This Week in Health IT
September 18, 2020

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September 11, 2020: What does it take to pave a path to success as a healthcare CIO? Lee Milligan, CIO for Asante Health shows us the lay of the land. It’s critically important to understand the clinical space, understand the workflows and really view the technology, from the inside out. What does your team need from you as their leader? What kind of operational challenges will you face? How can you get honest feedback? What should you focus on in order to build a strong framework?

Key Points:

  • Create a plan with the right people involved [00:06:15]
  • Hire a coach. Get feedback from your team and your peers. [00:10:25] 
  • It’s critical to develop relationships and part of that is understanding that you’re open to feedback [00:12:10] 
  • Reviewing contracts. Do we even need it? Are we calculating it correctly? Does the software overlap with anything else moving forward? [00:17:20] 
  • Doing an IT budget for the first time [00:19:10] 
  • How does the CIO actually take a two week vacation? [00:24:50] 
  • How do you manage people working from home? [00:34:00] 
  • Recognize your limitations [00:38:15]

Paving a Path to Success as a Healthcare CIO

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Paving a Path to Success as a Healthcare CIO with Lee Milligan, MD

Episode 302: Transcript – September 11, 2020

This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.

[00:00:00] Bill Russell: [00:00:00] Before we get started. I want to share with you something that we are extremely excited about here at This Week in Health IT and that is clip notes. Clip notes is the fastest growing email lists that we’ve ever put together. if you can’t listen to every show, but you want to know who was on and what was said, the best thing to do is to sign up for clip notes.

[00:00:17] One paragraph summary, key moments in bullet point format with timestamps and one to four video clips from the show. It’s a great way for you to stay current, share insights with your team and maintain your commitment to their development. During these [00:00:30] extraordinary times, the best way to sign up. The easiest way to sign up is just send an email to clip notes.

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[00:00:55] Welcome to This Week in Health IT. My name is Bill Russell, healthcare, CIO, coach, and creator of This Week in [00:01:00] Health IT a set of podcasts, videos and collaboration events, dedicated to developing the next generation of health leaders. This episode and every episode, since we started the COVID-19 series has been sponsored by Sirius Healthcare.  Now  we’ve exited that series, but Sirius has stepped up to be a weekly sponsor of the show through the end of the year. Special thanks to Sirius for supporting the show’s efforts to develop the next generation of health leaders are we’re going to do an episode that I’ve wanted todo for a long time. And I’m titling this episode, paving a path to success as a healthcare CIO. [00:01:30] And I’m talking to a really good friend of mine, someone full disclosure, someone who is a coaching client, and we’ve gotten to know each other really well. Former guest of the show and someone who has really been in this role probably for about, I think about 18, 19 months now.

[00:01:46] And, so we’re going to take a journey across the start, the whole thing, becoming a CIO, and then what it’s been since. So Lee Milligan CIO for Asante Health is with us. Good morning, Lee. How’s it going? 

[00:02:00] [00:02:00] Lee Milligan, MD: [00:02:00] Good afternoon. from Oregon. Nice to see you Bill. 

[00:02:03] Bill Russell: [00:02:03] Yeah, that’s the good afternoon, good morning thing is as always.

[00:02:08] Yeah in a podcast. I really shouldn’t do that anymore because people listen to it when they listen to it for the most part. 

[00:02:13] Lee Milligan, MD: [00:02:13] Just say hello. Hello. 

[00:02:15] Bill Russell: [00:02:15] Hello Lee. How’s it going? I’m looking forward to this conversation and because I think your story is an interesting one. even from the point of how you became the CIO and then, some of the things that you went through but let’s just, let’s start from the [00:02:30] beginning. Give us a little background on how you came to be the CIO for a Asante. 

[00:02:35]Lee Milligan, MD: [00:02:35] Sure. I came out of residency as an ER doc back in, 2000 and landed in Southern Oregon. Primarily, I wanted to be in a place where, my wife and I could raise kids, outside of the craziness of LA, we’d been in LA, at UCLA in there at the Harbor campus, which is in a rough area, for, the last few years doing residency and really wanting to find a space where we could spread our wings a little bit and raise our [00:03:00] kids.

[00:03:00] And so we looked around a few options, landed in Oregon. And at that time I always knew I wanted to go into technology on some level. But I also recognized that it was critically important to, understand the clinical space and develop competence sees as not just an intern, a resident, but as a practicing physician and developing those relationships, understanding the workflows and really viewing technology, from the inside out. As the end user of that technology. 

[00:03:28] And so I did that for quite a while. [00:03:30] It was eight, nine years or so. and then at that point I decided to go back to school to pursue computer science. And, my wife was like, wait, what’s going on here? And so we had good conversations about what made sense, and she was very supportive to her credit.

[00:03:44] And as I did that, our system was going from paper to electronic health record. And we ultimately selected Epic. I got involved in that and essentially became an informaticist before. That was even really a term around here. And, that was a great experience. So [00:04:00] as I did that, I learned a lot about how, how older folk and a physician think and internalize new information, the concept of anchoring new concepts to old concepts and identifying what things stick and what things don’t stick.

[00:04:14]I’ve affectionately referred to it as a handyman combat with the docs in terms of getting them from paper to electronic health record. But I learned a ton about our internal system for our docs in terms of how they think and what are, what the social relationships [00:04:30] are here. As it relates to technology.

[00:04:32] And I learned a lot about how, how folks do new things and how new things stick or don’t stick. So that was a great experience. And in the midst of all that, the former CIO decided to send a couple of docs back to Epic to do the physician builder thing. And that’s essentially where the doc learns to, build as if they were an Epic analyst and they are given, access to production and other environments to build things out, to have hopefully good ideas, create them and then put them into production.

[00:05:00] [00:05:00] And I did that for a long time. as a, as a pseudo analyst and working with the analysts, learn a lot about change management, the change process, how you can break production by not being very thorough and completing your thought process. and then after doing that for awhile, I was asked to serve as, the CMIO.

[00:05:17]they first called it medical director of informatics, but eventually switched to CMIO. And that was really about getting the whole system to a better spot. And I really began focusing on, training and education, as well as [00:05:30] trying to understand where we can have better governance as it relates to getting the input from docs associated with the electronic health record, and then as that one on, my then CIO asked me to leave our efforts to revamp analytics and that’s a whole story in and of itself. But, I work with my team. We have some really gifted people here at Asante, Michael Olson. who’s now a director o f  Analytics for Asante as well as innovation for us, Dante, Mark Stockwell, somebody who has led our data [00:06:00] governance efforts, the three of us really got together and work through how are we going to recraft analytics associated with Asante.

[00:06:08] That was awesome. Experience a learning experience about, deep diving and understanding the problem, creating a plan with the right people involved. Presenting that plan to the executive team and getting their input and buy in and support eventually executing on that plan. Hopefully a better experience for the end users.

[00:06:25] Midst of all of that, I was asked to take on health information services. [00:06:30] And so here’s where it gets a little bit atypical. HIS or medical records, isn’t usually within the tent of its, but in this case, I guess it was, and I was asked to have them report to me and as CIO, it was a great experience because I had a number of cost centers associated with, with my position, including the Fisher builder cost center and the analytics cost center.

[00:06:50] And then they were adding on top of that, a fairly large cost center in HIS, that was a great experience, learning about it, budgeting and planning and strategy and accounting associated with [00:07:00] that. And that went on for a few years. And then almost two years ago, now I was asked to step in as CIO and now take on the rest of IT.

[00:07:08]And I’m really grateful to my team because they really rallied to help me be successful in those first few months while I was trying to get up to speed. 

[00:07:16] Bill Russell: [00:07:16] So basically with that background, you had it wired. You were pretty confident going into the CIO role that you I’m just kidding by the way.

[00:07:24] I f  people want to hear about your antelope sturdy. We [00:07:30] actually did an episode, back when you were a CMIO and we focused in significantly on the analytics journey and what you guys had done. It. There’s a lot of great content in that.  Alright so they say to you, hey, we would like you to step in as CIO what’s what can, you have the cost center experience. You’ve you’ve got physician builder. You’ve worked with a lot of physicians. You’ve been there for a long time. You got a lot of history. A good relationship. They’re asking you to be the CIO.

[00:07:57] So good relationship with management. do you [00:08:00] have any concerns walking into it or, doubts, 

[00:08:02]Lee Milligan, MD: [00:08:02] yes. in a word, I will say that, one of the things that worked out really well. Is that, if you can step back and do some sort critical self reflection and be honest with yourself, including identifying other folks who can weigh in, including yourself, you’ll recall, what do I bring, what do I not bring asking your, your executive peers, asking the people who report to you.

[00:08:25] Those are hard things to do. but getting that level of feedback, is [00:08:30] critical to identify where you should focus your time. So for me, I talked about this previously for me, typically I focused in, on things like security, cause I hadn’t had a ton of exposure to security and I recognize how critical it was to understand that.

[00:08:44] And to be a good steward of that piece of, of it, is some of the technical pieces, focused on some of our infrastructure pieces. And I actually set up a framework with, my technical, services director to have folks from each of those areas come in [00:09:00] and present every other month to me around the work that they’re doing.

[00:09:03] So can I can have a clear understanding of what that body of work looks like. And I can ask good questions in a focused environment, specifically, focusing on things like security and servers and all the stuff that I hadn’t had a significant exposure to previously. 

[00:09:19] Bill Russell: [00:09:19] So you, you saw it as a requirement of the job to really understand the technology and the technology platforms.

[00:09:26] I it’s interesting. Cause I recently saw a picture of you. [00:09:30] you’re getting your, CSO certification from CHIME. is that all part of it that you want to have that underlying technology background so that you can. Being a more effective leader in those areas. 

[00:09:42] Lee Milligan, MD: [00:09:42] Yeah, I think that’s fair to say, prior to this role, I worked on getting a board certified in clinical informatics, thinking that was going to be my role all moving forward.

[00:09:50] And that was a great experience. I learned a ton. Yeah. And no matter where you are, it’s helpful. I think to have kind of a broad academic experience that allows you to see [00:10:00] everything within that domain. And so I had a good experience with that. And so I pursued that, finished that up, after becoming CIO, I focused on the CHC IO certification with chime, which was a positive experience, learned a lot and then afterwards, now pursuing and the CSO certification as well. And, so far so good. 

[00:10:17] Bill Russell: [00:10:17] Yeah, Lee, somebody has gotta be listening to this saying why did you even hire a coach? It sounds like you, you have the certifications, you had the background, you have the support of leadership.

[00:10:26] Why would you even consider hiring a coach? 

[00:10:30] [00:10:29] Lee Milligan, MD: [00:10:29] So the coaching piece to me was critical out of the gate. And when I came into my position that the day that I was asked to come into my position, my CEO, that was his first day on the job. And so we were in that interesting space where we’re both looking at this brand new opportunity.

[00:10:47] And I was, I have a good relationship with him. And I think because of that, I was able to ask him for a couple of things that I think would be really helpful moving forward. the first was around a financial. A financial person who can [00:11:00] help me focus on our budget, our planning, and our, our analysis of our, how our spend is going.

[00:11:06] And that’s been really helpful. And then the second was the idea of having a coach. And in my mind, the idea of having a coach is just. it’s a no brainer, right? I think about, Tom Brady, he, amazing player, you may like him, you may hate him, but amazing player, no doubt. but he wouldn’t think of going on a field without a coach.

[00:11:23]He’s got Bellacheck, he’s got a quarterback coach, whatever it might be. In fact, I would say that the idea of a coach should go [00:11:30] beyond, the idea of technology. I think physicians should have a coach. we have coaching in place through medical school, internship and residency, and somehow magically, when we graduate from residency, we no longer need a coach for the next 40 years.

[00:11:44] And even until Gawad has talked about this, previously, the concept of having somebody who can give you good feedback can be objective, can tell you things. You may not want to hear in a way that you want to hear it, that’s critical. And so I think, the idea of having a coach for me is a no [00:12:00] brainer.

[00:12:01] Bill Russell: [00:12:01] Yeah, it’s interesting. one of the first things we did is, we needed to get feedback, right? So we needed to get feedback from your team. We need to get feedback from your peers of how is health it going and where could we do better and what expectations they have of the CIO’s.

[00:12:17]And so back in the day, I flew up there with those people, gather that information and gave it back to, what were just to give people a lay of the land? What were some of the things as you came in that people were [00:12:30] looking for from IT and looking for, from you as a leader? 

[00:12:33] Lee Milligan, MD: [00:12:33] So I do want to, focus on, or I want to separate my team versus others.

[00:12:39] So it is an interesting thing to do is to ask your team for critical feedback on how you’re doing as a leader. And I remember having a conversation with our head of HR around this topic. And, there is a kind of an anonymous way you can do that within our system, but not, it’s not very appointed and it doesn’t really give, [00:13:00] Always very specific feedback, to the leader.

[00:13:02] So what we were proposing was really the next generation of getting feedback. And I’ll tell you, it made sense to do it, but after we made the decision to do it and you were on your way up here, I was like, wait, what are we doing? Are we doing it again now? What’s this going to look like exactly?

[00:13:20] So there’s that piece. And then getting feedback from others who you intersect with about, the kind of job you’re doing, equally, challenging, I think too. Yeah. To get that feedback, but I [00:13:30] also think it’s critical to, to develop it, the relationships with folks and part of that relationship is built by them, understanding that you’re open to that feedback.

[00:13:39] And you know what? I look back on our experience doing this. I recall there being a long list of things to talk about. I also recall you taking that long list and distilling it down to some digestible pieces and to have some bounded goals over the course of the next year, that corresponded to that feedback.

[00:13:57] And that piece was really helpful. 

[00:13:59]Bill Russell: [00:13:59] One of the [00:14:00] mistakes of being a coach is that part of being a coach is being a cheerleader, but one of the mistakes is that’s all you are. And the, one of the things that was interesting about that process is  it also forms a baseline, right?

[00:14:13] So we interview your team. We interview the, and get the expectations of the organization. we then do that every year. So coming back the next year and doing it and having the conversations, we’re able to say, okay, Have we made progress. These are the things we were looking at, and there’s a lot of [00:14:30] things that you get measured on as a CIO.

[00:14:33]but it’s interesting, the things that people will give feedback anonymously to a third party that, that you might not get in a, in a standard scorecard or those kinds of things. and so it was interesting. It was really interesting to see. what had transpired in the culture of the organization?

[00:14:51] What had transpired in the perception of it as you moved into that role? 

[00:14:57] Lee Milligan, MD: [00:14:57] I take, say to your, sorry, just to your point [00:15:00] there, Bill, when I finished my discussions with, my, my reports, and others, I always end, essentially the same way I asked what can I do for them?

[00:15:10] In the next month. Or some time frame. And then I ask, is there anything I should be doing different from your perspective? And, it’s an uncomfortable position people to be in to think about that and then, and actually give that feedback. If it’s really being honest right there in the moment.

[00:15:26] And I infrequently get feedback, there’s usually one [00:15:30] individual who gives me a pretty honest feedback in the moment, but for the most part, it’s a hard thing to do when you came in. I think they had the capacity to, to give that feedback. And it was a longer period of time to think about it a little bit.

[00:15:42]and it was not, they were looking at their boss, They were looking at you guys have developed some rapport and had a conversation and they could share that with you, which I think was healthy. 

[00:15:52] Bill Russell: [00:15:52] Yeah. So let’s talk about it. So we, so I introduced the framework and we talked about a bunch of different things, but I wanna walk through some of those things around the framework.

[00:16:00] [00:15:59] So finance, operations strategy and people, What kind of challenges did you face in the area of operations as a new CIO? did you feel like you walked into that and really understood it operations or was that one of the areas where you, needed to come up to speed a little bit more? 

[00:16:16]Lee Milligan, MD: [00:16:16] Part of it is I had come up to speed for sure. The other part of it was that, my predecessor had been here for 24 years and, the process had been put in place, worked for, I think an individual who’d been here for a long time. There was a lot of. undocumented [00:16:30] processes by which things happen. And it simply worked because, he and that team had been here a long time, but for a new person coming in, you’re looking for documentation.

[00:16:39] You’re looking for pathways, you’re looking for the structure and the process workflow associated with it. And so I can give you, I can give you one financial, example if that’s okay. our process for tracking tracks, was a bit disjointed. And, it might simple, ER, doc brain.

[00:16:55] I was like, alright, I need one spot where all of my [00:17:00] ITS specific contracts are located. I need to be able to go through that and be clear that it is, it is complete. It is up to date. And then the last piece that we added this year is the concept of having specific financial questions added to this, this central location for all of our contracts.

[00:17:19] So when we review the contracts, when they come up for renewal, We have the capacity to ask good, basic questions about whether we even need it, whether we’re calculating it correctly. Does the software [00:17:30] overlap with anything else moving forward? These are questions that I actually stole from Will Leader, CIO of PeaceHealth.

[00:17:38]He posted this a few times in the past and he and I have had conversations about this. but it was really influential to me when I saw questions he was asking, and he’d been doing this for a long time. Cause and so we incorporated that. So now we have a single location with all of our contracts.

[00:17:53] We’d renew it. and we, as we renew it, we look at these nine financial questions that we ask every time. and we’ve caught a few [00:18:00] things and it’s all in one place and it triggers four months before it expires. So now I have confidence in my team is doing the right work at the right time.

[00:18:08] So for example, if we don’t want to redo, we have enough lead time to be able to negotiate, with the vendor around that versus that last minute, hurry up scenario that can frequently happen. So that’s just one example. 

[00:18:21] Bill Russell: [00:18:21] Yeah. And that’s a great example. I actually, I had a similar story when I was CIO.

[00:18:25] Just asking those questions. When you come in, like where are the contracts? It’s which one? [00:18:30] And some of them were in IT. Some of them were in finance. Some of them were other places. Some of them were at the hospital and you’re like, Whoa, how do we, how did, first of all, how did we get here?

[00:18:40] And I don’t, I almost don’t care how we got here. how do we bring it all in? We didn’t, there’s a lot of contracts that I would get an email. and you may have had this same experience. you just get an email and somebody says, Hey, you have 30 days to renew your contract. You’d be like, We can’t live like this. was the feeling, 

[00:18:57] Lee Milligan, MD: [00:18:57] it’s very reactionary, Versus, having, being [00:19:00] proactive and having time to think through it and have, a polished response. 

[00:19:04] Bill Russell: [00:19:04] Yeah. And we could probably go into each of these specifically, but, let’s talk a little bit about your financial journey.

[00:19:09] The first time you have to do an IT budgets. There’s a lot of, generally there’s a lot of learning that goes on in people’s minds. no matter where you sit within health within healthcare, if you’re not in it, and you’re looking at the health, their budget, healthcare it budget, you generally thinkwe send them a lot of money. A lot of people [00:19:30] think too much money. I’m not sure what we get in return. So there’s this lack of transparency and whatnot. So now you get behind the curtain and now you’re the person who’s on the other side of the curtain. what were some of the learnings as you went to the other side of the curtain and had to deal with the budget for the first time?

[00:19:47] Lee Milligan, MD: [00:19:47] Yeah, the budget I would say was the second most important thing I wanted to focus on. We talked about out of the gate, that kind of the things that we’ve identified that, I do well versus where I need some additional polishing budget was one of the two things [00:20:00] besides security. And so I spent as, a ton of time reading and learning and talking to people across the country.

[00:20:07]When I first came into the role. I was fortunate enough to be able to speak to a variety of CEOs across the country. Ed Marks, John Halamka a whole bunch of people who were kind enough to share, their experiences with me and give me some advice and some guidance, a lot of it focused on finance and I got a lot of good ideas about how I can improve my thinking around that.

[00:20:26] So I focused on that, as I said before, I brought somebody on board. Who [00:20:30] I intersect with a once or twice a week. And so we’re constantly in contact and talking through issues as they have it. I sat down with our director of finance and went through our current process for budgeting and tracking and all that jazz stuff I’d used before, but I need to take it to the next level.

[00:20:46] And I need to look at it from a roll-up perspective as CIO and really try to understand it. And so all those things came together. But having said that the very first time you do a budget as CIO, it [00:21:00] is a, nearly overwhelming experience because you have so many light items and so many things going on that it’s so complex that the only way to survive it, in my opinion, is be able to take all that information and then translate that into a story.

[00:21:15] And that story that you’re able to develop is what you’ll use when you’re in meetings with your CFO, with the other executives or your CEO, when the discussion is just like you said, wow, we send you guys a lot of money and I don’t know what happens with it. [00:21:30] So to that end, some of the things that I did out of the gate was I asked our financial folks to give me the info on the last five years, going back for its what is our spend?

[00:21:42] Over the operational spend. And we were coming in around 4.8 or 4.9% a total. Now, mind you, our its framework here is a little different than most. We have medical records. We have training, we have biomedical engineering. So we have a lot of stuff that may not be typical for most places, but we’re coming at a [00:22:00] 4.9 or 4.8%.

[00:22:01] I also reached out to Scottsdale Institute and Epic to benchmark. So I want to know, okay, where are we shaking out over time and how are we benchmarking against a comparable, community based health systems? And so that was really helpful cause it got my head around. Okay. Here’s where we are.

[00:22:18] Here’s how we compare. And here’s the trend associated with that. Okay. With that information. I shared that with my directors and my managers, and we talk through how we can make improvements in that spend moving forward. There [00:22:30] were a number of specific areas that we identified that we could work on everything from being more detailed in our scrutiny of some of our bills to identifying overlap of services that we were taking. And I will share with you that, we went on that 4.8 to 4.9% for five years. Last year, we came in at 4.1% and I think that was really essentially due to the team being I’m, smart about critically. You’ve got, Oh, you’re waiting how the spend is going to be [00:23:00] spent. 

[00:23:02] Bill Russell: [00:23:02] Yeah. that’s interesting. So compare and contrast first year dointhe budget to second year, doing the budget. I have. We have you gone through the second year completely yet? 

[00:23:12] Lee Milligan, MD: [00:23:12] We’re almost done, It’s October 1st deadline.

[00:23:15] So we’re almost done a few last minute tweaks here and there, but we’re almost done. 

[00:23:19] Bill Russell: [00:23:19] So yeah. Compare those two. 

[00:23:22] Lee Milligan, MD: [00:23:22] Yeah. So  night and day. first I, the processes have been put in place. one of the things that I wanted to have [00:23:30] in place, to, support what I was saying before around telling a story is I really wanted to be able to separate out our spend, based on categories, a very big category.

[00:23:40]What are we already spending? And what’s new. And of what we’re spending, which one is an operational imperative and which one is an operational option, same thing for what’s new. and one of the things that I think operational folks don’t always realize is what a capital project comes through.

[00:23:58] And it goes through your PMO [00:24:00] process and it gets approved. There’s nearly always an ongoing operational OPEX spend associated with that. And so being able to specifically call out and highlight. The additional costs allocated to its that came from their decisions about what to put into the system, helps paint that picture and tell that story.

[00:24:21] Bill Russell: [00:24:21] Yeah. That’s interesting. So talk to me, a little bit about the I’m trying to figure out which way I want to take this. [00:24:30] So you’re in the role. and one of the things that I’ve talked to you about is just the, the fact that I put on almost 25, 30 pounds in my first year as CIO within healthcare.

[00:24:41] So I’d been in those kinds of roles in other industries, but when I came in healthcare, I put on all that weight, but you just went on a two week vacation. How do you, how does the CIO actually take a two week vacation? 

[00:24:54] Lee Milligan, MD: [00:24:54] Yeah. Great question. So I hadn’t taken a really, any significant vacation for [00:25:00] almost two years.

[00:25:00] So let’s start with that. and, traditionally I hadn’t been taking long vacations prior to my dad when I was growing up, my dad would take a month off. And, he, in a different scenario, he was a cookie salesman for Nabisco. And so it’s a different scenario, but they still had to meet their margin and they still had to meet their, their sales goals, et cetera.

[00:25:18] And as I was thinking through that, I thought, my kids really deserve and I deserve my wife deserves focus time or making really, Yeah, peel away the layers and really be able to connect on a traditional [00:25:30] vacation. And so I had a conversation with my CEO who was very supportive and, we decided to move forward.

[00:25:35] Having said that I was concerned initially about how things were going to play out during that time. I did meet with my team to talk through that a little bit. and we developed a framework for decision making while I’m gone. And it really boiled down to this. We have a daily standup now where all of the directors.

[00:25:51] Get together on a daily basis to very crisp process that is now in place. Thanks to COVID by the way. And they bring forth [00:26:00] problems. They bring forward decisions. they bring forth, things that are happening that will impact, multiple domains. So we’ll cross one director’s domain to another director’s domain.

[00:26:09] And so we talked through that and we talked through the process by which they’re going to make decisions on something they otherwise would have brought to me. And they were pretty clear on what that would look like. And I have to say they did a terrific job. They all have my text number.

[00:26:22] They all know they can get ahold of me. The only caveat to this whole scenario is, two days into my vacation. We were going live on [00:26:30] two separate quarterly updates and on base. And so for that specific day, I came out of hibernation and made myself available to, one of the directors, Michelle Strickland, and she and I communicated multiple times until we were both comfortable.

[00:26:44] It was going the right direction, moving forward. So that’s the framework that was put in place. I have to say it worked really well this time. I don’t know if we just dodged a bullet or if, or if things just worked out the way they were planned, but I’m really happy. We took it. 

[00:26:57] Bill Russell: [00:26:57] Know I going to camp on this for a minute, because it’s [00:27:00] not a topic we talk about enough. And, and actually I know part of your story, how valuable was this to you? How valuable was this to your family? 

[00:27:10] Lee Milligan, MD: [00:27:10] Yeah, hard to put into words, I would say that, the level of conversations, were much deeper. Than they historically have been over the last, almost two 

[00:27:18] Bill Russell: [00:27:18] Because it takes a couple of days just to be on vacation. Doesn’t it? 

[00:27:22] Lee Milligan, MD: [00:27:22] Absolutely. In fact, ultimately what I ended up doing was, on your cell phone, you can put multiple email accounts and of course you have your work email on [00:27:30] there. I actually took my work email off my phone. And that ended up being key to actually taking a real vacation, because I think without even thinking about it, you’re constantly just looking.

[00:27:40] And if you see something in the subject line that looks enticing, you can’t help, but open it up and your brain starts going there. Of course it’s opportunity cost, right? If your brain is there, it’s not on your kid. And I can give one example of where I think that was really impactful. My, we’re sitting around the campfire and a talk, a few random things, and I’ve got a 19 year old boy, [00:28:00] 17 year old boy, a 15 year old girl and a 12, almost 13 year old boy.

[00:28:04] So a boy, girl, boy. And, she’s grown up in an environment where she’s got all boys around her. And th they frequently, boys, they have the capacity to critique. And so she finds herself frequently in a defensive position. Growing up with the kids. She did something that really impressed me.

[00:28:22] She said, how far she said, you know what, and by the way, she’s a straight ass dude. She’s never not gotten an A, and she’s going into 10th grade. She said, you know what? I’m not a [00:28:30] very good reader. I go to read my friends. We talk about reading and what I read it’s, it’s painful. Like I felt tired at the end and, it just, it’s hard to hold my interest and I don’t know what to do.

[00:28:41] She said that, and I was waiting for everybody to pounce on her and give her a hard time. Cause the other boys are really good readers. They were reading Harry Potter when they were, just in kindergarten and, but they came go closer to her, started asking her questions about that. And that ultimately led to a scenario where she and I decided to pick four or five [00:29:00] books and read them together.

[00:29:01] Now, mind you, she’s going into 10th grade. It’s not like she’s eight, but she was willing to do that. And so we picked out these books. I actually went to our local Barnes and noble and spent time with this one lady who did a great job of kind of showcasing what would make sense. And I wanted books that were about two years behind where she’s at right now.

[00:29:18] So a 13 year old girl. story would be perfect. And so we picked out four or five and began doing that. And as we sat down and began reading it, I tried to make it fun and she tried to make it fun. We went back and forth doing this on vacation. [00:29:30] And about four or five days ago to doing this, I realized she was flipping her words.

[00:29:35] So she was flipping, word a with word B and then even within a word, she was flipping her letters. I would ask her to spell the word and she would spell it and she would flip the letters and it became apparent at that time that she had at least a mild form of dyslexia, something I had never realized in 15 years, despite the fact that my wife and I spent a lot of time trying to, focus on and support education within our home.

[00:29:58] You’ve been to our house. You’ve seen our [00:30:00] education room. And, but despite that, somehow we had missed this. And I felt really awful about having missed it, but also grateful that we identified it now. And so we reached out to, the educational system, elses and friends, that are teachers and we’re starting to get her on the right track.

[00:30:15] And she and I still, every night when I come home from work, we read four or five chapters of the next book and it’s been a fantastic experience. So that’s just kind of one example of how a vacation led to some great stuff. 

[00:30:26] Bill Russell: [00:30:26] Yeah. and actually those, one of the best things about coaching you is I [00:30:30] get to hear those stories firsthand as they’re happening and it’s just, it’s fun.

[00:30:33]One of the things about you that people may not know is you’re a phenomenal writer. I think you’re a phenomenal writer. I’ve read some of your stuff. You’ve written. Some things about your experience, back when you were in the ed and whatnot. But I also read your letters that you were sending out to your team during COVID.

[00:30:50]That’s really where I want to talk about What were you trying to communicate as COVID was sorta. Happening and peaking. And there was a lot of questions. What were you trying to communicate [00:31:00] through those messages to your team? 

[00:31:03] Lee Milligan, MD: [00:31:03] Yeah, early days, Bill, I think, I try to put my myself in the shoes of frontline staff.

[00:31:10] And try to understand what their fears or concerns might be. in the absence of information, we tend to fill it with, worst case scenarios. And so I try to think to myself, what do they need to hear? What are the messages that they need to hear? And as I thought through that, I thought, there’s a couple of things that come to mind first.

[00:31:27]they need to understand that there is a plan. To get through this, [00:31:30] that we’re still a team. we’re still very much, together and there is a plan and I wanted them to understand what that plan looked like. and that planning evolve, as the incident command structure is something that was quite nimble and had to pivot and adjust from time to time.

[00:31:45] But for the most part, there was a robust plan in place. And I wanted them to understand they were part of a health system. It was organized, was attacking this head on. And had a clear plan that was being communicated. and then the second piece I wanted them to understand is that we’re still connected.

[00:32:00] [00:32:00] No, I do think of its very much like my extended family. there’s really amazing people with it. It, yeah. And I continue to, Argue that its folks are usually the unsung heroes of the health system. they do so much to create the, the end user experience. And ultimately the patients experience and frequently are unsung.

[00:32:18] So I wanted them to know that, we continue to be a family and we continue to stay connected. Despite the fact that we’re in the midst of this pandemic, the other piece I would say is I try to break it up a little [00:32:30] bit by showcasing some of the human element of what we’re all going through. So I would tell some stories, that I thought somehow related in some fashion related to the work we do in it.

[00:32:40] And, and that helped keep it real, I think, to some extent. So I’m grateful for the opportunity I had to, to write those out and get feedback from folks and I consider it a, it’s definitely, I’ll call it a duty of the CIO is to stay in communication with your frontline staff and make sure they know that you’re thinking of them and you care about them.

[00:32:58] Bill Russell: [00:32:58] Yeah, absolutely. [00:33:00] and. And you are a gifted writer. So if people search the internet, they’ll find some of your stories from, from, back in the day back when you were in the ed and they’re really moving stories. I, I also, I’d be remiss if I didn’t touch on this. Andrea 10 break in a post on LinkedIn, and it’s pretty much viral at this point.

[00:33:19]380 re reactions, 29 comments. And it talks about work from home. And it’s a great picture. It’s a picture of her, and her, and I think her youngest, I can’t, I [00:33:30] actually, I don’t know what age the child is. And she says, I’ve seen my kids more in the last six months than I’ve seen them since they were born.

[00:33:37]and she says, let that sink in. I had them and I’ve been missing. I’ve been missing all of it. And she goes on to talk about the benefits of work from home. I say that first of all, to make people aware of that post cause it’s a phenomenal post and it’s really touching as you think about work from home, where do you think we’re going?

[00:33:56] Lee Milligan, MD: [00:33:56] Yeah. So just first on, Andrea. So yeah, she’s a very gifted, [00:34:00] she’s our privacy or privacy officer, and she’s very gifted and has the ability to, understand the human connection, even within the domain of privacy that you wouldn’t normally I think is amenable to that, but she really brings a human element to it.

[00:34:12] And I agree with you that post was awesome. It caused me to self reflect a little bit about. The journey we’ve been on both for myself personally, as well as for the division. I don’t have a specific, point in the future that I think we’re headed to. But I do think the lid was blown off of the old model.

[00:34:29]here at a  [00:34:30] how we’ve, we’re focusing on it is we have two separate, but related teams put together to look at this issue. The first is, I’ll call it returned from work from home. So there are, a few teams that needed to be, get back to on-prem. We pushed them to home, but probably overshot it a bit and he had to come back.

[00:34:51] So that team was dedicated to identifying. What are all the pieces that have to be in place so they can return to on-prem safely. And so we had our infectious [00:35:00] disease physician specialists on their HR, myself, others coming together to try to answer that question. And then the second related, it’s actually same people, but different agenda.

[00:35:11] One day is really around what is our long term strategy around work from home. And when we think through that, there’s a lot of things to consider. One of which is, how do we want to hire. our hiring practices will likely change moving forward. Previously, we had to have people within our local geography and as I’m in [00:35:30] Southern Oregon and that isn’t always an easy thing to accomplish per se, but the way I sold it to HR, and to their credit, they were very open to this was the concept that.

[00:35:40] It’s not just us who are going to be hiring. Other folks are going to be hiring. So if we don’t have the capacity to open up that hiring to folks who aren’t in our geography, so maybe they’re in the Northern part of this state, or maybe they’re in California or Arizona or New Hampshire, or, we need to be open to what that looks like.

[00:35:56] And That is happening now here at a Asante or broadening that a [00:36:00] bit, we’re changing some policies and procedures to accommodate that. And then I think here, we’re also looking at what is the longterm impact working for home? Look So with my team, I’ve told my team plan on two years and I pick that timeframe two years from now.

[00:36:14] In terms of having the same COVID type stuff happening. And the reason I picked that timeframe is because I want it to be like, long enough that if you were thinking about doing something, but yeah, we’re holding your breath to see what happens that you wouldn’t, you’d realize that you can’t hold your breath long enough that if you have to [00:36:30] make a change, now’s the time to make it.

[00:36:32] So whether it comes to ergonomic. Stuff, sit, stand desks, the proper seat, the proper miles, whatever it might be. Let’s get that on board now. So you can be effective. And so as we move forward, I think the question is going to be, do we come back to the old system, which I don’t think is going to happen?

[00:36:47] Do we keep everybody at home or do we have some sort of hybrid scenario that allows us to be on prem at the right time, but we can also, work from home as needed. 

[00:36:58]Bill Russell: [00:36:58] Lee, I’m gonna, so [00:37:00] I hate to end this, but I’m going to end this and I’m going to do it by making you feel uncomfortable, but I’m going to get, if you have a chance to do some shout outs here.

[00:37:06] And so the title of the episode was paving a path to success as a healthcare CIO. And one of the things I’ve learned from you because you’ve exemplified, this is, you have a thousand coaches. which is beautiful. you, there’s so many people that you rely on, that it takes a team and you have a great leadership team at a Santa.

[00:37:26] You guys work really well together. You have a great, [00:37:30] set of leaders, appears and leaders within health it, but you also have reached out to CHIME or their support. You’ve reached out to other CEOs for their sport. And I can’t think of anyone that I’ve ever seen. That really has as mobilized the community to make sure that the CIO at a Asante is successful.

[00:37:51] And that’s the that’s. The takeaway for me is a path to success. As a healthcare CIO is really mobilizing your [00:38:00] team and expanding that to the players that you may not have even met before, but who are willing to give you some time to, to help you think through things and to grow into the leadership role.

[00:38:12] Lee Milligan, MD: [00:38:12] Yeah. Yeah. I would say that, the first part of that is, you just gotta recognize your limitations, right? it’s pretty clear to me that there’s a lot of limitations and this role demands a tremendous amount. And as soon as you, you have a realization to get that mantle of responsibility on your shoulders and you’re like, Oh, This is a lot, as soon as you recognize [00:38:30] that, I think it’s critical at that point to say, okay, if that’s what they ask is what are they resources to fill that ask?

[00:38:36] One of the things I’ve been really surprised about is the generosity has been shown to me from other CEOs and other, healthcare leaders across the country. I mentioned before about the CIO I reached out to, I reached out to 15 seat CEOs and I can tell you, I had 15 discussions within a week.

[00:38:54] And, as CEO’s time is a, it’s hard to get, but folks are very willing to do that. people like ed [00:39:00] marks, John Halamka and others, they, they just shared their time. Because I think on one, on the one hand, they recognized that I had a lot to learn and they wanted to help out in that process.

[00:39:09] And so I’m grateful for them most grateful for my team. my team, this was an awkward scenario for them. This happened abruptly again, almost two years ago now. And it, would’ve been easy to just shy away from what’s happening and again, hold your breath and see what happens.

[00:39:24] But I’m really grateful that my team rallied and came together and brought their expertise to these [00:39:30] discussions. We also framed up our decision making pathway and process that is, fairly inclusive. And I think that’s helped, helped us navigate into these new waters.

[00:39:40] Bill Russell: [00:39:40] Yeah. And Lee, I just want to thank you again for coming on the show for those who are listening to the podcast.

[00:39:45]Lee now looks like a young Kris Kringle from the, from the old, Claymation shows that were out there. nice. COVID beard  you have going on there? Thanks again for coming on the show. I really appreciate it. 

[00:39:57] Lee Milligan, MD: [00:39:57] Thanks so much, Bill. Thanks everybody. 

[00:39:59] Bill Russell: [00:39:59] That’s [00:40:00] all for this week. Don’t forget to sign up for clip notes.

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