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.
- Her mantra: “Listen twice as much as you speak.”
- EMR forensics consulting — “Taking complexities out and making it simple.”
- Understanding the architecture of EMRs
- Building a bridge between IT and clinical
- CIO’s role in strategic & business planning
- “Biology isn’t as predictable as dollars and cents.”
- Patient engagement’s evolution
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Listen more than you speak, and make sure that you have a good answer with several options. Many times people think there’s only one direction to take, but if you listen and really understand the problem, simplify it, and explain it in a way that people can understand, I think that’s really helpful.
How things look in the system and how things print out in paper are so very different. What the date and time stamps mean and how the data got into that format — all of that complexity, most people can’t explain, because they know a piece of it but not the entire architecture of how the technology works.
If you don’t have the healthcare background, you really need to bring in some trusted leaders that will give you the truth and honesty about what’s going on in the environment, because people’s lives are at stake.
The more that family or caregivers can participate, I think the better outcomes we’re going to have. I love the fact that patients are becoming much more engaged and that we’re really reaching out to them and trying to make it a better experience.
Gamble: So really your strategy was to kind of just build trust over time and establish yourself and show what you could do and kind of let things go from there?
Crous: Sure. One of the mantras in my life has been there’s a reason we’ve been given two ears and one mouth — so that we listen twice as much as we speak. I remember when I was the CIO at Long Island Jewish Medical Center. We had a core leadership team that would meet regularly and I didn’t speak a lot; I would always speak up when I felt it was necessary, and one of my counterparts that was at North Shore University Hospital always said that when I spoke up, everybody listened, because they knew I wasn’t just going to bloviate and talk about something unnecessary.
I bring that strategy to every place that I go — whether I’m a consultant or a permanent employee — to listen more than you speak, and make sure that you have a good answer with several options. I think many times people think there’s only one direction to take, but if you listen and really understand the problem, simplify it, and explain it in a way that people can understand, I think that’s really helpful.
One of the other things I do is the EMR forensics consulting. I’ve been working with Anthony Guerra to do a presentation on that. I was hired by an attorney to help with a health system that was being sued. They were claiming that the EMR was incorrect and had resulted in a bad patient outcome. I was able to take the complexity of an EMR and explain to a jury the functionality of how the data turned out the way it did when it was printed. Because as we know, data input and data output are different things, and many of the EMRs have been designed for data input.
I remember early in my IT career, we actually started deploying an EMR that had no reporting capabilities and we ended up having to throw it out and start over. And so taking complexities out and making it simple so that even a jury of laypeople could understand is one of the strengths that I have because I’ve got such a complex and diverse background in my career.
Gamble: That’s really interesting. It’s a concept that I don’t think a lot of people are familiar with, but certainly there is a need as we’re seeing a lot of times when an implementation goes bad or there are problems, seeing things take really a different direction.
Crous: Right. It’s something that I’ve found fascinating. I felt so fortunate to be asked to do that. Understanding the architecture of how an EMR works is really important because how things look in the system and how things print out in paper are so very different. What the date and time stamps mean and how the data got into that format — all of that complexity, most people can’t explain, because they know a piece of it but not the entire architecture of how the technology works. And so in the many conversions that I’ve done and even the system selection that I did at a former job where we ultimately ended up picking Cerner and going through the contract negotiations and everything, it all builds on that knowledge base that is able to take the complexity and make it simple for others to understand.
Gamble: That’s sounds like a strong case for a using a third party when selecting systems, just to really make sure that understanding is there.
Crous: We had a very structured process when we picked our system. This was at a former place that I worked. We had 2,000 production interfaces, so on any given day, even if 1 percent of them were down, we were at risk for data loss, revenue loss or operational inefficiencies. And so we put together a very structured process for doing the evaluation. We had participation from about 14 of our 25 hospitals in making that system selection, and we made sure that the clinicians made the decision.
Being a clinician myself and being in technology, it was very difficult sometimes for me to sit back and say, ‘It’s not my job. I’m in IT; I shouldn’t be making these clinical decisions anymore,’ but I understood the compelling reasons. And so sitting on that bridge, you can really help people understand a little bit better a) if it’s going to work, and b) if it is a patient safety, because many times people will throw those two buzzwords around. But somebody with the unique skill set of both understanding the clinical and the technology can debunk any myths about whether it really is a patient safety issue or a technology issue. So it’s been kind of a fun role for me.
Gamble: That’s interesting. And that’s kind of an interesting segue into one of the other issues I wanted to talk about, and that’s just the evolving CIO role. It seems to be taking a different turn now where CIOs are thinking beyond IT and really becoming more involved in strategic planning and aligned with the business side. I wanted to get your thoughts on that and how the tide is turning.
Crous: It’s an important thing to discuss because I’m not sure we’re really there yet. I think that many CIOs, in healthcare anyway, have a very strong technology background and not a real strong clinical background, so understanding the operations of the business is key. Obviously the ones that have worked in healthcare have a better understanding of it, but I’ve seen places where there are CIOs that had been brought in from outside of healthcare, and I’m not sure that they have that business savvy of how unique the healthcare environment is because biology isn’t as predictable as dollars and cents or schedules and airline industry. So it really helps if the CIO has either worked in healthcare or has some clinical knowledge, whether they worked as a medical technologist or even any of the functions in the hospital, like a respiratory tech. If you have some of that foundational clinical understanding or if you’ve worked in a physician’s office, it helps you better understand the uniqueness of healthcare and technology. You can speak to the workflows, you can understand the patient experience, you can understand the fears of many patients and families and those kinds of things, so you can make better decisions, I think, if you understand the complexity of healthcare.
Gamble: That’s a good point. And if the CIOs don’t have that, is it that much more important to have somebody on their team that really has that background that they are in close communication with?
Crous: Absolutely. It really is key. One of my colleagues has worked with somebody that doesn’t come from a healthcare background, and when they’re sitting at the hospital and having a conversation about a workflow, it’s a whole lot easier if you can actually understand what it means. Somebody that comes from the banking industry or finance just doesn’t have that sense of understanding how critical this is. When you have dollars and cents, you can reverse something and you can have down time, but when you’re dealing with people’s lives, it’s just so much more urgent. It’s a 24 x 7 operation; you can’t just take systems down. Understanding those kinds of things is so important, and so if you don’t have the healthcare background, you really need to bring in some trusted leaders that will give you the truth and honesty about what’s going on in the environment, because people’s lives are at stake and those of us that work in healthcare understand that.
Gamble: It’s interesting when you see health IT taken the task against other industries that are further along in things like consumer engagement. You really have to take everything into consideration. It’s such a good point that this is biology and it’s human beings, and it’s just a whole different animal.
Crous: It is, and I think our healthcare consumers, are becoming much more conscious of their rights. They understand HIPAA and those kinds of things. It’s so important for them to get engaged and participate and have an advocate and a healthcare proxy and all of those things. I think it makes the experience much less frightening if you include the family or the intimate caregiver of somebody in the process.
I think we’re getting there. We’re getting to the point that people are starting to participate and realize that they’re consumers in a different capacity. Before, the doctor would say this is what needs to be done, and we’d just assume that they knew everything. But as we all know, there are a lot of medical errors and things that lead to patient outcomes that are adverse. The more that family or caregivers can participate, I think the better outcomes we’re going to have. I love the fact that patients are becoming much more engaged and that we’re really reaching out to them and trying to make it a better experience. Although in my personal opinion, how fun can it be to go to someplace where they stick sharp objects in you and expect you to enjoy it? I mean, that’s just wrong.
Gamble: Exactly, it’s an uphill battle. I think it’s going to be really interesting to see how patient engagement continues to take shape. We’ve seen a lot of changes in the last year or so, and I think that’s going to be a really interesting thing to watch.
Crous: I’m a little fearful. As we look toward the patient experience and being part of the amount of funding that we get, I’m concerned, because again, people come to the hospital not because they want to but because they have to. And so, there are things that happen in hospitals that are painful — this is a very expensive resort, but it’s not nearly as fun as going to a hotel with a beach and a swimming pool. We have to be careful to balance the customer experience with making sure that the hospitals can stay viable and get reimbursed appropriately. So I’m a little bit fearful about reimbursement based on patient experience.
Gamble: Yeah, I think there’s definitely a rationale for that.
Gamble: Okay, well, we’ve touched on a lot. I don’t know if there’s anything else you wanted to add, but it’s been really interesting to hear about what you’re doing and all the changes the organization is going through, and I definitely would like to catch up somewhere down the line and see how things are going.
Crous: Sure, I’d be delighted to. Every healthcare system’s a little bit different and I think we all learn from each other. I’ve been very fortunate to have many opportunities, but never in my wildest imagination did I think that growing up in a small town in Canada, I’d end up working in New York City. So here I am. But it’s been fun.
Gamble: I’m sure. Best of luck, and I definitely would like to catch up again and see how things have progressed.
Crous: Thank you. Pleasure to speak to you, Kate.
Gamble: You too. Thank you so much.