Rural healthcare is fighting an uphill battle. Consider the following facts, courtesy of the NHRA:
The statistics may seem jarring. But to those who live and work in rural America, it’s reality. And unfortunately, the economic hardships suffered by many during and after Covid-19 have not helped matters.
“It has gotten harder – a lot harder,” said Linda Stevenson, CIO at Fisher-Titus Medical Center. Although organizations like hers still work hard to immerse themselves in the community, it has become increasingly difficult to invest in service lines when their own margins are so tight. “If we do too much of that, we won’t be able to sustain ourselves.”
Fortunately, what rural healthcare organizations lack in resources, they make up for in resourcefulness and a passion for serving the underserved.
In the first of a two-part series on rural healthcare in America, Stevenson and two other leaders – Scott McEachern (CIO, Southern Coos Hospital & Health Center) and Brian Sterud (CIO & CISO, Faith Regional Health Services) – open up about the myriad challenges they face. Not just in keeping the doors open, but being able to serve people across wide geographic areas, recruiting and retaining both providers and IT staff, and finding ways to leverage cutting-edge technology without putting data (and patients) at risk.
Scott McEachern
When most people hear the words “rural healthcare,” they don’t typically envision rapid growth, but oftentimes, that’s exactly what’s happening.
Case in point? Southern Coos Hospital and Health Center in Bandon, Oregon. When the 21-bed critical access hospital was built in 1999, it fit the needs of the coastal community. Now, however, “we’re bursting at the seams,” said McEachern. “We need a new spot.”
But it’s not just about constructing a new facility – which, of course, would be a significant financial lift. As part of its strategic objective to be “the hospital choice on the southern Oregon coast,” Southern Coos embarked on a master facilities planning process to better understand the “demographic changes” the area has undergone and develop a long-term plan to better serve the population. “That will give us a roadmap for our service line development,” said McEachern, who contracted with a consulting agency to determine next steps. “We know we need more space, but we also need to know what services to invest in. We’re taking a closer look at our current footprint, which will determine how we’re going to grow and what type of financial plan we need to support that.”
However, it’s not just about expanding the physical footprint, he said, adding that plans are in place to incorporate telemedicine in the ED and join the state’s telestroke network. “That’s our first step. The second is to expand into specialty care and the outpatient space,” which includes connecting with organizations in urban areas for consults.
While those initiatives can help buck the trend, access to care remains a challenge, prompting leaders like McEachern to get creative. One tactic he’s pursuing is a partnership with Bandon Dunes Golf Resort, one of the largest employers in the region, to open an occupational clinic staffed by Southern Coos clinicians.
Others include opening an outpatient retail pharmacy to help patients secure medications in a timely manner, something that has eluded chain pharmacies in the area, and providing a nurse for the Bandon School District.
By having a nurse onsite, “we’ve been able to more effectively triage issues, especially behavioral health,” he said. As the local provider, “we must have those collaborations in place. And so, we’re really working hard toward those.”
Linda Stevenson
Like so many organizations, Fisher-Titus had to place projects on the back burner during Covid-19. And when the dust settled, they found that costs had spiked. “Everything we have to buy has gone up in price,” Stevenson said. “Our salaries had to go up to attract people to the organization, but our reimbursement hasn’t gone up. That’s the challenge we’re facing.”
In addition to its 100-bed hospital, Fisher-Titus has a skilled nursing facility, an assisted living facility, Home Health Center, and more than a dozen ambulatory locations, all of which are fighting for resources.
Fortunately, leadership had the foresight to invest in AI-power voice assistants, and saw positive results with Nuance Dax before switching to Suki Documentation. “There’s an opportunity to leverage AI for things like revenue collection and documentation so that we don’t need as many bodies, which are hard to find in rural health,” she said. “AI can do some of that for us.”
Based on the success it has had with physicians, the organization hopes to expand it to nursing and revenue cycle. “We’re looking at how we can automate pieces where people are making phone calls to get claims status, for example,” Stevenson noted. “It’s a waste of someone’s time when they can be digging into more complex challenges. Let’s let AI or bots do that work.”
When it comes to staffing the IT team, which has proven challenging, Fisher-Titus doesn’t rely on remote work – not for productivity reasons, but because it doesn’t match the culture. “They want to see people here. If we try to recruit someone who lives in California and has never set foot in our hospital, it doesn’t work,” she said. “We’ve tried it. There’s no buy-in, and there’s no attachment. You don’t get the feeling of our culture.”
It’s a quandary that other rural leaders can relate to, which is why Stevenson is such a big proponent of collaboration. “When I have a question, the first thing I do is phone a friend and ask, ‘what are you doing in this space?’ or ‘which vendors have you had success with?’ Those recommendations count for a lot.”
Fisher-Titus is part of Vantage Healthcare of Ohio, a coalition of independent hospitals formed in 2015 to help improve efficiency and patient care through sharing ideas. Last fall, Vantage became an affiliate member of the Suburban Health Organization, granting member organizations access to even more resources. “It’s rural healthcare organizations coming together to talk about our priorities, help with vendor selection, and get better pricing from that vendor,” she said.
Stevenson’s involvement goes beyond Ohio, as she is an active member of the CHIME Policy Steering Committee and has spoken on panels at ViVE and other events discussing the obstacles facing rural health systems. “We monitor what’s going on in Washington, whether it’s telehealth expansion or what’s happening with Medicaid reimbursement,” she noted, encouraging peers to get involved on the local and national levels, and utilize resources like the Rural Health IT Community, a partnership recently formed by CHIME, Microsoft, and Nordic.
“I don’t think people realize how many thousands of rural, community and critical access hospitals are in this country,” Stevenson noted. “We need to get the word out and get people to help make a difference.”
Brian Sterud
The recruiting hurdle is nothing new to Sterud, who has been at Nebraska-based Faith Regional Health Services since 2013. “It’s our biggest challenge,” he said, despite the fact that the organization boasts “exceptional” employee engagement scores. “We’re always in the top tier,” and still, hiring remains a struggle, particularly as other industries continue to leverage remote and hybrid models. “We’re competing with the whole nation,” he noted.
The realization prompted Faith Regional to reach out to Wayne State College, a nearby university. Sensing the opportunity for a mutually beneficial partnership, the two organizations formed Growing Together, a program that helps place students in internship roles at the hospital. And although it hasn’t yet resulted in a full-time hire, Sterud’s team is encouraged by the progress that’s been made.
“I’m really proud of what we’ve done,” he said, adding that the program isn’t limited to IT, focusing also on HR, finance, and other key roles. And while it’s still in its infancy, he believes it will help build a pipeline of talent, and could eventually serve as a model for similar organizations. “It’s already made a huge difference for us.”
Improving access
Another challenge comes in the sizable geographical area Faith Regional covers – and the resulting gaps in access. “Some people are traveling three hours or potentially more to get care,” Sterud said. Once again, the team put its head together and developed a solution: outreach clinics. “On any given day, we have specialists who go to other hospitals and provide the type of care people wouldn’t normally be able to get,” he said. “That’s the best way we can expand access.”
Faith Regional has also been able to continue the telemedicine programs that proved popular during Covid, especially in the behavioral health space. And in fact, “we’ve integrated it into all of our practices so that when people schedule, they can choose telehealth,” he noted. “It’s interwoven into our strategy.”
The cyber piece
Of course, along with the use of digital tools comes added security risks, according to Sterud, who holds the CISO role in addition to CIO. “We may be small, but we have the same struggles as everyone – but not the same budget,” he said.
And although he has an extremely qualified director who’s able to take tasks off of his plate, Sterud has also leveraged outsourcing to fill in the holes. “Hiring security talent is next to impossible,” he noted. “We pick our spots where we can use external consulting,” which has helped the team score high in risk assessments and ensure resources are being leveraged appropriately.
The final component in easing the security burden is in organizations like CISA, which offers free resources such as onsite vulnerability assessments for rural health organizations. When Faith Regional leveraged their service, “it opened our eyes to a lot,” he recalled. And although these resources are still available, CISA and similar agencies are at risk of losing their funding, he noted, making it critical for all CIOs – especially those from small or rural organizations – to lend their time to advocacy efforts.
“Everyone needs to have a voice, regardless of the size of the facility,” said Sterud, who received the CHIME Public Policy Award in 2023 for his commitment to policy issues. He urged others to get involved – or at least, “stay on to speed on what’s happening and network with others who are going through the same thing.”
For rural health leaders, it comes with the territory.
“There are historically important events that serve as markers in our lives,” said Jamie Nelson, CIO Emeritus at Hospital for Special Surgery. “And when you get through them, your life becomes about before and after, because everything transforms.”
One of those events, of course, was the Covid-19 pandemic. Since the beginning of 2020, so much has changed – not just in terms of how people receive care, but also how they work, communicate, and engage with other industries.
Times like these, according to Nelson, “really do force transformation: personal and societal transformation. We are living in interesting times.”
That’s an understatement.
As we mark five years since the initial lockdown – and since the origin of the 229 Project – it feels like an opportune time to reflect on how much has changed. To that end, we spoke with Nelson and two other leaders about their experiences during the pandemic and what they believe were the key lessons learned.
Daniel Nigrin, MD
For MaineHealth CIO Daniel Nigrin, MD, one of the most important takeaways from Covid is that “it pushed us from a financial point of view to be more economical and resourceful, and to do more with less.” Of course, that’s not exactly a novel concept for nonprofit healthcare systems, but during the pandemic, it was amplified.
And that meant adopting a nimble mindset and leveraging tools that were already in place, albeit underutilized. Case in point? Telemedicine, which expanded exponentially when the lockdown went into effect. “All of a sudden, the majority of care was being delivered that way,” and the majority of tasks were being completed virtually.
Both proved successful.
“I think we all learned that remote work does work, and we should capitalize on it,” said Nigrin, who came to MaineHealth in 2021 after 26 years at Boston Children’s Hospital. “The majority of the concerns around productivity and collaboration have been debunked. In fact, in the last few years, we’ve rolled out more big initiatives and been more successful than ever. It’s clear that people are working – it may be happening at odd hours, but they’re working.”
As a result, employees have come to expect flexible schedules, and in most cases, Nigrin supports the premise, but with a caveat. “We have to be careful that we don’t lose something along the way,” notably the camaraderie that stems from face-to-face interactions. At MaineHealth, “we’re very forthright still about having regular times where we bring the entire team together, even just for social reasons.”
And while there’s certainly value in that, he also encouraged leaders to hold in-person events – but cautioned against making it mandatory. “I allow it to happen organically,” he said. As a result, those meetings have been successful in enabling teams to become better aligned on projects and more productive.
Another core objective in getting teams back onsite – at least periodically – is to ensure IT remains closely connected to the mission of the organization. “We were already a little bit removed from the actual provision of care; it’s even harder now to get that point across to our teams and make it real for them,” he said. For CIOs, it means prioritizing clinical rounds. “We’re talking about peoples’ lives, and that’s hard to do when someone is on Teams meetings all day. I strongly encourage our teams to schedule time to go meet with clinicians so they can see what the work environment is like.”
And hopefully, feel more connected to it.
Eric Neil
If there was a “ground zero” for Covid in the United States, it was Washington State – and not just because the nation’s first coronavirus case was confirmed at Providence Regional Medical Center. UW Medicine’s virology department developed a groundbreaking lab test that expedited the process of obtaining results. And on March 6, 2020 – just a week after the first reported US death – the health system stood up one of the first drive-through testing sites in the country.
This required a significant lift from the IT team, whether it was distributing devices, ensuring connectivity, or configuring systems to enable rapid changes, according to UW Medicine CIO Eric Neil.
Sharing knowledge
And it didn’t stop there.
Neil, who had just taken on the role of interim CIO in January 2020, immediately recognized the need to share the knowledge his team had gained on the fly, particularly as Covid cases started to escalate. “As we jumped onto calls, we realized we had nothing to refer to,” he said. “We had that light bulb moment of, ‘we have to document this. We have to help other systems so that they’re not in reactive mode.’”
To that end, a team of leaders led by Neil published their findings in the Applied Clinical Informatics Journal, describing their strategies for critical tasks such as building order sets, creating dashboards, and setting up vaccination sites. The goal was to ensure no one was flying blind, he added. “Our mission is to improve the health of the public – not just in our local region or community.”
Under normal circumstances, of course, UW Medicine wouldn’t have been able to move so quickly. But because of the public emergency, the red tape that can often hinder innovation was removed, which was a game-changer, according to Neil. “We didn’t have time to run a formal request process. We needed to develop these things rapidly.”
They did so, and found that the unique circumstances allowed them to take on more risk. The other critical factor? “Everyone had each other’s back,” he added. “If a mistake was made, there wasn’t any finger pointing. It was accepted because we were moving at such a quick rate.”
And while that mindset has dissipated for the most part, Neil would like to see more of the innovative thinking and collaboration that proved so valuable during Covid. “We need to remind ourselves that we can operate that way. We don’t always need to be so cautious in the types of decisions we make,” he said, adding that there’s a lot to be learned from that time. “Everyone was rowing in the same direction. The culture change, the rapid decision-making, and collaboration between clinicians and IT staff was unprecedented. It was definitely lemonade in a time where it felt like we were being thrown lemon curve balls every time we came around another corner.”
Jamie Nelson
New York City may not have been ground zero for the Covid-19 pandemic, but it was certainly an epicenter, with nearly 1.7 million cases reported between March 2020 and March 2021, according to Statista.
For Jamie Nelson, then CIO at Hospital for Special Surgery, it wasn’t the first disaster faced during her time in New York. And in fact, her experiences with the 9/11 attacks as well as Hurricane Sandy had taught her an extremely valuable lesson: Act quickly.
“I think that recognizing a situation and pulling the cord early is important,” said Nelson, who recently retired after 40 years in the industry (including 13 with HSS). “You’re better off doing that and pushing back, versus letting something happen and reacting too late.”
And so, instead of waiting to hear from state officials, the organization’s leaders opted to close its doors and start to transition operating rooms into ICUs. “We decided to take matters into our own hands,” she recalled. That meant not just providing physical space, but also lending out anesthesiologists as critical care providers. “The idea was to recognize it quickly, shut things down, and prepare to take on patients from other organizations. Getting in front of that and reacting thoughtfully and quickly is very important.”
Standing up an ICU, however, is no small task, according to Nelson. It required a “tremendous amount of work” to make that happen, while also focusing on enabling remote work, setting up vaccine sites, managing supply chain challenges, and ensuring a solid infrastructure was in place.
It was an enormous lift, and not one she believed could be led virtually. And so, Nelson made a point to show up every day in support of her team, despite the risk of contracting the virus. “We wanted to keep caregivers and patients safe, and we knew the fewer people you had at the hospital, the better,” she said. “But on the IT side, we still needed desktop techs. We needed people who dealt with clinical devices. There was still a lot of IT that needed to be onsite. How could I ask people to come in and put themselves at risk while I stayed home safely?”
As it turned out, there was another key advantage to being present. “It allowed me to be on the front line with the rest of our executive leadership team,” and gave her a key voice in decision-making. “Because I was at that table, it helped me feel like I was part of the solution.”
It also helped accelerate key initiatives. For example, when the head of surgery requested a change within Epic to more easily identify Covid patients, a resolution was quickly reached. “In the old days, it would’ve gone through the quality and safety committees and we would have to prioritize it,” she noted. During the pandemic, on the other hand, “we made some significant changes in record time, because we were all going after the same thing. There were no distractions. We really had tunnel vision.”
That vision was exactly what healthcare needed at the time. Five years later, however, it’s clear that leaders have learned from the experience, and are able to see things from a different perspective.
Said Nigrin, “My goal is to prioritize so that we can allow ourselves to focus on fewer things, do them really well, do them quickly, and move on to the next ones. That’s a good lesson learned from Covid.”
There’s quite a bit of excitement around innovation in healthcare, and for good reason. After spending many years – and allocating resources – implementing and optimizing technology, organizations are eager to leverage it to improve care and provide better experiences.
If anyone understands the enthusiasm, it’s Michelle Stansbury, Associate Chief Innovation Officer and VP of IT Applications at Houston Methodist.
“Innovation is exciting – there’s no doubt,” she said during a recent interview. “But change is hard.”
It’s a topic she knows well, having held leadership roles in the space since 2011 – long before innovation reached buzz-word status. And while being able to successfully innovate is undoubtedly a moving target, particularly in the current landscape, there are core principles that can help guide teams in the right direction.
Michelle Stansbury
With any initiative – particularly one involving cutting-edge tools or processes – resistance is pretty much a given, Stansbury noted. That’s where involvement from operational leadership comes into play.
“Before we start something we ask, ‘what is our reason for trying this?’ We’re not changing to make things difficult. We’re changing to make things better,” whether it’s enhancing workflows or improving communications.
And when senior executives are along for the journey, that becomes more evident. For instance, when Houston Methodist rolled out virtual nursing, “our CNO was right there with us, speaking with the nursing staff about how it was going to benefit them and the patients,” she said. Doing so reinforces the idea that it’s not “another innovation or IT project being slammed in.”
Another critical piece in their success, according to Stansbury, was in staffing the Center of Innovation with representatives from across the organization rather than creating new roles. “We didn’t want it to be separate. We needed operations and IT to be very much engaged,” she said, which meant everyone kept their day jobs.
“As we started meeting and talking about the problems we wanted to try to solve through digital innovation, we recognized that we knew exactly what those were, and where we needed to focus,” she noted. As a result, when it came time to implement solutions that had been identified, piloted, and validated, they were able to do it quickly. “All we did was put on our traditional hats to ensure it was successful.”
As organizations advance their use of digital tools, it has become common to see that reflected in innovation goals. But it’s important not to lean too far in one direction, said Stansbury.
Case in point: aiming to eliminate call centers, an idea that her team toyed with. What’s more realistic, she found, is to focus on reducing the number of calls by leveraging voice automation technology. “We’re learning that you can’t completely get rid of things,” she said. “That’s been a journey for all of us to realize that digital tools are great; they can help automate a lot. But there are still some things you have to keep in place, because not everyone is ready for that.”
The challenge for CIOs are other leaders, she added, is in finding the right balance. “We want to meet our patients where they are, even if it’s not where we are.”
Perhaps the most important takeaway is one that applies for any initiative, innovation or not: look beyond healthcare. That philosophy was the basis for the Houston Methodist Tech Hub @ Ion, a “collaboration space for cross-industry partnerships and a living laboratory for digital health technology in the healthcare setting.” The Tech Hub, which includes simulated environments for an inpatient hospital room, an outpatient clinic, and a patient’s home, was modeled after Houston Methodist’s Center for Innovation Technology Hub.
The vision, according to Stansbury, was to “foster an environment where people think out of the box” and can leverage their unique experiences to solve universal problems. “What can we learn from each other? That’s what we’re trying to accomplish.”
Of course, things don’t always go according to plan, which is why it’s important to be willing to pivot. A few years into the Tech Hub, Stansbury’s team realized that a large portion of the pitches they received didn’t meet the organization’s current needs. And so, they decided to adopt a different approach that would still tap into the diverse Houston community; except this time, the health system would offer a pitch based on a specific problem, and solicit solutions.
In this case, it was developing a digital solution to accurately authenticate employees and read their TST (Tuberculin Skin Test) results remotely, which could result in significant time and cost savings without having to reinvent the entire TB surveillance program. The reverse pitch garnered interest from 175 registrants, with 80 showing up at the information session. “We were extremely impressed with the quality of effort these teams invested and look forward to incorporating the innovation into our current program,” Stansbury wrote in a LinkedIn post. “With the success of this initial pilot, we intend to replicate the reverse pitch model with a new problem statement year after year.”
The hope is that more ideas will come forward that can help boost efficiency, experience, and outcomes – not just for Houston Methodist, but across healthcare. If the reverse pitch was any indication, that goal isn’t out of reach, according to Stansbury, who believes a fire has been ignited when it comes to innovation.
“Everyone we’ve seen is appreciative to be on the forefront of these new technologies and to be engaged,” she said. “They want to be the first to try a solution, because they recognize the value it can bring.”
Even more importantly, “people understand that we do this for a very important reason. It’s not just to have fun with a new tool – it’s about truly solving problems.”
“It’s an exciting time to be in healthcare,” said Chuck Podesta, CIO at Renown Health. And more specifically, it’s an exciting time to be in a leadership role.
But as Podesta – along with Jeri Koester, Chero Goswami, and countless others – can attest, it isn’t without its challenges. What separates successful leaders is the ability to capitalize on the obstacles they’ve faced. In this article, the aforementioned leaders shared perspectives from their own journeys on how they were able to learn from mistakes and build off of successes en route to the C-suite.
Jeri Koester
One of the most important attributes of leadership is the ability to recognize when a strategy isn’t working, and pivot – as efficiently as possible. Jeri Koester learned that during the onset of Covid when both her job, and her kids’ school, became virtual.
The challenge came when her daughter started struggling with schoolwork (as many did with remote learning). By the time Koester was available to help, teachers were offline, leaving everyone feeling frustrated. “She was in tears, I was in tears, and I thought, ‘this isn’t working. This isn’t the mom she deserves,’” she said. “So we made an adjustment.”
Koester blocked out time on the calendar to help her daughter and make sure she understood the assignment. As she quickly learned, it wasn’t about putting in less time with her team, but rather, adjusting the schedule.
“I remember thinking, ‘why am I not doing this all the time? Let me be the mom I want to be and support my daughter in a way that she needs to be supported, while supporting my organization and be the leader I needed to be,’” she noted. “It was just a couple of different breaks in the day.”
And although schools and offices have transitioned back to in-person models (or at least hybrid), the lessons learned during the lockdown continue to guide Koester in her role as Chief Information and Digital Officer at Marshfield Clinic Health System, particularly given the blurred line between home and work.
In fact, she believes that blending the two can help individuals more effectively manage tasks, which can be empowering. “You will always be asked and demanded more than what you can give; that’s going to happen,” she said, advising others to carve out time for priorities and be transparent.
“My calendar represents not only what I have to do for work, but it also gives people visibility as to the non-negotiable things in my life that are important,” whether it’s a class at the gym, or her son’s basketball game. This way, “people can see that this time is important to me.”
Blocking out times, she believes, is a key aspect of time management. “I’m very judicious about my calendar, and I don’t apologize for that,” Koester stated. “I’m building in space for my family and for me in order for me to be the best when I’m here.”
And as the industry continues to evolve – and expectations continue to mount – doing so is becoming critical. “At some point, you have to fill your cup. If you’re not taking care of your mental and physical well being, you’ll drain yourself. And when you drain yourself, you are not at your best, especially from a leader’s perspective.”
To Chuck Podesta, perhaps the most egregious mistake a CIO can make is to focus their energies – and resources – on headline grabbing initiatives. “Unless you’re the CIO of Stanford Medicine or Cleveland Clinic, you can’t be going after those shiny, bright objects,” he said. Instead, “stick to the knitting and the organization.”
It was a lesson he learned early in his career, when he accepted a role as interim CIO at Baystate Health. His instructions were simple: “Keep the lid on,” which he did. And although he didn’t get the nod for the full-time position with that organization, another (Berkshire Health System) soon came calling, naming him as their first CIO.
But Podesta never forgot that advice; he was able to put it into practice when he arrived at Renown in 2021 and quickly realized that the IT shop desperately needed an overhaul. “We were at 7 percent of total OpEx; you should be somewhere around 4 percent,” he noted. His team was eventually able to reach that goal, but it took 18 months and a lot of work, starting with application rationalization. They also eliminated a few management positions, which turned out to be a morale-booster among the staff. As a result, the organization “is in a much better place,” and is positioned for growth.
Although what he did “isn’t flashy or sexy in any way, shape, or form,” it was “work that needed to get done,” Podesta added. “And while you’re doing that, you’re building the culture and improving customer service and employee engagement.”
Part of building and maintaining a positive culture, he has learned, is in resisting the urge to react to negative events – which have become unavoidable. “With ransomware and everything else, a CIO has to be comfortable with complexity,” Podesta said, adding that it was something he struggled with earlier in his career. “When we had a downtime, for instance, I was freaking out just like everybody else. But you can’t do that, because they’re all looking at you.”
And while mastering these types of situations takes time and experience, the process can be accelerated by connecting with mentors, he noted, citing a former leader who invited him into strategic planning discussions. “I learned a lot by watching him and being involved in things at a pace that I could understand.”
Having spent three decades in the industry, Podesta has absorbed a great deal of knowledge. And although the technology itself has evolved significantly, especially in recent years, the core tenets of leadership have not changed. “That has not changed at all. People are still people, and the skills needed to lead them are the same,” he said. “And even without understanding the technology, you can still lead a successful team. That's one of the biggest things I’ve learned.”
Chero Goswami
There are quite a few misconceptions regarding change management, from why it’s so critical to what it entails. And in an industry like healthcare that’s rife with change, that can be a recipe for disaster, according to Chero Goswami, CIO at University of Wisconsin Health System. “Change management is often confused with communication, which is seen as a combination of PowerPoint presentations and email messages,” he said. In reality, it’s understanding what changes are being made and how they’ll impact stakeholders. It's also about “helping people understand what to do when the plan doesn’t work,” which isn’t a rare occurrence in the hospital setting, especially the ED.
From the leader’s standpoint, change management is about incorporating discipline to ensure all decisions support the organization’s overall mission to improve care delivery. “And if that means providers have to click three extra buttons, so be it, he said. “It’s going to get harder before it gets easier.”
That was the case at BJC Healthcare, where he helped lead a project to centralize Epic across a system of hospitals and ambulatory practices varying in size and scope. One of the key insights he gathered during that time? “There’s no such thing as a technology project; it’s always a change management project.”
Another was the importance of rounding, which his mentor leveraged to help build buy-in around the Epic migration. “He would go around the organization championing this program and explaining to people why it is difficult to do, yet important to do,” said Goswami, who has become a big fan of rounding and spending time on the front lines.
In fact, he took it a step further by implementing “purposeful rounding,” which goes beyond simply observing and enables individuals to see firsthand how technology delays can affect care. “To me, it’s not even a task anymore; it’s become more than that.”
As someone who has been “very fortunate to have excellent mentors and coaches,” Goswami has made it a priority to pass that guidance along to the next generation. “We’re in the people business,” he said. To that end, his team has created a professional development program in which all directors are expected to mentor at least one team member. So far, it hasn’t been met with any resistance. “I’m yet to find a person who doesn’t find joy in doing it.”
It’s a testament to the both culture that has been built at UWHealth, and the growing sentiment across the industry around the criticality of growing future leaders. “It is incumbent on us,” said Goswami, who also believes it’s key to “meet people on their time and at their convenience.”
Finally, it’s important to bear in mind that mentoring isn’t designed to achieve immediate results, and it should never be self-serving. “The goal isn’t to help an individual get the next promotion; it’s to train the person to become a leader,” he said. “Good leaders count their followers on Facebook. Great leaders count how many other leaders they develop.”
As the healthcare environment becomes increasingly complex, and organizations grapple with seemingly endless challenges, the need for dynamic leaders has never been greater. Whether it’s the CIO or another top role, health systems need leaders who can navigate the storms and position their teams for success.
And while a knowledge of IT systems is certainly beneficial, it’s no longer enough. Now, just as much value is placed on qualities like adaptability and the ability to collaborate. Leaders with diverse backgrounds are emerging – and bringing with them new approaches to solving common problems.
In this feature article, we offer perspective from three individuals who share insights on how the CIO role has evolved, and the unique skillsets that will be needed to guide organizations into the future.
Gretchen Britt
One of the most important qualities in leaders today, according to Gretchen Britt (VP, Information and Technology and CIO of The University of Kansas Health System Liberty Market), is the ability to adapt to change. “We’re the face for our team, and so we need to set the right example. You need to have a positive mindset and be willing to collaborate,” she said. “If we’re integrating two organizations and you don’t know how to play with others in the sandbox, it isn’t going to go well.”
Fortunately, that wasn’t the case when Liberty Hospital officially became part of The University of Kansas Health System in July 2024. “It’s been a true collaboration,” she noted. “We’ve taken those opportunities to learn from one another and move forward together. I think that’s why we’ve been successful.”
And while it can be tempting to hit the ground running, the organization has taken a deliberate approach toward the goal of full operational integration across the system – a strategy that Britt fully supports. “Patience is key; you don’t want to do things too quickly. You want to do things right, and that’s something both organizations agree on,” she stated. “We want to do what’s right for our patients and for our people.”
For Britt, a registered nurse with several years of NICU experience, that means ensuring IT initiatives aren’t presenting roadblocks for those on the front line. “That’s the dream – to let nurses focus on taking care of patients,” rather than getting bogged down with clicks and documentation requirements, which is often the case. “I remember being on the night shift after we had rolled out different pieces of the EMR and thinking, ‘there has to be a better way,’” she recalled. “I want to walk into a room and just talk to patients. I want to verbalize my assessment and have that information gathered and then placed into the chart.”
And while she believes the organization – along with the industry as a whole – has made significant progress in reducing the administrative burden, it’s important to maintain momentum and stay focused on outcomes.
A large part of that entails ensuring the right people are at the table. In Britt’s experience, the “right people” tend to ask a lot of questions – and don’t hesitate to challenge the status quo. “I’m looking for a critical thinker,” she said. “When you have an informatics person who has a critical thought at the bedside, that transitions so well into building systems and making sure the right workflows are in place.”
The “soft skills” like collaboration and attentiveness, “play heavily in these roles,” noted Britt. “Being able to partner with others, listen to concerns, figure out the right solution, and help present those ideas and make informed decisions” has become critical. “These pieces of the puzzle are important to making all of this work.”
Jordan Ruch
Jordan Ruch (CIO, AtlantiCare) is no stranger to large-scale IT initiatives; in fact, he genuinely enjoys the experience. That’s not to say it’s ever been an easy road, but there are steps that can be taken to make it smoother.
One of those? “Have the end state in mind,” he said. “Once you have that vision, it’s a lot easier to figure out the endpoint.” On the other hand, “if you haven’t taken the time to invest and think about what that future state looks like, and make sure everyone agrees to it and feels solid in the plan, it’s really difficult to navigate.”
This philosophy, which can be attributed largely to Ruch’s background in project management, has served his team well as AtlantiCare embarks on Vision 2030, a strategy “designed to redefine how we deliver healthcare in our region through innovation, workforce empowerment, and community centered care.”
One of the core initiatives aims to address the administrative burden, which has become “significant” in recent years. “The work we ask our physicians and nurses to do is coming between them and our patients, which is the last thing we want,” he said, citing a study which found that primary care physicians need more than 26 hours in a day to provide the recommended care for adults and document it.
And it’s not just physicians; nurses devote more than half of their shift time to EHR data entry and retrieval, and another 30 percent on searching for supplies. “That leaves only 20 percent for the bedside,” Ruch said. This is where AI and other technologies can make an impact by “streamlining processes and automating routine tasks to free up time for providers.”
Case in point: Oracle’s Clinical AI Agent, which has helped AtlantiCare decrease documentation time by 42 percent through ambient listening, saving an average of 66 minutes per day. Ruch hopes to see similar results as the tool is rolled out to more than 800 providers. “It’s really rewarding to see some of the tools that we’re deploying actually make a difference and do what we’ve intended to do all along, which is provide better care and a more efficient experience.”
Sometimes, however, that requires making major changes; for example, his team is “changing out or optimizing pretty much every application,” including the EHR, ancillaries, and revenue cycle suite. And although it’s a “significant undertaking,” it’s precisely that type of initiative that drew him to the organization.
“My background is in these projects,” said Ruch, who managed all aspects of the Epic implementation while serving as CTO for RWJBarnabas Health before joining AtlantiCare last summer. “The opportunity to put a plan together, see it through, and realize the benefits is something that really motivates me.”
And in fact, it’s become an expectation for CIOs and other leaders to not only provide technology in a reliable and seamless way, but also to help strategically grow the business, which means staying connected with operations.
“In order to know where to apply the technology or help strategically find an area where IT can support the business, you need to sit with the operators and learn the business,” Ruch added. “You need to understand how it operates. You need to understand the challenges. You need to spend time on the units.”
Finally, as CIOs continue down unchartered paths, he believes AI literacy will become increasingly critical. “We’ve long adopted an automation mindset where we break down a process, standardize a process, and then consolidate or re-implement tools to try and automate as much as possible,” he said. Now, however, it’s just not about automation. As new AI technologies come online, IT is expected to “help evaluate those tools, implement those tools, integrate those tools, train the workforce on those tools, communicate those tools, and ultimately, support them.”
By adopting an AI Literacy mindset, they’re able to approach problems differently and help advocate for best use of the technology. “We need to be up to speed with where the industry is going.”
Ryan Cameron
Where direction the industry takes, it’s undoubtedly going to involve innovation and it’s going to be spearheaded, at least in part, by “outsiders,” according to Ryan Cameron. When he joined Children’s Nebraska as VP of Technology and Innovation in 2022, it was his first foray in healthcare, having previously spent time with an AI startup, and before that, in the world of academics.
Where he did have experience was in problem-solving and digital growth, which appealed quite a bit to the team at Children’s Nebraska. “When I asked them why they were interviewing me, they said, ‘we feel like you could address some blind spots for us,’” Cameron noted. “They’re very forward-thinking. They’re focused on consumerism and how that impacts the patient experience.”
As healthcare tackles increasingly complex issues, having representation from other sectors has become more common, and will likely continue in that direction, according to Cameron. “We have all these disruptive forces that are influencing and shaping what healthcare looks like, and that requires innovation,” he noted. “It requires us to do things differently, meet people where they are, and evolve with the changing expectations.”
By incorporating departments (like anesthesiology, for example) that aren’t traditionally seated at the table, Children’s Nebraska can foster collaborative discussions and identify new approaches to problems.
One area in which they’ve never struggled, however, is in generating ideas. “Innovation has been a core value for many years now. There’s always been a lot of activity.” Unfortunately, it has largely happened in pockets, noted Cameron, who referred to it as ‘heroic innovation.’ “You have one superhero who puts on the cape, gets a great idea, and runs with it.” The problem arises when they leave the organization. “There’s no sustainability or cross training – things you would need for a healthy innovation program.”
On the other hand, by building a dedicated program in which digital health and innovation “go hand-in-hand with what we do,” organizations can reap the benefits of tools like virtual reality and 3D printing, both of which are priorities for his team. For instance, VR simulations have decreased the rate of sedation by 96 percent in patients coming in for CT scans, while also dramatically reducing surgical times by enabling providers to share plans and consult with each other.
“We’re tripling down on those areas,” said Cameron, adding that VR headsets are also being leveraged to reduce stress and anxiety in employees. “It’s a stressful job. You have the weight of the world on your shoulders. It’s been amazing to see VR become an employee wellness tool on top of everything else.”
The good news? Practical ideas like this can be found – if leaders are willing to look beyond healthcare conferences. In fact, it was at a CES Conference where Cameron first heard about Ocular View, a holographic videoconference solution from Steelcase and Logitech that “genuinely feels like we’re in the same room having a conversation.”
Children’s is currently leveraging the tool for behavioral and wellness visits throughout its wide coverage area, and plans to expand in the near future. “It’s been a huge success for us, and so, we’re thinking about more care modalities, adding cameras, and doing more with telehealth,” he said. “And we never would have encountered that just by going to healthcare conferences.”
Attending events like CES, Cameron added, has empowered his staff to “think outside the norm. We’re seeing a lot of really great, compelling innovations that are going to help a lot of people live happier, better lives. That’s the goal.”
And by keeping an open mind, whether it’s by leveraging different technologies or considering different skillsets, leaders can take steps toward that goal.
“Be open to change,” he said.
The introduction of artificial intelligence into healthcare didn’t just change the game – it flipped it on its axis. But after a few tumultuous years, AI may be hitting its stride, according to Clara Lin, MD.
“These are exciting times we live in,” she noted. “People are starting to see the broad applicability of AI” and recognize the potential it has to automate manual tasks and improve diagnostic capabilities.
At Seattle Children’s, where she has held the CMIO role since 2022, AI is layered on top of decision support to give clinicians quick access to decades’ worth of research. As a result, providers “don’t have to scroll through algorithms to figure out what to do with a three-year-old who’s vomiting,” she said. “They’re able to deliver the best quality care to the child in front of them.”
Clara Lin, MD
Reaching that point, however, hasn’t been without challenges. In fact, as AI assumes an increasingly vital role in care delivery, it is becoming more important for organizations to develop a structured, deliberate approach to evaluating and implementing tools. During a recent interview with This Week Health, Lin discussed the strategy her team is utilizing to ensure any application of AI isn’t just solving a problem, but is doing so in a way that’s compliant, secure, and equitable.
A critical part of that strategy is in establishing governance around AI and incorporating it into executive roles, noted Lin, who sits on the AI Review Board along with Zafar Chaudry, MD (whose title now includes Chief AI and Information Officer in addition to Chief Digital Officer).
“We assembled a group of experts, including AI specialists and technologists and our chief architect (Nigel Hartell), to have the same sort of structure that we have for human subject research,” she said. “We want to have the same guiding principles when it comes to AI,” which means assessing every initiative from multiple perspectives.
The driver for the review board was the explosion in AI that started with ChatGPT’s introduction into healthcare. “Everybody wanted to use AI because they could see, even at the beginning stages, how ChatGPT could help them write emails, PowerPoints, or patient letters,” she recalled.
It was so promising, however, that she and Hartell were bombarded with “raw, unfiltered ideas” that were focused more on the technology itself than on solving a problem. Then, once reports of AI hallucinations started to surface, the demand plummeted. Now, however, “we’re coming out of that lull and moving into a place where the requests we’re getting are much more structured and well thought out,” Lin said. Clinical, operational, and administrative users are coming forward with specific use cases in which AI can have an impact.
That’s where governance comes into play, she said, noting that every proposal goes through a standard intake process that asks specific questions around risk management, equity, security, and more. For example: Have you thought about equity? How does this impact people you haven’t thought about? What are the risks it may bring to privacy? How are you planning to mitigate those risks?
The board then provides recommendations on how to move forward – and it isn’t always a green light, Lin noted. “Once we get the idea, we start to think about, do we build it? Do we buy it? Or do we wait for Epic to develop it? Because we know Epic is working on some things.” And if that’s the case, “we don’t necessarily need to spend money to buy or build. We can wait for Epic, which can be integrated seamlessly into our clinical experience.” If that’s not an option, they won’t hesitate to develop in-house or in partnership with Google, Microsoft, AWS, or another vendor.
Before that can happen, of course, a set of criteria need to be met, one of which involves equity. “We’re looking at every AI project from the lens of ethical considerations,” she said, ensuring that no solution works to “further marginalize our underrepresented and underserved groups. Equity is a really big deal for us. It’s in our blood at Seattle Children’s.”
To that end, the standard intake includes an impact assessment that encourages users to examine the training data sets used for algorithms and make sure various groups are represented.
“A lot of times we don't even think about it,” she said. “We think that if it’s an algorithm, it has to be right. We have to be very rigorous about how we’re evaluating the quality of the data.”
When the proper policies and structures are in place – as is the case at Seattle Children’s – there are myriad ways in which AI can increase efficiency and improve outcomes.
One is by leveraging AI to search Clinical Standard Work Pathways, a set of documented treatment approaches developed to improve quality of care through standardization.
Weeding through dozens of these decision trees, of course, isn’t feasible at the point of care. A chatbot, on the other hand, can sift through information and answer key questions for clinicians, who are able to focus more time and energy on patients and families.
The organization is also utilizing AI to reduce administrative burdens by taking on tasks such as prior authorizations and coding. “The burden of that work is heavy,” Lin noted. “The same workforce member who’s doing that work could be interacting with our clinicians and giving direct guidance on how to document better.”
Another area of focus is improving translation, which has been a significant challenge for many organizations. According to research from the UPenn School of Nursing, those who don’t speak English well “have lower satisfaction rates and worse health outcomes, including more hospital readmissions and longer stays.”
As part of a pilot scheduled to take place early this year, Seattle Children’s hopes to determine whether GenAI can facilitate improved communications.
“We’re dedicated to making sure the correct translation gets into the hands of our patients and their families,” she said. The problem is that it takes time, “particularly if it’s a language of a lesser diffusion,” which in some cases can entail sending discharge instructions to a specialized translator, who then has to relay the information back.
“Best case scenario, we get it back later that day after the patient has already left. You email it to them, call them, and hope they get it,” she said. “The worst case scenario is that it takes two days or even more to get it back, and you then send it to the patient. By that point, we’re done.”
It’s not acceptable, particularly when it comes to time-sensitive instructions such as caring for a post-surgical wound, for instance.
The ultimate goal is to be able to speak with patients and families in person, through an interpreter, and be able to address any concerns. “That will improve the quality of our care so much for patients who prefer not to use or can’t use English to communicate with their physicians or receive instructions,” said Lin, who presented on the topic at the ANIA Annual Symposium along with leaders from Boston Children’s, Stanford Children’s, and University of Washington. “It’s super important to us.”
What’s also important, she added, is ensuring any initiative – regardless of whether it involves AI – is designed and implemented with pediatric patients in mind. “A lot of times, pediatrics is an after thought. We trained it on adults, and if it doesn't work for kids, we’ll improve it later on,” she said. “That doesn’t work.”
What does work, in any clinical setting, is acknowledging that it’s not just the patient that needs to be considered, but caregivers as well. “They’re the reader and receiver of the information.” And therefore, patient family experience has to be front and center in the design of technology.”
The numbers don’t lie.
According to research conducted by Zippia (and amplified in a blog post by Christopher Kunney), the most common ethnicity among CIOs in the United States is White. And while that may not come as a surprise, the actual statistics are alarming: 76.9 percent of CIOs across all industries including healthcare, are White; 7.5 percent are of Hispanic or Latino ethnicity, 7.4 percent of Asian ethnicity, and just 3.7 percent are African Americans.
"This tells me that something is missing," said Cletis Earle, a former CIO for multiple organizations, including Penn State Health. "Some are still being left behind."
It's a trend that leaders like Earle hope to eradicate, particularly given the rapidly evolving healthcare needs and increasingly sophisticated user expectations. By assembling leadership teams with diverse backgrounds, many believe health systems will be better equipped for digital transformation.
The problem – or at least, one of them – is the inherent bias that can prevent organizations from building diverse teams.
"As we put teams together, we tend to gravitate to people who are most like us," said Lori Boisjoli, SVP and CIO at The University of Vermont Health Network. And yet, "there's a lot of data supporting the idea that the most high-performing teams are well-rounded with diverse people and opinions." Having at least some degree of dissent can compel leaders to "think differently."
Recently, we spoke with Boisjoli, Earle, and Karla Arzola (a former CIO at HCA and most recently, Rocky Mountain Human Services) about why diverse representation is so important, the obstacles organizations face with DEI initiatives, and steps leaders can take to overcome them.
Lori Boisjoli
When Boisjoli sought out her Computer Science degree, "there weren't many women in STEM programs." The trend continued as she progressed in her career, starting on the vendor side in product development roles until she landed the role of director of clinical and business systems with UVM, eventually becoming network CIO, a position that has often eluded women in academic medical organizations.
Shattering glass ceilings, however, was not necessarily her goal. "I never counted how many women were at the table," Boisjoli said. "For others, it's very important, but it didn't resonate with me." Instead, she has been laser-focused on providing a better user experience by establishing a shared services model across the organization. Now, rather than having separate systems for each of the six hospitals as well as home health, "we brought them together under a single umbrella."
And while she chooses not to put too much emphasis on gender, she does firmly believe that it's important to have representation in the C-suite. "We need female leaders at the table," she noted. "We do bring a different perspective, and that balance of different ideas is important to move any organization forward."
Karla Arzola
What's also critical, according to Arzola, is ensuring the leadership teams reflect the makeup and needs of different communities. In Colorado, for example, nearly a quarter (22 percent) of the population is Hispanic. "If the core team that is trying to solve a problem doesn't understand the root, it's going to be harder to come up with a resolution," she said. "Bringing different perspectives from someone who can relate more to the problem we're trying to solve is super important."
And that's just one subset. "We have people from different backgrounds, countries, and upbringings, and everyone has something of value to bring to the table," Arzola noted. And even if a particular group comprises 2 percent of the population, leaders still need to figure out how to provide the right care, whether that means implementing translation services or working to understand different customs or preferences.
"We need to understand their challenges," she noted. "That's why I believe diversity is key for everybody's success. The more we get to know each other, the easier it is to solve problems."
Cletis Earle
The harsh reality is that not everyone places the same value on diversity, equity, and inclusion (DEI) initiatives, according to Earle, who has seen significant pushback in recent years. When his team at a former organization launched a series of TEDTalks focused on different aspects of DEI, "we got a lot of backlash. People were asking, 'why are we taking time to learn about different barriers?'"
But instead of caving to the pressure, Earle forged ahead, continuing to offer 5-7 minute talks demonstrating why DEI measures are important and how they can strengthen teams.
"It started to filter through the organization," he said. "One week we would talk about the benefits of hiring people with disabilities, the next we would talk about veterans and the amazing things they've done in technology."
Of course, the naysayers will always be there, and while it might be tempting to try to turn them, it's often fruitless, he said. "I don't understand how people can see something wrong with this, but I've realized that some people don't want to think differently. They don't want to accept a different narrative." But as a leader, "you can't let the squeaky wheel win."
However, as in many situations, the 'how' is the difficult part, according to the experts, who offered advice based on their experiences.
Finally, it's critical that leaders are able to acknowledge gaps that exist and challenges being faced – even if there is no personal connection. "Sometimes we don't see the problem if it doesn't impact us directly," said Earle. It can just mean looking around and taking stock of representation, particularly in the C-suite. "I'm not Hispanic, but I can see that there aren't a lot of Hispanic leaders in healthcare IT."
By speaking up, leaders can start to affect change, even if it's a slow burn. What they should not – and cannot – do is stay silent. "We need to continue to fight this."
As healthcare organizations face mounting pressures, from budgetary concerns to cybersecurity attacks, it has become vital to identify leaders who can navigate difficult situations and think on their feet. It’s the type of skillset that can be difficult to develop – but is, in fact, quite common in one key subset: military veterans.
In the past, healthcare hasn’t exactly been a common landing spot for commissioned officers, but in recent years that has changed. Now, a growing number of former military personnel are taking on leadership roles at hospitals and health systems, bringing with them the valuable lessons they learned while serving the nation.
In the second of a two-part series (click here to read the first), we share perspectives from two individuals – Rusty Yeager, SVP and CIO, Encompass Health, and Shannon Becker, VP, Information Systems, Sentara Health. who discuss how their military experiences shaped them as leaders. And although they had very different expectations, both were able to gain the education and mindset necessary to take on key roles.
Rusty Yeager
Rusty Yeager’s military experience didn’t exactly start out the way he had hoped. “I wanted to be a fly guy, but that didn’t work out,” he said.
Instead, he was placed in healthcare administration, much to his chagrin. “I remember thinking, ‘you’ve got to be kidding me,’” Yeager recalled. “I didn’t want to do that. I did not like hospitals, and I really did not like computers.”
Fortunately, he was able to put aside his feelings. His first assignment as the Chief of Resource Management, which then included computers, started him on a path that would eventually culminate in the role of SVP and CIO for Encompass Health (formerly HealthSouth) Encompass Health operates 165 inpatient rehabilitation hospitals across the nation and in Puerto Rico.
“It was one of the best things that ever happened to me,” said Yeager, who earned a wealth of experience during his career as a US Air Force officer (both Active Duty and Reserve), serving as a CIO, Regional CIO, and CTO responsible for the USAF Health System’s IT worldwide operations. He was also a senior staff advisor to various levels of the DoD’s Military Health System on strategic matters related to IT policy, procedures, procurement, solutions, and cybersecurity.
And although he may have benefited from fortuitous timing given healthcare’s digital transition, the most critical factor in Yeager’s success was the foundation he built during his time with the military. “I would not have been as successful without that underpinning of leadership, discipline, teamwork, and problem-solving,” he said. “We’re always planning for potential scenarios and making sure our teams are prepared.”
Another critical lesson he learned was around the importance of effective communication. Regardless of an individual’s age or rank, “there’s an expectation that you can communicate and convey to leadership what’s going on with your particular area and what is the impact on the overall mission,” he said. “That’s still the number one thing any IT person can do; learn how to communicate in the appropriate language.”
Not to be overlooked, particularly considering the cybersecurity epidemic, is the ability to “be flexible and make decisions in the heat of the moment,” Yeager said, adding that veterans often thrive in the cybersecurity world because of their ability to remain calm. “We train like we fight, and we fight like we train. That’s something we said in the military, but it works in this context because cyber activity is like a war,” and the more prepared teams are, the more effectively they’re able to lead response and recovery efforts.
Most importantly, military training incorporates a mission-driven mindset that’s extremely valuable across all industries, but especially healthcare. “It’s all about working in support of our caregivers,” he said. “To me, that transcends everything.”
Shannon Becker
Shannon Becker didn’t necessarily have the experience she expected to have during her time with the military, and she didn’t necessarily learn the lessons she expected to learn.
What she did glean, however, ended up being quite valuable – and, in fact, career-altering.
“I learned a lot about self-reliance and leadership behavior” – including those she chose not to embody based on her own philosophy. “That draconian path wasn’t something I found I would align with, and so for me, the military was about letting me figure it out.”
What she initially sought was discipline, Becker said, admitting that she felt “very lost” as a college student, and lacked the baseline of skills she needed to be successful. “I got two speeding tickets in two days and dropped out of school because I didn’t know what I wanted to do for a career.”
Joining the Army seemed like the best option at the time, and in Becker’s case it was, primarily due to her determination to “use the time as effectively as possible.” That meant not just earning credits toward a B.S. in Respiratory Therapy, but also rising through the ranks as an Army Reserve Officer. She eventually earned a Master’s of Science in Health Informatics from Northern Kentucky University – the same school in which she earned her undergraduate degree – and began working at Bon Secours Health System, initially as an OpTime Application Coordinator.
Again, Becker got the most of the experience, leveraging the opportunity to obtain 11 Epic Licenses and Certifications, which helped boost her career profile while also equipping her with the skills necessary to turn around a struggling hospital billing department that had been through five managers in five years.
Leadership took notice, with Becker eventually being promoted to manager role, then named Epic Revenue Cycle Applications Manager of Bon Secours Mercy Health. Part of what propelled her was the experience she built in the Army learning how to “manage different personalities” and adapt to changing circumstances.
The latter proved extremely beneficial when the Covid-19 pandemic hit – and delivered a sizable dose of humility. “Not everyone can handle all that life throws at you with the same amount of resilience,” said Becker, who believes that the experience “forced me to reengineer how teams work together.”
It also forced leaders to focus on results, looking carefully on how productivity was (or was not) affected by having remote teams. “Are we meeting our deadlines on projects? Are people happy? All of those factors that would lead you to believe you have a healthy, productive workforce,” she noted. What they realized is that “when you give people more room to breathe, they actually are more productive.”
Her recommendation? Take “a more individual approach to how you’re going to be the most successful, and empower your employees to own that. It’s holding them accountable when they’re not, and giving them support to help them do so.”
As healthcare organizations face mounting pressures, from budgetary concerns to cybersecurity attacks, it has become vital to identify leaders who can navigate difficult situations and think on their feet. It’s the type of skillset that can be difficult to develop – but is, in fact, quite common in one key subset: military veterans.
In the past, healthcare hasn’t exactly been a common landing spot for commissioned officers, but in recent years that has changed. Now, a growing number of former military personnel are taking on leadership roles at hospitals and health systems, bringing with them the valuable lessons they learned while serving the nation.
In the first of a two-part series, we offer perspectives from two individuals – Michael Carr, CIO at Health First, and Joey Meneses, Executive Director of Technology at Grady Health System – on how they’ve benefited from their past experience, the challenges they’ve faced, and why health systems shouldn’t overlook this demographic when filling roles.
“Standard, repeatable processes”
Although his time in the U.S. Army was somewhat limited, it was time well spent for Carr. “Nothing prepares you to be part of the team like being in the military,” he said. “You can be as skilled as you want to be, but if you can’t work with others, if you don’t trust people and have a shared mission, it’s just a bunch of people doing random things.”
In addition to the team component, Carr also benefited significantly from the emphasis on training and preparation beyond the basics. “The military is really good at training. It’s not just your job; I learned my squad leader’s job,” he noted. “I learned the job of the person to the left and to the right of me, because you never know when you’re going to be called on.”
The objective is to develop leaders by ensuring individuals are always prepared for the next opportunity, while further emphasizing the importance of continual education.
“It’s not about you,” Carr added. “It’s about your team.”
That training has proven beneficial on several occasions, including Health First’s Epic implementation, which is scheduled for next June. Keeping that initiative on track is contingent on his team’s ability to meet major milestones while also executing on the basics.
“It’s the little things. It’s the training, the preparation, the hard work that’s not exciting and doesn’t get you accolades, but that’s where success comes.”
That, and having “standard, repeatable processes,” which are core ingredients in an Epic project. “I don’t think you can put enough emphasis on having those processes, giving people the opportunity and the framework to accomplish the mission,” he said, adding that the military offers a master class in these areas that should not be overlooked by hiring managers.
It all comes down to being able to communicate these attributes. “You have to be able to tell your story,” Carr said. “You’ve learned about discipline. You’ve learned about accountability, and those are skills any employer would love to find.”
“No buy-in in the military”
For Joey Meneses, one of the biggest lessons learned during his 28 years in the Air Force was the importance of adaptability. “As military personnel, we often work in diverse and challenging environments. That’s been really useful in navigating changes within the healthcare technology landscape,” he said. “We don’t even think about it; it’s normal to us because we’ve been exposed to these types of situations.”
Being in the AIr Force instilled in him an appreciation for structured processes, “which is valuable in managing complex healthcare IT systems and teams,” he added. Also beneficial is the crisis management training that has long been a core competency of the military.
“We’re trained on that on a daily basis, and so we know how to respond,” whether it’s a system failure or a cybersecurity event. “We’re very focused and know how to do that.”
Another critical component is succession planning – an area in which healthcare can learn from the Armed Forces. Because leadership tenures tend to be shorter, the military is focused on ensuring the second (or third) in command can step into the role. “We’re trained to know who is the backup if something goes down,” Meneses said, adding that it’s all part of being mission-driven.
Carrying that into the civilian world, however, can be difficult – but not because there’s any doubt around the mission at Grady, which, of course, is caring for patients. The challenge is in navigating the command structure. “In the military, it’s a downward direction, but on the civilian side, it’s a different story,” he said. “You have to learn the culture. You can’t just direct people and say, ‘here’s how we’re going to do things.’ It doesn’t work that way.”
For Meneses, that has meant honing his listening skills and seeking to understand the reason for the push-back. “I have to listen to why they want to do things differently,” he said, noting that it’s important to solicit feedback from different stakeholders in different areas. It’s a departure from the military, where “there’s no such thing as buy-in, because that’s the structure.”
It’s a philosophy that tends to work better in some sectors than others. The military’s emphasis on training, however, can have enormous benefits in industries like healthcare, according to Menesis.
“When they send you to training, you’re only focused on that. You’re not focused on the work you left behind because there are senior leaders who can do it while you’re gone. That’s the biggest thing we can take to the civilian side,” he said, encouraging leaders to help teams carve out time. “That’s the only way they can learn is if you make it part of the schedule.”
“Built-in” community
For both Meneses and Carr, transitioning out of the military meant adjusting to different philosophies and learning new systems. But it has also meant introducing concepts that can be beneficial in challenging fields like healthcare. And while they may have left the military, they’re still part of a “strong community” of veterans that offers much-needed support.
“I’ve noticed a much bigger kinship amongst veterans than when I got out. There are so many opportunities for us to connect,” said Carr. “You have a built-in community wherever you go. That has really helped me.”
Establishing a strong culture has always been a priority for healthcare IT leaders, and for good reason. But as expectations continue to mount and the available talent pool continues to shrink, it is becoming even more paramount for CIOs to create an environment that can attract and retain the highest-quality individuals. That, according to Reid Stephan, means “ensuring they have the tools and resources they need, they feel safe in their work, they have permission to make decisions, and are recognized and rewarded for the work they’re doing,” he said an interview with Bill Russell, Founder of This Week Health.
The question is how to make this happen. And while there isn’t a precise formula that can be plugged into any setting, there are best practices that can be applied to help create solid teams and build leaders.
Below, we’ve assembled insights from recent interviews with four influential leaders on how they were able to break through challenges and develop a foundation for success.
Developing and maintaining a solid culture within IT can be challenging, particularly with a system like HCA, which includes 184 hospitals and approximately 2,000 sites of care. But if it’s approached the right way – by ensuring the mission is ingrained into every decision – it can be surprisingly “easy,” according to former CIO Marty Paslick.
“It starts with the roots,” he said during a 2023 interview. “We’re a company founded by physicians who wanted a better way to execute health care. Our mission statement is paramount.”
Marty Paslick, Former CIO, HCA Healthcare
But what makes it possible to carry out the promise delivered in the statement – “We are committed to the care and improvement of human life” – is leadership’s dedication to sustaining a healthy culture. According to Paslick, who retired in April after nearly 40 years with HCA, the IT department has notched some of the highest employee engagement scores in the company. The secret? Being “active listeners,” which means embracing all types of feedback. “No matter how high the scores are, and how proud you are personally of your organization, you’re going to get constructive criticism,” he said. “But if we want the culture that helps us produce results, we have to listen and we have to react. We have to put into action plans that address those things. And I think we've done that fairly consistently.”
Another focus was interacting with the IT team, which became significantly more difficult when remote and hybrid models were introduced during the pandemic. Paslick’s answer was to create “virtual hallways,” a weekly 30-minute segment during which participants can “chat about projects and ask each other questions,” he said.
The only rules? No PowerPoint slides and no prepared questions, which was met with resistance at first. “People were intimidated,” Paslick recalled. However, once they saw the positive impact of having impromptu conversations, it became a valuable tool. “We got to a place where people would walk in, grab a donut, and say, ‘what’s on your mind, Marty?’ I’d ask them questions and we’d have a dialogue, just like we would’ve had if we had bumped into each other in the hallway.”
It created a camaraderie that has been a game changer for HCA, he added, and a belief that “we’re all in this together.”
Like many others in today’s dynamic healthcare industry, Susan Ibanez has held leadership roles with multiple organizations. But while the CIO position has similarities from one system to the next, the culture and the people who comprise it are always distinctive. As a result, she has made it a point to start each new role with a “listening tour” to help get to know the team and understand their professional and personal goals, she said during a Townhall interview with Karla Arzola, CIO at Rocky Mountain Human Services.
Susan Ibanez, CIO, Southeast Georgia Health System
“It’s a great opportunity if you’re new to the organization to have one-on-one meetings with your team members to get to know what’s important to them. As the leader, you can help support those goals,” said Ibanez, who came to Southeast Georgia Health System in July 2023, having previously served in leadership roles at Vail Health, Memorial Hermann, and Driscoll Children’s Hospital. And although doing so can help boost engagement, it’s also critical to the development of individuals. “We’re building leaders,” she noted. “Our overall goal is for them to be successful, whether it’s within our organization or outside of it. Getting your head around that is important.”
The other critical benefit of engaging in open dialogues with team members is that it can help identify roadblocks and inform more effective strategies. “People are very eager to share,” especially when it comes to workflows and procedures, said Ibanez, who holds a doctorate in Healthcare Administration. “What we’re looking for is, what are your pain points? What works well about technology in our organization? What would you change about technology? What is your barrier from a technological perspective or an IT leadership perspective?”
By inviting those conversations, CIOs can glean valuable insights into what’s working and, more importantly, what isn’t working, and marry that with the information received from other leaders, Ibanez added. “It helps you build the plan that’s going to be your roadmap.”
For Corewell Health CIO Jason Joseph, perhaps the most important lesson he has learned isn’t how to build a successful team, but rather, how not to do it. “Teams don’t get created by being told they’re a team, and they don’t get created because you put one leader in charge,” he said during a Keynote interview. Instead, “teams get created when you have them walk through fire together; when you give them a project and they have to rely on each other and go do it.”
Jason Joseph, Chief Digital & Information Officer, Corewell Health
The ‘fire,’ in this case, refers to the “very aggressive plan” to create a standardized platform across Corewell, which was formed as the result of a 2022 merger between Beaumont Health and Spectrum Health. And it’s not just the Epic environment – several other systems are being modernized, which makes for a significant lift considering the size and scope of Corewell (21 hospitals and more than 300 ambulatory sites).
Pulling it off requires strong teams, as well as alignment across the organization. Without both of those in place, “you’re going to be fighting with one hand tied behind your back for the foreseeable future,” Joseph said. And while some organizations choose to divide and conquer, having one team supporting the old technology and another focused on the new implementation, it doesn’t always result in harmony. In fact, it can end up “fragmenting and splintering your team even more.”
To avoid that scenario, Corewell went through a “deliberate” restructuring to form a single team with a single mission. “They started to rely on each other,” Joseph said, noting that Corewell saw a subsequent boost in employee engagement scores. “That never would have happened if we didn’t have teams aligned right up front.”
More importantly, it drove home an important point about the power of unity. “A big part of it is getting your team aligned to say, ‘we’re on the same journey. We’re going to do it together, and we’re going to do it with integrity,’” he said. “When you get those things in line, all the other stuff starts to work itself out.”
When starting a new role, it’s only natural for leaders to want to dig right in and start tackling the biggest strategic needs, but that shouldn’t be the first priority, according to Reid Stephan, CIO at St. Luke’s Health in Boise, Idaho. Instead, the focus should be on assessing the culture and ensuring the right people are in the right seats. Surprisingly, “a lot of leaders are reluctant to address that,” Stephan noted during a 2021 interview. “They’d much rather figure out their disaster recovery strategy. I have smart people who will do that in spades all day long if I surround them with the right team and the right structure to get the best out of them.”
Reid Stephan, VP & CIO, St. Luke's Health System
And if individuals aren’t in roles that can most effectively leverage their skill sets, leaders must be willing to do some shuffling, even if it’s met with resistance. “Those conversations can be grueling,” but they’re critical in helping to determine culture fit, something Stephan holds with high regard. “Certainly you have to have aptitude, but if you don’t have some of those core foundational personality pieces in place, it makes everything else so much harder,” he added. “The technical skills are much easier to grow and develop.”
Culture, on the other hand, requires constant care and feeding, and it starts with listening. “Spend some time sitting and observing,” Stephan advised. “Watch how they’re using solutions. Be curious. Ask questions.” But don’t do it in a way that can cause people to become defensive, he said, suggesting a different approach. “Try saying, ‘I noticed you doing this. What’s the reason you do it that way, or what’s good about that?’ That’s a concept that has resonated powerfully in our department.”
By soliciting this input, leaders can draw valuable insights into “whether the culture is trickling down to the degree that you want, or if there are gaps,” Stephan said. And if there are, those insights can help point teams in the right direction.
At the end of the day, “I work for these 450 people in my department,” he concluded. And the best way to serve those constituents is by ensuring they feel supported. “That’s really the role of the person at the top – to make sure all those teams are high-functioning teams, and that means having the right culture, the right leadership, and the right framework for getting work accomplished.”
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