Electronic Health Reporter

Chris Fox, CEO of Avantas, discusses how he and his firm help physicians improve their operational performance; healthcare staffing; the need for addressing operational efficiencies across a health system without following some traditional approaches — like layoffs; and market trends that continue to perplex, yet offer opportunity for growth and development.

Avantas started as a group within Alegent Creighton Health more than a decade ago with the goal of optimizing its workforce across the health system. Its efforts were so successful that it became a separate company and began offering its expertise to the entire industry.

In 2007 Avantas developed a healthcare scheduling software, Smart Square, as no other solution on the market offered the flexibility and customization necessary to fully automate our strategies and provide a transparent view of staffing, scheduling, and productivity at the enterprise level.

Avantas executives provide thought leadership in healthcare labor management.

What keeps your passion for this mission, and the organization, alive? Tell me more about what excites you about your work and why you love what you do?

Very simply, if we are successful as a company it is because we have helped our clients – healthcare providers – improve their operational, clinical, and financial performance. Stronger healthcare providers means more services, more community outreach, basically, better, more affordable healthcare for everyone. It’s pretty easy to be passionate about that.

What draws you to healthcare? Did you seek out the sector when you began your career?

I’ve worked in software development and innovation for more than 15 years within a number of industries. It’s a funny story, but I actually got involved in healthcare because of a chance seat assignment on an airplane almost 10 years ago. I was seated next to Lorane Kinney, Avantas’ co-founder. We got to talking about Avantas and what she was trying to build there. Hearing Lorane’s passion for the company and the need to automate a new approach to labor optimization in healthcare was very inspiring. I knew I wanted to be a part of it, and I knew I could play a big role in bringing Lorane’s vision to fruition. Avantas has a compelling story and big aspirations. As Avantas’ CEO, I, like Lorane, seek out individuals who are passionate about the vision we have for the industry and want to be part of that change.

Tell me more about the evolution of Avantas, from where you started to where you’ve come today? Where are you headed and why?

Avantas started as a group within what is today Alegent Creighton Health more than a decade ago with the goal of leveraging economies of scale and standardizing its labor proactively across its then five Omaha hospitals. Our purpose was to develop and implement strategies that would leverage the system’s care staff, both proactively and in the moment to cost effectively adjust to the natural rise and fall in patient volume. Our efforts were so successful we became a separate company in 2001 and began offering our workforce management expertise to the entire industry via consulting. In 2006 Avantas conducted an RFP to find a scheduling solution we could use within our client base to automate the labor strategies we had developed. After we were unable to identify an appropriate solution we developed our own healthcare-specific enterprise scheduling solution, Smart Square. Now Smart Square is being utilized in more than 200 facilities across the country. Our strategies and technology solutions are packaged in a comprehensive methodology called HELM, which stands for healthcare enterprise labor management. HELM takes a step-by-step approach at restructuring an organization’s labor management strategy by first right-sizing its staffing sources, standardizing policies, and implementing best practices. Next we automate those policies with Smart Square. We also work with our clients to develop centralized methods of managing staffing resources as well as helping them build out the necessary layers of contingency staff, enabling them to cost effectively adjust to constantly changing patient demand. We help our clients implement these strategies across their systems: inpatient, ancillary and outpatient areas, like medical group practice sites.

What is the biggest trend that you’re seeing in terms of healthcare staffing and scheduling? How does that affect healthcare organizations?

We get a lot of traction with providers when we talk about building a Center of Excellence to manage labor resources. A lot of healthcare organizations understand that labor is one of their most valuable resources, and there is an inherent need to make every dollar count in light of a competitive market, declining reimbursements and shrinking margins. However, too many providers let individual cost centers manage their own processes. Once you have established a foundation of best practices and standardized policies, and have right-sized your labor sources, centralizing the deployment of final resources creates an environment that fosters consistency. A Center of Excellence provides organizations with economies of scale, it saves managers time (as the resource center takes on a lot of the administrative and staffing duties previously done by the manager), and it enables a transparent, enterprise view of the system, resulting in the better placement of resources. It’s not a “plug and play” strategy, however. A Center of Excellence is something that requires continual attention to refine processes and ensure it is working as it should. Early adopting Organizations that have implemented this strategy and are diligent about sticking with it see incredible results.

In regards to labor management, layoffs are increasingly a concern for healthcare organizations, what would you say to a healthcare executive who is facing possible layoffs?

The topic of layoffs in healthcare is gut wrenching. No hospital administrator willingly comes to the decision that they must eliminate jobs, especially caregivers, without having first weighed all the options on the table – losing a lot of sleep (and hair) in the process. But by the time this decision is made their backs are against the wall. They feel they have no choice and must do something that shows an immediate result. Sadly, layoffs do show an immediate, albeit short-term, result on the balance sheet. What organizations need, and they know this, are savings opportunities that are both immediate and sustaining. This is the potential of effective labor management strategies.

The better utilization of staff that already exists can have an immediate ROI, sometimes as much savings as layoffs produce. These savings are sustainable year over year as more strategies are layered on and the organization begins to adopt these changes culturally. With any major operational change, and restructuring a health system’s approach to managing labor certainly fits that description, a lot of heavy lifting and sustained attention is required to make the changes stick.

It’s a generally accepted idea that the need for health services is only going to increase as our population ages. Organizations may have to transition to more of an outpatient strategy as a result of the Affordable Care Act, but the need for caregivers is not going away. Many organizations that are laying off staff will more than likely be hiring in the near future. That’s a dangerous cycle that can hurt providers, both in terms of their reputations and the quality of care they provide. Every staff member has tacit knowledge that is lost when they leave the organization. That’s not something that can be easily replaced.

Who are your primary clients? Tell me about your footprint.

Our primary clients are larger healthcare providers, often with multiple facilities and service lines. We are not a large company with hundreds of clients because we take on a real partnership role with our clients, and that takes a lot of effort on our part. Because of the nature of the work we do – transforming a healthcare provider’s approach to managing labor – we have a mutually vested interest with our clients in their success. It is important that we grow our company in a way that doesn’t compromise our clients achieving their goals. That being said, we have provided our consulting engagements to hospitals and health systems across the country. Our scheduling and productivity software solution, Smart Square, is being used in 200 facilities around the country, including Penn State Hershey, Alegent Creighton Health, Mountain States Health Alliance, and WellStar Health System, to mention a few.

Where are you seeing the highest demand for your services right now? Least demand? Any shifts or surprises you expect/didn’t expect?

This has been the case from the beginning for us, but we get the most organic interest from hospitals and health systems that are recognized as innovators and early adopters. These groups most easily envision a better way of life and aren’t afraid of change, and they realize that to achieve their ideal future state they need to partner with an organization that has the expertise and a history of success with organizations like them. Alegent Creighton Health is a top 15 health system, as recognized by Truven Health; Mountain States Health Alliance won the National Quality Forum’s National Quality Healthcare Award in 2012; SSM Health Care – St. Louis won the Malcolm Baldrige National Quality Award. The list goes on.

In your personal opinion, what do you think is the biggest issue no one is talking about in health IT?

Let’s try a different approach here if you don’t mind. I’d prefer to address an issue in the overall healthcare IT market versus talking about the provider IT groups.

The healthcare IT market does not spend enough time talking about optimization of solutions and instead focuses on simply executing and implementation. There’s a big difference between optimization and implementation and too many projects are structured around a successful go-live versus having a multiple-year perspective on the expanding adoption and optimization of a tool. This results in wasted opportunity and money, considering the large investments being made in healthcare IT. I try to encourage provider organizations to work with their vendor partners to spend equal time discussing operational best practices, use cases, and appropriate integrations that will lead to optimizing their investment over time.

It’s important to remember that technology serves to automate best practices. It will not fix anything unless the people using it are engaged and have bought into the new processes and tools. The vendor must continually work with the client (post implementation) to ensure the tool is working as promised and that it is being leveraged how it should be, and by who it should be, for the organization to achieve its goals.