You've not only been physician champion Peter but you've of course worked with many. Can you speak a bit to the important role that they play in large-scale change? They're just enormously important for health IT system roll outs and maybe the first thing to touch on is, who do you want as champion? It really fits perfectly with this course because most importantly what you're looking for is someone who has leadership potential, it might be that you can't get the existing leaders. Because they may be too busy to do what's required to really be the champion, but what I look for is emerging leadership potential and I don't necessarily look for people that are the most technically fluent or are highly trained on the informatics side, you really want folks that are going to be able to explain how to use the system to regular users and some of the people who are well-known to be information technology advocates. Sometimes, they can get written off because they it's easy for them and they love to show what they're able to do and that's really not what you want. What you want is someone that can make the system easier to use for everyone, and so that's the most important thing that you look for. Then in coaching them what I tried to do is explain that it's going to be very important that you are able to stand up in front of your colleagues and say we've thought about how the system can and should be used, and here's how we can use it to take better care of our patients. You're not just in the design stage, you're going to be with us as a champion through this process all the way through getting it adopted. As you do this well, because you're going to do it well, as you do it well, your leadership potential is going to be recognized and I can't tell you how many people who had been champions in IT system projects, have gone on to be division directors, department directors, chief medical officers, etc, because they realized that those people were good at leading the change process. Yes, it's really been exciting to see the tentacles being spread wide around the country and there's individuals who led that change here, lots of blood sweat and tears, and have gone on to do great things here as well as other institutions. When you were talking about how important it is to have individuals, be the spokesperson within their particular division or department, it takes a certain amount of humility I think. Right? You talk about empathy. But one has to have humility that they're not the subject matter expert in each clinical domain. One can be a clinician, one can be an expert with the data and the information, but when it comes to obstetrics and gynecology, when it comes to the workflow in the liver transplant hematology, having the boots on the ground, experts, is not only important from them knowing the nuanced workflows but them being able to communicate that change vision to the individuals and that really helps with adoption and decreasing resistance to change. It absolutely does and it's not just that the different perspectives from a specially standpoints, the multiple disciplines as well. So, that's a very important aspect that we also coached the physician champions on is to recognize that they're going to get nothing done, if they don't understand how to work with nurses and pharmacists and other disciplines in the process. So, what we try to do is define a process whereby we've got a good governance process and I think that's another critical aspect of this as well, and I had a map as we rolled out our EHR, epic EHR system. I had a map that I used over and over again that had all the governance boxes on it and it was a bit overwhelming to look at. But it was really important that you define where the decisions we're going to get made and if they couldn't make decisions timely, what the escalation process going to be. The map ended up being a getting a lot of questions and a lot of concern because folks thought, and I had to say over and over again, this is not a reorganization of Johns Hopkins. We're not changing who people are reporting to, we're not changing the structure of legal entities that are all a part of Hopkins, but this is the decision-making process that we're using and everyone got more comfortable once they saw that. Then it was also great because within each group that was making the decisions, it was very important that they understood that if they couldn't be timely and decisive and get consensus, then it would get escalated up and everyone discovered quickly that they didn't want things escalated. So, they wanted to keep moving with the process of making decisions. Yes, I think you know if you had a dollar for every time you had to say this is not an org chart, this is a governance structure. I want you to reflect back a bit at the time of rolling out the current enterprise-wide electronic medical record system when it came to all of the different committees and meetings, can you speak a bit to how the cadence of your schedule has changed? Were you finding yourself being a part of so many more meetings and now you're able to pull back and let some of the committees, when on their own when it comes to decision support or user design? Yes, point from my perspective you're exactly right. I was used to in smaller deployments being sort of able to sit in on every critical meeting myself. I had developed sort of a comfort of doing it myself. I'll make the analogy to cardiac surgery where you spend nine years training and you get to the point where you're comfortable doing an operation and then July 1st, you switch to being an attendant and you now have to train people to do that. So, I had to learn that as well and the informatics side and realize that, what I really have to get setup is the effective, efficient governance process and Hopkins used to be in this mode where everybody felt like they had to be in every room. This wasn't just me, as everybody felt like they had to be there. You'd call a meeting to do design and and 50 people wanted to be on the invite list or even be present and what you have to get the organization comfortable with is say hey, we can trust each other, we're going to make decisions, we're going to communicate those decisions and we're going to get the right people there, not everyone, but we're going to get the right people to have a representation. So, that's really important at this phase of the process. Is that concern in the early going but it's just not sustainable to be a part of everything. It's a fantastic now to sit in on it, ambulatory, decision support committee meeting where things are really running like clockwork. They're empowered. It's back to this empower notion. So, if you don't get that set up and the group, the only thing you can have as groups meeting and there is no recognition that they're meeting. So, it's really important to sort of track what the scope is? What's being done? How they're working? And along the lines of governance in clinical decision support the students will be hearing from Aimee Knight, who is a hospitalist at Baby Medical Center and a board certified clinical informaticist. Talking about you know governance and clinical decision support with the case study, what I want to pivot to right now actually Peter, is step six, the concept of generating short-term wins. I think we were getting there in some ways. Let's go back to the time of implementation, you talked about harmonization and sort of the phased roll out. Can you speak a bit to the early success of certain go lives and how that really helped to generate the short-term wins? Absolutely. So, I think even before you go live, the way you demonstrate those wins, are you want to celebrate people that have been able to get together and harmonize and get something built. So, the way you show those wins, this is even before you've gone into clinical production with the system, is that you in the design meetings you have you show things and this is everybody who's worked with me has heard me say this over and over again, show the system, show how it works and you might have IT builders that they live in the system every day but the clinicians don't. It's really important to show how the system works, let everyone have a shared understanding and that becomes a win, every one of those becomes a win. It becomes a win if you get a clinical agreement, that hey we had multiple clinics that were doing monitoring any coagulation and they all had their own set way of doing it and it made no sense for us to build different ways for those clinics. But they were able to come together and agree that hey we could we could adopt this process and then were able to show the system actually running. So that really helps during the design phase. Then to your point, as you get the system actually running clinically and in production successfully, the clinicians and others who got that running then become unbelievably valuable champions, and they've had wins. So, you want to think about where you could be successful early on, and we very deliberately pick some of our roll out strategy to make sure that we were going to have some of those early wins that could be shared with the rest of the group. Then by the time you get to more complex environments, you've built some organizational confidence that you're going to be able to execute on. Yes, as you move from that planning phase to the operations phase though, I'm sure even with forms of organizational change that you're leading today, it can sometimes be easy to go on autopilot and forget that step. So, it's great that you make a point of patting people on the back and having them feel that success, because otherwise people are jumping from meeting to meeting, not getting lauded and sometimes end up getting, dealing with the negative feedback or the areas that need to be changed. It is so important and it's useful for if you're in a position of running the meeting or if you're a critical participant. It is worth recapping some successes especially if you know you're leading into a meeting where you've got some difficult issues that you have to tackle. It's really important to just quickly say hey you know what, here's what we have gotten drawn this sort of build the confidence of the group and that's a very important framing. Yes. Great.
