It’s no secret that rural health is facing significant hurdles, with many struggling to stay in the black — or in some cases, to keep their doors open. But it’s not all negative, according to Denao Ruttino, Chief Innovation Officer at Southern Illinois. “We talk a lot about the challenges, but there are benefits,” he said during an interview with Kate Gamble, Managing Editor at healthsystemCIO.com. One of those is the “personal relationships” IT teams can develop with service lines, which helps build accountability.
Another is the collaboration with outside organizations that tends to be more rampant in rural communities — and can be extremely helpful. “Every time I talk to one of my peers, I learn something,” he noted. “We feed off each other.” And there are certainly a lot of issues to discuss, whether it’s balancing growth and cost-cutting, improving care access, or retaining talent.
In the interview, Ruttino shared thoughts on how his team is dealing with these challenges, and how his prior experience in consulting and technology helped prepare him for role with SIH. He also talked about the careful approach he took in being the “new” CIO, what drew him to the provider side, and the valuable lessons he learned while serving in the military.
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- At Southern Illinois Healthcare, the chief innovation officer role “is a mix of the traditional chief information officer role, but with an expectation that innovation is going to be a key part of it.”
- Upon entering the organization in 2022, Ruttino’s strategy wasn’t “to be very disruptive in the beginning, but instead, to do more listening and talking and figure out what’s working well and how to evolve some things.”
- One of his core objectives is to make care more accessible and less frictionless for patients, while also improving the experience for the staff. “It’s just as important as the patient experience.”
- Establishing strong relationships with service lines – and having them “drive a lot of the change,” is critical to the success of projects, said Ruttino. His team’s approach is to “reach out to every one of them and make sure they’re part of that selection process, part of the scoping process, and also part of the accountability process.”
- “The military teaches you that you are capable of much more than you might have thought,” said Ruttino. “It also teaches you how important it is to have a strong team.”
Q&A with Denao Ruttino, VP & Chief Innovation Officer, Southern Illinois Healthcare
Gamble: Thank you Denao, we really appreciate your time. Let’s start with by getting some background information about Southern Illinois Healthcare — what you have in terms of hospitals, where you’re located, things like that.
Ruttino: Southern Illinois has four hospitals; one was just acquired within the last couple of years, and we have a number of outlying facilities as well. We’re the major healthcare provider in Southern Illinois.
Gamble: And you cover both rural areas and cities?
Ruttino: We’re pretty much all rural. We’ve got Shawnee National Forest, which takes up a big portion of Southern Illinois. We have a hospital where we do some tertiary care that’s based out of Carbondale. But pretty much everything is rural. There are no big cities here.
Gamble: The role of chief innovation officer is still fairly new or at least not that common in healthcare compared with other industries. What do you consider to be the primary scope of your role?
Ruttino: It’s an interesting role because it really is a mix of the traditional chief information officer role, but with an expectation that innovation is going to be a key part of it. A number of years ago, Southern Illinois said, ‘We want this to be innovation technology services and we want it to be a chief innovation officer role.’ Technology isn’t just here to implement what people are asking for; the role is to transform care.
Gamble: Very interesting. It makes sense, but it seems like it puts a lot under your purview.
Ruttino: It does. But we’re blessed to have a lot of great people who work here and a number of people who are really focused on transformation and improvement. And that’s good. I think SIH is in an interesting spot — we’re in a rural area, but we’re large enough to have some really good leaders with experience in other places. And so, there’s a lot of innovation coming from what I’d call a good mix of tenure and turnover.
Gamble: When you look at your role, you have the more traditional IT piece and innovation — is the goal to try to make those two coalesce?
Ruttino: Absolutely. It’s really hard to see where those things diverge. The word ‘innovation’ is used quite a bit in a lot of different contexts, but it really has to be embedded in everything we’re doing at this point. And fortunately — or unfortunately, depending on which way you look at it — we leverage technology to do most of those innovations.
Gamble: Right. You’ve been with the organization since summer of last year; not a whole lot of time, but enough to get your feet wet and get to know the organization and the people?
Ruttino: Yes. Southern Illinois is a beautiful place. It has a small-town feel, and yet the health system is big enough to do some really interesting things. A lot of my time so far has been focused on learning. They made it clear coming in that they weren’t looking for somebody to necessarily be very disruptive in the beginning, but instead, to do more listening and talking and to figure out what’s working well and how to evolve some of those things. I was really blessed that both the people who are here now and the people that were here before me have really done a good job of evolving things. My role is just to continue that.
Gamble: I imagine that’s a better situation than when you have to jump right in and make major changes.
Ruttino: You always see a combination wherever you are. You have certain projects that are going to need that, but overall, I think it’s in a pretty good place. Like all health systems, there are some financial challenges that are relatively new to this organization. And so, that takes a little bit of extra focus and maybe a different perspective, but you’re definitely not trying to rescue this organization from themselves in a larger sense, so that’s good.
Gamble: I like what you said about listening and learning. By doing that, you can really understand what’s needed and what should be the top priorities.
Ruttino: Yes. What I’ve been really pleased to hear is that, as with many organizations, I think the reason certain things aren’t done or aren’t moved further along, isn’t the result of a lack of ideas. It’s a lack of budget, or it wasn’t a priority at that time. A lot of people have said to me, ‘This is where we think we need to be,’ and I’ve learned a lot from that.
As a senior management team, we have a number of new leaders in key positions, along with a number of tenured people. We’re trying to advance that as part of our strategic planning process; it’s been really fun so far.
“Balancing growth and cost cutting”
Gamble: Great. So, what do you consider to be your core initiatives at this point?
Ruttino: A lot of it is balancing growth and cost cutting. I think that’s key for everybody in healthcare, and especially rural healthcare. I don’t see anybody immune to it at this point. That drives a number of projects. It’s about being fiscally responsible going in, renegotiating current contracts, and leveraging technologies to do things in a more cost-effective manner. We’re also deploying Community Connect to other entities. We acquired a hospital not too long ago; we’re getting them on our version of Epic. A lot of those traditional IT processes are going on at the same time.
Another big focus is access. In rural areas, we have provider shortages and access issues. And so, we’re thinking about how to use both the human components and the technology components to improve the level of access and the time that it takes to get people in, and to reduce the friction. Navigating our health system is a big priority.
We also have some traditional projects underway. We’re leveraging CRM technologies to facilitate some things, and we’re going through an ERP replacement project.
Gamble: Can you talk a little bit more about the access piece? It’s something we hear a lot in rural communities. Are you using certain technologies and innovations to try to alleviate or fill those gaps?
Ruttino: Our digital health team is spending a lot of time working primarily with our medical group, which is focused on going out to the patient. We’ve seen a lot of remote patient monitoring and telemedicine tools since the start of the pandemic. They grew fast initially and then pulled back a little, but in an area like ours where it’s a long drive for people to get to a health system, they’re very valuable. We may have behavioral health resources that are located an hour away from our patient population. And we’ve got tertiary care options and consultations that need to happen, but it’s a long drive times between a lot of these locations.
Using those flexible tools has really helped us quite a bit. So, there’s that portion of it where we’re going out to the patient, but then we also have patients coming to us. It’s a lot, especially when you have turnover and workforce shortages. And so, we’re taking a look at abandonment rates — how quickly and effectively people navigate when they call us. They’re literally reaching out and trying to get ahold of us; how do we make it as simple as possible for them to get access to the care that they need as quickly as possible?
Gamble: I imagine equity fits into that as well and that gaps that exist, whether it’s access to care or access to technologies to make sure underserved communities are getting what they need.
Ruttino: Absolutely. If anyone has a silver bullet for that, I’d love to hear it. But I can tell you, it’s top of mind as we start looking through the things that we’re doing. How do we reach some of these people? Some of it is still physical outreach; we need human-to-human connections, which can be really hard to do.
Particularly in rural populations, many people aren’t focused on preventative care. They’re not focused on how to get the resources they need, and they’re unaware of some of the resources that are there to help manage a lot of their chronic issues. We spend a lot of time on that type of outreach, both from a digital perspective and a human perspective, because not everybody is able to interact with us digitally at this point.
Gamble: Right. I definitely haven’t heard about any magic bullets yet, but it’s encouraging to see more focus on this area.
Ruttino: Yeah, I think so. I think you have a lot of really smart people focused on it so we’ll get there. I think as an industry we’re moving in the right direction. First, you have to admit you have a problem, and we’ve done that. We see that these disparities are negatively impacting certain populations’ health and we need to fix that problem. That’s what we’re here for.
Gamble: You mentioned ERP. That seems like a significant undertaking. What has the approach been there?
Ruttino: It is. SIH was going through a discovery process of where they wanted to go with some of the technologies they’ve had. One of the decisions that was made was to move to a more up-to-date enterprise resource planning system, and so, we went through that evaluation. Generally, we like to consolidate as many things into core systems as we can.
Getting to frictionless
After that discovery process, we said, ‘how do we align with a good integration partner and what are the outcomes we’re looking to achieve?’ A lot of those are around visibility. We spend a lot of time talking about how to make it frictionless for patient populations to navigate our health systems. But a lot of the ERP is focused on how we do that for our employees and for our staff — how to make it so that our human resource systems as part of that ERP are easy to navigate, that people can do a number of self-serve things, and that the employee experience is also good. Because at this point right now, that’s as important as patient experience.
Gamble: Absolutely. How do you go about getting input? I’m sure that can be tricky getting to the pulse of what challenges the staff has and how to work through those.
Ruttino: It is. A lot of it is working with the different service line leaders that are out there. I think that’s really important. We talk a lot about the challenges of being in rural healthcare, but one of the benefits is that there are a lot of personal relationships. And so, we can reach out to these service lines and have conversations, pulling in third parties where necessary. It’s really looking at what are the problems you’re having, and if things could be perfect, what would that look like? Let’s map some of the solutionwe have to the challenges you’re experiencing.
Working with service lines
The other thing we need to do is to get accountability from those service lines, because the success of a project like this really relies on them being engaged and driving a lot of that change. It’s not just a technological solution; it’s looking at how will it be trained? How will it be serviced afterwards? How are we going to utilize those things? Otherwise, you can waste a lot of money on something that maybe has a better user interface, but really doesn’t achieve the organization’s goals.
That’s really our approach; reaching out to every one of them and making sure they’re part of that selection process, part of the scoping process, and also part of the accountability process for a successful implementation.
Gamble: That’s really interesting. I would think that concept of accountability applies to different levels, and also comes into play when you’re dealing with vendors and other partners.
Ruttino: It is to be built into everything, right? We look at it from a data perspective. We spend a lot of discussion around analytics — here’s the information you want coming out of it. But do we have data literacy programs in place? And are we holding leaders accountable for using that data? It’s the same with ERP, EHRs, or any solution where you’re spending multiple millions of dollars — you need accountability from the vendor perspective, but you can build that into contracts. You don’t really necessarily have that same functionality internally. And so, you have to say, ‘Okay, how do we make sure that we’re holding people accountable for advancing these initiatives?’ Because they own a lot of the success there, but they also can contribute to it to its failure. I think it’s important that we all move forward on the same page.
Gamble: That accountability piece has to come from the top, right?
Ruttino: Absolutely. It needs to start at the top, and I think that weighs heavily on us as executives. You can only put your weight behind so many things. You need to ask, what are the things that are critical to the organization? And people will pick that up.
Interestingly, as you navigate these, it’s apparent to all of us that the people who are closest to the work know most about it. I think a lot of our success has been attributed to how we solicit that information from them. Not what do we need to do, but what are the right ways to hold people accountable at this level — how do we make sure that your teams are engaged in this? While we can prioritize things and remove other work, they really need to help us with that accountability structure.
“Basic hitting and pitching”
Gamble: Along those lines, do you participate in rounding or similar initiatives to get a feel for what end users want and what challenges they run into?
Ruttino: We do. Organizationally, there are a number of processes that are in place to say, ‘this time is blocked out specifically for leader rounding.’ Now, there are challenges in some departments especially when you have a remote workforce where it’s not easy to do rounds. It’s what I call the basic hitting and pitching with physical locations like hospitals and clinics where you can round and see what’s happening.
Where some of the challenges come into play is with a remote workforce — how are you soliciting that? I think we’re all still learning the best ways to do that and trying different things. We’ll have fireside chats and virtual town halls and different ways to put out information and solicit information from big groups of people when you’re not able to exactly walk around. We’re still trying to figure some of that out. We use a combination of surveys that are web-based and text-based and individualized conversations that are happening via video. We’re doing a lot to solicit feedback.
Gamble: It’s funny; remote work is still relatively new for so many organizations, and it keeps evolving. It’s so important to have those discussions.
Ruttino: It is. I think we talk a lot about the challenges, but there are a lot of advantages as well. I’ve got a number of people reporting through me that are across multiple states. That’s good because now we can access skill sets and have people contribute that historically wouldn’t have been able to. And by the way, I can meet with five of those people individually over a short period of time without having to drive an hour to one of our other facilities. So, there are some advantages there as well that I think help with that connection.
Gamble: For sure. So, looking at your career path, prior to Southern Illinois, you were with Firelands Health for a while?
Ruttino: Yes, I was with Firelands Health since 2013. I was VP of operations and chief information officer. And so, I had the traditional CIO role along with some operational responsibilities for imaging, our center for breast care facilities, and clinical engineering. It was really nice.
Gamble: And that was your first CIO role?
Ruttino: It was. Prior to that, I was the CEO of a technology organization.
Gaining an “operational focus”
Gamble: Very interesting. How would you say that experience has benefited you?
Ruttino: It was really helpful because it gave me an operational focus where it wasn’t just looking at the technology side; we were building new services. We were worried about revenue. We did a lot across different industries. It gave me exposure into banking and hospitality in a number of other places, both from a technical perspective and also from an operational and business perspective. As you’re meeting with those CEOs and other people trying to help advance their goals, you learn a lot.
And then coming into healthcare directly, it’s a totally different model. But you can leverage a lot of what you’ve learned in consulting and in these other areas, and it applies pretty well to healthcare. When I came in, my CEO at the time had assessed that healthcare was quite a bit of a mess; we’re trying to change things just like we did in technology, moving from fee for service to managed service models and things like that. So yes, I think that experience helped me quite a bit in healthcare.
“We are only here to improve lives.”
Gamble: What made you want to move to the provider side?
Ruttino: A number of things. I had done some consulting there, primarily around information security. My wife was in healthcare and my daughters are in healthcare. Looking back, I know this sounds cliché, but I really wanted to do something that made a difference. I can’t think of anything that’s easier to get passionate about than dedicating your skillset to help improve lives and serve different populations. That’s unique to healthcare. In every other industry I’ve worked with, been part of, or consulted in, the primary motivations seemed to be financial. Even when you’re negotiating things across an organization, you had to make sure you were looking at what was important to the different stakeholders.
In healthcare, we can all agree that we are only here to improve lives. And yes, it’s ‘no margin, no mission.’ We have to make money. We have to cut expenses. There’s a lot of things we have to do. But at the end of the day, we really are doing something that nobody else can do. That passion drove me to get into healthcare; once I got here, the more I learned, the greater the impact I could see on people in local communities. That just drives me, and I think it drives the teams I work with — that’s refreshing.
“I like challenging myself”
Gamble: Certainly. I would think that played a role in you seeking professional certifications and building upon that knowledge with things like CHIME’s CHCIO program and becoming a fellow of ACHE. Is all of that based on a desire to keep learning more?
Ruttino: Yes. I tend to like structured learning paths and I like challenging myself. I think in these types of roles, having a balance of technical leadership and operational leadership is increasingly important. We have to be able to look at things from different perspectives in order to make a difference. And especially at an executive level, whether it’s our chief nursing officer, chief financial officer or chief executive officer, everyone needs to have the ability to get the perspective from a wide base, but then also specialize in an area of expertise. That desire has kind of driven me.
The other thing I gained from it that was maybe a little bit unanticipated was the amount of support you get from peers as you’re going through that process. It has really been noticeable to me that in healthcare, CIOs, CEOs, and CFOs from other organizations are willing to help and share ideas and think through things to see if we can all elevate our entire game. And so that’s been really a great process.
“You feed off each other”
Gamble: It’s such a supportive community, especially CHIME. I’m sure it’s so important from your perspective to have that.
Ruttino: Absolutely. And it’s good because you feed off of each other. And it happens on a regular basis. We’re on the phone with different sized organizations and different challenges, and we try to help each other. Sometimes we’ll say, ‘I don’t know what I possibly add to this conversation,’ because we think we’re all going through the same thing and maybe looking at it the same way. But I can tell you that every time I talk to one of my peers from outside of our organization, I learn something. There’s always something being shared that is of tremendous value. And you can’t buy that experience. It comes from people who are living through it; people who are thought leaders in their own regard.
Gamble: The last thing I want to talk about is your military experience. I always like to ask leaders how it helped build you as a professional. Can you think of anything you gained from that experience that you’re able to apply in your current role?
Ruttino: Yes. I think the biggest thing for me personally is that it has given me a sense of discipline and a sense of appreciation. By that, I mean that not all the work we’re going to do is easy, but even if I’m having a bad day, it’s much better than a day I’ve had previously. You tend to appreciate that.
I also appreciate working with really smart and good people. I have a chief healthcare information officer here and some other leaders who are great people — very competent and extremely intelligent. And so, I think the military teaches you that you are capable of much more than you might have thought before you were challenged to do some of those things. It also teaches you how important it is to have a strong team. It has really built a good foundation for my career, but I would say discipline and appreciation are probably the biggest two things I’ve gained from it.
Gamble: Well said. I always enjoy hearing people’s perspectives. And no one has yet said their time in the miliary taught them nothing.
Ruttino: It’ll definitely teach you a lot.
Gamble: Right. Well, that about wraps it up. I want to thank you so much; we really appreciate your time and hearing your perspectives.
Ruttino: Thank you, Kate. I appreciate the opportunity.