Q&A with University of Utah Health CIO Donna Roach: “Change management is core to everything we do.”

There are a lot of things that seem to come full circle. Change management, according to Donna Roach, is one of them. She believes the most effective way to successfully drive change is through a feedback and improvement loop, rather than a one-time interaction. Think of it as “morphing change management and agile,” said Roach, who has learned quite a bit about the topic during the past three decades. Both in her role as CIO at University of Utah Health and CHIME Boot Camp faculty member, she has preached the importance of guiding teams thoughtfully through change, building and cultivating partnerships – particularly with clinical leaders, and listening “with a critical ear.”

Recently, she spoke with Kate Gamble, Managing Editor and Director of Social Media, about her team’s digital transformation strategy, the innovative work they’re doing with AI sandboxes, the deliberate approach they utilize with any implementation, and what it was like to take on a new role during the pandemic.

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Bold Statements

We have a governance process that allows groups to submit case studies or user stories or situations that they would like to have AI assist them in. We have set up some sandboxes so that we can start to test the usability of the tool with AI in the background.

In our digital architecture, we have a platform approach that we apply; we stick with that rather than one-offs, because you can get into trouble with too many bright, shiny objects.

We learned this through Covid, we can do things faster. And you definitely have to fail fast. But if we weren’t doing it in conjunction with our nursing leaders, our physician leaders, and our clinical leaders, it fell flat on its face.

Sometimes you have to listen with a critical ear to say, ‘okay, tell me more. You’re telling me you don’t like it — what don’t you like about it? What are the pain points? Are there pain points that are more pronounced than others?’

Fall in love with the problem, not the solution. We have to focus on the problem and not move so fast to the solution. A lot of times people will come to me with a solution, and I’ll ask, what are you trying to solve for? Tell me more about that.

 

Q&A with Donna Roach, CIO, University of Utah Health

Gamble:  Hi Donna, it’s good to see you.

Roach:  You too. How are things?

 

Gamble:  Things are good. I see you’ve been busy. You’ve gone to quite a few conferences this spring.

Roach:  I have. Actually, I just got back from Becker’s, which was good. I did two panels there and talked to a number of people — my typical CIO cohorts and what they’re up to. AI is still big — it’s the main topic, but there is so much going on. For me, the topper was meeting Martha Stewart.

 

Gamble:  I’d love to meet her. I’d love to interview her, actually.

Roach:  You know what?  You would be a really good interviewer for her. She has been so good at creating her brand, managing it, and evolving it. She’s very astute. She has different groups of people who follow her, and she has this wide expanse from Snoop Dogg to her wine and now Sketchers. And she’s 82. I want to be as astute as she is at that age.

And she hates the word ‘reinvent’; I can see that it’s a little demeaning because it’s been much more evolution than reinvention. She’s an interesting case.

 

Gamble:  I agree. There have been so many iterations of her career. It’s a great opportunity to learn from someone like her.

Roach:  She is fascinating. Even my 26-year-old daughter follows her, and she’s a screenwriter in LA.

 

Gamble:  That’s great. They really do get fantastic speakers at Becker’s.

Roach:  They do. George Bush was the first speaker, and he was really good. I heard his father speak twice and his mother once, but this is the first time I’ve heard him speak. He was very self-deprecating. His approach was, ‘there are a lot of people here who are smarter than me.’ He was also very astute about the current situation. I give him a lot of credit.

 

Gamble:  Very interesting. But today, I get to interview you, which I’m looking forward to. So, let’s start with a little background. How long have you been with the organization?

Roach:  It will be 4 years in October.

 

Leading a hybrid workforce

Gamble:  So, you joined in 2020 — I’m sure that was an interesting time for a career change.

Roach:  Yes. I started smack in the middle of Covid. It was strange because I like to get to know people. I’m an introvert, but at the same time, I really like developing relationships with my staff and my leaders. There’s still a lot of people I haven’t met, mainly because we’re a hybrid workforce. I would say about 90 percent of my folks work from home. I like that.

The only downside is that I don’t get to know them like I would in a typical work environment. I encourage my leaders and staff to use the tools we to reach and be able to understand what’s going on with people. We need to make the most of those.

We used to do a quarterly survey — we moved it to twice a year, which I was disappointed about, but we still make the most of it. We get great feedback from people. But feedback is feedback, right? They’re going to tell you how they feel — sometimes it’s going to hurt but they’re also going to tell you some really insightful things about what they’re thinking and how they’re contributing.

As I tell my team, you’re caregivers. You’re just as much a part of the care team as the physician or nurse touching that patient. Don’t ever underestimate the role that you play. I don’t care if you’re a ServiceNow person or you’re on the customer service desk — you’re part of delivering care. And the insights you bring are tremendous.

“You have to shift.”

And so, we’ve decided to bring the team together for quarterly meetings. I have 450-some people, so bringing them together can be tricky. But it’s important to get them together and have that social aspect, while also disseminating information about what’s going on in the organization.

You have to shift. You have to morph into what is needed. I love the fact the staff can still work remotely. I think you get more output that way; you also get a happier person.

Now, there people who say, ‘I need an office. I can’t work from home.’ We still have a whole office building and a floor, and we’re always looking at whether we can ratchet that down a little bit. But there are office spaces and cubicles because I can appreciate the fact that for some people, working from home isn’t ideal. But they’re the minority.

 

Service delivery points

Gamble:  That’s consistent with what we’re hearing. I guess what’s important is as long as you have enough ways to communicate and strategies for doing that.

Roach:  I think this is the wave of the future and it’s all going to morph into a bit of a hybrid environment. About 2 or 3 years ago, there was a Harvard Business Review article about the hybrid workspace — I need to resurrect that.

We’re situated right in Salt Lake City, up against the Wasatch Mountains. People can live far north or far south. They can live in Parley’s Canyon, or to the east in Park City, or south in Heber City.

We’re looking at whether we can create hybrid office spaces, because we have service delivery points in those areas. If somebody had to or wanted to have a small team meeting, what would it look like? We have a few spaces that we’ve set up, but not as much as I would like. I don’t want to do it for the sake of saying, ‘look what we created.’ I want to do it because people are asking for it.

 

Creating a digital road map

Gamble:  Okay. So, at this point, about a third of the way through the year, what would you say are the key priorities for your team?

Roach:  When I first got here, one of the things I was asked to do was create the digital road map and strategy. The organization hadn’t had a true roadmap. And so, we created one relatively quickly and it has evolved. We’re now in the fourth year of our digital road map. It’s fun to see what we started with and how it’s improved.

We still have what I would call our 6 main swim lanes with that digital strategy. Those are: virtual care, access, community, personalization, innovation, and digital architecture. Those have changed a little bit; we’ve made some tweaks along the way.

Improving access to care

Our main focus is access to care — specifically, how to do that in an academic medical center that’s very quaternary focused. We’re the only academic medical center in a 5-state mountain west region. And so, access to care becomes really key especially when we’re at capacity in our ER and hospital beds. How do you morph out of that focus of always having to bring individuals into the hospital setting? What are some other ways of thinking about it?

From my group’s perspective, it’s how do you focus on access to care while also focusing on the continuum? One way in which we’re doing that is Heal at Home. We work really closely with our home care agency to identify patients early in the process who are good candidates for Heal at Home — even those in the ED setting who don’t need to be admitted. This is different from Hospital at Home, which is a CMS-type program. With Heal at Home, we’re discharging the patient and moving them home, whereas with Hospital at Home, there is no discharge.

Open scheduling

In the ambulatory setting, we’re looking at the continuation of virtual care with online scheduling and access to care from a telehealth or virtual care setting, and building it out so that the physician and the subspecialty groups are comfortable in opening up their schedules. We started at zero and now we’re up to 10 percent, which is great, but 30 percent is really where we want to be.

AI for ambient listening

And of course, AI is a huge part of what we’re doing. We have a partnership with Microsoft on DAX Copilot for about 100 to 120 licenses so that our docs can go into ambulatory visits with information. It’s deeply integrated with Epic. They can turn on Haiku, capture the notes, and have a great conversation with the patient. Now, they can look at patients face to face because the system is collecting that information. We’re learning a lot about the workflow and what are the best specialties to do this with — not all specialties are good for this type of tool just yet.

“Don’t take it away”

We’ve heard great feedback. Physicians are like “don’t take it away.” We did somewhat of a pilot for the first year and we’ll most likely continue it. But having that capability and seeing those improvements that DAX Copilot and Microsoft are doing with the tool is just unreal.

AI sandboxes

One of the things we set up, which is pretty cool, are AI sandboxes. We have a governance process that allows groups to submit case studies or user stories or situations that they would like to have AI assist them in. We have set up some sandboxes so that we can start to test the usability of the tool with AI in the background. We partnered quite a bit with Microsoft on this.

One area we’re looking at is virtual care and how we can improve upon real-time data analysis that we can then feed into the sandbox and say, ‘Okay, here’s how we can improve and be more actionable rather than waiting 6 to 8 weeks and saying, ‘we could have done this.’ We can do things in real time.

Convincing the skeptics

That has a big feeder into what we’re doing. We have a lot of use cases that have come in just recently. It’s been great. We actually brought in Microsoft to do a session with prompt engineering, which is big from an IT perspective. How do I teach people the best way to prompt an AI tool? Because there are some learnings that go with it. And the better you prompt, the better the answers you get back.

We had probably 25 people from all over the university, and they gave it great feedback. Even my most cautious, doubtful people were like, ‘okay, I see where this could work.’ That’s what I want to be able to do. I want to avoid rushing into it and making the mistakes you can’t really recover from. I think doing it in a thoughtful way has really worked out well for us. It’s exciting.

 

Easing the case load

Gamble:  It is exciting. I imagine that for people who get to participate in the sandbox and get to see what AI can do on a practical level and not just focus on shiny things — that’s so helpful. And prompt engineering is really interesting as well.

Roach:  Yes. Hallucinations are going to happen. How do you minimize or take into account that when you’re looking at the output, that it might be a hallucination, or it might not be the correct conclusion to make? And that’s okay. That’s why there’s a person involved. We just don’t take it and apply it. Even with our DAX Copilot when it goes into the note, the physician still has to review the note. But it’s so much better now in terms of flow. Physicians have told me, ‘I had a full case load and I got to go home at 5 pm today. In the 10 years that I’ve been doing this, I have never been able to do that and feel confident that my notes and my documentation are good.’

 

Epic first, but not Epic only

Gamble:  I’m sure that’s really gratifying. You mentioned Epic before — I would think adoption and optimization are ongoing priorities.

Roach:  We try to have an Epic first mentality; I’m going to borrow phrasing I heard from someone else and say, ‘Epic first but not Epic only.’ I say that because there are certain things they can’t do or aren’t ready to do. That’s why we have other solutions, or why we can do development to get us to a point. In our digital architecture, we have a platform approach that we apply; we stick with that rather than one-offs, because you can get into trouble with too many bright, shiny objects.

If you focus on your core platforms, you’ll be better off. For example, Qualtrics is our experience platform; and so, we use it not only for patient experience surveys, but also in our employee and our physician survey process. That way, we have data on the full experience. We work heavily with Qualtrics to evolve and be able to do more.

Real-time, actionable data

And Qualtrics and Epic are actually working on a partnership to get feedback data in real-time, which will make it actionable. For example, if I’m in the hospital and the noise level is really high, that feedback can be received and adjustments can be made. It’s similar to what we’re seeing in other industries. Yes, healthcare has been slow with adopting these things, but I think we’re quickly learning how to use some of those platform structures and pull that data in.

 

Gamble:  And you’re certainly no stranger to Epic. Before you came to Utah you were with BJC Healthcare and did a lot with Epic there. I’m guessing that gave you some valuable experience.

Roach:  That was a great team. I actually inherited that team from Chero Goswami who is now Chief Information & Digital Officer at University of Wisconsin Health System. I always tell him that he hired the best people and had the best structure in place. And they were evolving too; you can’t just sit still in a system like that. It’s such a core delivery mechanism, not only for the medical school, but also BJC, which has such a big reach into Missouri and Illinois.

 

Working for large organizations

Gamble:  I would think that there’s always going to be pros and cons in being with a large organization. But do you feel that that experience help you prepare for your role now?

Roach:  Yes. I have a great appreciation for Jerry Fox, who’s the CIO there. He was trying to introduce a product strategy. When I was at Ascension, they were trying to introduce a product strategy and it makes sense when you have more agile or fusion teams here in terms of how we look at a product and marry up the operational owner to the initiative.

I think that in Utah, there was a little bit of a disconnect from the operational owner and handing it off to IT. Now we’ve created really strong partnerships, whether it’s between the ambulatory care side or the inpatient side or transplant or cardio. We need that operational owner to help guide us through it.

Ownership and partnerships

And you might think that’s obvious, but as IT has evolved, decisions were made in IT that weren’t necessarily in conjunction with best practices. I think Epic holds us accountable to partner effectively. We have a huge medical informatics program and a huge nursing informatics program — they’re the ones that are right at the elbow seeing the day to day and working with us to improve our workflow. Because if we come out with something, or if Epic comes out with something, and it hampers the workflow or isn’t thoughtful about it, what do you do with the output of that system after you go live? Why did you implement it?

Early on in my experience, I saw a lot of situations where IT wanted to own it. Well, no, IT owns the infrastructure. IT owns the network, but it’s really the application that sits on the infrastructure. We have to partner with the various owners. Some people are great partners and others are like, ‘that’s not my strength,’ and that’s okay. We’ll partner with you in a different way.

I think more and more, and we learned this through Covid, we can do things faster. And you definitely have to fail fast. But if we weren’t doing it in conjunction with our nursing leaders, our physician leaders, and our clinical leaders, it fell flat on its face. I think the organizations that really excelled and learned through COVID are the ones that learned that partnership piece.

 

Change management “is core to what we do”

Gamble:  This speaks to change management, which is so interesting to me. It’s a huge component of leadership, as you know. What are some of your thoughts on what it takes to lead change?

Roach:  I actually teach the CHIME Boot Camp, and change management is one of the things I talk about. It is core to everything we do. And yes, there are going to be situations like Covid where you have an immediate problem or crisis. It’s like they say, ‘don’t let a good crisis go to waste.’ It’s how you take that and create that guiding force — individuals who will partner with you to move to the next level to align with the strategy of the organization. One place where change management is critical is in connecting the dots and helping people to see how the dots are connected.

Sometimes change management means going back to what’s the crisis and what’s the guiding force and guiding principles, and re-establishing those. It can be circular sometimes within the various steps. We’ve seen that. You have to be ready for when there’s a huge need and be able to address it right away, and not be so caught up with the project management steps that have to occur. Sometimes you have to do a pilot; sometimes you have to put something in a test mode in the hands of somebody so that they can give you feedback, and you can iterate off that feedback. That’s change management.

Change management & agile

It’s kind of like morphing change management with agile — making sure you’re constantly in the improvement and feedback loop so that as you evolve, you’ve impacted the culture. You’ve changed the culture of what’s going on. There’s big change management and little change management, and you have to be able to address both. And some of that has to be leader led.

For me, it was a gift when I saw the 2025 strategy that [Dr. Michael Good] created. That helped define the strategy of what we want to do with our digital road map. Those linkages are key in knowing your coalition and the people that are going to help move things forward and guide you on your road map. I am a big proponent of change management. We use it constantly in IT, as well as the organization as a whole.

 

“You have to listen to people.”

Gamble:  It seems like change management can be subtle; that sometimes you might not realize it’s happening, if that makes sense.

Roach:  Yes. One of the things I’ve realized about leadership is that you have to listen to people. Yes, you can lead and be upfront, but if you’re not listening and taking into account some of the impact, you’re missing what it means to be part of a coalition.

Sometimes you have to listen with a critical ear to say, ‘okay, tell me more. You’re telling me you don’t like it — what don’t you like about it? What are the pain points? Are there pain points that are more pronounced than others?’ Change management takes into account that if you don’t address some of those, that will be your downfall. People are going to use the new and improved in the beginning because they have to use it. You want them to want to use it.

 

Focus on the problem

Gamble:  You want to have the type of culture where people can give honest feedback and it will be heard.

Roach:  Yes. At the Becker’s conference, Ellen Wiegand [CIO at VCU Health System] reminded me of a great mantra: fall in love with the problem, not the solution. We have to focus on the problem and not move so fast to the solution. A lot of times people will come to me with a solution, and I’ll ask, what are you trying to solve for? Tell me more about that. Again, what are the pain points? Why do you think this will help? Sometimes they’ll say, ‘well, the vendor told me.’ No. I want to know why it was so intriguing that you wanted it and what problem you’re solving for, because just implementing a solution isn’t going to give you what want. You’re going to put a lot of time and effort into it, and then at the end of the day, it‘s not going to solve whatever problem or solution you wanted solved.

 

Gamble:  So it’s about really listening.

Roach:  Yes. And pulling it apart. I’m someone who asks pointed questions, and sometimes people I work with will say, ‘uh oh, where’s she going with this?’ But that’s how I understand what you’re trying to do. I hope it makes me a good partner with my executive team in the organization to say, ‘here’s what I hear you’re saying, and here’s that path I think we could follow. What do you think about that? Sometimes they’ll say, ‘I never thought about it that way.’ And I’m like, ‘okay, can we try it?’ Sometimes they say sure, and sometimes they’re like, ‘no, I want that.’ And I’ll say ‘well, let’s break that down a little bit.’ You have to go on that journey with them, but be careful not to rub their nose in it. You wouldn’t want the same thing to happen to you, so don’t do it to someone else. Just be a good person.

 

Gamble:  That’s good advice. I like that and I can it can be applied to many facets of life actually. Well, I want to thank you so much for the time. I know we ran over a bit, but I’ve really enjoyed chatting.

Roach:  Same here. Thank you!