…We also need to leverage family members. The challenge is empowering family members with knowledge, awareness and expertise. Virtual care techniques as described above contribute to this. I believe AI engines that leverage medical content can contribute to guiding non-clinical team members to take the right actions to avoid unnecessary deterioration. This is a bit further out, but we are seeing more and more applications emerge in this area.
Ihad the pleasure to interview Peter Bak. Peter is a seasoned leader and innovator with over 28 years of experience in healthcare informatics and applications, IT operations, people and system transformation, business development, and business operations. Peter was the subject matter expert for developing the digital transformation strategy and implementing the hospital’s digital vision. Peter’s areas of expertise include methods for effective sharing of electronic patient records, interoperability workflow to optimize care delivery, diagnostic imaging systems, IT operations, and transforming care delivery in acute centres. His skill and contribution to the healthcare industry are reflected in his recognition as the Canadian public sector CIO of the Year for 2017.
Thank you so much for joining us Peter! Can you tell us a story about what brought you to this specific career path?
I began my career as a mining engineer working in South Africa, so my path to healthcare was very non-traditional. While mining diamonds in a remote location, I realized that our future was shifting to a technology age and I needed to get out of digging holes and learn computers. In 1985, I jumped into a PhD program to develop 3D modelling software for geology and mining, which put me in the world of IT I was then recruited into the healthcare technology industry. After a decade of developing Radiology software, I shifted to consulting and engaged in the planning and deployment of the pan-Canadian Electronic Health Record. Here is where I gained tremendous experience in all aspects of healthcare IT at the hospital level as well as the regional and national levels. That’s what brought me to my current role as the CIO of Humber River Hospital, North America’s first fully-digital hospital.
At the end of the day, I’m a product-focused guy. I enjoy getting up in the morning to build and explore solutions that make a difference. In my career now, I’m thinking about how technology solutions and product development methodology can drive transformation and a culture of innovation in healthcare.
Can you share the most interesting story that happened to you since you began leading your company?
My family and I experienced a clinical event with a family member that really opened my eyes to some of the deficiencies in healthcare. This experience was also a driving force behind all of the communications technology I’ve strived to put in place at Humber River Hospital.
On my father-in-law’s 97th birthday, he had a heart attack. We rushed him to hospital, where he was given a stent. The cardiology team had never performed this procedure on a 97-year-old. The surgery went well, but the post op care did not. Working with a geriatric patient is quite different than working with sixty-something-year-old patients. It required coordination and collaboration with pharmacy, gerontology, and ultimately internal medicine. This collaboration did not happen without continuous management on the family’s part. Not because the clinical team was negligent but because the communication tools were cumbersome and time consuming. My father-in-law ultimately lived to 103, but the outcome could have been very different if the family had not been involved.
This experience continues to inspire me to push for change and achieve more effective caregiver communication in hospitals. So far at Humber River Hospital, we’ve found success with vendors like Ascom, who help us streamline communications and improve our workflows using an integrated system.
Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?
When I was working with the Canadian government as a subject matter expert for the pan-Canadian Electronic Health Record, I was presenting a conceptual (technical) architecture diagram for a regional record sharing solution that was regarded as a blueprint for the country. I added a new item to this architecture diagram — a simple line to convey a specific requirement for that region. Unfortunately, this caused the regional technical team and business leads to become confused and concerned that I was introducing a significant complexity. It took me three months to undo this “line.” It’s funny in hindsight.
Even if it’s something as innocent as drawing a line, I learned a valuable lesson — the way you communicate is incredibly important. Ideas must be thought through very carefully before they are delivered, so you can avoid triggering negative reactions that could set a team back days or months. Leaders must have a deeply-rooted understanding of their vision, or they will encounter unanticipated challenges and contend with team members running around in different directions.
What do you think makes your company stand out? Can you share a story?
Humber River Hospital implemented a transformation that has led to very significant quality, financial and patient satisfaction benefits. This transformation is characterized by three phases: digital transformation, achieving high reliability, and integrating with community care to reduce acute utilization. We are not finished, yet the results so far are enviable: reduced infection rates, zero sample labelling errors, almost no medication errors, seeing more patients with higher acuity at lower cost per weighted case, and more. We have people from all around the world visit Humber River Hospital and everybody says, “we have not seen a hospital like this.”
What makes Humber River Hospital stand out globally is that we are a beacon for what can be done. We are a community hospital. We had (and have) limited funds. We used commercially available technology. What we set out to do is what everybody wants and needs. Our success paves the way for others to strive to do better than us with confidence.
What advice would you give to other healthcare leaders to help their team to thrive?
Leaders in healthcare need to recognize that “digital transformation” is a must. It is not specific to healthcare but all industries. The importance of this statement is that leaders need to develop strong IT leadership and trust in the IT capability. Technology is complex and forever evolving, so clinical and business leaders will find it hard to be deeply knowledgeable in the domain. For an IT team to thrive in healthcare, you need to have a skilled IT leader that you can trust to provide vision and operational excellence.
In practice, this requires a leader with deep skills in technology, IT governance, change process, and a service-oriented mentality, as well as strong ties to the clinical providers.
According to this study cited by Newsweek, the US healthcare system is ranked as the worst among high income nations. This seems shocking. Can you share with us 3–5 reasons why you think the US is ranked so poorly?
As I work primarily in Canada’s healthcare system, I’ll let other United States-based executives answer this question.
You are a “healthcare insider.” If you had the power to make a change, can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.
As I work primarily in Canada’s healthcare system, I’ll let other United States-based executives answer this question for the United States.
What I can do is offer a Canadian perspective, which I think is not too dissimilar to other publicly funded health systems.
We struggle to deliver timely care to the growing populations and aging populations. The latter drives increased utilization of acute care. Many of our hospitals are already at full capacity. So how can we address this emerging challenge?
We need to maximize the efficiency of our existing hospitals. Simply stated, we need to increase capacity without increasing cost. One way of doing that is through digital transformation and high reliability. We have proven this at Humber River Hospital where we are seeing close to 8% growth year over year with higher acuity, without adding more beds while maintaining our nurse to patient ratios.
We need to leverage virtual care techniques to allow patients to remain in their homes or other community settings while delivering the expertise of a care team without being physically present. The objective is to avoid unnecessary deterioration. In principle this may seem easy given the modern IoT, but the challenge is how to do this cost effectively. My belief is that a Command Center, modern communications, wearables, and AI engines, all wrapped with the proper funding models is one example. At Humber River Hospital we intend to implement such an approach. We already have the foundations.
We also need to leverage family members. The challenge is empowering family members with knowledge, awareness and expertise. Virtual care techniques as described above contribute to this. I believe AI engines that leverage medical content can contribute to guiding non-clinical team members to take the right actions to avoid unnecessary deterioration. This is a bit further out, but we are seeing more and more applications emerge in this area.
Ok, it’s very nice to suggest changes, but what concrete steps would have to be done to actually manifest these changes? What can a) individuals, b) corporations, c) communities and d) leaders do to help?
I believe leaders need to have vision and be bold. If an organization doesn’t have bold leadership, especially in healthcare IT, then change will not be manifested. This leader needs to be someone who stands up, pushes and doesn’t worry about politics within their organization. When this happens, change is possible and achievable.
To actually manifest change, we need to become very process and project-minded. We have implemented many projects at Humber River Hospital, and even today driving change within our organization is not easy. We rely on strong project discipline, change request methodologies such as ITIL, strong executive sponsorship and a well-developed governance structure.
As a mental health professional myself, I’m particularly interested in the interplay between the general healthcare system and the mental health system. Right now we have two parallel tracks mental/behavioral health and general health. What are your thoughts about this status quo? What would you suggest to improve this?
I don’t have professional insights to share on this topic, but as a citizen I believe mental health awareness is lacking. I see certain countries making big efforts in this space and I believe mental health needs to be more widely recognized as an illness (i.e. PTSD, etc.). I believe many people have started to make this distinction, but we all still have a long way to go.
How would you define an “excellent healthcare provider”?
From an acute care perspective, an excellent healthcare provider is a high reliability hospital. High-reliability hospitals embody many things, but fundamentally they are classified as organizations that don’t make mistakes.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
I don’t have a favorite life lesson quote, but rather three phrases that I like to incorporate into all facets of my life. The three phrases come from Leo Tolstoy’s “The Three Questions:” What is the right time? (now), who are the right people? (the ones you are with), and what is the most important thing to do? (whatever is the right thing to do for the person you are with). I think this story is a great reflection on mindfulness.
Are you working on any exciting new projects now? How do you think that will help people?
Communication in hospitals is still archaic. The tools (VOIP, pager, locating service) do not facilitate rapid connection with the right care team members and with the right context. They lead to delays and possible negative outcomes for a patient. They impact length of stay and, thereby, capacity and cost. They do not support high reliability.
We need to embrace social media paradigms and technologies. WhatsApp is a good example. But interestingly, the consumer applications are not good enough. They assume a social etiquette is agreed upon and that we all behave like millennials. What we need is a very structured communication paradigm that includes patient context and closed loop action. More specifically:
- I need to connect with a role or a team
- We are talking about patient “X” and a specific medical content
- I need to convey the degree of urgency and I need to know you are free to engage
- We need to make decisions and act on them
- We need to record all of this in the chart for reference
Right now, we’re rolling out Ascom’s Mobile Heartbeat® MH-Cure, a smartphone application that enables our staff to communicate with one another using social media paradigms but with structure and in-patient context. Secure text messages, voice, video call, image and video sharing, and closed loop. This is combined with Ascom’s Unite platform that supports a wide variety of patient alerts, like nurse call and abnormal lab results.
This rollout will give our staff the ability to make clinical decisions in an expedited process.
What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?
I don’t particularly have anything to add here.
You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be?
If I could inspire a movement to bring the most amount of good to the most amount of people, it would be pushing digital transformation in all hospitals. Digital transformation would provide the ability to empower patients with understanding and transparency about what is going on with their health.
To expand on that, we need to invest in technology that extracts meaning from health records, and equips family members and patients with the ability to interact directly with caregivers. In the current healthcare climate, this level of health information is typically inaccessible to patients, so providing a solution to make that information easily available and digestible would enable patients and their family members to be more involved in the decision-making process.
I have seen an example where the entire patient history is reflected in an interactive 3D anatomical model with colour coding to signify presence of a record (by body part or organ system) and presence of a finding. More importantly, this model extracts the key information from the medical record and leverages this to bring decision support to the user. Amazing!
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