For Linda Stevenson, being a yoga teacher isn’t just a hobby; it makes her a better CIO. “It allows me to be more purposeful, more thoughtful about how I work with my team.” In addition to offering a monthly yoga class for the staff, she has incorporated meditation and breath work into her leadership strategy as tools to help work through challenges.
Since she started as CIO at Fisher-Titus Health in February of 2019, Stevenson has leveraged her passion for wellness to bring “positive energy” to the role — and after a few years of hard work (including rebuilding the infrastructure), it paid off. For two years in a row, Fisher-Titus has earned Most Wired recognition for both the acute and ambulatory settings, which is a testament to the hard work the team has put forward. “It’s nice to be able to say, ‘here’s where you were and here’s how far we’ve come,” she said.
Recently, Stevenson spoke with Kate Gamble, Managing Editor at healthsystemCIO, about the progress the organization has made in recent years, how she works to keep IT connected to the overall mission, the “cybersecurity by committee” approach that Fisher-Titus has adopted, and the burden faced by CIOs of rural health organizations.
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- On connecting IT to the overall mission: “For me, it’s very easy. Every conversation, every project starts with why. Why are we doing this project? How does this make a difference for our patients or our people?”
- On the need for continuous training: “There are people who get into bad habits, whether it be telehealth or bedside documentation where they’re slipping the paper into their pocket to do it later. Educating them as to the why is important. We still have to have those conversations. We have to keep going back to the basics.”
- On cybersecurity by committee: “We meet on a weekly basis to review outstanding risks, to review any assessments that are done, to talk about penetration tests, and to plan for tabletop drills. Everybody has a little piece of the pie.”
- On rural health: “Something has to change because we all as rural healthcare organizations will not survive. Everybody has to really look at what’s the bottom line, what does our budget look like, where does the money need to be spent, and where can we cut back in order to survive the shifts in our economy.”
- On dealing with AI hype: “Vendors can go to any one of the leaders in organizations and say they can solve all of your problems with this automated thing, and it’s our job to then give a sense of reality to all those conversations… let’s really talk about where we’re going to invest our money.”
Q&A with Linda Stevenson, CIO, Fisher-Titus
Gamble: Hi Stevenson, thank you so much for doing this. The last time I interviewed you was in 2019, which feels like it was the last century.
Stevenson: Like a lifetime ago, right. A lot has changed since then.
Gamble: I’d like to talk about some of the things that your team is working on and get into your leadership strategy. Let’s start with a high-level overview of Fisher-Titus — what you have in terms of hospitals and some of the other facilities and where you’re located, things like that.
Stevenson: Sure. Fisher-Titus is a rural healthcare organization located in northwest Ohio. We have a hospital with around 100 beds. We also have a skilled nursing facility, a nursing home, and our own EMS group. We have many employed physician organizations and providers out in the community.
Fisher-Titus’ new facility
Gamble: I read something about a new facility, Willard Health. Can you talk a bit about that?
Stevenson: We’re very excited to be taking a different approach to bringing healthcare to the communities. We currently have a physician office in Willard; we’ve been very successful with our providers there. Our goal is always to bring care to the communities and to the patients whenever possible. Because of the aging infrastructure there, we said, it’s time to look at a new building, but while we’re doing that, we’re also taking a different approach where it’s more of a health center versus just a physician office.
The new facility will house our family practice but also have rehab, radiology, lab, and various services where the physician or the patient who might normally come to the hospital can get some of those services right in their community, which would be great.
“Services next to home”
Gamble: And so, the idea behind it is not having to go into a hospital. That makes a lot of sense.
Stevenson: I think it’s really important right now, especially in a rural healthcare community. We end up seeing a lot of patients who are challenged by transportation or money — maybe they can’t afford gas or don’t have someone to babysit their children. In those situations, how do they go see somebody? This provides services right next to their home. And so hopefully, it’s more likely that they’ll seek care and stay on top of their care by having those things close to home.
Measuring social determinants
Gamble: It seems like it’s part of an organization-wide philosophy around preventative care and doing whatever needs to be done to prevent disease progression and treat things earlier.
Stevenson: Yes. This year, there’s a lot of focus on the patient in our strategic plan; on providing care when and where it’s needed. It’s also reaching out as it relates to social determinants of health and helping to find other things that impact patient care. We’re going to be doing a lot of connecting through our statewide HIE and statewide integration for social determinants of healthcare in Ohio. We’re going to be doing more work with our care managers, reaching out proactively to patients for services and doing patient monitoring. All of that is connected to our approach to the patient.
Rebuilding the infrastructure
Gamble: And of course, you need a good infrastructure in place to enable that. I imagine that’s been a focus for a while now.
Stevenson: When I joined here in 2019, we spent a good chunk of the 2 to 3 years rebuilding our infrastructure from wireless to network closets to our entire phone system. All of this is making us solid in terms of being able to now build on some of the more advanced technologies. We’re good now, but we need to maintain that going forward and layer that on top of some of the more progressive things such as AI, remote patient monitoring, telehealth, and RPM.
Patients, people & the community
We’re doing some automation in that area, because not only do we have to focus on patients; we have to focus on our people, and it’s really not possible for us to do everything we need to do for the patient in a proactive way if we’re not increasing productivity and giving our people the right tools to do that. That’s really how our strategy aligns for this and the next couple of years. It’s the focus on three things: patients, people, and community.
“Straight for the big rocks”
Gamble: So, you definitely had your work cut out for you when you started with the organization. What was your approach?
Stevenson: We did a lot with analytics. I went straight for the big rocks which are what does the infrastructure look like, where are our big holes, where are the pain points, and where are we with cybersecurity? I spent a lot of time on those things. We did a road map of those things over the course of the next 5 years; we’re wrapping that up now.
I know 5 years sounds like a long time, but if you’re not looking that far ahead, it’s really hard to know what else you can build on. We looked at those two things initially. Interestingly, we had been a Most Wired organization back in 2015 or 2016, and we kept that for a few years. But then we lost that because the infrastructure wasn’t maintained. It was my goal to make sure we get back to that level of integration and advancement. We were excited to be awarded Most Wired last year and again this year. It took a few years, but we’re there. That really goes to show the work that was done on the infrastructure and revisiting what we already had, but also adding on layers of automation.
‘Most Wired’ as a motivator
Gamble: That’s a big accomplishment. Like you said, it really speaks to everything that was done. Was that something you used as motivation?
Stevenson: It was a motivation for me. I knew how good this organization could be. I know where they had been, and it made me really sad when I got here to see that it had not been well cared for. And so, we made some changes to our people, our resources within IT, where we managed up those that were doing great jobs and we turned over some of the people that really didn’t fit with the organization anymore. I think that lent itself to developing a team that was excited to make a difference.
You don’t need certification or an award to show that. But it is really nice to be able to say to your team, ‘here’s where you were and here’s how far you’ve come, and you guys did this.’ It really made it a motivational factor for them and for me, and we continue that today. We are motivated not only by that award but also by how we can make people’s lives better.
Our team is 100 percent mission driven. I think that’s why they work in healthcare. You can be an IT analyst anywhere, but to be an IT analyst in healthcare means you can make a difference in people’s lives. You can help save patients’ lives. You can make the difference in a nurse’s life. I think that’s part of the motivation as well.
Connecting IT to the mission: “Every conversation starts with why.”
Gamble: Do you do things like rounding? How do you help connect your team to the organization’s overall mission? I imagine that’s not always easy.
Stevenson: Actually, for me, it’s very easy. Every conversation, every project starts with a why. Why are we doing this project if we’re not doing it for good, solid reasons? Yes, there’s the ROI, the financial reasons, but how does this make a difference in our patients or people? That’s our focus. That’s why we always start with the why.
Monthly Mission Award
We have an organizational mission and vision, but I’ve also developed an IT mission and vision which is focused on three things: communicating, being proactive, and being innovative. We go over that in every single team meeting. We also have an MMA award. That’s our monthly mission award which highlights our people who are doing great things to achieve that mission. It may be somebody who did amazing communication with a department on a particular item, or maybe it’s someone who came up with an innovative idea that saved somebody tons of hours. We have a monthly mission award focused around that.
We also did some really cool things like a brainstorming day where we sat in a room and had stickies on the wall and put all the ideas out there. Over the course of the next year, went through every single one of those ideas to show people that their ideas matter. They loved that. Although not all ideas could be adopted, all ideas were reviewed and discussed so that they understood that yes, everything I do mean something and can be part of that direction.
Gamble: I love that idea. One of the great things about brainstorming is that it might lead to something else, or it might change your way of thinking.
Stevenson: Absolutely. This year we’re doing an innovation challenge where teams compete with innovation ideas and there are certain categories of innovations that you can compete for. At the end, we have the Final Four of our innovation challenge; it’s like the Final Four of basketball. They’ll be competing and presenting their ideas to myself and a couple of the other chiefs, and there will be a monetary award at the end of the year.
Digital Front Door
Gamble: That’s great. So, I know you’ve already gone through some of this, but what do you consider to be your core objectives right now?
Stevenson: As I mentioned, our organizational strategy is people, patients, and community. Under that umbrella, my IT focus this year is on a few things. One is engaging everything around the patient, whether that’s a new digital front door, or any type of automation and technology that can serve the patient better and help them take better care of themselves. We’re doing a patient digital front door. We’re doing some patient payment plans, some automation on statements. We bring everything for the patient in one bundle so they don’t have to be confused about where to go to get what.
The other piece of focus is our analytics. I have a team that’s 100 percent dedicated to building our dashboards and building out analytics and monitoring for all of our leaders in the organization, because they really need the right data at the right time to make good decisions. And that’s been difficult. When you come from an organization in a rural area, you have a lot of people who have worked here forever. Those leaders may or may not be business savvy or data savvy, and so, that analytics program comes with a layer of data literacy, education that we’re doing as well with our leaders. That’s another big focus for us this year.
Training on digital tools
Gamble: That’s really interesting. We’ve spoken to a few people about rural health and some of the unique challenges it faces, and so that makes a lot of sense to focus on that.
Stevenson: It’s been very difficult. Let’s face it, if you’re a nurse, you went to nursing school and you grew up learning how to take care of patients. Then you become a nurse manager or a nurse director or whatever it may be, and no one sits down and teaches you how to look at data — what does it mean? What’s an income statement? What’s a balance sheet? That’s not something they go to school for unless they happen to get an MBA later. But oftentimes, they get more nursing degrees. We want to make sure that they’re successful and provide them with the education and support that’s needed.
Gamble: Did you do something similar with telehealth when that first really started to explode?
Stevenson: Yes, we had to do that. We stood up our telehealth in one week when Covid hit, because we didn’t have it in place. We literally jury-rigged a telehealth system in one week in this organization which was pretty impressive. I was so proud of my team.
We then went back and reintroduced a more appropriate integrated telehealth within our EMR, and that works really well today. But the same education had to happen: how are we doing this? Why are we doing this? Let’s help people understand what it’s like to be on camera, what it’s like to present to yourself, what your background should look like, what conversation should look like. It was definitely an education effort.
“Keep going back to basics.”
Gamble: Definitely. It’s probably not that different from when a lot of physicians and nurses started documenting at the bedside.
Stevenson: It’s funny you say that, because to this day, we still have to have those conversations. There are some people who get into bad habits, whether it be telehealth or bedside documentation where they’re I’m slipping the paper into their pocket and saying, I’m going to do it later. Educating them as to the why is important to continue that and have that information available at the point of care. We still have to have those conversations. We’ve got to keep going back to the basics.
Cybersecurity by committee
Gamble: Another issue that’s top of mind for everyone is cybersecurity. Being a rural organization, I imagine you don’t have dedicated CISO. How are you able to manage the data security piece?
Stevenson: I’m blessed in that I have an outside group that I contract with to help me with those areas that we don’t specialize in. If something arises that we’re not sure about and want clarification on, we’ll reach out and pay an outside team. For the most part, our program is managed by a committee.
“Everyone has a little piece of the pie.”
We have a cybersecurity committee that includes key IT leaders, network team members, compliance leaders, and our chief legal counsel. We meet on a weekly basis to review outstanding risks, to review any assessments that are done, to talk about penetration tests, and to plan for tabletop drills. Everybody has a little piece of the pie, and it has worked really well for us. The good part is that everybody is learning. Security is everybody’s job; it’s looked at more that way than it is than just the CISO’s job or a security analyst’s job. I feel there’s a real benefit in that management by committee.
“This is an organizational challenge.”
Gamble: Shared responsibility — that makes sense. The challenge is that everything changes so fast. I imagine everyone really has to do their part to make sure that you’re on top of the latest threats to educate users, which I know is probably a big piece.
Stevenson: It is. Obviously, we do the annual required education in healthcare. We do monthly (or more) phishing attempts. We have meetings with our board of governors. We do a lot of education. We recently brought in an outside resource who did a 2-hour education session with all of our leadership. While it sounds like a huge investment, getting leadership from directors into the room for this education was well worth it. I can’t tell you how many people said, ‘that was amazing.’ Because the education was put in a way that yes, this is an organizational challenge, but this also applies to your everyday life. This is what happens to your bank account. It really hit home. I thought it was a really good decision that we put all the leaders in that room.
Gamble: I’m sure it required some resources, but it’s so important.
Stevenson: When you’re in security, there is so much technology and so much detail that goes into everything we need to understand. It’s really hard to bring it down to the level that people understand. I think those moments are really important.
Organization wide, leadership wide, and even within IT team, the networking person’s understanding in terms of cybersecurity isn’t the same as what our trainers or clinical analysts need to know. They all have a piece to be able to tell each other and talk about those things.
Rural health challenges: “something has to change”
Gamble: Interesting. I would imagine that being a rural health organization, it has to be part of the fabric to be really deliberate about decisions and try to do more with less. But I imagine that that just has to be at the forefront of every decision that’s made.
Stevenson: It’s specifically challenging right now. As we all know, post-Covid, costs for everything went up. Reimbursement has not changed. My leader, my CEO, and several other leaders in the organization are doing a lot with advocacy through AHA and other state organizations to say hey, something has to change because we all as rural healthcare organizations will not survive. But to that end, each leader, me, the CFO, the CNO, everybody has to really look at what’s the bottom line, what does our budget look like, where is the money need to be spent and where can we cut back in order to survive the shifts in our economy we’re living with right now.
Pressure on CIOs (to do more with less)
I think particular pressure is put on the CIOs to say, what tools can you find us to automate; to take out some of the manual labor to save time and savings and hopefully, eventually, maybe even FTEs? Not that we ever want to remove people from the picture, but as attrition happens and people leave, let’s see if we can do more with less through some of the tools.
Gamble: I imagine that’s a big part of the strategy going forward — leveraging automation to handle some of those non-top-of-license tasks.
Stevenson: Correct. That’s why we’re looking at remote process automation from a revenue cycle side, and other tools like that. We’re keeping an eye on some of the AI and the ChatGPT stuff in terms of how we can help people do things quicker. We’re a little slow to go down the AI path right now. I mean, we’ve got pieces of it, but we’re being cautious of the release of some of these things. For cybersecurity and confidentiality reasons, we’re trying to get policies and practices in place so that we have a little bit of control over that.
Dealing with AI Hype – “Let’s talk about why”
Gamble: It makes sense to wait it out and see what the use cases are. There’s so much excitement around it and it is an exciting concept, but a lot needs to be figured out first.
Stevenson: That excitement is fun to hear, but on the same token, it’s also causing vendors go to any one of the leaders in an organization and say they can solve all of your problems with this automated thing, whatever this thing may be. It’s our job to then give a sense of reality to those conversations and to do some prioritization. I can tell you that at least five or six different leaders have come to me and said, ‘I want to buy this AI tool or that AI tool.’ Okay, but let’s really talk about what the why is and where we’re going to invest our money, because you might have good ideas, but some are going to have more of an ROI than others. We have to look at those, bring them back to the chiefs, and sit down together and say, what are our priorities?
Gamble: I also want to talk about your leadership philosophy, specifically your experience as a yoga teacher and wellness coach. That’s so interesting to me. How do you incorporate that into your strategy?
Stevenson: Absolutely. I think being a part-time yoga has made me better at my day job. Being a yoga teacher makes me a better CIO. It allows me to be more purposeful and thoughtful about how I treat my team and how I work with my team. I’m able to bring some of those skills to my team. I offer a yoga session once a month — anyone can come.
I also do Wellbeing Wednesdays once a month with my team. I develop content to present to my staff on topics like sleep, mediation, or breath work and the benefits of all those things so that they have the tools to help them through the work-life balance challenge everybody is experiencing. I think it’s also important to provide those tools to help people manage the loneliness or isolation that comes with remote work. I really try to engage with them on camera. Those things are top of mind for me because of my background in health and wellness. I hope I bring good energy to my leadership because of it.
Making a difference
Gamble: I really like what you said about how practicing yoga makes you better at your day job, and I love that we’re seeing more emphasis on the importance of well-being. It makes a tremendous difference and lets people know that they can come to you and that you’re looking out for them.
Stevenson: I hope they know that I care because I really do. The success of my team is everything, because their success is my success. I’m just the coordinator and the prioritizer.
I’ve had this conversation a few times with my team: if you don’t enjoy your job; if you’re not getting up in the morning and you’re excited to go to work and do your job, then you’re in the wrong job. And I do feel that. I drive an hour to work each way every day. I don’t live near work, but I do it because I get up every morning knowing that I can make a difference in the lives of my employees, the organization, and our patients. I think that’s a mindset and a motivation and a moment of gratitude you take every day. We should all have that going into work. Otherwise, we should be doing something else.
Gamble: Absolutely. To me, if you’re having discussions about well-being and it’s part of the culture, you’re going to see results, because people are going to be in a better headspace. They’re going to be more open about themselves. They’re probably more apt to look out for each other, which is really important.
Stevenson: Yes. Hopefully they’ll also stay with the organization longer because they’re being treated well. Reducing turnover and keeping people happy here is one of the most important things.