Most CIOs deal with a great deal of complexity, but what Kathryn took on when she started with Kings County Hospital nearly a year ago takes it to another level. The hospital is part of NYC Health & Hospitals, which recently began an organization-wide conversion to Epic, while at the same time going through a major governance transition. Adding to it is the fact that NYC H+H is a public system, meaning all leaders report to the mayor’s office. In this interview, Crous talks about what it’s like to lead through change, the advantage she had in having to “test drive” the organization as a consultant first, and her thoughts on the evolution of patient engagement. She also discusses her leadership mantra — “listen twice as much as you speak,” her interest in EMR forensics, and why healthcare shouldn’t be compared to other industries.
- Reporting to NYC’s mayor
- “It’s much more complex than anything I’ve worked in before.”
- Engaging with patients through community outreach
- Standardizing IT systems — “We’ve got so many different things that are swirling.”
- From consultant to full-time CIO — “I got to test-drive the job.”
- Talking the clinical & technical talk
- Winning over the CEO
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This was first role as a public hospital system employee, and I’ve discovered that it’s much more complex than anything I’ve worked in before, and things move much more slowly. I’m used to doing rapid cycle conversions in my consulting roles, and it’s just very different here.
We’re trying to actively participate with the community. We also work with the Brooklyn political leadership to help them understand that we’re here to serve you and we really want to partner with you and meet the needs of a very diverse community.
With my background, I can speak the clinical talk and the technical talk and relate to the physicians in in a very easy way because I can speak their language and I know the workflows, and so it’s been a really fun organization to be a part of.
Having been a consultant and having worked all across the county, you pick some gems of wisdom from every place that you’ve been. And when you’re working with people that have only been in one place, they don’t know a different way to do things, and so it’s been really fun to consider different options and present it in a different way.
Gamble: You mentioned Ed Marx — that’s an interesting role he has. He’s serving in almost a CIO-consultant type position?
Gamble: And he’s someone who you could have a decent amount of accessibility to if you have issues or questions, well I guess really mostly for the hospitals that are really getting ready for go-live?
Crous: Yes, he’s actively engaged. We hired one of our AVPs who is really running the Epic conversion from Sharp Healthcare in California. She had done a lot of conversions there and she’s brilliant — she really knows what to do. One of the challenges with being a political machine in that we report to the New York City mayor, is every cycle of political change changes some of what happens at the Health and Hospitals level. And so we’re looking at a new mayoral election next year, so things are up in the air. We could potentially change; we could potentially have a new mayor next year. And so all of these people, Ed Marx, Pam Saechow (Senior VP, EMR Implementation and Support), Sal Guido — all of these people report directly to the mayor and the board of directors. And so they have not only the operational and functional responsibilities, but also the political responsibilities in a very highly charged political organization. So when it comes to getting the governance together and getting the access, things move a lot more slowly, just because it’s so complex.
Gamble: Yeah, that’s a really unique situation. I don’t have to tell you. Being a public health system, I think people see the size of NYC Health and Hospitals and equate it to other large health systems, but this is a whole different animal, it sounds like.
Crous: Sure. I worked in the for-profit and not-for-profit sectors for many years. This was first role as a public hospital system employee, and I’ve discovered that it’s much more complex than anything I’ve worked in before, and things move much more slowly. I’m used to doing rapid cycle conversions in my consulting roles, and it’s just very different here.
Gamble: As far as some of the other initiatives on your plate, what is your strategy with patient engagement? You mentioned before that you have a very diverse population and I’m sure that that’s true in a lot of different ways, so what’s been the strategy for trying to engage with the patients?
Crous: Our chief nurse, Opal Sinclair-Chung, has been working very hard with Press Ganey in trying to get our community involved. We work closely also with the marketing department here with community outreach and engaging some of the religious organizations and community organizations and inviting them in to participate in the patient engagement activities as well all kinds of social events.
Karen does a great job of bringing the community in and doing social events, art events, and music events in our atrium and in our auditorium. So we’re trying to actively participate with the community. We also work with the Brooklyn political leadership to help them understand that we’re here to serve you and we really want to partner with you and meet the needs of a very diverse community. So there are many outreaches that are happening. We’re working with Press Ganey on the surveys and trying to find every way that we can, even through interpreter services and having as many different versions of discharge instructions with the different languages. It’s just a massive effort with patient experience.
Gamble: And then as far as things like portals, what are you doing in that area?
Crous: We’re rolling out our patient portal with the Epic conversion, and so we don’t have an active patient portal at the moment for the hospitals that are on QuadraMed, so that makes it a little more challenging.
Gamble: I imagine that the challenge is not quite being in a holding pattern, but knowing that there are so many things that are going to change down the line. But right now, what are some of your biggest focuses from an IT standpoint?
Crous: As an organization, we’re really trying to standardize our technology platforms. We’re moving to a vendor-neutral archive for our PACS imaging, making sure that as we move to this shared services model, we have a project intake process where we bring all of our local projects to the corporate offices and have the architecture and the security reviewed and have that kind of visibility. And so that’s where we make the decision: is this the product that we’re going to roll out to all the facilities or are we going to go with a different standard because of some compelling reason at a facility? Sometimes the infrastructure needs a huge facelift, uplift — a whole redo. Technology is changing so quickly, and of course, this hospital has been around since Walter Reed did his internship; that’s how old this facility is.
The infrastructure is changing, is just is. And so we’re doing a lot of those infrastructure upgrades and looking to standardize a lot of the different clinical systems in the niche areas. We have a new Varian linear accelerator for doing the image-guided radiotherapy, we’re trying to expand our cardiology services, and we bring in residents and interns from all over the world. We have a very robust dental program, and we are looking to hire an ophthalmologist that does oncology — that’s how subspecific the specialties are.
It’s just a really interesting environment to come into because we’ve got so many different things that are swirling, that are changing, and that are unique, and it makes every day a new adventure.
Gamble: Sure. How long have you been with the organization?
Crous: I actually I just officially converted into a formal employee. I started last November as a consultant, knowing full well that I would be converted into a permanent employee, so I’ve been here almost a year now. Like I said, there’s been a lot of changes, so the leadership role is still not really clearly defined, but I’m finding that the executive leadership here at Kings County has been so grateful. With my background, I can speak the clinical talk and the technical talk and relate to the physicians in in a very easy way because I can speak their language and I know the workflows, and so it’s been a really fun organization to be a part of.
Gamble: Right. I imagine you had some hesitancies going into this role. How did you approach that knowing that there were going to be a lot of changes and that it’s such a different environment?
Crous: Having spent a good part of my career as a consultant, you’re always looking for that next place to make a huge difference. And so coming in as a consultant was a good thing because had I been here six months and really hated it, I could still stay in my consulting capacity and move on once they’d found a replacement for me. I actually got to test drive the job before I got hired into it. And once you’ve been an adrenaline junkie — I used to be certified in the OR, and OR nurses tend to be adrenaline junkies, much like ER nurses and ICU nurses — moving into a role that is as dynamic as this one is has been the best of both worlds in that it keeps me interested and I never know what’s going to happen next because there is so much to do here. And yet I get to go home every night, be in my own bed instead of getting on a plane every Monday or Sunday going to some other city.
So it worked so well. I got to test drive the job, I got to see how the executive leadership here felt about me participating because they felt like they really needed a strong CIO. Women in technology, especially healthcare technology, are not as common as men, and so you really have to prove yourself. And so it’s been really nice. The executive leadership team has been amazing.
It took this CEO a little bit of time to warm up to me. I think he was a little skeptical that I would be able to deliver, but as the doctors started speaking highly of me and as the COO would speak highly of me and the CNO. It’s really kind of been a blessing to me because I remember being introduced to the CNO one day and they’re like, ‘here comes the new CIO,’ and she’s like, ‘Hi, how are you.’ And then they said, ‘oh, she’s a nurse too,’ and of course the handshake got much firmer.
It’s incremental. And I think that’s the thing that’s been fun about this is the incremental change and the fact that the trust is developed with time. As a consultant you want to leave it in a good place, but you also know that you’re going to get to move on. Once you become that permanent employee, it means that you own the problems forever, or at least until your job takes you somewhere else.
Gamble: And how do you think it has helped shape your role having that consultant background? I imagine you look at things from a different lens.
Crous: One of the things that I’ve found here is that there are many tenured employees. My oldest employee right now is 84 years old and has been with Health and Hospitals for 40 years. There are many tenured employees here, and I find that having been a consultant and having worked all across the county, you pick some gems of wisdom from every place that you’ve been. And when you’re working with people that have only been in one place, they don’t know a different way to do things, and so it’s been really fun to consider different options and present it in a different way. The wealth of experience that I’ve brought to the table with consulting has given me a lot of credibility, and many people are really kind of excited about the possibility of things being done a little bit differently — perhaps a little more efficiently and cost-effectively.