One of the most important things Gretchen Britt learned during her tenure as a NICU nurse was the importance of educating parents on how to care for their infants so that they feel prepared at discharge. In her role as VP of Information Technology at Liberty Hospital, she has adopted the same tactic; this time, however, the emphasis is on ensuring users are properly trained on clinical systems.
“I’m not doing a new parent or an end user justice if I’m not spending that extra time and making sure that they know what they’re doing,” she said during a conversation with Kate Gamble, Managing Editor at healthsystemCIO. Setting teams (and individuals) up for success has become a cornerstone of her leadership philosophy, along with demonstrating “empathy and kindness,” having a solid governance structure in place, and extending the same opportunities to others that she has received during her career.
During the interview, Britt also shared thoughts on the keys to effective change management, the organization’s goal to standardize and simplify, and the value of peer-to-peer education.
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- Liberty’s core objectives from an IT standpoint include standardizing on ERP, rolling out a new physician documentation system, and eventually migrating to a single patient record.
- Britt’s strategy for winning over a skeptic? Inviting him to join the physician informatics committee and become part of the process. As a result, “he’s one of our biggest cheerleaders. He loves coming up with new things to improve workflow.
- One thing leaders can never underestimate? The importance of proper training for physicians and nurses. “If we don’t invest in their training, they’re going to struggle… we set them up for failure.”
- A critical step for Britt was establishing an IT governance process at Liberty and creating a change approval board designed to evaluate every request. “Is this something we need and why?”
- The best ways for CIOs to support nurses? One is to “find the best way to do it without extra clicks.” The other is to explain why things are being done. “Nobody knows better than your direct bedside nurses.”
Q&A with Gretchen Britt, VP of IT, Liberty Hospital
Gamble: Hi Gretchen, thanks so much for doing this. Let’s start by getting some basic information about Liberty Hospital.
Britt: Sure. Liberty Hospital is just north of Kansas City, Missouri. It’s a small suburb of Kansas City. We have a 204-bed acute facility and 15 clinics. We have an ambulatory surgery center, urgent care, and a breast center. We have sports medicine, which is in partnership with MU Orthopedics; we have their surgeons on site at our hospital.
Gamble: Those partnerships aside, is Liberty a standalone hospital?
Britt: Yes, we are a standalone hospital.
Gamble: I don’t have to tell you that’s pretty rare.
Britt: It is. But we also partner with Children’s Mercy Hospital for our Level 2 NICU; we have them on site. We partner with St. Luke’s for our cancer center. We have some great relationships in the area that have definitely benefited our patients. Our coverage goes all the way up to the Iowa state line, and it covers quite a few counties. So, we’re doing well, and those partnerships have been key for us.
Gamble: I would think being a standalone is advantageous from a standpoint of making decisions.
Britt: It is. Of course, we don’t get all of the funds to do the technology that some organizations are doing. But yes, we do get to make our own decisions, which is amazing.
Standardizing ERP & EHR Systems – “It’s a process.”
Gamble: What do you consider to be your core objectives at this point?
Britt: Right now, we’re working on standardizing our ERP. We’re trying to get rid of the bucket load of applications we have and bring it down to one ERP solution. That’s been a big one. We’re also looking at standardizing our clinics, which right now have several different EMRs. We’re looking to bring it down to one so that eventually we have one record for the acute side and the ambulatory side. It’s a process.
We’re looking at anything we can automate. We’re actually rolling out a new physician documentation system that will allow them to quickly document and pull data into their notes and hopefully get them home at a better time. We want them to focus less on the electronic record and more on their patients. That’s a big initiative we’re working on right now.
Phased go-lives provide “elbow support.”
We’ve been working in partnership with our physician IT group or PIT Committee. They’ve been very involved working on how to improve the workflow for their peers. Of course, we have made some mistakes and have had to pull some things back. But it’s definitely been a partnership with that group, and that’s been key to our success.
We’re working through each specialty to bring them live. And while that’s happening, the others are documenting the old way, because we want to make sure we have that focused attention and elbow support for everyone.
Gamble: With the PIT committee, it seems like that’s really ideal to have a group that’s engaged and willing to give their time to this.
Britt: Right, and that’s key. We’ve had pretty good participation. We have some new physicians who want to join, which I love, because they’ve seen things at other organizations and can bring that to the table. But first, they have a trial period here so that they can get their feet wet and build up their practice before joining the committee. And we cycle them through so that they don’t get burnt out. It’s been great; they’re excited to be able to contribute and bring their ideas.
Winning over the skeptics
I had one physician who didn’t like anything we did here. He was used to another application, and he didn’t like the one we were using. And so, I said to him, ‘why don’t you join our PIT Committee?’ He asked what it was, and I explained to him, and he was interested. We brought him on board, and now he’s one of our biggest cheerleaders. He loves coming up with new things that are going to improve workflow. And I think he’s happy working here and he doesn’t mind doing documentation, which is a win.
“Training is key.”
Gamble: You mentioned having a small staff, which can be challenging. How are you dealing with that?
Britt: It’s tricky. Sometimes we need to roll things out a little slower than I’d like to so that we can have dedicated onsite support. We have physician support coordinators — that’s actually how I got my start. That’s their person. By rolling things out in a slower manner, we can do more focused elbow support.
For me, training is key. If we don’t set them up for success, they’re going to have a lot of long nights. They’re going to have a lot of frustration if they don’t have that foundation and understand the system. I equate it to when I was in the NICU training new parents. If you don’t give them the skills and the tools that they need, then when they go home with their new baby, they’re going to struggle. And you could have helped them to have a better time. With a physician, AAP, nurse, or anyone, we have to invest in their training because if we don’t, they’re going to struggle. They’re going to be frustrated.
My original role here was as a physician support coordinator. When I became VP, I asked for a second PSC, so we now have two. But I don’t have the entirety of EMR education under me. I would love to have that in the future. Right now, we have one trainer on the nursing education side for all of our EMR, and we have a few scattered throughout our other systems. I’d like to look at centralizing that and developing standard programs so that we’re training everybody in the same way.
Gamble: What type of EHR do you have in the hospital right now?
Britt: We use Altera Sunrise. It’s a very useful tool. The challenge has been getting providers to learn how to utilize it.
“We want to make the right decision.”
Gamble: In terms of the plan to migrate to one system, I’m guessing that’s a long-term vision.
Britt: It is, and I don’t know what that system will be. We have a lot of homework to do. We want to make the right decision going forward. We’re going to be looking at what other sites are doing, scheduling site visits, that type of thing. We’re going to bring our physicians on board and make sure we have buy-in from nurses, the front desk staff, and everyone involved. We need to look at the whole picture so that we can set everyone up for success.
“I was that nurse.”
Gamble: Switching gears a bit, you’ve been in your current role for a little less than a year, but you’re certainly not new to the organization.
Britt: Right. So, I actually started at Liberty Hospital in 2003 as a grad nurse. I worked as a tech for a few months before that to get my foot in the door. I started my nursing career as an RN in the NICU in May of 2003, and spent the majority of my time there. I worked at Children’s Mercy for a few years in critical care. Then, I came back to Liberty to work in the NICU. I became a charge nurse, then supervisor. When I was supervisor, I started dabbling in IT projects around staffing and scheduling.
When we rolled that out, I was the nurse that wanted to do process improvement. Like, ‘do you know that if you do this, you can eliminate five clicks for us?’ I was that nurse. I put in lots of change requests. I was trying to redesign all of the documentation. I was the person who helped the physicians when they needed help. I was their person.
And when this role opened up, I actually had to leave Liberty. I was still part of Liberty, but I was doing work for Allscripts at a managed service site. It was hard for me because Liberty is home. But I became an Allscripts employee. When I came back, I was physician support coordinator for a few years, and then I transitioned to manager of the applications for all the acute sites in June of 2019. At that time, Liberty decided to bring us back in house; that’s when they offered me the position of vice president information technology reporting up to our CFO. It’s been a fun journey.”
Gamble: How was it spending time on the vendor side? I bet it was interesting.
Britt: Yes. I’ve seen both sides now. But for me, Liberty was where I came up. They’ve supported me and helped me to grow. When I was on the vendor side, I wanted to make sure I was doing the right thing. It was a little tricky at times.
Empathy & kindness
Gamble: I bet that gave you some valuable insight into why things happen the way they do.
Britt: It’s a whole other world. But I’m grateful for that time. They’re still our partners now; I’m just working on the other side of it. It was interesting to flip back and forth.
I think being a previous end user was really key for me. I’ve been where everybody else has been. I’ve been the one documenting. I’ve been the one to call for help when something isn’t working right. I was a NICU nurse, and so empathy and kindness — that’s me to the core. That’s how I deal with people in my role now. I’ve been told that I have a different perspective and I approach things differently. I really think it’s that empathy and kindness. I’ve been where you are. I’ve felt that frustration. I hear you and I want to make it better.
When the position was offered to me to lead the IT department, I heard a lot of people say, ‘I’m glad it’s you because you get it.’ And that just warms my heart.
“Spending extra time” on training.
Gamble: As a former NICU mom, I can really relate to what you said about what nurses do to make sure parents are prepared. I’ll never forget it. I’d try to sit back and watch while they bathed the babies and the nurses said, ‘No, come here.’ They made sure I was armed with as much information as possible. And that’s such a great foundation.
Britt: It is, and it’s the only way to do it. I’m not doing a new parent or an end user justice if I’m not spending extra time and making sure they know what they’re doing. They need to know all the tips and tricks that are going to help.
It really was an organic transition into this role. I approached it the same way I did as a bedside NICU nurse.
Managing requests – “You can’t change everything.”
Gamble: As a nurse, you wanted to dabble in IT and make improvements; how do you see that now as an IT leader? I’m sure you have a lot of requests coming in.
Britt: There are, and I think that good change management is what we have to do. We have a great change management board here. We have a business tab and a clinical tab. But you can’t change everything. We don’t want to get too far away from the standard; we want to do what’s right and create the best workflow. And so, it’s evaluating everything and managing those requests against competing priorities.
Setting up IT governance
During my first 90 days — it actually took a bit longer — I set up IT governance at Liberty, which is something we had never had. It used to be, here’s another IT project or here’s another product we bought; let’s implement it. And IT would think, how are we going to fit that in with everything that we have going on?
Now, we have an IT governance committee made up of senior leaders that meets regularly. We go through all new requests. We prioritize them and communicate that. We might say, ‘This is a great idea, but not right now.’ Or ‘yes, let’s do this. Let’s put this on the roadmap.’ Or ‘this is going to increase our revenue’ or ‘this is a patient safety issue, let’s get this in right now and move things around to make it work.’ That was key.
And I will say, the CHIME bootcamp was huge in helping me get that knowledge and understanding. I was setting up IT governance at that time, and so, having those resources and being able to ask those questions was so important.
“It’s all documented now.”
Gamble: It’s mind-blowing that there was no IT governance. I can’t imagine what that felt like for the IT team.
Britt: Right, because without that, it just keeps coming. But also, having IT governance has been an adjustment. We have to remind people that we have a policy now — this is how you submit a request. This is the process that you follow. Here’s the flow and here are the steps. It’s all documented out now.
But we’re still learning. There are still times when people try to sneak something in on the board agenda. And we have to say, ‘we haven’t evaluated that. Maybe we better take a look at it before you get some approvals.’
It’s been great. I’ve had great support from the senior leadership team, from my CFO, Mike Leone, and from our new CEO, Dr. Raghu Adiga. He’s a fellow clinician, and so he’s really been supportive and said, ‘this is the way we’re going to do this. We’re going to remove the silos. We’re going to work together and we’re going to move forward as a team.”
“Is this something we need?”
Gamble: I would think it’s a tricky balance; you don’t want to stray too far from standardization, but at the same time, you know the pain nurses have been through.
Britt: It is. And I will tell you, we have customized our Sunrise product a lot over the years. And so, with our ERP solution and with all new initiatives, our change approval board is going to ask, ‘is this something we need, and why?’ And not just because one person wants it. We want to truly evaluate whether we need it. Is this best practice? What should we be doing? We’ve done that with our ERP.
We’re supposed to be implementing Sunrise Financial manager in the future to move revenue cycle over. We’ll have a cap for that. Our Sunrise Health Information Management will have a cap for that. We want to make sure we’re doing the right things going forward.
Recruiting people into informatics
Gamble: Based on your own experience and how you got into informatics, do you have a path that others can follow, especially nurses and physicians who might be interested in that field?
Britt: I’m really pushing people to get involved into committees and different organizations. Nursing informatics has a committee — our physician IT group calls them the NIT pickers. We’ve expanded that; it’s now our nursing and informatics ancillary department. We’re looking at who else we can bring in. If someone is interested, they know they can come to me, I’ll help guide the path. I had someone from one of our clinics that was really interested in coming over and working with us; she’s our new physician support coordinator. She wasn’t from one of our clinics, but she still was interested, and so she came to us.
“I want to grow people”
I want to grow people. I want to give them the same opportunities I’ve had, because I’ve had some really great opportunities, and I hope to keep going. I want to get people involved and bring them into projects. With the ERP initiative, I went to the leadership group and asked, ‘do you have anyone? We’re going to need people to build these new schedules and work on this new module that we’re putting out. Do you have anyone who’s interested? If they are, put them in touch with me. I’d like to have a conversation with them and see if they can be part of these projects. We also like to tap into those users for our super user and testing groups. We want to find those who are truly interested and bring them into the fold in the future.
“Find people who are curious”
Gamble: I like what you said about encouraging people to be on committees; sometimes people just need a little push.
Britt: You have to just get in there. When I started, I was the one putting in the tickets. We had a book of deliveries that sat there. We had to write everything in it, and then enter it into the computer. I said, ‘why are we doing this? This doesn’t make sense.’ And so, I met with the applications group and said, ‘can we make this a report? And then it goes to a folder and files away and we have it for legal records later, but it’s going to pull everything that I put in.’ And they said, ‘yes, we can do that.’ Nobody had ever asked before. You have to find people who are curious and want to improve things and embrace technology, and bring them onto your team.
Advice on how CIOs can help nurses: “Tell me the why.”
Gamble: Not many people in your position have nursing experience. Do you have any advice for CIOs and people in similar roles on how to make sure they’re taken care of and aren’t shouldering so much of the burden?
Britt: It was definitely a frustration for me and a pain point when we weren’t told why. Tell me the why. When Meaningful Use was coming out, we knew we had to check all of these extra boxes, but nobody told us why. You don’t want people to be resentful and think you’re just making them do extra clicks.
One, find the best way to do it without extra clicks if possible. And two, explain the why; why we’re doing these things. And then invite them in to look at the workflows and make suggestions on how they can make it better. Nobody knows better than your direct bedside nurses, physicians, or registration staff. They know the workflow and they know what’s painful. And so, bringing them in to help you make improvements would be my number one piece of advice.
Gamble: That’s a really good suggestion because even if it’s ‘just a few extra clicks,’ it’s hard to process what that means unless you’re in it.
Britt: Yes, especially when it’s over and over again. If we just made a few changes, those clicks are gone.
Gamble: Right. You don’t want them to be bogged down even more and interfere with patient care.
Britt: Anything that we can do to keep the focus on the patient — that should be our number one goal. With burnout the way it is these days, we’ve got to find better ways to do things. We have serious staffing shortages, and I don’t see it getting better anytime soon. And so, we have to step up and figure out ways to make their lives easier and take that burden away from them so they can focus on patients, or we’re going to lose more caregivers. That’s the last thing that we need right now.