Can Academics and Hospital Operations Be True Partners?

As a student at LDS Hospital in the 1990’s, my PhD supervisor and other mentors were embedded in leadership and operational positions, and graduate students came from around the world to get their PhDs at the University of Utah because they knew it was one of the few places where they could actually implement and evaluate their research in a real setting. Over time, the role of the academic informatics researcher in the healthcare business has shifted and declined. And yet, the need has never been greater for research to contribute to developing digitally enabled care models and a learning health system in the complex system of healthcare. 

My main goal when I accepted the position as chair of the Department of Biomedical Informatics at the University of Utah in 2013 was to build a working partnership between our research faculty and the operational IT groups in the University of Utah Healthcare. I launched a seed grant program, and we funded eight academic-hospital collaborations. We spent months building relationships across the hospital leadership from quality and safety to patient experience to clinical decision support. I sat in the office of the hospital CEO while he sorted cards to prioritize the potential projects we could fund. 

A few projects generated academic outputs or generated insight about existing problems or ways to make improvement, but in the end not a single project was successful in seeding collaboration between our department and the hospital. It was clear that not all researchers are well suited for or interested in working on operationaal projects. But the biggest barriers were structural: executive leadership may support pet projects when they are subsidized by the University, but most of the projects do not have a pathway to routine use within the organization.

I was excited to read a new publication by Devin Mann and colleagues at NYU Langone: From silos to synergy: integrating academic health informatics with operational IT for

healthcare transformation. 

They point out that academic informatics and operational IT need each other: 

• For an academic department in applied health informatics to have impact in the health system, it will need close ties to health system leadership and operational IT. 

• Adapting, scaling, and responding to new technological developments required for achieving an academic Learning Health System will be hindered by the separation of the academic department and operational IT. 

An integrated informatics system will not happen without a deliberate shift, but if successful, it will drive progress in real-world applications and innovation at scale. Their system reminded me of the Gartner model of Bimodal IT.

Bimodal is the practice of managing two separate but coherent styles of work: Mode 1 is optimized for areas that are more predictable and well-understood. It focuses on exploiting what is known, while renovating the legacy environment into a state that is fit for a digital world. Mode 2 is exploratory, experimenting to solve new problems and optimized for areas of uncertainty. Both modes are essential to create substantial value and drive significant organizational change, and neither is static. Both play an essential role in digital transformation.

How Stella Saved the Farm is an allegory describing the need for these two modes in business, and The Other Side of Innovation explains that without proper alignment of the two modes in an organization, there is a high chance that operational teams will dedicate their attention only to everyday work, and the areas of uncertainty will not receive the support needed for ‘disciplined experimentation.’ 

At NYU Langone Health they have vertically integrated academic informatics and operational iT through the establishment of a corporate operations department of health informatics (DHI) within the health system IT group. 

“IT resources and staff are not assigned to specific divisions. Instead, the DHI and Divisions request and get assigned corporate IT resources (EHR analysts, reporting resources, software architecture resources) as needed. They are prioritized in the same enterprise prioritization processes that all IT requests get reviewed. Similarly, non-DHI academic faculty and staff are recruited to lend expertise to DHI initiatives. They are provided an official channel to raise their health informatics research for support from DHI. This allows projects to be easily worked on by multiple teams and divisions organized around the user experience they seek to improve at scale.”

This has required significant restructuring. They have reorganized “exclusively IT application-based teams (clinical, hardware, security, etc.) to include joint structures based on shared goals around a theme e.g., a digital experience-based portfolio (patient digital experience, clinician digital experience, researcher digital experience, etc.)."

Without the support of system-level frameworks, our seed projects at the University of Utah have joined a sea of research and innovation waste. 

“​​In this new digital health era, where applied health informatics will predominate, creating an integrative system—where a true partnership is established to join operational and academic informatics people, resources, and missions—will be essential for health systems to achieve informatics healthcare goals effectively.”