Q&A with Laura Marquez, Part 1: “Having the voice of the consumer is so important.”

For healthcare leaders, creating a culture of collaboration can be extremely challenging, particularly in groups that include both extroverts and introverts. Laura Marquez has a solution that involves doing something out of character for those in senior positions.

“I have an idea, but I’d like to hear from you guys first.”

Doing so, she said during a recent interview, “opens up the platform” and encourages individuals to float their own ideas. It’s one of many pieces of advice Marquez, AVP of IT Applications at UConn Health, offered to colleagues based on her own experiences.

During the discussion, she shared insights on what it takes to build “a culture of safety, her approach in leading virtual teams, the critical role IT governance strategies can play, and what UConn Health is doing to more effectively engage with patients.

LISTEN HERE USING THE PLAYER BELOW OR SUBSCRIBE THROUGH YOUR FAVORITE PODCASTING SERVICE. 

Podcast: Play in new window | Download (Duration: 14:49 — 8.0MB)

Subscribe: Apple Podcasts | Spotify | Android | Pandora | iHeartRadio | Podchaser | Podcast Index | Email | TuneIn | RSS

Bold Statements

We’re also taking a step back to say, how can we improve access for our patients in terms of reducing new patient lead time? Let’s stand up direct scheduling. Let’s implement fast pass in more areas. We want to leverage the tools that we have at play.

It’s imperative that we’re working both with the marketing and patient experience offices, as well as our other business stakeholders throughout the organization. We want to make sure we’re rowing in the same direction.

We wanted a diverse selection of patient volunteers who would then have access to our test environment. That way, before new features are rolled out, we’re able to bring it to the work group. We get their candid, honest feedback, and we’re able to pivot.

I think all systems struggle with the fact that there’s never a shortage of work. As a matter of fact, there are far more projects submitted than we could even get accomplished.

 

Gamble:  I’m really glad we could set aside time to chat. Can you start by providing a high-level look at UConn Health — what you have in terms of hospitals, where you’re located, things like that?

Marquez:  Sure. We’re a 224-bed academic medical center located in Farmington, Conn. We pride ourselves on serving the community as a state organization. We have a great ambulatory network with clinics representing a wide variety of specialties. We also have the School of Medicine and School of Dental Medicine. We’re diverse in who we serve. It’s been a wonderful opportunity to continue to use technology in different ways to help our caregivers.

 

Gamble:  In your role as AVP of IT applications, what do you consider to be your core objectives?

Marquez:  We’re an Epic shop, and so there’s no shortage of work keeping up with the quarterly updates and the new migration to Hyperdrive. One of the really important things on our roadmap is our partnership with Connecticut Children’s to stand up a NICU within our hospital. As part of that, we’re bringing them onto our electronic health record. It’s been a great cross collaboration with Connecticut Children’s to partner and find some creative solutions for how we can best serve those critically ill babies.

 

Gamble:  Were they already on an EHR?

Marquez:  They were still on paper. UConn went live on the EHR in 2018, but because the NICU is owned and operated by Connecticut Children’s, it was out of scope for the EMR implementation. We certainly had plans to bring it live much sooner, but unfortunately, the pandemic got in the way of our priorities, as it did for every organization. And so, we made it a point to make sure we circle back and get them brought up to an EHR.

 

Gamble:  I imagine that comes with a unique set of challenges when you’re going from paper to electronic.

Absolutely. Connecticut Children’s is on their own Epic instance, and we have our own instance. And so, it’s working through some of the unique scenarios for the legal medical record and things like release of information. There are two different MyChart accounts between UConn and Connecticut Children’s. But I’m happy to say it’s been a wonderful opportunity. We established a great relationship with them.

 

Gamble:  What are some of the other areas you’re looking at right now?

Marquez:  We’re very focused on access. Epic is rolling out the new customer relationship module, Cheers, so we’re looking at that.

We’re also taking a step back to say, how can we improve access for our patients in terms of reducing new patient lead time? Let’s stand up direct scheduling. Let’s implement fast pass in more areas. We want to leverage the tools that we have at play.

One of the unique pieces with UConn Health is that we went live in 2018 and got through one major upgrade, and then the pandemic hit, and we had to pivot. Now that we’re on the other side of that, we’re thinking about how we can engage more with patients. How can we make sure they have a frictionless experience with our health system? And that’s from soup to nuts; it starts with a prospective patient, someone who might be shopping for services, and goes all the way through to when they receive a bill. We want each of those touch points to be a seamless journey for the patient. Because if you get through all of it and have wonderful experiences, but then you get a bill that’s wrong, it could ruin the entire experience. We’re really mindful of that patient journey and are trying to make it as seamless and frictionless as possible.

 

“Change the culture”

Gamble:  There’s probably a multifaceted strategy involved in making that work. Can you talk a little bit about that?

Marquez:  Absolutely. As the IT department, it’s imperative that we’re working both with the marketing and patient experience offices, as well as our other business stakeholders throughout the organization. We want to make sure we’re rowing in the same direction. For example, looking at a CRM module that allows us to avoid having a multitude of different vendors and, and thinking about how we can streamline it, because the source of truth is the EMR. The more native CRM is to the EMR, the fewer bolt-on solutions you need.

All of our executives share the same vision: how can we continue to improve this? Our first touch point in thinking about access is, how can we make sure patients can request appointments? Do we have access to open slots on the provider’s schedules? That’s a big project we’ve been working on with our operational counterparts to change the culture and have practitioners let go of their schedules so we can meet the needs of patients differently and not have all these blocks and holds. It’s letting the system and automation help fill some of those slots.

It’s definitely a different perspective. We’re targeting a lot of our focus there, as well as on the billing side. Especially with the different regulations that have come down with price transparency and shoppable services, we’re making sure that we’re meeting our patients’ needs so that they can make informed decisions and know how much a procedure might cost them.

 

Patient experience workgroups

Gamble:  What’s your process in terms of getting input from patients so you can make sure their needs are being met?

Marquez:  When I came to UConn Health, we looked at the MyChart steering committee and decided to do things differently. And so, we created a patient experience work group that actually sits outside of the advisory council. Most hospital systems have patient and family advisory councils. This actually sits within IT, alongside our portal experts and analysts. We surveyed patients to invite them to volunteer and sit on this work group.

We looked at a wide variety of factors. How often are they using the system? Do they have accounts at multiple health systems? Is English their second language? What’s their age range? We wanted a diverse selection of patient volunteers who would then have access to our test environment. That way, before new features are rolled out, we’re able to bring it to the work group. We get their candid, honest feedback, and we’re able to pivot and rapidly make changes based on that feedback.

For example, it could be something like the verbiage across the page. While it might be clear to an IT teammate, maybe it doesn’t make sense or isn’t that clear to the patient, and we’re able to quickly make those changes. Having that voice of the consumer, the voice of the patient, is so important.

That’s just one way we’re doing it. We also partner with the patient experience office and review Press Ganey results and comments that are submitted. We want to turn any pain point the patient encounters into an actionable finding — what can we do differently? How can we make that improvement so that another patient doesn’t have to go through that same pain point?

 

“Continuous feedback”

Gamble:  Very interesting. I bet you get some very honest, unfiltered feedback.

Marquez:  We do. And sometimes they’ll bring forward suggestions that are completely homegrown—those are sometimes the best ones. For example, one patient said to us, ‘There’s a character limit when I message my provider. Can we increase that?’ And so, we brought it to a MyChart work group where we socialized it amongst some of the clinical directors, who then helped form a recommendation. It was at 400 characters, and so we said we could go up to either 1,000 or 1,500 characters. That recommendation went to the MyChart steering committee — which many physicians participate in — and they decided to increase it to 1,000. We tested that out, and queried practitioners to determine whether it was causing an undue burden.

That continuous feedback loop is just so important. We’ve had a lot of great suggestions come through there.

 

Nursing informaticists as liaisons

Gamble:  What about caregivers — what are you doing to ensure they have a positive experience?

Vasquez:  We’re using data to drive some decisions. Our focus is going to be on nursing documentation, especially given the staffing shortage and burnout rate. We want to look at the minutes spent. Where are nurses spending most of their time? Our data show that they’re focused a lot on the flow sheets. Do we have redundancies? We’re using some of the tools to tease out what’s required versus what might be extraneous or duplicate documentation, and determine how we can reduce that.

One of the ways we’re doing that is by making a pitch for a nursing informaticist to come in and act as a liaison between operations and caregivers. Informaticists typically have clinic experience, and so they can serve as a translator for some of the recommendations that might come forth.

UConn Health hasn’t had a nursing informatics team in quite some time. We’re looking to build that back up, because I think that’s really key. For our projects to be successful, we need to make sure we understand what problems we’re trying to solve. And then let’s look at some solutions or potential ways to combat those problems. An informaticist liaison is key to understanding the workflow.

 

“Downstream impacts”

Gamble:  That seems to be a really important piece — having an informatics team in place to make sure the EHR and other systems are being utilized effectively.

Marquez:  Correct. And also, when someone might be struggling, and they call in a ticket or engage an IT resource, they might not realize that the request that they’ve made could have downstream impacts for someone else. That’s where we want to vet some of those requests and be able to better understand the problem.

It could be a training opportunity. It might not even require a build change; perhaps it’s an opportunity for that caregiver to understand a different way to do things. They may not have been privy to a new feature or technology that could solve some of these problems.

 

Gamble:  Right. And that’s where governance comes in as well.

Marquez:  We’re still young in our PMO origination and IT governance. I think all systems struggle with the fact that there’s never a shortage of work. As a matter of fact, there are far more projects submitted than we could even get accomplished. And so, it’s really critical for those who sit on IT governance to make sure we have true priorities. Because if everything’s a priority, then nothing is a priority. How can we get out of that vertical thinking and start to think more horizontally and ensure that we’re selecting projects that are agreed upon across the continuum and support our larger organizational goals?

Part 2