Is change really so bad? Can implementing a new system really shake a staff to its core, paralyzing the ability to provide the best care? Yes, and that’s why it has to be handled with extreme care, says Edith Dees. Of all the lessons she learned during her two decades as CIO, the most valuable was how to effectively introduce and manage change. In this interview, Dees reflects on her experiences — not just as an IT leader, but as a clinician and consultant — and shares how she was able to conquer some of the biggest roadblocks in advancing an organization. She also talks about what excites her most in today’s industry, why she made to the move to consulting, and the direction she believes the CIO will take.
- CIO role at St. Mary’s
- Maine’s “very progressive PC physicians”
- Replacing legacy systems — “It was at the tipping point.”
- Merging 3 systems into 1 with SMS
- The “consultant glow”
- Early career as ICU nurse — “Each alarm meant something to me. I get that.”
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Everybody that’s impacted by it needs to be able to tell themselves that. ‘That’s why we’re doing this,’ to remind themselves. With the HIE, we can cut costs, we can speed care. That’s why we need to do this.
Not every organization embraces change. Some leaders have more of an appetite for it than others, and it’s kind of like, ‘if it ain’t broke, don’t fix it.’
Any time you get a situation with a merger or an acquisition, everybody has so much pride. It’s the ‘you’re killing my baby’ analogy with what they’ve done what they accomplished. It’s hard to let go and say that whatever those successes are that brought us here, we can use those skills and talents to take us somewhere else.
That’s what outsourcing brought. It brought some outside perspectives, it brought stability, it brought methodology, and it brought ownership and accountability. What I liked about it is you had 100 percent executive support because they finally said, ‘We need help and we’re willing to pay for it.’
I understand with probably much deeper appreciation as an IT professional than I did as a nurse how interdependent the different groups are in healthcare — what are the handoffs, what do you need from me, what do I need from you? When I was a nurse, I just did what I did.
Gamble: It’s interesting to think about how Meaningful Use really changed the outlook of the industry, even though a lot of people talk about stage 1 really laying a foundation and being what so many organizations were already striving for or doing, and how stage 2 really ramped things up and challenged a lot of organizations.
Dees: I think it was really good for us to do the 1-2 where didn’t have a chance to deaccelerate and we still had all our engine steam going. Because typically, from my experience, after you do a big deal, you want a break; you want to rest a little bit. And if you’re thinking there was going to be a rest between stage 1 and stage 2, I think that may have disciplined a lot of people.
And Stage 2 was more aggressive than stage 1, because stage 1, in my opinion, involved things that were pretty much within the organization’s control. Stage 2 didn’t. You had to collaborate with competitors in your HIE. You had to support, cajole, and encourage your patients to come forward and use your portal and send you emails. It’s hard enough to control your own workforce — now you’ve got folks that you have no direct influence over.
But again, it’s like any change — why are we doing this? We’re doing it to make things better and everybody that’s impacted by it needs to be able to tell themselves that. ‘That’s why we’re doing this,’ to remind themselves. With the HIE, we can cut costs, we can speed care. That’s why we need to do this. We all get it and we’re just going to push through and make it happen.
Gamble: Prior to Holy Spirit, you had a CIO role at St. Mary’s, correct?
Dees: Yes, St. Mary’s in Lewiston, Maine.
Gamble: And what time period was that?
Dees: It was 2000 to 2005, so that was five years. And that organization had no clinical systems either. The clinical systems were in the ancillaries, and not even every ancillary. In radiology, for example, there was no radiology management system. There was no OR scheduling system, there was no outpatient scheduling system. The electronic health record in our primary care sites were actually required by contract from the new physicians that were being recruited into this area. They would accept a position here if they were supported with an EHR. I thought, ‘wow, that’s impressive.’ But there was no corporate vision or mandate for them or anyone else to use it.
Gamble: That’s really interesting. You really do have different outcomes depending on where you are and who you’re working with.
Dees: It was interesting to me because Maine had, I thought, very progressive primary care physicians and much more automation there than the hospital did. And it was interesting to me that when I moved to Central Pennsylvania, the hospitals were so clinical information system advanced and very few of the practices were automated. I mean, it was interesting to me.
Gamble: Right, how it can be so different from one area to the next.
Gamble: So a lot of your focus there was on replacing those legacy systems?
Dees: Yes. First of all, there was no really clinical clamoring, because not every organization embraces change. Some leaders have more of an appetite for it than others, and it’s kind of like, ‘if it ain’t broke, don’t fix it.’ So there was toying — and there had been for years — of, ‘Let’s just check and make sure we’re not really missing something. Let’s talk to some vendors, let’s see some demos,’ and unbeknownst to me, that had gone on for years before I got there — that talking about clinical information systems. But before I left, I made a business case where we found a solution where we could automate essentially every aspect of the organization and pay less annually than we were for the meager automation we had had for years. I think that was finally the tipping point. It was like ‘Okay, well, at least financially it makes sense. We may not get the rest of it, but financially it makes sense.’
Gamble: Yeah, I’m sure that often is the key to things finally being pushed through is showing that business case.
Gamble: And before then, you spent some time doing consulting work?
Dees: Yes, immediately prior to St. Mary’s, I was with what then was SMS’s Outsourcing Division. Again, as luck would have it, I was really excited to be one of the first employees in that new business division in SMS that was called Outsourcing. I immediately became the site executive at a new health system in Western New York in Buffalo. Mercy Health Systems, Sisters of Charity and the Diocese Hospital formed a new Catholic Health-Western New York Health System. And Kenmore, formally Mercy, had made a long-term commitment with SMS to bring in Envision and use outsourcing for what I think was a 10-year agreement. So that was pretty exciting.
In the meantime the health system was forming Western Health of New York, the rest of them did not have the same long-term relationship with Outsourcing or SMS that Mercy did, so it was interesting how that unraveled; how in that merger, these three independent systems formed a new one. Executives changed — CEOs, directors, etc. — because the thinking was, ‘How many VPs of nursings do you need at a new health system? How many CFOs do you need?’ We went through all that.
Plus, from an IT point of view, we don’t even want an outsourcing deal here. We want to manage our own. The Sisters of Charity was the more dominant organization — it was much larger, so it was like the flagship. Mercy had two fairly good site hospitals, but Sisters had the biggest, and their CIO was the System CIO. They had one product from SMS and the Mercy Health Systems had a different product running on different platforms with different functionality, so it was just all fascinating how it all meshed out and became the new health system.
Gamble: And what was your primary role in all of that?
Dees: I was managing primarily the former Mercy Health Systems, and working with the IT council and the executives because the executives brought in McKinsey to help them sort things out too. Because they were doing all this while the budget amount was just killing New York hospitals, so whatever they had to do, they had to get immediate return and relief, because it was a very tough situation.
I was there doing everything I could to support creating the new vision, the new structure, the new organization, and helping to get the efficiencies we could get and the best practices we could get, and get clear on what they wanted from the former Mercy IT folks — how can we help you support the strategic vision of the new organization? I worked with the staff, and of course any time you get a situation with a merger or an acquisition, everybody has so much pride. It’s the ‘you’re killing my baby’ analogy with what they’ve done what they accomplished. It’s hard to let go and say that whatever those successes are that brought us here, we can use those skills and talents to take us somewhere else. Let’s just let go of it, let’s move on. So it’s working with the staff and helping them get on board.
Gamble: I can imagine a lot of valuable takeaways from that that I’m sure you were able to draw upon later in your career.
Dees: Oh, yes. Every opportunity has been unique and invaluable.
Gamble: Yeah, I’m sure. That’s probably one of the really interesting things about being in this industry.
Dees: Yes, it’s changing. And that’s the thing, too. Everybody says, ‘we’re different.’ And they are different. You’re all hospitals under the hood, but everybody’s got a different approach, a different mindset, a different vision, a different culture, and a different leadership style.
Gamble: I can imagine that having experience with SMS, that’s something that you really saw firsthand and had to go through the process of working with different personalities, different agendas, different egos, and trying to create one strategic vision.
Dees: Outsourcing is interesting to me, just the whole sense of outsourcing. In the three organizations I worked with — Denver Health and Hospitals, Tulsa Regional and Catholic Health System Western New York — they all had such difficulty stabilizing IT leadership that they needed some outside help. They needed somebody, a vendor, to help us. We had too many strategic initiatives hinging on IT, and we can’t get permanency in our leadership. And we can’t get done what we need done if we don’t have some consistency in our leadership. That’s what outsourcing brought. It brought some outside perspectives, it brought stability, it brought methodology, and it brought ownership and accountability. What I liked about it is you had 100 percent executive support because they finally said, ‘We need help and we’re willing to pay for it.’ So you still have that consultant glow, I guess, if you will, that people thought maybe you had something to offer when they’d hear it the first time, which I really liked that.
Gamble: You mentioned before that you started out as a nurse. How long did you do that?
Dees: I only did that for a couple of years. I worked in intensive care, and I liked the challenge. I liked being on your toes where you have to deal with the mental as well as physical challenge and emotional challenge, and, if you will, a little technical, because everybody’s rigged up to one or many monitors, and each alarm and tone and blip meant something to me. I get that, and I get alarm fatigue. It’s got to be meaningful data and it’s got to be actionable.
And I can talk the talk. Before outsourcing, I had a few years break where worked in a hospital, but early in my career, my first HIT job was an installer with SMS, and I felt like SMS at that time hired people that speak at least the healthcare language, and they would teach you the SMS language and the IT language. But you had to come speaking one of them, and I came speaking the clinical language. And I understand with probably much deeper appreciation as an IT professional than I did as a nurse, how interdependent the different groups are in healthcare — what are the handoffs, what do you need from me, what do I need from you? When I was a nurse, I just did what I did. It was between me and the patient, basically.
Gamble: That’s really interesting. Having had these different roles and different experiences, you really do develop a viewpoint that becomes, I would think, really helpful in getting to the CIO role.
Dees: I think so. Because I have empathy, I understand what you’re saying, but we have to move on, folks. With everybody, unquestionably, our prime objective is to support our community — our patients, their families. I love the concept of accountable care organizations and population health. I think in our current delivery system is somewhat inhumane in that we let people get so sick that they have to be hospitalized instead of paying closer attention to them, keeping them out of the hospital, keeping them with their family, keeping them at their job and just keeping them feeling better.
I think that’s what helps with change too is when you just refocus and you remind everyone on the team them this is why we’re doing this, this is why we all came to healthcare. And now we’ve got a lot more tools, a lot more opportunities to go to a whole new level than we could ever have imagined before.