A rural Idaho health system and one of the most venerable technology companies in the world have teamed up to improve medical care.
Desert Sage and IBM Simpler Consulting, an arm of the highly-respected Watson Health division of IBM, have worked together for almost two years on a variety of projects to streamline their business operations and care delivery. Most recently, Desert Sage worked with the IBM consultants for setting-up a drive-thru clinic to provide care during the COVID-19 emergency.
Based in Mountain Home, Desert Sage has additional locations in Glenns Gerry and Grand View. The organization is a federally qualified health center serving Elmore and Owyhee Counties. The staff of 70 includes medical, dental and behavioral health care providers.
The Idaho Business Review recently sat down with Mary Ferguson, CEO, and Amber Jordan, COO, of Desert Sage Health Centers to discuss their experience with IBM Simpler Consulting.
The interview transcript has been edited for clarity and length.
Can you profile Desert Sage Health Centers for me?
Ferguson: Desert Sage is an FQHC, which is a acronym for federally qualified health center. We’re partially funded through grants from HRSA (U.S. Health Resources and Services Administration). Probably about 30% of our funding comes from the HRSA grant, and the rest is from patient fees. Essentially, for all intents and purposes, we look like a private clinic, but we’re not. We are a nonprofit clinic. We serve anyone regardless of their ability to pay.
Many of our patients are insured. Maybe at one time they weren’t, but they got jobs, they got insurance and they stayed here (with Desert Sage) because they liked the provider and they liked the doctors and the care that they received.
We have three locations, Mountain Home, Grand View and Glenns Ferry, so we are in a very rural setting. We serve a population that doesn’t have the greatest health. They’ve been underserved. When they do need specialty care, they sometimes have transportation barriers that make it hard for them to get to Boise or another area to receive that care.
In addition to medical, we also have a dental and behavioral health program. Right now, with the COVID-19 event, our behavioral health program is very busy. As you can imagine, for individuals who suffer from mental illness, one of their problems is the isolation with stay-at-home orders. Of course, we told everyone to self-isolate, and that’s the last thing these individuals should do – but with telehealth, our providers are able to stay connected so that’s been pretty good for our patients.
Can you tell me how Desert Sage and IBM got connected and how that resulted in your new program for drive-thru care during the COVID-19 emergency?
Jordan: We’ve actually been involved with IBM Simpler Consulting for two years. We started working with them specifically on our cancer screening workflows. We were just so happy with our results that that turned into more of a long-term arrangement.
So we have a coach (from IBM) and he’s onsite for a week every other month. We work on specific workflows here at the clinic that we want to improve. So that existing relationship just continued through to our drive-thru clinic design.
Our current coach helped us and asked us some good questions as we were designing (the drive-thru). He gave us some principles to work with and supported our development as we worked through that. Clearly, he couldn’t be onsite. He was in Wisconsin. We called him when we needed him, and we put him on FaceTime to do some walkthroughs with us. So this was all part of the support that IBM Simpler Consulting has been providing to us for the last two years.
How long did it take from the time that you realized you wanted to do a drive-thru to actually having it work? At how long did it take to set it up?
Jordan: It was four business days from design to launch. That included process mapping, testing, getting equipment and supply, planning out staffing and launching. So we started on a Tuesday morning, and we finished planning on Friday afternoon. Then on Monday morning, we opened it.
Ferguson: I would like to add that what made this all possible is that we’re at the stage with working with our consultants, we now have an environment where everyone’s ideas are respected. So we were able to bring individuals from all perspectives into a room and started working. No one is fearful about what they are going to say or if it’s not the right thing or if it sounds stupid – all the way from someone at the front desk through to our doctors. We need all of their perspectives. And having that freedom to share your ideas, the freedom to be wrong – that’s what helps us get the results that we want.
What services are you providing through the drive-thru?
Jordan: It’s essentially functioning as an urgent care. So we’re trying to get all of our patients going through the drive-thru … It primarily was designed as a clinic so that we could keep patients separated in a way that patients felt more comfortable getting care. That’s the main service. We are talking about adding some pediatric services one day a week, but for now it’s primarily an urgent care clinic.
We have been offering COVID-19 testing there as well. If people come through who meet the testing criteria, we have all the PPE and supplies there for our staff to test people right in their vehicles.
How much of the effort was needed on your side of the consulting relationship to see the drive-thru set up to succeed?
Jordan: That’s a little bit of a tough question. We have five people on the planning team, and every single person on the team could not have done this as quickly or as successfully without having that lean foundation and without having built the Desert Sage way. So while our coach wasn’t necessarily in the room with us planning for all four days, the work that we’ve done with IBM Simpler Consulting was the foundation for the design.
As far as the actual personnel time spent, it was probably 90% Desert Sage, 10% IBM; but if you look at the overall effort over the past couple of years, it was probably 90%-10% the other way.
So what brought Desert Sage to get into this relationship with the IBM Simpler Consulting?
Jordan: We have an individual locally who was going to donate some money through the American Cancer Society for sustainable cancer improvement. He reached out to us and told us the goal of his donation. (For) cancer screening, producing health fairs and buying the screening kits and all types of things like that – all of those are really one-time efforts.
We pointed out that the only sustainable thing that we could do would be some process design to better understand our system and to better understand what was getting in the way of our cancer screening. So we did quite a bit of looking and interviewing different groups. We came across IBM Simple Consulting and spent some time on the phone with them, getting to understand their approach and understand what they had to offer. Then we did a contract to work with them (for the cancer screening project).
Afterwards, we really thought the proof was in the pudding. We (decided to) sustain the relationship and committed to a full organizational transformation and the development of the Desert Sage way at our clinic based on these principles.
So the donation funded the first contract that you had with IBM?
Jordan: That’s right.
So after that, you decided it was such a valuable relationship that you would continue it?
Ferguson: Correct. Part of that was working with a board of directors. We sat down and did our strategic plan and understood how we could leverage off of that (first) success. They approved going through this two-year journey (with IBM). We’re now about one and three quarters of the way through that two-year journey.
So what exactly has IBM Simpler Consulting provided? Was it process design? Project management?
Ferguson: I’m going to share from my perspective. I really think they teach people how to think; and they teach everyone from your frontline workers all the way through the organization, providing them with the tools and skills to be able to think through challenges and how to provide improvement in their need areas and in all the areas that they’re connected to. That’s my perspective on it.
I think the key thing for me was respecting employees. That goes back to individuals’ feelings: feeling safe in their work and safe in their ideas.
Jordan: In the beginning of our transformation journey with IBM, there was a heavy focus on tools and we used those tools to create continuous improvement in the organization.
(When our IBM coach is onsite), from the beginning of the week to the end of the week, we take a part of a process and redesign it and implement all of those changes in the course of four and a half days. So that’s what our onsite visits are like every other month. Then we have weekly calls with our coach to follow up and for our coach to provide support as needed.
After the tools were understood and widely adopted by the staff – and we rotated all of our staff through (learning the tools) – we got to a place where we were customizing tools and techniques, which is what we’re doing with the Desert Sage way.
That’s where we are in the transformation right now, customizing the approach of what works for us … mapping processes and getting rapid improvements over the course of the week-long events (when the IBM coach is onsite). Over time, this becomes culture change and that’s what we’re shooting for.
In the long haul, we’re creating a way of thinking and a way of operating that’s so embedded in the way we do business that when a person or a group of people leave this organization, the culture change stays. We want this to be the foundation that we operate from.
How well did your staff and IBM work together?
Jordan: It’s been a really interdependent relationship. It required giving and humility and effort by both sides. And because of our really strong relationship with our coach, we’ve had a fantastic experience.