Is change really so bad? Can implementing a new system really shake a staff to its core, paralyzing the ability to provide the best care? Yes, and that’s why it has to be handled with extreme care, says Edith Dees. Of all the lessons she learned during her two decades as CIO, the most valuable was how to effectively introduce and manage change. In this interview, Dees reflects on her experiences — not just as an IT leader, but as a clinician and consultant — and shares how she was able to conquer some of the biggest roadblocks in advancing an organization. She also talks about what excites her most in today’s industry, why she made to the move to consulting, and the direction she believes the CIO will take.
- Consulting after 20+ years as CIO
- Reflecting on 10 years at Holy Spirit
- Chance to redefine the CIO role — “It was love at first sight.”
- Visible leadership & accountability
- Change management strategy — “This is what’s going to happen”
- Staff education curriculum
- “It was a night-and-day satisfier.”
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The organization saw the need to provide state of the-art clinical equipment, technology and information systems, so with that, I think it was very insightful to rethink the whole role positioning of the CIO.
IT governance is absolutely essential, and in every organization I’ve been in, I’ve done it to the extent the organization could accept that model. You have to adapt to the culture and you to adapt to the leadership style and you have to do whatever is totally consistent with the CEO’s vision.
It was painfully obvious that it didn’t matter what kind of hardware the vendors said it should run on, we were just trying to run it on the hardware that we were familiar with. We thought we knew better. And what we found out is we didn’t.
I’ve almost come to expect that when technology makes us uncomfortable, it’s IT’s fault, so let’s talk about that. Let’s not let that happen, let’s know what we’re getting into before we get into it.
Do I have the right people in the right positions? Do I have leaders leading or do I have leaders defending the old guard? That’s a reality you just have to accept. People are people. Some will let go and grab on, and some won’t. And the ones that don’t, you have to take care of that. You have to address that, because the staff doesn’t need that confusion.
Gamble: Hi Edith, thank you so much for taking some time to speak with us today.
Dees: My pleasure, Kate. Thank you.
Gamble: I’m looking forward to getting a lot of your thoughts about the industry, and I think the best way to do that is to first give our readers and listeners an idea of where you are right now.
Dees: I had been a CIO for over 20 years and my career is exclusively healthcare. I started as a clinician, got a degree in business, got a Master’s in organizational development and stayed close to healthcare. I can’t imagine a more rewarding discipline to be in.
Right now I’m heading up a consulting company collaborating with an organization psychologist in Maine whose practice also was exclusively healthcare. We’re helping organizations make it better through the change that everyone is going through. My practice, in particular, is focused on issues that executives and leaders just can’t get their arms around because the pace is too fast, there are too many imposed deadlines, there are too many competing priorities and some of these underlying things that need attention just aren’t getting it, that could make things go more smoothly, so I’m pretty excited about that. It’s something I had been toying with for years, and I’m glad I got the opportunity to go for it now.
Gamble: Right. And that’s for a couple of months that you’ve been doing that?
Dees: Yes, since August.
Gamble: Let’s talk about some of your experiences as a CIO, a role that obviously you held for a while. Most recently, you were at Holy Spirit Health System, correct?
Gamble: And what was that time period?
Dees: That was 2005 until the end of 2014, so just shy of 10 years.
Gamble: That’s a really interesting chunk of time in this industry. I can imagine you went through some pretty significant change in that decade or so.
Dees: We did, and it was very exciting. I had a great partnership with a CEO and the other C-suite members, and we did more collaboratively than we ever thought we could and it was just a wonderful experience.
Gamble: Can you talk about what the picture looked like when you arrived at the organization — where things stood from an IT standpoint?
Dees: From an IT situation, there had not been a CIO there for several months. They had been looking for a while and they had advice from Accenture saying, ‘let’s revamp this role. Let’s have it not report to CFO anymore. Let’s change reporting structure and just rethink IT.’ Because at the same time, the board had approved a 20 million dollar, 5-year expenditure in clinical information systems, and this was prior to Meaningful Use investments. The organization saw the need to provide state of the-art clinical equipment, technology and information systems, so with that, I think it was very insightful to rethink the whole role positioning of the CIO, too.
So for me, it was love at first sight. They had already signed a contract, and they had good guidance from Accenture, good guidance from legal, and were setting a nice solid foundation for vendor management, contract management and involving clinicians. Everyone had a really clear picture of what they were doing, why they were doing it and what they expected the vendor to deliver, and a pretty good sense — maybe not as strong in hindsight — but a good sense in knowing what their role would be. There was a good sense it was going to be some hard work and we were going to have to rethink some of the things we’d always taken for granted. We were under-budget and under-time. We did it quicker than we thought we could and we did it cheaper than we thought we could, basically from the team pulling together, being accountable, being disciplined, and talking to each other.
Gamble: That’s always an impressive thing to hear. What do you think were the key factors in being able to do that in a reasonable amount of time and under budget?
Dees: I think it was visible leadership endorsement and sponsorship. It was very clear that the board was watching us, and we didn’t want to disappoint our CEO. We owed it to ourselves, we owed it to our community. We were all kind of in this together, and we were going to make it happen. There was a strong sense of accountability to everyone, including each other.
Gamble: And had there been a system in place before then? I know that they were doing a lot of rethinking of IT, as you said, so there hadn’t been a clinical information system in place at that time?
Dees: No, there hadn’t been. Because I think they didn’t have the leadership at every level to rethink their approach and to get all clinicians on the same timeline. And that is probably the most painful part of Meaningful Use — all the clinicians have to be on the same timeline. When it was a best-of-breed world, the labs could automate and they could automate it to their heart’s content, until they needed other practitioners to join in. And that’s usually as far as they got in their system development. It was the same with any ancillaries; with these core clinical systems, every clinician’s a contributor, and every other clinician is relying on them to contribute at their point of data capture.
Early in the implementation, it’s a matter of, ‘Who should enter allergies? Who’s the first one to hear them?’ Let’s get them in there, because back in the day, folks, we’d have to struggle to find any information. As soon as it is entered, at least the other clinicians treating that patient have something to work on. As you get more information you update it, but you having nothing now.
So it was a new way of thinking about the tool and its impact, and we looked at everything on the impact to patients — what makes sense to the patients, and in the broader sense, their families, our community? We want patients to get the best care they can get and we want them to get back home to their families as quickly as we can. So one of the ways to do that is for us to be very expert at our internal communications so there are no missteps. Everybody’s acting on the most current and accurate information.
Gamble: Did you find that even though there was a willingness to get into this new world of having a clinical information system, there were still some challenges as far as that change management piece and getting into some of those details of how that was going to happen?
Dees: I was very excited to have the opportunity at Holy Spirit, because the CEO let me try some of my ideas. I thought, let’s try this and see if it has a good outcome or makes a difference. One of the things I did early on was when we announced our timeline at leadership meetings, I did a little presentation on change management that people were still talking about right up to when I left the organization.
Basically what I told them is, ‘this is what’s going to happen and how we’re going to behave when we go through this, and it doesn’t mean let’s back off. This is a normal thing to expect.’ I think my model was using Dr. Kubler-Ross’ stages of acceptance and grief. I said the same kind of principles could be applied to change — we’re letting go of how we used to be and we’re not really clear on what’s coming. And so we have to believe it’s the right thing to do, and we’ve got to believe we can count on each other to get through this. And I think my last slide was a trapeze artist and the expression was, ‘let go and grab on.’ It was depicting the implementation in that free zone where your legs are loose from one and your hands haven’t grabbed the other, but you will. We’re going to help you, we’re all going to help each other.
Gamble: And as far as IT governance, how did you manage that? I imagine there had to be some either new roles or different roles created to make all of this happen?
Dees: Yes, I think IT governance is absolutely essential, and in every organization I’ve been in, I’ve done it to the extent the organization could accept that model. You have to adapt to the culture and you to adapt to the leadership style and you have to do whatever is totally consistent with the CEO’s vision. Sister Romaine Niemeyer and I had a great partnership. We made things happen, and I was really grateful for her support.
The way I start IT governance is I just lay it out there. I see IT as a limited resource like brick and mortar and capital — what’s the best way to spend it? And I’m not here to tell you what my job is. You — the executive team and my colleagues — your job is to tell what my job is, and I will align my staff and budget around what you want.
And so early on, we spent probably a year just talking about what do we want. And for everything, there’s a cost and a benefit. Early in the conversations, we would say, ‘We would like it so that when we call the help desk, they could walk us through mail merges and how to do animation and PowerPoint, and answer Microsoft questions.’ We talked about the ramifications — if I really hired people that did that, would that make financial sense? Would that really meet the need?
We talked through that, and I think we came to the realization that it might be better to expect some computer literacy in our new hires and our current staff that had those core job functions, and to provide them education — formal education, not hit and miss and try to teach me how to do this one thing, but a real curriculum working with our education department. That’s where we landed on, and it was beautiful. The education department, unbeknownst to me, had been lobbying for that for years. So it made everybody more confident in their jobs. They were developing better skills and they were the masters of their own destiny. They didn’t have to wait to get through on the help desk or get somebody to try to figure out what they’re trying to do; they were more empowered to solve their own problems because the organization had supported them to acquire those necessary skills. It wasn’t a focus that everything IT-related needs to reside in IT, but computer literacy to varying degrees belongs throughout the organization.
Gamble: This also speaks to the fact that you were walking into a situation where you had a chance to redefine the CIO role, and maybe this is an example of how were you were able to do that.
Dees: Well, it was very interesting. First of all, this is a community hospital that I think they purchased a PACS system in 2003, which was very impressive, but that was their first foray in it, and they didn’t really know what they were getting. It was really hot competition. We opened our cardiac hospital, and one of the vendors did that to tip the scales. Well, how about we help you get into digital imaging? By the time I got there, it was painfully obvious that it didn’t matter what kind of hardware the vendors said it should run on, we were just trying to run it on the hardware that would take backups that we were familiar with. We thought we knew better. And what we found out is we didn’t. We needed spinning disk technology, which we weren’t experts at. So while we already had this many studies in there, the physicians couldn’t retrieve the priors. That’s a problem. That was probably my biggest priority when I got there.
Then soon after that, we wanted to implement a new billable in the cardiac hospital and it just couldn’t get done, so I asked my manager to go in there with a spreadsheet, outline all the steps you see need to be done. And literally, on an Excel spreadsheet, it was, ‘I can’t do anything.’ Why? ‘Because I need finance to do this and I need imaging to do that.’ I said, lay that all out and meet with them and tell them that’s what we need to get this thing done. I think that is the first time, at least in those folks’ recollection, that there was any semblance of a work breakdown structure and roles and responsibilities and contingencies and milestones and critical paths. They embraced those concepts. Now instead of just being frustrated, they know why doesn’t it happen, they knew what was needed from them, and they knew what to expect from the next hand-off — and it got done. They got done at a lot less time than they had spent talking about it.
Project management was one of my big priorities — understanding and clarifying IT’s role, and working with leadership. I’ve been in a lot of organizations over my career, and I’ve almost come to expect that when technology makes us uncomfortable, it’s IT’s fault, so let’s talk about that. Let’s not let that happen, let’s know what we’re getting into before we get into it. And that was part of that governance — adding some more discipline, because just like everywhere else, we would hear, ‘my vendor’s here now and they want to get in the network.’ I was like, ‘who are you and why are you calling?’ We have to do security checks. And so a lot of the IT governance pretty much revolutionized the way we were interacting with the organization and the organization interacted with us. There had been no formal help desk, there were folks that acted more as receptionists that would just transfer the calls. They literally worked like receptionists. So we researched a system that’s widely used, implemented it, got professional folks that were certified, and it was a night and day satisfier to our customers to have folks at the help desk that could actually help them settle most of their problems when they called.
Project management and governance helped us, and then we worked on the staff. Do I have the right people in the right positions? Do I have leaders leading or do I have leaders defending the old guard? That’s a reality you just have to accept. People are people. Some will let go and grab on, and some won’t. And the ones that don’t, you have to take care of that. You have to address that, because the staff doesn’t need that confusion. The leaders need to be lockstep on what the vision is, where they’re going, and how they’re going to get there.
I also worked with the staff to talk about career planning. Again, it’s not atypical from positions I’ve been in that IT pretty much did what they liked to do. And it’s like, ‘who’s doing the stuff that needs to be done — and only IT can do it — that nobody likes to do. Let’s talk about who’s going to be responsible, who’s going to be accountable, who owns this.
Those were new conversations or so it seemed. People did what they liked to do and if the customer called and said, ‘I need a cable change made.’ Why wouldn’t a customer have access to make that cable change? Why are they going through the effort and the hoops to call us to make that change? If it only impacts their job function, why don’t they have the ability to do that? It was rethinking the entire role of everyone in IT, and our interaction with our customers. And oddly enough, most customers embraced it. Why do I have to call you when in half the time, I could have made the change myself? So it was a lot of change. And then on top of that, stage 1 hit us in no time to spare, and we were the first in line for that, the first in line for stage 2 and we were waiting for stage 3 when I left for the final regulations.
Gamble: That’s really interesting because you get there and you’re helping to make all these changes that are obviously going to take a lot of time. I can imagine the challenges presented when Meaningful Use came down the pike.
Dees: Actually, the structures we had in place to do the first rapid implementation served us well, because we didn’t get a chance to take a breath, which was good, because I think it kept our momentum up. It was the same vision and justifications that fueled us to the first one—we are accountable to our community, we’re accountable to our board, we’re accountable to our CEO, this is not bigger than us, we can do this and we’re going to, and we did.