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Executive Interview: Making Big Innovations Without Risking It All with Mark Galea

[00:00:00] MEDITECH empowers healthcare organizations around the globe to expand their vision. of what's possible with Expanse, the intelligent EHR platform. Expanse answers the demands of an overburdened workforce with personalized workflows, interoperable systems, and innovative AI applications, all working together to drive better patient outcomes.

Discover why healthcare organizations of all types and sizes choose Expanse to meet the challenges of the new era in healthcare. Visit EHR. MEDITECH. Com to learn more.

I'm Bill Russell, creator of this Week Health, where our mission is to transform healthcare, one connection at a time. This is an executive interview

quick powerful Conversations with Leaders Driving Change. So let's get started.

Drex DeFord: Hey everyone, I'm Drex. I've got Mark from Willis Knighton Health here with me today. Welcome to the show.

Mark Galea: It's an honor to be here.

Drex DeFord: So why Willis Knighton Health? What was the thinking [00:01:00] when you went there?

Mark Galea: You know, with my background I've deployed and actually had to do turnarounds on deployments with some of the most prominent EMRs out there with really big, well-known places like Parkland, Stanford, the Cleveland Clinic.

And you know, the thing that really got me very interested in Willis Knighton was that it was an opportunity to show and demonstrate that a world-class EMR result can be achieved. Really at a fraction of the cost that most organizations are faced with. And you know, my fundamental belief is that with the right people in the right approach, and obviously with an EMR and technology solution that is capable, that's a, you know, necessary entrance point, right.

But with the right people in the right approach, you can get really. The same or better result at the fraction of the cost because kind of at the end of the day [00:02:00] with most of us in running technology and healthcare, I mean, we don't have an unlimited amount of money, right? And we invest and have a huge demand for technology.

And really, the question is should you be spending your money on advanced clinical diagnostic equipment? Or execution equipment. And we have a lot of robotics here in our organization and a lot of advanced technologies. We were one of the first organizations at Willis Knighton to put a proton therapy asset in place.

But the opportunity was to basically demonstrate that this could be done and you could gain, you know, world-class results at really a fraction of the cost and possibly. Redirect that spend to buying more clinical assets or buying a hospital or building a hospital, that's what we're talking about.

In meeting with the leadership team at Willis Knighton, it is just a great group with a fantastic mission [00:03:00] and a very similar mindset of you know. Patients first with providers and nurses second, and you know, the need to have technology supporting that group so that the best and most effective patient care could be delivered to the patients possible.

And Willis Knighton just was really a great opportunity to do that and frankly accomplish it in a short period of time. So that was really the draw for me. Really kind of like right place, right time, perfect fit situation for me personally.

Drex DeFord: It's not a small hospital. I mean, , you think about maybe I do this in other places, someplace will have a name that'll be associated with clinic.

And you think that it's small, but Willis Knighton is not small.

Mark Galea: No, we're actually, we are the market share leader in northern Louisiana. We've been recognized for that for many years. We've got four hospitals in a large rehab. We're about 1.4 billion in net revenue. We serve well over a half a million patients in northern Louisiana, and our [00:04:00] market's about a hundred mile radius around Shreveport.

But, you know, we see a million people. We've got every type of service you could imagine, and we give our patients no reason to wanna go elsewhere as part of our philosophy.

Drex DeFord: I feel like with your background too, they're really lucky to have you. That you are able to add something special to the mix at the executive cabinet level.

Mark Galea: You know, and the reality, I think it's mutual. , It's been extremely challenging.

I've been here about two years, but you know, as you come out of COVID, the one thing we've learned, technology is a huge asset to healthcare and health systems. And there's a lot of pent up demand, if anything that came outta it. COVID proved right, is that, you know, all the things people wanted to do before COVID that they had to put on the back burner just got amplified afterwards.

Speaker 3: Yeah.

Mark Galea: Yeah. So, high desire to enable and embrace technology, and for me a place to do a lot of different things that [00:05:00] really makes an impact on our patients, doctors and nurses.

Drex DeFord: So talk about digital transformation and the digital transformation. You know, you get there, you get started, there's a lot of work going on.

You talk about this backlog of stuff. Where did you start? How did you get started?

Mark Galea: Yeah. Well, it's actually pretty easy. So the first thing I did is I went and I talked to all the leaders. Within a couple weeks before starting. I interviewed probably 65 leaders and I got they're top things that they were most interested in needing. So I came in with a plan but the call to action was actually pretty straightforward at Will Knighton. You know, unfortunately Willis Knighton invested in technologies that. In historical years that didn't work out so well. They had an ERP that they elected not to deploy because of cyber threats that pretty much took them down.

And then they built an EMR from the inside out and with another vendor where [00:06:00] basically the deployment model was. To build up your own clinical workflows and solution as you go and as old timers know, I mean we can't name very many CIOs who actually remained employed, who tried to build their own EMRs.

It's just really hard. And I could tell you around, I remember around the nineties when about a slew of them ended up going and doing different things. 'cause they tried to build their own, but doing it yourself is super hard. So they went through. Probably six or seven years of planning and prep.

And then the company got bought and the company that bought them came and said, Hey, you know, that's great, but we're gonna force you to go to a new platform. And at that point. Willis Knighton said, well, you know what? I think we're gonna go back to the one tried and true partner that we have in this, and we're gonna look to them to help us deploy.

That's MEDITECH. It's affirmed that they trusted and worked with over time and they deployed acute in about a year. Which is very similar to the experience [00:07:00] I had at Parkland where we deployed Epic in about a year out of a, you know, really a stressful and financial requirement. But I came in after that ACUTE had settled

with a call to action to really stabilize the environment and then deploy expanse to all the clinics. So we have about 140 clinics that needed to be moved. They were historically on kind of a build your own type of model. So we had to standardize and deploy in rapid scale about 140 clinics, which we did in about.

12 to 14 months. So that was really job one. What I kind of call part of the foundation. The other part of the foundation was stabilizing the performance and the infrastructure and then organizing the IT team to not only be focused on the customer, but also to be better focused on how to deliver.

Services in a predictable and reliable manner. And I'm, I would just say [00:08:00] like, I'm an ITIL bigot. I completely believe in the methodology with ITIL and PMM and so we started to adopt those types of operating models within IT to improve level of service.

Drex DeFord: I'm a Toyota production guy too. So this idea of good standard work and how do you get that foundation settled? And reliable and comfortable.

Really interesting coming in, kind of settling the inpatient side and then deploying to the ambulatory side, resistance in that or challenges how did you think about that and how did you cut through whatever the challenges might have been with that?

Mark Galea: the organization.

Had really come to a point where they knew that the way that they had been working historically wasn't gonna be the way they needed to move forward. So there was a lot of encouragement and desire to, changed the way that service was being performed and how it technology was being delivered.

So in that cc, being part of the C-suite cabinet is really [00:09:00] critical to that because I would just say the you know, doing change management became more of communication than decision making. People had a common alignment and desire to be on one EMR. And to deploy workflows and decision protocols that help doctors serve better and help nurses deliver service better and caregivers respond and align better. All focused on that. System is a core system, not just of record, but of management of workload. So the business and clinical leaders were already there. The IT technology was one that had to be built up and prepared in order to meet and accommodate the things that they wanted to do.

So you know, if I take it back to like, I was involved with doing case management and Pathways when it was all paper. Right. And it was a whole different thing getting people lying on paper versus them doing it electronically. Just so here it was a matter of enabling and really [00:10:00] unleashing the clinicians with our IT support team to build out the workflows, the orders, the documentation in the most effective way, and then also to help our IT team be able to know.

Which demands and incidents and requests needed to be responded to in the right way. Prioritization we're serving in the most effective way, and we relied on ITIL and PMM to do that.

Drex DeFord: that's a great story. So let me kind of continue that story then, from being stabilized, being deployed in both the inpatient outpatient environment.

Now we have this rapid evolution of. Healthcare technology tied to artificial intelligence. How are you looking at that artificial intelligence and how you're prioritizing investment and time transparency with your teams, all of that? Talk to me about ai.

Mark Galea: So we spent probably a [00:11:00] year and a half.

Doing the stabilization work and during that period our strategy was follow the leader. So when use cases were coming up for investment that were tried and true, and proven, we looked at them. And we picked a few that were able to make an immediate impact where the load on it was minimal.

And I'll tell you our biggest challenge was around ensuring that data was being protected and transmitted in a secure manner. And weeding through all of the vendors that who I call, you know, the land grab guys, trying to basically get market share to those that fundamentally had.

Solutions that could actually work and fit in our environment. And that really narrowed those candidates down quite a bit. we will not take a second step to data protection and data security. That's a, you know, I take that as a fundamental responsibility that, we are the protectors of data and all of the patient's data, and that is [00:12:00] Non-negotiable. You're speaking my language. How's that?

Drex DeFord: Yeah, I

Mark Galea: love that is the best way to say it. Right? So we did that and and then in terms of ai what we've adopted is we're trying to help the organization figure out how to embrace it. There's a lot of pen up demand here in a lot of desire to try.

New technologies and do things. So we've done a few things. We formed an AI governance council that's really a cross-functional group that is focused on not only helping us determine what is responsible and ethical use, but also helping us figure out. What's the best way to help guide and help the organization embrace the use of ai?

And I'll come back to something given our size. You know, we don't have a lot of funds, you know, we're, we don't have funds in technology for RD, right? Right. So we're looking at proven solutions. So we use tried and true examples and techniques to provide that. So we can look [00:13:00] at. Companies like Microsoft, other health systems that have done the same thing.

And then figure out what components we wanna adopt, but then do that quickly. You know, improvement's all about making change, making decisions and velocity. Right. So we're using the council to help us. Not only help people understand how do we want to use AI here? What's acceptable use?

And then what use cases should we be running at? And then which partner should we be working with in order to help us show results, get people excited, show real clinical and process improvement results. And I think our careful. Follow the leader approach has helped us to avoid making some mistakes that o other folks have made.

It's interesting. So we're learning from the industry, if you will.

Drex DeFord: So it's really interesting. I talked to A CFO the other day and the CFO said something to me to the effect. And now I've heard this term placing [00:14:00] bets from CTOs, from CIOs over the last several weeks. I kind of have been listening for this term, but the CFO said.

There used to be a time where I could try things, I could place bets on technology, potential capabilities, and I could lose the bet and I would be okay. But I've kind of moved into a version of the world now where the bets I place have to be sure things. And that's really the approach that you're taking and the follow the leader approach.

Mark Galea: My whole career, I've never had the luxury of placing bets. When I got hired to transform things, it's either I did it or I got fired. Okay. Guess it's probably a the way that I look at the world, but like, we don't have enough money to try things.

For fun. I agree. Yeah. And, you know, being our size I I would put one other thing out there that's really, to me, the most important thing. we've done a lot of adjustment in [00:15:00] technology that impacts our doctors and nurses. We have done a lot of things that are actually changing their workflow that they probably wouldn't do unless we.

Enforced it with our EMR uhhuh. Okay. What I'm trying to do is get us back to even get our doctors to the point where they're saving time. And they can look at the system and go, Hey, you know what? I can see more patients now. So I'm looking at technology as a way to get back to even, I want them to be able to see as many patients.

As they did before and get better results, get paid more accurately and effectively from based on what they do. But the bottom line is help them help patients and the more patients they can serve, the better job we've all done the better we can help our nurses and our clinicians support them. The better job we've done us in IT.

I mean, we are the folks here to support them, not the other way around. So I think we all owe it [00:16:00] back to our people that are serving patients to help them do better and that's what's really driving our investment strategy. That drives how we allocate our time on innovations and projects.

We ask that simple question. We try to ground this with all of us, and it's like, what are we doing to help the doctor, the nurse, or the patient? And if we can't answer that question, we step back and pause and you know, we work through it. We make sure we know what that end result's gonna be. And that's really wired in everything we do.

And it's an easy thing to lead IT people with they all, I mean. Everybody aligns to this really well, and it excites people.

Drex DeFord: I think having that kind of alignment to giving them a true north, this is what we're doing every day. Here's a question you should ask if you are ever confused about whether or not this is a thing we should be doing.

Yeah. Come back to that anchor point.

Mark Galea: Yeah. And I think the tough part is getting the leaders to make the decisions on what comes first, what comes second, what comes [00:17:00] third. I don't wanna be doing that for our leaders. I want our clinical and business leaders to make that. We do that and sometimes it's an uncomfortable discussion as it should be. You know, there's competing conflicts for, improved digital and automation and, there's a lot of way offs, but I'll come back to the question that you answered. It's like. Placing bets. I mean, we don't have the luxury to place bets.

Is the problem. We, and that really

Drex DeFord: helps with the prioritization. I mean, nothing brings clarity more than a lack of resources. Right?

Mark Galea: And then working with a third party and saying, okay, prove it. Show. Show me how it works. I mean, I'm not an alpha, I'm a bad alpha. I'm a okay beta, not the greatest, but I like wanna be 10th or 15th in, not in the first 10.

I don't want to live through those, you know, getting through those mistakes if I can, that are natural in any new technology deployment.

Drex DeFord: Mark, one of the things I wanted to ask you was that you've.

Also had some [00:18:00] really good results from the work that you've done with the team, can you tell me about some of the work and some of the results that you've sort of had given all this background, all this effort?

Mark Galea: The first thing I would say that is, is that what I'm gonna share is really the result of our entire team really rowing north together and taking ownership for these initiatives. I dunno if I mentioned, but we've got about 90, 95 people that are employees, and then we have another 15 or 20 contractors okay. Is really part of this group.

But, you know, a couple things, besides deploying the EMR we basically did it in the desired timeframe. We got all the clinics up and then really within maybe a week to two for all those clinics, we got them stabilized back to the point that they were pre-live. You know, a couple of key things that happened with that we standardized all of our ordering and clinical [00:19:00] documentation across all those clinics, and we did it in terms of specialties.

So there were 32 models that we developed, all designed to optimize what MEDITECH Expanse can provide and then actually minimize. The doctor or clinician workflow within the system. And that led to some really great results. So, I could tell you for example when we track, like our sepsis scores our sepsis scores dramatically reduced through the use of the data that we're documenting very discreet in running 'em through algorithms that we set, that we saw nearly a two standard deviation decline.

Speaker 3: Wow.

Mark Galea: In the sepsis rates and our response and ability to respond to those.

We have a standardized multimodal VTE Prophylax protocol that we developed. I think if I say that 10 times, it's

Drex DeFord: a little time twist differently,

Mark Galea: But that was used as a way to help us [00:20:00] prevent or actually reduce the incident of promo Em belong Embol events during inpatient stays.

We have our medication safety and pain management program. We have a big effort to reduce the use of opioids. And so our order set protocols. Have automatic triggering around the use of Narcan, and we've seen a two standard deviation reduction in the use of opioids around these protocols.

Wow. As a direct result. So these are great examples. There's dozens of amount there where we're trying to basically show real improvement in outcome. A few things that were really key that we did to redirect cost in the most effective way. Oh, yeah. So I don't think I mentioned this, but we're.

A 25 to 35 percentile it OPEX player. So we're in the lowest cost performing quartile. And when I started, we were about average [00:21:00] and our objective was is to redirect that spend to modernization in new technology. So we did a couple things. One is we eliminated a couple of redundant systems. We consolidated a lot of the patient messaging that we do.

So we had a single platform that we do that with and eliminated some of the unnecessary spend going on there. But, one of the biggest things we did is we converted contractors to employees and that move. Freed up an enormous amount of money that we could then either apply to innovations or CapEx.

But we brought our spend level back to the point of pre-deployment on the EMR. And we did that this last year. The third thing is we renegotiated a bunch of the vendor contracts. And really curbed unnecessary spend in that way. And I'll give you a couple of examples of some things where we did some selective [00:22:00] sourcing, purely driven by the use of contractors.

So we had like, you know, 14, 15 contractors writing reports. And so what we did was we moved that to a sourced model with one of our existing partners and then implemented governance around it. And it's all around analytics. Yeah. But we are doing probably three times the report generation that we were before with a third of the people.

And in terms of the cost per unit for that you know, we eliminated some of that labor, but even with the labor that we did a long-term agreement and we cut that cost by about 30%. So we got a lot of great results. Now what we're trying to do is accelerate the use of analytics to get more clinical and business results out from the examples that I showed.

But these are examples. I mean, we deployed the oncology module without bringing in outside people, which was amazing.

Speaker 3: Wow.

Mark Galea: [00:23:00] Actually, Uhhuh, so lots of examples like that, it's been a, a challenge for our enterprise because that also meant we directed a lot of it people for these big projects versus really what I would call discretionary.

Types of work we might have done before. So we've all done it together. We've all kind of made a lot of sacrifice, but the results financially have been really strong as a result.

Drex DeFord: So, mark, a lot of the work that you're doing, I know you're also digital health technology as a team sport.

You're focused on a particular group of partners and you've actually spent a lot of time thinking about who are those partners? How do you limit the number of partners on the spirit of sort of simplification and standardization. Talk a little bit about that.

Mark Galea: I think we've taken a pretty pragmatic approach to that.

We look to probably three partners for a broad variety of innovation and investment. As well as you know, looking to them first for new things, and that's our [00:24:00] EMR vendor. MEDITECH. We go to them first whenever possible. CloudWave is our hosting partner, so we have about half of our stack locally and half of our stack at CloudWave, and so we look to them as well.

And then we also look to Microsoft. Microsoft is our primary. Source for security defense. We use other vendors, but primarily Microsoft. And we also use them quite heavily for cloud services using Azure and the like. So we tend to look at those three in the innovations. In investments they're making and ask ourselves the question, how can we best benefit by that?

How does that crossover into what our priorities are? And then we would go to them first for those solutions where that. Cross matches, and then we keep an open ear to them on things that they're trying to do or test or evaluate to be, you know, a good partner with that regard

Drex DeFord: because you're of a particular size, this is a good opportunity for them also to be able to test things [00:25:00] at an organization that's kind of very well represented across the country, size wise.

Mark Galea: Right, right. Agreed.

Drex DeFord: Last question I'll ask. You've been very generous with your time. I appreciate the insights. They've really been incredible. If you could offer some advice and guidance to anybody else, any other CIO, any other healthcare IT leader or for that matter, just healthcare leader not in information technology looking to do digital health transformation, what would the advice be?

Mark Galea: you're a CIO you have to have the business and clinical leaders help you make those priorities. And you have to have those people part of your team. We have the person that is over the clinical EMR used to run the informatics team.

He's perfect for that role. He knows the nursing workflows. And he knows the EMR product. We have a physician advisor [00:26:00] who loves building and optimizing the EMR. He's the perfect person to help us. Evaluate what the clinical protocols should be and how we should be describing them in the EMR.

So I mean, part of that advice is to have the right people on the team to do those key functions that you need. And then I think the other thing is recognize the suppliers that are really investment partners versus those that are, you know, delivering tried and true proven use cases. I mean, you have some folks that are great at platforms and others that are great at products, so recognize what that is.

I for one, have been a one EMR guy. I've been that since probably, you know, 2008, 2009, because I've just seen so much money being wasted by just moving data. [00:27:00] So, you know, I am definitely one of those folks that say how I want it all in one EMR. So we use MEDITECH Expanse, and the first thing I always ask when we look at technologies is what's MEDITECH doing with Expanse?

What's their roadmap? How does that compare to what we might be looking to buy? Should we, or should we wait? Should we do something interim? Or should we actually make that investment that might not be? Completely aligned with our EMR and I, they have us do that thoughtfully. But what it does, and this is kind of the third piece of advice, is beware of the drag created when you start adding too many tools and the impact on cost and people that it takes.

In order to actually support and bring them out into the environment. Tools outside your

Drex DeFord: normal platform.

Mark Galea: Yeah. Yeah. I mean, I, thoughts to, you know, total cost of ownership. Look at it more than just one year. Look at it, five to seven years. What is this really [00:28:00] gonna do?

And is it the best investment to make?

Drex DeFord: Great advice. I appreciate it. Hey Mark, thanks for being on the show today. I really appreciate it.

Mark Galea: Excellent, Drex. All right. Very good. It's great to talk to you and it's been an honor.

Thanks for joining us for this executive interview with me, bill Russell. Every healthcare leader needs a community they can lean on and learn from. Subscribe at this week, health.com/subscribe and share this conversation with your team. Together we're transforming healthcare.

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