Q&A with Karen Marhefka, Part 2: “In a remote structure, everyone has more of a voice.”

Things have changed quite a bit since 2012 in healthcare IT.

When it comes to EHR implementations, how much has really changed since 2012? There’s one way to find out: by taking on a similar initiative in today’s world and comparing notes. Last spring, Karen Marhefka had the chance to do just that when she accepted a CIO with a medical group that was rolling out Epic. For Marhefka, who had been through an extremely similar situation with UMass Memorial nine years ago, it felt like déjà vu at its finest.

There were, however, a few major differences. This time around, Marhefka was in perfect spot from a career standpoint; she had just completed her Doctorate of Healthcare Administration and was looking for an opportunity to channel her passion for helping organizations with implementation and optimization efforts.

And of course, there was another key factor. “Health systems know so much more. The vendors know so much more,” she said. “It was like we all graduated with PhDs in how this works.”

A year after her arrival, the rollout is rolling along smoothly, thanks to the “intense amount of planning” put forth by leadership, and the decision to utilize a phased approach, according to Marhefka. During a recent interview, she talked about how RWJBarnabas is working to merge cultures; how Epic is nudging her team toward standardization; and why it’s critical to focus more on operational change than technology change. She also opens up about what she learned during her time with Liz Johnson, and why powerful people need someone watching their blindside.

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Key Takeaways

• For Marhefka, taking on the interim CIO role at RWJBarnabas offered the perfect opportunity to channel her passion for “helping organizations and continuing with implementations and optimizing what they’ve achieved.”
• The difference between rolling out Epic in 2012 and 2021 was significant for Marhefka, who brought nearly a decade of industry experience and knowledge the second time around.
• As an advisor to Liz Smith, then CIO of Acute Care Hospitals and Applied Clinical Informatics at Tenet Healthcare, Marhefka was able to hone her skills in “navigating the different levels of hierarchy in the IT world, and the politics and all of the nuances that go into the profession.”
• Not only can working in the remote setting increase productivity; it was also encourage independence and add “some individuality into how work gets done.”

 

Q&A with Karen Marhefka, Part 2 [Click here to read Part 1]

Gamble:  What was your approach coming into the role?

Marhefka:  I had just joined a new firm, Impact Advisors. This was during Covid when many consulting firms weren’t hiring to the bench; they were hiring to fill a need where a request has been made. A person within Impact who has become a very good friend called and asked if I wanted the role and I thought, ‘do I want to go back into a CIO role with a medical group that’s just deploying Epic? I don’t know that I want to do that again.’

My husband was actually sitting on the couch next to me and he looked at me said, ‘You absolutely want to do that again.’ And we talked about all the reasons for that. I had just finished a doctorate. I wanted to focus my work from a consulting perspective into something — where am I going to put all this passion that I have and for helping organizations, continuing with implementations, and optimizing what they’ve achieved with all these big implementations? Here it was presented to me, literally on a gold platter. ‘We want you to help this huge organization through this big implementation, both from a cultural merging perspective and a go-live perspective.’

I was very hesitant because at the time, I felt it meant going back to my going UMass roots and picking up where I left off. I’m so glad I did, because for me, it’s taking my expanded education — both academically and experience-wise — and applying it in 2021. I wasn’t going back to 2012 and doing a repeat. This was Karen 10 years later, with a lot of experience and a lot of tough years in between, of learning things and expanding knowledge and all that goes with that, to be able to apply that to this organization.

Every day I’m rewarded with the fact that people appreciate that knowledge. They appreciate the collaboration, and I get that every day. I didn’t know that would be the case, and so I’m extremely grateful for the encouragement of my family, my husband, my friends in the consulting world, and former CIOs I’ve stayed close with who said, ‘Go for it. This is going to be an unbelievable experience.’

 

Gamble:  As far as becoming a full-time, how did that come about? That sounds like that was certainly a welcome situation.

Marhefka:  It really was. I’m truly flattered, honored, and humbled by the fact that this organization wanted me to come on board full-time as a permanent member in a remote capacity. I will be traveling once the bans are lifted. I will be traveling to New Jersey when it’s appropriate, but not having not to move was huge. I was in the interim role for about 6 months and had a chance to prove to myself, to the organization, and to the folks I oversee that I could do this. For them to come to the conclusion that it was working out and they wanted me to come on board permanently and that not much would change was so gratifying. We love what you’re doing and if you love what you’re doing, then let’s just do it.

It was a natural evolution; it wasn’t a jarring decision, at least on my part. It was a very natural progression. I’m the luckiest person on Earth to have all of this come together. I really am.

 

Gamble:  It’s nice when things happen that way. Prior to Impact Advisors, I know you were with Tenet for a while. How do you feel that that experience well prepared you for this role now?

Marhefka:  I was with Tenet for 7 years; all of that was through Encore Health Resources. Encore underwent a lot of changes, but throughout all of it, my contract with Tenet remained. I was very fortunate that I didn’t have to switch companies.

In terms of how the experience affected me, there were a few things. First, Tenet is massive, and so change is going to be hard. They have to be very focused on the things they want to change. In my role, I worked very closely with Liz Johnson the entire time. My role was twofold; it was to help advise Liz and her staff when they were handed things to pivot on. I would do some research and help them figure out their go-forward plan. It was very much of an advisory capacity.

But it was also an opportunity for me. She was a very powerful senior person in an HIT leadership role at a very large organization, and my role was to watch her blindside. When people at CHIME and HIMSS would see Liz and I walk into those forums, they had that look in their eyes — I saw it every time — that said, ‘Karen, what the heck are you doing?’

My role was truly watching Liz’s blindside, making sure that she knew things, was prepared for things, and could stay ahead of things, whether it was federal regulations or anything. That was my job. During that time, Liz was very supportive of me because I was getting my doctorate. Through the work that I did, the people I was exposed to, and the organization I was working with, I had incredible subject matter for every paper that I wrote. For five-and-a-half years, I had case studies of everything you can imagine. It was just a perfect platform — not only to do my job, which was first and foremost, but also to feed my academic needs.

It was incredible, and I’m still reaping the benefit and the reward from that. But I hope folks understand that for me, it’s about paying it forward, and protecting someone’s blindside is a very noble thing to do.

 

Gamble:  That’s really interesting. I’m sure it really was a great opportunity to watch and learn, especially when you think about how many times someone like Liz is approached.

Marhefka:  It was. I would say the educational part was in honing my skills in navigating the different levels of hierarchy in the IT world — all of the politics and nuances that go into the profession of leadership in an ever-changing world. It’s maneuvering around the vendor world versus the consulting world versus the health system world, as well as the professional enclaves like HIMSS and CHIME. It’s maneuvering through all of that and using it to make a difference — that was my classroom for learning how to do it, while applying it to help someone who was in the middle of it.

 

Gamble:  I would imagine you approach things differently, having that experience under your belt.

Marhefka:  Yes. And as I’m describing my Tenet role and with Liz, it’s occurring to me that I’m doing the exact same thing with Bob Irwin; with Andy Anderson, the CEO of the medical group; and with Tip Ford, the chief operating officer for the medical group. I’m doing the same thing with them. I’m watching their blind sides. That’s a passion for me. It’s very rewarding and it’s a big enhancement to my job. It’s not just making sure things are happening and going through status reports; it’s watching out for people, even though they’re not asking for it. They’re not asking for me to step into that role. But where I can give someone a heads up or be their whisperer, I tend to do that. Again, it’s not asked for, but it’s always appreciated. And you have to be careful how you do it, because some folks don’t want that, and so there’s a sensitivity around doing that.

 

Gamble:  It’s fascinating. People like Bob Irwin and Liz Johnson are extremely perspective people, but the number of organizations and individuals who are trying to get through to them is more than one person can handle.

Marhefka:  With Liz, there were two or three things she was most wary of, and so we were able to define those as danger points. But they’re different for everybody. By being able to do that as for as many years as I did with Liz and with Tenet via my consulting role, I found that I’m a very non-hierarchical person. Healthcare IT tends to be a very hierarchical, and I’m just not that person.

Of course, you definitely have to have order. I always say that people will find a line and stand in it, because it just feels better. The same thing is true with reporting lines. But I just don’t feel comfortable in super structured, hierarchical organizations. RWJBarnabas has its hierarchies, but there’s just so much room for collaboration. That’s one of the reasons why I was excited to join, because that really fit me.

 

Gamble:  I think there are definitely people who share that viewpoint, but I can see that changing in the future as roles evolve.

Marhefka:  Yes. And I think remote working has a lot of impact on that as well. I’m on GoToMeeting calls from 7 in the morning until 7 at night; we can pack a lot into a day without the challenges of going to conference rooms or getting on airplanes or just going across the parking lot to another building. That all takes time. A remote setting not only enhances work productivity; it pushes the buttons on independent working, and actually adds some individuality into how work gets done. There’s just so much more opportunity to be able to do that rather than sitting around conference tables and having the focus and the attention be on one, two or three people. I have a real sense that in this remote structure, everybody has more of a voice.

You have less of that hierarchical culture, which is what I have whenever I go into a conference room. There’s a difference there. There’s respect that needs to be there; that’s what we all grew up with. But in a remote setting, everybody’s on even ground. It’s even-steven right across that screen, and I think it has given everybody more of an individual voice, an opportunity as an independent contributor to maybe see themselves a little bit differently than in a pure hierarchical structure.

 

Gamble:  I agree. I can see that too and I think it’s pretty amazing how it has helped take steps in a more positive direction. Well, I want to thank you so much for taking the time to speak. I know things are crazy, and so we really appreciate it. 

Marhefka:  I am too. Thank you so much for reaching out.