Process automation for hospitals: lessons from Beaumont Hospital and Forrester

Niamh Lordan00:00

Hello and welcome to today's webinar, Focus Your Digital Process Automation Efforts Squarely on Customer Outcome. I'm Niamh Lordan, digital marketing manager at FlowForma, and I'm the host of today's event. With me are Forrester's vice president and principal analyst, Rob Koplowitz, and Mark Graham, director of ICT at Beaumont Hospital.

Niamh Lordan00:27

Before we get started, some housekeeping. Today's webinar is being recorded. Your lines will be muted, but you can use the Q&A function on the right-hand side to ask questions, which we'll answer at the end. After the webinar we'll send everyone a copy of the recording.

Niamh Lordan01:04

Rob Koplowitz is vice president and principal analyst at Forrester, serving application development and delivery professionals. His research focuses on digital process automation, artificial intelligence and cognitive computing, and he has many years of experience in enterprise software consulting, product management and strategy.

Niamh Lordan01:28

Mark Graham is director of ICT at Beaumont Hospital, where he heads up the information and communications technology department. With 4,000 staff and 820 beds, the hospital provides emergency and acute care services across 54 medical specialties. Mark is passionate about digital transformation and the role of ICT in delivering excellent patient care. Rob, would you like to get started?

Rob Koplowitz02:01

I would love to. Thanks, everybody, for joining, and especially thanks to Mark Graham. I've been stalking Mark for a long time, because the story of Beaumont Hospital aligns so well with everything we've been doing in our research. Mark and the team at Beaumont have been able to cut through some really significant problems, and do it in the service of patient care.

Rob Koplowitz02:37

At Forrester, we work with business and technology leaders to develop customer-obsessed strategies. When we say customer, think of it as a proxy for patients, citizens and employees, because all of these people are ultimately involved in serving the people you work for. In Beaumont's case, that's patients. Where automation is going is right where it matters most: where it can make the greatest difference. And it hasn't necessarily been that way.

Rob Koplowitz03:35

Is digital transformation nothing more than a buzzword? We have the thumbs up and the thumbs down, because this is incredibly interesting to our client base right now, which includes a lot of people in financial services, insurance, banking and healthcare. If you're in retail, financial services or insurance, you feel the pressure from competitors. Industries like music, entertainment and retail have been disrupted by incredibly transformed, highly automated organizations.

Rob Koplowitz04:50

Nobody wants to wake up one morning and find that Amazon has entered their market. They're so efficient and so automated that it becomes difficult to compete. In healthcare, you're not necessarily thinking of yourself in a competitive situation, but in terms of efficiency, and making what is often a very difficult process for a patient easier wherever you can.

Rob Koplowitz05:28

But these efforts fail, at an incredibly high rate. We're tracking this very carefully at Forrester. The majority of things labeled digital transformation fail, across a number of key factors: they fail across organizational boundaries, they fail across legacy systems, and they fail because the task of automation is just too large and too daunting.

Rob Koplowitz06:01

For anyone not familiar with the term cargo cult, it's a story I love. During World War Two in the South Seas, the Japanese, and later the Americans, would show up on remote islands, clear a strip of jungle and build a tower. Then planes would come with lots of cargo, and they'd share it with the islanders. So the islanders concluded that if you clear a strip of jungle and build a tower, planes come and bring you cargo. Obviously, that's not the case.

Rob Koplowitz07:11

The term now describes seeing something happen on the surface without understanding what's happening underneath. We see chief digital officers getting hired, and the first thing they do is build a great mobile app. In healthcare, it's an app for scheduling appointments or picking up prescriptions, and it doesn't hook up to anything going on in the back. Just like the planes never came. Then you fire the chief digital officer, and it happens over and over again.

Rob Koplowitz07:52

Process technology is a very hot topic right now. It's a bit like kale and Brussels sprouts: things your mom cooked that you hated, but now we've discovered they're power foods and we really need them. The goals of process are changing. Process used to be a fairly mundane topic, with large, complex, traditional BPM projects involving a small number of people. They led to significant outcomes, but they didn't digitally transform the organization.

Rob Koplowitz09:01

Every two years, Forrester surveys process professionals. We ask what their primary focus was two years ago, what it is now, and what it will be in two years. Two years ago, the primary focus of process improvement was cost reduction. Today it's 16%, and two years out it drops to 8%. Digital transformation, by contrast, was 13% two years ago, is almost a third today, and two years out is almost half.

Rob Koplowitz10:09

These goals are deeply intertwined: you don't succeed at one without the others. But the primary objective has changed, and people now see digital transformation as something with a key effect on patients, customers and citizens.

Rob Koplowitz10:36

There's a dirty little secret behind this data. When I first saw the refreshed survey, I told my research associate it was the old data. It wasn't. It was almost identical. Two years had passed, and we'd made no progress. Today we'll dig into why digital transformation is so difficult even though the goals are so important. A lot of it is heavy lifting: automation and application development between IT and the business. What's different from the old days of BPM is that we have to do a lot of it, so we have to do it in a fundamentally different way.

Rob Koplowitz12:03

When we ask about the role of process improvement, a third of people still say it's about reducing costs, cycle times and error rates. That's what built the big BPM companies, and it remains very relevant. But almost twice as many now say it's a critical part of business strategy, directly supporting initiatives like digital transformation and customer service. You can't just call a digital agency and have them build an expensive mobile app on top of something that's fundamentally not automated. Mark, let's talk about your objectives.

Mark Graham13:45

Beaumont has used clinical IT systems for the past 27 years. We were one of the first hospitals in Ireland with electronic ordering: a doctor places an order for blood tests, a label goes on the sample, it's analyzed in the lab and the result comes back electronically. Lots of hospitals in Ireland still use paper for that. So for 27 years we've been digitizing where we can, and digital transformation will be key for at least the next 10 years. That top line on your slide is exactly what we're trying to do.

Mark Graham14:56

The reason is better access to data for our clinicians. Think of a patient who arrives in our emergency department very sick. The doctor has to find the paper notes, which could be on a different floor or in off-site storage. To make a decision and treat you the best way they can, the clinician needs access to your previous clinical information, as close to real time as possible. That's what's driving our digital transformation.

Mark Graham15:43

We've been building on the systems we've had for the past 20 years, across multiple platforms, to give clinicians access to the data they need. I've heard stories from clinicians that patients have better outcomes when that data is available as soon as they arrive. So for me, that's the driver: digitizing as much as we can, so people aren't running around with pieces of paper to treat a sick patient.

Mark Graham16:27

We're lucky to have doctors who trained and worked in the United States and came back to Ireland after 10 or 15 years with really good ideas from the technology they saw there. We tap into them, and it's great to have that source of ideas to help us digitize. But it's a long process. Over the next 10 years, we'll keep driving forward to digitize as much as we can.

Rob Koplowitz17:22

Mark, I didn't count, but you must have said patient 10 or 12 times. That creates a different focus. One thing in our data that caught our attention was the use of methodologies process professionals haven't traditionally thought about. We gave people a mix of methodologies, from BPMN process mapping to Lean Six Sigma and development methods, and interspersed customer journey mapping and design thinking.

Rob Koplowitz18:55

Customer journey mapping is popping to the top: 57% of process professionals are increasing their use of it, and 26% are increasing it significantly. That's a sea change in how people look at process. But when a process professional says customer journey mapping, they mean the interface an end user touches and how to automate the back end behind it. A customer experience professional means something far more expansive, starting with who you first see when you walk through the hospital's front doors.

Rob Koplowitz20:38

They're both right, and they need each other, but right now there's a fundamental disconnect. My research associate checked how often technologists are in the room when customer experience professionals do journey mapping. The answer was 30% of the time. So the people designing a better patient or citizen experience don't even know what's possible to automate, because IT isn't represented. The goals are correct, but we have a big cultural problem to overcome.

Rob Koplowitz22:05

Design thinking is similar: 55% increasing, and 26% increasing significantly. When Mark shows us Beaumont's work, notice how simple and crisp the interfaces are. They're used by people on the front lines with patients, not in a back room. When you roll technology out from a few people in suits to people sitting next to a patient, you need a really great user experience, and eventually it can reach patients and citizens directly.

Rob Koplowitz23:06

Mark, in our interviews you talked a lot about the white coats, a different class of user. Can you explain why that's so critical to Beaumont's success?

Mark Graham23:25

By white coats, I mean clinicians: nurses, doctors and allied health staff, all the frontline staff treating patients. About two years ago, we shifted our focus to delivering systems for the people on the front line, and making their processes easier, so they're not spending time filling out paper forms or using cumbersome systems. They spend more time with the patient.

Mark Graham24:08

That's been successful because we formed a clinical advisory group, with doctors, nurses and allied health staff from across the hospital's directorates, from surgery and neurosurgery to medicine. It's always very well attended. That's where we discuss strategy and what they need from IT. Instead of IT trying to interpret what clinicians need, we hear it from them directly, go back to the team and check, 'Is this what you mean?' We're building systems based on what they've told us, not what IT thinks they need.

Mark Graham25:23

Most of our systems focus on clinical staff, but that's not to say we ignore corporate. We probably have twenty flows built in FlowForma for HR and other corporate functions, so we keep the corporate side moving. But the focus is on improving processes for clinical staff, so they can spend more time with patients.

Rob Koplowitz25:54

You can't separate the front office from the back office. Sometimes the patient experience is sitting next to a clinician. Sometimes it's arriving at the next place and finding the paperwork already there, not moved manually. Sometimes it's smoother billing. We've created an arbitrary front office and back office split, but the patient journey exposes it, so you have to think about it holistically.

Mark Graham26:58

And the data our clinicians capture gives the back office a rich pool of data to drive process improvement: how many patients they're treating, and what types. The back office can use that to change processes. It's a win-win.

Rob Koplowitz27:29

Let's look at three things tripping up our clients, at a 100,000-foot level: crossing organizational boundaries, crossing legacy systems, and the sheer amount of automation required. Look at how many processes still run on paper-based, manual routing of tasks. Beaumont has done brilliant work there.

Rob Koplowitz28:44

The second is electronic manual routing, and this one really trips up our clients. It's where tools like FlowForma come to the forefront. Today, people update a spreadsheet, run macros and email things around. If you lie awake at night worrying about Amazon entering your market, this is what doesn't happen at Amazon: everything is radically transparent. Spreadsheets moving through email aren't visible to any system, so you get no transparency.

Rob Koplowitz29:54

The last is packaged applications. Processes run very effectively inside SAP, Oracle or Salesforce, but they're difficult to modify, so often we simply don't, and processes don't run well across those systems. Mark, you have some demos and screenshots of how Beaumont addresses paper, manual work and integration with existing systems.

Mark Graham30:46

To be clear, we still have lots of paper-based and manual processes. If you see a doctor in Beaumont today, they still write in a paper chart. It's a 10-year process, and there's no single electronic system that will replace every paper process in a hospital. A fully integrated system would cost many millions of euro, which we don't have. So every week, every month, we turn another little piece digital, and eventually we'll be paperless, or at least paper-light. Without one fully integrated system, integration with existing systems becomes key.

Mark Graham32:06

This is our hospital information system. It's over 20 years old and records everything you need to know about a patient: appointments, blood tests, results and X-ray results. All our doctors use it daily. We've built 14 systems in the middle of it, many of them on FlowForma and some developed in C#. There's an eForms button, and when a doctor clicks it, they get access to the FlowForma forms for that patient.

Mark Graham33:23

In this example, the doctor chooses a waiting list card. The patient's details are already filled in, pre-populated from the hospital system, so the doctor saves time by not having to type everything in. This is a training video we use for doctors. They choose the type of referral and its priority, and if it's urgent, an extra box asks whether it's needed within weeks or within three months.

Mark Graham34:32

On the next page, as the doctor types the procedure, it searches and suggests procedures, and it does the same for the diagnosis. After 30 seconds or so, the doctor has placed the patient on the waiting list without filling in any cards, and the form is instantly in the admissions office, so there's no delay. FlowForma then generates a PDF summary that's stored digitally against the patient's record, permanently, so there's a full record that the patient was referred to the waiting list.

Mark Graham35:40

The next one is our theatre notes. When a surgeon came out of surgery, they used to fill in a yellow paper sheet. Now they choose the patient, everything is pre-populated, and they record the theatre, the procedure, the surgeon and assistants, and free-text notes on what they did. Importantly, there are post-operation instructions, so as the patient goes back to the ward, the nursing staff know exactly what has to happen. The system generates a PDF that's stored against the patient record, and it's very clear and easy to read.

Rob Koplowitz36:49

Three things I love about that story. First, it crosses legacy systems, which is traditionally very difficult and has been an impediment. Second, you're automating manual and paper-based processes, which have generally been hard for IT to get its arms around. And third, the biggest one: it's all done in the service of patients and patient care.

Rob Koplowitz37:24

What you saw is agile development. Things happen rapidly. These aren't long projects where months are spent analyzing the process. You're doing something quickly and easily, and involving the right people. That's consistent with our survey data, which shows a huge move from waterfall approaches to agile, quick wins.

Rob Koplowitz38:11

We're also seeing a massive shift to low-code. You mentioned things previously developed in C# and in the underlying legacy systems. The move is on in a big way to doing this much more quickly: 43% of people planned to expand their use of low-code in 2016, and 67% in 2017. That approach is a very real part of driving digital transformation.

Rob Koplowitz38:59

There's an awful lot of work to be done. On the right is a long tail of things that need automating, which we call the business developer zone. The highly controlled applications IT traditionally worked on aren't going away, but they're increasingly augmented as processes are smoothed out and automated with low-code tools, so business and IT can work much more quickly. This is where digital transformation happens: all the work behind the scenes that's so difficult to get to.

Rob Koplowitz39:53

Mark, who's building these applications? This is a very different way of approaching it. Can you share how that's changed?

Mark Graham40:05

We have a very enthusiastic and dedicated IT team, and over the years they would take an idea, run with it and try to give it back to the users. But in the past, users weren't always committed to the project. We might spend weeks or months developing what they asked for, and then it wouldn't get used, or only 8 or 10% of it would. Users would say, 'I'm not doing this because IT is telling me to.' That was one of the mistakes we made in the past.

Mark Graham41:05

We have a small team of developers and a small team of FlowForma-trained staff. When I took over as director of ICT, I was amazed at how well they knew the business. They're not just people who write software; they understand how the business runs. Now every system is built with the business. No system is approved unless it has proper sponsorship and is designed with the users.

Mark Graham42:01

When doctors or consultants sponsor a project, it gets used, because they're developing it for themselves and each other. It's a joint effort. Changing processes in a hospital isn't just an IT project. You don't put a system on top of a process; you change the process at the same time. That engagement has been really positive for us over the last couple of years, and we know that when we develop something, it will be used and make a difference.

Rob Koplowitz42:52

I love this story. The most important point is that this isn't an IT thing or a business thing. Automating what the business does needs the business deeply involved, and I love how you're doing it quickly and iteratively, because the pattern of spending months analyzing and building has led to a lot of failure.

Rob Koplowitz43:36

Low-code isn't brand new. It's well-proven technology. But the world is changing, and customers and patients will expect you to change with it, particularly around artificial intelligence. In healthcare organizations around the world, doctors and nurses sitting with a patient can interact through voice, so they don't have to turn their back on the patient, and they can take notes more effectively. The things you do with Siri on your phone or Alexa in your kitchen are becoming real applications.

Rob Koplowitz44:39

We're seeing big vendors make big bets on AI in healthcare, infusing external expertise into the experience. And we're seeing a big focus on systems that find where processes are inefficient and suggest root causes for why they aren't running as efficiently as they might.

Rob Koplowitz45:21

Let me leave you with a few thoughts. Start with your strategy and executive support: at Beaumont, support at the CEO level was a big differentiator. Let your experience professionals lead: Beaumont focused from the start on the patient and how their experience changes. Process is more critical than ever. Taking paper out and moving it from floor to floor seamlessly isn't always glamorous, but it's really important.

Rob Koplowitz46:21

IT won't be able to do this by itself, so the partnership between IT and the business is vital. Those training videos are a nice example of change management. And last but not least, technology standards and governance: Beaumont made a bet on FlowForma, so it can train and build applications consistently, and people get used to the user experience. That consistent, standard approach is sometimes undervalued. With that, back to the FlowForma team.

Niamh Lordan47:17

Thanks, Rob and Mark. We have a few minutes for Q&A. Mark, people are asking: when you rolled out these processes and made paper processes digital using FlowForma, how did you get buy-in from staff, and how quickly did that happen?

Mark Graham47:48

It wasn't IT selling it. We used the clinical people who helped us design these processes to sell them to the business and the users. People don't always like IT arriving at their desk with a new system, so our lead clinicians promoted these systems: Grand Rounds, posters around the hospital, but always coming from the consultants rather than IT. When someone thinks, 'The doctor told me to do this, not IT,' that made a huge difference. With 14 systems, it's been a really positive experience for the hospital, with lots of positive feedback.

Niamh Lordan48:55

Thanks, Mark. Rob, someone is asking: who is best placed in my organization to own digital transformation and the focus on customer outcomes?

Rob Koplowitz49:14

There are multiple parts to that. Who owns it is increasingly the person responsible for the experience of the user: the employee experience if it's employee facing, the patient experience if it's patient facing. That end-to-end experience is increasingly the defining factor, and those people understand the end-to-end process. Below that, technology has to be a partner, because you can't automate without them, and standardizing on a technology you can build with quickly becomes really important.

Rob Koplowitz50:30

The third is the business. Mark talks about the doctors and nurses over and over, and the people who see a process's inefficiencies best are the ones serving your customers or patients every day. So it's a three-part partnership between experience, technology and the business, with the experience people probably in the lead. And lastly, don't do it without executive support. At Beaumont it came from the CEO, and that's why you're gaining business value almost immediately.

Niamh Lordan51:46

Thanks, Rob. Another question for Mark: what devices are your clinicians using to enter data?

Mark Graham51:58

Mainly PCs. We've trialed a number of mobile devices on the wards, but we lack the Wi-Fi infrastructure there, so we're looking at what infrastructure we can put in place for next year. For now it's mainly PCs or laptops; we haven't moved to mobile devices yet.

Niamh Lordan52:29

Thanks, Mark. We're coming to the end of our hour together, so thank you all for watching. You've been listening to Rob from Forrester and Mark from Beaumont Hospital. To discover more about how FlowForma process automation can help your digital transformation journey, visit flowforma.com, where you can sign up for a free trial or book a one-to-one demo with one of our experts. A special thanks to Rob and Mark for speaking with us today.