Being Digital vs. Doing Digital

Our teams continue to see an incredible amount of change. Health care is increasingly moving to a focus on value, with a growing focus on quality, cost, and experience. The COVID-19 pandemic has required all of us to adapt on a very regular basis to new guidance, new procedures, and new ways of delivering care services. If there is one thing about working in health care right now, it is that change is constant.

Change can be unsettling, can make us feel uncertain, unsure of ourselves, and nostalgic for days past. But we are all in this together. We continue to support one another, we continue to raise each other up, coach each other, and find ways to rise to the occasion of what we must do for those we serve and for our colleagues.

COVID-19 has accelerated digital transformation for many organizations, but we had already been on that journey. Looking around, we see that we are squarely in the information age. Handheld computers (a.k.a. our phones) are in every pocket or pocketbook practically. Digital has profoundly changed the way that we do banking, communicate with one another, order food, look for new places to live and share experiences.

We must also digitally transform our work to continue to be a high performing organization in these times. This goes much far beyond adoption of electronic health records. EHRs were a fundamental step to putting our observations and notes into a digital format. And while the EHR will continue to evolve, we really need to focus more on the broader business that we’re in.

If we are to be digital, or digital by default as we have been saying, we must look at things differently. We must not look at digital as a sidecar to our work and strategy, but rather a force that enables and changes our work and strategy. We must move from thinking about doing projects to creating experiences and we must transform from thinking about digital capabilities as costs of doing business to looking at these capabilities as our assets. We must develop flexibility to take advantage of newer digital trends.

Think about big stores in our lives. Think Target or Walmart. Do you know them as physical stores or as digital companies? How are they able to compete with Amazon? Why are they still relevant in our lives? The truth is that they have become, or are on their way to becoming, digital companies that happen to have a physical presence, rather than physical stores that happen to sell merchandise online. They have heavily invested in their digital capabilities, and everything from marketing, supply chain, to data analytics for what their customers want. Make no mistake, they are companies that have made the digital transformation. While you probably haven’t heard of Walmart Labs, it’s important to know that a core component of Walmart’s recent success is based in Silicon Valley, not just Bentonville, AR.

In our organization, just as in other organizations, we must continue to make some fundamental changes. These changes are strategic, cultural, operational, clinical, financial, technical, and personal.

Strategic:

Beyond being able to meet our patient needs through video visits and telemedicine, which we have certainly increased over the last few months, we will need to continue to focus on how digital becomes core to our strategy. This is why our Froedtert & MCW app is an important gateway for people and our services. We must continue to develop digital strategies that correspond to our key work in products whether it is in our service lines, and our core operational services, or in our incredibly important support and ancillary services. A key strategic shift here is that we need to change our orientation from ‘leveraging digital to support how we deliver care’ to ‘delivering care digitally.’

Cultural:

We need to continue to embed digital into our culture and fabric of our work. It will not be enough to have a few programs leveraging technology, but this must change all of our work. We must think and be digital. Digital should be used to highlight the best parts of human-centered healthcare, and remove the non-value added parts. We must shift our focus away from year-long planning processes and utilize a much more agile methodology, as it will be impossible to stay ahead of the curve in the other way.

Operational:

We must automate more of our clinical and corporate functions. Automation is at its core the use of software and hardware to replace human work. Automation is impossible without digital. Our work is to define where automation adds value and where a human and personal touch is still very important. Successful operations will be the combination of automation and meaningful human interactions.

Clinical:

Care is being reimagined and tested outside of our walls by numerous organizations, small and large. We must continue to do research and development ourselves. These include exploring new care models, such as those based on text-messaging and video, and those that enable those we serve to be in the driver’s seat.

Financial:

We have to start seeing digital capabilities as assets to us rather than costs. We must continue to make important investments in our digital infrastructure and to support our operational transformation all the while — measuring return and impact on our key business goals. For our clinicians, we have to begin to reimagine compensation models that begin to value what patients value, time providing advice, managing care and integrating across disciplines, rather than purely face-to-face visits.

Technical:

While, having invested tens (hundreds?) of millions of dollars, we have arguably the best commercial electronic health record, this alone is not sufficient for us to be digital. We must do the work of developing and integrating our experiences that we want our patients and staff to have. This includes building a technology pipeline of deployment within our walls, leveraging our investments in technology and electronic health record to engineer experiences, and embedding data and analytics in everything we do. Reporting numbers will shift to developing insights to drive our clinical and business decisions and ultimately to learning algorithms that personalize experiences for our customers and workforce.

Personal:

We each will need to make personal changes. For those of us who were not born into the digital era or for whom technology is uncomfortable, part of our responsibility will be to make technology part of our personal development plan. As just a simple example, if we are asking our patients to use our mobile app as the gateway and front door into our world, we should also have that app on our own devices and be prepared to be ambassadors.

We have put together a few steps that we recommend that all of us can take to be successful in our new future.

Recommended Steps for Staff Members

• Inform yourself more about why digital is so important for us to integrate into our organization’s DNA.
• Begin to use our own digital tools. No matter what your role is in our organization, everyone plays an important role in helping us promote and improve our tools (don’t have it yet, download it at https://links.froedtert.care/download)
• Be inquisitive, and talk with your leaders about digital. What is your unit doing? How can you incorporate digital into your work?

Recommended Steps for Clinicians

• Download and use our digital tools for yourself and your family. Be able to talk about them with patients.
• Encourage every patient and/or family member to engage with us digitally. Don’t make assumptions about who will or will not engage digitally. Our research has shown that assumptions can be wrong, and can lead to disparities in the form of implicit bias. Make it part of our standard practice.

Recommended Steps for Leaders & Executives

• Educate yourselves about the digital transformation. Make sure you have a grasp of common concepts and vocabularies. Check out these resources to start.
• Think of digital as your job, not someone else’s or as a responsibility of someone else in the organization

Check out these resources:

1. What Digital Really Means: McKinsey & Co Karel Dörner and David Edelman
2. Trends Driving The New Normal: Providence Aaron Martin & Sara Vaezy
3. Digital Transformation Is Not About Technology: Harvard Business Review by Behnam Tabrizi , Ed Lam , Kirk Girard and Vernon Irvin
4. What is the Cloud? (AWS)

Recommended Steps for Clinical Educators

• Incorporate digital into educational plans. Asynchronous messaging and telemedicine are two examples of how to integrate digital care.
• In lessons of healthcare disparities, medical ethics, and social medicine courses, incorporate concepts of digital divide and digital disparities.

Being digital is not a slogan. The transformation we all need to undergo will take time but that does not change the urgency. Starting to engage with a personal reflection of where you are in the journey is a great first step. Our collective future is dependent on all of us making this transformation.

Acknowledgements:
With thanks for collaboration with Mike Anderes, Eric Langshur, and Melek Somai.