Of the many lessons Maggie Ratliff learned from working at large organizations, none was more valuable than the need to do your due diligence. For some CIOs, that might mean using data to argue the case for a new system. For Ratliff, it means doing everything she can to avoid a major rip and replace, including bringing in the vendor to do an optimization study. In this interview, she talks about what it’s like to lose the red tape, how she approached being the new CIO, her concerns about MU stage 2, and how she is leveraging physician leaders to help drum up support for IT tools. Ratliff also talks about the staffing challenges that come with being in a rural area, the one thing you can’t do with physicians, and what she does to unwind.
Chapter 3
- Going lean
- HITECH’s impact — “IT has become more critical to operations than ever before.”
- Population health management
- Patient portal-lite
- “We learn so much from our colleagues.”
- Adjusting to a new home
- Baking as therapy
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Bold Statements
IT has become more critical to operations than we ever have been. ARRA and HITECH have forced us to look at how we can provide good data to the physicians for things like readmissions and care protocols and things like that that we would have never focused on before.
That’s a totally new concept to most of us in healthcare — this whole idea of caring for the patient from the beginning to the end. Before, when patients left the hospital, the work was done. Now, we have to work on providing that care from the initial visit all the way through the hospital stay and when they go home.
We as healthcare providers cannot control the patients outside the hospital. We can’t make them sign on to the portal. We can’t make them be compliant patients. All we can do is give them the information.
We all approach things differently and have different strategies — if we can learn from one another, that’s the best way. That’s how we’re going to all be successful.
It’s been a challenge to come into a new environment want to give a 110 percent at what you’re doing professionally and then want to give 110 percent at home as well. It’s very difficult to do.
Gamble: You talked a little bit about leadership development. One of the things I noticed on your LinkedIn page is that you are certified in either Lean or Six Sigma — I’m not sure which one it was.
Ratliff: Six Sigma.
Gamble: Okay. Have you had experience in both?
Ratliff: I have had experience in both. Here at this organization we’re going down the Lean path. I do have my green belt in Six Sigma, which is the basic certification for Lean.
Gamble: How do you think you can possibly use that going forward to maybe improve some processes in the organization?
Ratliff: Our organization here is very committed to the Lean process. We actually have an entire department that focuses on performance improvement. At any one time, we probably have two or three RIEs — rapid improvement projects — going on. We’re very focused on implementing Lean processes to drive out waste and help to improve efficiencies in all areas — not just the patient care areas or the supply chain areas, but in all areas. We have a very active organization working toward Lean.
Gamble: That’s an interesting thing, and it’s something where I feel like we heard more about a few years ago and now it’s starting to come back, because so many organizations are asked to do more with fewer resources.
Ratliff: Absolutely.
Gamble: Talking a little bit about your own career path, were you always in healthcare or healthcare IT, or if you weren’t, how did you transition into it?
Ratliff: I’ve always been in healthcare IT; my entire career. I just sort of grew up through the ranks and found myself in this role, and have really just been very fortunate to be involved with some quality healthcare organizations and been able to work up through those. I’ve been very lucky.
Gamble: Where was your first CIO role?
Ratliff: My first CIO role. Wow, that was probably Alaska Regional Hospital with HCA. It was a director role — they didn’t have CIOs in the hospitals, but we acted as CIOs back then. That was back in the late 90s, I think.
Gamble: I’m sure you’re seen a lot of significant differences from now and then in terms of the scope of that role.
Ratliff: Absolutely, a lot of different focuses. I remember when Y2K the main issue and the main focus — everybody was panicked about Y2K. It’s always something new coming along.
Gamble: As far as how HITECH has really changed the game, could you just give some of your thoughts on that — being someone in your role, how that flipped things around for the industry?
Ratliff: In the past, we really focused on having systems in place that would help us financially. That really was the focus early on for IT. Now, our scope or our focus has completely turned to a more clinical focus, and IT has become more critical to operations than we ever have been. ARRA and HITECH have forced us to look at how we can provide good data to the physicians for things like readmissions and care protocols and things like that that we would have never focused on before, I think. Some hospitals probably started going down that route, but I think ARRA, HITECH, and HIPAA forced us to really start looking at things like that.
Gamble: It seems like that there’s so much more of an emphasis now on patients once they have left the hospital. It’s something that makes complete sense because what’s the use of providing this quality care if once they walk out the door, it all goes out the window.
Ratliff: I think that as an organization and as a healthcare system in general in the United States, we need to focus on population management. That’s something that’s a totally new concept to most of us in healthcare — this whole idea of caring for the patient from the beginning to the end. Before, when patients left the hospital, the hospital’s work was done. Now, we have to work on providing that care from the initial visit all the way through the hospital stay and when they go home, making sure that they have appropriate homecare and that they follow up appropriately. It’s making sure patients have access to the information they need, and making sure the providers have access to the information they need. Those types of things now have become extremely important in the care model, and it’s completely changed how we look at it.
Gamble: I imagine that’s something that’s a really large part of your organization strategy going forward, just being able to follow that patient after discharge.
Ratliff: Absolutely. Our administrative team has even been restructured and we now have someone that’s working solely on developing our population management program.
Gamble: I don’t believe I asked this before, but you mentioned a little bit about portals. Is that something that you’re doing now or looking to do down the line?
Ratliff: We have a patient portal now — it’s sort of a patient portal-lite, if you will. We haven’t really encouraged a lot of involvement in it, but with this new update and with the requirements coming in Stage 2, a patient portal is one of the requirements. We’ve been struggling with making sure that we have the patient portal available to our patients but our struggle has been how do you get the patient to sign on to the portal? We’ve batted around some ideas, and other than when they present to the office, showing them the portal and encouraging them or when they present to the hospital doing the same thing, I think that’s one of the big challenges with ARRA and the new reform — we as healthcare providers cannot control the patients outside the hospital. We can’t make them sign on to the portal. We can’t make them be compliant patients. All we can do is give them the information and make sure they’re educated and can make good, informed decisions, but we can’t hold them to that. I think that is something that really needs to be reviewed with this whole healthcare reform strategy. The patients have to be empowered. We can do that, but we can’t make them adhere.
Gamble: Yeah, that’s a really common theme that we hear. There are a lot of CIOs and other leaders who are looking for best practices and want to know — if there are organizations that are doing this well, how are they doing it?
Ratliff: You’re right. We’re struggling with that right now. Hopefully we’ll be able to do some sharing of information with some other organizations soon.
Gamble: On that note, do you participate in groups or organizations like CHIME just to touch base with other CIOs and get ideas of how they’re dealing with issues?
Ratliff: Absolutely. I’m actively involved in CHIME and HIMSS and the American College of Healthcare Executives.
Gamble: I would think that those are really valuable resources, maybe now more than ever.
Ratliff: They are. We learn so much from our colleagues and our peers when they’re actually facing the same things that we are. We all approach things differently and have different strategies — if we can learn from one another, that’s the best way. That’s how we’re going to all be successful. Sharing information like that is invaluable.
Gamble: Yeah. The last thing I wanted to touch on is work-life balance. This is a concept that I find really interesting and I like to talk to people about — what they do to make sure you have time away from work that’s quality time. I saw on LinkedIn that you’re involved with baking, is that true?
Ratliff: That’s what I do — I bake. Baking is my therapy. I also have a huge family, and my family is very important to me. So I do struggle with the work-life balance, especially lately where we’ve just moved to this new place. We have a new house and we’re trying to get things in order. It seems like things have been very hectic on the home front. It’s been a challenge to come into a new environment want to give a 110 percent at what you’re doing professionally and then want to give 110 percent at home as well. It’s very difficult to do. What I try to do is make sure my husband and I have a day at least every other week where we go and spend time together, just the two of us, and that I spend time with my family on the weekends and we focus just on family time.
Gamble: It’s interesting. I’m a fairly new mom — I had twins last June, and so I’m always looking for best practices with work-life balance. I find myself talking to other working moms and just trying to get any hints or advice or anything to help make sure once I’m away from work I’m really away from it and spending quality time with family. It’s something that’s so important.
Ratliff: It is. That’s why we do what we do. We do what we do for our families and our community. It wouldn’t make sense to work this hard to try to provide a better life for our community and not focus on our families as well.
Gamble: Yeah, absolutely. It’s funny what you said about baking being a therapy. I actually really enjoy cooking because I’m able to just focus on that and kind of clear my mind, and it’s a really good thing. It’s good that you can find the time to do that.
Ratliff: I make myself find the time to do that, because it is my therapy. My poor husband says, ‘Doesn’t that drive you crazy,’ because I really get in to the whole decorating thing and try to do things in detail. And I say, ‘No, that’s actually my therapy. That’s what takes my mind off the rest of the stuff and this is fun for me.’ It helps to have something you can just focus on that’s different.
Gamble: Yeah, absolutely. If I’m ever in the area, I’d love to stop by and sample some of your baked goods.
Ratliff: Please do.
Gamble: Well, we’ve been able to touch on a lot of great topics so unless there’s anything else you wanted to talk about, I should let you go. But thank you so much for your time, I really appreciate it.
Ratliff: No, thank you, and if there’s ever anything else that you want to talk about that that I have the expertise to address, I would be more than happy to do that.
Gamble: Okay, that sounds great. Thank you so much and enjoy the rest of your day.
Ratliff: Thank you.
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