Sheri Rawlings, CIO, San Juan Regional Medical Center, Chapter 3

When Sheri Rawlings started as CIO at San Juan Regional more than 4 years ago, the EHR picture in the physician community was dire. Users were giving up and going back to paper, and action needed to be taken. Quickly. But as a longtime veteran of healthcare, Rawlings knew that the situation wasn’t going to right itself unless the clinicians participated in and owned the selection of a new solution. And so IT stood on the sideline and offered support instead of running the show, and it paid off. In this interview, Rawlings provides her honest take on Meaningful Use — and why it’s much more challenging for community hospitals, and the strategy she employs when introducing change. She also talks about business continuity planning versus disaster prevention, why culture plays such a huge role in engagement, and when she got bit by the health IT bug.

Chapter 1

Chapter 2

Chapter 3

• Her leadership style — “I participate more as an analyst than as a CIO.”
• Open-door policy
• Departmental conflicts
• 30-plus years in healthcare
• An education in “how hospitals should work and don’t work.”
• Getting bit by the health IT bug
• Career lessons — “I have never wasted anything.”

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Bold Statements

I’m very clear upfront what the expectations are. I don’t tell them how to get there. I’ll tell them what to avoid if I have to — what can they not do, but then I pretty much leave it up to them.

I get things done. That’s my biggest strength, and that means I have to be able give directions clearly, succinctly, and filter out all the noise.

Our customers are smart enough to know what’s right, and if you give them all the options and explain how all these things work, they’re going to come up with the right answer because they’re pretty smart people.

You’ve got to know so much. You need to understand workflow design. You need to understand your customers. You need to understand how your system plays with everything else, plus all the technology. To me, it’s one of the most fascinating things I’ve ever, ever done.

Gamble:  I want to switch gears a little bit and talk about your leadership style. I always go to LinkedIn pages and look around, and I saw that you had a recommendation which was very positive. It said you had a direction that is specific and clearly defined and feedback that is candid and pertinent. I want to talk about that. Is that a fair reflection of your leadership style?

Rawlings:  Yes, I would say so. I really try very hard not to micromanage, but I also feel like what we do is so ambiguous most of the time. Maybe it’s because I’ve been doing it so long and I’ve been bitten so many times, but I’m very clear upfront what the expectations are. I don’t tell them how to get there. I’ll tell them what to avoid if I have to — what can they not do, but then I pretty much leave it up to them. I’m engaged way more than I should be, but it’s not because I want to be. It’s because I have a lot more technical knowledge than a lot of the folks on my team. I’ve been a lot more places and seen a lot more things, and so I tend to stay engaged and participate more as an analyst at times than as a CIO.

That’s one of the benefits of working in a hospital this size. I’ve only got a 30-member team. Before that, at the hospital in Kansas, I only had 10 members. At that level, you know what’s going on all over the organization. You have to know all of it — the security, the networking. Now, I’m not an expert. I can’t sit down and do it, but I certainly know enough about it to be able to coordinate the whole thing.

From my perspective, because of the size of the team, I’m less a CIO with my team and more of a team member. That gives me the opportunity to keep them focused. Like Meaningful Use, while we’re juggling the clinics, we’re juggling the hospital. All the time lines are different. Along with Meaningful Use, we want to get e-prescribing done even though that’s not going to be one of our measures. Keeping all those priorities in place, that’s my primary role of logistics.

I would say that’s very true. I’m more of an executioner. Not an executioner, that sounds bad. I get things done. That’s my biggest strength, and that means I have to be able give directions clearly, succinctly, and filter out all the noise. So yes, I think that’s true. Sorry, that was a very long way of saying I agree.

Gamble:  That’s really useful. When it comes to things like communicating and being transparent, is that a pretty big priority for you?

Rawlings:  Yes. My door stands open all day long. If I’m in it, they’re available to come inside. They’re walking by me now with my door closed looking at me like, ‘that door’s never closed. What’s going on?’ Yes, they do know that. Again, if I can let them make the decision, they make the decision. They know that, and they also know that if they can’t, I will let them know in a very transparent, very honest way. If we’ve got to make budget cuts or something, I’ll always do it immediately and not make people wait around and worry about things. We just get it done.

Gamble:  Based on the style you have, I would think that’s a little bit more likely for you to serve as a mentor because I feel like a manager or leader who’s a little bit more involved is going to be a little bit more likely to take on that role, even if it’s not a formal type of arrangement.

Rawlings:  I think that’s true. I haven’t had much turnover in the time I’ve been here, and the ones that have left have always expressed it that way that they learned a lot about not just IT, but how to work with other people and how to get along. I’m sure you’ve heard that HIM and IT can have huge conflicts. IT can have huge conflicts with all departments, but there’s some that we have difficulty working with. I wouldn’t say it’s them, our customer — I think we have trouble with clinical areas because we’re not the touchy-feely types. It’s black and white for us.

I’m very big on teaching them that the customer makes the decisions, we don’t. ‘Yes, but we know what’s right.’ Yes we do, and you know what, our customers are smart enough to know what’s right, and if you give them all the options and explain how all these things work, they’re going to come up with the right answer because they’re pretty smart people. There is a lot of that kind of coaching going on. I enjoy that. People have said, ‘you need to go to a bigger hospital. I wouldn’t have the hands-on experience that I have here. I don’t know that I’d be happy that way.

Gamble:  It’s a different role. When you talk about going to the bigger and bigger organizations, it does seem like the CIOs are pretty further removed. It’s not necessarily for everyone. There’s not a one-size-fits-all CIO role.

Rawlings:  Right.

Gamble:  Okay, so the last thing I wanted to talk about a little bit was your career path and some of the different experiences you’ve had — what you’ve gained along the way from working in different hospitals and then on the vendor side as well.

Rawlings:  I actually started out in the late seventies — we won’t say what year — as a unit secretary and a nurses’ aide. My original career path was nursing. I did not finish. I had all but three classes left when I just realized it wasn’t for me, but I stayed in health care. I’ve had the opportunity to do a lot of things, including adult care and pediatric care. I spent 10 years at Children’s Mercy in Kansas City — not in IT but in the clinical areas, in the ICU doing business management, things like that. I have over 30 years of health care experience.

I started in IT in 1998 at Truman Medical Center in Kansas City as an analyst. Because I’d spent so much time, so many years, in health care, particularly in hospitals and in the roles that I had, I’ve had a really good education in how hospitals should work, don’t work, and all the changes that have happened.  When I started, we had glass IV bottles, and if you had a C-section, you were in bed for 10 days. Those things aren’t the same. I’ve had an opportunity to watch technology change.

Early on I realized when I saw my first Access Database that, ‘wow, we can do some great things in health care with this stuff.’ That was when the bug bit, in the early nineties. I had an opportunity to help that hospital build Meditech as a business unit. That was my second connection with IT.

From there, I spent two and a half years at Cerner helping them build one of their organizational units and then decided, you know what, I can take all the things I’ve learned and do the CIO role. This is my seventh or I think eighth year now as CIO — my fifth year here, and I’ve had a lot of fun with it.

Gamble:  It really seems like you’ve been able to draw on the analyst experience, but then also having at least some nursing education and that vendor experience. It seems like you’ve learned from all of it and you’ve learned different things from all those experiences that can be applied.

Rawlings:  Yeah. I have never wasted anything. I even had a short stint teaching private school early on between jobs at one point. I had to teach a combined classroom for fifth and sixth graders. I’ll tell you what, I’ve not even wasted that training because I learned time management — how do you keep 20 kids under control and teach three different sets of classes at three different learning levels? There is nothing that I have done in the past 35 years that’s been wasted. It seems like I draw on something every day.

Gamble:  I would think that there’s a lot to be gained by teaching kids. In addition to time management, I’m sure a lot of other things came out of that too.

Rawlings:  That’s true.

Gamble:  Really interesting. I always like to hear about the different experiences people have had and when they knew IT was something that they really wanted to pursue and really felt right. I think that that’s really interesting.

Rawlings:  I think one of the other reasons I like IT is that it’s complicated. I think one of the hardest jobs in the organization is that of an IT analyst. I do. You’ve got to know so much. You need to understand workflow design. You need to understand your customers. You need to understand how your system plays with everything else, plus all the technology. To me, it’s one of the most fascinating things I’ve ever, ever done. Anything else to me would be completely boring. I just don’t even understand how people do it.

Gamble:  I think that’s when you know you’re in the right place.

Rawlings:  Right.

Gamble:  All right. Well, we’ve covered a lot of ground. I don’t know if there was anything else you wanted to touch on, but that’s about what I wanted to talk about. I really appreciate you taking the time to speak with us.

Rawlings:  Thank you. I really appreciate the opportunity. I do. Have a great holiday.

Gamble:  Thanks, you too. I’d like to touch base with you again down the road to see how everything is progressing.

Rawlings:  That would be great. I would love it. Thank you very much.

Gamble:  All right, thank you.