With any healthcare IT initiative, the change management piece is critical. This comes as no surprise to CIOs and other leaders, for whom transformation has become the new normal during the past few years.
As a result, they’re learning valuable lessons. During a recent panel discussion, two industry veterans — John Mason (SVP and CIO, Quorum Health) and Karen Marhefka (Deputy CIO, RWJBarnabas Health, and VP of IT, RWJBarnabas Health Medical Group) — shared their perspectives on what it takes to successfully drive change in the increasingly complex healthcare landscape, and what pitfalls must be avoided.
One of the most significant missteps, according to Mason, is underestimating the effort required by those in the trenches to bring about change. It’s a lesson he learned when, upon arriving at Quorum, was tasked with shifting away from a five-year transition service agreement with Community Health Systems, from which the organization had spun off. For Mason, it meant leading a complete hardware replacement, which included networks, data centers, refreshes, and more.
“We essentially stood up an entirely new IT organization,” he said. “It was a huge undertaking.” One that wasn’t expected. “I don’t think they realized that the scope of that change was so massive.” And so, Mason took it upon himself to ensure the CEO, CTO, and other key stakeholders understood what IT was being asked to do and build a sense of urgency. “If I didn’t get them on board and get them to understand what was coming and start thinking through the implications of the change with me, we weren’t going to get through the project.”
“Things have shifted”
It’s a reflection of just how far the CIO role has come, according to Mason, who can clearly recall a time when the focus was less on change management, and more on the fundamental blocking and tackling of IT systems. “Things have shifted,” he said. Now, “I have to be able to ask the hard business questions” about the financial impact and how they plan to extract value from an implementation. “I need to ensure they’ve thought things through. So yes, the CIO role has changed quite a bit. We’re not just the techies and propeller heads. We have a different level of value than we did 10 years ago.”
Marhefka, who held leadership roles at UMass Memorial and Tenet Healthcare before joining RWJBarnabas in December 2020, agreed. In fact, she believes coming from an operations background, as both she and Mason did, “makes us very dangerous CIOs, because we understand the business.”
That understanding has been put to the test during RWJBarnabas’ multiyear Epic implementation, which has been particularly complex on the ambulatory side. According to Marhefka, there was “very little centralization,” with more than 400 business offices working independently in areas like scheduling, pre-registration, authorization, and referral management. And while she was admittedly “horrified” at the potential revenue loss, Marhefka also saw a “beautiful opportunity to centralize a lot of that using information technology.”
A playbook for change management
Capitalizing on that opportunity, however, requires a shift in mindset, said the panelists, who shared nuggets based on their own experience on how to successfully drive change and avoid common pitfalls.
- Strong messaging. For Marhefka and her team, working with operational counterparts to “keep the messaging strong” has been a key priority. “It’s not about the technology,” she said. “The day-to-day workflow is the most drastic change that our customers are going to feel – providers, staff members, everyone.” And although the technical component is far from simple, “it’s easier than the human aspect of change.”
- Managing expectations. When an organization is accustomed to things happening at a certain pace, it can be tricky to set realistic expectations. This was precisely the case at RWJBarnabas, which had a platform in place to get practices up quickly. With the Epic rollout, however, it wasn’t going be quite as smooth, said Marhefka, who made it a priority to help educate business development colleagues about what can happen and when. “It’s been a big challenge for our organization to settle into a new reality that things can’t just happen like that.” The good news is that once those conversations have been held, things tend to go “a lot smoother,” she added.
- Demand accountability. The other party with whom CIOs need to engage is vendor partners, said Mason, who admitted to spending “a lot of time” holding vendors accountable to contractual terms and obligations around their service delivery. But it goes beyond that, he noted. “I’m also pushing them on cost reduction, performance improvement, and the subsequent implementations of new technologies and new business lines.”
- Hold your ground. At the same time, leaders need to ensure vendors don’t look too far ahead, Mason said. Oftentimes, “once a vendor is in the door, they get excited, and they want to push new things and start selling outside of the original scope.” This is where CIOs need to step in and make sure vendor partners are working within the health system’s plan, and not the other way around. “It’s really important that you work with them and set boundaries, because if you don’t, it can create chaos in the message that you’re delivering.”
- Beware of “tweaks.” In Quorum’s case, a vendor’s decision to change the position of a button on the screen caused a great deal of frustration for nurses — and, subsequently, leadership — and prompted some important discussions. “I’m going to hold off on any change that has no value,” he noted. “It’s death by a thousand paper cuts. If you continue to make every little tweak here and there, they might seem small, but at some point, you start bleeding out.” Knowing why a change is being proposed, and how it will help, is critical.
- Take a walk. Another important piece is in gaining buy-in, which must be approached carefully, according to Marhefka. Her strategy? “Walk in their shoes,” she said — and be authentic about it. “You have to respond with empathy. Don’t just say, ‘I hear you. I feel your pain,’ and then not follow up.” And when you do, position it as, ‘here’s what we’re going to try,’ rather than, ‘here’s what we’re going to do.’
As with so many facets of the CIO role, it’s a constant give-and-take that must be navigated carefully, according to Marhekfa, who likened it to America’s pastime. “I try to make sure that the governance model within IT is built around pitching and catching,” she said. “We have to receive requests for IT components, but at the same time, we have to be aware of the reason for those requests. We have to keep the budget in mind. We have to think 5 and 10 years out as we’re dealing with those requests. We’re catching and pitching every day, 24/7.”
It’s quite a deviation from the CIO role of years’ past, she noted, but it’s a welcome back. “I’m having a ball.”
To view the archive of this webinar — Examining the Art & Science of Change Management — please click here.