(upbeat music) - Welcome to the ASHP official podcast, your guide to issues related to medication use, public health, and the profession of pharmacy. - Thank you for joining us for our latest episode of the Perspectives from the C-suite Leadership Podcast. Our discussion for this podcast series focuses on leadership topics with healthcare, pharmacy practice development, of leadership skills and more. Today, we'll visit with two accomplished hospital and health system executives that just so happened to be pharmacists. We are very fortunate to have Rhonda Lehman, President, Mercy Health, Wyman Market for Bon Secours Mercy Health, and Wayne Bohenick, Chief Officer, Ancillary Services for Bon Secours Mercy Health. And my name is David Chen, and I'm the Assistant Vice President for Pharmacy Leadership and Planning for the Office of Membership Relations, and I'll be your host. And today, we're sitting down with Rhonda and Wayne to discuss leveraging data to drive change for multi-hospital health systems, a C-suite perspective. Rhonda and Wayne, thank you for joining us today. - Thanks for having us. - Great to be here, Dave. - Great. Well, Wayne, I'd like to point to you first, or actually to both of you for this first question, just to break the ice and get us started talking about your personal journeys before we jump into the topic. And if I could ask each one of you to briefly share your background and career journey from pharmacist roles to the C-suite role, and what were some of those critical points in life that supported your pursuit and achievement of your current positions? Rhonda, if I could point to you to share your story with us first. - Sure, so thanks for having us today, David. I really appreciate it. My journey took a little bit of a different, I'll say path than a lot of people. I actually have been with the same organization for nearly my entire career. I learned from an early age that I've had an interest in pharmacy and had some volunteer opportunities. And so started in pharmacy, knowing pretty young, that's what I wanted to do. I got my bachelor's from Ohio, Northern University, and a PharmD from Ohio State. And when I got started at St. Rita's, part of the Mercy Health System at a very young age, I had an opportunity to start working on some multispecial projects. And I'll date myself a lot by saying that that was the advent of barcoding and some of the scanning and some of those different automation and technology pieces were really coming online quickly. While I was assigned to that task, I really started to discover that my passion, maybe even more than for pharmacy was for healthcare and really working with the multidisciplinary team. I had the chance after working on some of those initial projects to really start expanding my horizons and working with other types of departments. First, some of the other ancillary departments. And using my knowledge of processes. And I'll say kind of that, that methodical type thinking you get from pharmacy training to apply that to some other areas. I had some great mentors along the way. I'm Wayne being one of those who really, I'm encouraged me to do some different things and quickly started to work with everything from case management to bed flow. And even had a five or six year stint on the physician office practice side of the world. So really started to mix the hospital base as well as ambulatory setting. It really just had a lot of chances to say yes and expand my learning and my knowledge. I've continued to try to better myself by being part of the ACHE group and a fellow in that organization and continuing to grow and learn throughout my journey. - Well, I really appreciate that, Rhonda. Thank you so much. And I appreciate you mentioning the alignment of the pharmacy training and background and how those skillsets and experiences really sort of set you up for the role that you're in today. And I find it coincidences. You mentioned bar coding is one of your projects. And today we're going to be talking about data. And you just look at the journey of how we manage data and automate data over the last couple of decades. Timely mention of a past project. And so, and Whitten, would you mind sharing? - Sure, thanks, David. I was always interested in pharmacy from the very beginning. I did a PharmD at the University of Illinois, did a master's in hospital pharmacy administration, along with a general and advanced administrative residency at the University of Wisconsin Hospital and Clinics. My first job after that was an assistant director at the University of Chicago, where I was both a clinical and an operational leader in that organization. I was there from 1991 to 1997 and pretty much managed every area of the pharmacy before I left. In 1997, I took a job as a chief pharmacy officer at the University of Cincinnati and was there for five years. I was then recruited to Mercy Health in 2002 as a vice president of clinical transformation. I was fortunate to work with Rhonda at that time and we did a lot of projects. Over the next five years, I really focused on a lot of quality and safety outside of pharmacy. Working with the IHI chaired some NQF committees, I was oftentimes the only pharmacist in the room. It was, I felt like I was a square pagan around hole, but really pushed my comfort zone. And I learned a lot about the national quality agenda, which was really big at that point in time. In 2008, I was part of an executive group that made a decision to convert all of our hospitals to a single EHR. We had probably around 30 hospitals at that time and was pired onto the team that was implementing Epic. I actually converted 24 hospitals from paper to electronic on the physician side. Again, it was a very outside comfort zone. I chaired a medical informatics committee, but really felt that that helped me and everything moving forward in my career. It was just very beneficial knowing Epic inside and out, making decisions today based on that information I learned back then. In 2015, I felt I learned what I could, working with the electronic healthcare record and really stepped out of that and was given pharmacy, lab, and five service lines across Bonsacore Mercy Health. In 2018, we merged Mercy with Bonsacore and was given lab and pharmacy and have had that physician as chief officer of ancillary services since. I have pharmacy and lab people report up through me in the organization, not to the individual hospitals, but that makes it a challenge. There's a lot of pros and cons to that. It's a matrix department. I have to make sure that pharmacy and lab are serving the needs of all of the ministry. So you have many, many bosses across all of the organizations. So that's been my career, David. It's been wonderful. And I think as Rhonda mentioned, continuing to learn along the way. There's other programs that I did and Rhonda did this with me. We did the Wharton Executive Program, you know, in the way back then. I did the Center for Creative Leadership with Rhonda. So another executive training program and six-sigma and lean training. So again, I think you just try to push the learning curve as much as you can along the way. - Thank you for that, Wayne. And I think common thread that I heard between both of you is that you both seized opportunities that were beyond just the pharmacy service line itself, you know, itself and solve problems for the institution. And probably a conversation for another day, but Wayne, when you mentioned you converted everything from paper to E.E.A. charge during one of your key projects, few challenges lately, right? That we've been facing as a nation with cybersecurity where we've actually had to go the other direction for a short period of time. But as I mentioned, another conversation for another day. So again, thank you both. Really appreciate listening to your stories there. And so let's jump into the topic today. And Wayne, I'd like to start with you. And just the challenge of harnessing the plethora of data that is critical, a critical success factor for hospital and health system executives. And Wayne, I've had the benefit of seeing some of your presentations on how you've established dashboards to inform and help drive change. Can you share your thoughts on how to strategically develop a data strategy for a complex health system and maybe share some of those lessons learned along the way? And I think also people learn a lot from the things that didn't work so well as you developed your data strategy over the years. - Sure, David. And I agree with you wholeheartedly that you have to think strategically around data and the areas that you focus and what's also important to the organization. I think at various points in time, there are different key areas that the ministry may be focusing on. When I think about data, I look at really three areas. One is kind of operational. And that's how do you know that you're running a highly efficient operation? When you're looking at, we're always looking at productivity, how you're staffing the departments. We built an internal program within Bonsicore Mercy Health that has an internal waiting system and able to compare from site to site. It's something that I make sure that all of the pharmacy leadership across the organization understands how they're operating. In addition, we require them to do an FTE staffing grid. So how do they staff their departments such that if they're called upon from a productivity perspective, that they'd be able to stand up and speak to how they staff each of those departments? So that's from an operational perspective. The second area that I think is always important is financial and how you look at the finances across the organization from what you're charging, your expenses, your revenues, how do you categorize them across a large organization? When you look at inpatient pharmacy, infusions, retail, mail order, specialty, how do you identify areas of opportunity ahead of time and then be able to focus on that from an improvement perspective? So within Bonsicore Mercy Health in all of those areas, we, all of those roll up into a central ledger. I can sort our retail pharmacies top down on how they're doing. I look at that, I focus on all of those areas where we may have opportunity to focus. The third area that I think is important is kind of clinical around quality and safety and have multitudes of dashboards around that. One of the things that Bonsicore Mercy Health focused on for many years was controlled substance prescribing at a system initiative. So this was a KPI that we incentivized everybody across the organization to reduce our prescriber, opiate prescribing. We had a system initiative that was focused on decreasing the opiate burden in our markets and decreasing the morphine equivalent dose greater than 30. This required everybody in the organization to focus and move the metrics. IT with the Epic build and how you build guardrails around physician prescribing. We actually built a data cube where all of our Epic data was dumped into a cube so we could sort it on how they did on a multitude of metrics with our markets between our hospitals and even the physicians. So I can look at if you're a hospitalist, if you're an ED physician, what are you prescribing and how are you prescribing in relative to your other colleagues across the system? And then if needed to have conversations about that. That work was published in age HP and we had significant reductions in our opiate prescribing during that time. Another example of a quality metric that we're using today is really our meds to beds, trying to decrease our 30 day readmission. And so we matched up discharge data and discharge prescribing from the Epic environment with our retail pharmacy system. So real time, I can say what prescriptions I'm filling from any discharge unit in our system and then share that with our system leaders to say, where do we have opportunity for improvement? That is part of a KPI this year and we are increasing our meds to beds across the system significantly. So if you look at these three areas, the operational, financial and clinical, really thinking about what do you need from a data perspective, a foundation to measure, identify areas for improvement and then to act on that improvement. I think now from a pharmacy perspective, one of the areas that we haven't been involved in the past is really looking at reimbursement, reimbursement for our infusions and what and how we're getting paid and how payers are paying us and developing databases to be able to determine that real time and take action based on that. So I think a lot of opportunity to go. - Well, that was a lot, Wayne. And actually you teed up the question that I had prepared for Rhonda next. So again, thanks for that. I mean, there's so much data from the sources, but then also just the collation of the data. You know, and Rhonda, as president for the Lyman market, you know, for Vonsic for Mercy Health, you must be equally concerned about the accessibility and usable data as you are the quality of the data to make decisions, especially in light of all the sources of the data continually growing and the complexity and the reliability that we heard just a little bit from Wayne and as we grow more acutely concerned around data security, can you share your perspectives and what are your expectations and needs on having high integrity data and how you've taken steps to ensure that this data is available for you, your executive teams and all the way down to the front lines to be able to enable effective change. You know, and I think Wayne, I even foreshadowed one around the opioid usage. - Thank you, David. There's a lot there and some of the things that Wayne was commenting on. I was able to see how some of those initiatives kind of, I'll say, came to life in those conversations as I worked on the medical group side during the advent of few of those things to really see the impact they had. So when I think about the plethora of data out there, it can be really overwhelming. I love how Wayne kind of broke it down to those categories. And yet within each of those categories, I was just a mind-numbing amount of information coming at each of us. So I'm the kind of person who likes to simplify things where it can be simplified and believe that's a key, safety principle too to keep things very straightforward. And so for our frontline leaders, I think about making sure we're holding the mantra of the things that we measure is what gets managed. And so making sure that we make the most important things, the things that we are measuring and making readily available. I find that if people need to search for information or try to create some of those things on their own, that's when we start to have that data integrity issues that come about. And so as much as we can have reports and information and as real time as we can have some of those things that really just kind of land in the hands of those who need to see them, I think is really critical. So some examples of things that we do in our organization. First of all, you need to understand if what you're measuring is a leading or a lagging indicator. We talk all the time about the fact of patient experience is so important, but getting a survey back is a lagging indicator. That's not where the heart of what it is that we need to do to make process changes happens. So really understanding, I would say, whether it's a leading or lagging indicator. And also understanding the why behind some of those things. For getting reports, if you're getting data and information and you're not able to make valuable use of it, why are we generating it? What else could we have in our hands each day that will make a difference in the lives of the patients each day? And boy, if you wanna know if it's meaningful or not, just go ask any frontline caregiver if they ever look at it or pay attention to it. And I think that's really where the truth resonates. In so many ways, automation, technology, reports, data have made us so transactional in nature. I think that's a fight and a struggle that we're encountering in healthcare today. The data is amazing, but it's only amazing and as much it's serving the purpose and the mission of organization. So how are we taking that data, connecting it to someone's why and helping them view that as important? I'll go back to kind of this thread that Wayne started of the opioid cube or opioid data. What a story, right? To be able to sit down with a provider and be able to say, this is what we're finding. This is the why. This is the impact this is having on our community, our country, all of those pieces and be able to invoke change that way is so powerful. Wayne is right. The results were staggering when we were able to start comparing specialty to specialty provider to provider and help people understand how to bring that in check. Providers that were, I'll say off the reservation, weren't intending to be necessarily. I think those are the anomalies. Those are the things that make the news. But on the whole, what we were able to do with that data was connect it back to their why and their why was to help patients be better and to feel better and that created that change. So I guess I get excited in a strange way about data. When we can go back and see the change it makes in people's lives, both as a caregiver and why they went into this. And the lives of our patients when it improves their financials or the quality and the safety of what they experience with us. And definitely even the timeliness of it, true. We want patients, patients want to come to us and be cared for, I'll say quickly or in a timely fashion too. And so when we improve those operational metrics I think there's a direct patient connection as well. So those are a few of all say the things that resonate with me on that data integrity, how we use it. Not just creating data for the sake of it but really understanding how do we come down to that sharp end of it and make it make a difference. - All right, thank you very much Rana. I love the way that you sort of cold out, you know, if it's being measured can it be managed the whole connection to the why? And even the comment you made about even the responsiveness or from the front lines can be almost a measure itself, right? And so, you know, what I'd like to do for the next few minutes here with both of you is if we could kind of revisit, you've given at least one case study, you know, around the opioid use. But if you could continue to share some notable projects where, you know, harnessing the data was the underpinning to drive change, impact opinions. Like you just shared a little bit, Rana, clearly to inform stakeholders. And probably just as important maybe cases where it shifted the paradigm, right? Of stakeholders to enable some action and just helped overall success of the patient care and sustainability of the organization. Are there a couple other examples that you'd be willing to share with us? - Yeah, David, I've got a perfect one that's relevant that involves Randa and St. Rita's medical center as well. So we have about 60 hospital-based infusion centers across the ministry. And for probably the past two years, you know, we've been seeing as payers tried to move those infusions to alternative sites of care to try and make sure that we have those alternative sites of care. We're keeping that within the ministry. Whether that's in a home, you know, a home infusion setting or whether that's coming from our specialty pharmacy area. And so we put together, one of the things that we have seen doing, you know, we saw a doing is that we may kind of track the, contact a payer, getting prior off for that medication, the payer, we say it's not allowed in a hospital-based infusion. Our rev cycle company kicks it back to the physician's office. The physician's office says, "Okay, we'll just use this infusion center across the street." And we've lost that book of business outside of the organization. Or we go to a payer to get a prior off on that infusion. They say, "You have to use our specialty pharmacy." And so the rev cycle company who's doing this prior off is sending that prescription outside of our organization when we may have access from our specialty pharmacy. So when you look at what's going on across the organization, how do we, as an organization, keep the business inside? And so we presented data to our market presidents, presented it to Rhonda as far as what we are trying to do. And we've really launched a pilot program in her market where pharmacy is going to take the lead on those prior authorizations. And we're building alternative sites in sites of care to provide that for patients. But to keep this business in-house. And so when you're talking about who do you have to bring on board? And you look at those stakeholders, it's finance, it's rev cycle, it's managed care contracting, it's clinicians and operators in the markets. And all of those people, it takes time to move them to where you want to go. But that's a real life project today that was based off of data that we were seeing. And then we brought that to Rhonda and we're moving that forward as a pilot project at the same area. - That's great, Wayne. And I think that's a clear case of where you shift the paradigm, right? The paradigm was is that you guys could not retain patients at a higher percentage level and maintain the continuity of care. And that of course, through the data, you demonstrated that the opportunity was there and shifted the paradigm. So really appreciate that example in Rhonda. - Yeah, so I have several examples I can think of. I was kind of thinking about which one would be, I'll say most interesting to the audience listening today. I think we can all agree that workforce challenges continue to plague our industry. And there's another application of this data that Bonsoquar Mercy Health has made available to each of the sites that I think is just particularly intriguing. We call it our flight risk model. And that model takes a variety of different, I'll say HR related demographic information about associates and through an algorithm determines who may be at a risk of leaving the organization. Some of it is based on age, it's based on commute time, it's based on years of service, based on absenteeism, which shifts there are so many factors. And I will tell you the first time that information was provided to us, I think we were all incredibly skeptical. Like you don't know our people, no way. But we were able to deliver just a few names to each leader on the nursing units and say these people are popping up as flight risks. You might wanna check in with them. Incredibly powerful. So even our skeptics, committed to the process, had a discussion with some of those nurses and pharmacists and technicians and the variety of people in that database. And we're actually able to do what we call some of retention interviewing, retention pieces, just by generating that. And a few, you'll always have some pieces that aren't relevant. Maybe someone hasn't worked for a while because they're in school and they're only there on breaks. So there's some things, there's a little bit of noise in the data. But on the whole, that data was particularly profound. I couldn't believe it myself, quarter over quarter, to see what providing that to our leaders and just shining a light on a couple of areas was able to do for us in our turnover rate. We have the lowest nursing turnover rate in our ministry throughout Bon Secura Mercy Health at our site. I like to think that data like that played a small part in us being able to drive that number down. - That's a great story, especially in today's climate as you indicated at the beginning of your comments. And I think it also emphasizes that the composite of data by itself doesn't get the work done. Engaging with the users of the data and then even asking for support and help from different places on how to actually package it so that it can be used. And then ultimately follow through and see sweet support and maybe a little bit of downward pressure that we are going to try this and see where it takes us. So, fabulous story. Well, we're coming to the close of our time and I'll put you both on the spot here with just a final reflection question of just this whole world of data, we're entering this world of the discussion of AI, which is going to be driven by even more data. You know, wait, if I could put you on the spot first, any closing comments of just your projections, I know you've been working with big data for a long time and been a thought leader within the pharmacy community around collecting the data across systems. What's next? Are there a couple of things that are top of mind for you that you look around the bend and go, "Yeah, I haven't solved this one yet, but I know it's something I need to solve." - Data, I think you put it in the nail on the head. AI, we've seen already within Bonsa Corps Mercy Health real live examples of how AI can help us. You know, one of those is around controlled substance diversion that takes, it's a software that takes in to consideration our automated dispensing cabinets, our work day module, epic information, something that we would never be able to look at, bring together and, you know, bring about results for the organization. And what I would call maybe a little bit more of a prospective than a reactive environment. So I really think that AI will help us going forward. And David, we talked a lot about cybersecurity and the risks of that is, you know, we become more automated across, I think it's a real live risk. So as we get more data, we get more automated in things, we run a risk of, you know, more loss with a cybersecurity is something that I think we're going to have to deal with as we go forward. So those two factors, you know, with data, I think are important for us to focus on going forward. - Thanks, Gwen. - I agree with what Wayne said. I would add that I think where we're heading with some of the amazing artificial intelligence pieces is to a place that I'm excited about because I think it's going to help us from a patient's safety and quality standpoint. There's still a fair amount of things within healthcare that are pretty subjective. And when I think about that, it can be anything from monitoring, fetal monitoring strips on OB patients, identifying D cells, identifying strokes for patients, identifying patients who are deteriorating, patients who are in early indications of heart failure. So I get pretty excited about the early detection monitoring tools and the things that not only will help us detect things sooner in patients, but will also serve as a safety net for our healthcare workforce who already has a lot on their plate. So everything that we can do to take out the subjectivity or that you just miss this kinds of things, there's currently some technology we've viewed that will kind of comb the chart for, did you see this value or I put these things together and I think you should be taking another look at this patient. We already use deterioration index scores to help us with early identifications of patients who may be heading the wrong direction. So those are the places that I get excited about because I think long term, that's going to be what the future of healthcare looks like and less about kind of relying on people to do better. They're trying their best. There's a lot of information out there and just a lot of pieces to put together to create a true picture of a patient's health. - Well, thank you both so much. I think just listening to you and your perspectives on what it means from the C in the C suite on using data to manage very large complex organizations all the way down to the front lines to influence day to day change of the care of our patients. So thank you both so much for spending time with me today on this podcast. And for all of you listeners, that's all the time we have today. And I want to thank again, Rhonda and Wayne for joining us to discuss leveraging data to drive change for multi-hospital health systems, a C suite perspective. You can find more member exclusive content, including resources for self-development, leading pharmacy enterprises and teams and practice management on the ASHP website. Thank you all for joining us. And if you enjoyed this episode, be sure to subscribe to @ASHPofficial podcasts. Again, Wayne and Rhonda, thank you so much for spending time with me today. - Thanks for having us. - Thank you. - Thank you for listening to ASHP official, the voice of pharmacists advancing healthcare. Be sure to visit ashp.org/podcast to discover more great episodes, access show notes and download the episode transcript. If you loved the episode and want to hear more, be sure to subscribe, rate or leave a review. Join us next time on ASHP official. (upbeat music) (upbeat music)
