knew we had to do.
University of Texas Medical Branch primarily used in-house faculty and staff for this project, why was that?
That was one way to be able to save on the total cost, and also, we felt some of our key managers and supervisors were actually so knowledgeable in what we needed to do that we would be better off having them in leadership roles for this. It turned out to be really good, because people in the organization who wanted more opportunity to do higher level work were given that opportunity. Both to do the system change, but also to be able to do some of the daily work their supervisor or manager wasn’t able to do because they were assigned a project.
How did this benefit the project compared to if you had used more outside resources?
There were many moving parts. We have about 14,000 employees, and about 7,000 of those were affected by the change, so communication was a key aspect of our project. I think what was easier was that we had people on this major IT project that really understood how our systems worked and, I think, better understood the problems we had with those systems. From a decision-making point of view they were in a better position to help guide us through that implementation.
I’m sure there were some bumps along the road. Can you talk about those and what was done to overcome them?
Yeah, one or two. We had bumps in the road. This was such a big change and we changed so many jobs and how people did their work; from the coders to the billers to the physicians to the collectors. Everyone that interacted with any of those systems had a major change. There’s always some resistance to change, and we did run into some of that. Having what we called our “guiding principal” that we developed at the beginning helped. When we ran into difficulty getting decisions made, we’d go back to those as our guidepost so we were making more consistent decisions. The resistance to the change was expected, but that’s when communication, management and the involvement of leadership come in. Not to say you pound your hand on the table, but you guide people to understand what changes are important for patients and why they were important for our patient’s experience — that was a big hurdle.
We also underestimated the change on the physicians, especially the ones who had been in practice a long time. Our residents and junior faculty not as much, because they were trained on electronic systems, and a lot more self-sufficient on an IT system. It was a bit of a challenge in trying to get them comfortable. Having a lot of people on-site, working elbow to elbow with the doctors as the system came up and when the system went live all helped to get them over that hurdle.
What kind of advice would you give to hospital leaders on approaching a large project?
We’re always faced with major projects, not just IT, but also others. I think many leader think, ‘I have everyone hired,’I have my CIO and a CMO, a COO at the head of the group practice, and they can get together and lead the change. Many times, the CEO or C-suite leaders don’t understand the amount of time they should be involved on the project from a steering perspective. It’s important for them to really understand the change and be visible, so staff knows that you’re supportive and you’re taking your time to handle the project. I also think the leaders need to be able to articulate the vision. Change is hard, so helping people understand where you’re going, why it’s important, and what the benefits of that will be is key. I always say leaders have to have a roadmap even when you don’t have a road. They have to understand who are the right people to put on this project, to provide some substantial day-to-day leadership and not just delegate that. Staff gets concerned, so I probably spent more time on the clinics in the units, during this change than on many others. The day we went live I was out on the units, kidding with people saying, “If there’s issues let me know. I probably can’t fix it, but I’ll make sure someone is there. They appreciate that you know what they’re going through, but also that you don’t know everything either.