Sometimes, a quick glace is all you need. And then other times, it only gives part of the story. That’s precisely the case with Citizens Memorial, which appears to be an 86-bed rural facility, but in reality is an integrated health network that includes 650 long-term beds and a growing base of clinics. It was also the first rural health system to achieve HIMSS Stage 7, and one of the first small systems to achieve MU Stage 2. So when Denni McColm says her organization has been “ahead of the curve in many areas,” she’s actually being modest. In this interview, she talks about what it takes to foster innovation (particularly on a small budget), the organization’s journey with Meditech (and why they aren’t rushing to implement 6.1), what it’s meant to have the same CEO throughout her long tenure, and why Citizens feels like home.
- Make It Better — asking “all the right questions”
- Most Wired Innovator
- “We’ve build able to build on that early innovation.”
- At CMH since 1988
- Director roles in HR and finance
- Choosing Meditech — “We started with a clean slate.”
- Learning while leading
- A CEO’s vision
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It’s something completely new where we say, ‘Okay, stop just a second. What are the alternatives to this? What are the risks of moving forward this way, and what are the risks of not moving forward this way?’ And so it’s a little bit more of a formal process just to make sure all the right questions are answered.
We added patient status like ‘ready for discharge’ or ‘pending admission’ or ‘assigned to a doctor’ — things that we take for granted because we can see them ourselves in the system, but for patients, it’s very confusing under a very stressful situation.
To move into the role and not be technical — because I rely on people with technical skills and expertise now — it was a big change. It did help knowing the organization from the human resources side and the finance side.
Instead of being in silos where lab has their own system and they can have whatever they want in there, everything has to flow. It used to be that lab built all the new lab tests; now if there’s a new lab test, it doesn’t just affect the lab, it affects long-term care, it affects the physician practices, it affects the hospital.
I would hear people say, ‘We need this hospital, but it’ll just be a glorified nursing home,’ and he really had another vision. I don’t think the community had the vision; I think he had that vision and he brought it.
Gamble: Is there a system in place or is it kind of an unspoken thing where if you have an idea or some thoughts on how to make this work better or get this type of functionality, you just come forward and we’ll talk about?
McColm: We have developed, over the years, a little bit more process around it. It’s based a lot around having a collaborative atmosphere and having a fairly flat organizational structure so that if you have an idea, you get the right group together, and we work together to get everybody involved. We do have a process though now we call MIB, or Make It Better. It’s something completely new we have where we say, ‘Okay, stop just a second. What are the alternatives to this? What are the risks of moving forward this way, and what are the risks of not moving forward this way?’ And so it’s a little bit more of a formal process just to make sure all the right questions are answered.
But mostly, I think it comes back to people being willing to work together to solve problems. Like the electronic whiteboard — that’s one of the things we get the Most Wired Innovator Award. We looked at lots of vendors and they were very expensive, and what we’ve done has really given us a lot of flexibility. For example, they’re asking to add the patient’s readmission risk score to the whiteboard so that everybody knows if this patient is a high risk for readmission and we need to pay some extra attention to their needs. Things like that we wouldn’t be able to do if we had an external vendor.
Gamble: Right. And the whiteboard was developed completely in house?
McColm: Yes. After we looked at the outside vendors, we were like, it’s our data, it’s in our data repository, and it’s basically a webpage. There was more trial and error for sure, and there has been more trial and error over the years — getting the colors right so that it wasn’t too glaring for the patient but they could see it, getting the font right, not getting too much on there because everybody wanted a little piece of it.
We’ve recently revamped the ones in the emergency department to include not just if you have a lab or a rad pending, but what lab and what rad is pending. It’s a huge satisfier for patients because they’re so confused about what mom is having done. Well, she’s having a CAT scan. And then also we added the patient status like ‘ready for discharge’ or ‘pending admission’ or ‘assigned to a doctor’ — things that we take for granted because we can see them ourselves in the system, but for patients, it’s very confusing under a very stressful situation. So those are some things we’ve been able to do kind of building on that early innovation.
Gamble: Definitely, it seems to be a trend with the organization and now you’ve been there for a while. When did you actually first arrive there?
McColm: I started in July of 1988. I can’t believe it’s been that long. I started right out of graduate school. I’m from Bolivar and I had actually done the books while I was in college and right after undergrad for the gift shop at the hospital. Their auxiliary needed somebody to help them with the bookkeeping part of the business, and I had done that before I went to grad school. And so I kind of knew the organization a little, and then came back and originally was the director of human resources. We had, I want to say, 400 employees. We had acquired one nursing home at that point, and now we have 1,900 employees. I did that for a couple years and then I moved to director of finance, where I was for about 12 or 13 years, and then in 2003, I moved into this role as we were just implementing Meditech and really making a big move with our technology in the organization.
Gamble: There hasn’t been a CIO previously, I’m guessing?
McColm: No, there was a director of IT. The organization had purchased an old IBM patient accounting package in the early 80s. It had been discontinued from support sometime in the early 80s and we’d had programmers that just sustained it, and we had a few other pieces of software, but they sustained that old system through Y2K. Totally crazy.
We knew, though, that it could never be HIPAA compliant when HIPAA became more of a requirement, so that was sort what made us think, ‘we’ve got to move.’ And it turned out to be an advantage that we hadn’t invested that much in systems over the years because we could kind of start with a clean slate and not have legacy systems to work with. We had a lab and a pharmacy system, but it wasn’t huge, so we could move to Meditech systems kind of all at once without regret.
Gamble: So, what was it like for you to go into that role? You were in finance, obviously you know the organization, but this is a different role, so what was that like?
McColm: It was very different. I had been part of the steering committee and have been part of the team over the years that have looked at should we do something different, and if we did what we do, and we just never had made a move. I’m very active with the steering committee, so I was really involved in the selection decision when we decided to go with Meditech. We had an RFP, the whole formal process, but to move into the role and not be technical — because I rely on people with technical skills and expertise now — it was a big change. It did help knowing the organization from the human resources side and the finance side. I did budgets, so I knew every department and I did external finance, so I kind of knew how to negotiate contracts and that sort of thing, but it was a big deal to make that kind of change.
Fortunately, I have been supported by great staff. I have some people who have been with the department since even before I came in, there are a few. So we really have a great team; everybody has some expertise and works together and we’ve grown. The department is a bit bigger than it was in 2003.
Gamble: And was it something where the department just gradually grew?
McColm: It’s the oddest thing. The organization really has supported a centralized approach for supporting the IT systems. Some people do decentralize and some are kind of in between, but they really supported to the extent that over the years, we’ve gradually added. But also, I think five of our positions came from somebody saying, ‘You know what? With this new system, I don’t need this clerical coordinator on the medical surgical floor anymore, but I’d really like for her to have a role in IS because she’s been so instrumental in helping us get the system up and going.’ People would give up positions so that we can build. It’s crazy; it never happened when I was doing budget, so I don’t know.
And then some of it has just been growth and complexity, because like most organizations, we are software junkies now — software will solve all of our problems, and so we have a lot more software systems now and with that complexity comes the need for more people to manage it.
Gamble: So, I can imagine it’s been really interesting to be with this organization for as long as you have, in those different roles, to just be part of its growth. I’m sure that being in your current role as long as you have that your own leadership style has probably changed just as the organization and its priorities have evolved?
McColm: Oh yes. For the first few years, it was really a lot of hands-on communication, making sure everybody was talking. An integrated approach means everybody has to talk about what everything’s called. Instead of being in silos where lab has their own little system and they can have whatever they want in there, everything has to flow. It used to be that lab built all the new lab tests; now if there’s a new lab test, it doesn’t just affect the lab, it affects long-term care, it affects the physician practices, it affects the hospital. It all flows through the same system, so we in IS actually build all the new lab tests.
So initially, it was getting people communicating and talking about workflows and processes and hands-on figuring out how to make systems work together, and I don’t have time for that now. There’s so much complexity and so many systems — we’re just so much bigger, and so that’s been a big transition. I think it would be for anybody, but again, fortunately I’ve been able to have a great team to world with. We have a really good senior leader team as well and everybody’s supportive. All of us are going through about the same thing because of the growth, and so it’s just adapting to that. Every once in a while, I’m like, ‘I can’t go down that hole because I have too many other fish to fry. I want to sit on this project and solve this problem,’ but I have to trust that to someone else.
Gamble: And as far as having the same CEO, I guess it’s one of those things where you don’t really know anything else. But I’m sure that that’s been a positive thing to have, because it’s definitely unique.
McColm: Oh my gosh, yes. It is unique and Bolivar is so fortunate — this whole region is so fortunate that he just happened here. He came here under a contracted arrangement in 1981 and helped complete the construction and opened the hospital. I was getting out of high school in 1981 and I would hear people say, ‘We need this hospital, but it’ll just be a glorified nursing home,’ and he really had another vision. I don’t think the community had the vision; I think he had that vision and he brought it and he infected the board with that vision and he just kept after it. And we’ve really ended up with something special for the community.
I’m from here; I’m from Bolivar, so it’s really gratifying for me to be part of a healthcare system that serves my family, from my nieces and nephews being born here to broken bones. My father’s in one of our long-term care facilities now, so I’ve really experienced the whole gamut.
Our mission is caring for every generation through exceptional services by leading physicians and a compassionate healthcare team. And they called on me the other day in the meeting to say, what does that mean to you? And I said, ‘You know what that means to me? It means caring for my husband and my sister-in-law, my mom and my grandpa through exceptional primary care, surgical services, ER care, cancer care by Dr. Smith, Dr. Harris, Dr. Nicks and more, and a compassionate healthcare team of people that I know and trust.’ I think for a lot of us here in the area, it’s very personal, and so we’re grateful to be able to be a part of the team.
Gamble: The organization’s is definitely doing a lot of great work, and it’s been really interesting to hear your perspective. And I think that a lot of our readers and listeners are going to appreciate hearing your take on things and how you guys have been able to find success.
Gamble: All right, well, thank you so much. I appreciate it and I definitely would like to check back with you in a little while to see how things are going.
McColm: That’d be great, Kate. Good to talk to you.
Gamble: Good talking to you too, and I’ll be in touch.