THE REAL TIME HEALTHCARE PODCAST · Feb 1 · 18:59 min

#27 - Ian Worden, MBA, MS, MA, HFMA, CPA, System Vice President and Chief Operating Officer, Virginia Mason Franciscan Health.

In this Episode:

Join us for a podcast conversation between Jeff Terry, GE Healthcare and Ian Worden, System Vice President and Chief Operating Officer of Virginia Mason Franciscan Health. They talk about the recent merger of CHI Franciscan with Virginia Mason Health System, the impact and vision behind Mission Control, vaccinations, and much more.

Jeff Terry:
Hello and welcome. I'm Jeff Terry, very happy to be joined today by Ian Worden, who's the System Vice President and Chief Operating Officer of Virginia Mason Franciscan Health, which of course is the recent merger of CHI Franciscan with Virginia Mason Health System. Thank you for joining Ian. Good afternoon.

Ian Worden
Thank you, Jeff. I appreciate the opportunity.

Jeff Terry
So first things first, we're only two weeks since this Virginia Mason CHI Franciscan merger. Can you please give us your perspective on that merger? Why did it happen? How is it going?

Ian Worden
Well, this is the culmination of four years of developing relationships between the two organizations. Virginia Mason, as you know, has a national and international reputation, is very high in specialty care and in very many single specialties. We also have a very high quality of care and are known in number of programs. So for example, the three top programs for cardiology in the State of Washington happened to be two in CHI and one at Virginia Mason. So we believe this merger provides a wider geographic area to have very good, comprehensive high quality services for our patients. And also allows us to really bring together both our physician network and their specialty network, to be able to provide direct contracting to large employers, let's say like Boeing or other employers like the state within the next couple of years. So we're very excited about this merger and it really is attribute to both our co-CEOs Dr. Gary Kaplan and Ketul Patel for bringing this together. And I'm very pleased to be part of it as the COO.

Jeff Terry
Brilliant. And if I understand correctly there was already strong ties between the two organizations. So this is sort of a natural step?

Ian Worden
Yeah. There had been a number of ties, one of which is that we are a very big fan of the Virginia Mason process improvement and had our execs trained. And in addition to that, we had a joint venture in women's services. They had not had women's services in their organization for quite a long time, and we are very strong in that. So we had a joint venture to provide that and finally a joint venture in some oncology services at one of our hospitals. So great opportunities to broaden those relationships because those three relationships that I mentioned, if not more, were working very well.

Jeff Terry
That's brilliant. Well, congratulations.

Ian Worden
Thank you.

Jeff Terry
Another topic of great interest to our audience is the vaccines. Obviously you're doing vaccinations for 1A and looking ahead, could you give a thumbnail where you are with the vaccine?

Ian Worden
Sure. I remember January 29th, 2020 was our first call on the COVID-19 and obviously we've been dealing with it from an operational standpoint for almost a year now. Most interesting just before Christmas, we got distributions of the vaccinations and we've done over 23,000 vaccinations in that period alone, mostly focused on the 1A, so those are the clinicians on the frontline, doctors, nurses, independent physicians, as well as EMS, firemen, and policemen. So we've been really focused our efforts on that first tranche of patients or individuals getting the vaccination. Having said that the governor of the State of Washington just opened up vaccinations to 1B that 65 years and older, as well as those who are 50 and older that live in a multi-generational family situation. So not only do we have to have vaccinations within our hospitals and clinics, but we have to now get ready for mass vaccinations.

Ian Worden
And the goal is to get about 45,000 vaccinations done in a day. And we're using both the Moderna as well as the Pfizer vaccinations, but we're looking at venues like airports, large facilities like football stadiums, Tacoma Dome, all of those different areas where we can get thousands of people there through each day to meet the governor's goal and expectations. So we're in the middle of this. We're very excited about this. Everyone is being uplifted by the fact that they can get vaccinations and we are inundated thousands and thousands of calls from the community that we serve, wanting to know how they can get scheduled for those. And we are meeting that demand as we speak.

Jeff Terry
That's great. Perfect. Let's turn our attention to just a couple of days ago there was an article about the artificial intelligence and Mission Control work that of course you, and Ketul were the visionaries that went in that direction to create what a body of work that's captured under this term Mission Control, which we can unpack a bit, but maybe to start, why was it necessary to create CHI Franciscan at the time, Mission Control?

Ian Worden
Sure. Jeff, thank you so much for recognizing that visionary approach, but we would not be here without the great support that we've had from you and GE and all the people that help make this vision a reality. I just want to say our thanks and appreciation to you and GE. The real Genesis for this was real day-to-day practical issues. This is a certificate of need state, where it's very hard to get approval for beds. And even if you need a bed today, it may take three or four years to really be able to get a bed in service, just simply because of the timeframe for the certificate of need process, as well as a building bed and staffing. And during that time, Seattle and the surrounding areas we're South of Seattle was experiencing tremendous growth of population as they moved into the Seattle area with the .com companies like Amazon and Microsoft and things of that nature.

Ian Worden
So we had this dilemma where how do we get patients through? And we felt that the fuller we are the more difficult it was to maintain our high quality standards. So we felt that we needed a way to choreograph the care of a patient. And that started with what patients are we getting and where do they go and how do they proceed through the hospital? So we really started envisioning this way to manage our patient flows so that patients got it to the right facility at the right time, that we can transport patients around our ten facility so that they got to the right hospital, maybe one that was closest to their home that could provide the services rather than just having that happen to us. So it was born out of a real need to better service our clients, be more patient-centered in our care.

Jeff Terry
And I noticed to create virtual capacity and, it also resonates with me, to maintain the high standards of care, even when under at high occupancy?

Ian Worden
Right. The best way to, as you said, creating virtual care, what we realized is that we could use our facilities more efficiently if we worked on how to create that virtual bed. What we mean by that is that how do we make sure that no one stays in the bed five days longer, three days longer, whatever. Because those days are used that could be actually used by another patient. And so we really wanted to make sure that we choreograph the stay of each patient based upon their needs and their clinical progress, so that we could increase our capacity to meet the demand of the growing communities around us.

Jeff Terry
In the a couple of days ago in that article that the organization published at some of the impact of that work, which includes 1,432 patient days saved, patient care expedited for 142 critical care patients, at least 561 patients were discharged sooner than they otherwise would have. And there's obviously lots more numbers, but how would you characterize the impact?

Ian Worden
We've had very tremendous results in the things that we wanted to measure, but what we did realize is there's so much other things that we could measure. For example, observation, what we found is that we could improve observation and that gives us more flow. We found that with our clinical expediters, there was things that we were missing on the floors for example, if the patient had eaten that would stop a surgery. And we were able to, in many instances, make sure that that surgery occurred because we found that issue. So we've had tremendous results. One of the things that is not as easily measured, but as equally as important to the things that we've actually achieved is the fact that we have much more coordination of care across our 10 hospitals, both with the doctors and nurses and with our clinical expediters, by having that we have conversations and can solve problems in real time.

Ian Worden
It's not happening through a phone call where we wait for a call back. We're actually making these decisions. And because our information is refreshed every 30 seconds, everything is done in real time. So that, that choreographed is not a slow dance, it's a very fast fluid dance as we move patients through and we are removing roadblocks that are occurring in front of them as quickly as we can. So there's a lot of other things that we really didn't anticipate, but we're very pleasantly surprised that came along with not only just the flow, but that better communication with physicians and nurses, the ability to manage the care much at a faster pace, the ability to stop bad things from happening, maybe because we have one tile that looks at patients at risk and that comes out of our Epic system. And we're able to bring that to attention of maybe a busy floor that might be at full capacity. So there's a lot of things that we didn't anticipate, but the benefits have been just tremendous in addition to the ones that you mentioned.

Jeff Terry
Yeah, that's brilliant. And you touched on some of that, but can you say more about the artificial intelligence, the data science and sort of what you see the value of that being?

Ian Worden
You know, what's interesting is one of the key competencies that GE brought is the artificial intelligence. Think about this as a data flow of information that's refreshing every 30 seconds. And in that 30 seconds you can apply algorithms that help you make decisions. And that artificial intelligence then becomes predictive like every Thursday we have an increase of patients from this area and that ability to predict allows us to better manage resources against those predictions. Are the predictions 100% right? Not all the time, but they are very close in the 95 to 99% accuracy, which is much more than we had where we had no algorithms. And these algorithms will improve over the time, but that allows us really to manage demand and resources so much better so that we're not waiting for things.

Ian Worden
The other thing is not only the data in the second, that you can apply artificial intelligence, but data happens over long periods of time, 30 seconds over five months is a significant amount of data. And the ability to analyze that data for trends and correlations like is there a correlation between how well we've done with COVID with what hospital, what floor that patient has been? Sometimes we have them in the PACU, sometimes in the ICU, sometimes we had them in our LTACH facility. Is there any correlation? That data then is available to us now to ask those types of questions and as a result of getting answers and correlations, we can formulate better strategies to take care of our patients. So it is a tremendous opportunity that we're just starting to grasp the beginning of. And I'm really excited about that. I think that's the future of healthcare. We're on the cusp of using AI and data trends to be able to formulate better strategies to take care of our patients.

Jeff Terry
We'll continue on that trend so a lot of the work's been done a lot has been achieved over several years what's your vision for where it goes from here?

Ian Worden
Well, we always envisioned two phases of this, and our first phase has been a very big surprise to us. It's been very, very successful, but we found with each phase, we had about 10 different parts of that first phase. We had to sit back and reformulate our processes so that we could improve. The second phase that we've always wanted to get to, we're going in that direction now is how do we use it to improve patient care? And our thoughts are along these lines, if there's a patient pathway, let's say related to orthopedics, can we develop itinerary for a patient?

Ian Worden
So when they come in and of course there'd be decision trees and points where decisions might change, but could we sit down with Mrs. Jones and say, ""Mrs. Jones, your bed is 304. Your care team is X, Y, and Z. The physician-in-charge will come at 4 o'clock talk about your care plan. And then, oh, by the way, based upon the diagnostics that will happen at 3:00 he'll incorporate that, or she will incorporate into the discussions then we'll have a care plan. And we'll talk about that and if that care plan includes surgery, we have you scheduled at 6 o'clock and we can give you, and your loved ones that itinerary to set expectations and reduce concern, and the uncertainty that happens healthcare.""

Ian Worden
And I envisioned that to really start a lot in the procedural areas. It'd be very beneficial to our patients and their families as they go through a very uncertain time when they're feeling not so good, they're anxious about their care and they're uncertain of what that. And we believe that our patient care bring it to the next level includes cutting out the uncertainty about what's going to happen in their care to the extent that we can.

Jeff Terry
That's brilliant. The last question, it's a super interesting part of this, 10 hospitals lots of different points of view, obviously a health system sort of as any big organization has politics, whatever you want to call it. And there's always questions of is this thing big brother? Are you here to help? But you're very thoughtful and deliberate in creating the governance of the Mission Control program could you talk about that a little?

Ian Worden
Yeah. My experience as a leader has always been that people will support what they help create. In order to help create that I needed a governance board that was led by one of our chief operating officers at a hospital that included all of them, including our CNOs, our chief medical officer, our individual on clinical informatics, as well as all the people that are using it so that they can inform the board and make choices that affect themselves. So it's a complete synergy between the people who use it and the people that are making decisions. What I give them is broad guidelines of what I want the board to engage in and decisions that I want them to think through. But it's that group that makes those decisions and leads the organization forward because they see not only that they're involved in it, but they also see the benefits from a clinical side.

Ian Worden
So we deliberately set up an oversight board that includes not people who've never worked in the hospital, not people who are outside of the organization, let's say at a corporate office, but people who are working day to day dealing with those issues, because ultimately I would fail as a leader if I didn't make it better for them and better for our patients. And I felt the best way to do that is having them in the boat with me, rowing and making sure that they're developing it consistent with what they need and what they believe is best interest of the patients that they take care of.

Jeff Terry
And I think by and large, from what I... Certainly the numbers speak for themselves. But I also think anecdotally, the operators are supportive and have felt the positive impact?

Ian Worden
Right. You know, the people that are on this are predominantly operators. And they have also the responsibility of working with our hospital operations, mainly charge nurses and others to make sure that we can get things done smoothly. One thing that we also included, but it wasn't one of our ideas, we shamelessly plagiarized it from another organization that did a great job. Was add our physicians on duty, where we have physicians rotating through, because we have found that clinical decisions between two physicians can be made at a faster pace than a nurse or other clinician having that discussion.

Ian Worden
The other thing that it does for those clinicians, it gives them insights into some of their own areas where they're having problems, whether it's ED or cardiology. So again, we've tried to include the broadest level of people including physicians, nurses, clinical expediters on the teams to be able to not only identify the issues, but resolve those issues and have oversight through the board to move the organization forward and that's been very, very successful. Everyone wants to sit on it.

Jeff Terry
That's good. And I think you've had people signing up for the physician on duty program in large numbers too?

Ian Worden
Oh, absolutely. Absolutely. Some of our best physicians we're so curious once they started seeing this, they really thought that there's a lot of things that they could do to improve it because nothing is more frustrating to a physician than to have the patient in front of them and not have the resources or know that the patient needs it and we can't find the bed. So I think they clearly recognize what we're really trying to do is make them and their patients have a better experience, not only so that they can focus on care, but they can also focus on the patient's flow. And I think it's been wildly successful and we really appreciative of all those physicians that really stood up and they are some of the best and brightest we have in this organization. So it's also good to have great minds thinking through these problems.

Jeff Terry
That's brilliant. And what a great indicator of the whole thing so brilliant. Ian, thank you for joining today. Thank you for letting us at GE serve you the last couple of years and long may it continue.

Ian Worden
Well, you know it's been a real pleasure working with you and the people that use you staff. I know you brought in the A-team for me, and I really appreciated that. And please say thanks to all of those behind the scenes that helped.

Jeff Terry
Will do, thank you very much.

Ian Worden
And more to come in the future.

Jeff Terry
Definitely. And with that we'll close the podcast. Thank you everyone.

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