As nurses and physicians continue to exit the workforce, healthcare organizations are pulling out all the stops to try to turn the tide, whether it’s automated staffing or continuing education opportunities. But as leaders are learning, the most powerful for retaining top talent – nursing, in particular – doesn’t involve any technology.
“It’s that culture of empowerment that drives retention,” said Theresa McDonnell, SVP and Chief Nursing Executive, Duke University Health System. “When people feel like they’re just a cog in a wheel, they don’t feel any sense of belonging.”
At DUHS, her team has made a concerted effort to involve frontline workers in the discussion, and has seen impressive results.
In a recent Keynote episode, McDonnell spoke with Sarah Richardson about the strategy they’ve mapped out, what she believes are the keys to fostering innovation in the clinical environment, and the enormous potential AI holds – if leveraged the right way and guided by the right people.
Over the past few years, DUHS has reduced nursing turnover by a significant percentage (going from 21 to 11 percent), thanks to a series of initiatives. Among them, virtual reality-based workplace safety training and AI-powered staffing tools, both of which have been widely accepted.
Theresa McDonnell
But the biggest difference maker, according to McDonnell, has been an emphasis on “engagement, listening, and understanding the pain points,” she said. Her team seeks to do that by not only asking about “the pebbles in their shoes,” but seeking input on the best path forward. “That helps create a culture of empowerment.”
Another key step they’ve taken? Sending out surveys to measure the pulse of the culture and ensure all staff feel a sense of belonging within the organization. They do, according to the most recent iteration of the survey. “Our scores were some of the highest we’ve ever seen, and we benchmarked far higher than some of our sister organizations,” she said. “That brings me joy to know that people feel like they belong here.”
As a nurse practitioner, McDonnell is uniquely attuned to the needs of frontline workers, and has made a point to prioritize them. “I know the challenges of seeing patients in a clinic, and the challenges when things don’t go right,” she said. “That experience helps me bridge the gap between what happens on the front line and the decisions we need to make at the highest levels of the organization.”
For leaders who don’t have clinical experience, it’s critical to carve out time for rounding – and make themselves available for conversations. Doing so, she noted, can help build empathy and strengthen relationships. “You have to be able to walk in the other person’s shoes and understand their pain points, their anxiety – the thing that’s driving them,” she added. “You need to talk to people and be present. When people are willing to talk to you and share all the things that they see are wrong, that to me is success.”
Another core function of healthcare leadership, particularly in recent years, is the ability to foster innovation. At DUHS, “a number of different levers” are pulled to create a culture of innovation.
In addition to hackathons, which solicit ideas from thousands of staff, the organization recently launched an initiative geared specifically toward nurses. The goal was to make it user-friendly and easily accessible, which her team accomplished by creating a QR code that walked participants through a series of questions. Ideas were then organized into buckets based on scope and budget requirements.
While some of the days can be incorporated right away – for example, a pitch to make walkers available in interventional radiology – others are heavier lifts that need to be baked into the budget. What’s important is that a blueprint has been established for sharing ideas, which can significantly boost satisfaction.
“When you have a group of nurses that are frustrated about the thing that they can’t fix for the patient and you bring them a solution, that unlocks something,” she noted. “They can start thinking bigger.”
Perhaps the biggest (and most talked about) concept out there right now is AI – specifically, how it’s being used to boost efficiency and alleviate some of the burden on care providers. It’s an area that holds a massive amount of potential, but must be harnessed in a thoughtful way, according to McDonnell. “Technology is coming fast and furious, and I personally believe that nursing and frontline clinicians need to own what that integration looks like. We need to embrace it.”
Doing so is becoming increasingly vital as the silver tsunami approaches. “We have an aging population and we have dwindling resources, meaning our precious human resources,” she said. “We simply don’t have the size and magnitude of workforce that we need.” The question then becomes “how do we integrate AI and technology in a way that really allows nursing, advanced practice providers, and physicians to utilize that technology and provide the best comprehensive care experience we can to patients?”
It’s a complex question, but one that leaders can’t avoid. What they can do is have critical conversations about how to leverage both AI tools and clinical experience to augment the care paradigm. “What does a truly integrated, team-based care model look like? That’s the key,” she said.
For McDonnell, it’s a willingness to think – and even step – out of the box. “We need to be agile and not be so fixed to the past,” she noted. “We need to be open to what the future is going to bring. That’s going to help us succeed in any care setting.”
“My role as CIO isn’t to present the best technology. It is, in collaboration with my peers, to really understand the problem.”
Years ago, that statement from Chris Harper likely would have raised many eyebrows. But in today’s healthcare environment – where it’s becoming increasingly clear that people and processes are more critical than the technology component – it makes perfect sense.
“At the end of the day, we’re all trying to accomplish the same mission,” he said. And although it can be tempting to play the part of hero, that’s not what organizations need from their CIO. What they need is a “pro” who will partner with the team and work to “solve problems together.”
Chris Harper
During a recent Keynote interview, Harper – who holds the dual roles of CIO and Senior Associate Vice Chancellor of AI at The University of Kansas Health System and University of Kansas Medical Center – discussed the philosophies that have served as the backbone for IT advancement, and the deliberate approach they’re taking to drive transformation across the organization.
When it comes to AI – or any tool, for that matter – his team’s approach has been simple, yet effective: identify the problem, then start to look for a solution. One of the problems they identified was physician and nurse burnout, which was first addressed through “conventional methodologies like process improvement,” Harper stated.
However, “once we hit a critical mass and aren’t able to move the needle anymore,” it’s time to start looking for a different solution. In this case, ambient listening and documentation can help fill that gap.
But what’s even more important than finding the right tools is having a solid foundation in place, which started years ago when the organization implemented Epic, then built an integrated data and analytics platform. As a result, “we’re now able to truly automate and leverage all of those assets to be able to do, in my mind, what healthcare technology is meant to do, which is to alleviate the waste and manual work for patients and providers,” said Harper. Making those “big bets” early on, he added, has positioned the organization well for incorporating AI and automation into the strategy.
Implementing AI tools, however, comes with a unique set of considerations, and therefore requires a different game plan than an EHR rollout. To that end, the University of Kansas Health System has adopted a “clinical trial-type approach,” he said. The key elements? A small sample size, a feedback loop that includes clinical and physician champions as well as engaged vendor partners, and a willingness to be agile.
And the feedback loop needs to be tight, according to Harper. “You can’t wait a month or six months to solve an issue. You have to commit to an iterative but rapid approach,” he noted. “If you break it, you have to fix it right away. There’s no room for error.”
Not just because human lives are at stake – which is clearly the most important point, but also because of the high level of interest in AI capabilities, especially among physicians. And in fact, he recommends tapping into the knowledge of super users and leveraging it to develop better products and strategies.
“There’s going to be tremendous value created through this. As CIO, you need to think about how to position your organization, and more importantly, your team and your people, so they can succeed,” he said – and do it quickly. “We don’t have a lot of years to get there. You have to start teeing up your team to take advantage” of the AI gold rush, and use those capabilities to achieve tangible outcomes.
“Whether it’s the retail space or financial sector, you have to be able to show value,” he added. “You have to think every day about the value your team is adding and the value the technology is adding.”
And if there’s no value, consider pulling the plug – even in the middle of a project,” noted Harper, who recalled a time earlier in his career in which his team “stopped a multimillion dollar project halfway through and decided to recalibrate. “It wasn’t the right thing to deploy that technology, because we knew that it wasn’t going to solve the problem.”
In the end, the decision proved to be the right one, and offered further validation of the importance of seeking – and acting on – feedback. Doing so, he added, requires something that he believes has become a critical component of leadership: listening.
“I think a lot of high performing IT individuals are quick to come up with solutions,” Harper said, noting that he’s been guilty of it as well. “Earlier in my career, I remember that someone would be talking and I would already be architecting how it comes together and coming up with answers and questions.”
The more advantageous move, for all parties involved, is to turn all focus to the person speaking. “That’s the biggest piece of advice I would offer: take time to listen and sit in silence.”
As mergers and acquisitions continue to rock the healthcare industry, organizations are faced with critical decisions, particularly when it comes to leadership. Consequently, more are turning to interim leaders to hold down the fort.
“There’s a lot going on right now,” said Judy Kirby, Executive Recruiter at Kirby Partners. “We’re seeing a lot of individuals back on the marketplace looking for opportunities,” and a lot of hospitals that need a stopgap.
It has the potential to be a win-win situation. However, while the qualities teams look for in interim and permanent CIOs are relatively similar, there are nuances to each that require a different approach.
Judy Kirby
During a recent Keynote interview, Kirby and Christopher Scanzera, who recently served as Interim CIO at Lurie Children’s Hospital, shared insights on why organizations opt for temporary leaders and the skills they value most in these individuals. They also offered advice that can be leveraged by all healthcare leaders as the landscape continues to evolve.
Kirby, who has more than three decades of experience in the field, believes that while M&A has undoubtedly played a role in the surge of interim roles, there are also other key factors. “I think organizations are asking, ‘do we have the right person in the chair?’” she noted.
Another key element is the circumstances under which the predecessor left, and the time that has lapsed since. In some cases, an internal person might be available to fill the role, at least on a temporary basis, but the reality is that most organizations lack a solid succession plan.
In some cases, however, the absence of CIO presents an opportunity to assess the current strategy and make adjustments, according to Kirby. “A lot of organizations, especially now, aren’t sure what they need in their next technology leader. Where are they going with digital? Where are they going with AI and cloud? I think sometimes having that interim come in and give an independent assessment can help level-set for where they need to be going.”
One of the questions Kirby’s team often gets is what to look for in an interim leader. And while there isn’t a universal answer, she places high value on individuals with a consulting background, as well as those who have previously helped interim roles. “They’re going to be a little more successful because they’re got a playbook coming in,” she said.
Chris Scanzera
Scanzera, who spent time with Deloitte and PriceWaterhouseCooper before becoming CIO at AtlantiCare, believes that his consulting experience benefited him significantly. But what’s really important is the ability to “deal with uncertain situations and size things up very quickly,” he stated. “You need political acumen, especially if you’re walking into an organization where someone who was loved as a CIO departed. You have to understand the political temperatures of not just the C-Suite, but also the IT executive team.”
And while technical knowledge will certainly come in handy, the ability to communicate effectively across multiple levels is even more vital. “You’re going to get hit with a lot of different questions. One afternoon you may have to wear the CTO hat, another you might have to put on the hat of a cybersecurity leader or VP of applications,” he noted. “You need to be able to go across different domains and occasionally go deep.”
Once an individual lands an interim role, the next question (another one Kirby hears often) is, what’s the best approach? Her answer is simple: “You need to take this job and own it. Treat it like it’s your own,” she said. “Trust that you’re ready for the job and can do the job.”
Doing so, however, requires knowledge, much of which is gained during the interview process. Smart candidates, said Scanzera, are always “taking notes and learning to get a sense of what the real scoop is going to be.”
That scope might entail keeping the trains running, or it could be “a situation in which they want you to come in and make aggressive changes,” or help prepare the organization for transformation, he noted. “It’s all part of the walking tour to find out where everybody is, because you’re going to get multiple opinions and multiple wishes, desires, and interests in terms of direction.”
At the same time, it’s important to come in with a roadmap of what you’d like to accomplish, said Scanzera, who advised breaking it into two-week chunks. “You have to come in with a structured framework and mindset of listening, learning, and assimilating very rapidly.”
Unlike with a permanent role, interim roles don’t tend to have a “honeymoon period,” which can ratchet up the pressure to deliver results. “You have to hit the ground running and come in with a preconceived notion of what you’re going to do – and do that very quickly.”
The key to that, according to Scanzera, is creating a healthy culture. “For one reason or another, you have a somewhat fragmented situation, and there’s an element of trust that has to be rebuilt,” he said. “You have to go down the path of learning and respecting the institutional knowledge.”
The more transparency and authenticity a leader can bring to the table, the easier it will be to make decisions that lead to early wins, he noted. “You want to be open and be accessible, and when you get wins, you want to share the credit. As an interim CIO, you absolutely need to do that.”
Just as critical, of course, is establishing rapport with the C-suite and Board, which requires communication – ideally in the form of “structured and relevant updates,” Scanzera added. “I believe results move at the speed of relationships. The more durable you can build them, the better off you’re going to be. That, to me, is the difference between success and failure.”
Above all, CIOs – whether temporary or permanent – must continue to build their skills, and not just technical, according to Kirby, who believes emotional and social intelligence is what separates good from great leaders. “The ability to listen, talk beyond the bits and bytes, and understand the business – to me, those are the most important things.”
Scanzera concurred, noting that the focus should remain the same, regardless of how long an individual has been (or will be) in the seat. “When you’re the interim CIO, you are the de facto CIO; the role, the responsibility, the fiduciary duties are the same,” he said. “You get up every morning and give it 110 percent. The job is still the job.”
Is it possible that something positive came out of the cyberattack that knocked Change Healthcare offline a year and a half ago?
Alan Smith thinks so.
Though it had extremely detrimental consequences – at last count, 190 million individuals were affected – the event “forced everyone to say, ‘what are we going to do?’ and rethink their vendor management philosophies.
“It’s interesting; we pride ourselves on running pretty efficiently. One way to do that is to get to one contract, one vendor,” said Smith, CIO at LifePoint Health. After the headline-grabbing cyberattack, “we’ve changed our dialogue to, maybe we should have two. Maybe we should spread out the risk a little bit.”
Alan Smith
The Change Healthcare incident also sparked another discussion that he believes has been muted for too long. “As an industry, I don’t think we talk enough about business continuity,” said Smith. “As the chief operator, you need to own how we continue to operate in a degraded environment because it’s going to happen.”
During a recent Keynote interview, the veteran leader talked about the mindset shift he’d like to see in healthcare, the constantly evolving CIO role, and the qualities he finds most valuable in future leaders.
One of the biggest challenges with business continuity, according to Smith, is the ownership piece. “Some people say it falls under cybersecurity, and some say it’s the CIO’s job,” he noted. “It’s not. It’s a shared game,” particularly when an incident hits and EHRs are down for days – or even weeks, and everyone feels the impact.
Fortunately, the conversation has changed “to some degree” in recent years, but there’s still room for improvement, and it starts with clarity. “What does business continuity mean? It doesn't mean the same thing to different people,” he said. “You’ve got to come up with a common lexicon and get everyone to agree on it.”
The ability to lead that conversation is a reflection of the transformation the CIO role has undergone in recent years from tech expert to ‘chief translator,’ according to Smith.
“When you’re with your internal teams, you probably talk a little bit more tech,” he said. “But when you’re with the business, you need to talk about use cases. You need to talk about innovation. What does that mean? How are we going to grow the top line? How are we going to decrease costs and increase efficiencies? It’s more about business enablement and less about hardcore tech.”
What that entails, he noted, is the ability to help prioritize tasks and help lead others down the right path – which sometimes means steering away from AI. “I start with, ‘what are we trying to do?’ Because no tool is the answer to everything,” Smith said. “Let’s talk use cases, and back into the technology that supports whatever we’re trying to do.”
And it’s not just AI tools that can crowd the environment. In fact, most healthcare organizations have more solutions than they need–and it’s affecting them in terms of costs and security. To that end, Smith and his team embarked on an initiative two years ago to review spending across all departments. “We literally went team by team. We sat together for two hours and asked, ‘what does this team do?’ It might be, ‘we’ve got Meditech and we have six people to support that. Here are the metrics.’ We went through all of that, and I think it was really enlightening.”
As a result, they were identify solutions that weren’t essential, and take steps to remove them. If teams wanted to keep them, they had to defend the spend.
What it did, according to Smith, is provide a level of accountability that hadn’t necessarily been in place.
“The IT spend is ultimately the result of a lot of peoples’ decisions; it’s not IT making those decisions,” he noted. “I didn’t decide to put a new payroll system or install PACS or Hemodynamic. Somebody else made that decision and the costs came to us. We’re trying to turn that around and say it’s business ownership that drives these costs.”
As part of that same philosophy, LifePoint is moving toward a consolidated EPR, which has helped improve visibility and boost cost savings. “That’s been huge,” Smith noted. Because “if you don’t know how many contracts you have, you don’t know the spend.”
Another critical decision his team made was to pull all of the TCOs together, which has helped bring awareness to the amount of money being spent. “All of our leaders, AVPs, and directors are looking for opportunities. It’s part of our DNA,” he said. “When they run into some contract that a facility sign that we didn't know about, they always ask, ‘do you need this? Why can’t you go to the standard vendor that we have?’
In doing so, LifePoint is able to “make it more of a team sport and ingrain it into our DNA, which has been huge. Because one person alone can’t do this; you need to have a whole bunch of people finding it, negotiating it and thinking about it.”
Although the orgnaization has undoubtedly made progress, they still have a ways to go when it comes to transprency. “People don’t completely understand how many projects we get hit with,” he said. “We’ve got work to do there.”
Fortunately, he believes the industry is headed in the right direction. The key to steering that ship, Smith added, is to ensure the right people are in the right seats.
One of the attributes that he believes will tip the scales? An inquisitive nature. “I think attitude wins over aptitude. The people who are willing to figure it out and challenge why we can’t do things a different way are going to get a lot farther,” he said.
On the flip side, one of the most important qualities leaders can have is to admit when they’re wrong. “I think that goes a huge way,” said Smith, who also believes leaders should embrace a healthy debate. “I wouldn’t want a team where everybody thinks the same and comes from the same background. I think that’s a recipe for disaster.”
Finally, Smith urged both current and aspiring leaders to stay focused on what’s most important. “Do this job because you want to make a difference. Don’t do it because it’s part of a career path,” he said. “It's a tough job. Do it because you want to impact patients and caregivers.”
When asked about the biggest challenges facing cybersecurity teams, most would probably cite budget – or more accurately, lack thereof. And while that’s certainly valid, there’s another obstacle that’s proving to be just as formidable: isolation.
“The biggest adaptation that I had to make coming to work for healthcare was understanding how isolating it is,” said Chris Plummer, Senior Cybersecurity Architect at Dartmouth Health. “Why are 6,000-plus hospitals still fighting as independents?”
On the other hand, when organizations combine resources, it provides “a suit of armor” that can create a stronger defense. It also helps foster a spirit of collaboration that hasn’t always been present in the security world. “When you’re able to put your arm around another hospital that comes into the network, you can provide that layer of protection really quickly.”
Chris Plummer
However, it isn’t just organizations that find themselves working in silos, but also individuals, Plummer noted. During a recent Unhack the Podcast, he shared insights on the isolation that security professionals often face, and discussed the steps that health systems can take to improve outcomes, from forming partnerships to exploring AI tools.
For many organizations, especially rural and small hospitals, small budgets can limit the cybersecurity staff to a single position, meaning that one person has shoulder all of the operational responsibility. “It’s exhausting,” said Plummer, who admitted he has felt “truly burnt out” in previous roles. “You bear the responsibility of securing everything, and bailing out the organization if something goes wrong.”
This phenomenon of being the “only cyber FTE” isn’t rare, he said. In fact, “I’ve been to a lot of places where you sit down with presidents of those hospitals and they ask each other, how did you talk your board into giving you money for a second IT person?” Plummer noted. “Those conversations show the lack of resources that we’re all facing right now as a country.”
And although that isn’t the case at Dartmouth, which he said has been “an amazing change of pace,” it continues to be a sticking point for many organizations.
One of the areas that suffers most in these situations is the ability to notify parties of possible breaches. If organizations don’t receive that information in a timely matter, it can severely limit the response. “How do we know something has gone wrong?” he said. And if it does, “should I be concerned? Do we need to do one of the rinse-repeat things we do every time someone is breached? Turn off VPNs? Cut off remote access or email?”
And while they don’t need all of the specifics upfront, leaders do need to know whether it’s okay to keep sending and receiving emails and lab results, for instance. “Everyone needs to understand the state of affairs,” he said. “We’re all searching for those same answers, and it can consume so much oxygen in the room trying to understand it all.”
This is where the collaboration piece comes into play – particularly when separate organizations are all exerting efforts to try to get the same answers. “We’re all doing the same thing. We patrol news sources. We look at social media. We’re trolling Reddit. It’s wild that this is what we’re doing to try to get the intel that we need to make decisions,” he said. And yet somehow, “we’re still on an island fighting our own battles.”
The way to buck that trend? By getting involved in professional organizations, noted Plummer, who participates with the Health Sector Coordinating Council Cybersecurity Working Group, H-ISAC Membership Committee, New Hampshire Cyber Threat Working Group, and New Hampshire Cyber Healthcare Sector Working Group, among others.
“You’re not going to get ahead in the information war without people. If you don’t have the personnel, you’re losing on all fronts,” he said. “A big part of that is building networks between people across health systems so that you’re comfortable sending an email or standing up a conference call and getting five or 10 people who you trust to troubleshoot this together. That has to be a big part of this.”
Another benefit of those relationships? Knowledge sharing around important topics like how AI is being leveraged in the security environment. Although it’s “clearly not at a point where it can practically augment cybersecurity operations,” Plummer believes it has the potential to be “incredibly powerful” – not necessarily in making decisions, but rather, guiding them.
“We all have that dream of being on full-blown autopilot and turning it over to AI,” he noted, but that’s not the reality – yet. Troubleshooting, on the other hand, is an area that’s ripe for innovation. “If it can provide a series of five steps to check if you’re trying to solve a given problem, that would be big.”
For now, Plummer is happy to remain “pinky toes deep” in AI. But at the same time, he doesn’t want to wait too long to get a bit more immersed. “I don’t feel like it has to be perfect,” he said. “On one hand, the institutional knowledge required is so deep, but the rate of innovation is so fast,” and no one wants to get left behind.
What Plummer and others have learned is that in healthcare – and particularly, cybersecurity – “things happen quickly,” and leaders need to stay aware and be prepared to adapt. And of course, collaborate.
One of Michael Han’s least favorite tasks during his surgical days was dictating operative notes. And so, the idea of being able to automate that process and remove some of the documentation burden from surgeons is extremely appealing. In fact, he believes the ability to generate notes from a video recording “isn’t that far off.”
However, he also believes clinical documentation shouldn’t be the primary objective with AI technologies – at least, not yet. For now, it should be all about the “administrative, non-sexy stuff; that's where the technology is right now,” said Han during a recent Keynote Interview.
Michael Han, MD
At MultiCare Health System, where he serves as CMIO, that’s precisely the plan: to leverage AI capabilities to address the pain points associated with call centers, scheduling, and managing referrals and prior authorizations.
In doing so, “we can reduce our overall costs, which should result in improved productivity,” he said. “We’ll get to the clinical space eventually, but we’re not there yet. Let’s focus first on all of the administrative things that have to occur around the delivery of care.”
And of course, on reaping benefits of using AI to automate scheduling and prescription refills and address frequently answered questions, which in turn can free up individuals to focus on more complex issues. “It’s about controlling costs as much as possible,” he said, while also improving the experience for patients and staff.
One area where he sees a great deal of potential is the ambulatory space, where large language models can be used to assist in preparing and summarizing charts and identifying care gaps. Having data in the right place, he noted, can help providers determine which labs or tests are needed, and quickly access referral and authorization information.
Post-acute appointments also stand to benefit, as physicians can leverage ambient listening to draft summaries that include all the pertinent information, and in a language that patients and caregivers understand. “We’re talking about referrals to other physicians, advanced imaging, prior authorization that needs to occur, and scheduling that needs to occur,” Han said. “It’s making sure you’re the medical home and patients take those next steps,” such as consulting with a cardiologist prior to surgery. This way, if the cardiologist requires an EKG or echo, for instance, it can be done and reviewed ahead of time.
As a result, “the patient’s encounter is as high-value as possible. This is how we’re going to be able to extract more productivity out of the system,” he added. “Because right now, there's too many times where patients show up at a specialist visit or a primary care visit without having had the tests and gone through necessary steps. I’m excited about improving the value of those visits.”
He’s perhaps even more excited about the clinical documentation piece – and the opportunity it presents for frontline workers. Through AI-powered automation, “we’re no longer requiring some of our most highly educated and highly paid resources to enter data,” Han said. With that burden removed – or at the very least, lessened, “it gives physicians and nurses more bandwidth to understand and analyze the data,” which can lead to better outcomes.
In preliminary trials at MultiCare, ambient technology has already scored high marks in these areas. “We haven’t seen a decrease in time in chart, but we have seen a decrease in time in documentation, with an increase in chart review and in orders,” he noted. “That means physicians are using their increased time to analyze and understand the chart and act on it. Which we think is an excellent narrative, and so, we’re extremely bullish on what Ambient can do in this space.”
However, no matter how much potential a solution might have, technology is only one piece of the puzzle. In order for ambient tools to succeed,
With ambient tools – along with any other technology, for that matter – the path to success is in conquering the other two parts: people and process. This, according to Han, is where CMIOs or other informatics leaders play a critical role by helping users understand WIIFM (what’s in it for me).
“If I enter this data, how is it going to help me with my patients? Helping them understand the ‘WIIFM’ is critically important in establishing trust and credibility with the medical staff,” he said, which can go a long way toward driving adoption.
Just as critical, Han noted, are the processes that are in place. And there’s no better time to test those processes than when a new technology is being introduced. “It’s an opportunity for you to examine the existing workflow and optimize the workflow with technology in mind,” he said. “Because you don’t want to automate chaos. You don’t want to automate a bad process. You want to make the process as clean as possible so that it can be automated, and so that you can actually improve outcomes.”
Also critical, of course, is the people aspect, which can be a significant hurdle in gaining adoption. What often happens, according to Han, is that one department head might advocate for a solution while another is resistant to it. One way to avoid that, according to Han, is to encourage stakeholders to get involved from the beginning and help identify the problem before choosing a solution.
The key, he noted, is in “guiding end users to the problem that you’re trying to solve, and working in collaboration to come up with a solution.”
And while that may not be the easiest aspect, it is the most important, Han noted. “If you don’t lay the foundation in terms of the people and the process, it’s not going to work; no matter how good the technology is, it's not gonna be adopted.”
On the other hand, if organizations approach the people, process and technology pieces deliberately, healthcare will move closer to realizing the benefits of AI tools.
If a health system wants to successfully execute a major initiative, there are several components that need to be addressed. And while some are nice-to-haves, others are table stakes.
Standardization falls into the second category, according to Jennifer Stemmler. In fact, it is becoming “a hill to die on,” particularly as care models continue to evolve.
“It creates the ability for us to do things faster, smarter, better, and cheaper,” she said of the massive EHR migration currently happening at Adventist Health, where she serves as Chief Digital and Information Officer.
Jennifer Stemmler
Achieving it, however, is anything but simple, especially when it involves a system with 28 hospitals and 400 clinics across three states – one that’s been using the same EHR for more than two decades. A disruption of this magnitude, according to Stemmler, can’t happen without a clear roadmap, a shared ownership model, and a rock-solid change management strategy. And while her team still has a long way to go before the scheduled go-live of September 2026, they’ve already taken some enormous steps toward integration. During a recent Keynote interview with Sarah Richardson, Stemmler discussed Adventist’s journey and shared practical advice for others in similar situations.
For Adventist, the decision to move away from Oracle Cerner was difficult – Stemmler referred to it as a “saga” that went through multiple iterations – but it was necessary given the organization’s growth. “We needed a platform that was focused on the future,” and could support M&A strategies while also providing a better experience for users. After a substantial time period during which leadership worked closely with the board, Adventist signed an agreement with Epic and has been “full steam ahead” since then.
One key factor that enabled them to hit the ground running, she noted, was a concerted effort to identify and share core objectives. “Let’s be very clear about it so we know how to build something we can measure against,” and emphasizing the reasons behind the migration. “It sounds basic, but it’s a big deal when you’re thinking about the size of the transition and transformation that we’re asking our operators to make.”
And so, along with establishing five primary objectives, leadership created a benefit realization scorecard that included “decision guardrails and escalation points” to help course-correct. Doing so helped “define a framework” for the 77 workgroups across the organization while recognizing the anxiety brought on by a major shift. “A lot of people thought, ‘We’re going to implement Epic? Why now?’” To that end, Stemmler’s team provided a roadmap that they could point to for questions or clarification. “The technology part is the easy part. It’s everything else that goes with it and the operational readiness that’s required.”
The not-so-easy part? Keeping the lid on unauthorized changes. “We’ve got a very tightly controlled budget process; anything that deviates from a specific line item immediately goes up through an escalation track” and is put through the advisory council governance process. “Every part of that structure and organization understands that the decisions they’re making need to be in line with that.”
That’s where Adventist’s mantra of ‘On time, on Epic, on budget, on us” plays a critical role – particularly the ‘on us’ component. “If we don’t own the change or the responsibility, we will never actually see the transformation on the other side, whether it be in the net revenue, the clinician experience or the patient experience change,” she said. “We have no white knight on a horse to come save us. “We are the team that is going to do this. So let’s roll up our sleeves. It’s on us to get this change on the other side.”
With a shared ownership model, individuals tend to be more invested in success – and subsequently, more likely to adhere to tight governance processes, which can lead to improvements in quality. “At the end of the day, they want the outcomes,” she said. “They own it, not me. And that accountability is going to get us to the next level.”
Another core component in Adventist’s early success? Leveraging data to drive decision-making. What that does, according to Stemmler, is “pull feelings out of the decision” and ensure the right choices are being made based on available information. “We’re moving everyone’s cheese with this program. It would be insensitive to think there aren’t feelings involved.”
There certainly were feelings when the decision was made to implement Epic’s Cupid in cardiology rather than sticking with a homegrown CDIS. When it was met with resistance, leadership – including the Chief Clinical Officer, who happens to be a cardiologist – provided hard numbers supporting their choice. “We brought data to the workgroup and said, ‘here’s the impact of keeping the custom solution,” she said. “It’s off budget, because now we’re going to have to pay for these 10 CDIS systems we have all over the market. We presented it that way and tracked it back to a benefit scorecard.”
When it comes to “very emotionally charged decisions,” such as the aforementioned example, the ability to rely on the best practices and standards advisory council has been invaluable, according to Stemmler, and will likely continue to be. “There will inevitably need to be a tie-breaker.”
It also lends further credence to the importance of solid change management, which she believes starts with a foundation of transparency and authenticity.
The first step? Communicating the vision effectively. “We need to help paint a picture of what things could look like,” she said. And once that’s been accomplished, explain their role in reaching that goal. Oftentimes, individuals are too focused on their current work to see “the other side,” which is where leadership – and data – can help tip the scales. “People sometimes make decisions based on fear or historical bias,” Stemmler added. The CXO’s role is to provide a window into the future by focusing on shared goals, and how the changes being made can help meet those goals.
Leaders also need to expect – and even welcome – a certain level of tension, especially when so many stakeholders are involved. “We need to be prepared to have structured conversations around what’s the right thing to do,” she said, noting that Adventist has often had to go through multiple iterations before reaching a conclusion. “When you have multiple teams coming together under a shared goal, there’s tension, but it’s healthy tension.”
The other important part of that is ensuring individuals are empowered to voice concerns. “I always tell my leadership team, ‘don’t be afraid to realize where we have a failure point in the process and suggest a change,’” she added. “We’ve got plenty of room and a long road ahead where we should be able to say, this really isn’t working. We’re not seeing the benefit on the other side.”
On the other hand, when users do see the benefits, it can be a game-changer – as well as further validation that leadership made the right decision. “Once we go live and get past stabilization, if people can see the change that they’ve put all of their muscle and sweat into, it’ll be worth it,” Stemmler noted. And although there will still be much more to do, individuals will have seen the potential, and will have something to build on.
Throughout his career – which has included stints in the military, law enforcement, and logistics – Dennis Leber has amassed a wide breadth of experience. But the skill that has proven the most valuable, particularly in today’s healthcare landscape, isn’t technical acumen or adaptability – both of which are critical.
“It’s communication and teaching, and it’s not making assumptions,” said Leber, who has “always had some type of instructor role,” whether it was teaching firearms during his early Marine Corps days, his numerous adjunct professor roles, or even his current consulting work.
That background has served him well, and could do the same for other cybersecurity leaders as risk management becomes a bigger priority throughout healthcare.
During a recent Unhack the Podcast, Leber – who is currently providing virtual consultant services, having most recently been CISO at Honest Health – talked about the evolving skillsets for C-suite leaders, the importance of basic cyberhygiene, and his unique career path.
Dennis Leber
The good news for cybersecurity leaders is that awareness seems to be increasing, as a result of the alarmingly high number of incidents healthcare has experienced. The not-so-good news? It doesn’t necessarily reflect in how the CISO role is perceived.
Part of that, according to Leber, falls on leaders themselves. “If you listen to some of the things CISOs say at events, you’re like, that’s the way we did it 20 years ago,” he said, adding that many aspiring leaders fail to leverage the resources available and, consequently, aren’t building the necessary skills. “They’re being pigeon-holed into positions because they don’t report at a level that would enable them to have impact and authority.”
One possible solution is to schedule regular meetings with the board and CEO, which can lead to improved decision-making. “CISOs shouldn’t operate in a silo. Regular collaboration with CFOs, COOs, and legal teams ensures cybersecurity strategies align with broader business objectives,” he wrote in a recent installment of his LinkedIn Newsletter (The Cybersecurity Doctor Is In). Board engagement is also critical, said Leber, adding that “CISOs who present regular briefings to leadership foster transparency and accountability.”
Addressing the board, however, is a strength not many cybersecurity leaders have fully developed. “That’s another problem we need to solve,” he said. Leber’s advice? Rather than focus on metrics – no matter how powerful they may seem, CISOs should anchor the conversation around organizational goals, and how they might be affected by a cyber incident.
“That’s where I started changing my thoughts to, ‘what are the goals of this company?’ and pulling up examples of where we increased or decreased by a certain percentage,” he said. Contrary to popular belief, “it has nothing to do with technology or cybersecurity. It’s, ‘here’s how implementing Control X or Tool Y impacts that objective that the business stated,’” and then talking about vulnerabilities and risk.
The ultimate objective is to be able to definitively say, “if we do or don’t do this, we won’t make a million dollars next year,” Leber said. For leaders, the key is in recognizing that people tend to learn differently and adjusting to fit their needs.
Another critical component is ensuring teams are trained on basic cyberhygiene – which should be a given, but is not in many cases. “Somehow or another, we’re still failing,” he said. “I’ve been in this industry for 20 years and we still fall victim to the same things over and over.”
The answer is education – and not just to those in IT or security, but throughout the organization, he said, urging colleagues to take a page out of the military playbook.
In the Marines, for example, “every soldier who goes into combat is taught basic life-saving skills,” which has helped dramatically improve survival of those suffering injuries. Healthcare, he believes, can achieve similar results by investing not just in solutions, but phishing education and testing exercises. Doing so regularly, he noted, can reduce social engineering risks by 80 percent.
And in fact, that potential to make a difference by leveraging technology is what drew him to cybersecurity – and eventually – healthcare. “I always liked technology. I was probably one of the first police officers in Louisville to have a computer in my car,” recalled Leber, whose decision to zero in on technology proved fortuitous. “That’s the future; that’s where we need to be.”
It’s amazing. A CIO can lead a hundred successful initiatives and have one that doesn’t go smoothly, and that’s the one they’ll remember.
But it’s the mistakes that end up having the biggest impact – and can even help create a better path forward. For Bridgett Ojeda’s team, it was an ill-fated decision to roll out smartphones to nurses, replacing the hands-free communication badges they had been using.
“These smartphones were giving them five additional features,” which they thought would rate highly in terms of user experience. However, “we quickly found out that hands free was the holy grail that we didn’t take into account. And so, the nurses were not appreciative of having a smartphone that could do a lot more.”
The lesson was pretty clear: input from customers should be considered, and frontline staff should be included in the evaluation phases of any new technology initiatives, say Ojeda, who has been CIO at Nebraska-based Bryan Health since 2021. “Making assumptions is dangerous; we learned quickly from that moment.”
Bridgett Ojeda
And importantly, they applied those learnings to subsequent rollouts, particularly those involving advanced AI. During a recent Keynote interview with Sarah Richardson, Ojeda talked about her team’s AI strategy, what she believes are the biggest stressors facing CIOs, and the importance of having regular chats.
Like most organizations, Bryan Health isn’t immune to the excitement around AI tools like voice recognition and natural language processing. But before leadership even considered making the leap, they ensured a solid business case was in place. “We’re very diligent about ensuring that the AI tools we’re implementing are solving a problem we have. Otherwise, we’re just creating a disruption with no return,” she said.
And of course, there’s the infrastructure piece. “It’s also critical not to lose sight of the digital transformation triangle or the people/process aspect when implementing AI,” Ojeda added, and to ensure they’re designed for optimal workflows and usability. “We need to think through our strategic plans and how we align AI tools that meet our organizational goals.”
The answer was ambient listening, which has helped minimize the administrative burden on clinicians, and consequently, improve staff retention. Not only that; it has brought joy back to the practice medicine, which has been the difference maker. “Now technology is working for us, not against us,” she said. “That’s where I want to see AI tools continue to advance.”
Enabling that, however, means contending with some significant challenges. The first, not surprisingly, is tight operating margins, which make it difficult to drive innovation. Bryan is working to solve it by building a roadmap to help identify lifecycle demands and anticipate needs for enhancements or upgrades.
The second? Enterprise cybersecurity risk management and the critical balance leaders must strike between user experience and security. It starts with implementing action plans around SIS controls to strengthen their cyber posture, Ojeda noted. As such, Bryan not only has a solid IT governance structure led by operationss, but also “built-in oversight of our cybersecurity and legal teams. This ensures that our innovation and initiatives align with security and compliance requirements.”
Part of that dedication to security means willing to take a hard stance, she said. “We work very closely in concert with our tech vendors and partners to ensure their solutions meet our security standards. We have clear expectations regarding data protection and how that data can be used.” And if the two sides can’t agree on data standards, leaders must be prepared to walk away, which her team is. “We won’t compromise our integrity, or do anything that threatens our mission of putting patients first.”
The third challenge is building and maintaining an engaged workforce. To that end, her team is developing IT career pathways that highlight opportunities available to staff, while also devoping programs focused on mentoring and job shadowing.
What’s just as important as the structure of a program, however, is the culture driving it. “First and foremost, it’s hiring incredible managers who are invested in their team’s success. It's ensuring we actively listen to our staff and build in multi-channel feedback loops,” Ojeda noted. Doing so helps to create a culture where gratitude is a priority and staff feel a sense of belonging. “We want to ensure we know what’s important to our staff.
There are number of ways to do that, including rounding, regular check-ins, and sitting down to lunch with each new staff member. “It’s important that I get to know every player on our team.”
Another method is through what she calls “coffee talks” in which small randomized groups meet to discuss concerns and get to know each other.
It’s all part of the collaborative culture her team has established. “We try to promote ongoing education and investment in our team members. We encourage our team to spend time with their customers so they can see how their work impacts the day-to-day lives of the people we serve,” she said. “It also keeps our team members tied to our purpose.”
What ties all of that together, according to Ojeda, is Bryan’s mission statement: ‘One patient, one story, and one health system, forward together.’ At its core, it’s about ensuring stakeholders are involved and invested every step of the way. “We are very methodical in our implementation strategies to ensure our operations are in lock step with us,” she said. “From the kickoff date to go-live, all the way to the closure and post implementation reviews, forward together is where we really need to lean into our governance structure to ensure that we have buy-in and initiatives are operationally led and IT supported. Our stakeholders prioritize the projects and the work we do.”
By adhering to those standards and fostering a culture of collaboration and innovation, Bryan’s aim is to create “a robust healthcare IT infrastructure that ultimately creates efficiencies for our staff and physicians, and creates great outcomes for patients.”
There are several myths floating around in healthcare. One of the most troubling, according to Reid Stephan (VP and CIO at St. Luke’s Health System), is the idea that clinicians are change resistant.
In fact, he believes it’s “lazy” to suggest that’s the case. “They’re overwhelmed. They’re drowning. And so, any added task, even one extra mouse click, can be the extra water that breaks the damn.”
Since EHRs first became part of the vernacular some two decades ago, clinicians have been dealt massive amounts of change, and have handled it quite well.
That’s the good news. The not-so-good news is that change isn’t going to slow down anytime soon, particularly as AI technologies become increasingly pervasive.
As a result, CIOs and other leaders face added pressure to prioritize the needs of frontline workers and make sure technology fits into their workflow. “The AI of the future has to be out of the way and require virtually no training,” he noted.
Reid Stephan
During a recent Keynote Interview, Stephan spoke about the ever-evolving relationship between CIOs and vendor partners, and how it can affect users. He also provided insights on the quest for the “middle truth” when it comes to AI initiatives; the role of EHRs as gatekeepers; and why, now more than ever, no one should settle for “good enough.”
One of the most critical aspects of a successful partnership between IT leaders and vendors is trust, according to Stephan, who commended St. Luke’s relationship with Epic as well as the EMR provider’s “genuine desire to improve healthcare.”
The challenge in working with Epic is that “sometimes we settle for a good enough mindset when excellence is within reach.” For example, if a CIO asks their internal Epic team analyst to see the roadmap, and they’re given a blueprint for Epic itself rather than the organization. “That’s a problem,” he added. “That’s not strategy; it’s vendor alignment dressed up as vision.”
And although his team operates with an Epic-first strategy, both due to the quality of its products and the high cost and complexity of using third-party solutions, Stephen believes leaders owe it to their clinicians to adhere to the highest possible standards.
“What if 80 percent isn’t good enough? Or what if the Epic solution technically checks all the boxes, but the user experience is frustrating, because it doesn’t solve the problem that needs to be solved? We can’t allow functionality to be a substitute for usability.”
What leaders should do, he added, is to raise the bar by asking for a “more modern, intuitive design” from EHR providers. “We need to expect and demand deeper, cleaner, more open integrations when we have to go beyond what Epic can offer,” he said. “We need to expect that our needs – and not just Epic’s roadmap – are guiding what we build, what we buy, and what we adopt.”
Part of the more modern Stephan seeks with EHRs is the ability to incorporate AI capabilities – something he believes is lacking. “Our EHRs are the gatekeepers, and that gate is effectively locked,” he noted, adding that “integration friction” can prove fatal to transformation initiatives. In some cases, EHRs aren’t just “hard to integrate with; they’re actively hostile.”
For that reason, he strongly urged CIOs and other leaders to educate themselves about AI, surround themselves with experts, and don’t hesitate to raise questions – especially when predictions vary so widely. “We’ve gone very quickly from ‘AI hasn’t delivered much’ to ‘it’s going to replace most doctors and teachers,’” he said. “What’s the middle truth? What has to happen over the next decade to certify or add credence to either of those statements?’”
That’s where the questioning comes in, Stephan noted, adding that AI is being marketed as transformative when in reality, it’s basic rule-based logic wrapped in a package, and people are starting to call that out.”
They’re also demanding solutions that require minimal training while offering the benefits that have been promised with AI. “People don’t want tools that look smart. They want tools that are simple,” he said. And “they don’t want AI to take over. They want it to work.”
The same can be said for C-suite executives who are part of the decision-making process around AI initiatives. Rather than focusing on the shiny new toys, his main concern is that the 550 members of the IT department have the tools and training needed to do their jobs effectively. “Do they feel supported and celebrated in the work they do? Do they feel safe? Do they feel like they can take reasonable risks in the work they do and learn from that?”
That’s the main objective, he remarked, adding that the CIO has become, in many ways, “more like a generalized administrator.
“If you’re worrying about cybersecurity or the network or applications at a micro level, you’re not adding value. Quite honestly, you’re probably stepping on team members who are doing good work.”
And, as we’re learning, the last thing anyone needs, whether it’s clinical, IT, or other areas, are barriers.
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