When Brian Tew arrived at Greater Hudson Valley Health System two years ago — as the organization’s third CIO in 3 years — he knew he had his work cut out. But despite the fact that 40 percent of the IT positions were vacant, Tew knew that the core group in place was strong; what they needed was some stability. And so he was deliberate in his approach, building a leadership team from the ground up and improving processes one at a time. Within 20 months, GHVHS had achieved HIMSS Stage 7 recognition, and Tew’s plans don’t stop there. In this interview, he talks about what it took to change the organization’s mentality, the challenge of “keeping the lights on” while developing standards and setting up committees, the biggest priorities he hopes to tackle, and why managing expectations is absolutely critical.
- Managing expectations — “That was key.”
- Leadership, then governance
- “We didn’t have the basic things in place.”
- Creating service level agreements
- The prioritization challenge
- Daily huddles
- 3rd CIO in 3 years
- Gaining credibility & buy-in — “We had to do what we said we were going to do.”
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I didn’t want to meet with the physician committees or anything until I was ready to be able to deliver and be able to meet their needs. And so I put on hold a lot of the governance piece of my job just so that I can build the team and just do the basic blocking and tackling that IT department has to do.
If you were to ask my staff what was the biggest issue two years ago, they would tell you that it was prioritization of projects. And so we deferred to them for the first 10 months or so of prioritizing the initiatives and the projects that they had. Once leadership was in place and we would have our daily huddles, that helped the process.
If you’re the third CIO in three years, your boss and the other senior leadership team are going to make sure you’re successful. They’ve gone through the pain of no leadership with a department that is so interwoven to what they do day in and day out that they’re going to do whatever that it takes to make you successful.
Morale was down. So I had to give them some sense of focus on, ‘this is my approach, here’s the direction we’re going to take, here’s the plan.’ And I was fully engaging them through the process, making sure that they were buying in to the vision.
Gamble: In building this team, I imagine it was interesting because there was really so much that needed to happen right away. What was the kind of the strategy there just as far as like get the right people in the place and then like let’s focus on optimizing the EHR or how did that kind of go?
Tew: One of the things that I have to focus on every day is managing expectations. That was key here, because I didn’t want to meet with the physician committees or anything until I was ready to be able to deliver and be able to meet their needs. And so I put on hold a lot of the governance piece of my job just so that I can build the team and just do the basic blocking and tackling that IT department has to do.
We really didn’t have any type of standards or processes when it comes to incident management and change management. So we brought in some idle standards and those are the things that I was focusing on really for the first year before I started to develop the physician advisory committees, the IT steering committees, and all the other workgroups. The workgroups existed before I arrived, and they continued, and we actually added on them. But as far as the strategic committees, I really put those on hold for a year until we actually had the team in place. We had our vision and our mission, and then we started meeting, and when we meet with the group of physicians that have a list of ten things that needs to get done, we were able to deliver. We were able to do those ten things.
Gamble: You talked about like idle standards — can you give an example of that?
Tew: Well, we weren’t really tracking how many calls we were getting, how many tickets were being created. There wasn’t a formalized service level agreement with the organization — which we did implement — which basically says, based on the urgency and the impact of your issue, we’re going to fix this within 4 hours or 8 hours or whatever the service level agreement is for that issue. We really didn’t even have the basic things in place. And so, collectively with the team, we sat down and we created a formalized agreement with all the organizations within the GHVHS umbrella, and we published that agreement. We created a dashboard which gets updated monthly. We’re in the process of switching that to real-time data, so that we’re being transparent about the service that we’re performing.
Gamble: So it was really putting processes into place, in addition to building the team and really getting to a more stabilized place before you could go forward with too many new strategies.
Tew: Right. The organization still has expectations; the lights still have to stay on. A good example is the unscheduled downtimes. We weren’t really tracking them, but they were happening weekly — not necessarily within Epic, but there are 150 other applications and we have different locations and so throughout the system every week, something was down at a given moment. So we started tracking that and putting attention on that, and we’ve upgraded just about the entire network at Catskill Regional and all of the sites in Sullivan County. And so there are still the basic things we had to do that if we didn’t do, all we would be doing is putting out fires.
So the important things that needed to get done — the standardization of our approach and all the rework we were doing — all of that takes time. We really had to focus on holding those things in check, but at the same time, we still had workgroups that were meeting with the different areas within the patient care setting, and there were requests coming in constantly. We still had to optimize and get Epic to a place that it needs to be at.
Gamble: Right. I imagine that was a challenge just as far as prioritizing — like you said, you have to keep the lights on, you have to keep everything going. But then once you did figure out some of the things that you wanted to do, was prioritization a challenge, and how did you approach that? Once you did have a little bit more stability, what did you want to get to first?
Tew: Right. We really didn’t have the formalized approach that we have now. I don’t want to say it was the squeaky wheel, but when senior leadership, the initiatives that they had took priority. There are always patient care things that pop up and need to be addressed immediately. If you were to ask my staff what was the biggest issue two years ago, they would tell you that it was prioritization of projects that they had in their queue. And so we really deferred to them for the first 10 months or so of prioritizing the initiatives that they had and the projects that they had. Once leadership was in place and we would have our daily huddles, that helped the process. We’re now looking in other areas of leveraging Agile and other methodologies to help improve that.
But prioritization was a huge concern and issue for them simply because there are only so many hours in the day, and there’s always more work than you have resources. But once we implemented the governance piece of it, we had the clinical transformation committee, which will help prioritize these tasks and initiatives that come up, and it affords everybody an opportunity to kind of weigh in on what is the priority for the organization. So once the governance was in place, it really helped with some of the prioritization issues that we we’re having.
Gamble: And you mentioned being the third CIO in three years and I can imagine that when you’re walking into situation like that, there are going to be trust issues, because the stability isn’t there. Did it take some time to get people to buy in with what you wanted to do? How did you approach that?
Tew: To me, I think there are advantages to that as well. If you’re the third CIO in three years, your boss and the other senior leadership team are going to make sure you’re successful, automatically, out of the gate. They’ve gone through the pain of no leadership with a department that is so interwoven to what they do day in and day out that they’re going to do whatever that it takes to make you successful. So from a senior leadership perspective, I knew that I had that support.
As far as the people that we support and serve throughout the organization, we had to basically do what we said we’re going to do. It didn’t matter what I was telling them — if the printer that they print it to everyday jams and they have to call the helpdesk, they’re not going to listen to what I say. So I had to fix all of those things first just to get what I would call street credit throughout the organization. And again, the original core group already had that street credit. They just needed more people, more resources. I think we’re out of the gate; I had all the support I needed.
Gamble: Right. You talked about that group that had been in place through the turnover, and maybe some of the other previous CIOs or other leaders thought they were part of the issue. Was that something you had to handle carefully, just as far as assessing their talents and letting them know that they are doing good work? How did that go?
Tew: Well, there was a lot of that where they kind of felt underappreciated. When I arrived, there were people that had just resigned a few days before I arrived, and so morale was down. So I had to give them some sense of focus on, ‘this is my approach, here’s the direction we’re going to take, here’s the plan.’ And I was fully engaging them through the process, making sure that they were buying in to the vision. After I had the leadership and the staff here, I pulled everybody in and said, aid I want to get Stage 7 and Most Wired next year. Some of them were excited about it, and others looked at me like I just hit them in the chest.
Tew: But I explained why I wanted to do it, and really I wanted to do it for the core group. I wanted the organization to see that despite the disruption in leadership, we’re fortunate to have the team that we have, and we were able to do that. Last month was Stage 7 and this month was Most Wired. We were able to accomplish that in really 12 months.
So this is a good core group. They did feel underappreciated and they did feel somewhat downtrodden. That being said, once we got the leaders in place and once they bought in on the vision and saw my leadership style, things just continued to grow from there.
Chapter 3 Coming Soon…