How to build an effective hub-and-spoke relationship [podcast]

When you’re in the thick of an extension project, it can be easy to get caught up in the everyday details. You have a long list of priorities, and more than likely, you’re focused on building a solid system for your extension partners over building a solid relationship with them.

We get it. There’s a lot to manage during this process. And sometimes it’s more convenient to put the relationship-build on the back burner. However, to deliver an EHR system that leads to effective outcomes, you’ll need to establish a strong relationship with your extension partners – sooner rather than later.

Recently, members of our Affiliate Solutions team sat down to discuss how to build this relationship, offering advice on setting expectations, improving communication, and establishing a partnership mentality. If you’re looking for ways to strengthen your hub-and-spoke relationship, listen in on the podcast below. And if you’d like to discuss this topic further, or if you’re looking for additional advice on your EHR extension project, please schedule a meeting with us.



Show notes

[00:00] Intros
[03:55] Focusing on relationship-building at every level of the organization
[07:28] How expectations may change throughout each phase of an EHR implementation
[09:55] Advice for setting expectations on both sides of the extension project
[14:41] Establishing a partnership mentality
[16:59] The key differences between inpatient Connect and ambulatory Connect relationships
[19:10] The importance of the Hub’s role as a support system and the account manager’s role in project management
[23:47] How Nordic can help

Affiliate hub spoke blog image 2


Lauren Piazza: Hello, and welcome to the latest episode of the HIT breakdown. I'm Lauren Piazza, Director of Affiliate Solutions here at Nordic. Today at the podcast, we're giving relationship advice, and no, not your standard relationship advice. We're going to be talking about affiliate relationships, and specifically how an organization's hub and spokes, or affiliates, can establish effective relationships that lead to positive outcomes for everyone.

To help shed some light on this topic, I'm sitting down with two experts in this area, Andrea Schmeichel, also a Director of Affiliate Solutions at Nordic, and Lauren Griessmeyer, Director of Training Solutions. Both Andrea and Lauren have extensive experience helping organizations develop strategies for effective affiliate extensions. I'm going to hand it over to Andrea and Lauren to introduce themselves. Lauren, would you like to start?

Lauren Griessmeyer: Sure. Thank you. My name is Lauren Griessmeyer, I'm Director of Training Solutions here at Nordic, which doesn't sound like I would be part of this podcast, but in my role, I focus across all of our business lines and make sure that we have solid adoption strategies in place anytime we do a project. As part of my role here, I've worked on a number of affiliate projects, making sure that the long-term training and support strategy that the organizations are adopting are going to lead to effective long-term usage of the system.

I've also worked with the optimization team representing some spokes and some optimization projects, making sure that they are getting the most out of their vendor relationship with the hub, and making sure that they're also adopting strategies internally to really own their system and give their customers, their clinicians the best support possible. Andrea, would you like to go ahead and introduce yourself?

Andrea Schmeichel: Yes, and I think it's important in any podcast to have as many Laurens as possible, so I'm really excited to be with both of you today. Lauren Griessmeyer is absolutely right, she and I worked very closely together on several different client projects, as training is a really important part of any affiliate project.

I'm Andrea Schmeichel, I'm also a Director of Affiliate Solutions, and at Affiliate Solutions, we focus on any Epic extension after the fact, whether that's a rollout to owned sites, Community Connect/affiliates, or mergers and acquisitions. So, we work with clients who are looking at potentially setting up a Community Connect program, whether they are looking to roll out and want some Nordic help with that deployment, whether they're looking at some planning, or even if they want to work with us and our Managed Services team on any support after the fact.

Lauren P: So, Lauren, what would you say is the first topic that we should discuss as it relates to affiliate hub-and-spoke relationships?

Lauren G: Well, I think that one of the things that we've seen as a big determinant for success when we've either seen organizations that are rolling out successfully or organizations that have been extended too, that are really happy in their relationship with the hubs and spokes that are really happy with that, is that they've developed relationships across every level of the organization. So, they don't just have connections at the executive level, and that's important, but they also have strong relationships all the way down to the analyst and the end user level. So, the spoke is consistently feeling supported by the hub, and the hub feels like it's got a genuine partnership with the spoke.

Andrea: Yeah, I worked with a client recently – it's interesting you bring up leadership relationships –because, surprisingly enough, they had really great on-the-ground relationships with their affiliates. So, the way that the help desk was supporting them, their account manager, the project manager, was really involved. So, everybody that was really on the ground doing the work, had great relationships, but the leadership did not. They hadn't cultivated and nurtured that relationship, they felt like, oh, we'll just let each other know if something goes wrong.

That's never the way they’re going to do a good leadership connection, so they found that they really had to look across the board at the leadership at all their affiliates and make sure that they were meeting on a regular basis, that they had some connection calls, and that they really were making sure that to understand the strategic goals of their affiliates as the hub organization, so that then they could connect, and the leadership really felt like, "Oh yes, we are being supported." Because of course, they were, but the leadership didn't know that because they weren't connected into the day-to-day of what was happening in the support world with their particular organization.

Lauren G: Yeah. That understanding of the strategic roadmap of the spoke can be really important for the hub because what I've seen with some organizations is that the issues being reported back to the hubs sometimes can be de-prioritized by the hub, and that can be really frustrating for the spoke. That de-prioritization can sometimes just come from a fundamental lack of understanding of why something is important for the spoke.

And so, if you have that understanding, and everybody's on the same page at all levels of the organization, it can help make sure that requests and issues are being prioritized and escalated in an appropriate fashion. And like you said, that getting those regular touch points and making sure that those meetings actually have an established agenda, and that you're really actually talking through those bigger picture strategic roadmap sorts of issues, is really important for that.

Andrea: Yeah, one of the big worries of an affiliate is, am I going to get lost in this giant organization? Are they going to care for me? Are they going to remember that I exist? And so, that's where that leadership connection can be so important because then you can really drive home the point that yes, we do think about you, you are important to us, we do have a lot of other priorities, but you are one of them, and you're important.

Lauren G: Yeah. And like with every relationship, one of the most important things about developing that relationship and keeping it strong, it's about communication. So, making sure that there is a two-way stream of communication, that both sides feel heard, and I actually do feel prioritized is really important as well.

Lauren P: So, do you think during the different phases of a project – pre-implementation, implementation, and post-live – do the relationship building expectations change during that? Or is it just important throughout the entirety of their relationship?

Andrea: It's a good question because I think it does change. When you're starting the pre-implementation, it's all about showing what you have to offer as a hub organization and making the affiliate or the spoke feel comfortable with what they're potentially going to be getting, because they haven't signed with you yet. They haven't paid anything yet. It's a fragile relationship as you're starting to build it. During the implementation, then you can potentially be in crisis mode. There's always something that happens during an implementation. It never goes completely smoothly, or you may have some unexpected scope increases, or some unexpected charges, and then you've got to deal with some of those difficult conversations. So, being able to really manage their relationship during a period of ups and downs is important, and then in support, if things are going well, it can be easy to potentially not check in as much.

What do we always say? A silent affiliate is not necessarily doing well, so it's important to continue to check in, and also, to make sure that there's more than just continual use of the system. There are things like optimization and upgrades. It's never ending, and so, it is important to have a regular cadence, although it may not be quite as urgent as in the implementation timeframe.

Lauren G: Yeah, and the roles that you designate during the implementation for what that long-term support is going to look like, because that's also really important. Andrea has mentioned a couple of times the concept of an account manager. Somebody who is really the representative for the spoke at the affiliate, and really acts as that bridge and the voice helping the spokes concerns be spoken to in conversations at the hub – that role's really integral in making sure that there is somebody that is getting on the ground, understanding why certain things might be a struggle for the affiliate organization, why some workflows that maybe work really well for the hub don't work well for the spoke, maybe understanding a little bit more about their priorities, that's really important to allow for that relationship between the hub and the spoke and the communication to be strong.

Lauren P: Now that we've discussed building relationships and the importance of that, once you have those relationships built and understand who was all at the table with you throughout the entirety of your relationship, what is the next step as part of the process of really growing that hub and spoke relationship?

Andrea: I think this is a really good place to talk about setting expectations. When we look at the most successful hub and spoke relationships, it’s those where the expectations are clear, they're communicated, and they're agreed upon by both parties. One of the things that we like to say when we work with clients is an affiliate will assume something's included in scope unless you tell them it's not, and that's a reasonable human thing to assume. So, it's important to write down what's included, what are they getting, what are they not getting, and then what could they potentially pay for? That works, I think, for any hub-and-spoke relationship that you really need to be open, and it can be a little unnerving at first to say, well, do we really want to explain to them all the things we're not offering? But that's really important because then they know where they need to fill in the gaps, or they can then understand, oh, okay, cool, we're maybe not getting this, but that's okay because we're getting all of these other things.

So, one of the things that we like to talk about is even documenting those things, so putting down in a document that's outside of the contract – you've already had the contract signed, let's say – but put a different document together to just say, “here are all the things that are in scope. Here are the things that we require of you: You need to get your folks signed up for training, and you need to make sure that you're not taking any vacations at go-live. You need to have certain subject matter experts available.” All of those things, so they know, OK, this is my responsibility. This is your responsibility. You're going to take out the garbage. I'm going to do the dishes. And then you can work together to figure out are there any gaps here that we need to talk through? So, I think it's really just bringing those things out into the light, putting them in writing, having them really talked about and discussed, that can be very powerful.

Lauren G: And setting those expectations can allow the affiliate to take more ownership of their system. So, in any implementation, or in any post-implementation when they're in support, it can be easy to forget this is something that I should be doing, or to sit back and wait for the hub to help you with a particular thing. Just like any other organization that owns their own system, there needs to be a sense of ownership of, this is our system and we need to be invested in order for it to really work. That's going to trickle down to the end users, and you're going to see a lot bigger buy-in of adopting the workflows and adopting the build that has been put in place if there is a sense of ownership of the system. So, that expectation up front of, like Andrea said, I'll do the dishes, and you take out the garbage is really important because it does give some clear sense of ownership to the affiliate.

The other thing that I've seen organizations that are successful post live do really well is make sure that they both have and understand the service-level agreement in place between them and the affiliate. So, they understand that if they put in a ticket for a particular issue, how quickly is that going to be acted upon, with what urgency, what is the communication stream going to be? For organizations that haven't had as strictly defined of a service-level agreement, that can sometimes lead to a feeling, which a lot of times is misplaced, that the affiliate isn't really fully supporting the spoke, and in reality, all it is, is just miscommunication, but being really up front with those expectations of, “if this is a break-fix, we are going to both respond to and fix it within 24 hours.” But if this is an enhancement request, for example, even if it's something that you don't have to pay for, it will be taken care of in X amount of time.

That sort of detail is really important to make sure that both sides are clear on what needs to happen in those situations and make sure that the spoke feels supported.

Andrea: Yeah. I think for the affiliate, the most common questions or concerns that I see are during the sales process. It's what are we getting, and how much do I have to pay for it? During implementation, it's who do you need, and when, and how much time are you going to take, and what kind of meetings do I have to show up for? And then for support, it absolutely is, if we have an issue, how fast are you going to take care of it?

Lauren P: I think that flows great into our third topic that we're going to discuss, which is establishing a partnership mentality. Lauren, would you like to dive into the different pieces around creating a partnership mentality between the hub and the spoke?

Lauren G: Yeah, for sure. I think again, this starts with a sense of ownership from the spoke, being really clear about what pieces the spoke is going to be responsible for on an ongoing basis, whether that be training for example, or at-the-elbow rounding, making sure issue reporting is happening in a particular way. Having that ownership, allows the spoke and the hub to feel like equal partners in the system that they've basically built together. Even though the hub is acting as a vendor, the spoke does have responsibility in making their side of the agreement work. So, organizations that I've seen be really successful are organizations that have had a very clear sense of ownership over the system, and have put in place their own strategies for supporting their end users and providing ongoing education and adoption support.

Andrea: Yeah, and I think governance is so key in this, so you establish – I think it's something that's more commonly established during the implementation because you're setting up the team – you have a project, but it can sometimes fall apart during support, where then you don't have that same urgency and maybe the weekly challenges that you have during implementation that you need to address. So having that governance structure set up, documented, and communicated, and then committing to that governance structure after implementation through support.

[Commercial break]

Lauren P: Do you find there's a difference between inpatient Connect and ambulatory Connect as it relates to these topics?

Andrea: I think that's a good point because the way I look at hospitals, they are their own contained cities, and so a hospital may have its own IT department. It may have more of a leadership structure, so there's more that you may need to connect to there. And so you may address each hospital individually in terms of governance, in terms of communication, whereas the ambulatory practices or the physician practices, you may address them as a group or regional groups depending on how many you have, because you want them to learn from each other. They're much smaller. You want to include them potentially together when you're talking about things like optimization or upgrades. So you could have a shared governance in the ambulatory realm. I think that's less common when you're looking at inpatient.

Lauren G: Yeah, that absolutely jives with what I've seen. Again, being from the training side of things, it's much more common that you see the ongoing education and support being provided in-house, in an inpatient setting, because a lot of times those educators are already there. You have nurse educators. You have informaticists that naturally roll into that education and support role for inpatient settings. That's a lot less likely in an outpatient model, at least from what I've seen, that you'll have somebody that's in-house in a clinic, unless it's a really large clinic that's playing that role. And so going back to setting expectations and really defining roles, that's one place we're having specific conversations about what does ongoing education look like? Who's going to be providing training for new employees? How is that going to happen? Are they going to have to go to a central site? Etc.

Those conversations can look different in outpatient and inpatient setting, and it's really important to be upfront about what that's going to look like over the long term for organizations because it's not like the system goes static. It's not like you stop hiring people after you've gone live. So having those conversations around what will this look like in the future is really, really important.

Lauren P: We've talked a lot about creating a partnership mentality, setting expectations across the board for both the hub and the spoke. I'd like to talk a little bit now about the hub's responsibility as the support system for the spoke. The hub really is a vendor in any Community Connect relationship. Andrea, would you like to speak a little bit about the responsibility they have to their spokes?

Andrea: Yeah. It's a shifted mindset that vendor mindset that you have to get into as a hub, if you're used to rolling out to your own sites, it can be a very different experience to roll out and support sites that you don't own and that are paying for your services in a way that your own sites are not. So, it is something that's critical as we look at the support relationship, is really understanding that you need to treat these affiliates slightly differently. That there are situations where potentially, they're going to look back at the contract and see what you promised them. Or they're going to want something that you're going to want them to pay extra for, and you're going to have that conversation. Or, as we talked about, they're going to expect something potentially that you haven't articulated, and then you need to have that conversation, and you're having that conversation knowing that they are a customer of yours, and they want to be treated as such.

So, I think that's really important, and that's where then having those already established relationships can really help with that. Another thing that we've touched on a little bit and that we talk about anytime we talk about Community Connect is the account manager. This is a critical role that can make or break your program, and this is really the person that's on the ground working day by day with the affiliate sites during implementation, and then also through support. They are their number one contact when they don't know where to go to. I describe the account manager as the person who's helping that affiliate navigate the complex web of the hub. So, when you have a problem with the network, who do you go to? When you have an Epic build issue, who do you go to? When you have a new hire that needs to be trained, who do you go to? If you don't know, the account manager is always your first stop, and that person can really help you then understand where does this issue go? How does this issue get resolved?

And that person always then has their finger on the pulse of how the affiliate's doing, how are they doing with the system adoption? How are they doing with happiness? And that person can be a great escalation point, if they see things that need to be addressed.

Lauren G: They can also be a great source of proactive support because, as we said, the system doesn't go static after you've implemented it. So, you're going to be going through upgrades. You're going to be adding on new features, etc., and your affiliates need to know that those are coming, and they need to be able to prepare for them. And that account manager can be a key piece in that communication flow to make sure that the affiliate does actually feel well prepared and well supported when you start doing things like upgrades, especially as more organizations are moving to a quarterly upgrade model. So, that is a really, really key role throughout the implementation and for solid support.

Andrea: And it's the little things too, of even letting your help desk know who the most current list of your live affiliates are, so when they call and they say, "Hey, I'm from Wisconsin Family Doctors ..." And they say, "Who?" That can make a big difference in how they feel as your customer, and so it's those little details that can make a big difference as you're looking at your support and building your relationships. You want them to feel that when they're calling your help desk, they're a known entity. "Oh yes, of course, I know you. Welcome, how can I help you today?" It's a very different reception than the help desk person potentially being confused just because they weren't aware that you're a new live site.

Lauren P: I think something that we've also found is the help desk in the talk track around that, if there need to be directed to a different area for example, not just say, "Oh, we don't do that, sorry." Direct them maybe to their account manager or something along those lines.

Andrea: And educating the help desk about that, so they know, oh, there are these things called account managers, we have, let's say five of them, they own different sites, that can be very powerful and really can empower then that help desk person who's just trying to do the best job they can to direct then this person who is a customer, again, like that vendor-customer relationship and having them feel like they're well taken care of in that workflow.

Lauren P: Andrea and Lauren, would you like to talk through how we can help?

Andrea: Sure, at Nordic, we love talking about all kinds of affiliate projects. We have 300+ consultants with extension experience, and we help our clients soup-to-nuts, whether that's setting up your community connect program, which we love talking about strategy, how you're going to set up your governance, how you might determine your scope and your pricing with pre-implementation planning, getting ready to do your implementation, deployment, so simply getting from kickoff to go-live, and then working with you on potentially using managed services for affiliate support. We also work with hubs and spokes, so we work with the large healthcare organizations, but then we also work with affiliates, if they're looking for some advice and counsel on how best to implement this new EHR.

Lauren G: We also do optimization work. Andrea mentioned a couple of our different strategic services in that little plug for what we can do from an affiliate standpoint. So, we try to leverage our teams across our internal teams here at Nordic, so affiliate is its own standalone business line, but it also has relationships with managed services for the ongoing support piece. It also works across to the optimization team. We have done projects in the past looking at how the spoke is currently leveraging their system, and how they can maybe do some things that they have full control over such as tweaking processes or training, to get better use of their system, or improving that relationship with the spoke or with the hub, so that they are going and getting those expectations a little bit more firmed up, and they're feeling like they're being supported a little bit better from the vendor. On the hub side, we can also work with you on how to put some of these processes in place so you are providing better customer service for your spokes, and have happier spokes, have happier customers.

Lauren P: Great. Well, thank you Lauren and Andrea for sharing your hub and affiliate relationship advice with us today.

Andrea: Thank you, it's a pleasure.

Lauren G: Thank you.

Lauren P: If you'd like to learn more about Nordic and our affiliate or training solutions, visit our website,

Topics: Epic Community Connect, featured

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