When you’re the new CIO, the first few months can be a big adjustment period, but the key, according to Sarah Richardson, is to listen. “You talk to everybody and ask a million questions and listen.” For Richardson, who joined NCH as CIO last fall, this strategy has paid off in the past, and continues to be pivotal in becoming part of the leadership team. In this interview, Richardson talks about how her experiences in the not-for-profit and corporate IT worlds helped prepare her for her current role; what she’s learned about how to build a strong team and keep staff motivated; and how to determine when it’s time to move on. She also discusses the benefits of being a fully outsourced IT shop, her team’s strong focus on population health and patient engagement, and why volunteering is so important to her.
Chapter 2
- Focus on portals — “How can we make it seem like an engine?”
- Internally marketing initiatives
- Security — “No matter what we do, it’ll always be a when, not an if.”
- Data loss prevention
- Culture changes
- Lessons in leadership — “We got really creative at making things work.”
- “I care about the people before I care about the technology.”
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Bold Statements
Quite often, the people within the hospital can be the least informed as a population about what it is you bring to the table.
We know that healthcare will move to more of an outpatient and home setting, and we are actively partnering to figure out how to make that happen. We’ll still be on the wellness journey with our population, it’s just in the next few years, you’ll see services move out of hospitals, and we are keeping up with that trend.
It’s a true hybridization of a not-for-profit healthcare system that has a corporate relationship with an IT provider. I didn’t plan my two roles coming together 15 years later, but they absolutely have, and it’s really been the perfect alignment.
We got really, really creative at making things work. In an ideal environment, you don’t want 25 different desktop types and 30 different types of images and cobbled together network gear, but you get what you can get.
When you take the time to connect with people on a personal level and you carve out time — literally, on the calendar, one-on-one time — that’s where the rubber meets the road.
Gamble: Just hearing about the smart rooms and then everything you’re doing with the devices, it must be a gratifying thing to see because it’s like the focus has been on laying all this groundwork, and so to see some of this technology really come to life is something that I think would be really beneficial for the users.
Richardson: It’s fantastic because the technology is a differentiator — that’s how we look at it. And so how does technology allow our caregivers and physicians to provide better outcomes and to improve the average length of stay, the healing environment, reduced readmissions, etc. — all those things that you get measured for as an organization. You really do care about because we always say here in our environment, nobody wants to spend the night in the hospital. If you’re going to be in a hospital and you’re going to be at NCH, you already know that your caregivers have the latest technology at their fingertips, whether it’s evidence-based order sets or the fact that they can securely text one another to make sure that when you ring the call light there’s somebody exactly at your bedside with what you need, to sepsis prevention and how we continue to measure quality and be a top performer.
You know that when you come here we’re going to take good care of you, and then when you leave the hospital, through your portal, you’re going to know all your results. You’re going to be able to order a refill on your prescription. You’re going to be able to connect with your physician through secure messaging as well. You’re always connected to the system and a wellness component, both preventative while you’re here, and once you leave. We are really on your lifetime journey with you.
Gamble: Okay. I was going to ask about the portal and how that’s something that you’ve been able to build out.
Richardson: Absolutely. So, always the driver of Meaningful Use, we have to have these components, and so we took stage 1 very seriously. We qualified for stage 1 in our hospital system and we absolutely did a great job. We met the metric for phase one. We’ve also qualified for stage 2 Meaningful Use, but as we sat down and started to roll out phases of our portal, we asked, ‘how can we make this seem like an engine? How do you use your portal to be that first stop into your healthcare system? So we just recently started teeing up all the pieces of phase 2, from a lot of the backend stuff that people don’t think is very fun, like Google analytics — what are people clicking on once they’re in the portal and what do they care most about — to radiology results, requesting different scheduling components, secure messaging, patient friendly locators, all that type of information, but then also, the internal marketing plan.
One of the things I’ve realized in any healthcare system I’ve ever been with is that quite often, the people within the hospital can be the least informed as a population about what it is you bring to the table. And so we’ve really worked on the internal marketing of all of our new initiatives, whether it’s information security programs, clinical endeavors, even our infrastructure and the things that we’re doing to stay steps ahead of what applications are coming onboard. Informing the users about what we do as an organization gives them that sense of pride to say, ‘I already knew we were good, but I didn’t know how good we were.’ When you know how good the pipes are you’re a lot more inclined to tell people about it. The portal is something we’re really excited about because we keep rolling out new functionality and working with our physicians, working with our patients, and working with the Mayo Clinic to say how do we get to phase two, three, four, and even pushing on Cerner to say, ‘here’s what our patients are asking for. Can we be a development partner with you in adding new functionality so that this really is the best way to connect with us,’ because half of our patients leave for season. We have a huge seasonal influx. Come Memorial Day, we’re going to have 300,000 people leave Collier County for the summer — how do they stay connected to NCH when they’re not here, especially since most of that population is an older population who potentially has greater ongoing healthcare maintenance needs.
Gamble: Right. That’s something that I can imagine is a big challenge when you’re dealing with a really widely fluctuating population, and like you said, having the portal as an engine is something where you can keep them more engaged even when they’re not in the area.
Richardson: Absolutely. And you think about technology being useful for different populations. For example, one of my favorite stories to tell is we have a couple of volunteers — most of our volunteers are older — and one of our ladies is in her 90s. She is the sweetest lady and she loves technology. She likes to text her grandkids. We have a story about her teaching a patient how to use the portal who was in their 80s, and she’ll say, ‘I’m just teaching the youngsters how to use the new technology.’ We have a 90-year-old volunteer teaching an 80-year old patient who’s leaving the hospital how to get onto the portal to look at her records and make sure that she has what she needs. So it’s pretty fun when you can engage everybody at every level of your community.
Gamble: Yeah. Now, looking at things like analytics, is that also a priority just to be able to do more with the data?
Richardson: It is. In fact, a huge initiative for us is analytics in terms of population health and how we want to continue to grow out that opportunity for us. When you think about ways to really have more of an ACO-type of environment and move away from the fee-for-service type of procedures, the analytics around population health become very critical. It’s a big initiative for us right now. It’s something we’ll continue to flesh out through 2015 and 2016 and forward.
I’m relatively new to the team. They didn’t have a CIO for over a year, and then we just hired our CMO. We had a gap in that leadership space as well. He’s been onboard about a month, and I’ve probably spent more time with him than anybody else in the organization recently. Analytics and how we can, interestingly enough, keep people out of our hospitals is really our long-term plan, because we know that healthcare will move to more of an outpatient and home, and we are actively partnering to figure out how to make that happen. We’ll still be on the wellness journey with our population, it’s just in the next few years, you’ll see services move out of hospitals, and we are keeping up with that trend.
Gamble: Okay. Before I move on, I just wanted to ask if there any other big priorities on your plate. I know we’ve already mentioned quite a few.
Richardson: For me, information security is the thing that, for my lifetime, will keep me awake at night and we are building a very robust security plan. And it’s funny because presenting to the board recently, they said, ‘So what does this mean?’ And I said, ‘it means we’re still not secure. No matter what we do, it’ll always be a when, not an if. Here are all the things that we are doing to be as secure as we possibly can, and here’s that strategy.’ We’re very serious about security maturity, both informational and awareness. Technology, policy, procedure, risk, access, education — all of those are things that I make part of the fabric of the organization, because your greatest risk is humans. If you think about it, in any situation where somebody got into some of the recent breaches you’ve seen, it’s been through either a phishing attempt or a system that didn’t necessarily touch clinical information, but it was still an entry way into the front door of the hospital. And none of them were on purpose. It was just human behavior that allowed for a vulnerability. And so I make security that everybody thinks about all of the time and we’re make good progress on doing the right projects to keep our environment as secure as we can.
Gamble: And does that also include having those procedures in place for when something should happen and things like, ‘here’s how to communicate’ — does it go pretty detailed as far as what we have to do in the event that there is any type of breach?
Richardson: Absolutely. You think about the importance of having data loss prevention policies in place, about having cyber security in place, about having up-to-date penetration testing, both from an internal and external perspective, doing vulnerability scans, having active HIPAA risk assessments. It’s a lot of ‘what-iffing.’ I always say that none of us is as smart as all of us collectively. And don’t even assume that it’s just within our system. We have all the resources available to use from Cerner and we partner with them and have their security team down here a lot to say, let’s do this what-if scenario. But we also actively third-party audit ourselves with McGladrey, and then we’ve got some feelers out with a couple of other security agencies to say, ‘come in and look at our security model and tell me, is there a gap here? What do you think? Here’s what we want you to find. Tell us what else you find. Build that gap analysis and roadmap with us.’ That’s how active we are in that pursuit to your point of, ‘what happens if.’
Gamble: Yeah. So obviously a lot going on there, but I wanted to also talk about your background and how the experiences you’ve had have helped shape your leadership philosophy. You said that you’ve been at NCH since November and you were previously CIO at HCA for about four years?
Richardson: Correct. I was with HCA for almost 10 years total. I had four roles with them in three different states, everything from IT director at a local facility, then I went into information security for about a year and a half. Then I was program director at the corporate office in Nashville and rolled out a shared services model for IT before going out back into the field and doing about four and half years in a division CIO role.
Gamble: So you were able to gain experiences in a lot of different areas.
Richardson: Yeah. And before that I was at a county hospital in Las Vegas, University Medical Center, a Trauma 1, indigent care, teaching hospital. I was there for five years. It’s interesting — I’ve taken my five years of not-for-profit experience with UMC, plus my corporate experience at HCA for almost 10 years, and come to NCH, where it’s a true hybridization of a not-for-profit healthcare system that has a corporate relationship with an IT provider. I didn’t plan my two roles coming together 15 years later, but they absolutely have, and it’s really been the perfect alignment. I couldn’t have planned it better. It happened by accident and it’s worked out great.
Gamble: Right. I can only imagine how beneficial it is having those two different worlds of experience. One of the things I wanted to talk about was culture change and being able to kind of transform the IT culture. I wanted to talk about some of the experience you’ve had with that, and how that’s benefitted you.
Richardson: My favorite story to tell in that space has happened twice actually. When I worked at the county hospital in Las Vegas, I walked into a place that was always going to be in the red. There was never going to be a budget that really worked for the county hospital there. IT was going to be the last place on the pipeline — if someone was going to money from the budget at the end of the year, IT was last in line. But we got really, really creative at making things work. In an ideal environment, you don’t want 25 different desktop types and 30 different types of images and cobbled together network gear, but you get what you can get in that environment.
When I first got there it was a team that was unionized. They were angry and didn’t like the way things worked and just felt very unempowered. And after five years with them, there was no longer a union on the IT side of the house. We still had about 25 different types of equipment and images, but they were standardized. When we started to think about, where can you make the biggest impact, how do you make your life easier? How do you deliver the best value to the organization? The guys came up with a lot of creative things, and I said, ‘you tell me that story, I’ll get you the funding for that.’ We’re always going to have this ramshackle environment, but how do you make it better? How do you work together as team? And so I think that the most pressing tale out of all of that is bringing people together to help them achieve things they never thought that they could do, that were never possible. I carried that with me everywhere I went.
The next big opportunity to do it was at the mid-America division of HCA. I inherited a team that was incredibly talented — high-talent, high performers, but they lived in a world of silos. How do you bring all of those people together? And then, right through that journey, we combined two divisions at HCA. We combined our Delta region, which was Louisiana/Mississippi, with Kansas and Missouri to form mid-America. So we went from eight hospitals in one city, essentially, to 15 hospitals in four states. Bringing those two teams together from a culture perspective you had hard-working, hard-core, Midwest Missouri, and then you had Louisiana. I had teams in New Orleans, in Lafayette and Alexandria and Gulfport, with a totally different perspective on the world. It was sort of a clash of the titans originally. This side is saying, I’m going to do it better than you, and the other side is saying, I’m going to do it better than you and I was like, okay, let’s figure out how we can do this together.
The one thing I will always do is I care about the people first. Before I care about the technology and all of the particulars of what IT is doing, I know every single persons’ name. I know their birthday. I know their families. I know what they do for fun. I know what they want to be when they grow up. And when you take the time to connect with people on a personal level and you carve out time — literally, on the calendar, one-on-one time, no matter how big your team is — that’s where the rubber meets the road.
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