It was a little more than three years ago when Ryan Smith was interviewing for a senior level IT position at Banner Health, the Phoenix, Ariz.-based integrated health system, one of the largest of its kind in the U.S. At that time, Smith said there was one common thread to his 12 different 1-on-1 interviews with the executive leadership team at Banner: the senior executives said that traditionally, the IT department had been difficult to work with, had its own processes, and did its own planning.
As such, Smith, who got the job and is now senior vice president of IT and CIO at Banner Health, knew there had to be more of an emphasis on aligning business and IT—a pain point across many healthcare organizations today. Smith told the story of how Banner Health has been able to create a business plus IT partnership model that has driven increased organizational success at the College of Healthcare Information Management Executives (CHIME) CIO Fall Forum at the JW Marriott Phoenix Desert Ridge Resort in Phoenix.
Smith’s presentation on Nov. 3 was in front of a packed room of healthcare leader attendees, many of whom face similar challenges as Smith did at Banner. What’s more, Smith noted that when he took the job, he was told that there wasn’t any major merger and acquisition (M&A) activity forthcoming, thus limiting the “craziness” from an IT standpoint for a new CIO. Lo and behold, within 30 days of Smith joining the health system, it closed a deal with a small community hospital, with many more academic medical centers and other hospitals being acquired since then. “It has never stopped; this week alone we announced a joined venture with Aetna, and we also acquired 32 urgent care clinics,” Smith said.
So, the job proved even more challenging than Smith imagined. Here, he pointed to three critical success factors: Banner's operating model; the business/IT partnership; and Banner's planning process. The operating model was the biggest part, Smith said. It consists of a single board of directors that governs all of Banner, meaning attentions and loyalties aren’t split up in different directions. And, there are centralized corporate functions. “It’s designed to achieve results,” Smith said. “The work has changed in healthcare, so taking out unneeded waste and cost was key for us, as well as improving patient and member experiences. There is great alignment at Banner [regarding] how we think about strategies from senior leaders and board members. And with that, comes great opportunity,” he said.
To this end, Smith said it became clear that this organization was driving and leading too many of the technology projects. “Isn't that what we do as IT leaders?” he asked rhetorically. “Not necessarily,” he answered. “We're a key stakeholder in that process, absolutely, but over the last few years at Banner, we have named a strong business champion who has partnered with an IT champion. We find the right person at the right level to be that dyad partner,” Smith explained, noting how the dyad leadership model is a strong one to solve problems that could be too big for any one individual. He compared the relationship to one Batman and Robin, with the business champion being the one to take the lead. “They are co-responsible for developing and communicating strategies, planning, and strategy execution,” he said. “This dyad model is applied to each major technology initiative.”
Smith added that whatever the case may be, a broader governance is still needed. “So we set up a business-driven IT governance structure in which the business champion typically serves as committee chairperson and the IT champion serves as the co-chair,” Smith explained. “I coach my team to let that business or clinical champion run the meeting, and be the face whenever possible. The dyad oversees the subcommittees, and it's also their responsibility to make sure key stakeholders are participating from the outset,” he said.
Putting the Operating Model into Action
Smith said the dyad model is driven by Banner's overarching operating model, and necessitates consistent, consolidated, and efficient IT services system-wide. As such, this facilitates rapid integration planning and execution processes, and allows for massive leveraging of enterprise technology investments, he said.
“So for the small community hospital we acquired, we don't have to sit down and debate every week and month how much they should look like the rest of Banner,” Smith said. “It doesn't matter what EHR (electronic health record) or network they put in, because at the end of the day, we recognize that our model requires consistency and allows us to be really fast when we think about M&A integration.” Indeed, the model: assumes ALL acquisitions will be rapidly integrated; allows for less time spent on deciding whether or not to integrate; and provides a playbook for executing all phases of IT integration efforts, he said.
The time and resources saved in this approach are invaluable, Smith added. “I don’t have to fight constantly about any organization we acquire; the debate and discussion has already occurred and agreed on up to the board level. That means we need good contracts in place and good licensing agreements, so there is a lot of homework involved. But it also allows us, from an IT perspective, to ‘Bannerize’ acquisitions quickly,” he noted.
Smith gave a few examples of this strategy being put into action on the M&A front. For one, when Banner acquired Goldfield Medical Center in Junction Ariz., the business systems and EHR were integrated 30 days post-acquisition. “And this was without ever walking into the medical center prior to the [merger],” Smith attested. Meanwhile, Casa Grande Medical Center, 20 miles south of Phoenix, had its business systems integrated over and completely done on just one single day, while the EHR integration took seven months. Smith explained that this was because Casa Grande was a Cerner customer and was progressive in Cerner's cloud and revenue cycle software, so it took time to “Bannerize” them. Finally, Payson Medical Center in Payson, Ariz., only took one day total for both its business systems and its EHR.
Smith credited these incredibly quick timeframes to Banner’s operating model. “We believe this is a very viable model. And we have advanced care management and clinical decision support processes, so while it might look vanilla, in reality, these [acquired] organizations get the best of Banner very quickly. That brings lots of intrinsic value to those sites that historically might have been underserved,” he said.
Smith was asked about getting the new clinical staff up to speed with these technology changes, to which he said Banner has a very hands-on training and shadowing staff in the weeks following the go-live. “What's key is that we need them to look like Banner quickly. Otherwise they continue to hemorrhage,” he said, adding that sometimes he can't even share with his team that Banner is acquiring a facility until 30 days before it happens. “So it can be challenging and we are scrambling at times,” he acknowledged.
Regarding data migration from older, legacy systems, Smith said there is no crisp solution to that, but the general approach is that Banner will bring forward the normal pieces from a clinical perspective, such as patients’ allergies, problems, and schedules, and migrate that data as quickly as possible so there are easy screens and processes inside Banner’s systems for when that information is needed by clinicians.
When the dyad model was set, Smith said he immediately partnered with Banner’s CMIO, who admittedly never “felt the love from IT,” so he had felt hamstrung when it came to shaping clinical IT. “But we sat down and came up with the concept of one patient/one health record, anywhere across the care continuum; being able to share data across all organizations [across Banner]; and having a single platform for patient engagement from a portal perspective,” Smith explained. “We co-engineered what that strategy looked like and we have delivered on it over the last few years.” He concluded, “Part of our success also is creating very strategic relationships with your core vendors, even if that means kicking vendors out who don't share your vision.”