With any major project, establishing guiding principles is an absolutely critical step, but it’s one that doesn’t come without a healthy dose of dissidence. In fact, Laishy Williams-Carlson believes “there are some things you should argue about,” especially with a major EHR rollout. For CIOs, what’s most important is being able to establish a consensus, even where there is disagreement, and use those principles “as your north star.”
During a recent interview, Williams-Carlson talked about the Epic project she’s taking on in her new role as CIO at Roper St. Francis, and how she hopes to leverage some of the many lessons learned during the pandemic to ensure a (relatively) smooth implementation. She also talks about how she has navigated the transition from Bon Secours Mercy to Roper St. Francis — a move she made “with eyes wide open,” the difficult balance leaders face in sticking to a proven formula while also remaining “tried and true,” and how her thoughts on work-life balance have evolved.
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- Although Laishy Williams-Carlson is new to Roper St. Francis, she’s no stranger to the organization, having done some consulting during her previous role as CIO at Bon Secours Mercy. “I went into it with my eyes wide open.”
- In her first major initiative at Roper, Williams-Carlson is guiding the organization through an implementation of Bon Secours Mercy’s Epic instance, which entails creating a timeline and establishing governance.
- The biggest challenge in being a physician-led organization? “It can feel a little bit like getting pulled in a lot of directions.”
- Rolling out an EHR doesn’t have to feel like reinventing the wheel; in fact, if you’re doing it right, it shouldn’t. “You want to get that right blend of avoiding tinkering just for the sake of tinkering but also making it your own.”
- One of her key goals as CIO at Roper St. Francis is to “elevate the reputation of the team and frankly the performance of the team.”
Q&A with Laishy Williams-Carlson, Part 1
Gamble: Let’s start with an overview of Roper St. Francis Healthcare — what you have in terms of hospitals, where you’re located, and things like that.
Williams-Carlson: Absolutely. Roper St. Francis is located in the Charleston, South Carolina area. We have four hospital locations and we have hundreds of partner providers. We’re a very highly regarded provider in the area and have the highest percentage of market share. We’re also very proud of our quality scores. We’ve been ranked by Leapfrog as well as other patient safety initiatives, and we rank as a desired place to work.
Gamble: I’ve heard that before about Roper St. Francis scoring highly as a place to work. Was that something that appealed to you?
Williams-Carlson: It is. I don’t know that it’s well known by folks, but back in the day, Bon Secours owned a facility here at St. Francis. Our full name is Roper St. Francis Healthcare, which came about when we merged with Roper Hospital. I’ve been familiar with this market throughout my career with Bon Secours.
After the merger of Bon Secours and Mercy, we actually increased our share of ownership in a joint venture for Roper St. Francis. I had started working with Roper St. Francis in 2019 in my role as the CIO for Bon Secours Mercy Health. And so it wasn’t entirely a leap of faith when I took on this role, because I had been doing some consulting work for the organization. I went into it with my eyes wide open.
Gamble: So that’s a different scenario than going from one organization to a completely new one.
Williams-Carlson: It’s kind of an in between. It is very different than the relationship Bon Secours Mercy has with facilities that are wholly owned. It’s a very different role in a lot of ways. I went from being CIO of a health system that supports more than 60 hospitals on its EMR and provides services across Bon Secours Mercy, including our partners and thousands of employee providers, to a single market where there’s a much more intimate interaction with the business of taking care of patients.
It’s been a profound change in many ways, but I still get to interact with a lot of my former team and my beloved colleagues. I actually have on-going role with HealthSpan, which is a subsidiary of Bon Secours Mercy. I’m wearing a couple of hats
Gamble: Can you talk a little bit more about the role with HealthSpan and what you’re doing there?
Williams-Carlson: Sure. If you’re familiar with Catholic health systems, it’s pretty prescriptive in how we comply with ethical and religious directives, as well as some other aspects of governance that some of our partners cannot comply with for a variety of reasons.
HealthSpan is the division of Bon Secours Mercy in which some of the non-purely Catholic ventures are organized. Under the Epic Community Connect program, for example, we’re providing IT services to other organizations that could be considered a HealthSpan-type of role. It’s very closely integrated with Bon Secours Mercy but there are some things we do where they’re under a separate corporate structure.
Gamble: That is quite a few hats.
Williams-Carlson: It’s interesting; Roper St. Francis recently determined that we’re going to implement Bon Secours Mercy’s Epic Instance, switching from the current array of applications that we have. That was not a foregone conclusion when I joined Roper St. Francis, although I knew we were looking to change our array of applications to create more of a single platform.
As it turns out, the team that supports Epic and integrated solutions for other business partners is one that I created and continue to work with, and now will be providing services to me as customer. It’s very interesting. Sometimes I’m sitting on both sides of the table in negotiations. Of course, we do our best to make sure there are other parties at the table and that we’re conducting everything in a very transparent fashion.
Gamble: Right. So you knew in taking on the role that the organization was moving in the direction of a single platform. What are you now in terms of that initiative?
Williams-Carlson: We’re very early in our journey. It was just in late March that our board approved this initiative. And it’s obviously not an inexpensive project to undertake. I’ve done many, many Epic implementations over my career, so it’s fun to be doing one again. We’re collaborating with Bon Secours Mercy’s team on creating the timeline and guiding principles, and establishing governance.
Gamble: Having done this before, you know what some of the challenges are when rolling out Epic, but of course, this is a different scenario.
Williams-Carlson: That’s true. One of the really fascinating things about Roper St. Francis is that the other partner in the organization is the Medical Society of South Carolina. Roper St. Francis is a physician-led organization and our CEO is a physician. He has his MBA; he’s brilliant and I already love working with him. In fact, it’s one of the reasons I was excited to join this team here.
In a physician-led organization, the leaders of the health system are involved at a different level than I’ve ever seen before. Occasionally it can feel like getting pulled in a lot of directions, but the tone from the top has been great.
But yes, I am aware of all the perils. I think Roper St. Francis’ leadership team is going into this eyes wide open with an appreciation for what went well and not so well with prior system implementations and we want to take all those lessons learned and make sure that we have a great tone from the top and a great governance structure.
We’re also going to be partnering with Ensemble to guide our revenue cycle implementation of Epic and assure we have great outcomes. We certainly don’t want to be one of those health systems that makes headlines for having a bad financial outcome from its Epic implementation. I really do think we’re going into it eyes wide open about what the risks are, and that we have the right risk mitigation approach.
Gamble: Right. Now with this Epic rollout, will you change your approach?
Williams-Carlson: The Epic implementation methodology has not been an approach of, are you in love with this work flow and is it the very favorite one you’ve ever seen — it’s more about building consensus. It’s asking why something wouldn’t work, and trying to guide teams to not reinvent the wheel. We will be doubling down on that approach with our implementation at Roper St. Francis. We have a system that works in 60 hospitals and thousands of practices now.
To me, it’s liberating in that we’re not trying to write our own recipe or start from scratch. We’re adapting a system that’s tried and true and that we know works well. The challenge for us will be to adapt as much of it as we can as it exists in its current state, but also infuse a little bit about what is best about Roper St. Francis. There are some signature things that we’re really proud of and do well. And so we want to get that right blend of avoiding tinkering just for the sake of tinkering but also making it our own. I don’t know what that blend exactly will look like; it’s early in the process. But hopefully, we’ll get that right.
Gamble: I can’t imagine it’s easy to strike that balance.
Williams-Carlson: We’re reviewing all of Epic’s best practices for implementations. Again, it’s not my first rodeo. And so, as I’m reviewing the materials, it’s like, ‘Yes, I remember this.’ What I’m really excited about is that Roper St. Francis already has a great reputation for patient safety and holistic patient care, and that’s with a current array of software solutions that are not a single platform — not a one patient, one record platform. And so I feel that this opportunity to elevate our care even further is really exciting. Throughout the organization, people are excited about implementing a single platform.
It’s something I’m really looking forward to. My plan now is that this will be the last chapter in my career. It’s a great place to be. I think 2020 was such a crazy year with the pandemic and the way that healthcare stepped up to meet the challenges of the pandemic, specifically information technology. We did a lot of things at Bon Secours Mercy that I was extraordinarily proud of as part of our response to the pandemic.
And yet, being remote and away from the frontlines of patient care for that year gave me an opportunity to reflect on what fills my cup, as my boss from Bon Secours Mercy calls it. I love my team and I love working with Bon Secours Mercy, but I really missed being in a single market where the healthcare system is one you interact with daily, both as a community member as well as an executive leader. It reminded me that what fills my cup is really being integrated with healthcare operations.
I felt that call to get back to those roots and I went in very excited. I only had my first panic attack when my husband, who was incredibly supportive as always, said, ‘it’s been a long time since you only had four hospitals to worry about. The budgets you’re going to be dealing with are going to be like missing a zero.’ That was the first time I panicked. But so far it’s been a lot of fun.
Gamble: And of course you already knew people in the organization, which makes a big difference.
Williams-Carlson: Yes. Because we were doing some consulting from Bon Secours Mercy with our new partners at Roper St. Francis, I knew the IT leadership team. I know a lot of the members of the C-Suite. As I said, I was able to go into it eyes wide open and knew what the strengths and weaknesses were and are.
Gamble: Now, aside from Epic, which is clearly a big priority, what are some of your other core objectives?
Williams-Carlson: Outside of using the Epic implementation, which is the tool we use to transform care and create a better experience for our patients, my second big area of focus is to elevate the credibility, reputation and performance of our IT team. It’s an extraordinary team that works really hard, and doesn’t get a lot of credit for what they do.
I’d really like to elevate the reputation of the team, and frankly, the performance. Some of my early team building work with my direct report has been focused on building a high-trust team. I’m a big fan of The Five Dysfunctions book and focusing very intentionally on building a team. Early on, they said one thing they felt they did really was to get a lot of work done. They accomplish a lot, and yet, if you went to other areas of the organization, the perception was not that IT got a lot done. That highlights a disconnect between the effort that IT is expending and what’s seen by the organization. I think a lot of that stems from the disaggregated portfolio we have right now; the number of touches and efforts required to keep all these systems up and running is phenomenal and not well understood.
I really look forward to elevating the team, coaching some of the leaders to the next level of performance, and making sure that when I move on to do something else, that Roper St. Francis will be in good shape with strong leaders at the helm for IT.