November 5, 2024 • 41 mins
Scaling Success in Healthcare IT for Alberta Health Services
Today, my guest is Penny Rae. Penny is the Chief Information Officer for Alberta Health Services. AHS is the health delivery organization for the province of Alberta in Canada. AHS is the largest health care delivery organization in North America. And with nearly 150,000 employees and contractors, it's one of the top five employers in all of Canada. The IT department alone is 2,500 people. So the scale of Penny's operation is massive.
Penny has spent the last few years leading a rollout of the EPIC health care management system as a wholesale replacement for hundreds of individual healthcare information management systems. It's one of the largest IT projects in Canada. And in an industry where only 30% of IT projects like this reach success. Penny's approach is beating all the odds.
You're going to hear Penny talk about culture and trust as the driver for success and her own philosophy about how to lead technical teams. I hope you enjoy the conversation.
--
Resource Links:
- Greg Price story, Falling Through the Cracks [2017]
- Cynefin Model
- Sense and Respond
- Penny Rae - National recognition for AHS Chief Information Officer (2018)
- AHS selected Epic Systems Corporation as the partner for Connect Care. (link to FAQ PDF)
- https://northern.co/311-podcast
Recorded in May 2023
This is a show about the people that make digital public service work. If you'd like to find out more, visit northern.co/311-podcast/
We're going to keep having conversations like this. If you've got ideas of guests we should speak to, send us an email to the311@northern.co.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Penny Rae (00:00):
I'm Penny Ray, the CIO for Alberta Health Services.
Paul Bellows (00:04):
Wonderful.
And then maybe just because noteverybody in the world
understands the Canadianhealthcare system, you do have
some, uh, some non-Canadianaudience here.
Maybe just a little bit abouthow Alberta Health Service
operates its mandate and how itmight be different from how
healthcare is delivered in otherparts of the world.
Penny Rae (00:19):
In Alberta we have a public healthcare system, and
Alberta Health Services is asingle health delivery entity
that reports into the ministerof Health and it is accountable
for the majority of acute care,a good chunk of the ambulatory,
about a third of the long-termcare, a spattering of primary
(00:41):
care, and it works inconjunction with community
providers, who are primarilycontracted and primary care
providers, who are contractors,in the community.
And so it's a very interestingorganization to work with.
We have about, 110,000 peoplethat work for AHS in IT.
(01:01):
We actually support otherorganizations as well, so we
support Alberta Health Services,Covenant Health, which is a
faith-based care center, Lamont,which is another faith-based
care provider, Care West andCapital Care, who are two wholly
owned subsidiaries who dolong-term care, Alberta
Precision Labs, and Dyna Life,who is a contracted lab
(01:22):
provider.
So in all, we have about 140 to150,000 people that we provide
IT services for.
Paul Bellows (01:30):
My understanding is Alberta Health Services is
one of the largest employers inCanada, not even worried about
the province of Alberta or thisregion.
Where do you rate in terms ofsize of employer in the country
of Canada.
Penny Rae (01:41):
So we are the largest in Alberta.
We're behind the federalgovernment, I believe,
Canada-wide, but we'redefinitely one of the largest in
Canada, probably top five inCanada as well.
We are one of the five largestIT shops in the, in the country.
We have, well, depending on howyou count people and
contractors, we probably have inthe order of two and a half
(02:02):
thousand people that workdelivering digital health to
Albertans.
Paul Bellows (02:07):
That's a massive workforce.
Penny Rae (02:09):
Mm-hmm.
Paul Bellows (02:09):
2,500 people in IT is, you know, we're getting
towards unicorn scale here interms of the size of
organization you would be in theprivate sector here.
Penny Rae (02:17):
Yes.
Paul Bellows (02:18):
That's huge.
So, You're Chief InformationOfficer.
One of the questions I love toask folks, the CIO role, are you
the Chief Information Officer,the chief infrastructure
officer, or the chief innovationofficer?
Because they all start with I,and they're all sort of
different backgrounds and youhave a bit of a unique way you
got here.
How do you see the role of whatyou're here to do?
I'd love to actually hear alittle bit about how you landed
(02:39):
here?
Cause it's not a traditionalcareer path to this role.
Penny Rae (02:42):
No, I would see myself as the chief information
officer.
Really thinking about how do youget information from where it is
to where it needs to be?
How do you collect it?
How do you make sure that peoplehave it?
And how do you make sure thatpeople have the right
information at the right time?
And in healthcare, that'sparticularly important, right?
You want the right informationabout the patient at the right
place and the right time so thatyou can make the best care
(03:04):
decisions for them.
My career path was veryatypical, eclectic, I like to
say.
I'm a chemical engineer bybackground and I started work
with Exxon, so Australia and Iworked offshore oil and gas.
So I've been on oil rigs andI've got helicopter underwater
escape training.
I've got all sorts of weird andone firefighting training, all
(03:25):
those types of things.
I moved from there into HR,which was an odd sort of jump,
in an accounting firm.
And so I worked withPricewaterhouseCoopers first in
their HR department doing alltheir graduate recruitment.
And then I moved into internalaudit, from internal audit into
consulting within PwC[PricewaterhouseCoopers], both
in Canada and Australia becauseI married a Canadian.
(03:47):
So here we are.
Paul Bellows (03:48):
Well done.
Penny Rae (03:49):
Then I got seconded to lead the physical
infrastructure for the healthsystem as AHS was formed in
2009, 2010.
And so I was originally meant tobe doing some of the merger and
acquisition work in that group,as a consultant.
I was brought in to make sureeverything came together and
then hire my successor and theteam at the time had said, no,
(04:13):
no, no, stay.
And so I ended up staying,leading the capital management
team, which is.
Infrastructure, construction,real estate maintenance,
parking, security, that type ofthing.
My boss at the time had said,oh, you know, IT and Capital,
that's about the same.
They both have capital andoperating could you just do
both?
(04:35):
And so I'm like, well, I'll try.
So for about six months I didboth, which almost killed me and
IT really needed, they hadn'treally gone through the cultural
work they needed to do, which isreally, I think what, which is
unusual for an engineer, isreally what I think I'm good at.
And so they, ended up leavingcapital management and, and
(04:55):
keeping with IT.
And so it came in with noformal, like I did, I did
programming as part of myengineering degree, but really I
was very bad at it.
And I, my team even now tells meI could break anything.
Paul Bellows (05:06):
Well, someone has to be the ultimate tester.
Penny Rae (05:08):
I know.
I can test anything.
I, they're like, I've never seenthat before.
I'm like, of course you haven't.
Paul Bellows (05:13):
I don't think it's unusual that you would be
interested in culture comingfrom an engineering perspective.
Cause engineering isfundamentally systems and
interaction of systems.
It is not the entirety of whatengineering is, but it's a major
one of the cognitive skills youdevelop as an engineer.
Penny Rae (05:26):
Yep.
Paul Bellows (05:26):
I think culture work is also systems in the
interactions between systems,but instead of chemical
entities, we're looking atinterpersonal and behavioral
entities.
How people choose to behave,what they choose to do around
security, around design, aroundresearch, around testing, and
all of these behaviours that wewant from people, but don't
always get, when our cultureisn't strong.
(05:46):
I think often folks think whenthey say culture, they mean, oh,
is it fun to work there?
Are we nice to each other?
But that's, it's how do webehave?
Penny Rae (05:55):
Yes.
Yeah.
And how, what's the, and a lotof culture is built on what
level of trust do you have?
And so you start to say, wheredo people trust?
And then it'll get better orworse from there, right?
So if you don't trust, then youdon't communicate well.
If you do trust, then you cancan do things more efficiently.
And so, making sure that youhave a really strong foundation
(06:17):
of trust in your organization,in your team, and in the broader
organization is reallyimportant.
Paul Bellows (06:22):
For you, where does that trust come from?
What is your sort of secretingredient that you add as a
leader where you believe you'vebuilt trust?
I think this is trust comes issuch a, it's a hard thing to
gain, especially in IT with theorganization and then even
within IT.
Cause we have so many experts.
People who are experts ateverything.
Penny Rae (06:39):
Yeah, and I, so when I came, when I first came into
IT, and I've been in this roleon June the first 2023 for 10
years.
And when I first came in, ofcourse I had no IT background.
It was, people were veryskeptical.
And I sat in a room of my, mysenior leadership team about, I
don't know, 70 or 80 people, andeveryone was sitting there with
their arms crossed and saying,well, you know, who are you and
(07:02):
why can you do this?
What I had said to them at thetime is like, you don't need
more technical people.
You need someone that can helpyou translate, from where you
are into what they need and backagain.
And so I said to them, if aftersix months you don't think I'm
the right person for this job, Iwill absolutely find you
somebody else.
(07:22):
I think what's really importantis I am who I am all the time.
Every time people come, like oneof the, one of our great guys
who retired after 30 plus yearshad said to me, had an exit
interview with me.
We were talking and he said, oneof the things that, that I love
about you, and it's gonna sounda bit odd, but you're very
(07:42):
predictable.
I think that predictability interms of can I come and bring
you a difficult discussion, canI tell you the truth without you
exploding?
Like, do you shoot themessenger?
What does that look like?
And, and I very much came intoan organization that felt like
we shot the messenger.
And so I've spent a lot of timewith the IT team really helping
(08:05):
them understand like, I haveyour back.
I'm very, future focused.
So something may have happened.
Okay, let's fix it.
Right?
Like it's, let's not dwell onit.
Let's learn from it and moveforward.
And so I've been very consistentin my approach that, and people
can predict now what I'm likelyto say, and I'm building that
leadership capacity so that theydon't always feel they need to
(08:28):
ask me.
So I empower people to do whatthey need to do.
And I'm very predictable when wehave these discussions.
So if they ask me like sixmonths apart, they'll get
essentially the same answer sothat they know what to expect
and that they can bring forwarddifficult things.
And I'm like running a 1.4billion dollar project, which is
the largest in Canadian history.
(08:49):
You can't run a project likethat if people don't trust you
to tell you the truth aboutwhat's going on, because it will
very quickly derail.
Paul Bellows (08:57):
I love, you know, trust coming from predictability
and consistency and peopleunderstanding what is essential
to you and that not changing isfantastic, as a model for trust.
You know, communication could bea place trust comes from.
People need to know what you'rethinking and what's happening.
Penny Rae (09:11):
Yeah.
Paul Bellows (09:12):
But then, you brought this up and I just think
this is a fascinatinginitiative, that it's not just
one of the largest or thelargest IT project that you
said, but it's also in one ofthe most fraught areas I think
in IT.
Penny Rae (09:24):
Yeah.
Paul Bellows (09:25):
And in government, we deal with so many sensitive
pieces of information, so muchthat is meaningful to
individuals.
Healthcare even more so.
Even more so, we're dealing withpeople's wellbeing, we're
dealing with people's illnesses,we're dealing with people's
family, with their children.
These are places where peoplehave deep, deep feelings and
emotion connected to theinformation that they're
(09:45):
sharing.
Penny Rae (09:45):
Mm-hmm.
Paul Bellows (09:46):
This is not simply what year my car is.
This is, you know, maybe mygenetic condition, this is maybe
my child health.
Penny Rae (09:52):
And it's also interacting with them at their
most, most vulnerable.
Paul Bellows (09:55):
Absolutely.
Penny Rae (09:55):
Yeah.
So when they are not up totheir, they're not doing their
best because they're sick, it'sa challenge.
Paul Bellows (10:01):
Maybe the most fallible version of themselves.
Penny Rae (10:03):
Yep.
Paul Bellows (10:03):
Yeah.
Could you talk just a little bitabout what the nature of this
project is, and what it means toAHS as an organization and maybe
even to your constituents.
Penny Rae (10:11):
Mm-hmm.
Paul Bellows (10:11):
What is actually happening and what are you
trying to change?
Penny Rae (10:15):
So we started with one of everything, lots of best
of breed, and lots ofinformation embedded within
individual systems.
And as a patient or resident ofAlberta, what that feels like is
every single place I go, I haveto tell my story over and over
and over and over again.
(10:36):
And if I want any continuity, Ibring that pile of paper with
me, which is not it's not goodfor them.
It's not empowering to people.
It's a good recipe and we'veseen some challenging stories
like the Greg Price story,Falling Through the Cracks
[2017], if anyone's watched thatfilm that his family had put
together, which is quitepowerful.
It provides a lot of opportunityfor missing things.
Paul Bellows (10:59):
Mm-hmm.
Penny Rae (11:00):
So, We started with thinking, we had a look at an
assessment of is it better totry and integrate these thousand
systems throughinteroperability, and there's
ways of doing that, or is itbetter to pull them out and
replace them with somethingthat's built to be a single
system?
It's not really built to be asingle system.
(11:20):
We're using the Epic software asa core of Connect Care and we've
got about 85 systems that aredirectly integrated.
So it's not, it's connect careas a single entity from a
project perspective, but it's byno means a single piece of
technology.
So there's lots of it that we'reputting in place.
We had decided, we looked atthe, the pros and cons and the
quality that we were gonna beable to get to of information.
(11:43):
Cause every time you moveinformation from one place to
another, you lose some of it.
You don't quite get all thecontext that comes across.
So we had decided that we woulddo a, a rip and replace.
So we started, went out to rfpand this project, as we started,
it's the first time we hadbrought together the clinicians
(12:03):
across the province to have,start to have, a look at how do
we document some of theseclinical conditions?
What do we want it to look like?
How do these workflows work?
Because of course, we started asmultiple health entities and we
slowly consolidated, and we haddone a lot of work to
consolidate the corporateservices, but we hadn't done
anything in the clinical space.
So when we started, we broughttogether about two and a half
(12:27):
thousand people in our directionsetting.
So you can imagine we organized,a series of six.
The first three were just kindof getting started.
The second three werevalidation, but about two and a
half thousand clinicians.
In a conference style, three daysession.
So we had six sessions.
(12:48):
You
Paul Bellows (12:48):
had them all together.
Penny Rae (12:48):
We had them all together.
Paul Bellows (12:49):
Wow.
Penny Rae (12:49):
So we had, we booked out a conference center, a
couple in, like one in Edmonton,we did one in Calgary cuz they
shifted between the sites.
And we organized a schedule of,here are the workflows that
happened because the first piecewas all about workflows.
How do we do things in thesystem?
And we gave people a red cardand a green card, no Canadians
(13:12):
sitting on the fence,[no] yellowcards.
They had to decide, could theylive with this Part of the Epic
methodology, they show you whatthe foundation system looks
like, and say"can you live withthis?" If you can't live with
it, what do you wanna do?
But in the room, at any givenpoint in time, we might have a
couple hundred people who areincluding patients.
So we brought patients andfamilies together.
And the patients and familiesreally challenged our
(13:34):
clinicians.
Well, we couldn't possibly givethose patients their results
right away.
And the patients are like, whynot?
That's what I want.
And so we went through this veryintense design process on the
workflows with thousands andthousands of people from across
the province, from differentbackgrounds and different
specialties, and really startedthat change process of
(13:56):
understanding what does it looklike, what is it going to be as
we bring all of these peopletogether to design something
collectively.
And so we did.
That's the piece that we did forworkflows.
And then we went and built themand then came back and checked
with them that, is this what youmeant?
And then on the in parallel, wewere looking at the content.
So what is the standard contentif you have pneumonia?
(14:19):
What is the standard contact fora cardiac arrest?
What is the standard contentfor, like, what does that look
like?
And so in parallel, we hadset-up I wanna say it's about 34
area councils and those weremade of clinicians.
Another about two and a halfthousand clinicians involved in
this piece of work.
And looking at all of thedecisions that we needed to make
(14:43):
relative to what content we'regonna embed in the system.
So what is the, standard flowsheet for how we deal in the
emergency department.
All of those types of questionswe had to make decisions on.
And so as a government entity,anyone who works in government
will know it's a very slowprocess to make decisions.
So we had to get a lot faster.
(15:05):
So we made 5,000 decisions inthe space of about nine months.
Paul Bellows (15:10):
How did you track that kind of decision flow?
Can you just talk a little bitlike how that was actually being
like tracked and documented andshared and, and made, like what
did those decisions look like?
Penny Rae (15:19):
So we had, we had a support unit for each of the
area councils.
We had people documenting in thesessions live at the conferences
that we were having.
So you can imagine we had allthese people, we had all of the
list of all the decisions theyneeded to make and we would
document them in real time.
So that we could give them tothe build teams.
And then for the clinicalcontent, we had a whole bunch of
(15:43):
questions.
The support unit would prep thequestions with pros and cons,
here's what that looks like,what do you wanna do?
And then they would go into,those ones would go into a
SharePoint site and we wouldtrack all of them.
We would be able to filteragainst each of those area
councils and what they weredoing.
Paul Bellows (16:00):
Incredible.
Penny Rae (16:00):
But it was, it was a lot of work.
We have a Secretariat team.
That helps make sure we'retracking all of the decisions,
because of course we're spendinga lot of public money.
So we've had the auditor generalaudit us, our internal audit
people.
We've had, you know, every manand his dog wanna see what we're
doing.
The first clean audit report,ever, for a project here in
(16:22):
Alberta.
Paul Bellows (16:23):
In the province.
Penny Rae (16:24):
Yeah.
Paul Bellows (16:24):
The first clean audit report.
Congratulations.
Penny Rae (16:26):
So, and for something this size, so it was, it was
quite the undertaking.
Paul Bellows (16:30):
I don't know if you're familiar with the Cynefin
model of sort of like problemdefinition, it's a two by two
that came out of IBM years agowhere, you look at problem
spaces as simple, complicated,complex and chaotic Complex, I
think is the most interesting.
Penny Rae (16:41):
Mm-hmm.
Paul Bellows (16:42):
And sort of the fundamental definition is it's
an emergent solution.
There isn't something clear youcan take off the shelf.
Penny Rae (16:48):
Mm-hmm.
Paul Bellows (16:48):
Which in this case, since we're anytime we're
the biggest or the largest orthe most expensive, we're always
dealing with emergent solutions.
No one has quite done it at thescale before and scale matters.
And then the other dev thingthat triggers complexity is
multiple stakeholders, multipleperspectives are involved and
2,500 research participants.
And I don't think you get muchmore complex than that
(17:08):
environment.
Penny Rae (17:09):
No.
Paul Bellows (17:10):
You talked a little bit about, you came in as
a bit of a change agent at acultural level.
Penny Rae (17:15):
Mm-hmm.
Paul Bellows (17:15):
Just to say how we do the work matters as much as
what work we're doing.
So you're dealing with twothings.
You're dealing with a massivesystem change.
You're dealing with massivecomplexity, multiple
perspectives.
How did you design the designwork?
Culturally, what had to be truehere?
You talked about trust enteringthis, what had to be true of
this organization to be able toembrace a project of this
nature, of this scale, and withthis much ambiguity connected to
(17:38):
it, heading to a design processwith so many unknowns.
Penny Rae (17:41):
We did a lot of research before we started on
how this type of project fails.
Paul Bellows (17:45):
Mm-hmm.
Penny Rae (17:46):
And so we looked at all of the reasons for, from
clinical engagement, projectdelivery, leadership, and so
some in the leadership, some ofthat agility and vision and, and
it's a long hole.
It is a, it is a massive lift.
And when you think about it, inthe research we did when we
(18:06):
started, about 30% of theseprojects in this type of project
were successful.
So you're going into something
Paul Bellows (18:15):
sounds about right.
Penny Rae (18:15):
Yeah, you're going into something that's innately
fraught has had some really badpress.
And so we actually designed ourgovernance around the ways it
could fail so that we wereproactively looking at that.
We were poking at those thingsright from the beginning.
So when I first got here, we hadhired a CMIO, a Chief Medical
(18:37):
Information Officer and a ChiefOperations Informatics Officer.
So we have a nurse and a doctorthat are helping work on this as
well.
So we're doing it together.
Having said that, people stillsee us all as IT, and so it's a
bit of a, there's still that bitof a cultural shift and, and
because one of the challengeswe've had that I don't think
you'd see in a smallerimplementation is, and we did
(19:00):
this all through covid as well,so we started, our first launch
was right before Covid, and thenwe've had 4 sets, and we're
about to enter our fifth, oursixth launch, but we had four
during Covid.
Which was challenging.
But you need to get people tostart to think, well, I've
implemented in 2019, now I wantyou to fix the things I don't
(19:22):
like.
And so if you are implementingevery six months, which is what
we're doing, so we implementedin November, 24,000 people were
implementing.
Three weeks from now in Mayanother 20,000 people.
And you've often got an upgradein the middle.
So from a technical perspective,getting a whole bunch of
optimization is reallychallenging.
(19:44):
And so we've got this pent updemand that my team is working
with their clinical and medicalcounterparts are going through
close to 7,000, optimizationtickets that people would like.
And then how do you deal withthat, right?
It's just making sure they'vegot the right information, that
they're not overlapping, thatsomeone's saying, I'd like it
(20:04):
blue, and someone's saying, I'dlike it red.
And then how do you deal withthat, right?
You've got so many people, theprocesses you need to do to get
through it is, is a challenge.
So we have pretty goodgovernance and we've said to
people, don't come to fisticuffsat the working level if you
don't agree, escalate.
Yeah.
And then you'll get to a groupthat will make that decision.
But we don't want you to damageyour relationships cuz you need
(20:26):
to work together.
Paul Bellows (20:28):
I'd be interested to hear you talk just for a
minute.
You talked about the system Epicthat you're putting in place.
Penny Rae (20:33):
Mm-hmm.
Paul Bellows (20:33):
And it's a technology that comes with a
vendor.
Penny Rae (20:36):
Mm-hmm.
Paul Bellows (20:36):
Probably, and I'd love to hear just how this
project breaks down betweeninternal folks doing the work
versus external vendor folks.
Penny Rae (20:42):
Yep.
Paul Bellows (20:42):
And even just at a procurement level, one of the
things that famously happens inprojects like this is there's a
competitive process.
I sometimes joke it's likeplaying horseshoes with your
neighbor, but there's a fence inbetween.
No one's really sure that we'renot hitting the family pet as we
are sort of throwing ideas backand forth.
In the beginning into a businessrelationship and suddenly, the
complexities, comes to surface.
And now we're talking aboutscope or what was our intention
(21:03):
here?
And then you're talking about amassive design project where at
the start of the project to thepoint where we really understand
what we're building.
We want an enormous amount oflearning to occur.
Penny Rae (21:14):
Mm-hmm.
Paul Bellows (21:15):
And now you have passed an audit, which I assume
means you're generally on timeand on budget, cuz those are
some of the things that auditslook at.
How is that relationship withthe vendors and external
software companies?
Cause the industry is justfraught with stories of these
things coming to fisticuffs andto bad blood and to missed
expectations.
How are you managing a vendor tobe at this point in the project?
You're actually rolling out yoursecond traunch and you're still
(21:37):
tracking green from an auditperspective.
Penny Rae (21:39):
So we, we made a very deliberate discussion decision.
So when we had done our HR andfinancial system consolidation,
we had a third party come andhelp us implement a system
implementer.
And what happens, I find, inthat instance is there's a lot
of finger pointing between thesoftware vendor and the
(22:02):
implementation partner.
And that's a challenge and so wemade a very deliberate decision
that we were going to build it.
So we, we basically put a lot ofour systems on life support and
said, we're gonna pull from ourexisting like application teams,
(22:23):
about 250 people.
We sent them to Epic to gettrained and certified, and then
we came back.
So there isn't a middleman,there's Epic, who's a software
provider and us.
And we work very, very closelytogether.
And they helped us as we weregoing through build.
Like they had team, they hadpeople from their side assigned
to this project.
So we were working very closelybetween the two teams.
(22:46):
But there wasn't that, well,they said they should be doing
this and you know, they saidthey were gonna do that, and
which I think is where a lot ofthat finger pointing comes from.
And then the other thing itallows us to do now is our team
is often more experienced cuzthey've been doing this now for
[more] years than some of thenewer Epic staff.
And so this launch we're aboutto do is the first one where we
(23:09):
are completely in control of it.
So the previous one's, Epic'sbeen helping us in the launch
period, but this one is all us.
And so it's, you get thatknowledge transfer going and
we've actually gone, so we'vegot this, the uh, 250 people
certified initially that weredoing the initial build.
We've now gone and put the restof our staff through proficiency
(23:32):
training here, rather thansending them to Epic.
And so we have about 750 peoplewho are trained in, in Epic to
be able to develop and work onthe system.
And it's just a process overtime of, of saying, well, now
50% of your job is your oldapplication and, and we're gonna
train you on the new one.
And so you go a little bitbetween the two and then at some
(23:54):
point it flips.
So that they're working on the,this system.
Paul Bellows (23:58):
I love, in this new future, government and
public sector organizationsactually start to look a lot
more like software companiesthan they used to.
They used to be buyers ofsoftware, procurers of software.
Penny Rae (24:08):
Mm-hmm.
Paul Bellows (24:09):
And now you're really, if it's true that
digital is really gonna becomehow we operate and how we do a
major portion of our operations.
That really can't be delegatedout to a third party.
No, you have to build it inhouse.
You've absolutely embraced thatto say, no, we are gonna be the
center of excellence.
We're gonna have these expertsin-house.
It is what we do for thecitizens of Alberta is manage
(24:29):
information.
I love that.
But can you talk just for aminute about the kinds of
information you would manage inEpic and, and Cause I think the,
the risk and the and thechallenge of this gets down to
you know, what, what are weactually talking about here?
What kinds of potentialscenarios could we be looking at
and why is it so important toget this right?
Penny Rae (24:46):
So You can imagine we are implementing in every care
setting, in every geography, andwe're touching every process in
the care process.
Everything from registrationwhen you first walk in and, and
someone checks your name andaddress and your healthcare
card, to organizingappointments, doing lab tests,
(25:09):
diagnostic imaging, physiciandocumentation in hospital
documentation, surgicaldocumentation, wait list
management, like system flow,everything about the health
system.
And so the intention is from alearning health system
perspective, because it's reallyimportant that you learn as
(25:30):
you're going through thisprocess.
So we have a good understandingnow of, if I give this type of
care, I have this type ofoutcome.
And for the first time ever,we've got a way of connecting
those things.
Because up until this point,we've had administrative data
that says someone arrived at aclinic and did they get
readmitted or not?
Like things that we can trackthrough an admission, discharge
(25:52):
sort of system.
Now we've got what was theoutcome?
What was the.
The patient outcome is part ofthat.
And where I've got, you canstart to have a look at, where
I've got, some people who mighthave the same condition, who get
multiple interventions asopposed to people who get fewer
interventions.
(26:12):
What does that do?
What does the difference in carelook like?
There's certainly a differenceof cost, but is the outcome
different?
So we can start to have a lookat some of those things and, and
really reinvest back thatknowledge into the health system
and and update how the systemworks.
And we know that we're able todo that kind of virtuous cycle,
that closed loop.
(26:32):
And as we've got more and morepeople onto the system, so at
the end of this year, November,we will have all acute care in
the province on the system.
And the first time ever,everyone is gonna be speaking
the same language.
They're gonna be doing the samething, they're gonna have the
same care pathways.
And so we're able to say, whatdoes good look like then?
(26:54):
Right?
You start to learn more thantrying to cobble them all
together if they all had, so wehad different systems and they
were configured differently, andthey had different normal ranges
for things and.
So we've had to standardize allof those types of things as
well.
What are our dosage forpharmaceuticals and what's the
lab test norm here look like?
And those types of things.
Paul Bellows (27:16):
Those are the things that I think in 2023 when
we're having this conversation,the average North American, at
least, citizen would probablyassume is already happening or
possible, and yet, I know thisis a sea change in the
healthcare industry.
This really doesn't existanywhere else.
It is sort of the holy grail ofjust we have access to
information in a secure way.
So you're describing things thatI think, the average, Uber app
(27:37):
user would say, well, if Ubercan do it, why isn't my
healthcare provider?
What are some of the barriersbeen to healthcare organizations
like AHS been to adopting thesetypes of systems in the back?
What are some of the wickedproblems you're actually
overcoming right now?
Penny Rae (27:51):
So there's a language barrier.
Paul Bellows (27:52):
Yeah.
Penny Rae (27:53):
And people, they don't mean the same thing when
they write something down.
And so there's a lot of, what doyou mean by that, sort of
things.
It took us four years tostandardize our lab tests.
So we had a lot, I think westarted with 20 lab systems or
something in that order and tostandardize so that they had the
same name, they had the sameranges, they had the same
(28:14):
meanings.
It, that's a challenge, right?
Like, so some of those pieces,that was a wicked problem to get
through and get people to agreeon it is always a challenge.
I think the wicked problem nowis really on adoption of the
system.
So people are using it.
They're using it largely as adocumentation system.
That is a very expensive filingcabinet.
Paul Bellows (28:35):
Yep.
Penny Rae (28:35):
And so what we're really looking at now in the
next piece as we try and finishoff this implementation and
really start to think about whatdo we want it to do long term?
How do people use it?
How do people make theirworkflows smoother so that you
as a physician in GI might havea different requirement from a
(28:56):
surgeon in terms of what I wantto see on the page.
Have people taken the time topersonalize it.
Cuz that's one of the, thebenefits of this, you can
personalize it to make sure thatyour workflows are working and
are people using it effectively.
And do we have enough of afootprint of it that you keep
things within the system ratherthan keep trying to send them
(29:16):
out and then send them back inagain.
Right.
So it's, we're getting to thattipping point where some of
those big challenging problemsare gonna start to collapse.
We're starting to get rid ofsome of the interim states.
Paul Bellows (29:28):
So I think one of the things that can be,
liability of a project, thismagnitude is it is so large, it
is such a sprint.
You know, we get to the end ofthese things and we just want to
be done and we want something totell us.
It's done.
You can move on to somethingless complex now, something less
mind breaking.
Penny Rae (29:43):
There's never going back.
Paul Bellows (29:44):
See, there isn't, but you're talking now about
continuous improvement, about,user research ongoing as an
operational mandate.
Penny Rae (29:52):
Mm-hmm.
Paul Bellows (29:52):
This is design thinking.
This is sort of what the know,there's a historical design
thinking if you, you know, youdon't know.
We only know by watching whatpeople do, we only know by
Penny Rae (30:00):
mm-hmm.
Paul Bellows (30:01):
Doing the systems design work and then watching
what happens and seeing, thesense and respond we do.
So how do you sense and respondwith groups of this scale, do
you actually have a userresearch team now who works at
AHS?
Who's doing that kindamonitoring and checking in and
how has the team shifted overtime to be able to do this
thing, that probably wasn'thappening here five years ago,
(30:21):
of looking at how people wereusing systems at an individual
user level?
Penny Rae (30:25):
So there's two pieces to your question.
Paul Bellows (30:28):
Mm-hmm.
Penny Rae (30:29):
I think there's always been people who are
learning, like the learninghealth system is not a new
phenomenon.
And so historically we've donepaper chart reviews and those
types of things.
It's just very slow to be ableto get some of that, from that
research and knowledge intopractice.
Right.
That's a very long lead time.
(30:51):
And this system allows us to beable to move more quickly
through that because they've gottools within the suite that
allow the end user to be able togo, I wonder what happens if, I
wonder if there's a differencebetween.
So there's ways of looking atthe grassroots level to say, how
might I make this better?
(31:11):
So you enable much more of thatground up kind of quality
improvement visa work.
At the corporate level, we havea Quality Safety Outcomes
Executive Committee[QSO], andthey really look at what are
those big measures that we wantto move as a health system.
So we're looking right now atthe Alberta Surgical Initiative
trying to increase the numberand throughput of surgeries.
(31:34):
What does that look like?
How do we improve that?
So we're putting in centralaccess and triage, some of those
other things that help reducesome of those wait times to try
and improve how people flowthrough the surgical sphere.
And so those QSO, which is whatwe call it, QSO, is the group
that really directs some ofthose big ticket items.
(31:56):
And then you have thisupswelling from the ground up
and we've got analytics teamsthat are embedded throughout the
organization that use some ofthe information to say, how
might we learn from it?
So there's some central andthere's some very decentralized.
Paul Bellows (32:10):
The word innovation gets used so much
that it's mostly meaningless topeople, but like the root of it
is renewal and I
Penny Rae (32:16):
mm-hmm.
Paul Bellows (32:16):
And I love seeing situations where organizations
said, what are we already quitegood at and how does that apply?
That's innovation because that'srenewal of, you know.
Penny Rae (32:24):
Mm-hmm.
Paul Bellows (32:24):
We're really good at looking at paper documents,
seeing how they're used andredesigning them to be more
effective.
But that's at the cycle time ofgetting into clinics, seeing
paper and redesigning andreprinting and redistributing
paper docs.
Penny Rae (32:36):
Trying to read people's writing.
Paul Bellows (32:37):
Right.
And that too, right?
Yeah.
Yeah.
So with digital, the opportunityis cycle time and the challenge
is cycle time too.
Penny Rae (32:43):
Mm-hmm.
Paul Bellows (32:43):
To say it's our superpower, but we just need to
learn how to do it at a rapid,maybe a two week cycle time or
an eight week cycle time orsomething.
Penny Rae (32:50):
But in an organization of this size
Paul Bellows (32:52):
Yeah.
Penny Rae (32:52):
It's not, it's not coming up with the epiphany.
Paul Bellows (32:55):
Yeah.
Penny Rae (32:55):
It's how do you scale it?
Paul Bellows (32:56):
Mm-hmm.
Exactly.
Penny Rae (32:57):
We are a province of pilots.
Paul Bellows (32:59):
Yeah.
Penny Rae (33:00):
And we have pilots on everything.
And so it's how do you spreadand scale?
How do you get everybody doingthings the same way?
And that is still our challenge.
Paul Bellows (33:08):
Yeah.
Penny Rae (33:08):
So we've got strategic clinical networks that
we've been working with for thelast decade in the province and
they do really good work.
We still have a challenge with,does operations have the
capacity to absorb that work?
Paul Bellows (33:20):
Yeah.
Penny Rae (33:21):
And so what the site, an individual site in rural
Alberta might want to do, mightnot align with what the networks
are saying that they would likepeople to do.
And so when you have limitedcapacity, who wins that
argument?
Right.
And that's the discussion we'rehaving right now around how do
you get both that bottom up kindof quality improvement that you
(33:42):
want as well as some of the topdown.
And do that within, respectingthe capacity of operations to
absorb that work.
Paul Bellows (33:50):
Mm-hmm.
Penny Rae (33:50):
Because there's no use having coming up with 50
bright ideas, if operations hascapacity to absorb one of them.
Right.
You better to shift some of theresource into operations to be
able to say, maybe now I canonly come up with, 20
innovations, but now operationshas the capacity to deal with
them.
What does that look like?
So there's discussions on going.
(34:12):
In that space here as well.
Paul Bellows (34:15):
You'll appreciate this as someone from an
engineering background, I thinkevery system and every material
has failure points based onlinear scale.
You just grow anything.
Penny Rae (34:22):
Mm-hmm.
Paul Bellows (34:23):
And eventually every material breaks at a
certain weight or a tolerance,and you're pushing things to an
extreme that are, you're in thearea of unknown at all times
here at working at this kind ofscale.
And yeah, absolutely.
Edge cases and the way humanswill improvise in smaller
situations where improvisationis friendly but at scale, you
can't improvise.
We need structure, we needconsistency in systems.
(34:43):
And how do you put all of thattogether into one piece of
software That is a massivelychallenging problem.
Penny Rae (34:49):
Yeah.
And it's, we have tried toenable that.
The core record, like yourrecord, you want standardized.
So the headers that we use, theway we see them that like those
things, you want to beconsistent.
(35:10):
Everyone should have exactly thesame information.
By specialty, there are thingsthat like if you go, I go see a
cardiologist.
Your cardiologist has thecardiology group across the
province still, but it's asmaller group has to agree what
goes in that piece.
And then you've got theresearchers.
And so we have, we're justimplementing our red cap
(35:32):
integration with Epic so thatthe researchers have an easy way
of getting clinicians to, to beable to collect information at
the point of care.
How do you start to enable someof that work to happen?
Also Epic has a thing called AppOrchard where people can
innovate at the edge, butrespecting some of those APIs
(35:56):
the way that we talk with eachother, so that you're doing it
in a sustainable way.
Paul Bellows (36:01):
Mm-hmm.
Penny Rae (36:02):
Because then epic help vetting is helping us vet
those people.
Cause we can't necessarily copewith everyone's great idea cuz
like I would fall over again.
But it does give you structuredways for people to innovate.
And so we typically directpeople there to say, okay, if
you wanna play in thisenvironment, you have to be able
(36:23):
to talk to Epic because that'swhat we've built everything on.
Paul Bellows (36:27):
You've got clear river banks for people, but also
the possibility for them to, asyou say, innovate or make change
at a local level or for specificbusiness problems, whether
there's opportunity.
This really feels like it's oneof those IT stories that we're
all aiming for, where the, themassive change happens, people
adapt, things go wrong, and weidentify them and we
self-correct as we go and find.
(36:48):
So for you as a leader withultimate accountability for the
success of this, what have beensome of the levers you have
pulled or where you've really,you know, we talked about trust
early on.
What else do this project hasbeen essential for you in just
ensuring that people are havingthe right conversations, that
we're raising doubts early, thatwe're catching risks early.
That people in a sense have thepsychological safety in this
organization.
Not to be right, but to getright.
Penny Rae (37:10):
Mm-hmm.
I joke that my job is a partyplanner.
Paul Bellows (37:13):
Mm-hmm.
Penny Rae (37:14):
And so I hear anytime anything goes wrong cuz people,
I think before we had startedinto design, I'd been with IT
for a few years and I'd gainedthat trust of people here at
least.
So my team were very clear.
If something was going wrong, Iwould hear about it pretty much
straight away.
But we've really created thiswhole project so that we're very
(37:34):
transparent with what's goingon.
So we have risk mitigationmeetings, and the intention of
those risk mitigation meetingsis, if you're having a problem,
bring it to the table.
Let's talk about it.
Let's see how we can help you.
And it's very, it's veryvisible.
And we have launch readinessassessments at 120 days, 90
days, 60 days, 30 days, wherewe're saying, well, this is a
(37:55):
new emerging issue.
What are we gonna do about it?
Who do we need to connect?
And so whenever we have peoplewho are starting to, noise
starting to appear, I normallyget everyone in a room or a
virtual room now and say, what'sgoing on?
Let's think about how we fixthis.
And if you're not pointingfingers at people and you're
saying, okay, so what's our planto mitigate where we need to get
(38:18):
to?
And I think that goes a long wayof getting people to where they
need to be.
But it's, you have to be veryvisible, so I, and Debbie and
Jeremy who are my current nurseand doc partners, the three of
us are very visible.
We are in all of these meetings,we're interacting with people.
We're asking questions.
(38:38):
It's not something you can say,oh, that's going, I'll just
leave it over there.
Like, you really have to be verystrong sponsorship of the work
going on.
Paul Bellows (38:47):
And, and at the end of the day, that's what
culture is.
Culture is what you and yourco-leaders pay attention to.
Penny Rae (38:52):
Yep.
Paul Bellows (38:52):
And that's beautiful.
Well, Penny, thank you forletting us get a little bit of a
glimpse inside how AHS is doingthis massive, high risk, high
complexity shift that has somuch value to everyday citizens
and the healthcare systemitself, which at this point in,
again in 2023, we have beatenour healthcare system up so much
(39:13):
over the last three years.
Penny Rae (39:14):
Oh, we have.
Paul Bellows (39:14):
And we started brittle, especially here in a
Canadian context.
We already started working withthin margins for everything and
so we push people hard to bedoing something like this at
this time in history.
Leaders have followers.
There's a great little mantrathat I've always heard of.
You clearly have followersbehind you, so thanks for
sharing how you lead and some ofthe things that you bring to
this amazing game of changingtechnology inside of a massive
(39:35):
system.
Penny Rae (39:36):
Thank you for having me.
Paul Bellows (39:37):
Wonderful.
Penny Rae (39:37):
Hopefully it's helpful for people.
Paul Bellows (39:39):
Absolutely.
Thanks so much, Penny.
Thanks so much for listening.
Penny's mandate is formidable,but she approaches it with
courage and empathy.
Some of the themes she raisedthat I wanted to highlight
include (39:55):
one.
Trust is the basis for leadingtechnical projects.
Penny built trust through clearcommunication and consistent
responses.
Especially to challenging news.
Two.
The EPIC rollout at AHS is thelargest single IT project in
(40:16):
Canada at present, at least inthe public sector.
Penny is on time, and with herapproach, the team is delivering
well.
Three.
IT leadership doesn'tnecessarily require a deep
technical background.
But it does require leadershipthat understands how to work
with technical people andprojects.
(40:38):
I hope you enjoyed myconversation with Penny.
Please do subscribe and followthe many conversations we're
going to be releasing throughoutthe year.
I'd like to thank my colleagueswho work with me on this
podcast.
Kathy Watton is our showproducer and editor.
Frederick Brummer created themusic and intro.
We're going to keep havingconversations like this.
(40:59):
Thanks for tuning in.
If you've got ideas for guests,we should speak to, or you'd
like to join me on a show.
Send us an email tothe311@northern.co.
You can find that email addressand other links in our show
notes.
Government is all about all ofus.
Let's keep making a betterworld.
This has been the 3 1, 1podcast.
(41:20):
And I'm your host, Paul Bellows.
I'm Penny Ray, the CIO for Alberta Health Services.
Paul Bellows (00:04):
Wonderful.
And then maybe just because noteverybody in the world
understands the Canadianhealthcare system, you do have
some, uh, some non-Canadianaudience here.
Maybe just a little bit abouthow Alberta Health Service
operates its mandate and how itmight be different from how
healthcare is delivered in otherparts of the world.
Penny Rae (00:19):
In Alberta we have a public healthcare system, and
Alberta Health Services is asingle health delivery entity
that reports into the ministerof Health and it is accountable
for the majority of acute care,a good chunk of the ambulatory,
about a third of the long-termcare, a spattering of primary
(00:41):
care, and it works inconjunction with community
providers, who are primarilycontracted and primary care
providers, who are contractors,in the community.
And so it's a very interestingorganization to work with.
We have about, 110,000 peoplethat work for AHS in IT.
(01:01):
We actually support otherorganizations as well, so we
support Alberta Health Services,Covenant Health, which is a
faith-based care center, Lamont,which is another faith-based
care provider, Care West andCapital Care, who are two wholly
owned subsidiaries who dolong-term care, Alberta
Precision Labs, and Dyna Life,who is a contracted lab
(01:22):
provider.
So in all, we have about 140 to150,000 people that we provide
IT services for.
Paul Bellows (01:30):
My understanding is Alberta Health Services is
one of the largest employers inCanada, not even worried about
the province of Alberta or thisregion.
Where do you rate in terms ofsize of employer in the country
of Canada.
Penny Rae (01:41):
So we are the largest in Alberta.
We're behind the federalgovernment, I believe,
Canada-wide, but we'redefinitely one of the largest in
Canada, probably top five inCanada as well.
We are one of the five largestIT shops in the, in the country.
We have, well, depending on howyou count people and
contractors, we probably have inthe order of two and a half
(02:02):
thousand people that workdelivering digital health to
Albertans.
Paul Bellows (02:07):
That's a massive workforce.
Penny Rae (02:09):
Mm-hmm.
Paul Bellows (02:09):
2,500 people in IT is, you know, we're getting
towards unicorn scale here interms of the size of
organization you would be in theprivate sector here.
Penny Rae (02:17):
Yes.
Paul Bellows (02:18):
That's huge.
So, You're Chief InformationOfficer.
One of the questions I love toask folks, the CIO role, are you
the Chief Information Officer,the chief infrastructure
officer, or the chief innovationofficer?
Because they all start with I,and they're all sort of
different backgrounds and youhave a bit of a unique way you
got here.
How do you see the role of whatyou're here to do?
I'd love to actually hear alittle bit about how you landed
(02:39):
here?
Cause it's not a traditionalcareer path to this role.
Penny Rae (02:42):
No, I would see myself as the chief information
officer.
Really thinking about how do youget information from where it is
to where it needs to be?
How do you collect it?
How do you make sure that peoplehave it?
And how do you make sure thatpeople have the right
information at the right time?
And in healthcare, that'sparticularly important, right?
You want the right informationabout the patient at the right
place and the right time so thatyou can make the best care
(03:04):
decisions for them.
My career path was veryatypical, eclectic, I like to
say.
I'm a chemical engineer bybackground and I started work
with Exxon, so Australia and Iworked offshore oil and gas.
So I've been on oil rigs andI've got helicopter underwater
escape training.
I've got all sorts of weird andone firefighting training, all
(03:25):
those types of things.
I moved from there into HR,which was an odd sort of jump,
in an accounting firm.
And so I worked withPricewaterhouseCoopers first in
their HR department doing alltheir graduate recruitment.
And then I moved into internalaudit, from internal audit into
consulting within PwC[PricewaterhouseCoopers], both
in Canada and Australia becauseI married a Canadian.
(03:47):
So here we are.
Paul Bellows (03:48):
Well done.
Penny Rae (03:49):
Then I got seconded to lead the physical
infrastructure for the healthsystem as AHS was formed in
2009, 2010.
And so I was originally meant tobe doing some of the merger and
acquisition work in that group,as a consultant.
I was brought in to make sureeverything came together and
then hire my successor and theteam at the time had said, no,
(04:13):
no, no, stay.
And so I ended up staying,leading the capital management
team, which is.
Infrastructure, construction,real estate maintenance,
parking, security, that type ofthing.
My boss at the time had said,oh, you know, IT and Capital,
that's about the same.
They both have capital andoperating could you just do
both?
(04:35):
And so I'm like, well, I'll try.
So for about six months I didboth, which almost killed me and
IT really needed, they hadn'treally gone through the cultural
work they needed to do, which isreally, I think what, which is
unusual for an engineer, isreally what I think I'm good at.
And so they, ended up leavingcapital management and, and
(04:55):
keeping with IT.
And so it came in with noformal, like I did, I did
programming as part of myengineering degree, but really I
was very bad at it.
And I, my team even now tells meI could break anything.
Paul Bellows (05:06):
Well, someone has to be the ultimate tester.
Penny Rae (05:08):
I know.
I can test anything.
I, they're like, I've never seenthat before.
I'm like, of course you haven't.
Paul Bellows (05:13):
I don't think it's unusual that you would be
interested in culture comingfrom an engineering perspective.
Cause engineering isfundamentally systems and
interaction of systems.
It is not the entirety of whatengineering is, but it's a major
one of the cognitive skills youdevelop as an engineer.
Penny Rae (05:26):
Yep.
Paul Bellows (05:26):
I think culture work is also systems in the
interactions between systems,but instead of chemical
entities, we're looking atinterpersonal and behavioral
entities.
How people choose to behave,what they choose to do around
security, around design, aroundresearch, around testing, and
all of these behaviours that wewant from people, but don't
always get, when our cultureisn't strong.
(05:46):
I think often folks think whenthey say culture, they mean, oh,
is it fun to work there?
Are we nice to each other?
But that's, it's how do webehave?
Penny Rae (05:55):
Yes.
Yeah.
And how, what's the, and a lotof culture is built on what
level of trust do you have?
And so you start to say, wheredo people trust?
And then it'll get better orworse from there, right?
So if you don't trust, then youdon't communicate well.
If you do trust, then you cancan do things more efficiently.
And so, making sure that youhave a really strong foundation
(06:17):
of trust in your organization,in your team, and in the broader
organization is reallyimportant.
Paul Bellows (06:22):
For you, where does that trust come from?
What is your sort of secretingredient that you add as a
leader where you believe you'vebuilt trust?
I think this is trust comes issuch a, it's a hard thing to
gain, especially in IT with theorganization and then even
within IT.
Cause we have so many experts.
People who are experts ateverything.
Penny Rae (06:39):
Yeah, and I, so when I came, when I first came into
IT, and I've been in this roleon June the first 2023 for 10
years.
And when I first came in, ofcourse I had no IT background.
It was, people were veryskeptical.
And I sat in a room of my, mysenior leadership team about, I
don't know, 70 or 80 people, andeveryone was sitting there with
their arms crossed and saying,well, you know, who are you and
(07:02):
why can you do this?
What I had said to them at thetime is like, you don't need
more technical people.
You need someone that can helpyou translate, from where you
are into what they need and backagain.
And so I said to them, if aftersix months you don't think I'm
the right person for this job, Iwill absolutely find you
somebody else.
(07:22):
I think what's really importantis I am who I am all the time.
Every time people come, like oneof the, one of our great guys
who retired after 30 plus yearshad said to me, had an exit
interview with me.
We were talking and he said, oneof the things that, that I love
about you, and it's gonna sounda bit odd, but you're very
(07:42):
predictable.
I think that predictability interms of can I come and bring
you a difficult discussion, canI tell you the truth without you
exploding?
Like, do you shoot themessenger?
What does that look like?
And, and I very much came intoan organization that felt like
we shot the messenger.
And so I've spent a lot of timewith the IT team really helping
(08:05):
them understand like, I haveyour back.
I'm very, future focused.
So something may have happened.
Okay, let's fix it.
Right?
Like it's, let's not dwell onit.
Let's learn from it and moveforward.
And so I've been very consistentin my approach that, and people
can predict now what I'm likelyto say, and I'm building that
leadership capacity so that theydon't always feel they need to
(08:28):
ask me.
So I empower people to do whatthey need to do.
And I'm very predictable when wehave these discussions.
So if they ask me like sixmonths apart, they'll get
essentially the same answer sothat they know what to expect
and that they can bring forwarddifficult things.
And I'm like running a 1.4billion dollar project, which is
the largest in Canadian history.
(08:49):
You can't run a project likethat if people don't trust you
to tell you the truth aboutwhat's going on, because it will
very quickly derail.
Paul Bellows (08:57):
I love, you know, trust coming from predictability
and consistency and peopleunderstanding what is essential
to you and that not changing isfantastic, as a model for trust.
You know, communication could bea place trust comes from.
People need to know what you'rethinking and what's happening.
Penny Rae (09:11):
Yeah.
Paul Bellows (09:12):
But then, you brought this up and I just think
this is a fascinatinginitiative, that it's not just
one of the largest or thelargest IT project that you
said, but it's also in one ofthe most fraught areas I think
in IT.
Penny Rae (09:24):
Yeah.
Paul Bellows (09:25):
And in government, we deal with so many sensitive
pieces of information, so muchthat is meaningful to
individuals.
Healthcare even more so.
Even more so, we're dealing withpeople's wellbeing, we're
dealing with people's illnesses,we're dealing with people's
family, with their children.
These are places where peoplehave deep, deep feelings and
emotion connected to theinformation that they're
(09:45):
sharing.
Penny Rae (09:45):
Mm-hmm.
Paul Bellows (09:46):
This is not simply what year my car is.
This is, you know, maybe mygenetic condition, this is maybe
my child health.
Penny Rae (09:52):
And it's also interacting with them at their
most, most vulnerable.
Paul Bellows (09:55):
Absolutely.
Penny Rae (09:55):
Yeah.
So when they are not up totheir, they're not doing their
best because they're sick, it'sa challenge.
Paul Bellows (10:01):
Maybe the most fallible version of themselves.
Penny Rae (10:03):
Yep.
Paul Bellows (10:03):
Yeah.
Could you talk just a little bitabout what the nature of this
project is, and what it means toAHS as an organization and maybe
even to your constituents.
Penny Rae (10:11):
Mm-hmm.
Paul Bellows (10:11):
What is actually happening and what are you
trying to change?
Penny Rae (10:15):
So we started with one of everything, lots of best
of breed, and lots ofinformation embedded within
individual systems.
And as a patient or resident ofAlberta, what that feels like is
every single place I go, I haveto tell my story over and over
and over and over again.
(10:36):
And if I want any continuity, Ibring that pile of paper with
me, which is not it's not goodfor them.
It's not empowering to people.
It's a good recipe and we'veseen some challenging stories
like the Greg Price story,Falling Through the Cracks
[2017], if anyone's watched thatfilm that his family had put
together, which is quitepowerful.
It provides a lot of opportunityfor missing things.
Paul Bellows (10:59):
Mm-hmm.
Penny Rae (11:00):
So, We started with thinking, we had a look at an
assessment of is it better totry and integrate these thousand
systems throughinteroperability, and there's
ways of doing that, or is itbetter to pull them out and
replace them with somethingthat's built to be a single
system?
It's not really built to be asingle system.
(11:20):
We're using the Epic software asa core of Connect Care and we've
got about 85 systems that aredirectly integrated.
So it's not, it's connect careas a single entity from a
project perspective, but it's byno means a single piece of
technology.
So there's lots of it that we'reputting in place.
We had decided, we looked atthe, the pros and cons and the
quality that we were gonna beable to get to of information.
(11:43):
Cause every time you moveinformation from one place to
another, you lose some of it.
You don't quite get all thecontext that comes across.
So we had decided that we woulddo a, a rip and replace.
So we started, went out to rfpand this project, as we started,
it's the first time we hadbrought together the clinicians
(12:03):
across the province to have,start to have, a look at how do
we document some of theseclinical conditions?
What do we want it to look like?
How do these workflows work?
Because of course, we started asmultiple health entities and we
slowly consolidated, and we haddone a lot of work to
consolidate the corporateservices, but we hadn't done
anything in the clinical space.
So when we started, we broughttogether about two and a half
(12:27):
thousand people in our directionsetting.
So you can imagine we organized,a series of six.
The first three were just kindof getting started.
The second three werevalidation, but about two and a
half thousand clinicians.
In a conference style, three daysession.
So we had six sessions.
(12:48):
You
Paul Bellows (12:48):
had them all together.
Penny Rae (12:48):
We had them all together.
Paul Bellows (12:49):
Wow.
Penny Rae (12:49):
So we had, we booked out a conference center, a
couple in, like one in Edmonton,we did one in Calgary cuz they
shifted between the sites.
And we organized a schedule of,here are the workflows that
happened because the first piecewas all about workflows.
How do we do things in thesystem?
And we gave people a red cardand a green card, no Canadians
(13:12):
sitting on the fence,[no] yellowcards.
They had to decide, could theylive with this Part of the Epic
methodology, they show you whatthe foundation system looks
like, and say"can you live withthis?" If you can't live with
it, what do you wanna do?
But in the room, at any givenpoint in time, we might have a
couple hundred people who areincluding patients.
So we brought patients andfamilies together.
And the patients and familiesreally challenged our
(13:34):
clinicians.
Well, we couldn't possibly givethose patients their results
right away.
And the patients are like, whynot?
That's what I want.
And so we went through this veryintense design process on the
workflows with thousands andthousands of people from across
the province, from differentbackgrounds and different
specialties, and really startedthat change process of
(13:56):
understanding what does it looklike, what is it going to be as
we bring all of these peopletogether to design something
collectively.
And so we did.
That's the piece that we did forworkflows.
And then we went and built themand then came back and checked
with them that, is this what youmeant?
And then on the in parallel, wewere looking at the content.
So what is the standard contentif you have pneumonia?
(14:19):
What is the standard contact fora cardiac arrest?
What is the standard contentfor, like, what does that look
like?
And so in parallel, we hadset-up I wanna say it's about 34
area councils and those weremade of clinicians.
Another about two and a halfthousand clinicians involved in
this piece of work.
And looking at all of thedecisions that we needed to make
(14:43):
relative to what content we'regonna embed in the system.
So what is the, standard flowsheet for how we deal in the
emergency department.
All of those types of questionswe had to make decisions on.
And so as a government entity,anyone who works in government
will know it's a very slowprocess to make decisions.
So we had to get a lot faster.
(15:05):
So we made 5,000 decisions inthe space of about nine months.
Paul Bellows (15:10):
How did you track that kind of decision flow?
Can you just talk a little bitlike how that was actually being
like tracked and documented andshared and, and made, like what
did those decisions look like?
Penny Rae (15:19):
So we had, we had a support unit for each of the
area councils.
We had people documenting in thesessions live at the conferences
that we were having.
So you can imagine we had allthese people, we had all of the
list of all the decisions theyneeded to make and we would
document them in real time.
So that we could give them tothe build teams.
And then for the clinicalcontent, we had a whole bunch of
(15:43):
questions.
The support unit would prep thequestions with pros and cons,
here's what that looks like,what do you wanna do?
And then they would go into,those ones would go into a
SharePoint site and we wouldtrack all of them.
We would be able to filteragainst each of those area
councils and what they weredoing.
Paul Bellows (16:00):
Incredible.
Penny Rae (16:00):
But it was, it was a lot of work.
We have a Secretariat team.
That helps make sure we'retracking all of the decisions,
because of course we're spendinga lot of public money.
So we've had the auditor generalaudit us, our internal audit
people.
We've had, you know, every manand his dog wanna see what we're
doing.
The first clean audit report,ever, for a project here in
(16:22):
Alberta.
Paul Bellows (16:23):
In the province.
Penny Rae (16:24):
Yeah.
Paul Bellows (16:24):
The first clean audit report.
Congratulations.
Penny Rae (16:26):
So, and for something this size, so it was, it was
quite the undertaking.
Paul Bellows (16:30):
I don't know if you're familiar with the Cynefin
model of sort of like problemdefinition, it's a two by two
that came out of IBM years agowhere, you look at problem
spaces as simple, complicated,complex and chaotic Complex, I
think is the most interesting.
Penny Rae (16:41):
Mm-hmm.
Paul Bellows (16:42):
And sort of the fundamental definition is it's
an emergent solution.
There isn't something clear youcan take off the shelf.
Penny Rae (16:48):
Mm-hmm.
Paul Bellows (16:48):
Which in this case, since we're anytime we're
the biggest or the largest orthe most expensive, we're always
dealing with emergent solutions.
No one has quite done it at thescale before and scale matters.
And then the other dev thingthat triggers complexity is
multiple stakeholders, multipleperspectives are involved and
2,500 research participants.
And I don't think you get muchmore complex than that
(17:08):
environment.
Penny Rae (17:09):
No.
Paul Bellows (17:10):
You talked a little bit about, you came in as
a bit of a change agent at acultural level.
Penny Rae (17:15):
Mm-hmm.
Paul Bellows (17:15):
Just to say how we do the work matters as much as
what work we're doing.
So you're dealing with twothings.
You're dealing with a massivesystem change.
You're dealing with massivecomplexity, multiple
perspectives.
How did you design the designwork?
Culturally, what had to be truehere?
You talked about trust enteringthis, what had to be true of
this organization to be able toembrace a project of this
nature, of this scale, and withthis much ambiguity connected to
(17:38):
it, heading to a design processwith so many unknowns.
Penny Rae (17:41):
We did a lot of research before we started on
how this type of project fails.
Paul Bellows (17:45):
Mm-hmm.
Penny Rae (17:46):
And so we looked at all of the reasons for, from
clinical engagement, projectdelivery, leadership, and so
some in the leadership, some ofthat agility and vision and, and
it's a long hole.
It is a, it is a massive lift.
And when you think about it, inthe research we did when we
(18:06):
started, about 30% of theseprojects in this type of project
were successful.
So you're going into something
Paul Bellows (18:15):
sounds about right.
Penny Rae (18:15):
Yeah, you're going into something that's innately
fraught has had some really badpress.
And so we actually designed ourgovernance around the ways it
could fail so that we wereproactively looking at that.
We were poking at those thingsright from the beginning.
So when I first got here, we hadhired a CMIO, a Chief Medical
(18:37):
Information Officer and a ChiefOperations Informatics Officer.
So we have a nurse and a doctorthat are helping work on this as
well.
So we're doing it together.
Having said that, people stillsee us all as IT, and so it's a
bit of a, there's still that bitof a cultural shift and, and
because one of the challengeswe've had that I don't think
you'd see in a smallerimplementation is, and we did
(19:00):
this all through covid as well,so we started, our first launch
was right before Covid, and thenwe've had 4 sets, and we're
about to enter our fifth, oursixth launch, but we had four
during Covid.
Which was challenging.
But you need to get people tostart to think, well, I've
implemented in 2019, now I wantyou to fix the things I don't
(19:22):
like.
And so if you are implementingevery six months, which is what
we're doing, so we implementedin November, 24,000 people were
implementing.
Three weeks from now in Mayanother 20,000 people.
And you've often got an upgradein the middle.
So from a technical perspective,getting a whole bunch of
optimization is reallychallenging.
(19:44):
And so we've got this pent updemand that my team is working
with their clinical and medicalcounterparts are going through
close to 7,000, optimizationtickets that people would like.
And then how do you deal withthat, right?
It's just making sure they'vegot the right information, that
they're not overlapping, thatsomeone's saying, I'd like it
(20:04):
blue, and someone's saying, I'dlike it red.
And then how do you deal withthat, right?
You've got so many people, theprocesses you need to do to get
through it is, is a challenge.
So we have pretty goodgovernance and we've said to
people, don't come to fisticuffsat the working level if you
don't agree, escalate.
Yeah.
And then you'll get to a groupthat will make that decision.
But we don't want you to damageyour relationships cuz you need
(20:26):
to work together.
Paul Bellows (20:28):
I'd be interested to hear you talk just for a
minute.
You talked about the system Epicthat you're putting in place.
Penny Rae (20:33):
Mm-hmm.
Paul Bellows (20:33):
And it's a technology that comes with a
vendor.
Penny Rae (20:36):
Mm-hmm.
Paul Bellows (20:36):
Probably, and I'd love to hear just how this
project breaks down betweeninternal folks doing the work
versus external vendor folks.
Penny Rae (20:42):
Yep.
Paul Bellows (20:42):
And even just at a procurement level, one of the
things that famously happens inprojects like this is there's a
competitive process.
I sometimes joke it's likeplaying horseshoes with your
neighbor, but there's a fence inbetween.
No one's really sure that we'renot hitting the family pet as we
are sort of throwing ideas backand forth.
In the beginning into a businessrelationship and suddenly, the
complexities, comes to surface.
And now we're talking aboutscope or what was our intention
(21:03):
here?
And then you're talking about amassive design project where at
the start of the project to thepoint where we really understand
what we're building.
We want an enormous amount oflearning to occur.
Penny Rae (21:14):
Mm-hmm.
Paul Bellows (21:15):
And now you have passed an audit, which I assume
means you're generally on timeand on budget, cuz those are
some of the things that auditslook at.
How is that relationship withthe vendors and external
software companies?
Cause the industry is justfraught with stories of these
things coming to fisticuffs andto bad blood and to missed
expectations.
How are you managing a vendor tobe at this point in the project?
You're actually rolling out yoursecond traunch and you're still
(21:37):
tracking green from an auditperspective.
Penny Rae (21:39):
So we, we made a very deliberate discussion decision.
So when we had done our HR andfinancial system consolidation,
we had a third party come andhelp us implement a system
implementer.
And what happens, I find, inthat instance is there's a lot
of finger pointing between thesoftware vendor and the
(22:02):
implementation partner.
And that's a challenge and so wemade a very deliberate decision
that we were going to build it.
So we, we basically put a lot ofour systems on life support and
said, we're gonna pull from ourexisting like application teams,
(22:23):
about 250 people.
We sent them to Epic to gettrained and certified, and then
we came back.
So there isn't a middleman,there's Epic, who's a software
provider and us.
And we work very, very closelytogether.
And they helped us as we weregoing through build.
Like they had team, they hadpeople from their side assigned
to this project.
So we were working very closelybetween the two teams.
(22:46):
But there wasn't that, well,they said they should be doing
this and you know, they saidthey were gonna do that, and
which I think is where a lot ofthat finger pointing comes from.
And then the other thing itallows us to do now is our team
is often more experienced cuzthey've been doing this now for
[more] years than some of thenewer Epic staff.
And so this launch we're aboutto do is the first one where we
(23:09):
are completely in control of it.
So the previous one's, Epic'sbeen helping us in the launch
period, but this one is all us.
And so it's, you get thatknowledge transfer going and
we've actually gone, so we'vegot this, the uh, 250 people
certified initially that weredoing the initial build.
We've now gone and put the restof our staff through proficiency
(23:32):
training here, rather thansending them to Epic.
And so we have about 750 peoplewho are trained in, in Epic to
be able to develop and work onthe system.
And it's just a process overtime of, of saying, well, now
50% of your job is your oldapplication and, and we're gonna
train you on the new one.
And so you go a little bitbetween the two and then at some
(23:54):
point it flips.
So that they're working on the,this system.
Paul Bellows (23:58):
I love, in this new future, government and
public sector organizationsactually start to look a lot
more like software companiesthan they used to.
They used to be buyers ofsoftware, procurers of software.
Penny Rae (24:08):
Mm-hmm.
Paul Bellows (24:09):
And now you're really, if it's true that
digital is really gonna becomehow we operate and how we do a
major portion of our operations.
That really can't be delegatedout to a third party.
No, you have to build it inhouse.
You've absolutely embraced thatto say, no, we are gonna be the
center of excellence.
We're gonna have these expertsin-house.
It is what we do for thecitizens of Alberta is manage
(24:29):
information.
I love that.
But can you talk just for aminute about the kinds of
information you would manage inEpic and, and Cause I think the,
the risk and the and thechallenge of this gets down to
you know, what, what are weactually talking about here?
What kinds of potentialscenarios could we be looking at
and why is it so important toget this right?
Penny Rae (24:46):
So You can imagine we are implementing in every care
setting, in every geography, andwe're touching every process in
the care process.
Everything from registrationwhen you first walk in and, and
someone checks your name andaddress and your healthcare
card, to organizingappointments, doing lab tests,
(25:09):
diagnostic imaging, physiciandocumentation in hospital
documentation, surgicaldocumentation, wait list
management, like system flow,everything about the health
system.
And so the intention is from alearning health system
perspective, because it's reallyimportant that you learn as
(25:30):
you're going through thisprocess.
So we have a good understandingnow of, if I give this type of
care, I have this type ofoutcome.
And for the first time ever,we've got a way of connecting
those things.
Because up until this point,we've had administrative data
that says someone arrived at aclinic and did they get
readmitted or not?
Like things that we can trackthrough an admission, discharge
(25:52):
sort of system.
Now we've got what was theoutcome?
What was the.
The patient outcome is part ofthat.
And where I've got, you canstart to have a look at, where
I've got, some people who mighthave the same condition, who get
multiple interventions asopposed to people who get fewer
interventions.
(26:12):
What does that do?
What does the difference in carelook like?
There's certainly a differenceof cost, but is the outcome
different?
So we can start to have a lookat some of those things and, and
really reinvest back thatknowledge into the health system
and and update how the systemworks.
And we know that we're able todo that kind of virtuous cycle,
that closed loop.
(26:32):
And as we've got more and morepeople onto the system, so at
the end of this year, November,we will have all acute care in
the province on the system.
And the first time ever,everyone is gonna be speaking
the same language.
They're gonna be doing the samething, they're gonna have the
same care pathways.
And so we're able to say, whatdoes good look like then?
(26:54):
Right?
You start to learn more thantrying to cobble them all
together if they all had, so wehad different systems and they
were configured differently, andthey had different normal ranges
for things and.
So we've had to standardize allof those types of things as
well.
What are our dosage forpharmaceuticals and what's the
lab test norm here look like?
And those types of things.
Paul Bellows (27:16):
Those are the things that I think in 2023 when
we're having this conversation,the average North American, at
least, citizen would probablyassume is already happening or
possible, and yet, I know thisis a sea change in the
healthcare industry.
This really doesn't existanywhere else.
It is sort of the holy grail ofjust we have access to
information in a secure way.
So you're describing things thatI think, the average, Uber app
(27:37):
user would say, well, if Ubercan do it, why isn't my
healthcare provider?
What are some of the barriersbeen to healthcare organizations
like AHS been to adopting thesetypes of systems in the back?
What are some of the wickedproblems you're actually
overcoming right now?
Penny Rae (27:51):
So there's a language barrier.
Paul Bellows (27:52):
Yeah.
Penny Rae (27:53):
And people, they don't mean the same thing when
they write something down.
And so there's a lot of, what doyou mean by that, sort of
things.
It took us four years tostandardize our lab tests.
So we had a lot, I think westarted with 20 lab systems or
something in that order and tostandardize so that they had the
same name, they had the sameranges, they had the same
(28:14):
meanings.
It, that's a challenge, right?
Like, so some of those pieces,that was a wicked problem to get
through and get people to agreeon it is always a challenge.
I think the wicked problem nowis really on adoption of the
system.
So people are using it.
They're using it largely as adocumentation system.
That is a very expensive filingcabinet.
Paul Bellows (28:35):
Yep.
Penny Rae (28:35):
And so what we're really looking at now in the
next piece as we try and finishoff this implementation and
really start to think about whatdo we want it to do long term?
How do people use it?
How do people make theirworkflows smoother so that you
as a physician in GI might havea different requirement from a
(28:56):
surgeon in terms of what I wantto see on the page.
Have people taken the time topersonalize it.
Cuz that's one of the, thebenefits of this, you can
personalize it to make sure thatyour workflows are working and
are people using it effectively.
And do we have enough of afootprint of it that you keep
things within the system ratherthan keep trying to send them
(29:16):
out and then send them back inagain.
Right.
So it's, we're getting to thattipping point where some of
those big challenging problemsare gonna start to collapse.
We're starting to get rid ofsome of the interim states.
Paul Bellows (29:28):
So I think one of the things that can be,
liability of a project, thismagnitude is it is so large, it
is such a sprint.
You know, we get to the end ofthese things and we just want to
be done and we want something totell us.
It's done.
You can move on to somethingless complex now, something less
mind breaking.
Penny Rae (29:43):
There's never going back.
Paul Bellows (29:44):
See, there isn't, but you're talking now about
continuous improvement, about,user research ongoing as an
operational mandate.
Penny Rae (29:52):
Mm-hmm.
Paul Bellows (29:52):
This is design thinking.
This is sort of what the know,there's a historical design
thinking if you, you know, youdon't know.
We only know by watching whatpeople do, we only know by
Penny Rae (30:00):
mm-hmm.
Paul Bellows (30:01):
Doing the systems design work and then watching
what happens and seeing, thesense and respond we do.
So how do you sense and respondwith groups of this scale, do
you actually have a userresearch team now who works at
AHS?
Who's doing that kindamonitoring and checking in and
how has the team shifted overtime to be able to do this
thing, that probably wasn'thappening here five years ago,
(30:21):
of looking at how people wereusing systems at an individual
user level?
Penny Rae (30:25):
So there's two pieces to your question.
Paul Bellows (30:28):
Mm-hmm.
Penny Rae (30:29):
I think there's always been people who are
learning, like the learninghealth system is not a new
phenomenon.
And so historically we've donepaper chart reviews and those
types of things.
It's just very slow to be ableto get some of that, from that
research and knowledge intopractice.
Right.
That's a very long lead time.
(30:51):
And this system allows us to beable to move more quickly
through that because they've gottools within the suite that
allow the end user to be able togo, I wonder what happens if, I
wonder if there's a differencebetween.
So there's ways of looking atthe grassroots level to say, how
might I make this better?
(31:11):
So you enable much more of thatground up kind of quality
improvement visa work.
At the corporate level, we havea Quality Safety Outcomes
Executive Committee[QSO], andthey really look at what are
those big measures that we wantto move as a health system.
So we're looking right now atthe Alberta Surgical Initiative
trying to increase the numberand throughput of surgeries.
(31:34):
What does that look like?
How do we improve that?
So we're putting in centralaccess and triage, some of those
other things that help reducesome of those wait times to try
and improve how people flowthrough the surgical sphere.
And so those QSO, which is whatwe call it, QSO, is the group
that really directs some ofthose big ticket items.
(31:56):
And then you have thisupswelling from the ground up
and we've got analytics teamsthat are embedded throughout the
organization that use some ofthe information to say, how
might we learn from it?
So there's some central andthere's some very decentralized.
Paul Bellows (32:10):
The word innovation gets used so much
that it's mostly meaningless topeople, but like the root of it
is renewal and I
Penny Rae (32:16):
mm-hmm.
Paul Bellows (32:16):
And I love seeing situations where organizations
said, what are we already quitegood at and how does that apply?
That's innovation because that'srenewal of, you know.
Penny Rae (32:24):
Mm-hmm.
Paul Bellows (32:24):
We're really good at looking at paper documents,
seeing how they're used andredesigning them to be more
effective.
But that's at the cycle time ofgetting into clinics, seeing
paper and redesigning andreprinting and redistributing
paper docs.
Penny Rae (32:36):
Trying to read people's writing.
Paul Bellows (32:37):
Right.
And that too, right?
Yeah.
Yeah.
So with digital, the opportunityis cycle time and the challenge
is cycle time too.
Penny Rae (32:43):
Mm-hmm.
Paul Bellows (32:43):
To say it's our superpower, but we just need to
learn how to do it at a rapid,maybe a two week cycle time or
an eight week cycle time orsomething.
Penny Rae (32:50):
But in an organization of this size
Paul Bellows (32:52):
Yeah.
Penny Rae (32:52):
It's not, it's not coming up with the epiphany.
Paul Bellows (32:55):
Yeah.
Penny Rae (32:55):
It's how do you scale it?
Paul Bellows (32:56):
Mm-hmm.
Exactly.
Penny Rae (32:57):
We are a province of pilots.
Paul Bellows (32:59):
Yeah.
Penny Rae (33:00):
And we have pilots on everything.
And so it's how do you spreadand scale?
How do you get everybody doingthings the same way?
And that is still our challenge.
Paul Bellows (33:08):
Yeah.
Penny Rae (33:08):
So we've got strategic clinical networks that
we've been working with for thelast decade in the province and
they do really good work.
We still have a challenge with,does operations have the
capacity to absorb that work?
Paul Bellows (33:20):
Yeah.
Penny Rae (33:21):
And so what the site, an individual site in rural
Alberta might want to do, mightnot align with what the networks
are saying that they would likepeople to do.
And so when you have limitedcapacity, who wins that
argument?
Right.
And that's the discussion we'rehaving right now around how do
you get both that bottom up kindof quality improvement that you
(33:42):
want as well as some of the topdown.
And do that within, respectingthe capacity of operations to
absorb that work.
Paul Bellows (33:50):
Mm-hmm.
Penny Rae (33:50):
Because there's no use having coming up with 50
bright ideas, if operations hascapacity to absorb one of them.
Right.
You better to shift some of theresource into operations to be
able to say, maybe now I canonly come up with, 20
innovations, but now operationshas the capacity to deal with
them.
What does that look like?
So there's discussions on going.
(34:12):
In that space here as well.
Paul Bellows (34:15):
You'll appreciate this as someone from an
engineering background, I thinkevery system and every material
has failure points based onlinear scale.
You just grow anything.
Penny Rae (34:22):
Mm-hmm.
Paul Bellows (34:23):
And eventually every material breaks at a
certain weight or a tolerance,and you're pushing things to an
extreme that are, you're in thearea of unknown at all times
here at working at this kind ofscale.
And yeah, absolutely.
Edge cases and the way humanswill improvise in smaller
situations where improvisationis friendly but at scale, you
can't improvise.
We need structure, we needconsistency in systems.
(34:43):
And how do you put all of thattogether into one piece of
software That is a massivelychallenging problem.
Penny Rae (34:49):
Yeah.
And it's, we have tried toenable that.
The core record, like yourrecord, you want standardized.
So the headers that we use, theway we see them that like those
things, you want to beconsistent.
(35:10):
Everyone should have exactly thesame information.
By specialty, there are thingsthat like if you go, I go see a
cardiologist.
Your cardiologist has thecardiology group across the
province still, but it's asmaller group has to agree what
goes in that piece.
And then you've got theresearchers.
And so we have, we're justimplementing our red cap
(35:32):
integration with Epic so thatthe researchers have an easy way
of getting clinicians to, to beable to collect information at
the point of care.
How do you start to enable someof that work to happen?
Also Epic has a thing called AppOrchard where people can
innovate at the edge, butrespecting some of those APIs
(35:56):
the way that we talk with eachother, so that you're doing it
in a sustainable way.
Paul Bellows (36:01):
Mm-hmm.
Penny Rae (36:02):
Because then epic help vetting is helping us vet
those people.
Cause we can't necessarily copewith everyone's great idea cuz
like I would fall over again.
But it does give you structuredways for people to innovate.
And so we typically directpeople there to say, okay, if
you wanna play in thisenvironment, you have to be able
(36:23):
to talk to Epic because that'swhat we've built everything on.
Paul Bellows (36:27):
You've got clear river banks for people, but also
the possibility for them to, asyou say, innovate or make change
at a local level or for specificbusiness problems, whether
there's opportunity.
This really feels like it's oneof those IT stories that we're
all aiming for, where the, themassive change happens, people
adapt, things go wrong, and weidentify them and we
self-correct as we go and find.
(36:48):
So for you as a leader withultimate accountability for the
success of this, what have beensome of the levers you have
pulled or where you've really,you know, we talked about trust
early on.
What else do this project hasbeen essential for you in just
ensuring that people are havingthe right conversations, that
we're raising doubts early, thatwe're catching risks early.
That people in a sense have thepsychological safety in this
organization.
Not to be right, but to getright.
Penny Rae (37:10):
Mm-hmm.
I joke that my job is a partyplanner.
Paul Bellows (37:13):
Mm-hmm.
Penny Rae (37:14):
And so I hear anytime anything goes wrong cuz people,
I think before we had startedinto design, I'd been with IT
for a few years and I'd gainedthat trust of people here at
least.
So my team were very clear.
If something was going wrong, Iwould hear about it pretty much
straight away.
But we've really created thiswhole project so that we're very
(37:34):
transparent with what's goingon.
So we have risk mitigationmeetings, and the intention of
those risk mitigation meetingsis, if you're having a problem,
bring it to the table.
Let's talk about it.
Let's see how we can help you.
And it's very, it's veryvisible.
And we have launch readinessassessments at 120 days, 90
days, 60 days, 30 days, wherewe're saying, well, this is a
(37:55):
new emerging issue.
What are we gonna do about it?
Who do we need to connect?
And so whenever we have peoplewho are starting to, noise
starting to appear, I normallyget everyone in a room or a
virtual room now and say, what'sgoing on?
Let's think about how we fixthis.
And if you're not pointingfingers at people and you're
saying, okay, so what's our planto mitigate where we need to get
(38:18):
to?
And I think that goes a long wayof getting people to where they
need to be.
But it's, you have to be veryvisible, so I, and Debbie and
Jeremy who are my current nurseand doc partners, the three of
us are very visible.
We are in all of these meetings,we're interacting with people.
We're asking questions.
(38:38):
It's not something you can say,oh, that's going, I'll just
leave it over there.
Like, you really have to be verystrong sponsorship of the work
going on.
Paul Bellows (38:47):
And, and at the end of the day, that's what
culture is.
Culture is what you and yourco-leaders pay attention to.
Penny Rae (38:52):
Yep.
Paul Bellows (38:52):
And that's beautiful.
Well, Penny, thank you forletting us get a little bit of a
glimpse inside how AHS is doingthis massive, high risk, high
complexity shift that has somuch value to everyday citizens
and the healthcare systemitself, which at this point in,
again in 2023, we have beatenour healthcare system up so much
(39:13):
over the last three years.
Penny Rae (39:14):
Oh, we have.
Paul Bellows (39:14):
And we started brittle, especially here in a
Canadian context.
We already started working withthin margins for everything and
so we push people hard to bedoing something like this at
this time in history.
Leaders have followers.
There's a great little mantrathat I've always heard of.
You clearly have followersbehind you, so thanks for
sharing how you lead and some ofthe things that you bring to
this amazing game of changingtechnology inside of a massive
(39:35):
system.
Penny Rae (39:36):
Thank you for having me.
Paul Bellows (39:37):
Wonderful.
Penny Rae (39:37):
Hopefully it's helpful for people.
Paul Bellows (39:39):
Absolutely.
Thanks so much, Penny.
Thanks so much for listening.
Penny's mandate is formidable,but she approaches it with
courage and empathy.
Some of the themes she raisedthat I wanted to highlight
include (39:55):
one.
Trust is the basis for leadingtechnical projects.
Penny built trust through clearcommunication and consistent
responses.
Especially to challenging news.
Two.
The EPIC rollout at AHS is thelargest single IT project in
(40:16):
Canada at present, at least inthe public sector.
Penny is on time, and with herapproach, the team is delivering
well.
Three.
IT leadership doesn'tnecessarily require a deep
technical background.
But it does require leadershipthat understands how to work
with technical people andprojects.
(40:38):
I hope you enjoyed myconversation with Penny.
Please do subscribe and followthe many conversations we're
going to be releasing throughoutthe year.
I'd like to thank my colleagueswho work with me on this
podcast.
Kathy Watton is our showproducer and editor.
Frederick Brummer created themusic and intro.
We're going to keep havingconversations like this.
(40:59):
Thanks for tuning in.
If you've got ideas for guests,we should speak to, or you'd
like to join me on a show.
Send us an email tothe311@northern.co.
You can find that email addressand other links in our show
notes.
Government is all about all ofus.
Let's keep making a betterworld.
This has been the 3 1, 1podcast.
(41:20):
And I'm your host, Paul Bellows.
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