MariJo Rugh Discusses “Unintended Consequences,” Learning from Mistakes & the CIO's Responsibility

For health systems that cover large geographic areas, Community Connect programs make a lot of sense, as they enable smaller facilities to partner with larger hospitals to share the costs and benefits of Epic.

One of those is UCHealth, which provides care across Colorado, Wyoming, and Nebraska through its 15 hospitals, 4 affiliated hospitals and hundreds of clinics. But it’s not just about finances, according to CIO MariJo Rugh.

MariJo Rugh

“Not only does it enhance the information exchange, but that Epic to Epic interaction is huge,” she said during a Keynote with Sarah Richardson. And beyond the clinical collaboration component, “it really is good for the patient and the providers.”

Learning from Mistakes

On a micro level, however, it comes with challenges, particularly when requests are made that don’t quite make sense – at least, not at first glance. For example, during a recent go-live at Regional West Medical Center, a small rural facility, the perioperative team asked the uptime analyst to incorporate pre-admission testing data flow into anesthesiology, which had never been done.

“She said to me, ‘I know it was going to be tough for peri-op, but it’s worse than I thought,’” said Rugh, whose immediate thought was to have a conversation. “Let’s understand why they feel it’s important and what they were trying to accomplish.” As it turned out, a good amount of data gathered during pre-admission wasn’t getting into the physicians’ hands.

“When it was all said and done, what we thought was a really horrible idea turned out to be a great idea,” she recalled. And in fact, “our anesthesia providers agreed, and so, we’re going to do the same thing across UCHealth. It’s one of those positive unintended consequences that we were able to realize.”

What it further demonstrated to Rugh is the importance of listening. “As you walk into a situation, don’t assume you know where they’re coming from,” she stated. “Don’t assume you know what the issue or problem is.”

Making Connections

As more systems take on Community Connect-type initiatives, there are a few best practices that can be applied to ensure both sides are realizing value. During the interview, Rugh offered the following pieces of advice:

• Learn from mistakes. For UCHealth, making the leap from clinics to hospitals proved to be quite difficult. In fact, on their first attempt, “we did a lot of things wrong,” Rugh said. For the next, “we selected a really good partner,” and were transparent about the previous failure. This time, “we were more forthright. We know how Epic works. We know how it's used in our organization, but we're not exactly sure how it's going to translate to your organization. You might manage your providers differently than what we do. And so, there's a lot of risk around that, but these are the expectations.”
• Partners, not affiliates. Terminology matters, noted Rugh, who makes it a point to refer to “partners” rather than affiliates. “If they don’t think of themselves as being a partner with us as we go through this journey, it’s probably not going to work out.”
• Governance isn’t optional. For UCHealth, creating a system of shared governance was an imperative even before Community Connect, and will continue to be the case. “We have expertise or representation from every hospital,” said Rugh, adding that they have received pushback in some situations. “It can be difficult because sometimes they don’t understand the significance at first, but we have it written in the contract that you will participate in our governance. You will help us make decisions.”
• Think as one. When it comes to project planning, it’s critical to think beyond the health system, Rugh noted. “Oftentimes we have to stand up and say, ‘how is this going to impact our affiliate Community Connect partners?’ It has made us a better organization because we have to step back sometimes and consider not only how it’s going to work within our organization, across multiple regions, but also how it’s going to work in those smaller hospitals.”

The healthcare CIO’s “responsibility”

Another aspect of leadership that’s critically important – regardless of the size and scope of an organization – is making sure every decision reflects the needs of the health system. “As a CIO, you need to make sure you’re guiding the organization based on what they need and not necessarily what your career aspirations may be,” she said. “If you know in the back of your mind it’s not the right thing for your organization, but you want that experience, you should probably look elsewhere.”

In Colorado, for instance, 70 percent of hospitals have unsustainable margins, making it even more crucial that leaders “make the right decisions to help keep their doors open,” Rugh added. “It’s something that all healthcare CIOs need to take very seriously.”

“Here to help”

Part of that responsibility also includes taking care of your team, which she considers to be a core objective. “If we take care of our employees, we're going to take good care of our patients,” she noted. And while much of technology is focused on improving patient care and outcomes, it’s important not to let employees fall through the cracks – especially when it comes to user experience.

“Why should an employee have to go into SharePoint and enter it in the app when they have a facilities issue?” she stated. “Just like we need an integrated medical record where it doesn't matter if the patient was seen in a clinic or in the ED, we need to think the same way for our employees.”

Finally, she emphasized the importance of taking time out to recognize when milestones are met and identify individuals who have gone above and beyond. “We tend to move so quickly and go from project to project, you need to acknowledge those accomplishments,” while stressing the team aspect. 

“We’re here to help one another, and to make sure people know there’s always someone to fill in for them,” Rugh said. “I think I’ve been able to create that culture with this group. I think they understand that they're not just performing as an individual. They’re part of a team.”