Q&A with SUNY Downstate CIO Dennis Sutterfield: “It All Starts with the Vision and the Message.”

There’s been a lot of focus recently on the myriad challenges facing rural healthcare organizations – and for good reason. However, on the other side of the spectrum, urban health facilities also face uphill battles, whether it’s low adoption of digital tools or patients who can’t physically get to appointments.

In a recent interview, Dennis Sutterfield, CIO at SUNY Downstate Medical Center, shone a light on some of the struggles his Brooklyn, N.Y.-based organization contends with, and how a new leadership team (including a new CEO and new President) is turning the tide by making “strategic investments” and promoting transparency, which has helped build trust. Sutterfield also talked about the importance of “advanced storytelling,” what it’s like to wear multiple hats, and how his previous career experience helped prepare him to embrace challenges.

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Key Takeaways:

• On urban health challenges: With the patient portal, “which most organizations leverage highly through their EMR, we probably have less than 10 percent adoption, even though with information sharing, we are pumping out a tremendous amount of information for our patients to use.”
• On the “fragile equation”: “They want to call their doctor. They get confused by electronic opportunities. It’s hard to make them to feel safe without them feeling uneducated, and that’s certainly a really fragile equation; we never want to offend them.”
• On transitioning to a Covid-only hospital: “It has caused a significant impact on our operating income as a hospital. We’re working really hard to build back that volume and get that message out to our patients, and it’s working.”
• On SUNY’s turnaround: The key was “working with the senior leadership to find the why and the what, and put together the vision, the strategic plan, and the seven pillars. I think every employee now understands how they connect to the direction and the vision of the hospital.”
• On being the new CIO: “People can read my résumé, it doesn’t mean I did those things that I said I did them. Part of it is about showing my technical ability and my business acumen and that I keep my word — all the things we try to do.”

Q&A with Dennis Sutterfield, CIO, SUNY Downstate

Gamble:  Hi Dennis, I look forward to talking with you about the organization and what you guys are doing. Are you familiar with healthsystemCIO?

Sutterfield:  Yes. I pay attention on LinkedIn, and I certainly read and pay attention to what you guys are doing. Believe it or not, we actually get so few really tactical and poignant conversations. I’m always searching to hear what others are doing well and how they’re solving problems. The conversations I’ve heard about leaders that are managing similar challenges — I find that invaluable.

 

Gamble:  It really is. It’s so important to be able to share the good things everyone is doing, but to also talk about the challenges. We try to get a decent cross section of organizations, and so it’s great to be able to get the perspective of an urban medical center.

Sutterfield:  Usually no one programs toward us, and I’m always surprised given that we tend to face the greatest challenges and have some of the most needy people.

 

Gamble:  Absolutely. So, to start off, can you provide some information about SUNY Downstate Medical Center?

Sutterfield:  SUNY, which is the State University of New York, is a 64-campus organization. There are three academic medical centers: Stony Brook University Medicine in Long Island, Upstate Medical University in Syracuse, and Downstate Medical Center in Brooklyn, with is the southernmost facility. We are Brooklyn’s only academic medical center. The other 61 campuses are colleges and universities; we look and feel nothing like them.

That’s relevant because every dollar we spend is New York’s taxpayer money. Everything that we do goes to the state of New York from a governance perspective and an accounting perspective. We face challenges that the other 61 campuses don’t — some challenges that our peers don’t.  Our other two academic medical centers and trying to get the state to understand the complexity and the uniqueness of an urban academic medical center is quite a challenge, but it’s also an ongoing opportunity.

SUNY Downstate is a 335-bed hospital. We have 5 schools, the largest being the med school, which is very large. We produce about 1,000 medical students. There are more SUNY Downstate medical school graduates working in the state of New York than any other school by a long distance. It’s very unique and a very long tradition.

Our midwifery program is one of the earliest in the country and still going strong. We sit in the southcentral area of Brooklyn, which is a little Caribbean area. About 60 percent of our patients speak Haitian Creole but we have about 50 different languages that are spoken across our patient population. We face some interesting challenges in trying to program the old 80/20 rule; because of the language complexity that we face every day, it takes us a little bit more to do the same things as others.

We’re 86 percent government pay, and I think more than 46 percent Medicaid. Like many urban academic medical centers, we’re absolutely doing more with less. Probably 65 percent of our employees at Downstate live in Brooklyn and are users of Downstate. We have a very strong relationship with Kings County Hospital, which is literally right across the street. They’re considered the true safety net hospital for Brooklyn, but we share resources and see a lot of their patients as well. I think more than 70 percent of our doctors have some practicing relationship with King’s County.

It’s a very unique and proud organization. It’s been around a long time, and it’s really starting to spiral up.

 

Urban health challenges

Gamble:  You mentioned there are many different languages spoken. I imagine that’s one of a host of challenges being an urban medical center. Can you get into that?

Sutterfield:  Sure. I came from Temple University Health Systems in north Philly, and so, I’m familiar with the urban academic medical center setting. I’ve spent probably the last 8 years in this setting. There are a few things. One, the patient-doctor relationship, in their eyes, is sacred. Coming to the doctor is a social event. But these are people who often don’t have rides. They struggle for food. We get them rides, they get fed. They see people in the waiting room, and they converse.

They want and need to talk to their doctor. But some of the opportunities to provide digital services to urban academic patients are a little bit more difficult. We have people who are reluctant to give their email address. We have people who don’t have the same phone number every 30 days. With something as simple as the patient portal, which most organizations leverage highly through their electronic medical record, we probably have less than 10 percent adoption, even though with information sharing, we are pumping out a tremendous amount of information for our patients to use in their medical journey whether they do it at Downstate or at other organizations.

There are things we know are going to take longer because we need to explain them more in depth. Obviously, everything we do is about the trust between the patient and physician. We take that relationship we take very seriously and we want to make sure that at no point, we fracture that. That’s when things take a little bit longer.

Also, very much like urban academic medical centers, about 80 percent of our patients come through our ED. Our ED is insanity. Like everyone, we are working very hard to identify programs and opportunities for social determinants of health, and to get our patients who are in critical need connected to community-based organizations that can provide food or housing or counseling, things of that nature. My philosophy has always been to run to where the challenges are — an urban academic center certainly presents those challenges.

 

Improving digital engagement

Gamble:  When you’re not reaching patients through digital means like portals and phones, I imagine that a big part of your strategy is figuring out how to reach patients and how to reach the community.

Sutterfield:  We were lucky enough to write a grant proposal. New York City did an OpenNotes collaboration. We received a grant for $50,000 and it was all about how we best get our patients to allow us to provide additional information, mostly through our patient portal. But what does that mean to them and what value does that add to their medical journey? We spent the last year working through that. It was a fantastic program and actually just came to an end.

What we found is that we would have pockets of success but not a lot of long-term sustainability. Obviously, when we can impact the younger caregivers of those families who are taking care of aunts and moms and dads and so on, we tend to have more success with digital opportunities than we do with the actual patients themselves.

Lifelong patients – “they want to call their doctor”

We also have a scenario at Downstate, and this was similar at Temple, where we have patients who have been coming here for 40, 50 years. They want to call their doctor. They want to call and talk to someone. They get confused by electronic opportunities. It’s hard to make them to feel safe without them feeling uneducated, and that’s certainly a really fragile equation there; we never want to offend them. We certainly want to offer opportunities that they can take advantage of to make things easier. But at the end of the day, our call centers are overwhelmed.

 

Do-more-with-less organizations: “We don’t have all the roles filled.”

Gamble:  When you do have those pockets of success, do you try to build on that?

Sutterfield:  Absolutely. The hardest part of being at a ‘do more with less’ organization is that we don’t have all the roles filled. I’m the Chief Information Officer.  I guess technically I’m the Chief Digital Officer, the Chief Analytics Officer and a few others. Many of our senior leaders, even our managers and directors, have large portfolios. The marketing of our successes and that communication to our patients is a little bit less timely than it would be if we had a bigger marketing department or additional people and/or tools. And so, it’s hard to measure how effective it is.

Being a Covid-only hospital

There’s a really important point about SUNY Downstate that I want to add. During the height of COVID, from March until June or July of 2020, we were designated by the state of New York as a Covid-only hospital. We may have even been the only hospital in the United States to do that. And so, our entire practice became about Covid, which it already was in many ways. But our ability to do orthopedic surgery, cardiology, and so many other things was put on hold. When you translate that to a large patient base that doesn’t have English as a first language, and already has a bit of distrust and confusion about what Covid is, how it’s being treated, and how people get it, it explains why we’ve been incredibly slow to rebound from a patient throughput perspective.

It has caused a significant impact on our operating income as a hospital. We’re working really hard to build back that volume and get that message out to our patients, and it’s working. We’re starting to see volumes that are finally back to 2019 levels (and even somewhat above). We’ve been marketing a lot of positive things that Downstate is doing, but it takes time.

 

A “gradual build”

Gamble:  Once you were able to accept patients again that weren’t COVID patients, was that something that happened gradually? What was the strategy?

Sutterfield:  It’s still ongoing. Again, if you look at volume, we have over 50 specialty clinics at Downstate. We do some really unique and great things, but some of those values just aren’t back to where they were in 2019. There has been a gradual build.

New leadership, new vision

I’ve been with Downstate for 18 months. The CEO of the hospital, Dr. David Berger, was a large factor in my decision. He’s been here for nearly three years. Many of the senior leaders on [President] Wayne Riley’s team are newer to Downstate. We all arrived and picked up on his vision.

Dr. Berger, who came from a hospital background, set a vision and strategic plan with seven pillars. We’ve also embarked on a high reliability organization journey which is something I went through at Temple. It focuses on patient safety, zero patient harm, and everything that goes with that, including efficiency and quality — all of the things we should be doing. I think Downstate was doing those things, but maybe in a less organized way.

“Significant improvement” in Joint Commission scores

As a result, we’ve seen significant improvement in scores across a variety of areas. The Joint Commission recently visited, and we had an outstanding survey compared with the one three years earlier. The surveyors said it was virtually a different hospital — that’s a direct result of all the hard work, and the from the staff buying into the vision and leadership changing the culture and the accountability of Downstate from a hospital perspective.

Don’t get me wrong; the deans, the research teams — everyone is really involved in that. We’re focused on the hospital but the concept of one Downstate is certainly alive and well, and I think we’re starting to spiral up and see those results in a variety of tangible and measurable ways.

 

Turning an organization around

Gamble:  Right. And you came to the organization in September of 2021, when the organization was having challenges. What were some of the steps that you and the other leaders took to start to turn things around?

Sutterfield:  I think it all started with Dr. Berger from a hospital perspective, working with the senior leadership to find the why and the what, and put together the vision, the strategic plan, and the seven pillars. I think every employee now understands how they connect to the direction and the vision of the hospital.

That’s very important. Second, we listened to what had been going well prior to Covid. We worked hard to understand what the opportunities were and then started to chunk them off.

Third, you have to measure it. You have to be accountable, and if you can, call in an independent third party and say, ‘here’s what we are and who we are. Here are the numbers and the metrics. Here are the things that we need to do better.’ And then plot a plan to start doing those things better.

For instance, we became a visiting organization. That has helped tremendously with the quality component. We brought in a consultant to help us prepare for the Joint Commission visit. That was about a 10-month program. The hospital engaged Optum to look at a variety of financial things. I think everyone understands that we have to have business partners that can show us and our staff the way. They do that with industry benchmarks and best practices that we have gladly adopted.

An “honest look in the mirror”

But I think the most important thing was to actually define who Downstate was; to take an honest look in the mirror and collectively agree that we want and need to do better, and then plot that path to being better. As CIO, one of the things I’ve always tried to do is make sure that my IT staff know how we’re connected to every component of that strategic plan and to that tactical ability to do better, whether it’s in research area, whether it’s in our academic area or whether it’s in our hospital area. But I certainly think it all starts with the vision and the message.

 

More turnover = less buy-in

Gamble:  Was a lot of it geared toward improving efficiency? What were some of the steps that had to be taken?

Sutterfield:  There had been tremendous historical turnover in leadership at Downstate. There was a culture of, we know that leaders are going to come in and bring consultants, and they’re going to tell us what we’re not doing well. There were times when the employees at Downstate said, ‘we’ll just wait this person out because we know in two years they won’t be here.’

When Dr. Berger and President Riley came here, they went from the top level to the lowest level and got a commitment from each employee that this isn’t acceptable anymore. It’s not the way we’re going to do business. We’re here to care for needy patients. We’re here to educate important new medical leaders and do cutting edge research that improves our community. They spent a lot of time and effort on that.

“You need to make strategic investments”

The other thing they recognized is that in order to get out, you need to make strategic investments. I inherited significant technical debt, a woeful infrastructure, and department level systems that hadn’t been upgraded for 15 versions. And it wasn’t because the IT staff didn’t know that these things needed to happen; it’s that perhaps they weren’t able to get leadership to hear their message or understand how it connects. For example, these technical deficiencies prohibit you from seeing the data that allows you to improve your quality numbers.

A large part of my role is advanced storytelling and making sure senior leadership is crystal clear that there’s a people, process, and system component to all of these programs. If you ignore one or two of the three, it’s not going to work.

We’re very strategic about our technology investments. We’ve teed up a lot going forward. We’ve probably executed on over 150 projects during my 18-month tenure — some of them 80 to 100 hours, some of them 8 months. The key to that is making sure the president and the senior leadership of the organization, and certainly the senior leadership of the hospital, are critically aware that we all have to pull this forward together. And to do that, we’re going to have to spend some money that in the past was deferred.

 

“You need to hear from your customers”

Gamble:  Right. But it seems like even if you did come in and say, ‘these are the investments we need to make and this is what’s going to work,’ you can’t do that until you’ve laid the groundwork and changed the culture.’

Sutterfield:  That’s IT governance. The first thing I did was, from a clinical perspective, an academic perspective, and a research perspective, define what’s not working — where are our biggest problems. I had a pretty good idea of what our biggest problems were, but you need to hear from your customers, you need to actually spend the time doing that. I’ve met with every chair. I’ve met with over 60 leaders across the organization. I had several chairs who had been there over 30 years who said it was the first time a CIO ever sought me out to ask me what’s going well and what I need. And I thought to myself, boy, that seems like table stakes, right? How do we fix or how do we help our organization if we haven’t defined our problems and haven’t asked our leaders what’s going well and what’s not going well? When collectively 30 or 40 leaders are acting in that same manner, it certainly gets buy-in and it certainly helps engagement.

And then, obviously, you have to do some things. You have to fix some things for those customers so that you get some buy in and they see that there is a plan here; that way, they’re a little bit more willing to wait if things are going to take an extra week or two. Without question, you have to be incredibly transparent in communication. I want and need my staff to know everything I know.

They need to be empowered to make the decisions that they need to make, and they need to know whether it’s because the budget is not good right now, or we’re not spending any money, or something like we had happen, which is that our transplant program just got accredited by Optum as a center of excellence. By the way, Downstate is the only transplant center in Brooklyn for 3 million people. Our kidney transplant program is just taking off. That’s big; you have to put that out there.

 

Breaking down communication silos

Gamble:  One thing we hear often is that it’s important to get quick wins and start to build trust. It sounds like that’s what you’re doing.

Sutterfield:  When you’re the new person, you’re the risk in the room. People can read my résumé; it doesn’t mean I did the things I said I did. Part of it is about showing my technical ability and my business acumen and that I keep my word — things we all try to do. These are common sense things but believe it or not, I think doing them has helped break down some of the silos of miscommunication.

Because the grapevine is still strong, right? Even in the virtual world, there’s still storytelling. You want to make sure your story is heard. You want to face the questions. I’m always amazed at the senior leadership of our organization—they answer the good, the bad, and the ugly, always being honest about where we are and where we’re going.

 

Gamble:  That’s huge. Now, prior to this, you were with Temple. Did that experience set you up for what you’ve done here in terms of the heavy lifting?

Sutterfield:  It has been invaluable. I engaged with Temple in August of 2015 as consultant while I was with PWC. It’s a 5-hospital organization. It was, as I used to call it, CEO veto, IT governance. Everyone would be in the room, everyone would agree this is what we’re going to do as an Enterprise, and then we’d walk out of the room and the five CEOs would do whatever the heck they wanted. I’m not judging them — they did that for their own reasons.

I was brought in to help bring live the first ever integrated clinical system across all campuses. The project had been stalled for two years. They didn’t even know where they were; we were able to work with their team to get it live in about seven months. Then, subsequently, because oftentimes organizations use large technology-based projects as organizational change management, they updated their job descriptions. They weeded out some people who needed to retire. They brought in new technology. They addressed poor workflows. They tightened controls and systems. There’s a lot that goes into this.

By the time I left, we had Enterprise Lab, Enterprise Radiology, and Enterprise EMR and document imaging. We had done a lot of work on the technical and infrastructure side to consolidate and to get similar systems across the organization. I owned all the applications for the five hospitals at that system and worked under some tremendous leaders and learned and got an opportunity to be a part of riding the crest of technology projects and helping organizations spiral up. I thought that was applicable to the scenario at Downstate and they felt it was as well. I was elated that they granted me the opportunity to play this role for them.

 

Urban hospitals & the community

Gamble:  Right. And of course, there’s always some risk involved, but when it’s the right opportunity, you have to go it. Do you feel it was a risk coming to SUNY Downstate given everything that needed to happen?

Sutterfield:  Well, I did but I didn’t. The reason I say this is that I actually work for Heidi Aronin, the Chief Administrative Officer on the campus side. She’s the first person I had a chance to interview with. The story she told and the values she talked about with Downstate are very similar to the values of Temple. I was born and raised in east Baltimore; the city hospital, which is now Johns Hopkins Bayview, was a couple of blocks from where I grew up.

The concept of an urban hospital and what it means to the community is something I grew up with. It’s a big part of who I am. It makes sense to me, and I can easily understand the mission of that organization and identify with it. And so, I wanted to be a part of making that organization thrive. But it was the leadership at Downstate that collectively provided me with the hope that everyone was swimming in the same direction and was looking to make it a better organization. It’s really a fantastic senior leadership team.

 

Gamble:  In terms of the future, is there anything you really hope the organization is able to accomplish or move toward?

Sutterfield:  I think we’ve defined our roadmap.  We have ER pieces coming into our organization for the first time. We have an electronic medical record vendor and a future decision to make and we’re close to making that. We’re moving to the cloud with AWS. I think I’ve been able to come in and pick up some of the bones of the plans that were there, and work with my senior leadership team to really put them into action.

The next two years are laid out for us. It’s about execution. It’s also certainly about upscaling our current IT staff, retaining those staff, and getting some additional staff. I think as you start to spiral up, the energy gets contagious. If I’m recruiting you, I’ll tell a story where you can come in and work for me, and have an opportunity to a leadership role in some very important and legacy defining projects. You won’t be sitting in the ticket queue; you’re going to get to be on the frontlines of helping a transformation. That’s the opportunity I think we all collectively see it and are marching toward.

 

Gamble:  That’s great.  It sounds like you guys have a really good foundation for moving forward and I hope I can connect with you a bit down the road to see how things are going.

Sutterfield:  Of course. I appreciate you reaching out and giving me a chance to tell our story. We really do work on both ends of the continuum. I have a mainframe that’s so old I can’t find anybody to work on it. On the other side of the continuum, we’re doing some crazy cool cutting-edge stuff in both the clinics and the research setting. It’s fascinating and challenging and it’s where the complex problems are. I really enjoy what we’re doing and being a part of it.

The other thing is that in urban health, vendors have to work harder to be our business partner. We want them and we need them. You can’t just take it out of the box and hand it to urban academic medical centers. They have to do their homework and think critically about how to adopt and adapt for us, and they’re certainly willing to do that. We need their help. We need these partnerships because we don’t have all the talent in house. We don’t have all the knowledge in house. But yes, we do confound people; after a conversation or two, they’re like ‘wow, I never thought of that.’

 

Gamble:  That’s great. Well, thanks again. I appreciate it and I will definitely be in touch soon.

Sutterfield:  Sounds good.