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.
- The workflow gap — “These are things we can address and fix.”
- Importance of soft skills
- Security & the challenge with “human engineering.”
- Back to consulting — “It was the next step.”
- CIO as collaborator
- “Clinicians can’t opt out of discussions.”
- The most “exciting” trends in health IT
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It’s not, ‘put a stop to Meaningful Use. Stop the rollout.’ We need to look at some of the soft skills and listen. Set up some integration mechanisms so we can better appreciate the bigger picture here — what’s going on and what’s our role in it? What’s your individual role? I think that’s been neglected.
It’s a matter of saying, ‘I’m not doing anything that’s counter to your mission. We all have the same mission. I just have things I’m responsible for doing and you have things you’re responsible for doing. Together, let’s work through this and accomplish what needs to be accomplished and move on.’
A big part of my role as a CEO, and I think it will be continuing to be going forward, is clarifying your role and your colleague’s role — who does what, so there are no gaps and there is ownership and accountability. The ball is not dropped
You’ve got to sell a vision and you got to tell people how they contribute to it. And a lot of that is talking to your colleagues and negotiating with them, because they would much rather keep doing what they’ve always done and not think about the stuff that you live and breathe every day — how is this project going to get done, how are we going to stay in budget?
It’s going to be a real crisis if we don’t automate the stuff that we have clinicians worrying about now. Free them up to do the hands-on work, not chase things and say, ‘I know I charted it somewhere, where is it?’ Let’s get way past that.
Gamble: In your current role, what are you seeing as the biggest challenges for CIOs and other leaders?
Dees: The immediate word that comes to mind is workflow. When I was a bedside critical care nurse, I was just thinking the interaction and relationship between the patient and their family. That was it. I notice this a lot with clinicians, and I think that’s one of the big dissatisfiers — they don’t really understand that they have a workflow, and they don’t like the system not supporting their current workflow.
I think a lot of work needs to be done saying, ‘you do have a workflow — let’s understand it.’ My observation of nurses in particular is if you don’t deliberately tell them in their workflow to stop doing this, they’re overwhelmed, because they’re going to do everything they did in their prior workflow and everything you expect to support the system in their new workflow, and they can’t do that. They’re not staffed to do that. No human can do that. But if you don’t tell them, ‘let go of this,’ they will try to do that.
So I think it’s getting into the things that actually overwhelm them. In working with the organizational psychologists, people are upset about patient safety, and rightfully so, but folks, these are things we can address and fix. It’s not, ‘put a stop to Meaningful Use. Stop the rollout.’ We need to look at some of the soft skills and listen. Set up some integration mechanisms so we can better appreciate the bigger picture here — what’s going on and what’s our role in it? What’s your individual role in the bigger picture here? I think that’s been neglected.
And in all fairness, you can’t do it — IT leaders or anybody. You can’t do everything, and Meaningful Use is expecting you to do a whole lot of stuff right now at the expense of a lot of other things that need to be done.
Gamble: Another issue we hear about a lot is prioritization, because it becomes so difficult when there isn’t really anything you can push to the back burner.
Dees: Right. That, to me, is why processes and just that lean mentality and lean thinking are critical. Do it right the first time and move on. Don’t let something just keep coming back and fighting you. You have to take the time to fix that stuff and get it out of your way.
Gamble: What do you think are some of the other pressing issues that CIOs need a little bit of assistance with?
Dees: Security — and it’s the human engineering of it. I guess the good and the bad news is most of breaches are behind your firewall, so there’s definitely an opportunity there. When we were hardening our passwords and user IDs at Holy Spirit, I met with each of our physician practices and specialties to roll out the justification of why we were doing that. Admittedly, some of them came and said, ‘When I saw the agenda, I’m like I wasn’t ready for this, but once you rolled it out and said this is to protect our patients, it’s hard to argue with that.’ So it’s a matter of saying, I’m not doing anything that’s counter to your mission. We all have the same mission. I just have things I’m responsible for doing and you have things you’re responsible for doing. Together, let’s work through this and accomplish what needs to be accomplished and move on to the next thing. It was just talking to them and explaining it, not an arbitrary, ‘Well, because the CIO said you had to do it, you have to do it.’ That’s not how we did it; that’s not how we did change.
Gamble: Yeah, you’re never going to get the results you want with that approach.
Dees: Right. Because you’re talking to people that have a passion for what they do, and that’s good news. Help them be as passionate about the change you’re proposing as you are.
Gamble: Now, as far as your decision to get into this new realm, I can imagine there were pros and cons, but was this something that really just made sense to you as the next step?
Dees: It was, to me, the next step. In my career, I kind of came in and out of consulting and working for a provider in consulting. And for me, it was a way to segue back into consulting, because there is so much going on now that I don’t want to miss anything. To get that flavor of what other folks are doing, what are their challenges, how are they addressing them, what are they doing to rally the troops and what innovations are they pursuing — to me, it was the perfect time to go for it.
Gamble: I can imagine that there really are of a lot of experiences to be able to draw from, and having the ability to say, ‘this is how we did it at the organizations where I worked’ really carries a lot of weight with people who are in that position now.
Dees: I think that helps, and I think it’s also, ‘this this is a normal reaction. This is everybody’s initial reaction. Here’s what we do to move past that.’ It’s giving them hope that we can move past it. And there are some tips and techniques and all that jazz. But it’s like trying to get that cardiac initiative at Holy Spirit — there were really pretty straightforward ways to get through this and accomplish what we need to do. And you’re talking from experience. You’re talking from not just one organization or one part of the country, but from all over the country. Some of it is this is just human nature.
Gamble: Thinking about everything you’ve seen over the years with the CIO role, how do you think it’s going to continue to change? Or is a lot of just carrying the same principles along?
Dees: To me, it’s is evolving into more of a collaborator. I think a big part of my role as a CEO, and I think it will be continuing to be going forward, is clarifying your role and your colleague’s role — who does what, so there are no gaps and there is ownership and accountability. The ball is not dropped, and at all times, you know where it resides.
For example, I interviewed an executive team not long ago. They were doing very well in their market, but they hated IT — ‘they all need to go.’ When I asked for more specifics, the VP of nursing was the first to speak and she said, ‘The help desk doesn’t help.’ I said, ‘can you tell me more about that?’ And she said, ‘when my nurses call the help desk and ask how to do something, they can’t help them.’ I said, ‘So these are process questions?’ ‘Yeah,’ she said, ‘my nurses don’t have time to go to training.’ Well, that’s never going to fix itself. Somebody at the help desk is never going to be able to do OJT training when your nurses get in a bind. You keep getting what you’re getting when you keep doing what you’re doing. It had to be unsatisfying for IT, and the VP in nursing was totally unsatisfied, so I imagine her whole division was totally disempowered. And it’s like, we can fix this, it doesn’t have to be like this.
But if you’ve never heard anybody from the outside, you’d think, ‘it’s IT. They need to go.’ You need to get people there that can do OJT training when somebody in the clinical area calls. Well, good luck with that. I know in some places, they’re taking the model where clinicians are ‘at the help desk’ and that’s one model. But I don’t think even that model should be instead of training your clinicians.
Gamble: Right, it’s interesting because there’s definitely been talk about the CIO role evolving, but it seems like a lot of that is kind of managing the evolution of other roles as well and that’s really interesting.
Dees: Yes, and it’s you as a real leader now, not as a technician, not as a supervisor, not as a manager, but a leader. You’ve got to sell a vision and you got to tell people how they contribute to it. And a lot of that is talking to your colleagues and negotiating with them, because they would much rather keep doing what they’ve always done and not think about the stuff that you live and breathe every day — how is this project going to get done, how are we going to stay in budget? You need visible leadership from everyone you’re working with on a project. Nobody can opt out of it. There are no IT projects anymore. Well, there are a few. You have infrastructure upgrades and things like that, but most of them have a direct impact on clinician workflow and patient care. The clinicians cannot opt out of those discussions.
I would even argue that with some of the technical things, they need to know why it’s being done and what impact it will have. Even something like now we have to do a 10-character password — you can’t just spring that on people. So even while that may be seen as an IT project, if your customers are going to see what you did, they need to know why you did it, when you’re going to do it, etc., so they can be prepared for it.
Gamble: It goes back to what you talked about with the change management slide presentation and the different ways of trying to really communicate about how this change is going to affect you and helping people to embrace that.
Dees: I have this little equation that says communication leads to buy-in and buy-in leads to return on investment. It all starts with communication. If I don’t get why you’re making me do what I know works for my patient, I’m going to resist you, why wouldn’t I?
Gamble: Any last thoughts from you on where the industry is heading? It’s an interesting couple of years. You talked about population health really being a focus going forward, but any other thoughts on how you see things shaking out?
Dees: Yes, I’m really excited about patient engagement and the push to empower folks. And I’m really excited about the wearable technology coming out where even if you weren’t aware of a genetic tendency to get some weird disease, you could be monitoring yourself pretty soon with your watch, for example, something you’d stick under your pillow. It could pinpoint a problem before you or your clinician even know you should be looking for it. I think that’s very exciting. And you’re talking about more focused expanses. Don’t just do an annual panel — let’s focus on why your little watch is beeping on here and worry about that first. The good news for me, and I doubt it’s a coincidence, is the rate of change of technology and the rate of change in healthcare. I think it’s a great time to get the synergies for both of them.
Gamble: There’s so many interesting things going on. Talking about all of this, you can see how gets a little overwhelming, so it’s really important, I think, to go back to those principles you talked about. I think that’ll be even more important going forward to really emphasize things like communication and collaboration and things like that.
Dees: I think so, and humans are going to be the ones that make it work. Technology can’t do it by itself. We have to know how to apply it and maximize it and leverage it. I’m so glad it’s happening before all of the baby boomers become consumers, because in my opinion, it’s going to be a real crisis if we don’t automate the stuff that we have clinicians worrying about now. Free them up to do the hands-on work, not chase things and say, ‘I know I charted it somewhere, where is it?’ Let’s get way past that.
Gamble: Right. Well, this has been really interesting. I want to thank you so much for taking the time and sharing your experiences.
Dees: My pleasure, Kate. I appreciate the opportunity.
Gamble: Sure. I think this will be really interesting for our readers, and I’d love to definitely catch up with you sometime again.
Dees: My pleasure, thank you.