Q&A with Laura Marquez, Part 2: “Culture Change Is Hard, But We All Play a Part.”

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.

*Editor’s note: After this interview was held, Marquez announced she was starting a new role as Senior Director for Transformation at University of Utah Health in July of 2022.

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Bold Statements

Saying no is hard, but it’s so important. Because the more you deviate away from the foundation system and the more you deviate from how the EMR is set up, the more maintenance you’ll have long-term and the harder it is to continue to support and maintain. (1:15)

With every project, I encourage my teams to ask two questions: what are we missing? What did we not consider? And taking that a step further, what possible downstream impact could this have? Because when we have a questioning mindset, I think that’s what continues to promote a culture of safety. (3:30)

In order to move forward and get to the bleeding edge of pioneering and trying to new things to really digitize healthcare, we have to remember that every single person matters. What they do matters. And we have to reconnect it to our mission, vision, and values. (6:14)

It’s okay to ask for help. It’s okay to block out your calendar. It’s okay to turn off your camera. I think that really helps set clear expectations and remove anxiety, especially in this virtual world. (8:20)

I never thought in a million years that I would be leading virtual teams. I’m an extrovert; I thrive off the energy of others and I love being in the office. (10:05)

Q&A with Laura Marquez, Part 2 [To view Part 1, click here.]

Gamble:  You mentioned that sometimes when requests are put in, the people who make them aren’t aware of the downstream effects. That’s a challenge so many organizations are dealing with, and I imagine it has to be handled pretty carefully.

Marquez:  Yes. Especially before IT resources are dedicated to trying to build out a solution. At one of my prior organizations, tickets could only be submitted by managers and above for enhancement-type requests or optimizations. That had to be vetted at the departmental level because we wanted to make sure there was a little bit more oversight. It couldn’t just be anyone submitting a requested change.

In terms of governance, it’s important to have a body, whether it’s a physician advisory council or nursing advisory council. That’s the next step in our growth to establish smaller councils where we can have that continued input and have physician builders or other informaticists at the table to say, ‘This really doesn’t make too much sense. That’s not a workflow that we would want to support,’ and be okay denying those requests.

Saying no is hard, but it’s so important. Because the more you deviate away from the foundation system and the more you deviate from how the EMR is set up, the more maintenance you’ll have long-term and the harder it is to continue to support and maintain.

 

Gamble:  Definitely. It’s also about having the right culture in place. You want a culture where people are empowered to do their best and enjoy what they’re doing, but it’s no easy task. How do you approach that?

Marquez:  First and foremost, you have to create a culture of safety, where people are welcomed to have a voice. You do that by seeking feedback and making sure you’re inviting others to contribute — and not just the extroverts, but also giving the introverts a chance to participate. As a leader, rather than sharing your idea first, say something to the effect of, ‘I have an idea, but I’d like to hear from you guys first,’ which helps open the platform.

The other thing is welcoming debate by saying, ‘I want to hear an opposing view. What do you guys think? Why should we not do this?’ It’s having that dialogue to make sure there isn’t fear behind it, and if there is, helping to squash that.

People should be able to stop the line. They should be able to raise the white flag. Anyone at any point should be able to voice a concern or say, ‘there’s something I want to discuss further before we move forward.’ We need to promote that. We need to thank people for making suggestions and we need to reward the behavior that creates a positive loop.

 

Gamble:  That’s a really interesting philosophy. I would think it’s a great opportunity to voice concerns right from the right, which can help buy-in.

Marquez:  Yes. With every project – every body of work – I encourage my teams to ask two questions: what are we missing? What did we not consider? And taking that a step further, what possible downstream impact could this have? Because when we have a questioning mindset, I think that’s what continues to promote a culture of safety.

Everyone thinks a little bit differently, especially if they have different strengths. You might have someone with strategic foresight who can take that 30,000-ft. view and be able to predict things in the future. You want to tap into them, because they might be thinking differently about downstream impacts than someone who wants to move quickly. Culture change is hard, but we all play a part in it.

It’s also about keeping people accountable so that if we do see bad behaviors where people feel uneasy or don’t want to speak up, we can address them head-on. No one wants to work at a place where they don’t feel valued. Every single person should be able to contribute.

 

Gamble:  That’s important. I remember earlier in my career being called a ‘negative Nelly,’ because I would say, ‘what if this happens?’ And I know from experience that if someone is discouraged to speak up, they’re going to shut down.

Marquez:  Absolutely. You were probably being a realist – ‘if this happens, do we have a contingency plan? How are we doing to mitigate this risk?’ Everyone in the organization should be able to speak openly about these things. That’s why the question of ‘what are we missing’ is so important. It helps open up a dialogue where we can ensure we’ve thought about everything, and that we’re headed down the right path.

 

Gamble:  Another area I want to get into is the idea of connecting to purpose, which can be challenging in IT. I’d like to get your thoughts on how that can be done.

Marquez:  As we continue to use technology to meet the business needs and solve business problems, we want to enable strategies by offering different solutions. I think most organizations have a great opportunity to break down that wall of ‘us versus them.’ This is a partnership. This is a collaboration. In order to move forward and get to the bleeding edge of pioneering and trying to new things to really digitize healthcare, we have to remember that every single person matters. What they do matters. And we have to reconnect it to our mission, vision, and values. I think that’s so important when we have successes to celebrate those wins; big or small, everything should be celebrated.

We also need to take the time to acknowledge our workforce, whether it’s the helpdesk team, or someone who’s working on the server, network segmentation or security, or a developer or analyst — we all come together to play such an important role for the bigger picture. At UConn Health, it’s meeting our values and pillars to be innovative, to showcase leadership, and to be thoughtful about how we can integrate research and use different technologies or thinking to improve outcomes.

Connecting back to purpose helps remind people why they’re here. We all have a calling to healthcare, and I believe that acknowledging and showing appreciation for what people do can helps keep them showing up as their best selves every day.

 

Gamble:  What are some of the best ways to do that? Through rounding or similar initiatives?

Marquez:  Quinn Studer has amazing ideas for rounding — meeting with employees one on one to talk about what’s working well, what’s not, what we should keep doing, what we should change, and what ideas they have. It’s keeping an open dialogue. Do you have everything you need to do your job?

It’s very powerful. It shouldn’t just be an exercise to check a box; it should be on a personal level. We have what I refer to as unspoken rules. I have three slides I like to present; all of them include ‘it’s okay’ statements. For example, it’s okay to ask for help. It’s okay to block out your calendar. It’s okay to turn off your camera. I think that really helps set clear expectations and remove anxiety, especially in this virtual world.

It’s rounding with staff, setting expectations, and, as I alluded to before, acknowledgment. We have wow cards, which are electronic cards, as well as handwritten notes. We all love getting a piece of snail mail. It’s taking the time to say, ‘great job working on that project. I really appreciate your dedication and hard work’ — something as simple as that can go a very long way.

 

Gamble:  Right. Let’s talk about leading teams virtually. It’s something a lot of people struggle with because it was such a different concept. Can you talk about your approach?

Marquez:  We can’t forget to pick up the phone. We rely so much on email communication or instant messages, but it really goes such a long way to hear someone’s voice on the other end. You’re able to pick up on tone and mood, even if you can’t see their face. I think that’s still more meaningful than an email that could be easily interpreted the wrong way.

I never thought in a million years that I would be leading virtual teams. I’m an extrovert; I thrive off the energy of others and I love being in the office. But I’ve learned to appreciate not having a commute and being able to have a better work-life balance. Being able to exercise in the mornings before starting work has been a great way to clear my head. And I think it has made me a better leader.

I say that because I believe we have to model the behavior that we want our staff to follow. For example, I have lunch blocked out every single day, and I encourage everyone to do the same. We’ve also just implemented no-meeting Fridays. We heard a lot of feedback from our teammates that they were struggling to get things done, and so we instituted that. It also allows people to take a three-day weekend and not miss out on crucial project meetings.

So far, we’ve heard positive feedback on that, and I’ve encouraged my directors to hold the line. We have to do what’s right, especially with the great resignation happening. We have to take the time to hear our teammates’ needs and wants and try to think differently about how we do business; otherwise, we’ll lose them to a consulting gig that pays more money and offers flexibility. We need to find small, quick wins to make improvements.

I think it’s also being very mindful that you never know what’s going on in someone else’s life. They might be caring for an elderly parent or family member, or they may be facing a financial burden. The pandemic has shown that we can work remotely and still be productive.

 

Gamble:  The last thing I want to talk about is your career path. You came to UConn in 2019, and before that had some other roles on the west coast. What drew you to the organization?

Marquez:  I have an eclectic background. I started at the bedside; I was destined to go the medical school, but I never got in. And so, I pivoted and ended up getting a master’s in healthcare administration. During that time, I learned about clinical informatics and the EMR and I thought, ‘I can couple my analytical and troubleshooting side with my workflow knowledge,’ and I fell into that.

I spent most of my career on the west coast, and I knew I wanted to continue to grow into further leadership positions. And so, I started a nationwide search back in 2019. UConn was definitely attractive because it was a newer Epic shop, and I believed I could bring my decade of Epic experience to an organization that was a little nimbler. It’s been very fun and exciting.

I originally came to UConn Health as IT director. Unbeknownst to me, my boss had submitted her retirement, and so I was awarded a promotion to sit over all applications. It’s been a great journey getting to learn about ERP systems and work with the homegrown applications at UConn Health, which has been really exciting.

The app developers have done a tremendous job coming up with more creative solutions for things like Covid vaccinations and N95 masks — using technology in a way that helps drive business outcomes. It’s been amazing.