As a mother of six, Laishy Williams-Carlson knows a thing or two about multitasking and prioritizing — and she better, because of the 18 hospitals that are part of the $3 billion Bon Secours Health System, 14 are implementing Epic. And as Williams-Carlson has learned, dividing her time between the hospitals that are already live and those in the earlier stages is not easy, especially since the facilities are spread out across the Eastern seaboard. In this interview, Williams-Carlson talks about dealing with different cultures at different hospitals, maintaining the delicate balance between security and access needs, the benefits of having a financial background, and the importance of having go-to people on the clinical side. She also discusses the challenges in dealing with physicians who use different systems, and why conference calls can never replace face-to-face interactions.
- Creating order sets
- Managing the work/life balance while taking 14 hospitals live
- Managing teams at a geographically diverse organization
- “Nothing that replaces a handshake and face-to-face interaction”
- When silence doesn’t equal agreement
- The art of CIO leadership — “I would say 90 percent of my job is interpersonal skills”
- The benefits of a finance background
- Talking to the docs
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Sometimes when I would get really frustrated about it and frankly just exhausted, I would think, as a CIO, is there anything I would rather be doing than implementing an EMR? And then you realize it was your choice. No one did it to you. You signed up for it.
The only way that a lot of conference calls can be successful is if you first establish the relationship with the person. I think there’s nothing that replaces a handshake and face-to-face interaction.
We’ll have these big meetings and we’ll walk out and say, ‘That was quiet. That went well.’ And then we’ll look at each other and say, ‘No, there’s going to be a huge meeting after the meeting.’ And that’s where everybody is going to say what they really think about what we just said.
I would say 90 percent of my job is interpersonal skills—being able to walk into a room and handle a physician who might be yelling, or a CEO who’s concerned about the balance between security and access and feels like he’s losing business because of that. That’s where you make your mark and where you add value to your company, I think, as a CIO.
I thank my lucky stars every day for my business background. I think when I’m meeting with our CEO or our local hospital administrators, I absolutely get their concern for their bottom line and how the expenses and incremental costs for the system are blowing them out of the water.
Guerra: Standardized order sets are one of the most beneficial things in going electronic. With a geographically=diverse organization with many hospitals, have you created some sort of mega-super committee of physicians by specialty to create order sets? How did you handle that?
Carlson: Yes we did, and I think it was actually the first time our cardiologists had come together from across our entire system to meet and compare and agree on best practices for those order sets. So we came out of the gates doing that. I think the challenge is keeping up with all of that. And we’re using SharePoint and other tools to help us keep up with it, but that’s a challenge—especially when we’re still focused on seven more hospitals needing to go live and balancing that. There are a lot of days where you feel like, ‘Please don’t talk to me about perfecting what’s there. I’m still trying to get these seven out.’ But of course it’s important feedback that you have to attend to.
Guerra: Wow, I’m just thinking, your days must be long and intense.
Carlson: Yes and yes.
Guerra: What is it like for you—do you shut it off at some point, maybe 6 p.m., 7 p.m., or 8 p.m.? How are you managing from the point-of-view of just maintaining your sanity?
Carlson: You know, sometimes I think I’m not. I get feedback from colleagues that I need to check in to that whole work-life balance thing a little more. And to add insult to injury, I’m in a master’s program right now full-time getting MHA. And I love it, but I tell my husband that after May, when I graduate, I’m not sure I’m going to know how to relax on the weekend, because I just don’t do it. I think the great thing about working from home is that you can make it fit for your schedule, and the horrible thing is that it’s always there 24/7. If you can’t sleep at night, get up and work. So, it is very intense. And I have six kids and a wonderful husband, so there are lots of other things.
Guerra: Wait a minute.
Carlson: They’re all in school or graduated from school. I certainly couldn’t do this job with six kids at home. So I do have things that pull me away from work, like it or not, to keep me more grounded in reality. But you’re right, it’s very intense. And I don’t know if I have a good answer for how you on turn it off. Sometimes when I get really frustrated about it and frankly just exhausted, I would think, as a CIO, is there anything I would rather be doing than implementing an EMR? And then you realize it was your choice. No one did it to you. You signed up for it. So God punishes you by answering your prayers, right?
Guerra: Did you say you work from home?
Carlson: Some days I do. Certainly on Saturday and Sunday.
Guerra: That’s hysterical. That says so much about the mindset saying, ‘I work from home,’ but you’re just talking about the weekend.
Carlson: And also because we’re so geographically dispersed, we are the master of the conference call. If you had to get in a plane or in your car to go to the hospital you’re implementing every day, you would just be burning up travel time. So I’m talking to you today from an office in Richmond, which is two hours away from my home in Virginia Beach. And next week, I’ll be in Baltimore four days of the week. So it’s a good thing home is where the heart is, because I just work wherever I am.
Guerra: I would imagine you’re still doing quite a bit of travelling around to the different hospitals.
Carlson: Yes, absolutely.
Guerra: Are you leveraging any interesting technology? Are you using Skype? Do you do a lot of those kinds of things or is it just a conference call basically?
Carlson: We do video teleconferences (VTCs), not so much for formal sessions, for which we use Skype, but people informally are using it. Believe it or not, the VTCs have their place for the type of meeting you’re having and there’s times we found them to be really effective. But our whole team is used to travelling. Their office is in Richmond but tomorrow they’re going to be in Hampton Roads, for example, which is two hours away, to work on some workflows, and then the next day they’re going to be in Richmond. And they’re all scheduled all over the place, so even VTCs can be challenge. So our go-to is just good old conference calls.
Guerra: Do you feel like you’ve developed a good sense for which medium fits which interaction? Based on who you need to talk to and the seriousness of the issue, sometimes it’s a text message, sometimes a phone call, sometimes an e-mail, and sometimes you have to sit down with someone. Does that make sense?
Carlson: Absolutely. And I think the only way that a lot of conference calls can be successful is if you first establish the relationship with the person. I think there’s nothing that replaces a handshake and face-to-face interaction. When you’re talking to a CEO about the impact of implementation on his or her hospital and assuaging concerns about whether their docs are going to get upset that first week and vote with their feet and go to the competitor, how is that going to look? Nothing replaces doing it face-to-face. Once you’ve done that, you can use those other mediums as a supplement.
Guerra: I also have found that it depends on the people involved in the meeting too. For example, sometimes if you have multiple people on a conference call, it can be difficult to be heard for someone who’s trying to jump in. You know how it kind of only takes one line at a time? So you might not be able to get heard. And if you’re holding a meeting and you really need feedback from some people who may not be very demonstrative and outspoken and aggressive, they may just fade into the background. They may say, ‘Forget it. I’m not going to try and chime in because it’s not working.’ Sometimes it doesn’t work.
Carlson: Right. Well of course that can happen in face-to-face meetings as well if you have a big group and you have one person who wants to have the floor for a lot of time. And that’s where you need skillful facilitation in either medium to say, ‘Hey, there are some voices we haven’t heard from. What are you thinking doctor so-and-so?’
Guerra: Right, if you know doctor so-and-so is very quiet, right?
Carlson: Right, yes.
Guerra: One of the other things that I’ve heard recently from a few people is that you have to remember that when you leave a meeting, just because no one has expressed any concerns, it doesn’t mean they don’t have any. Sometimes you have to coax them out afterwards. Some people are just not comfortable with what they consider confrontation, even though it may be just raising a legitimate concern. Have you thought about that or experienced that?
Carlson: Oh yes, we call it the meeting after the meeting. I work with a wonderful colleague, Kathy Connerton, who is kind of the operational leader for our implementation, whereas I’m the CIO and attend to a lot of the technical things. We are both catching balls and running with them as fast as we can and not so much concerned about whose territory it is. We’ll have these big meetings, either in person or on a call, and we’ll walk out and say, ‘That was quiet. That went well.’ And then we’ll look at each other and say, ‘No, there’s going to be a huge meeting after the meeting.’ And that’s where everybody is going to say what they really think about what we just said.
Guerra: Right, and then you have to try and get that feedback if they’re not giving it to you directly.
Guerra: Have you had the pre-meeting too?
Carlson: You got to have your pre-game, right.
Guerra: You get together with the people you’re either co-presenting with or people that are going to help facilitate. So you have the pre-meeting, then you have the meeting, and then the post meeting?
Guerra: There’s your day. And your day is shot.
Guerra: These kinds of issues—interpersonal issues and managerial issues—are important. There are subtle things here that can make a big difference between the success and failure. How important are these issues to a CIO’s success, compared with the more technical, more IT-oriented types of issues?
Carlson: I think they’re paramount to a CIO’s success. I work in a big enough health system where we have a CTO. So happily, I can rely on that person for a lot of the technical issues where you really are doing a deep dive. I would say 90 percent of my job is interpersonal skills—being able to walk into a room and handle a physician who might be yelling, or a CEO who’s concerned about the balance between security and access and feels like he’s losing business because of that. That’s where you make your mark and where you add value to your company, I think, as a CIO.
Guerra: Now I did look at your LinkedIn profile but I’m not sure of your exact background. My question is, how comfortable are you dealing with physicians, and is that something you were always comfortable with? Most CIOs that come out of IT know the technology part but they often say that dealing with physicians is like dealing with someone who speaks a different language. What are your thoughts around that?
Carlson: Sure, that’s a great question. Well, my background is actually in finance. I was a controller at one of our hospitals—and this was quite a long time ago now—and I was very vocal about some issues where I felt like IT wasn’t hitting the mark. And so, oddly enough, they asked me to take on IT in addition to finance, and it just sort of grew from there. And I eventually when I was in a region and we grew to a size of three hospitals, I became the full-time CIO.
So I thank my lucky stars every day for my business background. I think when I’m meeting with our CEO or our local hospital administrators, I absolutely get their concern for their bottom line and how the expenses and incremental costs for the system are blowing them out of the water, and their concerns around revenue. And I think we do a really great job when we go live around monitoring the financial impact we have—all these indicators we’re looking at for about two to four weeks during the go-live period that if there are operational impacts we’re having because folks are stuck on ED and we’re not getting them upstairs because of some workflow thing or something, we’re coming around that quickly.
So that’s sort of my go-to place of my comfort zone. I’m definitely less comfortable talking to physicians, although I have become more so. And I think the art form, when you’re talking to them and it is a high pressure situation like a go-live, is just trying to separate the anxiety and the anger from the feedback that you need to hear about something that’s really not working. This isn’t just a guy coming off the rails because he used to be able to do it four times faster on paper and it’s day two and he’s frustrated. This is something profound that we need to hear because it’s going to cause an issue. So I think I do okay in that regard. I think you can’t shy away from talking to physicians and be a good CIO anymore.