Q&A: Ascension’s Erica Williams on Leading through Influence and Relationships

In recent years, there’s been quite a bit of talk about what keeps healthcare leaders up at night. What’s just as important, however, is what gets leaders out of bed in the morning. For Erica Williams, it’s having a job that feels much more like a calling. “Being a leader is what brings me joy,” she said in a recent interview. “I love coaching and mentoring. I love being able to help people who have the right skills to grow within the organization.”

As she has learned during the past 25 years, those skillsets don’t always translate from one organization to another. At a system with size and scope of Ascension, Williams believes the key to success is in learning how to lead through influence and relationships, rather than through authority alone.

Another key is patience, she said, noting that it took “a good 6 to 7 months” to fully understand the structure of both Ascension itself and the 14-hospital region in which she serves as RTO. During a conversation with Kate Gamble, Managing Editor and Director of Social Media, Williams talked about how she has worked to develop a culture of collaboration and accountability; the thoughtful approach she adopted when she entered the organization is 2022; and the “win-win” of being able to promote from within. She also shared thoughts on the importance of giving back and “investing in people” and why it has become more vital than ever to maintain balance in life.

Bold Statements

My focus has been on making sure everybody is clear on our role and making sure the right people are in the right roles. That’s always difficult, but much needed. Sometimes it’s not anything that someone is doing wrong per se; it’s just not the right fit.

You have to set expectations. Once you do that, you need to determine whether there are gaps. And if so, are there gaps because of education and coaching that might be needed, or is it an issue of fit? Secondly, once you’ve set expectations, it’s a matter of holding people to those.

What worked previously doesn’t necessarily work where you are now. You have to figure out if it meets the organization where they are and figure out how you can accomplish what you want to accomplish, but within the guardrails of your situation.

As you dig in and ask questions, you create accountability and trust with that person along the way. Even though I may not be the one to fix the problem, I can learn who to connect them with, make the connection, and then follow up to make sure that whoever I brought in to help is actually helping.

Q&A with Erica Williams, RTO Ascension

On her role with Ascension

Gamble:  Hi Erica, thanks so much for taking some time to chat. To start, can you provide an overview of your role at Ascension and how the organization is structured?

Williams:  Sure. I’ve been in large health systems for the past 15 years of my 25-year healthcare career: HCA, Community Health Systems, and now, Ascension. At a high level, they’re structured similarly from an IT support level perspective. There’s a CIO and a VP, and then there are regional executive leaders. Some organizations may call them Division CIOs; at Ascension, it’s Regional Technology Officer.

Basically, I’m responsible for the 14 hospitals across Texas. We’re divided geographically among 8 RTOs across the organization. The 14 hospitals [in my region] are fairly centrally located around Austin with the exception of Waco, and that’s only about an hour and a half north of us. We have about 250 clinics, as well as other sites of care. I’m ultimately responsible for all things IT across Texas regardless of whether it’s my direct team or if it’s indirectly matrixed to other technology teams.

My direct team includes service delivery, clinical informatics and account management. My account managers, which in the for-profit world, would be similar to an IT director, are leaders aligned with hospital operations and strategies to make sure that as an IT organization, we are meeting those needs. That’s my direct team, and then we have different technology towers across the organization that we collaborate with to make sure that we are supporting the hospital/market operations and strategic agenda from an IT perspective.

 

On learning a new organization: “It takes time.”

Gamble:  Even though you had worked for larger organizations, I imagine it was still an adjustment for you when you came to Ascension. What was that like and how did you approach it?

Williams:  It was. It took me about 6 months to figure it out. Because while the structure may be the same at a high level, every organization is different, especially once you get to the RTO or Divisional CIO level. For me, it was understanding the scope of my team versus the scope of the rest of Ascension Technologies — as we refer to ourselves — and understanding how to navigate that. It takes time.

 

On her key focus: people, process & technology

Gamble:  At a high level, what are your key areas of focus right now?

Williams:  I’ve been with Ascension for a year and a half. When you break down the typical IT leadership role, it’s about people, process, and technology. My focus has homed in on the people and the processes. We’ve had a lot of changes in our organization in terms of a reorganization of IT. We’ve also had some outsourced vendor partners enter our support model. And so, there was some opportunity to really clarify our structure, our roles and responsibilities in that structure, and how we navigate that.

And so, my focus has been on making sure everybody is clear on our role and making sure the right people are in the right roles. That’s always difficult, but much needed. Sometimes it’s not anything that someone is doing wrong per se; it’s just not the right fit.

 

On creating a culture of collaboration

Williams:  It’s also creating a culture of collaboration and accountability, especially when there are gaps in terms of leadership, which had been the case. When I came here, I had to break down some silos and bring everybody together — not only within my team, but also helping them understand who their counterparts are across the system.

Because in our organization, we don’t accomplish anything on our own. There’s always a partner, whether it’s in broader teams across Ascension Technologies or one of our vendor partners. It takes collaboration to be successful.

Delivering on our commitments

From an IT perspective, it’s about doing what we said we’re going to do and delivering on our commitments. As part of that, we needed to get our portfolio and governance structure down pat. That’s the people and process angle.

From a technology perspective, we were piloting several initiatives for the organization to really streamline and have our vendors work together to create one patient chart. We’ve made a lot of progress and have had a lot of wins in the interoperability space — not only internally, but externally. That’s been a big focus for us.

 

On establishing accountability

Gamble:  It’s interesting; you talked about accountability being part of the culture. How have you gone about doing that? Is a matter of getting quick wins and building trust?

Williams:  First and foremost, you have to set expectations. Once you do that, you need to determine whether there are gaps. And if so, are there gaps because of education and coaching that might be needed, or is it an issue of fit?

Secondly, once you’ve set expectations, it’s a matter of holding people to those. For example, we didn’t have a great view of our portfolio. It’s hard to hold people accountable, and drive execution when you don’t have a good view of the work. And so, it was important to get some processes and data in place to be able to see where we are (and are not) meeting expectations.’ At that point, it becomes much easier to create accountability.

 

On change management

Gamble:  In terms of getting the right people in the right spots, I’m sure that that’s something that comes with experience. But it’s got to be challenging to do that when you’re new to the organization.

Williams:  It is. We were starting from scratch because I was learning about the organization and the structure. I also had to understand what are the expectations for my role, and then further, what are the expectations for my team. Once I had that picture, it took a good 6 or 7 months for me to get to where I had what I needed to start holding the teams accountable and setting expectations. It’s not something where you can just come in and start making changes.

I had to give myself some time and give the team some time to understand what’s expected of them, and to help them see that I’m going to do everything in my power to help them be successful. Then at that point, everything is outlined and it’s up to them to decide, is this really what you want to do? Does this make you happy? That’s where the success points are.

 

Gamble:  You mentioned gaps in leadership. So, you knew coming in there was a lot that had to be done — it’s kind of like playing the long game. Was that difficult for you? I know that some people want to come in and get things done right away. But how did you approach that?

Williams:  Right. I knew I had to figure things out. I couldn’t come in fast. There were situations where I wanted to make a change, but I realized it wasn’t going to work if I came in fast. What worked previously doesn’t necessarily work where you are now. You have to figure out if it meets the organization where they are and figure out how you can accomplish what you want to accomplish, but within the guardrails of your situation. There are things you might make the right decisions on, but then others where it’s not going to work, and we have to look at it from another angle.

 

On leading with influence vs authority

Gamble:  Do you think you benefitted from being with other organizations that are large and matrixed?

Williams:  Absolutely. I think leaders sometimes come into these types of organizations and struggle to find success because it’s a very different skill set to lead through authority than it is to lead through influence and relationships. If you aren’t focusing on building relationships across the organization and you aren’t focused on leading through influence, and instead are just trying to just force and bully your way through authority, you will not be successful. I’ve seen that over and over again when someone is hired from a smaller organization where they’re used to tapping someone on the shoulder and saying, ‘you just need to get this done.’ That just can’t happen most of the time with our organization. As a leader, you need to be clear about what it takes to create success in the organization and go from there.

 

On identifying “gems”

Williams:  I will also say that I came here and had some really great gems within the organization. I found I had an amazing team to pull from, and I want to focus on how I can leverage those people and give them opportunities. They may not have had the leadership experience of someone coming in from the outside, but they have all of the other skills and knowledge that it takes to be successful.

The win-win of promoting from within

To me, the key things are grit and a focus on customer service. Those are things you can’t really teach or train. But I can teach someone how to grow as a leader and develop executive presence. Those things are teachable. When you work with people, it’s easier to identify who those main players and stars are in that way. As I say to my team, you come to work every day interviewing for your next role within this organization. When you can see who you have within the organization and pull from there, that’s a win-win, and it’s a job satisfier when people see that there’s opportunity to grow within the organization. That’s been a big part of my focus.

 

On being a leader: “[It] brings me joy”

Gamble:  That role of nurturing people and seeing them develop and progress—is that one of the things you enjoy most?

Williams:  Yes. I love coaching and mentoring. I love being able to help people who show that they have the right skill set to grow within the organization. I’ve been fortunate enough to do that throughout my entire 15 years in healthcare IT.

I’ve been given opportunities, and with every opportunity, I was tapped on to say, ‘would you be interested in this role within the organization?’ And each time, I already had someone I was grooming and growing who could easily step in, which was beneficial for both parties. It was a win-win. It enabled my leader, or whoever is looking to pull me into another opportunity, to feel safe that we already have someone groomed and ready to go. That’s one of the things that I love most.

 

On succession planning: “Be curious, not judgmental”

Gamble:  Very interesting. We’ve heard before how important it is to have that line of succession. So, as someone who’s always looking to develop talent, what do you look for future leaders? What are the characteristics that stand out to you?

Williams:  One of my favorite quotes is from Ted Lasso and it’s, ‘be curious, not judgmental.’ I’m looking for a curious mindset; someone who asks questions. For example, if someone comes to me and asks something I don’t know, instead of saying, ‘I don’t think I can help you’ or sending them to someone else, I need to inquire and dig in and understand what customers really need.

As you dig in and ask questions, you create accountability and trust with that person along the way. Even though I may not be the one to fix the problem, I can learn who to connect them with, make the connection, and then follow up to make sure that whoever I brought in to help is actually helping. It helps me to grow, and it helps them to grow as well.

I’m looking for people who look at the big picture. People who want to understand the why behind things — not just getting specific tasks done and keeping their heads down. I want people who are quick to learn and want to do more.

 

On working with CHIME University & Women Business Leaders

Gamble:  Right. So, I want to talk a bit about some of the work you’ve done with CHIME University as well as Women Business Leaders. It’s so important to help educate and give back. What have those experiences been like for you?

Williams:  I was at a point in my career where I wanted to continue to give back. That’s where I got connected with CHIME University. I was specifically part of teaching a cohort of IT resources who were new to healthcare. To dedicate that amount of time to investing their people and making sure they understand their customers and can better support them — I love that. I taught a few different courses, and I really valued having that time with those students to share what I know and learn from them. I’ve really enjoyed that as a coaching opportunity.

Women Business Leaders is something I was connected with through a friend of mine. It’s a little different from the other organizations like CHIME and HIMSS in that it’s focused on healthcare, but not just IT. It helps to broaden my network—it’s not just IT leaders, but also payers and different leaders. I enjoy being part of that network.

 

On outsiders entering healthcare: “It’s a big learning curve.”

Gamble:  I feel like we’re seeing so many people coming to healthcare from other industries, and it’s challenging because healthcare is so nuanced.  

Williams:  It’s a hard industry. It’s a big learning curve. I’m fortunate that I’ve been in the healthcare industry my entire 25-year career. It’s my world. But coming into it, I imagine, would be really difficult. It’s just unique from a regulatory standpoint and in terms of how we’re paid. It’s interesting when you have someone new come into the industry and they don’t understand why we aren’t able to move as fast as other industries. ‘We’ve been doing this for years — why can’t we do it in healthcare?’ The assumption is that there aren’t amazing, smart people in healthcare. There are. Once people get into this environment, they start to understand the regulatory pieces and the payer world — those things that are barriers for us.

 

Gamble:  It’s funny; when I first interviewed BJ Moore from Providence, he admitted that he had misperceptions before he came over from Microsoft. Once he was in healthcare, he was blown out of the water.

Williams:  I remember presenting at a HIMSS meeting and someone stood up in the audience and said something along those lines. They were excited and wanted to drive change, and said, ‘why are we doing it this way,’ and I kind of chuckled inside. You’ll understand once you’ve been in it.

But at the same time, it’s great to have that outside perspective. It keeps us on our toes. We can become immune to it, so it’s good to have that reminder or suggestion that we can do things differently.

 

On maintaining balance: “There’s always going to be more work.”

Gamble:  I agree. It’s important to have that perspective. So, the last thing I wanted to talk about is work-life balance — or maybe just balance. I think the pandemic changed a lot of peoples’ priorities, or changed the way we look at things. I wanted to get your take on how you view that for yourself and your team.

Williams:  Sure. I agree the pandemic did bring a shift — a good shift. It may have shifted a little too much one way, but we’re correcting a little bit. I tell my team there’s no prize for having the most PTO in the bank; nobody wins from that.  There’s no reason why you shouldn’t be spending time with your family.

Because ultimately, especially if you’re in a leadership position, you’re never going to be caught up. There’s always going to be more work than you can do. If you’re someone who finds joy in your work and that’s where you want to spend your time, that’s fine. But for most people, that’s not the case. And so, it’s really important to take time away and reconnect. At the same time, know what your priorities are and what has to get done, and when. Because there are going to be moments where you have to invest a lot of hours, more so than other times.

When I take PTO, for example, I want to stay connected a little bit because it helps me when I come back to not be blindsided — I want to know what I’m coming back to. But I know I have to be careful of that because I don’t want my team to think that I expect that from them. If they want to do that because they feel similarly as I do, that’s fine. But I don’t expect them to check in when they’re on a cruise. Your whole team has to be supportive of that so you can make sure you stay grounded.

 

Gamble:  I agree, one hundred percent. Well, I want to thank you again for sharing your time. I’ve enjoyed hearing about it and I hope we can connect again in the future.

Williams:  That sounds great. Thank you!