Federally qualified health center emerged stronger to serve the community during the COVID-19 pandemic.
When the Tubbs Fire came roaring down from hillsides northeast of Santa Rosa, California, in October 2017, it devastated a community and the Vista campus of its federally qualified health center, Santa Rosa Community Health.
But thanks to the courage and quick action of its CEO and other leadership, and key adopted technically-savvy outside technical operations, the clinic pivoted to continue operations while critical improvements were made. The story of how the organization approached this crisis—compounded by IT issues—and ultimately came out the other side better, provides a blueprint for innovation under fire.
The CEO, Naomi Fuchs, credits, among other things, her educational training in anthropology for sustaining "an interface of culture and healing" that enabled the clinic to do what it took to survive, including standing up a centralized call center in two days, which also let patients communicate with their clinicians via text message. Clinic staff also physically reached out to fire refugees camped on area beaches.
Her training "really informs my approach to leadership. It's about the people and the culture you create," she says.
"When we lost the building, that displaced about 150 employees and about 24,000 patients," Fuchs says. "The phrase we said over and over again is that we will be here for everyone no matter what."
Easier said than done, Fuchs admits. "You don't know how it's going to turn out," she says. "There's nothing predictable about any of it. You don't know where your money is going to come from. You have to take a leap of faith, and work really hard."
No Layoffs, Community Rallies, and Rebuilding Starts
Tough decisions bombarded leadership in the first days after the Tubbs Fire. On day number two, Fuchs and her team decided to press on with no layoffs. Meanwhile, the community rallied around the organization, including suppliers and lenders. "Most of them did, not all of them," Fuchs says.
"One of the other big lessons is that the people who are doing all the tactical work, day-to-day responding, probably should not be the people who are doing the planning," Fuchs says. "It's really two different states of mind. You've got your on-the-ground people, and then we designated a few people who stayed off-site to just help with planning."
Fuchs also drew upon professional relationships she had made in her healthcare career of more than 30 years in Sonoma County. "One of our employees has been embedded in the Santa Rosa Memorial Hospital ER for years now, connecting with patients," she says. The cell phone of the CEO was in Fuchs' phone.
Such connections were critical to the patient care coordination demanded by both the fires and the pandemic. "You need to build that foundation of collaboration and relationships all along, not just when there's an emergency," Fuchs says.
Communication from leadership to employees was critical in those early days. "We had a catchphrase, and we still use it all the time, which is communicate at the rate of change," Fuchs says. "In the beginning, we would have as many as 60 or 70 people on calls. It was before the big Zoom era. It might have been three times a day. Then, as things stabilized a little bit, we went to twice a day, and then we went to once a day," paced over time with emails and in-person meetings, she adds.
Unpaid Telehealth Visits Prompt State to Authorize Payment During Emergencies
After the Tubbs Fire, as they scrambled to provide service in leased office space around the community, Fuchs and her organization also championed California state legislation that made patient encounters via telephone visits billable in an emergency, Fuchs said.
"We'd already pivoted to telephone visits in 2017," Fuchs says. "We never got paid for them" until the California legislation change, she adds.
"And of course, now, everybody's been in an emergency, and nobody wants to give them up, because it works so well for the patients," Fuchs says.
The Tubbs Fire highlighted in graphic detail the sheer safety value of moving clinical information technology off site. "We had people basically going into the burnt building, dragging out our servers to see if they still worked, trying to reconfigure and redeploy them," Fuchs says.
The Tubbs Fire had cemented Fuchs' determination to change her IT environment to boost reliability of the clinic's operations—and employee satisfaction and morale.
"People were really at their wit's end with how unstable things were," Fuchs says. "We probably even lost some providers and some staff over it. When you're trying to take care of people, you can't be wondering or hamstringed by your EMR being so slow or not there."
Enter the Permanently Outsourced CIO
As the tech problems hit their zenith, the clinic's IT director resigned, and Fuchs turned to a small but rapidly growing IT company, itself a product of a health system-funded innovation incubator, to rethink IT and straighten out the clinic's tech mess.
"We were asked to come on-site in June of 2018 through a referral," says Marc Whinnem, vice president of operations at Hospitality Business Network Solutions (HBNS), a subsidiary of The Innovation Institute, backed by Avera Health, Bon Secours Mercy Health, Children's Hospital of Orange County, the Franciscan Missionaries of Our Lady Health System, MultiCare, and Valley Children's Healthcare.
At that point, Santa Rosa Community Health "didn't want the headache of an in-house IT company," Whinnem says.
Whinnem, a 25-year veteran of the IT business, had a lot on his plate coming on board. The IT systems had "a lot of bolt-ons on top of bolt-ons" as a result of years of rapid but relatively unplanned clinic growth. Outdated hardware had to be replaced. Access to current gear, such as network switches, was restricted, due to lost or missing passwords. The current desktop environment was a mix of Windows 10 and outdated Windows 7 operating systems that had to be replaced. Misconfigured and deficient Citrix technology that was serving up EHR screens from a Sacramento colocation facility caused frustration to those delivering care. Whinnem suggested migrating offsite servers to the cloud.
"People aren't looking for outsourced IT support when everything's going well," Whinnem says. "They're looking for outsourced IT support when things are not going well, and they need help to transform that environment."
While he was swapping out Citrix for Microsoft Remote Desktop technology that would accompany the move to the cloud, he also had to deal with an ongoing rebuild of the community's infrastructure after the succession of fires.
"Homes and businesses were burned to the ground," he says. "Power and cabling get melted underground, and they had to be replaced." In fact, the outages continued for years, and to this day, continue in certain areas, he adds.
Unfortunately, all this gave the on-site staff operations team "a lot of practice in moving between paper and digital systems as they were up and going," Whinnem says.
In short order, Whinnem's role expanded to that of 100% outsourced chief information officer for Santa Rosa Community Health. It's a role he is familiar with; at this point, he acts as the outsourced CIO for a variety of small health organizations and other businesses.
Whinnem compared untangling the jumble of IT problems to approaching an iceberg, not realizing that the bulk of the problems lay unseen, underneath the apparent size of the problem.
The Vista campus reopened in September 2019, shortly before the Kincade Fire threatened to, but did not, burn down the rebuilt campus.
The Clinic Makes the Transition to the Cloud
The clinic's transition to the cloud was a big lift. "We had hopes to really turn this environment around between six and eight months," Whinnem says. "Realistically, it took us about a year."
Whinnem's team started the cutover from the Sacramento colocation facility to an Amazon Web Services cloud-based environment in January 2020, and completed the transition and closed down the colocation site on the weekend of July 4, 2020. The time in between was "working through resolving all the bugs and issues of making sure that it was functional," he says.
"The largest transition was really at the end, which is when we moved the whole electronic health record environment over," Whinnem says. "That was one of the areas that really caused the most grief prior to the move. Within a week, it was a completely different environment. Everyone noticed instantly. It was transformational."
The improvement couldn't have come at a more fortunate time since the pandemic hit just as the new Microsoft Remote Desktop environment was being tested. "The decision was made to flip everybody over, and we had to do that within two to three days," Whinnem says. "It went very well, and every time we added users, it made things more and more stable." And as the pandemic emptied out offices everywhere, the new environment made working from home practical and doable, just as it had been during the 2019 fires, when air pollution had also sent staff to safer locations to work remotely.
Another series of nearby fires threatened Santa Rosa in the fall of 2020. And the pandemic raged. But the clinic kept up with each new challenge, such as helping with county efforts to set up mass vaccination sites, such as at the Sonoma County Fairgrounds.
Whinnem also notes that an IT staff that rotates between different clients, instead of always serving the same company, alleviates a problem that mature IT shops sometimes face: boredom.
Another advantage: "When you've got [IT] people that are seeing and experiencing new things, and they are seeing how they work in other environments, and going through the pros and cons of all of that, they bring all that experience back," Whinnem says.
Overall, "the return on investment comes with having a more stable environment is just such a better work environment for all of our employees," Fuchs says.
“The people who are doing all the tactical work, day-to-day responding, probably should not be the people who are doing the planning.”
Naomi Fuchs, CEO, Santa Rosa Community Health
Scott Mace is a contributing writer for HealthLeaders.
CEO of clinic, its main campus destroyed by 2017 firestorm, drew upon community ties to rebuild.
A permanently outsourced CIO position utilized his expertise to replace an unreliable IT setup with Amazon's cloud.
Effects of successive nearby fires further helped clinic prepare for the pandemic-plagued 2020 work world before it happened.