When Terri Barber arrived at Southwest General in 2008, she faced a number of challenges. One was to convince the board to invest in IT, and another was to improve efficiency. After clearing the first huddle, she got her staff trained on project management. The new model yielded quick results: in four years, the organization went from Stage 1 to Stage 6. In this interview, Barber talks about how to shake things up without alienating the existing staff, how her organization is capitalizing on its partnership with University Hospitals, and how her team is working to prioritizes projects. She also discusses her unique career path, her role as VP of support services, and what she is doing to prevent staff turnover.
Chapter 1
- About Southwest General
- The pros of being a standalone — “We can be more nimble”
- Partnering with University Hospitals
- From Stage 1 to Stage 6
- Project management training for everyone
- Being the new boss
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Bold Statements
I’m able to get things done relatively quickly here at Southwest General. I came from a much larger health system and it was so large that it really took forever just to get a project done. I like working in a smaller environment where we can be able to be a little bit more nimble.
I have a great relationship with the IT management team down at UH, and even though we have different information systems, we’re still able to share ideas and issues and help each other out from time to time.
I had a unique opportunity to restructure everything in a more workable, efficient model when I got here, starting with making sure everybody had some project management training, because their track record on actually completing projects on time was really dismal.
My management style isn’t such that I’m just going to come in and take over and not listen to anybody else. I met with each of my employees and learned what their skills and interests were.
I have a lot of docs that are just really accepting of this whole thing now that we’ve kind of crossed over from being in a real hybrid environment to being a lot more digital. Now we have docs actually asking, ‘when am I going to be trained for clinical documentation’. Three years ago, that would have never happened.
Gamble: Hi Terri, why don’t you start by telling the listeners a little bit about Southwest General — how many beds you have, what you have in terms of clinics, things like that.
Barber: Sure, I’d be glad to. Southwest General — it’s interesting, anytime I have that name on a badge or something, people ask me if the hospital is in Arizona, which it’s not. It’s in one of the southwest suburbs of Cleveland. We’re a not-for-profit community hospital. We have about 354 beds. We’re one of the few independent hospitals left in Cleveland, and we provide a large variety of different services at our hospital. We do almost any kind of surgery, except for transplants. Our hospital includes an inpatient psych unit and even a geriatric psych unit. We’re pretty diverse as far as the services that we provide.
Gamble: That puts you in a unique position being a standalone, because I know we’ve spoken to a few of the CIOs in Ohio, and most of them were from either large or medium-sized health systems. Do you think that puts you at a disadvantage?
Barber: From my perspective as a CIO, I don’t see it as a disadvantage. I see it as an advantage because I’m able to get things done relatively quickly here at Southwest General. I came from a much larger health system and it was so large that it really took forever just to get a project done. I like working in a smaller environment where we can be able to be a little bit more nimble around here.
Gamble: Yeah sure, you have fewer layers to deal with.
Barber: Exactly.
Gamble: Do you have physicians that refer into the system that are either employed or non-employed?
Barber: Yes, we have a very small employed group. The Southwest Medical group is only about 32 multispecialty physicians, and the majority of our doctors here are private practitioners or independent physicians. They’re community docs. That makes the IT part a little bit harder since the majority of them are not employed, but I think we’ve made good progress with our private docs as well. Also, since we have a partnership with University Hospitals of Cleveland, a lot of the docs that are employed by University Hospitals actually have their office practices on our campus — their offices are in our buildings and they see their patients in our hospital.
Gamble: I was going to ask you about the nature of the partnership. So your patients, as part of that deal, also can go to some of their facilities?
Barber: Right. We’re not managed by them or owned by them, but we do have a great partnership with UH. We offer some of their clinical services on our campus, like the Seidman Cancer Center, which is a UH service on our campus. Both of us take advantage of any kind of discounts we can get with regard to group purchasing on many of the things. It’s nice; I have a great relationship with the IT management team down at UH, and even though we have different information systems, we’re still able to share ideas and issues and help each other out from time to time.
Gamble: Let’s talk about the clinical application environment at Southwest General. What type of system are you using for your EMR?
Barber: We’re pretty much a Cerner shop. We’re about four years through a five-year strategic IT plan to implement an integrated comprehensive EMR. So we’re almost there. I’ve been at Southwest about five years, and when I came in 2008, I was able to convince the board to make a significant investment in IT over the next five years so that we can get as far as we are today. In 2008, we were at Stage 1 in the HIMSS Analytics EMR adoption model, and now we’re at Stage 6. We were able to do that in four years, which is pretty good. I could have never done that at a larger health system. And we just attested for Meaningful Use a couple of weeks ago as well.
Gamble: When you came in, was that one of the things that you wanted to do — say, ‘let’s lay this out in a five-year plan’ just so it was kind of easier to sell? Or maybe you knew it would be easier to attack it that way.
Barber: Well, Southwest didn’t even have a CIO in place at the time. That person had moved on about six months earlier, and I was actually brought in to put the plan together. The new CEO here used to work with me at the larger health system and so he asked me to join his leadership team to specifically bring Southwest up to speed from an information technology perspective.
Gamble: What was going on when there was no CIO? Who was taking care of all that responsibility?
Barber: There was a director level person that was kind of holding down the fort. It was kind of an interesting model. It was very, very flat; all the IT folks, whether it was the network people or the helpdesk people or the application analysts — everybody reported to this one director. And so I had a unique opportunity to restructure everything in a more workable, efficient model when I got here, starting with making sure everybody had some project management training, because their track record on actually completing projects on time was really dismal. And it occurred to me that it was probably because they don’t really understand that there’s a true methodology to managing a project. Now we’re just like a lean, mean project management machine here at Southwest General. Everybody’s really on board.
Gamble: What else did you do as part of that restructuring?
Barber: I brought in some people that had the right experience to really get us moving in the right direction, and I eliminated some people that were just not effective. I was able to get some folks that I had experience working with so I knew that they did a good job. And I was even able to get the person that was running the EMR project at the larger health system to come here as our project manager to help me organize and manage this five-year plan that we had. I think she’s one of the best project managers in the city. I was really lucky to get her. So getting the right personnel in place and reorganizing things where it made sense and getting people the right training — that took a good year to get everything in place, but it really paid off. The effort really paid off.
Gamble: I’m sure. You kind of whipped things into shape, right?
Barber: You know what, that’s a really fun position to be in. When you go into a place that really needs some help, it’s just so much fun to have the authority and opportunity to do what you think you need to do and then just watch it all happen. It’s like the ideal situation.
Gamble: It’s really interesting that you say that because I was going to ask how you were received there. Sometimes people are like ‘listen, we really need the help’ and then sometimes you get them saying, ‘who’s this new person coming in telling us what to do?’
Barber: Believe me, we had some of that, but that’s okay. You expect that. My management style isn’t such that I’m just going to come in and take over and not listen to anybody else. I met with each of my employees and learned what their skills and interests were, and I inherited a pretty decent team actually; they just needed some development and some organization. But it all turned out really well. I really inherited a good group of people that were anxious for some leadership and they were anxious to learn things too.
Gamble: That’s a good position to be in.
Barber: Absolutely.
Gamble: Now in terms of the plan, you said that you’re in the fourth year of a five-year plan. So what are you looking at next? What are the next big projects on your plate as part of that plan?
Barber: First of all, I have to say that the clinical staff at the hospital has been really awesome because we have added a tremendous amount of new technology over a short period of time. The nurse and the docs and the clinicians that work in all the other departments — we really threw a lot at them over a short period of time and pretty much rocked their world, but they have adapted very, very well.
Even with the medical staff, as most CIOs know, when you’re trying to implement an EMR, it’s just a little bit easier when you have a physician employed model. In a community physician model, it’s just a little bit more difficult. But I think that we have actually crossed the line with the docs, because this summer we put in clinical documentation using voice recognition, so with that, along with the CPOE that we implemented last summer, I have a lot of docs that are just really accepting of this whole thing now that we’ve kind of crossed over from being in a real hybrid environment to being a lot more digital than paper, because we still have a little bit more to go. Now we have docs actually asking, ‘when am I going to be trained for clinical documentation’. Three years ago, that would have never happened. So I think the docs have sort of crossed the line and are anxious to move totally over to the digital world.
Gamble: Do you think it made a difference for them seeing it work for other people and that after that, they wanted in?
Barber: Yeah, I think that observability does help. When we did our clinical documentation project early this summer around June, we just took a group of early adopter physicians that had been kind of working with us. We have a physician advisory committee of docs that are interested in giving us their input as far as how we set the systems up, and we use those physicians as our early adopters. And I think you’re right; I think once their peers saw them dictating and not having to write anything and saw how simple it was, we started getting phone calls from the other docs asking us when we are going to do more.
The problem is that I don’t have an unlimited amount of staff to train all these docs, so I’m sort of resource-constrained when you compare it with all of the training that we need to get the whole medical staff on board. So I’m sure they would like to us to move a lot faster than we’re able to move, but I’m very pleased that at least the physicians are asking for the technology rather than trying to resist it.
Gamble: That’s such a huge part of it.
Barber: It is huge. So that was our big one this year — voice recognition. We also turned on e-prescribing earlier this year. I think we’re one of the first hospitals in Ohio that actually turned that on for inpatient, and so that was pretty exciting. The docs love that. And we finished our implementation of medical device interfaces. The nursing folks really loved not having to transcribe values from medical devices, but rather having the EMR populated right from the medical device. That was a huge win for nursing as well.
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