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.
- The C-suite talent pool
- Finding support for weaknesses
- Balancing the governance process
- Defining culture — balancing regional differences
- Handling the docs — diffusing charged situations
- Balancing security and access
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I really think that the best relationship is if you’re reporting to the person that plays to your weaknesses who can help you with that and who can mentor you. Reporting to the CFO, for example, used to have a bad name, but as a CIO, if you don’t have a great relationship with the CFO, you’re not going to get anywhere.
It’s a balance and an art form—the slowing down that you do to include folks versus the need for speed. It’s a lot about the culture of that organization too, and our culture is very inclusive, so it would be a suicide mission to try to do certain things in the EMR without getting input of a lot of folks.
I think we put our physician colleagues in profoundly stressful situations. They’re still accountable for great care for their patient and they’ve been to 16 hours of class but suddenly, the whole way they practice medicine just changed overnight. And we are, in some cases, affecting their livelihood if they’re seeing fewer patients.
We had crazy workflows that were held together by a prayer and a band-aid, and they don’t translate well to EMRs, and you have doctors yelling about having to do with medication reconciliation, and they’re yelling at an IT person. I mean, really? That’s not an IT issue, that’s a practice of medicine issue.
His takeaways were that you end up spending so much time focusing on defensive measures and getting that right instead of being the visionary and the strategist, and boy, did that post speak to me. Because it does feel like we spend an inordinate amount of time trying to get that balance right.
Guerra: One of the things I’ve talked about before is that in a health system, you need a certain mix of talent at the C-suite level, and it really doesn’t matter how that talent is split up among the different titles. You’ve got the CFO, you’ve got the CMO, the CIO, the CTO, and you might have a CMIO, so you need a certain mix of talent in there. It’s all got to be within that circle, but like I said, it doesn’t have to be split up in any certain way. You’ve got a strong finance background, so you have a little CFO in you, but you don’t have the clinical background, so you need support there. I know CIOs who were MDs, so obviously they don’t need a strong CMIO, or they might not need one at all, but they certainly need a supportive CFO to help with their budgeting. What are thoughts? Does that make sense to you, that kind of concept?
Laishy: It absolutely it does. This is similar to a conversation I was just having with some colleagues. I’m on the advisory board for the Divergent, and one of the engagements they’re talking about where a CIO should report—and I know it’s sort of the go to answer—is the CEO. I really think that the best relationship is if you’re reporting to the person that plays to your weaknesses who can help you with that and who can mentor you. Reporting to the CFO, for example, used to have a bad name, but as a CIO, if you don’t have a great relationship with the CFO, you’re not going to get anywhere if you’re not on firm footing with that. And if that person can really mentor you and help you in dealing with the CEO, then maybe that’s exactly where you need to report. But I agree with you. You have to build relationships with those who have strengths that offset your weaknesses within that C-suite to be a successful team.
Guerra: There’s so much that the CIO needs. I mean they need everything. To be really effective, you need the clinical knowledge, operational knowledge, and financial knowledge, and that’s why to me, health care CIO is a very fascinating position. It takes a lot, right? It takes a lot of different talent sources.
Laishy: And it’s funny how you know more than you might think you do. A colleague of mine and I were laughing a few years ago. I don’t remember the exact nature of the call, but it was something about a patient safety issue we were concerned about, and she has our clinical support team who supports the application. We were on the call and I heard something in the conversation about a clinical workflow that concerned me, and I asked this really clinical question about workflows and the nurses and what they were going to do with this device. And it was funny, my colleague, who was the nurse, said, ‘What about the workstations?’ and we started laughing because they said, ‘Laishy just asked a clinical question and the nurse asked an IT question.’ Some sort of strange transformation had occurred, but I think that’s the great thing about working with electronic medical records. You do really get to know the business of health care in a way that you don’t if you kind of stay isolated in that C-suite.
Guerra: Do you have a close relationship with someone on the clinical side for you where you can pick up the phone and say, ‘Hey, can you explain this to me how this might work?’ Is it the CMO or maybe somebody else?
Laishy: Absolutely. We have two physicians who are on our implementation team. One tends to focus more on issues in the acute environment and the other on the ambulatory, and they are both fun, approachable, great guys. All the time I’m tackling them with, ‘This doc’s really upset with that, and I get this part, but what’s my blind spot here? What am I not understanding about this?’ Sometimes they say, ‘Well, you’re not understanding—he’s just a jerk and high maintenance.’ Or they say, ‘Oh yeah, this is huge. And this is how that affects his colleagues,’ or whatever. So yeah, I’m blessed. I do have those kind of go-to people I can lean on.
Guerra: How do you feel you’ve handled the governance issue around the concept of analysis, paralysis, or death by decision? Just too many people being involved, too many meetings, too many levels, too many approvals versus getting the input you need so that you have strong support. There’s a balance there, right?
Laishy: There is absolutely a balance there. I’ve definitely learned trial by fire on this implementation. My bias before was speed. Again, with my finance background, I’m thinking about our team spend rate and I just want to go. I want to get it implemented. I want to get the spend over with and get to the optimization. But I have definitely seen time and time again, from my own mistakes as well as the whole team’s, where at times where we have a bias for speed or action, and we’re less inclusive. That can really backfire and I totally agree with you. It’s a balance and an art form—the slowing down that you do to include folks versus the need for speed. I think I’ve just kind of gotten the hang of it. It’s a lot about the culture of that organization too, and our culture is very inclusive, so it would be a suicide mission to try to do certain things in the EMR without getting input of a lot of folks. I’ve learned the hard way not to do that.
Guerra: Right. You talked about the culture of the organization. For an organization that’s so geographically diverse, is it possible to say you have one culture or do you maybe have a few regional cultures?
Laishy: We absolutely don’t have one culture. What’s that saying—‘Culture eats strategy for lunch every day?’ Boy, I’ve seen that time and time again on this implementation. One of the challenges I think we have, as compared to a Sentara or Carillion or Inova, which are geographically consolidated, is that I would imagine those health systems have a more similar culture.
We implemented really successfully in Greenville and then we came to Richmond and a lot of the stuff that made us successful in Greenville, our Richmond colleagues would look at and say, ‘What are you doing? That’s definitely not going to fly here.’ And I’m not even talking about clinical things. I’m talking about who you’ve had ideas with, how much the CEO wants to be involved, and the power structure of the CNO and CMO—all of those types of things. And so our challenge with this implementation is that every market is just that market.
So when we went to Kentucky, there’s a completely different culture there. I’m from the Hampton Roads market and one of my hats I wear is also the CIO for that market, which has a completely different culture than Richmond. So I sure wish we had one culture that permeated throughout the whole health system, but we’re nowhere close. We share common values as a Catholic health care provider, and so there are some things that you know you’re going to see in every market that are wonderful to see.
Guerra: When we talked about dealing with physicians, you mentioned getting yelled at. I hear that all the time and it always make me laugh, because we’re talking about someone at the C-suite level, a CIO, and you guys are all getting yelled at by what I call high powered docs—independents docs that are bringing a heck of a lot of money into the health system. They know who they are, and they know the power they have in the organization, so I guess it’s just part of the game. You are at the C-suite and you’re still getting yelled at.
Laishy: I think we put our physician colleagues in profoundly stressful situations. They’re still accountable for great care for their patient and they’ve been to 16 hours of class but suddenly, the whole way they practice medicine just changed overnight. And we are, in some cases, affecting their livelihood if they’re seeing fewer patients. We’re certainly affecting their comfort level and you never like to be in a situation where people are so angry or frustrated that it’s literally yelling, but it happens, and I just always try to be little detached and put myself in their shoes and say that they’re yelling about the situation and not to personalize it, and that helps a bit.
Guerra: One of the things I’ve heard from some of your colleagues is that when there’s yelling going on, yell at me, don’t yell at my staff, or take it upstairs to me. I guess you don’t want to tell everyone to come yell at you, but I’ve written that that’s part of being a good manager. You take those hot issues.
Laishy: Absolutely, and you were asking me about working with CMOs and CMIOs and others. Dr. Butler is one of the CMIOs on this project, and he is fabulous in that often what happens during an EMR implementation is we have the saying that it shines a light on all of your darkest corners. We had crazy workflows that were held together by a prayer and a band-aid, and they don’t translate well to EMRs, and you have doctors yelling about having to do with medication reconciliation, and they’re yelling at an IT person. I mean, really? That’s not an IT issue, that’s a practice of medicine issue, and if you weren’t doing med reconciliation before, shame on you. It’s not the fault of ConnectCare or the IT guy that you have to do them now. That’s a medical issue and Dr. Butler recognizes those and he will literally step into fray and say, ‘This is not an IT issue. This is something you need to be talking to a medical person about. Yelling at this person will get you nowhere, so let’s take this offline. If you want to have a medical conversation, that’s what we’re going to have. By golly, you just signed up for it.’ I think sometimes you have to call them on what they’re yelling about. The IT guy didn’t do this to you, so let’s start over here.
Guerra: Do you know who on your staff can handle being yelled at and who you need to take to the side and sort of bolster after something like that?
Laishy: Well, let me back up and say that I don’t condone yelling at people. And so my hope would be that I’m not signing up anybody for ‘Okay, if you need to yell, go to Laishy or go to so-and-so.’ It does happen and you have to deal with it. You see, we’ve done seven hospital implementations now and it’s pretty intuitive. The ED nurse who’s been in all sorts of situations, when docs yell at her, it’s just another thing. That used to happen to me all the time. It’s still happening and they usually have a very graceful and funny way of throwing it right back at the docs so that it calms them down quickly. Others who maybe haven’t been in that environment and had to deal with that, you see them look a little bit like the deer in headlights and you step in, but hopefully that’s not the norm, and certainly in our culture, we wouldn’t expect to be. It’s actually a rarity and I feel like we’ve talked about it so much that it makes it sound like it happens all day, every day here, and it certainly does not.
Guerra: No, and I want to make that clear too that I’m not trying to imply that. But I do hear it from a lot of you colleagues too, and it just always struck me because of the dynamic in health care and the way the CIOs is running a service department, and people you’re serving are the physicians and sometimes they don’t like the way they’re being served with these systems.
Laishy: I’ll tell you, one of the issues that if you want to sign up for a fight, it’s usually between security and access. I feel like definitely half of the sources of anger are around getting that balance right with their docs, and when they’re trying to get in the system and see something that they or their staff perceive that they need to see and they can’t, strap in for that one.
Guerra: I just read an article, Dr. John Halamka, CIO of Beth Israel in Boston writes a blog and he just wrote this morning about the balance between security and access and he’s talking about doing some pretty dramatic pilots in terms of reducing the ability of people in the system to get on certain sites. He’s talking about even white-listing sites as opposed to black-listing sites meaning the organization will only allow a certain number of specific websites to be visited from within the network that are approved, because he’s saying that malware is just getting so bad out there. So we are getting into a world where it seems, from what he’s saying, you’re going to have greatly reduced access from within the network, because you just have to do it.
Laishy: Yeah, I really appreciated his blog. I think it’s very well-read by now, and I really appreciated the one where he was talking about have we gone too far with this. He said something like, if a guy uses a thumb drive, it’s the CIO’s problem. If an internal person does this, it’s the CIO’s problem. And his takeaways were that you end up spending so much time focusing on defensive measures and getting that right instead of being the visionary and the strategist, and boy, did that post speak to me. Because it does feel like we spend an inordinate amount of time trying to get that balance right.
I don’t know what the better way is because I absolutely understand from a patient’s perspective that they want to make sure their data is secure, and we’ve all seen cases where that doesn’t go as you would like to, so we still haven’t it quite right. But it sure feels like we’re spending a lot of time and energy on it that I wish we could spend on something else.