We're here today with Doug Burkhardt.

Uh, a Baptist Health Jacksonville.

He's a senior director of IS business operations.

Doug, thanks so much for joining us today.

Yeah.

You're welcome.

Happy to share.

So for those who don't know about this, health is a health system based in Jacksonville.

Florida operates 7 hospitals and 200 ambulatory clinics, and the system with 1100 beds and 2400 providers.

Today, we're going to be talking about governance strategies in order to improve efficiency and large health care delivery systems and achieve other desirable outcomes on the screen for those who are watching this and for those who are listening, you can go to podcast.healthydata.com to view the video recording and look at what Doug is sharing on the screen.

We're going to run through a new concept of governance within kind of A-frame.

Of that, Doug will operate in a moment.

So Doug, going to hand it over to you, could you please explain the book that you read as your inspiration and kind of what we're looking at and what you were able to do?

Yes.

So I pulled this from actually a lot of different sources, but the the forward means a governance.

These are not like, you know, personality traits.

These are sort of, I'll say, situational.

Umm, so the a couple of ways of looking at this are these four different opposing forces and the idea is to find a balance in between.

And there's that famous book, the Art of war, where cinzio talks about you have to identify your enemy if you're going to fight your enemy.

And so I thought, well, you know, these are kind of four different enemies of governance frankly.

So while these might look like personality traits are not as applied to governance, these are the things we want to avoid.

So if we wanna fight our enemy, we have to identify our enemy.

So one of the enemies is bureaucracy.

Obviously with governance, there's so many different committees that things need to go through and I believe in, like minimum viable governance, applying the least amount of governance to get a result in to get a decision or to make a prioritization decision.

So bureaucracy is definitely an enemy of gardens.

Probably the one thing people think of the most when it comes to governance and it's thought of as being safe analysis paralysis, including as many people as possible to make a decision and then any time you starting including vast numbers of people to make a decision, that usually leads to inefficient decision making.

And if it takes 6 to 8 months to make a decision on something, the opportunity is probably already passed, or it's just sort of lost momentum.

So that's kind of an all rules bureaucratic enemy that we have to fight.

Now the opposite of that is all risk.

So imagine no rules, no standards.

Chaos.

Let's say someone buys a product.

They haven't involved it.

They throw it over the fence to implement and it turns out my goodness, we need like a whole bunch of servers to stand this up or it's on a different platform we don't support.

We know the skill set for it.

It didn't go through any vetting, but because they had the budget for it, they were able to buy it.

And that's sort of like a no rules, no standards, absolute chaos.

Anarchy thing that we need to avoid as well.

So that's the that kind of that vertical axis when avoid that too, but.

So just to pause for a minute for a listeners who aren't able to view what's being shared, we're looking at a AX&Y vertical axis.

You have a circle in the middle on the top you have anarchy directly below it.

You have bureaucracy on the left hand side, you have mediocrity and the right hand side you have toxicity and the middle.

You have balance correct.

That's right.

Balance is where you wanna as you get pulled in these different directions.

You want to find a balance in the in that situation.

And before we jump into mediocrity and toxicity, just to kind of I know you're into photography, so I wanna frame the conversation with just the right lens.

If you allow the metaphor.

Very well done.

Umm you you've mentioned that in past years Baptist had an IT led IT decided governance structure.

I think many of our listeners can identify with that kind of this feature sets are XYZ and it sounds like you made a reference to Simon Sinek about starting with why, where you flipped it around to saying business led and business driven structures.

So instead of saying, here's the features.

It sounds like a lot of what you're working with with governance was determining making decisions based on why we're here, what the desired outcome.

Yes.

And within that context, that's how you set up this framework, right?

Yeah, I think IT people get wrapped around the feature sets in meeting the requirements when in reality and governance it's what's the problem we're trying to solve because it it's almost always solved by people in process and technology is just an accelerator for good people, meaning knowledgeable people that know what they're doing and good process.

So technology being that accelerator and knowing why we're doing something is usually the fastest way to make a decision when there's lots of feature sets and requirements.

It's just difficult to make decisions at at a governance level of an executive lever level of why we're doing this.

In fact, going back a few years, I was a new person.

Executive leader had joined.

I was going through our portfolio stack that different organization and I was going through each of these things and as explaining what these projects where I was describing the what and she said to me, Doug, why are we doing these?

Uh-huh.

And I was sort of taken aback.

Well, I I said, well, I I described what it is she's like.

No, Doug.

But why?

Why did the business ask for this?

And it's sort of like ohh my goodness, that's a really good question.

I was kind of embarrassed that I couldn't explain why we were doing it because frankly the business wasn't explaining why they were doing it.

So any time I talk about a project, it's always the why.

OK.

In fact, we just stood up a brand new project management platform service now and I built in a field when we receive requests, not just description of what you want, but I call it the why custom field we built in the why why are we doing this and the why isn't just a description of the what it's truly like, what's the business background context that has nothing to do with technology about why we do this thing.

We want to do.

So what I'd like to allow you to do now is complete your explanation with mediocrity and toxicity, and I'd like to launch into a concrete use case example where you applied some of these principles to actually improve the organization.

With this governance model.

Yes, certainly.

So our picking up where we left off on this other side so far to the right is what I call it toxicity, where it's, you know, just results over people's short term benefit is usually what it what it leads to and not long term benefit.

So imagine saying we've got to get this thing done.

I don't care if you've got to work a weekend or cancel a vacation.

All I care about is getting this result full stop, not caring about the people, which is obviously not a very long term strategy to have.

And so we want to avoid those things and planning ahead in time.

The opposite of that.

So going to the left, the the other extreme is well, I'll call all people haven't thought of a better name for it, but it's just really only about making sure everybody's happy and satisfied and all their needs are met.

And if things don't get done, well, that's OK.

No problem.

We'll get it next time, and this is constant kind of excuse of why things are not getting done well.

That leads to a lack of accountability at that level.

And again, nothing seems to get done.

We want to avoid that too.

We wanna avoid mediocrity, but we don't wanna pivot all the way to toxicity.

Yeah.

We wanna want to find the balance in between those two things.

I appreciate that.

So just to recap for our listeners who aren't able to view the chart here, if you pursue a strategy of all risk that leads to anarchy, it's opposite.

All rules leads to bureaucracy.

That's up and down on the right hand side.

If you pursue all results, that's a toxic short term culture could lead to burnout or conversely on the left hand side, all people will lead to mediocrity.

So the ideal is not to be extreme and any of these four measures, but to achieve balance in the middle.

So Doug, would you walk us through how you use case of how you've applied this governance model to improve Jackson Baptist Health Jacksonville?

Yeah.

So I talked about it one time again, a situation I was not not here on with Baptist Jacksonville, but in other instances where people buy things Willy nilly and they throw over the fence, other instances where it's just too much bureaucracy.

Well, it's it's these large scale massive projects that you've not included all the stakeholders that you need from the beginning to to get to a result of do we do this or not.

So if it's a an instance where it's a platform that's going to either replace a different technology, it involves nursing and involves physicians patient care.

But it's only been sort of vetted from a small, insular it perspective, and you haven't gotten those stakeholders on board early enough.

That's where those decisions for in bureaucracy will start to stall, because as they go through that decision making process, you'll find that people say, well, wait a second.

I didn't know about this and what's this all about?

Because it was only being handled sort of on the IT side of things.

Uh-huh.

So is it and even not just large things, even small things, if they're not being brought through the governance by the business, and it's just sort of just within IT.

That's that's leading this.

You're gonna find that things tend to slow down, and that's the other thing.

One of the things when I was developing the governance structure with our doctors and executives and nurses and everybody within Baptists, I wanted to flip the script.

So this is an IT governance that has led by the business and owned by the business.

So everybody on our IT committees, they're all business leaders.

It is there as they guided advisor, but IT is not making these decisions.

It's the, UM, the business is on, is the board and they actually the business person with the project brings it to that board and we talk about it and we always it always comes around why we're doing this.

Yeah.

How did?

How did how is IT been responding to essentially having been cut out of as a voting member of the governing body?

No, not cut out.

We love it.

I imagine this.

Imagine if our the people at Baptist that are in charge of our real estate in buildings and facilities just decided to start building and buying land all around Jacksonville and then they're saying, you know, it would be really good to have a primary care here and it'd be really good to have Pediatrics here and like, wait a second.

You guys are facilities and real estate people.

You're not clinicians.

You're not business people.

It's the same thing with it.

There's no difference.

We would never just start building technology and saying, hey, this would be really good for you to use.

No, we want the business to say, hey, this is where some these these this is where some problems we have with these are some opportunities we can take advantage of through people process and then again technology has that accelerator just like it would be like for the business to say you know what we're finding a lot of neighborhoods are being built here.

Let's put some primary care there.

So it sounds like the old model was building a solution in search of a problem.

To a certain degree, absolutely.

And you know IT.

So.

I I'd say in less the business is at the center of that discussion.

Umm, you're a lot of times.

Rarely do we know exactly what the business needs.

They are.

They are alongside us and they're the ones that are making a decision and it's not it.

We're the trusted advisor and we can help prioritize and sequence things, but ultimately it's the business that's making these decisions for it.

How do you?

I mean you you mentioned an example of integrating a new technology platform.

Umm, I mean is that an example that you've actually gone through with this governance model?

Can you finish walking us through the how that project got to completion?

Uh.

Let's see a lot of them have been new epic modules we implemented Epic last August and there are subsequent modules that were needing to add based on the demand for for the business.

Or.

And so we were typically.

What was the why?

Maybe for one of those epic modules, what was the?

What was the reason why you were implementing that new Epic module?

And then how is that implementation or the way that that project got executed different because of this governing model than how it might have been done a year or two ago?

Well, I really can't say how it was done a year or two ago because I wasn't there, but it's it's definitely from the perspective of of the business thing.

Yeah.

We wanna grow the service line in this area and IT you're along for the ride with us and not the other way around.

Umm.

Umm.

Got it.

I'm.

So and and the outcomes of this new governing model.

It's gone really well.

In fact, we're starting to find some really good data in these decisions.

So for example, interfaces, they're they're small in nature, but they're they're projects, they don't.

Umm.

They don't cost a whole lot, but we wanted to vet these things through our governance model.

We found out like, you know, actually these are pretty small in nature.

We don't need to govern these things as we do a large scale project, so we're starting to get to the point where we're figuring out what are the small enough projects that go through a formal governance structure or which ones are just obvious that are going through.

Yeah.

I think anybody that's in governments understands that, you know, not everything can go through governance.

I think of governance as like I hate to use the analogy, but like the federal government, we're like passing laws.

We're doing big things.

We're not doing the parking tickets at the local level like the order set build or that kind of stuff.

With that.

That's not something that's governed through this structure.

There are a separate governance structure for those operational type things, but this is like the big things that we're doing as an organization.

Uh-huh.

Have you set a threshold for the size of a project that goes through the formal governance structure?

We have not only because it's so new, there is a there is a lot of Gartner material that I've referenced as far as like, you know, how big is a project?

Well, a lot of times you can't do it based on the cost of the project.

A lot of times it's the complexity or the risk, so there's no hard and fast number, Gartner says 400 hours.

But what if it's a project?

That's 200 hours, but it's extremely important.

It's got to get done, you know immediately.

There's a high risk if we don't do it, whether it's, you know, we get there's a fine associated with or it's governance compliance.

So there's a tricky topic to say.

What's a project?

And I think any PMO director I've spoken with, they all have the same question about what's the threshold for a top for a project and really it's a give and take.

Then who determines if there isn't a defined preset threshold?

Who's the one to determine if the 200 hour high risk project with a lot of complexity and the risk of a fine is something that should go through this governance structure?

It's typically along with the business, our IT executive team has a good example, has a good understanding of you know what that threshold is just based on experience and a lot of times it's like you're rustics just like I said, it's a highly risky project or it costs this much.

So there's no real rubric that we have to determine what's a project.

We have rubrics for scoring of our projects.

As far as complexity, risk and value, but not a threshold for what's a project.

Got it.

So the whole board, the whole governing team, they're the ones who kind of vote on whether something is large enough to require the board's attention, kind of like the Supreme Court, whether they choose to accept the case or not.

That's correct.

Yeah, yeah, I hate using the big government approach, but a lot of times it applies when it comes to, you know, IT governance.

So.

Right.

All right.

Well, we're approaching the end of this podcast episode and we've covered a significant amount of ground of you've introduced a new governance model, Baptist Health Jacksonville, where you flip the structure on his head from instead of it led governance structure to a business like governance structure, beginning with why I guess I'd like to ask you to wrap up this episode by talking about you come in there and this is the way things have been done and you try to propose a new way of being done.

Now, what was the why that led to you creating this new governance model and how did you work to get people on board with changing the way our governance was led at Baptist Health?

Well, I don't want to think I'm the only one that did this.

This is definitely, I'd say the voice of the business needing to be involved in wanting to be involved in decisions that are made within IT, just like the example of we would never build buildings, the facilities people would never build them on their own.

And I think that's actually one thing that our business people relate to is like of course, we've been never have them just build buildings and buy property where we weren't involved.

It's the same applies to it.

Umm.

Got it.

Alright.

Well, thank you very much for listening.

This has been Doug Burkott, the senior director of IS business operations at Baptist Health Jacksonville.

Doug, thank you so much for joining us today.

Yeah.