The Intersection of Safety, Quality, and Technology in Ancillary Services Transformation

Wayne Bohenek is the chief officer of ancillary services at Bon Secours Mercy Health, one of the country’s largest Catholic healthcare systems with 43 hospitals in seven states, as well as one in Ireland. He combines his strong IT background with education and experience as a pharmacist in his current healthcare leadership role. He shared his insights about the benefits of combining a focus on safety, quality, and technology in ancillary services with us for this issue of Healthcare Performance Insider.

Wayne earned his doctorate in pharmacy at the University of Illinois, followed by administrative and general residencies at the University of Wisconsin, where he earned a master’s degree in hospital and pharmacy administration. After working at University of Chicago hospitals for seven years, he joined the University of Cincinnati as chief pharmacy officer. In 2002, he joined Mercy Health as vice president of pharmacy quality and safety, working on national initiatives and gaining additional Lean Six Sigma training.

In 2009, Wayne was recruited to lead the medical informatics side of Mercy Health’s Epic electronic health record (EHR) rollout across 23 hospitals. When Mercy merged with Bon Secours in 2018, Wayne was named the chief officer of ancillary services, including both lab and pharmacy.

Complexity creates opportunities for impact

Wayne’s strong background in IT, honed over 23 Epic go-lives, gives him an edge when it comes to managing pharmacy and lab. Both pharmacy and lab are complex and highly regulated organizations. They’re also similar in that both are highly automated and high-cost areas of a hospital. For Wayne, by understanding those operations from beginning to end and having a broad system approach, we can do things in our system that are beneficial from a patient care perspective.

With pharmacy and lab, pretty much everything now is highly automated and dependent on IT. When you look at the electronic health record really driving all of clinical practice, having an understanding of that has been really beneficial to what I do now in managing both pharmacy and lab. You really can control processes. You can control the ordering and what’s being done on the ordering and prescribing side.

Combining technical expertise with continuous improvement methodologies like Lean Six Sigma has enabled Wayne to drive innovation. For example, as his health system prepares to administer COVID-19 vaccines, the vaccine rollout with “warp speed” in a large system requires a tremendous amount coordination and project management on the back side. It’s a very complex process, and so having that background I think makes you successful.

The future of IT in ancillary services

IT will continue to grow in both of those disciplines [pharmacy and lab]. We have a tremendous amount of automation today, but it continues to expand and become more and more automated. We have, for example, a large automated mail-order pharmacy, where one pharmacist today can check 1,000 prescriptions…Everything is bar coded, and really, it’s a fail-safe system where automation has allowed us to function in that role from start to finish, to filling that prescription, to shipping it out the door.

As a result, the process results in very few errors. It is very difficult to get by all the checks and balances in that process today. It’s been, from a patient safety perspective, extremely beneficial. IT has brought a whole new level of safety, closing the loop from when a physician prescribes the medication to the point it’s administered to a patient or dispensed as a prescription that I first started out in pharmacy 30 years ago.  

Challenges, opportunities from 2018 merger

We created two  departments across both ministries. The final product is a department of lab and a department of pharmacy that does not report up through the hospitals. They report up through the corporate office, which is a very different structure.

Before the merger,  Dr. Bohenek indicated lab and pharmacy were in different stages across the two legacy systems, each of them having strengths and weaknesses. When you look at the merger, really taking time to align the departments of lab and pharmacy, analyzing strengths, and pulling in an organizational structure that supports the needs, but also plays upon the strengths, is key.

What that allows you to do is to look at the operations across the system and optimize that system across the enterprise. It is, Wayne said, a different equation than the one a standalone hospital would make.

Lessons learned from COVID-19

COVID-19 has been an opportunity to put everything Wayne knows about process improvement and efficiency into action. For example, there is a huge variety of COVID-19 tests, each of which may be best for a specific patient or in a specific situation. Building out the health system’s capability – across 43 hospitals and many more care sites – including equipment, testing materials, platforms, and electronic health record interfaces was a complex undertaking.

From a pharmacy perspective, Wayne said, it’s constantly evolving. We learn every day about what medications works and what doesn’t work, studying the data coming out on a daily basis.  We try to build a playbook that documents all of this information, and we house it for our system. But it takes a lot of work and understanding what works today may not work tomorrow.

Wayne notes that a strong IT background helps him use technology effectively in light of these complex problems. It goes back to the understanding of how the electronic health record is built and guide practitioners bringing information to them at the time of decision making so they can make the best decision.  

The COVID-19 vaccine is another multifaceted problem. The biggest challenges, Wayne said, have to do with logistics and communication across the health system – even though they don’t know yet which vaccine they will get.

First, we had to obtain ultracold freezers for the Pfizer product and put distribution and communication channels in place. Then, we considered additional questions: How are we going to schedule patients for getting a vaccine in each of our markets? How do we prioritize the patients that are maybe more exposed to COVID from a patient perspective? How do we educate all of our employees about the value of a vaccine?

In summary, from a lab and a pharmacy perspective, the pandemic has impacted pharmacy and lab tremendously across our organization.

The pandemic’s healthcare impact

In some ways, the pandemic has forced healthcare organizations to evolve. There’s a tremendous amount of positive improvement that we would have not otherwise realized.  For example, Bon Secours Mercy Health opened a mail-order pharmacy in January of this year, which is doing a tremendous amount of volume. When COVID-19 hit, the call center that serves the mail-order pharmacy handles 16,000 calls a month is now totally remote.

I think if we would have said up front, “we’re going to do this call center remotely,” no one would have ever agreed to do that. No one ever would have believed that we could do that. Well, we’re doing it today, and it’s operating efficiently, and people love it. That’s just one example.

Another example is virtual medication management clinics. We’re seeing patients for anticoagulation management, diabetes management, many medication management clinics across the system, and they’re all functioning virtually. It has pushed healthcare into delivering care and many different ways that we would have not seen had we not had the pandemic.

Wayne Bohenek

Wayne Bohenek

Chief Officer of Ancillary Services, Bon Secours Mercy Health

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