We spent a little bit of time in a previous segment talking about, when you were a cardiothoracic surgeon, your interest in health information systems moving towards CPOE. Take us to 2004 and what it was like developing a vision and strategy here at Johns Hopkins then? So, it's really important in this developing the strategic vision aspect of it that, you bring together the right people in an organization that can really drive change. We were increasingly realizing that Hopkins had acquired multiple institutions. We had several hospitals and a lot more ambulatory centers. But we really had not brought those institutions together into shared information systems at all. In fact, this strategy was very deliberately, let's bring them into the Hopkins umbrella, but let them continue to be successful in the systems that they're currently using. That I think, in the early part of that era that may have made sense, but what we began to realize organizationally is that we just had to do more as an organization. In a number of years later, rolling up into 2008-2009, we really realized that we need to make a major change to bring the institution onto one system. That flowed out of lots of different perspectives, understanding market forces for healthcare transformation, understanding meaningful use compliance requirements and understanding that we had gathered, we counted 250 different systems that all had patient information in them. We were just really struggling to integrate this systems. When you talk about bringing together so many different stakeholders, who were some of your compadries? Your partners in crime, who were helping to develop that strategic vision? Frankly that's both the 0.3 from Kotter and the four, which is that you have to get people from throughout the institution. We actually had nine different working groups that span to every aspect of clinical care research and education involved in that process. Very important on the communicating, you have to build that coalition of folks and you have to work with them to do that communication. We had a series of meetings realizing that this was going to be such a big deal for the organization from a financial standpoint. So, getting the buy-in is really important to get the buy-in of all arms to the institutions so that everybody was willing to make this a top priority. At Hopkins, ideally when you're doing something really big, you want to make it the top organizational priority, that's really never the case at Hopkins. You just want to make sure it's one of the top priorities but we really had to work hard to get the right people and to get the buy-in to come together. Yeah. That's no small task and certainly was years-long effort. Now, your role as the clinical liaison at times between the clinicians and the technology folks, can you speak a bit about what it's like to sometimes be the bearer of the message? The one that's communicating that vision and trying to keep both parties up to speed? Yeah. So, it's a really important exercise that people, and it's one that we take them through in this course of developing with that case is and what that pitches in terms of communicating. But I come back to the point that we made it the introduction to this course that, it's tremendously important to be authentic in this process. If you get distracted by issues that aren't important or you get distracted by the technology and you aren't focused on, and this is the other aspect being empathetic to the end users, If you can't express why we need to do this and why it will be valuable, you'll lose the audience quickly. They're always competing projects and resources. It was fascinating that everybody realized that we needed to change but there was a lot of organizational skepticism that we could come together and make that change. So, a lot of part of it was being able to provide perspective from both the clinical and workflow and clinical need perspective but also from the what's possible from an IT standpoint. So, put the communication it was how do those things come together. Yeah. I think you bring up a good point there Peter. In communicating the change vision, it's such a complex plays to tertiary medical center where there's so many disparate workflows. Can you talk a little bit about the competing priorities and how there's different departments that each have different nuanced workflows. It's not a one size fits all, that had to be a challenge from a clinical stand point. It is. One of the things that we talked about doing was, we talked about harmonizing and we chose that term rather than standardizing because if you overemphasize standardizing, I think that, we found at least here, that notion was a little bit off putting to folks. But the idea that they didn't have to have the same note but they had to come together with the same note, I think was seen as much more valuable. But really important to that, this is really getting into the design of the system. We develop some criteria where it was not going to be possible to harmonize and what were the reasons where, we should not be trying to harmonize. That was the case where there was truly a difference in the patients that we were taking care of or number two, a true difference in who is taking care of those patients. There are parts of the Hopkins health system that had no resonance at all and other parts that did and you really had to redesign and be distinctly different. Then, thirdly, if there were just insurmountable resource constraints, then we said we're not going to push to harmonize because, if you overdo it, then you end up trying to get too much done and you'll get push-back on the system. So, those three criteria were echoed back inside the design groups and it was really important that people be able to identify what was real and they challenged one another to say, ''Hey, the patients aren't really different or the providers are different or could you overcome that resource issue, couldn't you redo your current by-laws or your current policy to make sure that you can't be aligned.'' I think those are some great points in developing a strategic plan, developing the vision and communicating that vision are two important steps in organizational change. So, thanks for highlighting some of those stories. I would advise as the students go through this section. The way I use Cotter during, especially at the start, but during a big project, go back, reread it, and reflect on it. It's not something that you can just memorize but reflect on it and try to get your guiding coalition. The folks that are there that you've formed is a part of that to also use some of those same think through some of the same steps with you. That can be really valuable. You can't read this thing. You can't read and reflect on it on and off.
