One CIO recently described the pandemic as his organization’s chief innovation officer because it has spurred so much change. Geisinger Health System has a real chief innovation officer in Karen Murphy, R.N. She said one silver lining of this awful season is that it has given Geisinger the opportunity to re-examine its operations and reconsider what the organization will look like post-crisis.
Murphy was speaking Aug. 6 during a webinar hosted by the Harvard Business Review, along with Jaewon Ryu, M.D., Geisinger’s CEO, and Jonathan Slotkin, M.D., associate chief medical informatics officer.
Geisinger has a reputation for innovation, despite being a large organization with 11 hospitals across northern and central Pennsylvania. It also operates its own insurance plan with 550,000 covered individuals. Ryu began by describing Geisinger’s experience of the pandemic. Like other health systems, in early March it postponed elective procedures and visits. It saw spikes of COVID cases through April and into May, then a decline. However, since a nadir on July 22, they have seen some early indicators of upticks. “As we reintroduce services, we want to learn from some of the agile and flexible rapid change that was required to respond to the pandemic and infuse it into our day-to-day activities,” he said.
As an example, as Geisinger postponed much non-urgent care, it saw increased needs in other areas such as ICUs, emergency departments and screening tents. “We had to take people from areas where work had dwindled and reassign them to areas where it was feverish,” Ryu said. The organization reassigned approximately 2,000 employees to COVID-related work, and increased virtual visits 100-fold. “We were hard at work getting care into the home prior to COVID, and we were able to double down on that with telehealth and remote monitoring and mail-order pharmacy so people can get medications for chronic diseases without leaving their homes,” Ryu explained. “Almost immediately, Karen Murphy started doing post-crisis planning, so that how we reacted would set the stage for how we would shift gears.”
Slotkin said there is a natural desire to get back to the way things were before the pandemic, but Geisinger executives knew they should aim higher. “We do not want it to look like our world before COVID,” he said. “We knew that a new better reality for patients and the community would require accelerating the positive transformation and determining which things we had stopped not to resume.”
For its post-crisis planning, Geisinger convened weekly meetings with work groups focused on 11 core areas of its business. Each group deliberately included people who work outside that area to offer fresh perspectives. They carefully considered the impact of work on patients and front-line employees. The groups reviewed existing functions, and activities stopped and started since COVID, and made recommendations whether to start, stop or continue them. These activities were placed in a prioritization matrix with some labeled high-impact, low effort, for instance. The teams are identifying opportunities and risks and actions that need to be taken.
Murphy described the post-crisis planning in a series of stages — the first being the return of nonurgent work. More than 6,000 surgical cases had to be rescheduled. Geisinger used risk stratification tools to prioritize which patients to bring in first. It also has worked to expand its internal testing capacity for COVID and embarked upon a contact-tracing effort.
Murphy said that although Geisinger already practices lean principles, it is a complex organization with 35,000 people working on 11 far-flung campuses. The COVID response taught the organization that they could move faster and be better at collaboration, and it is making a commitment to continue that by looking at the culture and taking down silos. “We are eliminating some standing meetings, re-evaluating operating room block scheduling, and leveraging virtual meetings more.”
Geisinger is revamping its clinic footprint, she added. It closed many clinics for COVID, and some they have decided will not re-open. The system is restructuring primary care to include supportive specialty services.
During the height of the pandemic, she said, many employees who were redeployed expressed satisfaction with working in new areas, so Geisinger is looking to create a permanent floater position called “Super support person” to rotate from pharmacy tech to environmental services, etc. “We may take that principle and apply it up to professional level, because it provides a broader perspective on understanding the organization,” she said.
Both Murphy and Ryu stressed that Geisinger’s participation in value-based care models allowed the organization to pivot and provide needed services without having to worry about fee-for-service reimbursement. “We did the right thing to meet the demands of the community,” Murphy said. “We will continue to advocate that all payers move to value-based payment.”
Ryu said a silver lining of the pandemic is that it has proved Geisinger can fundamentally transform quickly and that innovation is critical to success. “Digital transformation must be a strategic priority and moving care closer to the patient is critical,” he said. It has reinforced our belief in building clinical programs closer to communities and to make healthcare easier. It obviates the need for people coming in for in-person visits and allows us to still manage their care.”
