Home > Webinar
Transforming the Patient Journey and Reducing Costs
/by Brian AndersonHear from Harvard’s Boston Children’s Hospital Digital Transformation Officer, Bill Gagnon, discuss how chatbots can streamline a patient’s journey, how to apply AI inside a chatbot, and more. If you’re ready to transform your system or are already in progress, you will learn from people who have successfully executed these tools, and you will obtain suggestions you can implement immediately.
Full Transcript
Brian Anderson: All right, we are live on the webinar. So thanks thanks for joining. I want to kick this off. We’re gonna run our second part of our series around digital transformation. This week’s or this month’s topic is transforming the patient journey and reducing costs with ai, chatbots and open source. And our guest again is Bill Gagnon. He is the Director of Digital Transformation for Boston Children’s Hospital and I’ll let Bill introduce himself. Hi Bill. Welcome to the show again.
Bill Gagnon: Great. Hi Brian. Morning. Thanks so much for having me back here. I appreciate it. Yes I’ve been basically working in digital transformation since the mid nineties working for companies such as Citigroup, GE, Cigna, and now recently Boston Children’s Hospital, so I’m excited today to talk about the chatbot that we’ve deployed and other things that we’re working on.
Brian Anderson: Awesome. Thank you, bill. And I’m Brian Anderson. I’m the CEO of Augusto Digital. We focus on digital transformation and software solutions in healthcare. And so we’re working in this space with clients every day. So we’re looking forward to this this webinar here. So let’s get this started. You know, why are we, why are we doing this? You know, we believe that the advances in healthcare in the healthcare systems benefit all of us. And so we’re trying to, you know, shine a light on digital transformation and why it’s so important and such a big part of the changes that are happening today. And that if we do this right, we can help each other improve and, and, and all of us create a stronger health system for everyone. So that’s why we’re doing it. And you know, again, I’m Brian Anderson and Bill Gagnon. And this is where we’re gonna cover today. We’re gonna talk a little bit about chatbots and some background, and we’re gonna talk about some of the catalysts and usage growth and some of these usage scenarios, what’s going on with AI in this space and the future what, what’s going on with open source and kind of how Boston Children’s Hospitals take advantage of open source. Talking about staffing and operations, lessons learned, and then you know, getting these quick wins and growing the adoption. And then we’re gonna have a Q&A session here. We’re live today. So let’s let’s jump in here to some questions. I just lost my question sheet here. Apologize for that.
Bill Gagnon: No worries.
Brian Anderson: Little technical glitch. Here we are. So hey Bill, why don’t you start by just sharing some background around your kind of usage of chatbots over the years and kind of why you’ve decided to implement one of these at Boston Children’s.
Bill Gagnon: Sure, absolutely. So one of the things, as I mentioned, you know, back in, you know, since my career kind of kicked off in the mid nineties working in digital, as it all kind of started to grow from, you know, basically nothing We actually, you know, started working on websites and doing all the different things. And when I when I transitioned over to GE, you know, I learned a little bit like we talked last webinar about all of the process mapping and going through and working with all the different departments that you work with and really kind of, you know, mapping out their patient experience or the customer experience and finding out what are opportunities and time over time at GE, at Cigna, and even now, Boston Children’s Hospital, what really resonated as a tool that could actually provide information 24/7, that, you know, could be, you know, hopefully as empathetic as possible in the healthcare you know, environment, but something that would be able to, you know, take a lot of the pain points away from the call center by getting calls for, you know, different things like where do I park, how, what time do I show up for my appointment, where at the location and all these different things and how do I find this doctor? And so we actually implemented chat and like I said, I’ve been doing this since we had, I had online chat or the chatbot in GE and also at Cigna, and then now more recently at Boston Children’s Hospital.
Brian Anderson: Great. And let’s talk a little bit about, you know, the catalyst, like what, you know, what led you to kind of improve your digital front door for Boston Children’s and like, you know, what was the first reason that really drove like the implementation of this chatbot?
Bill Gagnon: Sure, sure. And, and again, it goes back to, you know, when I first started in 2015 at at Boston Children’s Hospital. First thing I did is, you know, start meeting with all of the different 18, you know, service areas of the hospital and having working sessions with them. And as I mentioned in the last webinar, all the working sessions, basically we, you know, we get all the key stakeholders together. We do a process mapping session, and we really point out opportunities for improvement. And time over time, as I mentioned, was people were putting their hands up saying, we just need more information to be delivered to the end user, which is the either the patient, family, or even referring physicians, and sometimes even researchers. And one of the tools that I’ve had in my wheelhouse over the years is, you know, working with the I go back to the old school of in chatbots, AIML, which is the old Alice product, which is origination of, you know, heuristic Learning back and forth, and we implement that tool, and I’ve made changes over the years to it. And so even now, recently at Boston Children’s Hospital, we found that during these working sessions, what was really resonating is that we needed a quick win. Something we could turn around real fast, but also that would be a real value add to end users. And the chatbot was something that we could literally spin up in an hour or two. We could put information into it. And really, you know, it is like your online FAQs, but the way that if it’s implemented properly, It can actually be, you know, much like a real person chatting back and forth with the, you know, end user.
Brian Anderson: Yeah. That’s great. And so I have an example here, some information that you shared with us to kind of just give people like an example scenario. Let’s walk through that together. So this is a page on your website, right? I think you’re highlighting COVID-19.
Bill Gagnon: Right. So, so really just to kinda go back a little bit, we had the tool launched from 2018 and we did, you know, it is healthcare. So I think that we all have to be kinda careful of, you know, the tools that we, you know, put into place. It’s not a typical you know, inner retail, online, you know, e-commerce shop. And so, With that we wanna make sure the tools we have are, you know, kept compliant that we’re actually having the right data being, you know, put across to the end user and not sharing any PHI information. And so we did a slow start and we started looking at all the different areas that people really resonated towards. And that’s on our patient relations or experience area. And so inside that area, we had the chatbot live for about a year and a half. And, you know, we had about 40,000 different responses onto it. And then back, you know, in 2020 March it Covid came on strong. And we were in a real dilemma at the hospital because we had more than ever people, we were sending people home and people were sending themselves to our website. It was kind of crazy because they needed the answers, right? Is my child’s appointment gonna happen? What do I do about a, you know, a rare and unique condition? What do I, how do I reach out to people with this situation going on and learning more information about COVID. And so our team got together and thought, we’ve got a great tool at our disposal. We have this online chatbot. And so we immediately went to all the operational staff in the department and talked with them and said, look, we can, you know, we’re already standing up a covid specific website, you know, for this, but we need to have a tool that’s available 24/7. And we actually launched it within the third week of COVID. And we saw, you know, calls to the call center just dropped dramatically because a lot of the questions we were able to ask, you know, to answer. And the nice thing about the tool we have being open source, It’s something that on the back end that we can actually go in and program very quickly on a daily basis. So we’re able to see the questions that it, that it asked. We’re able to see that it has about 95% cancer ratio. And the nice thing is that any of the questions that we don’t get to, we’re able to email back the patient at the end of the day with the answer and then also program that back into the tour.
Brian Anderson: Yeah. Well, let’s go through this scenario here just to make sure it’s concrete for everybody. So this is the COVID-19 specific site that you guys set up, right?
Bill Gagnon: Yes, exactly. Right, that’s, that’s the home page and it leads you into the covid. So, as you can see here, you know, it’s unlike other chatbots that are out in the, you know, other websites, we do have to put a lot of disclaimers up on top because they’re making sure that, you know, they, first, they understand that it’s not a real live person. We don’t wanna mislead anybody, but we also wanna make sure that if it is emergency or a medical emergency that they call 911 or, you know, a, a person that can help out.
Brian Anderson: Yeah. So it kind of starts with that and then it turns into more of a conversation, right?
Bill Gagnon: Right, exactly. And as you see here, this is, this is the real life instance, so it’s not very robotic. We made sure that when we, when we’re putting questions into this tool, that it has over 10 different ways of answering it. We also have 10 different ways of asking that question. Cause we make sure that, you know, are we using the right terminology? Are we using slang or abbreviated words that might be used to make sure we catch all of it? But you can see here they’re looking for information about Covid 19, and this comes across as something that, as a real conversation would be, you know, the chatbot came back and said, absolutely can help. You know, we have a comprehensive section on Covid 19. We hear it click here. So we’re able to display links that they can actually go to open up another window. They can actually, we can show videos, we can show different images and different things like that through that. And the person actually came back. And this is actually a real live session that we actually recorded on this. So it’s very helpful you know, vaccine information. We, you know, what we do is the program picks up all these different, you know, terminologies in their, in their keywords and comes back with the response that yes, we have a parent you know, we have information for content, for parents, providers, and the community. And then, you know, just kind of keeps that conversation going with them.
Brian Anderson: Yeah. And it leads them into helpful resources, right?
Bill Gagnon: Right.
Brian Anderson: We’re trying to solve the problems for ’em through the chatbot to reduce the call.
Bill Gagnon: Exactly, and, and the chatbot, as you can see here, it actually grew another tool out of this tool because in having this, we learned that people wanted to have, okay, well I need a location of where do I get the vaccine? And so we immediately started building out a, a vaccine locating, you know, tool that we actually had location-wise, and we tied into the, you know, dot gov. So we actually had all of that information and we were able to, you know, show them a map where they could click on it. But as you can see, The tool is able to be a standalone on the desktop, so it still keeps working even as the webpage is working in the background.
Brian Anderson: Mm-hmm. Yeah. And this is like the tool that you guys developed for finding different locations, right?
Bill Gagnon: Exactly.
Brian Anderson: So you’re able to adapt and learn. Whereas a lot of times people will go to your website and you don’t know exactly what they’re doing. You have the analytics, but like this is much more. Informed because they’re asking questions. Right.
Bill Gagnon: Absolutely right. We looked at the heat mapping after this, and it was a very, you know, structured path as most to, as opposed to sometimes when, you know, people are all over the place because, you know, in healthcare there’s, there’s a lot of different entry points and you know, a lot of times, you know, in a regular situation for like non-COVID world, people usually would come into the website for conditions and treatments and find out how to make an appointment. In Covid times it was all about just different, like, okay, I need help and I need answers. And so this tool had this. What you’re seeing here is interesting is that the tool we morphed it very quickly as a helpful tool online, but also we installed it on the back end of all of our people’s frontline staff computers. The reason being is that when they receive phone calls from patients, everybody, you know, basically at that point they were being sent to work home and the people that were, you know, they had all of these different you know, tutorials that they had for all the information. Some, they had books on fax numbers, some of ’em had the phone numbers, location information, but there wasn’t a centralized location for all the data. And so by doing this tool, we built everything in there. So we, we immediately sent out you know, a desktop link to all of our our frontline agents that do scheduling or just answer questions to the people that are calling in. And they were able to actually sit there and talk through and, you know, get the answers right away. The nice thing about this feature, and I, I’m probably you know, probably jumping ahead to a question you’re probably gonna have on the future part of it, but you had helped us build out a new tool because we found that after COVID, this tool was used so much by our call center and it cut calls down by half that they wanted a faster way of using a tool. And so we actually developed and unknowingly we developed for ADA compliance reasons to develop a tool to be. Speech to text, and then we realized that that works the same way in our call center because when the people are ask, you know, if they’re talking to the agent, the person, the agent actually repeats what the question was into the tool was already live on the desktop, and it turns around with the answer for the chatbot and they’re able to tell them where the directions are in places to go.
Brian Anderson: Yeah. Yeah. Yeah. So I think that’s all interesting. So like, if I follow what you’re saying, it’s, you know, our, our team has partnered with you on this for a while now and, yes. You know, when you started using the chatbot, it was mostly focused on trying to solve the problem of a patient, a specific use case, but it’s really grown, right? It’s, it’s patients, it’s parents, it’s referring physicians. You mentioned it’s internal users, like you’re mentioning this, you know, the staff.
Bill Gagnon: Yes.
Brian Anderson: Is using this, the agents are actually using the chatbot internally because it has, it’s so helpful. And it has all the information in it, right?
Bill Gagnon: Exactly. And even right now, all of our, you know, 18,000 plus employee base is using it too on our intranet because the nice thing about the way the tool is set up, it’s think of it as like you know an aisle in the library that each section is specific to its itself. It can be attached to the whole library. You can look for everything, or you can look in specific sections. And so we have it set up for our employee base on different things from, you know, either it’s all the way down to the healthcare information. And the vaccine was, you know, a, a big topic point, even down to benefits and different things like insurance and all the questions that come up on that. So we have information that sits in a separate chatbot location just for that. So we have the ability to blend all the, all the different questions and answers onto it, or we have ability to segment down to deep dive in a specific area if they don’t want to have the information shared across the platform.
Brian Anderson: Right. Right. Yeah, that’s a powerful tool. So like, let’s dive a little deeper into, you mentioned ai, right? And Alice being that like, this is not ChatGPT, right? Like, you guys were using this before ChatGPT even came out. So like, what do you see with, with the, the AI and ChatGPT and how all this plays together?
Bill Gagnon: Right. Well, so, so as I mentioned earlier, I’m aging myself on, you know, back using this back in like the mid-nineties. When it came out, you know, I saw that there was a big use for this and you know, it’s always that, how do we actually, you know, reduce people’s time online and get them to, you know, either acquire or to engage or, you know, to work with us on some basis. And so the tools, I’ve, I’ve used it, like I mentioned you know, I had this. Being used when I was working at GE International. So we had this in many different languages, and they had the ability to select their choice and come in and talk to people about different things from different finance tools or insurance tools. And at Cigna the same thing. We did the replicated it where we had it for, you know, based on your language use. So it was very flexible. And the way the coding is the way that this tool works off is, again, you know, there was no, this is a predecessor to like, you know, ChatGPT. This is based on, you know, heuristic type of conversation back and forth. And it picks up on all of the different keywords and sentiments and actually pulls from the database. And so, which is, you know, even to this day, I think that, you know, people ask me, it’s like, will you keep using this? Will you migrate? I think there’s always gonna be a use case for this tool, particularly because it’s in a controlled environment, especially when you’re dealing with healthcare, HIPAA and a, you know, PHI personal health information. You’ve gotta be very careful on the database that you’re using that, you know, the terminology’s coming from. On that. Mm-hmm. And so whereas ChatGPT might be opened up to a larger database of information, ours is specific to what we’ve programmed and that we’re able to, you know, we have, we’ve had a lot of extensive work in the background working with our legal and compliance to make sure that everything that we’re responding to is actually the right answer to give. It doesn’t give out healthcare information or medical advice. It gives out just the information of like, how to find this, where to look and where to go. Yeah, so that’s important. And so, you know, we plan to keep using this version of it, you know? Yes, there’s, there’s parts of Boston Children’s Hospital that are looking at ChatGPT for other types of you know medical support. But right now this tool definitely has, you know, longevity and we’re even looking at, you know, doing more you know, we’re looking at working with your team now and building a different module that escalates. The chatbot session into a real live chat session with an agent that’s available because yeah, you’ve had so much of a need where people are, you know, last minute they’re driving to, you know, our area. And you know, I know that people may not, you know, they’re on the call, may not have ever been to Boston, but if you’ve ever been to the Longwood area in Boston it is not a place you wanna be driving to. And you’re always gonna, notoriously late, even if you’re walking, you’re gonna be late. A lot of traffic. And so a lot of people end up going to the website and the chat agent pops up and of course they’re like, great, I’m gonna be late for my appointment. So now we’re connecting that back to the access center to say that, you know, we wanna either give a 15 minute leeway time, or even update or change their appointment if it’s available to them. So then you talk to a live person.
Brian Anderson: Yep. Yeah, that’s great. And then let’s talk just slightly about open source. You know, like you chose an open source tool, there’s, there’s, you know, SaaS solutions out there for this kind of stuff. Why did you choose the open source?
Bill Gagnon: Yep. So I, I’ve been kind of always a big fan of open source since the day you know, it was available to us because a couple of things. You know, we are a, a nonprofit in, you know, we don’t have the large budgets. I mean, I, before Boston Children’s, I came from you know, many corporate large corporate companies and you had a, you know, budget to work with that you could actually bring in some different software, but it’s, it’s challenging when you have a restricted type of a budget. And also too, a lot of times the way that the hospital’s set up is that, you know, we have different tool sets that are available in different areas of the hospital. And, you know, sometimes if you don’t have you know, correct management of that, they may not use those tools. And so it can be frustrating if you’re paying the bills on that. So ideally, you know, we look for an open source solution for that reason on the financial aspect of it. Cause wanted something that was viable and not really put us in, you know a big debt. But also some kind that we could actually, I wanna put the money into actually making it better. And open source allows us to actually build out the right modules in healthcare. And like many businesses, healthcare is not really much of the difference. But you always, you know, you look at the software that you want to get and it maybe needs 80% of your needs and you still wanna make sure it has the other 20%. But when you’re with a software provider, you’re one of many people that are putting in a request to change or modify that, and it may or may not happen. Whereas open source, you know, we started working with your team and said, look, this are the things that we want to do. This is where we gap. Can you help us add onto that? You were able to go in, modify the tool and enhance it for us.
Brian Anderson: Yeah, yeah. So we continue to customize it to your needs, right. Specifically to your needs. So like what are, what are some of the customizations that come to mind for you that, that we were able to do really quickly?
Bill Gagnon: Yeah, I, I think the first one is that, you know, we did I mentioned earlier when you saw. When we were bouncing around the different sections, a lot of chatbots tend to be on that page and that’s it. So once you leave that page, it kind of ends the session our does, and it stands alone and it kinda walks with you and you could still do many different engagement aspects which you actually helped on programming course us, which is fantastic. The other one is that, you know, as we did our new site we transitioned from Sitecore to Drupal this last year, we had your team help us with getting the ADA compliance set up where we had the speech to text. And that was huge not only for people with disabilities, but also as I mentioned, it was a two for one because now we use it in our call center where people are just repeating the question of the, the caller and they’re able to have an answer immediately. So that cut back on the, the, you know, the phone time that they were doing and we’re going forward, get getting forward the live chat now. So that’ll be done probably in a couple of weeks. That’ll be live and offered there. And I think the tool’s always gonna be morphing. You know, every time we get on a call, it seems we, you know, I work with your team on a weekly basis in our Scrum calls, and I think that I always leave all of those management ones and thinking, Nope, that’s another thing we can do, we should be doing.
Brian Anderson: Yeah, yeah, yeah. And then you don’t, you’re not tied to the licensing costs associated with every user, so you’re free to scale it across the organization, right?
Bill Gagnon: Absolutely.
Brian Anderson: Optimization costs and infrastructure costs, but like it’s much less than the licensing costs associated with scaling.
Bill Gagnon: Exactly. And the way that our, our system is set up at Boston Children’s Hospital is we have a lot of different areas that, you know, we have the trust, we have our hospital, we’ve got the portal, we’ve got a referring physician portal. And you know, to your point, if this was a pro licensing thing, I would’ve to license that in all those areas. And then also set it up in different areas too. I can actually set it up on, we’ve got a secure database where the main unit sits, and then we’re able to spin up another instance of it inside that tool. So it’s basically like you know, it’s another room inside another, another store inside the mall basically that we have set up.
Brian Anderson: Yeah. Yeah. Well we’re we’re, we’re coming up on maybe a couple more questions and then we’re gonna take a couple questions.
Bill Gagnon: Sure.
Brian Anderson: What’s coming to mind is, you know, I always enjoy understanding kind of your prioritization process cuz you have a lot of things. You’re running digital transformation, you’re mapping out all these things. This is one of ’em that came to the top. Like, how did you, how did you get this prioritized? And you know, what do you recommend for others to do to get like a quick win if they want to do something similar?
Bill Gagnon: Right. Well, especially in healthcare you know, you’re gonna, the one learning I had coming from corporate America is that the, you know, it’s not just all administrative business type people. You’ve got administrative and you have clinical, and you’re partnering all the way through on all of this. And so the first thing you need to do is that you need to have champions. Either those areas, whether it’s the chief or it’s a clinician that is somebody that is always looking your forward motion. And so exactly the way that we walked through earlier on how that chat was working in a session. What I did is I actually stood this up in our urology department and then we went to a department heads meeting and I had the, you know, the clinician working with me and we went through and showed that, and I think it was a big wow factor because we weren’t even there to sell it. We were there to explain it and people were just like, I need it, because they saw it in motion. They saw that a patient was reaching out and actually, I apologize. Urology was the second one. One, the first time we did it actually was with orthopedics. That’s how fast it started to get momentum. We went to orthopedics and we had it, it was, it was an interesting story cuz the way that we did it, we, you know, I tend to like to start off with a little bit of humor in some of the things. And so we were talking about the parent having issues with the child being clumsy and then the child ended up having this problem with their arm and you know, and we were doing it real time. So, which is kind of, if you think about it, probably a little bit scary because as we know, like you never wanna do a real time presentation of things that could go wrong and happen, but we are fortunate that everything, you know, went well. And, you know, we even had a person call out and I didn’t say, well, what if you misspell it? So they were trying to chunk it and we were there. We had it because we knew that we had the program everything, at least like 10 different ways because people do, you know, fat finger things, they mistype it or they, you know, they have their cap blocks on. And so it worked perfectly fine. And you know, and it’s, it’s really good to have that business partner with you in the clinical environment because they respect that person saying that this is what we’re doing, this is working for us and you really should be using it too. We left that, that meeting with just basically everybody, like, when do we get it? So it was great. It wasn’t like pushing it uphill. It’s basically just, you know, getting it out in front of them.
Brian Anderson: That’s great. And kinda last question for me, and then we’ll take a question here. You know, how do you, how do you handle when people provide sensitive information? You know, like, I think you talked about a case where you had some people that are suicidal, potentially using this system.
Bill Gagnon: We, we do. Since the tool’s available 24/7 and you know, it’s basically front and center. It, you know, if people see it as support and they, they reach out to it and they want to like, communicate with it. And we’ve had had some, you know, delicate situations where people, you know, put in different things and, you know, we wanna make sure that, you know, we, we quickly triage when an incident occurred about a month ago. And we’ve had some other ones in the past, but nothing like this. And so, We were able to go in and we have the ability to basically put in triggered keyword terms. And so we have that available and we put in a bunch of them. We work with our very closely and we have a great legal and also our legal compliance and, and clinical staff because they’re the front, you know, people on the front lines and they’re getting all the right keywords. They know what they have. So now the tool actually then escalates and says that, you know, it sounds like you know, you need to contact this number so you can get somebody that can really help you with this. And then we’re even looking down the road of how do we actually staff that accordingly, you know, in the future. So it’s not a make a call to a, a hotline or a different clinic, but it’s, you know, getting a person live on the phone. And so we’re doing that right now and we’re able to see if other words, like I said, the database does save different keyword that we don’t maybe have track of, and we add that to its, you know, intellectual library the next, you know, day.
Brian Anderson: Yeah. Okay, so transition to a couple questions here that I’m seeing.
Bill Gagnon: Sure.
Brian Anderson: You know one of the question is how is content added to the chatbot? Is it centrally controlled or do multiple departments add content?
Bill Gagnon: So it’s it, it’s, so I’m gonna answer this in both. So it’s all the, all the departments add content, but it’s centrally managed by people in my team because we need to one get their learnings and their advice, but we also need to work with legal compliance to help us scrub it, to make sure that the answer is what we should be saying back to a patient, family, or referring physician or a researcher. And then, so we get all that information into a centralized database, my team takes it, they vet it, they scrub it, and then we go to the extension of writing questions that would answer that. So the way that the tool works is that, you know, like I said, it has that heuristic, you know, design where it looks for different, you know, parts of the context. It pulls it out and then it gives the respondent the best response answer on that. And so we have to make sure that, you know, especially in healthcare, a lot of clinicians, you know, they’ll be using like you know, the medical terminology, but a patient family might just use IBD or something for, or the bowel syndrome, so they’re not gonna have the whole description of it. So we might make sure we cover that. And we’ve also the team that I have running this is fantastic. They, they even on their own started doing it in multiple languages. Which is, so we have, you know, context in French, Portuguese, Spanish and we’re, we’re constantly extending that on a regular basis and to your point circling back, you know, which I you know, you asked earlier, what do we doing for the future? I think the future’s even gonna be as, how do we merge in a tool like a, a Google translate, you know, into this? So that way we can actually have that real time for non, you know, medical terminology. I think that would be a huge mm-hmm. Because that would take people from reprogramming it to have it doing it automatically.
Brian Anderson: Yeah. Yeah. Yeah. And then another question here is you know, what does it really take to maintain this chatbot? Like, does it require a full-time person? Like where does that person sit?
Bill Gagnon: So the person sits in my department when they’re digital. And its, it’s one of those things that’s like most tools you set up at first, it’s, you know, it takes a, you know, a village to get it all put together. When we first set this tool up, we had all of our web developers, all the content people, we had people in the departments that were having other things. And we had them all kind of come together and put all the different information they think people are would ask, and people are already asking the phone lines today. We scrubbed the website for questions people were asking, made sure we had all of that. So the first couple of months it was probably, you know, anywhere from like five to 10 people at a regular time just entering information in. They were trained to do that, but now I have my person at those reputation management also handles this tool because it’s maybe about you know, a half hour, you know, review every day on different things that pop up because it’s more manageable now. All the big questions are on the system. And then we just look at it and mainly a lot of the time now is actually tied to what are the comments coming in? Is there any concern that we need to pass along to a department?
Brian Anderson: Yeah. Great. Well, I think we’re at time here, so I wanted to let everybody know that if you’d like a copy of this presentation, just send me an email, [email protected]. We’ll also have this published on our website eventually here, and there’ll be a form you could fill out to submit it. So if you’d like this presentation, you know, please let us know. And then I also wanted to plug our next webinar. We’re gonna do the last part of our digital transformation series with Bill, and that is gonna be focused on building winning digital transformation teams that quickly adapt to changing priorities, processes, technologies, and security requirements, which is always relevant in healthcare. So please join us. That’s gonna be August 16th for our third webinar with Bill and With that, I just wanted to thank you and for joining. And also thank Bill for his time and his insight. If you have any questions, please let us know, and both I and Bill are available for, you know, consultations. If you need you need to talk, just reach out to me and be happy to to work through the process here of connecting the dots. So with that, just wanna say thank you again. Appreciate everybody’s time and we’ll see you next, next month.
Bill Gagnon: Great. Thanks for having me, Brian. Appreciate it. Take care.
Getting More Value From Your Digital Transformation Investment
/by Brian AndersonHow a Top Healthcare Executive Successfully Implemented Digital Transformation
Digital Transformation is viewed as critical, but can you show the ROI you expected? Health Care expert Bill Gagnon will share how he succeeded at Boston Children’s Hospital. Learn from Bill’s journey and learn how to show success, without the common pitfalls.
Full Transcript
Brian Anderson: Hi everyone. Welcome to “Getting More Value From Your Digital Transformation Investment”. I want to welcome you all to this, um, uh, webinar. You know why we’re doing this? We believe in an open dialogue among thought leaders in our nation’s leading health systems. We’re trying to help improve digital transformation and patient experiences for all of us. I’m Brian Anderson. I’m the CEO and one of the founders of Augusto Digital. Augusto helps healthcare organizations and health tech companies realize their digital goals by offering outsourced services, fractional teams, technical solutions concerning software development, user experience design, project management, and managed services. Today I welcome Bill Gagnon, Digital Experience Leader at Boston Children’s Hospital. I’m gonna let Bill introduce himself. Hi Bill.
Bill Gagnon: Hi Brian. Thanks for having me today. Excited to be here. Uh, yes. I’ve been working in digital since the mid nineties. Uh, so started off my days at Citibank. I went to GE International, then to Cigna, and then now most recently in healthcare at Boston Children’s Hospital.
Brian Anderson: Super. Bill, this webinar is focused on helping people get more value from their digital transformation investments. Um, we know many health systems are focused on improving digital journeys for patients and their internal staff. Why does Boston Children’s invest in digital transformation?
Bill Gagnon: Well, and I think it stems down to one easy statement. People expect to have the same digital experience they have with online shopping venues, right? You know, it’s all about, you know, easy to find information and answers at their fingertips, easy to engage with, and then also instant confirmation. They know that their appointment’s been set. And then lastly, updates ’em in mind of making sure that the day of their appointment is coming up, and then you know, what happens after their appointment. These are things that. They receive on a regular basis, whether it’s a retail shopping site or a travel shopping site, that they actually get this information. So it’s expected.
Brian Anderson: Right? Yeah. I mean, it’s pervasive in our lives. Right. And so, um, when you came to Boston Children’s Hospital, where was the hospital with the digital transformation process?
Bill Gagnon: Sure. So I, I started a little while back. I joined around 2015 and hospital is made up of about 26 or so service areas, um, which have different operating, um, processes in different places. Um, and so there’s a little bit of a challenge there, but you know, as in most businesses there’s, you know, a lot of different things, good things going on in different places, so there was some digitization projects already going, um, underway when I came in, but they weren’t laddering up to an enterprise strategy. That was the challenge.
Brian Anderson: Interesting. So how did you approach the process of understanding the gaps in organizing these digital projects? Like what process did you use?
Bill Gagnon: Sure. So, um, earlier when one of the slides was going by, it showed the Lean Six Sigma icon, and that’s something that I was very fortunate about my time working at GE to learn and get under my belt. And so I’ve created a, what I call a streamlined process of that, which you’re looking at here. And it’s basically simply laid out that the usual value stream mapping tools that they have for Lean Six Sigma, it, it takes, you know, a good couple days to a week. And sometimes when I knew that a lot of times we don’t have that, um, capability. And the reality is I just said there’s 26 areas in the hospital that I have to work with. So I have to do 26 different working sessions and also all the people that comes into that play. So one of the things I developed, the streamline process. So here it’s like a four step method that you saw was one with basically, um, you know, getting all the key stakeholders together and the key stakeholders. There are people that touch the patient experience, uh, you know, anybody from marketing to the call center, to the front desk when they check in, things like that. Um, then what we do is we actually talk with them and we do a full value stream mapping, which basically is just listening to each other to find out what happens, how do you, you know, attract patients in the door? How do you acquire them? What happens with the flow? And we document it all together.. Um, and then lastly, uh, the third step is that we call fact finding. So, as you know, not everybody can always go to these, uh, um, appointments. And so we wanna make sure that we circle back with people that might have missed the session, find out, you know, show them, we document it and find out if that actually, you know, resonates with them or if they have anything on their charts that they wanna put on there. And then a lot of the fact finding is things that you want to do a deeper dive on. So, for instance, um, at Boston Children’s Hospital, one of the service areas we learned had some challenges. In the waiting time, in the waiting room. And so what we do is the team would sit in the waiting room and mirror the experience. We would shadow permissions, we would meet with patients, talk with them, find out what was going on in their experience. So that’s all part of the fact finding. And then also going back to not only, you know, the, the nice part, but the first session is you get a full understanding of the process overall. But that’s from the side of our, you know, internal, what is the external person seeing. So that’s like the patient family. The referring physician and also researchers that use the site, what’s their experience like? So we meet with all those types of people to actually get their findings, put it all together in one document. And then the last part of it is coming back together as a team and looking at, you know, the process that we found, what are the opportunities we identified, and really working on prioritizing those to become part of a, a roadmap and a strategy for, you know, signing roles and rigor.
Brian Anderson: That’s interesting, like, and it’s interesting that you boiled it down to like these four specific steps and you’re working through this with, with, um, different, um, areas of the hospital and consolidating a lot of this together, right? So, um, it does seem like a quicker process. It’s more efficient, like at getting to the heart of the issues. Can you go a little deeper into how you represent, um, like the voice of the patient and other end users in your needs assessment?
Bill Gagnon: Sure. So with the, with the mapping process, again, you know, it points out all the different things of the challenges and some of the, you know, opportunities that come on. And so what I end up doing, and this is a great example here, you see here that this is an example of our surgery team went through that and you know, found out, you know, basically, you know, What are happening, you know, when the patient, um, you know, how they find us, how do they actually come in? And then what happens when they’re experiencing in the, in the waiting room. And so, as I was mentioning before, in the fact finding process, we sit down with them and we kind of go over this on a high level and then get their point of view of, you know, what was their experience? Did they, you know, what happened when they, uh, you know, how did they first find us? Did they come across us on a paid search ad or was it by searching or by word of mouth? Did they, uh, when they called in, you know, when they got the appointment, did they get the confirmation that was sent out? And then, you know, the appointment reminder that comes up days in advance of their meeting. And then how was their experience when they were in the hospital? Everything from parking all the way through to when they were, you know, leaving the hospital. And then next steps after, you know, are they gonna have a procedure or, you know, All these different things. So we documented all of that. So when we talked with them, we get their feedback. So we had a clear picture of what they were looking to do. And you know, at a hospital.
Brian Anderson: Yeah. And, and so like, I really liked where you were going with the fact finding too. So you, you work these sessions and you’re able to pull this information together and visualize it in a way that makes sense. So there’s all these stakeholders, like do they understand this map when it’s done? And how do they, what’s the process like to get to this, to this level of a map? With a, with a broad spectrum of people.
Bill Gagnon: Exactly. So I, I do something a little bit different. Um, you know, when I started off the conversation saying, you know, the Lean Six Sigma, anybody that’s listening in today, you know, a lot of people have, you know, do this on a regular basis and their, um, you know, their process and they do process mapping. And a lot of it is done, you know, on the wall with paper and post-its and, you know, the old fashioned way. And then it works fantastic. But I knew that, you know, basically I’ve got limited time to work with, you know, clinicians and staffing. And also I had to do 26 different areas, um, of the hospital. And so what I did is I took the, a finished version of this. So basically if you’re looking at this screen here, all these, um, swim lanes, I would keep the same. So I talk about the online, the offline backend, and also about the timing and things like that. But I would take everything the component wise, in the middle portions, and I’d move them off to the side. So I really did this in PowerPoint with the team. And so when I sat down with the stakeholders, they were looking at almost a blank grid except for the swim lanes. And so I would start talking to them and say, okay, let’s start from the beginning. How do we attract patients and families? And the nice thing about that is, you know, when you’re working with a paper process, a lot of people are gonna be, you know, a little insecure about going up to a board and writing things and putting it down. Whereas here, I’d already had a lot of these solutions already pre-done. I had things like direct to site, I had seo, paid search, email, so I can easily move them over and that’s a big time saver as well. And then they could add on and say, but we also do billboards on the highway. Great. And that takes me two seconds to really add one over and move it in.
Brian Anderson: Mm-hmm.
Bill Gagnon: So the process while you’re going through it, it’s always entertaining because it’s, it’s not pretty. And, um, there’s a lot of boxes. They’re not symmetrical, but at the end of it, it’s so much easier. I can literally spend an hour after the session. Clean this up and have a real clear view of what the patient journey is, and also the points of opportunities to actually improve that patient journey by doing it this way.
Brian Anderson: Yeah, that, that makes sense. And then, uh, um, kind of going into the, uh, the next stage, like you’ve, you’ve mapped this stuff and then you’ve done, you know, work to, uh, Prioritize with the team too. Maybe you could go a little deeper into that prioritization and the kind of, the fact finding and, um, you know, how do you get the green light from the C-suite to actually move forward with some of these initiatives?
Bill Gagnon: Sure, sure. So the, the thing is, and this is a snapshot of just that one instance of working and, and it’s a good example. So here we had 12 different opportunities identified, and the nice thing is that when you come back with the team, and again, this is something like maybe one or two days. Later tops, cuz you want it fresh in mind when people are, you know, just did the processing. Mapping and things. And the good thing is that these opportunities, the way that I run the session is that I don’t come to the table expressing to them what they need to put on the paper. They’re coming up with the solution saying, what if we did this? Or what if we tried that? Right there. That’s the advocacy already starts because it’s part of their brainstorming process. It’s a solution they came up with, and there’s more buy-in at that point. So when we get to this stage here, I remind them of, first of all, we look through the process map, one more time. We do a quick review, and then we look at, okay, this is everything that everybody here came up with. Let’s start looking at this from a point of view as a return on the investment, and also timing. What’s important here is this lower quadrant of the area chart is where I kind of gravitate towards because I’m also thinking long term when I need to get this all, all these 26 sessions done. Because ultimately, yes, I’m working with all the different service areas on all of these, um, Solutions. But in my mind, I’m laddering this up to an overall enterprise strategy, and so I’m gonna be presenting this out to the csuite. So what’s great is if I have a few of these at quick wins ready to go when I already go to that presentation. So I look at things like, um, you know, paid search or, um, chat, which is a great one. Chat on there is something that, you know, you and I, that’s when we first started working together.
Brian Anderson: Mm-hmm.
Bill Gagnon: Is that we had a rudimentary tool in place, so it was something that we could leverage, which meant we could do it right away, but it wasn’t fully tweaked the way we wanted to, to meet the patient experience. And so we worked together on doing all of that. So for me that was a quick win and a good return because it helped out with, uh, patients and families, referring physicians. But interesting what we found out afterwards, it helped out with the internal, um, stakeholders as employees because the people answering the phones. Uh, instead of using all different types of like tutorials or paper that they had written down with phone numbers, this tool had it all anyways, it had all the fax numbers, had all the locations, uh, valet parking information, um, you know, directions of the hospital so they could just easily use a tool as well. So it really worked on all four, all of those areas there. So again, the quick wins were nice on there and it gives people an understanding too. That it’s not so daunting, right? I mean, it’s one thing to do a working session. You’re taking time away from your day, you know, your day job to do this. The last thing you wanna see is an opportunity chart that might go on for months because it’s not attainable. And so we wanna make sure that we have it all documented. Yes, you’ll have some things that are bigger projects, of course, but it’s nice to have some of these really quick wins and have it mapped out so you understand like what, what’s gonna be the turn on the investment on this time, and things like that.
Brian Anderson: Right, yeah, I think that your approach in terms of trying to figure out how to get these quick wins is interesting. Maybe you could go a little deeper into that. We could slide to the, the, the, the, the last slide of, uh, when you’re consolidating all this information together. Right. Um, I mean these are, these are interesting the way you kind of approach this. Um, and, uh, Maybe you could just talk a little bit more about how you get to the point where you’re able to get the quick wins and like how do you piece together teams? Cuz you’ve talked to all these cross-functional people .
Bill Gagnon: Mm-hmm.
Brian Anderson: How do you actually pull them together and, and get the momentum behind the quick wins?
Bill Gagnon: Right, right. So, so what’s interesting is as I’m doing this in real time, As you can see here, I’m already creating, in essence, the strategy review at the end of the day, and that’s why I kind of have everything all this out. So for instance, here what you’re looking at is the 12 opportunities we have, but it’s also what are these opportunities? So they’re fresh in mind, not only for the team working on it, but also when you’re meeting with people, let’s say in the C-Suite or people you need to gain advocacy to go along with this strategic approach on that. And so having all these, you know, and it makes it easier to talk through at the end of the day too. And as I mentioned, you know, the quick wins are things that, you know, I usually outline when I’m going through this full list on it. Um, and it’s, you know, it’s something that it’s easy to follow through. And what’s nice is they, you know, people while we’re going through this list, like can already start to, you know, remind people in the room that this is something that you had already put your hand up, you know, you brought this to the table. We’d love for you to be a spearhead and kind of, you know, own this and run with this, going through it. The nice thing about this, if you look at this, is just like I said, one part of 26 working sessions. But what’s interesting though is even that, you know, um, coming into it, my concern was that as I mentioned before, 26 service areas that had unique, sometimes, you know, operating procedures in the back end. Ironically, this kind of came into the 80 20 rule where 80% of what we’ve heard consistently over the different working sessions was actually applicable throughout all of them. They all had the similar pain points with, you know, maybe how they’re getting out there to attract patients, and then also how they’re engaging with patients, and then how they’re actually working with patients. And so ideally, this all, you know, I, I took all these, and this was 12 here, but I would take all them together and ultimately collapse them all into one, basically, um, ROI procedure, and I was able to show all the different, uh, let’s say there was 47 of if they were all unique and we could prioritize ’em. So that helps you build up the overall strategy. And then from there, once everybody agrees that these are all the things we’re working on, it really comes down into let’s like basically putting together like a rules and rigor chart. They’ll say, okay, now that we’ve signed up for that, this is right. What’s gonna be actually, you know, driving forward and this is what it’s gonna take for, you know, you and your area to help build these out and get them going.
Brian Anderson: Let’s talk a little bit about roles and rigors. Maybe if we show that slide, um, you know, like how do you go through the roles and rigors process?
Bill Gagnon: So each, each session that I would do, each department or service area, I would actually have a, a basically a whole review of this, you know, process and also with the roles and rigor on there, because ideally when I, when I leave that team, We’re already gonna be working on things and so nobody’s waiting for this, you know? Cause if you think about it, 26 sessions, right? That’s gonna be, you know, a good like five, six months down the road. Yeah. But we’ve got time to wait for that and or will they have the energy to come back to it. If I say, okay, now we’re ready to go. Once we get everybody to buy into it. So ideally I run this like a two-lane highway. We basically have the working session, and at that day one we start doing projects together. Especially a lot of those things that are quick wins. You want online chat? Let’s get that going. We want the chat bot. Sure. Let’s implement that. We have all that there. And so what this does is just keeps like an understanding of a roadmap, kind of working. How are we gonna attach this? How are we gonna work on it? And I know this is very, you know, detailed slides, so it’s something that, you know, people here can look at, you know, and they get a copy of it. But if you, you know, when you zoom in on this, at the end of the day, you can actually have , it has multi purposes, it has not only the task at hand, but also the value add that it brings. Does it, you know, does it make a better customer or patient experience? Does it reduce the wait time? Does it, um, drive more people within the hospital? And then also, you know, what departments are needed because, you know, a lot of these sessions, even though it’s like a, you know, we’re looking at the digital roadmap. It brings in everybody. A lot of this work is operations that you need to get together with. It could be a finance question that you have to solve, and it could be maybe research you need to bring into that. So it’s like all those people are identified in there, but more importantly in the middle, that’s when you look at, okay, timeframe. What’s, that’s what the upper hits the road. Let’s start next week and then when is it gonna take two, three weeks to get this done? So we do that during the session. We’re able to get people to sign up, put the hands up in the air, say, I’ll take this. They build out a team to start working on it. And yes, some of these on the overall enterprise strategic approach will kind of come together as a larger project team. But for the most part, when we, you know, go onto another service area, we’re already helping getting this one going. And we’re onto data.
Brian Anderson: Yeah. And what is, what does your team look like? You know, like how, how big is your team and how are they able to execute these types of projects, so effectively?
Bill Gagnon: So, uh, I, I go back to my days at GE, we use the, uh, center of excellence terminology, and that’s what we develop. And so I’m doing that since the days of GE to Cigna, even to, um, Boston Children’s. And so basically, you know, we have our team that has key stakeholders in every one of those groups. Meaning that there’s people that do. Web work, web design, web production. We have coders, we also have, um, UX/UI, we have optimization people, so anything along this line of the solution area, they would actually be able to help out. And then, you know, at, at the hospital, the way it works is that most of the bench strength sits in our team. And so we take on all of that, and those, those people I just mentioned have teams of the role that actually do all of this heavy lifting. Sometimes there’s people in the different departments that actually have some bench strength that like to jump in and help, and we’re always, you know, happy to have extra hands on staff, so.
Brian Anderson: Mm-hmm.
Bill Gagnon: The more the merrier.
Brian Anderson: And, um, and then like, uh, Trying to figure out like, you know, what other things do you wanna highlight, um, for people that are, you know, looking to model off of what you’ve done here? Like what, what do you recommend?
Bill Gagnon: Sure. I, I think, I think the one thing that always stands out, especially, you know, when you and I have been talking about different projects that we’ve got, you know, and how do they come up to play? When you look at some of these working sessions many times in the past, I think where, you know, where I maybe had some not successful sessions is when we started off and we started saying, okay, we identified issues and issues is a word that makes people uncomfortable. And so I think that that was like one of the challenges. So I immediately switched my process over to opportunities and people feel excited that they’re actually bringing something valuable to the table and they wanna be part of that. Nobody wants to be part of issues and that’s huge. The other thing is too, is a lot of people that work in the, you know, the digital environment, you know, your job isn’t always gonna be digital. Yes. And, and that’s something you just gotta know today. It’s like a lot of the conversations I have, a lot of things I’m fixing were operational. Um, you know, when I joined the hospital, we started setting up the CRM system right away. And, you know, there was something that, cuz there was just, it was a need for things, but people weren’t there to do it. So we just jumped in and lend a hand. So these are things that, you know, you just need to be cognizant of. And the biggest thing is you’re, you know, what you don’t see here, but um, you know, it kind of organically happens is all the relationships and partnerships you have to have throughout the hospital with your no support people in operations, people in finance, people in your right, legal compliance, because none of this stuff gets going. And just you get some open approvals on those end.
Brian Anderson: Right. Well, this has been great, bill, and I think that, you know, this is a great introduction here. Um, just wanna summarize it a little bit more. You know, like you’ve got, you’ve used Six Sigma, you’ve been able to develop a process where you’re able to pull in all these different stakeholders. And then, you know, run through this four step process, um, and, uh, and really boil it down. And, and I think it really speaks to, you know, you’re, you’re willing to give back and help others. And, you know, Boston Children’s being, you know, well known across the country as a teaching hospital. And so this is just super that you’re willing to share all of this. And you’ve also said that you’re willing to share the presentation as well. So if anybody wants this presentation and wants to dig in deeper, you can just email me at [email protected]. And I also, um, want to let you know that if you need additional help in these areas, that Augusto is happy to, to help and facilitate, you know, conversations with Bill as needed. Um, if you, if that’s, uh, something that, uh, Is, uh, necessary, uh, but we’re definitely willing to help and, uh, be part of your digital transformation journey as well. And I also wanted to let people know that we’re gonna run another, um, uh, webinar on July 19th. Bill’s gonna come back, and this time we’re gonna go deeper into how health systems can get quick wins with chat bots, ai, and other new tools. So I wanted to, uh, uh, leave it to you. Bill, do you have any other things you wanted to, uh, say as we sign off here?
Bill Gagnon: Uh, I think you said it all. I think that, you know, we are, you know, we do come from a teaching hospital background. You know, I think that anything that I can do to help share and, you know, alleviate some, you know, pain points out there, uh, love to help out.
Brian Anderson: Wonderful. Thank you Bill. Thank you for your time. Look forward to the next webinar with you.
Bill Gagnon: Same to you guys. Thank you so much. Appreciate it.