Liz Johnson believes that one of the most important qualities of a leader is being able to “tell your story.” What does that mean, exactly? Bypassing “geek speak” and using real-life examples to demonstrate why a change needs to be made — it’s a skill she has honed over the past several decades, both as an advocate and an informaticist. Recently, we spoke with the newly-elected CHIME Board Chair about how the CIO role has evolved in recent years, the benefits of creating a virtual workforce, how she works to keep her team motivated, and her biggest goals for 2017. Johnson also talks about the need to stay positive, why HITECH was “nothing short of miraculous,” and what she believes is the ultimate reward for hard work.
- About Tenet Healthcare
- Virtual workforce — “We have a diverse set of needs.”
- Email guidelines
- Maintaining productivity: “We don’t have to be synchronous all the time.”
- Staff motivation — “We touch millions of lives every year.”
- Goal to “keep the fires burning.”
- 17-year research cycle
The best way for me to continue to ensure the quality of our people is to allow them to live and work in the areas where they already were doing it. That way, they can engage with the organizations where we have ownership or part ownership, and make sure we’re out there working with the people that are using our applications.
We’re working on strategies based on a vision of providing quality patient care in safe environments, where we support our employees, our doctors, and our patients. It really is about focusing on their needs; it’s really not about our needs. It’s also about making sure we have the mechanisms in place to translate.
I have to keep the fires burning. Keep the systems up, make sure availability is real, make sure we’re listening to whatever enhancements need to be made, and make sure we’re paying attention to the basics of everyday work. Because if you lose that and you haven’t taken care of the foundation, I don’t think we’ve won the battle.
It still takes 17 years from research to where it becomes common practice, and that really bothers me. It bothers a lot of people. We need to get much closer to being about to make current changes and interventions based on near-time evidence.
Gamble: Hi Liz, thank you so much for taking the time to speak with healthsystemCIO.com. I’m sure everybody is familiar with Tenet, a 79-hospital system that stretches across multiple states. What about the IT team — where are you located?
Johnson: The applied clinical informatics group, and the group that manages acute care and hospital information technology, is based in Dallas. But we actually have a very large virtual workforce; my goal is to not have people occupy space in Dallas, but instead to be out there working with our end users — our clinicians, our patients, and our doctors — to make sure we’re meeting their needs.
Gamble: In terms of your role, what are your primary responsibilities?
Johnson: I’m responsible for the application support and strategic vision across all the acute care hospitals, which is a large part of our portfolio. I have responsibility for clinical and revenue management applications, as well as the processes and policies that go along with that in the IT world. I also sit over applied clinical informatics, which is the ability to take the data we’re collecting and begin to merge it so that we can find a way to look at the world differently and determine potential outcomes. I also have responsibility for supply management, productivity systems, all of the clinical systems, and all of our Meaningful Use and e-Measure reporting, as well as the regulatory components.
Gamble: What was the impetus for the decision to have a virtual workforce?
Johnson: We have such a diverse set of needs. And so about four or five years ago, we looked at the population of people that were available that had the skill sets and knowledge to deal with that wide range of responsibility. In doing that, it became apparent that we needed to broaden our reach. We have great people in Dallas, but there are many more great people all across the United States, and so the best way for me to continue to ensure the quality of our people — which is phenomenal, in my opinion — is to allow them to live and work in the areas where they already were doing it. That way, they can engage with the organizations where we have ownership or part ownership, and make sure we’re out there working with the people that are using our applications. I would say that only about 25 percent of the people that work for me actually reside here in Dallas.
Gamble: It makes a lot of sense. There are so many ways now to communicate without being in the same physical location.
Johnson: It’s funny; we wrote guidelines for virtual work when we started, because we knew it was going to be a big change. We really had to think, as a group, about how do we communicate on telephones calls? Where do we bring in video conferencing? Think about how many things get left out if you assume someone can read between the lines. We needed to establish some simple rules; for example, if there’s an email trail that goes around five or six times, and it starts to go off-topic, pick up the telephone and call the person.
And it’s been great. Our employees do a really good job of stopping and saying, ‘okay, I’ve been explaining a concept or new approach for a few minutes. I’m going to stop and allow silence so someone can jump in and add their ideas.’ And then they’ll do the same. It’s not perfect; some days it’s great and some days it’s not so great, but for the most part, it works. And the best part is that people get to stay where they’ve lived most of their life.
Gamble: You said there were guidelines in the beginning; I’m sure there was room for some flexibility there based on how things went?
Johnson: There was. This was a new adventure for us, and I wasn’t sure how it would affect productivity. Usually if you travel a great deal, you have a home routine and a work routine. I didn’t know how hard it would be to make the adjustment; but I will tell you that probably 98 percent of our people are as productive or more productive, because we don’t have to be synchronous all the time. You can be asynchronous in a lot of the work that you do. You can also be on the time zone where your clients are, and that just makes sense.
When I think about what my role is, it really is about managing all of that. I have a tremendous management team working for me that really does make all of it happen. It’s by no means a one-person show; it’s a collaborative effort of many great people with a lot of energy trying to make things happen. We’re working on strategies based on a vision of providing quality patient care in safe environments, where we support our employees, our doctors, and our patients. It really is about focusing on their needs; it’s really not about our needs. It’s also about making sure we have the mechanisms in place to translate, whether it’s a process that the clinician needs to do their work, a requirement of getting information to a patient that they can understand, or translating a regulation or a policy — either internal or external to the organization — into a workable format. It’s very challenging, but I think it keeps us focused.
Gamble: How do you work to keep your team focused on the overall goal of improving patient care? Is it difficult to do that when they don’t always see the patients?
Johnson: It’s so important to us. I started my work almost 40 years ago as a nurse at the bedside, and that foundational desire to improve the care and outcomes for patients lends to my work today. Any time I speak, even in my all-hands meetings, one of the first things I do is remind them how important what we do is. We touch millions of lives every year, and you don’t have to be at the bedside to make a difference. Those people are critical to our care, no question; but I have lots of clinicians that work for me. When they can see results and know that what we’re doing is really changing outcomes, you can find enormous satisfaction, energy, and motivation in that knowledge.
Gamble: What are some of your key priorities in the next year or so?
Johnson: We have the opportunity to move from large-scale clinical application implementations, which is what we’ve done in the past few years, and use the power of computing to improve outcomes, and do it in an orchestrated and meaningful way. When I think about what I have to do in 2017, I think, first and foremost, I have to keep the fires burning. Keep the systems up, make sure availability is real, make sure we’re listening to whatever enhancements need to be made, and make sure we’re paying attention to the basics of everyday work. Because if you lose that and you’re off into innovation land — which is critical — and you haven’t taken care of the foundation, I don’t think we’ve won the battle.
Beyond that, the biggest thing we’re focusing on is interoperability. We need interoperable markets. When I say that, I’m talking about reaching beyond the four walls in which care is provided, whether that’s a hospital, a physician’s office, an ambulatory clinic, or a freestanding radiology center, and thinking about how to move information around so it’s available to patients and clinicians for better care. It’s a big task to tackle, and we’re taking it on in small bites so that we can be effective. We’re taking on interoperability one market at a time.
We’re also expanding our data science efforts. I absolutely believe in the power of data, and we need clinicians to interpret it and help us ensure that the evidence is being integrated into our systems appropriately. We need our data sciences to help us look at the data and answer all types of questions and help us formulate answers, which is a very unique set of attributes and a unique skill. We’re expanding that effort so we can apply the data. We don’t just want to collect a lot of data; we really want to be able to apply it.
We’re living in a world of economic stress on healthcare organizations. I think with our change in administration, we’re all trying to guess what might happen. We don’t really know. But we have to be in front of any changes that are made, and use them to the advantage of our patients and clinicians. Right now I don’t think we’re even at 10,000 feet; we’re at 20,000 feet trying to guess.
Another thing I feel strongly about is it still takes 17 years from research to where it becomes common practice, and that really bothers me. It bothers a lot of people. We need to get much closer to being about to make current changes and interventions based on near-time evidence. We’ve become very comfortable letting things run that very long time cycle, and if you think about how fast technology is changing, how much data we have now, and how much that is really a possibility, we need change to happen closer to real-time.
If I can figure out that by giving you one more milligram of something or one less, or doing one more test or not doing it, I’m going to really positively impact the outcome in terms of improvements in long-term viability. And I’ve also reduced the cost because we’ve done smarter, faster, and better. That’s the right way to go, but it’s hard. Really hard.