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.
- Managing meeting politics
- Becoming a strategic CIO
- Supporting physicians — “They don’t leave messages”
- Setting (and re-setting priorities)
- Taking the best of a survey — and leaving the rest
- Expanding one’s comfort zone
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In my situation, I am a CIO, but at a director level. So I’m not on the same playing field really. And that’s been part of my challenge over the last 13 years — I haven’t been at the same table, yet I have to be able to get consensus and direction and information from that table.
That’s what I’ve been tasked to do over the next couple of months — to get that structure in place at the steering committee level and then get the structure in place for how we’re receiving requests so that we have a clear way to be able to present projects for prioritization.
I found it kind of encouraging that there’s some common themes of what people are doing across the board and what they’re looking at. I don’t know how you actually say, ‘Yeah, that’s a best practice.’ I think I’m more qualified to be able to say, ‘that’s a practice that would work in our culture.’
We’ve been very successful to this point in having a plan and rolling it out with maybe not as much guidance as other people may have had. But I don’t think that we can continue to be successful following that model. So it’s really imperative that we have everybody on the same page.
What I’m struggling with right now is trying to figure out who I need at that middle manager level to be able to really step back and do less of that management-type stuff and more of the strategic thinking and the planning for what needs to happen next.
Guerra: I was thinking also when I was preparing for our interview today that everyone loves to complain about having to go to a meeting, but see what happens if you don’t include someone who thinks they should be invited.
Ligon: Oh yes.
Guerra: And when you do they’ll still complain about having to go, but if you don’t, they’ll make the biggest uproar about how they were left out.
Ligon: Sometimes the best thing to do though is to say to people, ‘You’re not required. If you want to come it’s fine, but your presence isn’t required.’ And a lot of times they’re like, ‘Well, maybe I better be there. If they don’t think there’s a reason for me to be there, then maybe I better be there.’
Guerra: I like that approach. They could say, ‘Well, maybe I should go and see what’s going on.’
Ligon: And figure out what they’re going to do without me, yeah.
Ligon: So it’s kind of interesting.
Guerra: It is fascinating. The politics, the interpersonal dynamics — that’s really leadership at its core.
Ligon: And in my situation, I am a CIO, but at a director level. So I’m not on the same playing field really. And so that’s been part of my challenge over the last 13 years — I haven’t been at the same table, yet I have to be able to get consensus and direction and information from that table. And so that’s been part of the other metric that’s been kind of lurking in the background — that I’m not up here. So I can’t really say, ‘turn that stuff off and pay attention.’ So, it makes a difference from that standpoint.
Guerra: Right. So in terms of the level of detail they get involved with, pretty much all of the answers were in the 60s and 80s, and one on the bottom with 20% IT operational issues, so I guess people are not getting down into the weeds. Is that the point of that?
Ligon: That’s what it seems like to me. A lot of the agendas too are higher about budget reviews and just very brief updates on where major projects are, but not really talking about the day-to-day operational things. And when you think about it, the way we’ve done things in the past, they’re not comfortable with making some of those operational decisions anyway because, again, it’s back to the education, and they don’t really know what they are deciding about that. And I feel like some of the operational issues are really mine to have to deal with. That’s what I get paid to do.
Ligon: And so what I need to be able to take to them is if we have staffing issues or infrastructure issues that are going to involve more FTEs, a large expenditure of capital funds that we didn’t anticipate, or something like that, then I think it does need to go to that level. But I think right now, we’re approaching a place where I think a lot of that will be handled outside of that committee as far as FTEs and things like that; it will be handled between me with the CFO going to the administrators. And I as far as the capital expenditures, we’ve been pretty spot on with on our budgets for what we’re going to need.
So I think we should be okay from that standpoint. But I think that they don’t really want to care about some of those other things. We talk about some operational things that are related to supporting physicians; for example, I recently changed the staffing to have more coverage from 4 p.m. to 8 p.m. when physicians are rounding in the evenings so that there’s always a person to answer the phone. Because they won’t leave messages, and then they’ll complain that they can’t get any help from IS. That I did bring up because to me that’s something they’re going to be hearing back from doctors about when they don’t get a response. So I think they needed to know about that operational change, but it wasn’t really to ask for permission; it was to just educate them on what we’ve done.
Guerra: Right. So in terms of overall takeaways from the survey, are you pretty much constructing a new steering committee plan from scratch, taking this and then you’re going to construct something, or are you going to be tweaking something that was in place based on some of these results?
Ligon: Basically we kind of had a steering committee before, but from the standpoint of how we’re approaching it now, it’s like we’re starting from scratch. The CHIME survey didn’t have huge surprises in it. I thought that there were probably people who were doing business like that. And so that was not a surprise to me, but it kind of is justification for putting some formality and some things around what we need to be able to do going forward. So I think that we are saying that we’re turning the page and starting over.
One of my personal goals for this fiscal year is to restructure the steering committee and to restructure how service requests flow to IS so it’s not just people sending you an e-mail or doing something like that, but having a more formal process for requesting a service and then being able to determine, is this something that I would put in the business as usual category — what we have to do to keep running what we have running, for example, tweaking nursing assessment or doing something like that — or is this more major in nature and it needs to go to the steering committee to be prioritized. That’s what I’ve been tasked to do over the next couple of months — to get that structure in place at the steering committee level and then get the structure in place for how we’re receiving requests so that we have a clear way to be able to present projects for prioritization.
Ligon: I think one of the biggest struggles that we’re going to have is that a lot of the C-suite thinks that you can prioritize staff and now you’re done with that. And you know, as fluid as everything is these days, just because you set your priorities this month, it doesn’t mean that something is not going to change next month that’s going to change your priorities.
Ligon: And it could be that it’s a change in priorities in a positive way. The delay until 2014 for the phase two stuff is really a change that you have to take into account for your prioritization. Because you may have thought, I need to get pass phase one or one-plus when we get ready to attest so that we’re ready for the next phase. You have a little more wiggle room there so you may decide to put something else in front of some of those phase two things. So I think that’s going to be the challenge — to not only set the priorities, but then to recognize when it’s necessary to come back and reset them.
Guerra: In terms of evaluating a survey, it’s probably not a best practice just to take the majority answers and say, okay these are the best practices, because the majority isn’t always doing the best practice—it could certainly be and probably is one of the minority responses, but how do you know which one. So my point is that I don’t think you can just take the majority of what everybody is doing and go with that. How do you evaluate it? How do you take away the winners and leave behind what even may be majority answers but could have been former best practices that just haven’t made it to the mainstream yet.
Ligon: Basically, I’ve been going through the answers, and in the places where people were willing to share their contact information to say ‘if you have additional questions, you know, here’s my email’ or the things like that, I’ve been trying to figure out more information by talking to those folks directly and trying to understand how the answers came across. I felt like that was a good response rate, and so I found it kind of encouraging that there’s some common themes of what people are doing across the board and what they’re looking at. I don’t know how you actually say, ‘Yeah, that’s a best practice.’ I think I’m more qualified to be able to say, ‘that’s a practice that would work in our culture.’ And so, sometimes we’re not ready for best practice. We’re ready for different practice, but we’re not really ready for best practice yet because we have to have the time to culturally mature on a particular topic to get to that place. Does that make sense?
Guerra: Yeah. And sometimes you may see a majority answer and say, ‘Well, I just don’t like that.’
Ligon: Right. It doesn’t fit how we do business.
Guerra: Yeah. Or it doesn’t fit my gut feeling of what will work or what is right. It could be based on the context of where you work it or could just be your personal preferences of how to do things. You might just not like doing it that way.
Ligon: There’s still always the component that if we’re able to assess all of the stuff and just say, ‘there’s this automated way you can do all the stuff,’ then they don’t need us, right?
Ligon: They could put a new model of a computer sitting at my desk and it can just decide whatever it needs to decide. I think that we have to kind of take some baby steps. Going through the process to even evaluate how our committee operates, to me, was a major step.
Guerra: Right, major growth.
Ligon: Yes. Because that’s saying that we recognize that life as it has been isn’t necessary as it should be or is what is going to make us successful. I think that’s the piece. I think we’ve been very successful to this point in having a plan and rolling it out with maybe not as much guidance as other people may have had. But I don’t think that we can continue to be successful following that model. So it’s really imperative that we have everybody on the same page and that we’re getting in on the planning process earlier. I think that’s what this is going to help bring to the table.
Guerra: How long have you been at DCH?
Ligon: I’ve been here 15 years.
Guerra: Very interesting. You’ve been there 15 years, you’re going through major changes, and it sounds like you’re dealing with them pretty well, but it definitely seems like you’re out of your comfort zone and you’re working through it. Is that accurate? How would you describe what you’ve gone through since the new boss?
Ligon: Yeah, I think that’s accurate. I think that in part, and she and I had this discussion, in the past, I’ve been a CIO who operated at a director level who was not as involved from the standpoint of not wanting me to really act like the CIO. Does that make any sense?
Ligon: Now I’m working for someone who believes that I am the CIO and I should act like that. And so I should take on those additional challenges like restructuring the steering committee and really beefing up our customer service principles and making sure that we are an integral part of what has to happen going forward. It’s a little stressful and it certainly is a lot of change in a short period of time, but I think that we’ll be fine. I’ve been blessed with having a crew of people where we are not overstaffed by any stretch but I have a lot of really hardworking people. The average tenure in my department is 14.3 years. You just don’t have IT departments where you have that kind of longevity. So I have a lot of folks to know how to do what they have to do. And I think that will help us get to the next place that we have to get to.
We’re starting to plan ahead for what we have to do to meet Meaningful Use and what are the things we have to do to be ready to go to 6.0. That’s the next thing on our horizon and that’s a fairly significant change. We have the data repository and now we need to beef it up about what are we actually sending to it. We have a separate scanning and archiving system, and we really need to move over to Meditech for 6.0 to flow as well as it needs to flow. There are some other dominos that have to be lined up for all of that. What I’m struggling with right now is trying to figure out who I need at that middle manager level to be able to really step back and do less of that management-type stuff and more of the strategic thinking and the planning for what needs to happen next, because clearly that’s the expectation that I’m operating under.
Guerra: Right. You can’t do all the new things that you’re being asked to do and still do all of the old things you’ve done. You need someone to do those for you now.
Ligon: Correct. And I have a really strong assistant director, but operationally, the number of projects we have going, on it’s been kind of divide and conquer figuring out how we can get these things done. We really need to beef up some of our other areas — ambulatory areas for example, because those people still need to have assistance even though they’re not directly related to Meaningful Use at this point. The clinics we have, the cancer center, the spine care center — they still have to have IT support even though they’re not going for Meaningful Use right now. And they are the growth area. They’re the places we need to support because the return on our investment is so much greater. So I need to have somebody who’s whole job is to make that division happy.
Guerra: And the dollars on that end could be a whole lot bigger than any Meaningful Use money, so we can’t just prioritize based on Meaningful Use.
Ligon: Absolutely. But that’s an example of where you can say, ‘Yes, we can help you and we can get to the next level, but it’s going to take me a good resource to manage that ambulatory technology.’
Guerra: So do you know of the willingness of the organization to invest in the human resources within your department?
Ligon: They are absolutely prepared to do that.
Guerra: That’s a key. You can sleep at night knowing that.
Ligon: Yes, and right now, it’s going through and figuring out what I’m talking about. What level people I’m talking about and how many people I’m talking about. With the example of the ambulatory manager, we’ve already started that discussion. We’ve already started looking and so I think that administration is prepared for that because they’re recognizing that we have to be able to support the area where our biggest growth is going to be. But that’s an example that there’s not just a real easy way to say, ‘okay, if it’s Meaningful Use, it’s in, and if it’s not, it’s out.’ You have to be able to prioritize things at a little different level.
Guerra: Absolutely, I can’t wait the government to take over your whole strategic plan. I’ve written that before.
Ligon: That’s exactly correct. But I think it was Oscar Wilde who said, ‘May you live in interesting times.’ I think we’ve got that nailed.
Guerra: Yeah, that’s not the problem.
Ligon: Absolutely. I’ve been doing IT stuff for 39 years in healthcare. I started when I was very young, and I tell people when they come in to interview that if they haven’t worked in an IT environment before — if they’re coming from a clinical area or something else, I say that I’ve never worried about being bored or about having to change jobs frequently or to do things like that because my job has constantly changed around me. It makes it interesting and you learn something new every day. I mean, who wouldn’t like a job like that? It’s just sometimes you need a little step back to take a couple of deep breaths so that you can settle down and keep going forward.
Guerra: Absolutely. Well Kim, I don’t like to keep people more than an hour and I’ve kept you an hour and 10 minutes. I had a great time, and I hope you did.
Ligon: I did. And I really do appreciate being invited to talk to you. I really enjoy reading your site and I always like it when I see somebody I know pop up as one of the people that you’ve interviewed.
Guerra: Great. Well I want to thank you so much for your time today, and I’ll be in touch. Mayb we could do something together again.
Ligon: Okay. Thank you, Anthony. Have a great day.
Guerra: Have a great day, Kim.