Q&A with CIO Terri Couts, Part 1: “If you’re not adapting, you’re not surviving.”

When the Guthrie Clinic hired Terri Couts as VP of Clinical Applications in 2016, it was for a very specific reason: her Epic expertise. To say that the Epic implementation hadn’t been going well is a massive understatement. Clinicians were leaving in droves — in many cases, citing the EMR as a key factor.

Couts, however, believed it wasn’t the technology itself, but rather, the way in which it had been deployed. And so, she led an effort to revamp the entire process, “from the time we onboarded a new clinician all the way through upgrades,” and focus heavily on building relationships with users. The strategy quickly paid dividends, as clinician satisfaction rates skyrocketed, and the organization achieved STARS 10 Epic Status.

Even more importantly, a playbook was established for future projects, helping to ensure that Guthrie would be able to roll out projects more efficiently in the future. During a recent interview, Couts talked about how her background helped prepare her for the CIO role — which she took on in July of 2021, why it’s so critical to focus on the end user, and how her team hopes to lessen the documentation burden on nurses through its Nightengale Initiative.

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Key Takeaways

• For Guthrie, the primary focus in 2022 is in three key areas: patient experience, quality and expanding virtual care. “By meeting patients where they are and having high quality outcomes, everything else will follow.”
• Both Couts and Guthrie’s new CEO, Edmund Sabanegh, Jr., previously spent time at Mayo Clinic, and are applying some of the same philosophies. “We’ve changed our thinking.”
• Unlike in years past, CIOs don’t necessarily have to understand all aspects of technology. What’s more important making sure the end user – whether that be patients or caregivers – in focus.
• Through the increased use of virtual care services and remote monitoring, Guthrie is “transforming to more of a holistic approach to care versus providing the traditional task-oriented care.”
• One of the positive impacts of Covid? “It has made us more agile. In healthcare, we have a tendency to overthink and over analyze everything, and it slows down our ability to deliver on a product.”

Q&A with Terri Couts, SVP and CIO, The Guthrie Clinic, Part 1

Gamble:  Thanks so much for putting aside some time to speak. Can you start by giving a high-level overview of Guthrie in terms of the types of care you provide, where you’re located and things like that?

Couts:  Guthrie is an integrated health system offering the full spectrum of health services. We’re located in Pennsylvania and New York, kind of where the southern and northern tiers of both of those states mesh together. We have five hospitals — two in New York and three in Pennsylvania, and about 36 associated multispecialty clinics. We are primarily rural care and we serve a large population over a wide geographic area.

 

Gamble:  So you cover the gamut of care. I imagine that’s one of the biggest appeals of the organization.

Couts:  It is. When I first started here, I wasn’t that familiar with the organization. But I committed to listening because I was recruited by a colleague I had worked with before, and I just fell in love with the organization. They’re very family oriented. They have a philosophy based off the Mayo Clinic; it’s very physician focused as far as managing practices. And the culture was very appealing — that’s why I joined. I’ve been here about six years.

 

3 Core Objectives

Gamble:  Looking at 2022, what are your primary objectives?

Couts:  We’re in interesting time at Guthrie. I’m new to my role; prior to the CIO role, I was the VP of Clinical Applications. I’ve only been in my role for a few months now. We also have a new CEO — Edmund Sabanegh Jr., MD — who comes to us from the Cleveland Clinic.

We just ended our 5-year strategic plan, so we’re in the midst of developing that. We’re focused on three key areas: patient experience and satisfaction; quality, which is number one; and expanding our virtual care services. We believe that by meeting patients where they are and delivering having high quality outcomes, everything else will follow — revenue, growth, and other things you typically strive for. Those are going to be our main priorities, and underneath that is cost containment.

 

Virtual care in rural settings

Gamble:  You talked about creating a new strategic plan. I’m sure that’s quite a process.

Couts:  It is. And on top of that, having a new leader. Our previous CEO was here for about 40 years, and was in the CEO role for about 9 years. It’s definitely a shift. Dr. Sabanegh is very focused on quality in patient experience. He brings his knowledge and skillsets to help us redirect how we care for patients.

When you look at patient experience, there’s this perceptive that rural populations can’t do virtual care well; that the clientele doesn’t have an interest because it’s usually an older population or people like farmers. During Covid, we found that not to be true. Most of our virtual care users were of the older population.

We’re looking at how we can expand that and provide care differently for our patients, because you don’t have to be in the geographical region in which you live to get care in many cases. I can sit in my chair today and get care from NYU. Like many organizations, we’ve changed our thinking, and Dr. Sabanegh has helped drive that.

 

Gamble:  Right. I’m sure he brings a lot to the table being from Cleveland Clinic. But at the same time, it’s such a different organization, so it was probably a big adjustment for him.

Couts:  He’s used to a different pace, which we’re all adjusting to. But I worked as a nurse at the Cleveland Clinic, and so I understand the culture and have probably acclimated to his leadership style a little more quickly than some of my peers. I’m excited about the change he’s bringing.

 

The “new dynamic” in the C-suite

Gamble:  You mentioned being relatively new to the CIO role. Can you talk about how you managed the transition?

Couts:  I think that there is a new dynamic in the healthcare C-suite, particularly in the CIO space, where you don’t necessarily have to understand all aspects of technology. I think being a clinician and understanding how technology can either enhance or become a barrier in your work is more useful when you’re looking at business opportunities than it is with deployed technology.

I approached my transition in the same way. I don’t have to be the expert in every area, but the fundamentals are the same if you look at the fact that with all of the technology we roll out, at the end is the patient or the caregiver.

And so, we need to make sure we always keep that in focus. No matter what we’re doing, whether it’s a business application or clinical application or even a printer, if you keep the patient in focus, you’ll always have the same outcomes. Anything we deploy enhances care or enables care in some way.

 

A more holistic approach 

Gamble:  Right. I can imagine the nursing experience really does come into play quite a bit in your role, especially with patient experience, satisfaction being one of the key pillars.

Couts:  It’s really interesting because we think about patient experience in so many different forms. But as we talk about physician or nursing burnout, there wasn’t really a focus until the last year or so on the patient impact. They really do have a choice now; the pandemic has highlighted that for those of us who are a little slower to get into the virtual care. I think we were kind of middle of the road. We had some telehealth capabilities. But the pandemic really highlighted the fact that the traditional ‘in front of the doctor’ visit isn’t necessary applicable in all cases.

There are these cases where virtual care is not appropriate. However, with wearables and monitors and cameras, we can care for patients in different ways and make them more comfortable. Who wouldn’t want to stay in their bed at home versus being in a hospital bed that’s loud, noisy, bright, and has constant interruptions? How can people heal that way? And so I think we’re transforming to more of a holistic approach to care versus providing the traditional task-oriented care.

 

“It forced us to be agile.”

Gamble:  Right. Even for organizations that were already adopting a holistic approach, things were certainly moved along quicker by Covid.

Couts:  I think it has made us more agile. In healthcare, we have a tendency to overthink and over analyze everything. It slows down your ability to deliver on a product, and before you know it, it’s already outdated. With reporting requirements and testing requirements, and even trying to figure out how to configure patient rooms — all of these things were being managed by state and federal regulation. It forced us to be agile and quick since we didn’t have the luxury of time.

I don’t think that’s going to go away. I think that now that patients have experience care differently, we’ve had to deliver at a speed that we weren’t traditionally accustomed to. These expectations are level-set, and we have to continue that. If you don’t deliver, you have to get off the bus, because healthcare is struggling in all areas. If you’re not adapting, you’re not surviving.

Part 2