The 311 Podcast

S2 E01 - An EPIC journey with Penny Rae

• Guest: Penny Rae • Season 2 • Episode 1

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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. 
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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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Penny Rae:

I'm Penny Ray, the CIO for Alberta Health Services.

Paul Bellows:

Wonderful. And then maybe just because not everybody in the world understands the Canadian healthcare system, you do have some, uh, some non-Canadian audience here. Maybe just a little bit about how Alberta Health Service operates its mandate and how it might be different from how healthcare is delivered in other parts of the world.

Penny Rae:

In Alberta we have a public healthcare system, and Alberta Health Services is a single health delivery entity that reports into the minister of Health and it is accountable for the majority of acute care, a good chunk of the ambulatory, about a third of the long-term care, a spattering of primary care, and it works in conjunction with community providers, who are primarily contracted and primary care providers, who are contractors, in the community. And so it's a very interesting organization to work with. We have about, 110,000 people that work for AHS in IT. We actually support other organizations 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 and Capital Care, who are two wholly owned subsidiaries who do long-term care, Alberta Precision Labs, and Dyna Life, who is a contracted lab provider. So in all, we have about 140 to 150,000 people that we provide IT services for.

Paul Bellows:

My understanding is Alberta Health Services is one of the largest employers in Canada, not even worried about the province of Alberta or this region. Where do you rate in terms of size of employer in the country of Canada.

Penny Rae:

So we are the largest in Alberta. We're behind the federal government, I believe, Canada-wide, but we're definitely one of the largest in Canada, probably top five in Canada as well. We are one of the five largest IT shops in the, in the country. We have, well, depending on how you count people and contractors, we probably have in the order of two and a half thousand people that work delivering digital health to Albertans.

Paul Bellows:

That's a massive workforce.

Penny Rae:

Mm-hmm.

Paul Bellows:

2,500 people in IT is, you know, we're getting towards unicorn scale here in terms of the size of organization you would be in the private sector here.

Penny Rae:

Yes.

Paul Bellows:

That's huge. So, You're Chief Information Officer. One of the questions I love to ask folks, the CIO role, are you the Chief Information Officer, the chief infrastructure officer, or the chief innovation officer? Because they all start with I, and they're all sort of different backgrounds and you have a bit of a unique way you got here. How do you see the role of what you're here to do? I'd love to actually hear a little bit about how you landed here? Cause it's not a traditional career path to this role.

Penny Rae:

No, I would see myself as the chief information officer. Really thinking about how do you get information from where it is to where it needs to be? How do you collect it? How do you make sure that people have it? And how do you make sure that people have the right information at the right time? And in healthcare, that's particularly important, right? You want the right information about the patient at the right place and the right time so that you can make the best care decisions for them. My career path was very atypical, eclectic, I like to say. I'm a chemical engineer by background and I started work with Exxon, so Australia and I worked offshore oil and gas. So I've been on oil rigs and I've got helicopter underwater escape training. I've got all sorts of weird and one firefighting training, all 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 with PricewaterhouseCoopers first in their HR department doing all their graduate recruitment. And then I moved into internal audit, from internal audit into consulting within PwC[PricewaterhouseCoopers], both in Canada and Australia because I married a Canadian. So here we are.

Paul Bellows:

Well done.

Penny Rae:

Then I got seconded to lead the physical infrastructure for the health system as AHS was formed in 2009, 2010. And so I was originally meant to be doing some of the merger and acquisition work in that group, as a consultant. I was brought in to make sure everything came together and then hire my successor and the team at the time had said, no, 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 of thing. My boss at the time had said, oh, you know, IT and Capital, that's about the same. They both have capital and operating could you just do both? And so I'm like, well, I'll try. So for about six months I did both, which almost killed me and IT really needed, they hadn't really gone through the cultural work they needed to do, which is really, I think what, which is unusual for an engineer, is really what I think I'm good at. And so they, ended up leaving capital management and, and keeping with IT. And so it came in with no formal, like I did, I did programming as part of my engineering degree, but really I was very bad at it. And I, my team even now tells me I could break anything.

Paul Bellows:

Well, someone has to be the ultimate tester.

Penny Rae:

I know. I can test anything. I, they're like, I've never seen that before. I'm like, of course you haven't.

Paul Bellows:

I don't think it's unusual that you would be interested in culture coming from an engineering perspective. Cause engineering is fundamentally systems and interaction of systems. It is not the entirety of what engineering is, but it's a major one of the cognitive skills you develop as an engineer.

Penny Rae:

Yep.

Paul Bellows:

I think culture work is also systems in the interactions between systems, but instead of chemical entities, we're looking at interpersonal and behavioral entities. How people choose to behave, what they choose to do around security, around design, around research, around testing, and all of these behaviours that we want from people, but don't always get, when our culture isn't strong. I think often folks think when they say culture, they mean, oh, is it fun to work there? Are we nice to each other? But that's, it's how do we behave?

Penny Rae:

Yes. Yeah. And how, what's the, and a lot of culture is built on what level of trust do you have? And so you start to say, where do people trust? And then it'll get better or worse from there, right? So if you don't trust, then you don't communicate well. If you do trust, then you can can do things more efficiently. And so, making sure that you have a really strong foundation of trust in your organization, in your team, and in the broader organization is really important.

Paul Bellows:

For you, where does that trust come from? What is your sort of secret ingredient that you add as a leader where you believe you've built trust? I think this is trust comes is such a, it's a hard thing to gain, especially in IT with the organization and then even within IT. Cause we have so many experts. People who are experts at everything.

Penny Rae:

Yeah, and I, so when I came, when I first came into IT, and I've been in this role on June the first 2023 for 10 years. And when I first came in, of course I had no IT background. It was, people were very skeptical. And I sat in a room of my, my senior leadership team about, I don't know, 70 or 80 people, and everyone was sitting there with their arms crossed and saying, well, you know, who are you and why can you do this? What I had said to them at the time is like, you don't need more technical people. You need someone that can help you translate, from where you are into what they need and back again. And so I said to them, if after six months you don't think I'm the right person for this job, I will absolutely find you somebody else. I think what's really important is I am who I am all the time. Every time people come, like one of the, one of our great guys who retired after 30 plus years had said to me, had an exit interview with me. We were talking and he said, one of the things that, that I love about you, and it's gonna sound a bit odd, but you're very predictable. I think that predictability in terms of can I come and bring you a difficult discussion, can I tell you the truth without you exploding? Like, do you shoot the messenger? What does that look like? And, and I very much came into an organization that felt like we shot the messenger. And so I've spent a lot of time with the IT team really helping them understand like, I have your back. I'm very, future focused. So something may have happened. Okay, let's fix it. Right? Like it's, let's not dwell on it. Let's learn from it and move forward. And so I've been very consistent in my approach that, and people can predict now what I'm likely to say, and I'm building that leadership capacity so that they don't always feel they need to ask me. So I empower people to do what they need to do. And I'm very predictable when we have these discussions. So if they ask me like six months apart, they'll get essentially the same answer so that they know what to expect and that they can bring forward difficult things. And I'm like running a 1.4 billion dollar project, which is the largest in Canadian history. You can't run a project like that if people don't trust you to tell you the truth about what's going on, because it will very quickly derail.

Paul Bellows:

I love, you know, trust coming from predictability and consistency and people understanding what is essential to you and that not changing is fantastic, as a model for trust. You know, communication could be a place trust comes from. People need to know what you're thinking and what's happening.

Penny Rae:

Yeah.

Paul Bellows:

But then, you brought this up and I just think this is a fascinating initiative, that it's not just one of the largest or the largest IT project that you said, but it's also in one of the most fraught areas I think in IT.

Penny Rae:

Yeah.

Paul Bellows:

And in government, we deal with so many sensitive pieces of information, so much that is meaningful to individuals. Healthcare even more so. Even more so, we're dealing with people's wellbeing, we're dealing with people's illnesses, we're dealing with people's family, with their children. These are places where people have deep, deep feelings and emotion connected to the information that they're sharing.

Penny Rae:

Mm-hmm.

Paul Bellows:

This is not simply what year my car is. This is, you know, maybe my genetic condition, this is maybe my child health.

Penny Rae:

And it's also interacting with them at their most, most vulnerable.

Paul Bellows:

Absolutely.

Penny Rae:

Yeah. So when they are not up to their, they're not doing their best because they're sick, it's a challenge.

Paul Bellows:

Maybe the most fallible version of themselves.

Penny Rae:

Yep.

Paul Bellows:

Yeah. Could you talk just a little bit about what the nature of this project is, and what it means to AHS as an organization and maybe even to your constituents.

Penny Rae:

Mm-hmm.

Paul Bellows:

What is actually happening and what are you trying to change?

Penny Rae:

So we started with one of everything, lots of best of breed, and lots of information embedded within individual systems. And as a patient or resident of Alberta, what that feels like is every single place I go, I have to tell my story over and over and over and over again. And if I want any continuity, I bring that pile of paper with me, which is not it's not good for them. It's not empowering to people. It's a good recipe and we've seen some challenging stories like the Greg Price story, Falling Through the Cracks[2017], if anyone's watched that film that his family had put together, which is quite powerful. It provides a lot of opportunity for missing things.

Paul Bellows:

Mm-hmm.

Penny Rae:

So, We started with thinking, we had a look at an assessment of is it better to try and integrate these thousand systems through interoperability, and there's ways of doing that, or is it better to pull them out and replace them with something that's built to be a single system? It's not really built to be a single system. We're using the Epic software as a core of Connect Care and we've got about 85 systems that are directly integrated. So it's not, it's connect care as a single entity from a project perspective, but it's by no means a single piece of technology. So there's lots of it that we're putting in place. We had decided, we looked at the, the pros and cons and the quality that we were gonna be able to get to of information. Cause every time you move information from one place to another, you lose some of it. You don't quite get all the context that comes across. So we had decided that we would do a, a rip and replace. So we started, went out to rfp and this project, as we started, it's the first time we had brought together the clinicians across the province to have, start to have, a look at how do we document some of these clinical conditions? What do we want it to look like? How do these workflows work? Because of course, we started as multiple health entities and we slowly consolidated, and we had done a lot of work to consolidate the corporate services, but we hadn't done anything in the clinical space. So when we started, we brought together about two and a half thousand people in our direction setting. So you can imagine we organized, a series of six. The first three were just kind of getting started. The second three were validation, but about two and a half thousand clinicians. In a conference style, three day session. So we had six sessions. You

Paul Bellows:

had them all together.

Penny Rae:

We had them all together.

Paul Bellows:

Wow.

Penny Rae:

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 piece was all about workflows. How do we do things in the system? And we gave people a red card and a green card, no Canadians sitting on the fence,[no] yellow cards. They had to decide, could they live with this Part of the Epic methodology, they show you what the foundation system looks like, and say"can you live with this?" If you can't live with it, what do you wanna do? But in the room, at any given point in time, we might have a couple hundred people who are including patients. So we brought patients and families together. And the patients and families really challenged our clinicians. Well, we couldn't possibly give those patients their results right away. And the patients are like, why not? That's what I want. And so we went through this very intense design process on the workflows with thousands and thousands of people from across the province, from different backgrounds and different specialties, and really started that change process of understanding what does it look like, what is it going to be as we bring all of these people together to design something collectively. And so we did. That's the piece that we did for workflows. And then we went and built them and then came back and checked with them that, is this what you meant? And then on the in parallel, we were looking at the content. So what is the standard content if you have pneumonia? What is the standard contact for a cardiac arrest? What is the standard content for, like, what does that look like? And so in parallel, we had set-up I wanna say it's about 34 area councils and those were made of clinicians. Another about two and a half thousand clinicians involved in this piece of work. And looking at all of the decisions that we needed to make relative to what content we're gonna embed in the system. So what is the, standard flow sheet for how we deal in the emergency department. All of those types of questions we had to make decisions on. And so as a government entity, anyone who works in government will know it's a very slow process to make decisions. So we had to get a lot faster. So we made 5,000 decisions in the space of about nine months.

Paul Bellows:

How did you track that kind of decision flow? Can you just talk a little bit like how that was actually being like tracked and documented and shared and, and made, like what did those decisions look like?

Penny Rae:

So we had, we had a support unit for each of the area councils. We had people documenting in the sessions live at the conferences that we were having. So you can imagine we had all these people, we had all of the list of all the decisions they needed to make and we would document them in real time. So that we could give them to the build teams. And then for the clinical content, we had a whole bunch of questions. The support unit would prep the questions 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 would track all of them. We would be able to filter against each of those area councils and what they were doing.

Paul Bellows:

Incredible.

Penny Rae:

But it was, it was a lot of work. We have a Secretariat team. That helps make sure we're tracking all of the decisions, because of course we're spending a lot of public money. So we've had the auditor general audit us, our internal audit people. We've had, you know, every man and his dog wanna see what we're doing. The first clean audit report, ever, for a project here in Alberta.

Paul Bellows:

In the province.

Penny Rae:

Yeah.

Paul Bellows:

The first clean audit report. Congratulations.

Penny Rae:

So, and for something this size, so it was, it was quite the undertaking.

Paul Bellows:

I don't know if you're familiar with the Cynefin model of sort of like problem definition, it's a two by two that came out of IBM years ago where, you look at problem spaces as simple, complicated, complex and chaotic Complex, I think is the most interesting.

Penny Rae:

Mm-hmm.

Paul Bellows:

And sort of the fundamental definition is it's an emergent solution. There isn't something clear you can take off the shelf.

Penny Rae:

Mm-hmm.

Paul Bellows:

Which in this case, since we're anytime we're the biggest or the largest or the most expensive, we're always dealing with emergent solutions. No one has quite done it at the scale before and scale matters. And then the other dev thing that triggers complexity is multiple stakeholders, multiple perspectives are involved and 2,500 research participants. And I don't think you get much more complex than that environment.

Penny Rae:

No.

Paul Bellows:

You talked a little bit about, you came in as a bit of a change agent at a cultural level.

Penny Rae:

Mm-hmm.

Paul Bellows:

Just to say how we do the work matters as much as what work we're doing. So you're dealing with two things. You're dealing with a massive system change. You're dealing with massive complexity, multiple perspectives. How did you design the design work? Culturally, what had to be true here? You talked about trust entering this, what had to be true of this organization to be able to embrace a project of this nature, of this scale, and with this much ambiguity connected to it, heading to a design process with so many unknowns.

Penny Rae:

We did a lot of research before we started on how this type of project fails.

Paul Bellows:

Mm-hmm.

Penny Rae:

And so we looked at all of the reasons for, from clinical engagement, project delivery, leadership, and so some in the leadership, some of that agility and vision and, and it's a long hole. It is a, it is a massive lift. And when you think about it, in the research we did when we started, about 30% of these projects in this type of project were successful. So you're going into something

Paul Bellows:

sounds about right.

Penny Rae:

Yeah, you're going into something that's innately fraught has had some really bad press. And so we actually designed our governance around the ways it could fail so that we were proactively looking at that. We were poking at those things right from the beginning. So when I first got here, we had hired a CMIO, a Chief Medical Information Officer and a Chief Operations Informatics Officer. So we have a nurse and a doctor that are helping work on this as well. So we're doing it together. Having said that, people still see us all as IT, and so it's a bit of a, there's still that bit of a cultural shift and, and because one of the challenges we've had that I don't think you'd see in a smaller implementation is, and we did this all through covid as well, so we started, our first launch was right before Covid, and then we've had 4 sets, and we're about to enter our fifth, our sixth launch, but we had four during Covid. Which was challenging. But you need to get people to start to think, well, I've implemented in 2019, now I want you to fix the things I don't like. And so if you are implementing every six months, which is what we're doing, so we implemented in November, 24,000 people were implementing. Three weeks from now in May another 20,000 people. And you've often got an upgrade in the middle. So from a technical perspective, getting a whole bunch of optimization is really challenging. And so we've got this pent up demand that my team is working with their clinical and medical counterparts are going through close to 7,000, optimization tickets that people would like. And then how do you deal with that, right? It's just making sure they've got the right information, that they're not overlapping, that someone's saying, I'd like it blue, and someone's saying, I'd like it red. And then how do you deal with that, right? You've got so many people, the processes you need to do to get through it is, is a challenge. So we have pretty good governance and we've said to people, don't come to fisticuffs at the working level if you don't agree, escalate. Yeah. And then you'll get to a group that will make that decision. But we don't want you to damage your relationships cuz you need to work together.

Paul Bellows:

I'd be interested to hear you talk just for a minute. You talked about the system Epic that you're putting in place.

Penny Rae:

Mm-hmm.

Paul Bellows:

And it's a technology that comes with a vendor.

Penny Rae:

Mm-hmm.

Paul Bellows:

Probably, and I'd love to hear just how this project breaks down between internal folks doing the work versus external vendor folks.

Penny Rae:

Yep.

Paul Bellows:

And even just at a procurement level, one of the things that famously happens in projects like this is there's a competitive process. I sometimes joke it's like playing horseshoes with your neighbor, but there's a fence in between. No one's really sure that we're not hitting the family pet as we are sort of throwing ideas back and forth. In the beginning into a business relationship and suddenly, the complexities, comes to surface. And now we're talking about scope or what was our intention here? And then you're talking about a massive design project where at the start of the project to the point where we really understand what we're building. We want an enormous amount of learning to occur.

Penny Rae:

Mm-hmm.

Paul Bellows:

And now you have passed an audit, which I assume means you're generally on time and on budget, cuz those are some of the things that audits look at. How is that relationship with the vendors and external software companies? Cause the industry is just fraught with stories of these things coming to fisticuffs and to bad blood and to missed expectations. How are you managing a vendor to be at this point in the project? You're actually rolling out your second traunch and you're still tracking green from an audit perspective.

Penny Rae:

So we, we made a very deliberate discussion decision. So when we had done our HR and financial system consolidation, we had a third party come and help us implement a system implementer. And what happens, I find, in that instance is there's a lot of finger pointing between the software vendor and the implementation partner. And that's a challenge and so we made a very deliberate decision that we were going to build it. So we, we basically put a lot of our systems on life support and said, we're gonna pull from our existing like application teams, about 250 people. We sent them to Epic to get trained 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 closely together. And they helped us as we were going through build. Like they had team, they had people from their side assigned to this project. So we were working very closely between the two teams. But there wasn't that, well, they said they should be doing this and you know, they said they were gonna do that, and which I think is where a lot of that finger pointing comes from. And then the other thing it allows us to do now is our team is often more experienced cuz they've been doing this now for[more] years than some of the newer Epic staff. And so this launch we're about to do is the first one where we are completely in control of it. So the previous one's, Epic's been helping us in the launch period, but this one is all us. And so it's, you get that knowledge transfer going and we've actually gone, so we've got this, the uh, 250 people certified initially that were doing the initial build. We've now gone and put the rest of our staff through proficiency training here, rather than sending them to Epic. And so we have about 750 people who are trained in, in Epic to be able to develop and work on the system. And it's just a process over time of, of saying, well, now 50% of your job is your old application and, and we're gonna train you on the new one. And so you go a little bit between the two and then at some point it flips. So that they're working on the, this system.

Paul Bellows:

I love, in this new future, government and public sector organizations actually start to look a lot more like software companies than they used to. They used to be buyers of software, procurers of software.

Penny Rae:

Mm-hmm.

Paul Bellows:

And now you're really, if it's true that digital is really gonna become how we operate and how we do a major portion of our operations. That really can't be delegated out to a third party. No, you have to build it in house. You've absolutely embraced that to say, no, we are gonna be the center of excellence. We're gonna have these experts in-house. It is what we do for the citizens of Alberta is manage information. I love that. But can you talk just for a minute about the kinds of information you would manage in Epic and, and Cause I think the, the risk and the and the challenge of this gets down to you know, what, what are we actually talking about here? What kinds of potential scenarios could we be looking at and why is it so important to get this right?

Penny Rae:

So You can imagine we are implementing in every care setting, in every geography, and we're touching every process in the care process. Everything from registration when you first walk in and, and someone checks your name and address and your healthcare card, to organizing appointments, doing lab tests, diagnostic imaging, physician documentation in hospital documentation, surgical documentation, wait list management, like system flow, everything about the health system. And so the intention is from a learning health system perspective, because it's really important that you learn as you're going through this process. So we have a good understanding now of, if I give this type of care, I have this type of outcome. 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 a clinic and did they get readmitted or not? Like things that we can track through an admission, discharge sort of system. Now we've got what was the outcome? What was the. The patient outcome is part of that. And where I've got, you can start to have a look at, where I've got, some people who might have the same condition, who get multiple interventions as opposed to people who get fewer interventions. What does that do? What does the difference in care look like? There's certainly a difference of cost, but is the outcome different? So we can start to have a look at some of those things and, and really reinvest back that knowledge into the health system and and update how the system works. And we know that we're able to do that kind of virtuous cycle, that closed loop. And as we've got more and more people 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 same thing, they're gonna have the same care pathways. And so we're able to say, what does good look like then? Right? You start to learn more than trying to cobble them all together if they all had, so we had different systems and they were configured differently, and they had different normal ranges for things and. So we've had to standardize all of those types of things as well. What are our dosage for pharmaceuticals and what's the lab test norm here look like? And those types of things.

Paul Bellows:

Those are the things that I think in 2023 when we're having this conversation, the average North American, at least, citizen would probably assume is already happening or possible, and yet, I know this is a sea change in the healthcare industry. This really doesn't exist anywhere else. It is sort of the holy grail of just we have access to information in a secure way. So you're describing things that I think, the average, Uber app user would say, well, if Uber can do it, why isn't my healthcare provider? What are some of the barriers been to healthcare organizations like AHS been to adopting these types of systems in the back? What are some of the wicked problems you're actually overcoming right now?

Penny Rae:

So there's a language barrier.

Paul Bellows:

Yeah.

Penny Rae:

And people, they don't mean the same thing when they write something down. And so there's a lot of, what do you mean by that, sort of things. It took us four years to standardize our lab tests. So we had a lot, I think we started with 20 lab systems or something in that order and to standardize so that they had the same name, they had the same ranges, they had the same 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 agree on it is always a challenge. I think the wicked problem now is really on adoption of the system. So people are using it. They're using it largely as a documentation system. That is a very expensive filing cabinet.

Paul Bellows:

Yep.

Penny Rae:

And so what we're really looking at now in the next piece as we try and finish off this implementation and really start to think about what do we want it to do long term? How do people use it? How do people make their workflows smoother so that you as a physician in GI might have a different requirement from a surgeon in terms of what I want to see on the page. Have people taken the time to personalize it. Cuz that's one of the, the benefits of this, you can personalize it to make sure that your workflows are working and are people using it effectively. And do we have enough of a footprint of it that you keep things within the system rather than keep trying to send them out and then send them back in again. Right. So it's, we're getting to that tipping point where some of those big challenging problems are gonna start to collapse. We're starting to get rid of some of the interim states.

Paul Bellows:

So I think one of the things that can be, liability of a project, this magnitude is it is so large, it is such a sprint. You know, we get to the end of these things and we just want to be done and we want something to tell us. It's done. You can move on to something less complex now, something less mind breaking.

Penny Rae:

There's never going back.

Paul Bellows:

See, there isn't, but you're talking now about continuous improvement, about, user research ongoing as an operational mandate.

Penny Rae:

Mm-hmm.

Paul Bellows:

This is design thinking. This is sort of what the know, there's a historical design thinking if you, you know, you don't know. We only know by watching what people do, we only know by

Penny Rae:

mm-hmm.

Paul Bellows:

Doing the systems design work and then watching what happens and seeing, the sense and respond we do. So how do you sense and respond with groups of this scale, do you actually have a user research team now who works at AHS? Who's doing that kinda monitoring and checking in and how has the team shifted over time to be able to do this thing, that probably wasn't happening here five years ago, of looking at how people were using systems at an individual user level?

Penny Rae:

So there's two pieces to your question.

Paul Bellows:

Mm-hmm.

Penny Rae:

I think there's always been people who are learning, like the learning health system is not a new phenomenon. And so historically we've done paper chart reviews and those types of things. It's just very slow to be able to get some of that, from that research and knowledge into practice. Right. That's a very long lead time. And this system allows us to be able to move more quickly through that because they've got tools within the suite that allow the end user to be able to go, I wonder what happens if, I wonder if there's a difference between. So there's ways of looking at the grassroots level to say, how might I make this better? So you enable much more of that ground up kind of quality improvement visa work. At the corporate level, we have a Quality Safety Outcomes Executive Committee[QSO], and they really look at what are those big measures that we want to move as a health system. So we're looking right now at the Alberta Surgical Initiative trying to increase the number and throughput of surgeries. What does that look like? How do we improve that? So we're putting in central access and triage, some of those other things that help reduce some of those wait times to try and improve how people flow through the surgical sphere. And so those QSO, which is what we call it, QSO, is the group that really directs some of those big ticket items. And then you have this upswelling from the ground up and we've got analytics teams that are embedded throughout the organization that use some of the information to say, how might we learn from it? So there's some central and there's some very decentralized.

Paul Bellows:

The word innovation gets used so much that it's mostly meaningless to people, but like the root of it is renewal and I

Penny Rae:

mm-hmm.

Paul Bellows:

And I love seeing situations where organizations said, what are we already quite good at and how does that apply? That's innovation because that's renewal of, you know.

Penny Rae:

Mm-hmm.

Paul Bellows:

We're really good at looking at paper documents, seeing how they're used and redesigning them to be more effective. But that's at the cycle time of getting into clinics, seeing paper and redesigning and reprinting and redistributing paper docs.

Penny Rae:

Trying to read people's writing.

Paul Bellows:

Right. And that too, right? Yeah. Yeah. So with digital, the opportunity is cycle time and the challenge is cycle time too.

Penny Rae:

Mm-hmm.

Paul Bellows:

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 or something.

Penny Rae:

But in an organization of this size

Paul Bellows:

Yeah.

Penny Rae:

It's not, it's not coming up with the epiphany.

Paul Bellows:

Yeah.

Penny Rae:

It's how do you scale it?

Paul Bellows:

Mm-hmm. Exactly.

Penny Rae:

We are a province of pilots.

Paul Bellows:

Yeah.

Penny Rae:

And we have pilots on everything. And so it's how do you spread and scale? How do you get everybody doing things the same way? And that is still our challenge.

Paul Bellows:

Yeah.

Penny Rae:

So we've got strategic clinical networks that we've been working with for the last 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:

Yeah.

Penny Rae:

And so what the site, an individual site in rural Alberta might want to do, might not align with what the networks are saying that they would like people to do. And so when you have limited capacity, who wins that argument? Right. And that's the discussion we're having right now around how do you get both that bottom up kind of quality improvement that you want as well as some of the top down. And do that within, respecting the capacity of operations to absorb that work.

Paul Bellows:

Mm-hmm.

Penny Rae:

Because there's no use having coming up with 50 bright ideas, if operations has capacity to absorb one of them. Right. You better to shift some of the resource into operations to be able to say, maybe now I can only come up with, 20 innovations, but now operations has the capacity to deal with them. What does that look like? So there's discussions on going. In that space here as well.

Paul Bellows:

You'll appreciate this as someone from an engineering background, I think every system and every material has failure points based on linear scale. You just grow anything.

Penny Rae:

Mm-hmm.

Paul Bellows:

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 the area of unknown at all times here at working at this kind of scale. And yeah, absolutely. Edge cases and the way humans will improvise in smaller situations where improvisation is friendly but at scale, you can't improvise. We need structure, we need consistency in systems. And how do you put all of that together into one piece of software That is a massively challenging problem.

Penny Rae:

Yeah. And it's, we have tried to enable that. The core record, like your record, you want standardized. So the headers that we use, the way we see them that like those things, you want to be consistent. Everyone should have exactly the same information. By specialty, there are things that like if you go, I go see a cardiologist. Your cardiologist has the cardiology group across the province still, but it's a smaller group has to agree what goes in that piece. And then you've got the researchers. And so we have, we're just implementing our red cap integration with Epic so that the researchers have an easy way of getting clinicians to, to be able to collect information at the point of care. How do you start to enable some of that work to happen? Also Epic has a thing called App Orchard where people can innovate at the edge, but respecting some of those APIs the way that we talk with each other, so that you're doing it in a sustainable way.

Paul Bellows:

Mm-hmm.

Penny Rae:

Because then epic help vetting is helping us vet those people. Cause we can't necessarily cope with everyone's great idea cuz like I would fall over again. But it does give you structured ways for people to innovate. And so we typically direct people there to say, okay, if you wanna play in this environment, you have to be able to talk to Epic because that's what we've built everything on.

Paul Bellows:

You've got clear river banks for people, but also the possibility for them to, as you say, innovate or make change at a local level or for specific business problems, whether there's opportunity. This really feels like it's one of those IT stories that we're all aiming for, where the, the massive change happens, people adapt, things go wrong, and we identify them and we self-correct as we go and find. So for you as a leader with ultimate accountability for the success of this, what have been some of the levers you have pulled or where you've really, you know, we talked about trust early on. What else do this project has been essential for you in just ensuring that people are having the right conversations, that we're raising doubts early, that we're catching risks early. That people in a sense have the psychological safety in this organization. Not to be right, but to get right.

Penny Rae:

Mm-hmm. I joke that my job is a party planner.

Paul Bellows:

Mm-hmm.

Penny Rae:

And so I hear anytime anything goes wrong cuz people, I think before we had started into design, I'd been with IT for a few years and I'd gained that trust of people here at least. So my team were very clear. If something was going wrong, I would hear about it pretty much straight away. But we've really created this whole project so that we're very transparent with what's going on. So we have risk mitigation meetings, and the intention of those risk mitigation meetings is, 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 very visible. And we have launch readiness assessments at 120 days, 90 days, 60 days, 30 days, where we're saying, well, this is a new emerging issue. What are we gonna do about it? Who do we need to connect? And so whenever we have people who are starting to, noise starting to appear, I normally get everyone in a room or a virtual room now and say, what's going on? Let's think about how we fix this. And if you're not pointing fingers at people and you're saying, okay, so what's our plan to mitigate where we need to get to? And I think that goes a long way of getting people to where they need to be. But it's, you have to be very visible, so I, and Debbie and Jeremy who are my current nurse and 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. It's not something you can say, oh, that's going, I'll just leave it over there. Like, you really have to be very strong sponsorship of the work going on.

Paul Bellows:

And, and at the end of the day, that's what culture is. Culture is what you and your co-leaders pay attention to.

Penny Rae:

Yep.

Paul Bellows:

And that's beautiful. Well, Penny, thank you for letting us get a little bit of a glimpse inside how AHS is doing this massive, high risk, high complexity shift that has so much value to everyday citizens and the healthcare system itself, which at this point in, again in 2023, we have beaten our healthcare system up so much over the last three years.

Penny Rae:

Oh, we have.

Paul Bellows:

And we started brittle, especially here in a Canadian context. We already started working with thin margins for everything and so we push people hard to be doing something like this at this time in history. Leaders have followers. There's a great little mantra that I've always heard of. You clearly have followers behind you, so thanks for sharing how you lead and some of the things that you bring to this amazing game of changing technology inside of a massive system.

Penny Rae:

Thank you for having me.

Paul Bellows:

Wonderful.

Penny Rae:

Hopefully it's helpful for people.

Paul Bellows:

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 raised that I wanted to highlight include: one. Trust is the basis for leading technical projects. Penny built trust through clear communication and consistent responses. Especially to challenging news. Two. The EPIC rollout at AHS is the largest single IT project in Canada at present, at least in the public sector. Penny is on time, and with her approach, the team is delivering well. Three. IT leadership doesn't necessarily require a deep technical background. But it does require leadership that understands how to work with technical people and projects. I hope you enjoyed my conversation with Penny. Please do subscribe and follow the many conversations we're going to be releasing throughout the year. I'd like to thank my colleagues who work with me on this podcast. Kathy Watton is our show producer and editor. Frederick Brummer created the music and intro. We're going to keep having conversations like this. 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 to the311@northern.co. You can find that email address and other links in our show notes. Government is all about all of us. Let's keep making a better world. This has been the 3 1, 1 podcast. And I'm your host, Paul Bellows.