The regulatory requirements that CIOs are grappling with are overwhelming enough—throw in a major leadership change, and it can feel like being caught in a whirlwind. It’s how Kim Ligon felt when DCH Health System had a new CFO take the helm just as Meaningful Use was coming down the pike. But rather than panic, Ligon, who serves as CIO for the West Alabama-based system, reached out to her colleagues for help. What she found is that there is no better source than CIOs for issues like dealing with steering committees, prioritizing projects, and balancing the budget. In this interview, Ligon also talks about having to interface with physician offices that use different EMR systems, her role in developing a statewide HIE, when a project needs to be delayed, and why she believes nurses bear the biggest brunt of CPOE.
- Meditech’s performance
- The CHIME Survey on HIT steering committees
- Getting docs involved in governance
- The nitty gritty of successful meetings
- As always, communication is key
- Keeping out the smartphones
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I have to believe that in these days, the people that are only meeting quarterly have to be doing an awful lot of leg work and having sub-meetings in between, because things are changing too fast and there’s too much on our plates.
The new CFO is very good about using the system-wide administrative meetings as an opportunity to start planting seeds for what needs to happen. And I think that means that she and I have to be on the same wavelength going forward, because what’s going to happen is that they’re going to have to hear stuff from more than one direction.
My personal experience has been that if you slot something for an hour and half and you can get it done in an hour, people are very appreciative of that and they enjoy the found time. So if you can do that, it’s better than slotting it for an hour when you really need an hour and 10 minutes.
I know everybody has situations where an emergency comes up and you simply can’t be there on time, or you have to leave, or something happens. But that should be the exception rather than the rule. If that’s the rule that you’re living under, then we have more serious problems.
I think people just have to think about what’s important and the kind of message that it sends that you’re either there paying attention, or you’re not. We’re in a place where we’re evaluating the information we received from the CHIME survey and we’re going through what does our culture look like and what do we need to do and who need to be the real people at the table.
Guerra: How has Meditech performed for you as a partner?
Ligon: Meditech has been very good. They assigned kind of a centralized go-to person for the project — for CPOE and Meaningful Use in general. So we have one person even outside of our HCIS coordinator whose job really is to prepare DCH to go to this next step. Our CEO has a very good working relationship and personal relationship with Howard Messing. They’re in regular communication with each other and I think that Meditech wants us to be successful and I think DCH wants to continue to use Meditech.
Guerra: All right. Let’s talk a little bit more about the survey you put out to get information on steering committees. The first question asked about who has a steering committee. Almost all of them — about 88 percent — had one. I would imagine the ones that didn’t were very small. Would that be your guess?
Ligon: They provided bed sizes and a lot of them were very small.
Guerra: Okay, so you have the bed size coordinated with the people who said no to that steering committee question.
Guerra: Oh good. I didn’t know if you had that. I do surveys too, and it’s a little painstaking on the backend sometimes to coordinate responses.
Ligon: And figure out who everybody is, right.
Guerra: So you have the context you’re trying to get with the subsequent answers to different questions.
Guerra: All right, so you were able to get some of that. So that was the first response. You had plenty of people who did have steering committees responding. The second question was, who are the members. Almost everybody has the C-Suite on board and then about 65 percent have IS management. Only about half have department directors. What was your takeaway from that response?
Ligon: Well, when I had talked to some of the people directly who responded to the survey, what I found was that some key department directors seem to be sitting on some of the committees, like the nursing director or pharmacy director — people at those levels. But a number of people, even if they don’t have regular directors sitting on the committee, they do have directors who are coming in for specific projects or specific educational topics for the steering committee.
Guerra: And as far as the physicians in the write-in answers about the members — a number of answers mentioned physicians, so those would be sort of physicians without another specific title, just to get some physician representatives. How did you decide how many and how did you pick the physicians you want on this committee, or have you even said to yourself, ‘I definitely want physicians on it?’
Ligon: Well, we have a separate physician advisory council that we do have physicians on, and have a representation pretty consistently of about 20 or 25 physicians. And I really am kind of relying on the steering committee level. We will have the CPOE project manager on the steering committee as well as the vice president of medical affairs, and I’m kind of relying on them to be the voice to represent the physicians because they will come out of that pack and be able to talk about the physician impact of things.
Guerra: Right. They’ll represent that view.
Ligon: Correct. So I’m really planning for that instead of having the physicians individually be named to that steering committee.
Guerra: Right. Question three was how frequently do they meet. Sixty-two percent meet monthly and then the second rung is split between every two months and then quarterly at about 17 percent for each of those, so certainly the majority meet monthly. I suppose it’s the kind of thing where, again, you want somewhere between not too much and not too little. You want to get it just right. You don’t want too much time to go by between the meetings so that they become fairly irrelevant in terms of informing decisions, but you also don’t want to meet so frequently that there’s really no updates and nothing to talk about because nothing’s happened.
Ligon: Well the C-Suites are just like physicians are in some respects. If you do not have a specific agenda that’s pretty robust, you lose their attention very quickly.
Guerra: Right. You don’t want them to say, ‘Why are we meeting again?’
Ligon: Right. And if there are no decisions for them to make or nothing for them to do, you’re much better off not having the meeting at all than to do that. I have to believe that in these days, the people that are only meeting quarterly have to be doing an awful lot of leg work and having sub-meetings in between, because things are changing too fast and there’s too much on our plates. I can’t imagine that you could meet once a quarter or less, unless it’s just a steering committee in name so that you could say you have one.
Guerra: Do you feel like monthly is the right way to go?
Ligon: I think monthly is the right way to go. We’ve been all over the map. Ten years ago we met quarterly, and then we went to what our VP of medical affairs at the time called virtual meetings. They just wanted us to send out a written update that fit into one page to tell us everything we need to know. And more recently now we’re back to the thinking that we all have to come together; we have to be face-to-face, and we have work to do when we’re there. This isn’t just about IS telling you what’s going on.
Guerra: Enjoying the sandwiches and the coffee.
Ligon: Correct. Yeah, over lunch.
Guerra: And the cookies. Don’t forget the obligatory platter of cookies, right?
Ligon: That’s exactly right.
Guerra: Okay. So you meet monthly, and it’s the kind of thing where you may not have too much to talk about this month, but when I was managing a staff and holding meetings, I was really reluctant to cancel a meeting because I just didn’t want it to become sort of optional in people’s minds — maybe we’ll have it, maybe we won’t. You want to get that regularity, that sort of iron-clad, on your calendar, you have to be here mentality. So what are your thoughts around that? With monthly meetings, you may not have too much to talk about at a particular meeting.
Ligon: I think right now because we’re so new to trying to regroup and refocus, there’s going to be quite a bit, at least over the next eight to twelve months anyway, that’s going to have to be used for education. It’s such a fine line when you go to those meetings because they have to be able to make decisions about things in the steering committee, but sometimes you have to take the time out to give them education because they don’t even know what they don’t know to make the decision. In some ways it’s almost a backhanded compliment. They would come and say, ‘Well, what do you think needs to happen?’ But in other ways, you really want them to know enough about what you’re asking them to decide so that they’re making a reasonably informed decision. Does that make sense?
Guerra: Absolutely. And I just thought that these meetings are a lot of work. Are you going to be cheering these or managing them?
Ligon: I’m cheering them. And they are a lot of work.
Guerra: They are a lot of work. You’ve got high-level people there, and if you want them to make decisions, you may have to provide them with education materials, beforehand, ask them to review the materials, tell them you’re going to briefly discuss this, and then ask for a vote or decision. But need them to brief themselves beforehand. It’s a lot of work. It’s a lot of work before, during, and after. These are no joke, these meetings.
Ligon: The new CFO is very good about using the system-wide administrative meetings as an opportunity to start planting seeds for what needs to happen. And I think that means that she and I have to be on the same wavelength going forward, because what’s going to happen is that they’re going to have to hear stuff from more than one direction so that when they get in there, it’s familiar. Some of the education has been almost staff education, but it’s not. So this is the first time I’ve heard about this project that sounds kind of familiar. And so at least I have a way to do that. The other people I think that we have to rely on to help do some of that education are the directors and people who want these other projects to happen, because they need to be making their case to their VPs so that they’re up to speed and that they can speak to what needs to happen.
Ligon: And I’m not sure we’ve always done a really good job of that. So I think that we don’t have the leisure anymore for people to not be so involved.
Guerra: That’s a good point, well said. There are a few things that are technical issues but they can really irritate people about these kinds of meetings. One would be duration. I didn’t see a specific question on duration. Do you have a gut feeling of how long these should be?
Ligon: Well, everybody hates to be in a very long meeting, but I think that you really have to plan for about an hour and a half. And I don’t know if you saw this, but on some of them when they sent the meeting agenda, they looked to me like a lot of them were hour-and-a-half long meetings. My personal experience has been that if you slot something for an hour and half and you can get it done in an hour, people are very appreciative of that and they enjoy the found time. So if you can do that, it’s better than slotting it for an hour when you really need an hour and 10 minutes, and you never get to last 10 minutes in. There are going to be occasions when it’s going to take that whole time, but I honestly don’t believe that people are good listeners after they’ve been listening to something for an hour.
Guerra: I think that’s a great point.
Ligon: My father-in-law was a lay preacher for years and he said, ‘The mind cannot absorb what the bottom cannot endure.’
Guerra: I like that. Even with the tray of cookies, right?
Ligon: I mean there’s only so much that people can do. And quite honestly, especially now, everybody is so wired to everything. If I could do anything in the meeting, I would have a signal buster that wouldn’t let any of the messages come through to their smartphones.
Guerra: I was going to ask you about that because if I was the CEO, I would have absolutely no problem putting in a policy that you cannot bring any devices into a meeting like this. I would absolutely put that policy in place.
Ligon: And I think honestly, it probably should be, but I don’t know that our administrators and CEOs would be ready to get on board with that, because they’re some of the worst offenders. But to me, it’s a new kind of rudeness in one way that you think it’s more important for you to do that, but I think it’s also a sign of the times that people are so torn. It is so hard to get their attention to really focus on something, especially when they have that electronic annoyance right that’s making a noise or something every time they get an e-mail. I come back to my desk and I’m getting 400 e-mails a day, but I don’t carry anything with me into the meeting.
Guerra: The fact is that if you are looking at your messages, you are not hearing what is being said, and therefore, you really shouldn’t even be in the meeting. You’re not absorbing, so why are you here?
Ligon: Yeah. If it’s that important to keep up and immediately respond to your e-mail, then you probably should not come to the meeting, because that would be a better use of everyone’s time.
Guerra: Absolutely. So that’s an issue and certainly, as you said, that’s got to be resolved on the highest of levels somehow. But as the meeting coordinator, certainly you can make the obligatory ‘please silent your ringers’ request, right?
Ligon: Correct. You can do that.
Guerra: And it doesn’t mean they won’t look at it, but I don’t know what you can do about that or what you’re willing to do about that. But it’s very interesting. Punctuality is another thing that can drive people nuts. You’ve got someone who always rolls in 15 or 20 minutes late, and everybody looks at each other and says, ‘Well, why do I have to be on time?’
Ligon: Right. Usually what happens is I try to start things not straight up on the money, but by five after. We need to go forward. But the thing about starting on time though is that there are some people who come in and then want you to stop and bring them up to speed about what happened, right? So the people who are on time are kind of being punished not for doing what they needed to do. I guess some organizations are better than others at having on-time starts, but when I first started working here, I was the applications implementation manager and we use to have an internal user group meeting. Some people were notoriously late for that meeting, and at about five after the hour, I would go ahead and start the meeting. And one day, there was a group of people sitting in the back of the room that, unbeknownst to me, had started a pool on how many people were going to come in after I’d already started the meeting. And when it got to the eighth person, somebody in the back said, ‘I won!’
Guerra: Oh my god.
Ligon: And the eighth person who came in actually went to my boss, the director of the department, and complained that I embarrassed them because when they came in late, somebody yelled that. And he wanted to know what I was going to do about it. And I said, ‘Tell her to come on time the next time.’
Guerra: That’s amazing.
Ligon: And he said, ‘No, you need to apologize to her.’ I said, ‘I’m not going to apologize to her. I was not late for the meeting. She was.’ And I wasn’t the person who was running the pool.
Guerra: Right. It wasn’t like you were running a fantasy football league.
Ligon: But the interesting thing is that woman was on time for all the rest of those meetings.
Guerra: It’s amazing what goes on people’s heads that they think they’re in the right.
Ligon: Yeah. So, it’s my story about being late, and I am a person who doesn’t ever like to be late for anything. If I’m going to be late, I’d rather not go.
Guerra: Yeah. And I’m not going to ask you to comment on all of these, but you also have attendance issues — not even just lateness, but attendance. And I think my point with these questions, and some people might think, why are you getting into these kind of weeds, but I don’t think they’re weeds. I think they’re extremely important, you know? I’m detail-oriented and I think these are the things that will, if some level of attention isn’t paid to them or policies aren’t put into place, they can make your regular meetings become a joke. If in each one of these areas—duration, attendance, punctuality, and checking Blackberries and iPhones—are suffering and not being done well, overall you’ve got a pretty bad meeting. You’ve got people not showing up, you’ve got some people coming in late, people looking at their Blackberries, and people who aren’t prepared. All of a sudden you’ve got a wreck of a meeting, right?
Ligon: And I think it speaks volumes to how important does somebody think something is. I know everybody has situations where an emergency comes up and you simply can’t be there on time, or you have to leave, or something happens. But that should be the exception rather than the rule. If that’s the rule that you’re living under, then we have more serious problems. If you’re always having to respond to an emergency before you can do whatever your normal work is, then that’s a different kind of an issue. And I think it’s just how important people think something is. You wouldn’t come cruising in late and play on your Blackberry in the board meeting, right?
Ligon: So I think people just have to think about what’s important and the kind of message that it sends that you’re either there paying attention, or you’re not. We’re in a place where we’re evaluating the information we received from the CHIME survey and we’re going through what does our culture look like and what do we need to do and who need to be the real people at the table. What I said in the last steering committee meeting, which was a couple of weeks ago, to the all of the assembled people, which included the CEO and the administrators, was, ‘Look around at this table. Tell me who’s not here and who needs to be involved in the prioritizations that we have to do and the things that need to happen. And if you’re looking around at this table and you’re wondering why you are here, then we probably need to talk about that, because if you don’t know why you’re here, then maybe you don’t need to be here.’
Ligon: And one of the administrators said to me, ‘Be careful what you offer.’ And I said, ‘Well, it’s either important and you feel like you have something to contribute, or if you don’t, then you don’t need to be here.’
Guerra: Or you don’t understand your job.
Ligon: You can’t really say that. But I said I’ll stick by my offer. If you don’t see a value to you being here, then we need to think about whether you should be here or not.
Ligon: Because it’s really more disruptive to have someone who doesn’t really want to be there than it is to have fewer people, but of course the rules are that if you’re not there and taking an active role and making the decisions, then you kind of lose your ticket to be able to complain about the result.
Guerra: Right. We’ll make these decisions for you and we’ll let you know what’s going to happen.
Ligon: That’s right. But you’re going to have to live with that because you elected to not participate.