Who “Owns” Digital? You? Me? We!

How we think about implementing digital engagement programs at Froedtert & MCW

Brad Crotty MD MPH
Inception Health

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We often hear “It takes a village” when thinking about raising kids. Anyone with children with family or close friends nearby knows how blessed they are to count on one another — not just at times of need, but also for that daily support, encouragement, appraisals and advice. Parents are accountable and responsible for their children while they are growing. Friends, teachers, spiritual leaders, coaches, and scout masters all play a role in support. Pediatricians are consulted. Facebook makes sure lots of high school acquaintances are informed. The path towards mature digital engagement also takes a village.

Society invests in the development of the next generation, through schools and other social programs. While parents are accountable for their kids, we all have a stake in seeing the next generation thrive. Similarly, while specific teams or groups within the Froedtert & the Medical College of Wisconsin Health Network are accountable and responsible for specific pieces of our digital engagement, we all play a role. Digital engagement is not owned by a person, entity, or team. Digital is a mindset. It’s the present and the future for fulfilling our mission to our community.

But what’s each of our roles?
In this post, I want to share a little bit more about how we can work across teams, share how we are using it for our 2023 initiatives, and also provide some drawbacks and criticism of the approach that should be understood.

Mapping Digital Engagement For 2023

We continue down a multi-year roadmap of increasing digital enablement for our patients and customers. To make the roadmap, we work closely with members of our clinical operations teams, clinical leadership groups, population health, finance, information technology, pharmacy, strategy, and our Medical College. Lots of stakeholders

Broad and high level map of stakeholder groups within the organization

Each year, we prioritize a few initiatives that move us farther down our roadmap and have this plan endorsed by our Clinical Executive Committee, represented by both Froedtert Health and the Medical College of Wisconsin.

For FY23, we have plans for the following capabilities

  • Improving digital data collection (further technology and process enablement of a prior entry)
  • Adopting new digital therapeutics in support of our patient and population health goals
  • Increasing usefulness of and engagement in our digital engagement platform and mobile application
  • Implementing technology and process to improve communication and experience of hospitalized patients and their family members (through an integrated acute care portal)
  • Continuing to explore new care models that don’t rely on in-clinic experiences

When we overlapped our main areas of digital work, we can clearly see that the work sits nearly within no single team. Quite the opposite.

Overlapping of key initiatives across teams

RASCI Diagrams Outline Roles

I used a few key words in the introduction for a reason. While the notion that “we all own digital” might be conceptually true, let’s get down to brass tacks… who is taking accountability for ensuring our digital growth and transformation?

In a large, complex adaptive system, like healthcare, we must find a balance between shared responsibility and ‘everyone owns it so no one owns it.’ Digital really does touch all facets of our delivery organization.

We can use the RACI framework (sometimes RASCI which I prefer) to guide roles

  • Responsible= This is the doer of the work. Although this person may delegate or seek support from others, ultimately this one person or team is responsible for getting the work done.
  • Accountable = This is the person accountable for the work that the Responsible person does and signs off on the work. The golden rule of RACI is that only one person can be Accountable for each task. Has oversight and can marshal resources. This is where the buck stops.
  • Supporting = Provides support, takes tasks, and provides help to the Responsible member(s).
  • Consulted = These contributors provide input, opinions, and advice through two-way communication.
  • Informed = Although they are not decision makers, these people are kept up-to-date on progress or completion through one-way communication.

Some versions also have a “D” For Decider or Delegator, usually for an executive sponsor.

We have listed teams and key stakeholder groups along the top, and specific 2023 bodies of work along the side. As this is a draft, I have redacted the names and projects as this is more of a tool for conversation and understanding than assignment, and hence for our purposes here those details are not important. This visual may be overwhelming in its complexity, but it is a good representation of our organization and its many parts today.

Sample RASCI outline designed by Digital Operations leads and CDEO as a starting point for conversations

Criticisms of the RASCI approach

Readers of our blog will point out that we try to avoid complex project management structures whenever possible, preferring to focus on empowering teams to reach their target outcomes and take a product rather than project approach. For our digital products, our emphasis is on empowering a team and providing autonomy to make decisions and move with reasonable pace.

RASCI drawbacks are that the framework generally shifts the conversation into focused on individuals rather than teams, and on prespecified project outcomes rather than a more fluid approach to achieving the desired outcomes like an Objective and Key Result approach would yield.

We recognize these drawbacks. Wherever possible, our preference is to set the objective and what we will measure it by (key results), empower a team, and clear their way.

Innovation teams within healthcare will inevitably hit roadblocks, though, with the complex structures that have grown over the decades. Outlining basics of ‘how’ a team will be called upon to contribute or stay informed about work is an important first step toward garnering alignment and a sense of shared responsibility. This is why we have elected to proceed with outlining our main 2023 work in such a way.

Concluding Thoughts (TL;DR)

  • It takes a village for digital engagement
  • No single person or team ‘owns’ digital, but specific teams can be accountable and responsible for aspects of a digital roadmap
  • Mapping out intersections of how digital touches and impacts various stakeholder groups yields important considerations for how teams will interact
  • RASCI can provide guidance for how teams are expected to engage within specific bodies of work that cross multiple teams and units
  • While agile is preferred, clarity and tamping down a sense of chaos can help with alignment

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Brad Crotty MD MPH
Inception Health

Chief Medical Officer, Inception Health | Chief Digital Engagement Officer, Froedtert & the Medical College of Wisconsin Health Network