A CEO's Experience: What an EHR Technology Change Really Needs for Success

Sobol: Anne Hargrave-Thomas is the CEO of OakLeaf Surgical Hospital in Eau Claire, Wisconsin. She is the senior vice president of operations at Surgery Partners and has been serving in healthcare and healthcare leadership for more than 25 years. Welcome to the CereCore podcast, Anne!  

Hargrave-Thomas: Thank you so much, Phil, for having me. I really appreciate it. 

Sobol: We always love to get started by hearing a little bit of your background. So, if you would not mind tell us a little bit about OakLeaf and Surgery Partners, your role, and how your journey led you to work in healthcare. 

Hargrave-Thomas: Oh, absolutely. OakLeaf is a 30-bed physician owned surgical hospital. We have seven ORs, four procedure rooms, and we are in Altoona, Wisconsin. Which is for those that will not know where Altoona is – we are about an hour outside of Minnesota. So, Saint Paul, so not too far from the big city.  

Surgery Partners is our corporate partner, and they certainly have a very strong presence in healthcare, with hospitals and ASCs across the country. And as you indicated, my roles include being the CEO of OakLeaf Surgical Hospital as well as VP of operations for Surgery Partners. 

So, as far as my healthcare background, you know, I've always wanted to be a nurse. Fortunately, I was one of those people that I always knew what I wanted to do. I began my career as a nurse in Detroit, and then for 20+years, and then I moved into administration and worked at the three large medical centers in Detroit. The ability to build a new hospital for OakLeaf, here in Altoona, was really what brought me to Wisconsin. And I have always loved patient care. 

Working at OakLeaf has really given me the opportunity to combine my two passions, which is patient care and administration. So, it has just been a wonderful experience for me and a great journey. 

Sobol: Well, that is fantastic. Yeah, certainly, we have talked to several people in the industry and one of those common themes that we talk to everyone about is just that passion for healthcare.  

It is fantastic when you see someone who has come out of the bedside care space and then crossed over into administration and how that really makes a difference in how that operation runs on a daily basis. 

So, that is great to hear. You recently completed a go-live on MEDITECH Expanse and our organizations: CereCore, OakLeaf, and Surgery Partners started working together early on in that process.  

As CEO, you were really involved in that Expanse project from the very beginning during physician advisory committee meetings and rounding. So, what is your leadership philosophy and advice when it comes to encouraging that sort of collaboration and teamwork around a technical implementation, such as an EHR implementation? 

Hargrave-Thomas: I think I am going to start with the first part — philosophy. With projects like this one, they are large. I would say for me, there are numerous leadership styles I used throughout the project. I don’t think that you could say there is one style for a successful project like this. For example, I used the democratic leadership style, which involves finding the right people to start. We started early to encourage participation in that collaboration.  

Then, I would also say we moved into transformational. Because a project like this, I moved a lot of people and challenged them to come out of their comfort zones. So, for some, it was a bit of a struggle. 

Finally, I think solution-based. We certainly were not without our challenges during this implementation or project. So, problem solving was key and we definitely needed everybody on board with it.  

I think the advice I would provide is to plant those seeds early to get ahead of communication, timelines for the end user — the physicians, your staff, and whoever your end users are going to be.  

We started 20 months before our go-live to start talking about this project with our staff, our physicians, and any of our end users. We wanted them to know what it was, how it would improve patient care, what the timeline transition would be like, and who we needed to be involved. 

Communication — with anything like this — communication is key. So, I would also encourage you to include the naysayers on your teams as well. Because in the end they can be really valuable as they move through the project. Ultimately, we found that we were able to convert them to become staunch supporters and really, it was due to their involvement. 

Sobol: That is a great response, Anne. Certainly, I think, so many projects and leadership comes down to that communication. We see it oftentimes where that senior leader is not involved in that communication process until something goes wrong. 

So, I really appreciate your leadership and discernment on tackling that early and personally to ensure that everyone, whether it be, the people that were on board or the naysayers — heard from you. 

It is kind of setting that tone and direction and providing them with that information so that they can begin processing and getting their heads around it.  

That’s a lesson that I know a lot of CIOs that particularly listen to this podcast would love for their senior executives to pay attention to.  

Hargrave-Thomas: I have always been an engaged leader. I think when they hear it from the top, it carries more weight. When you get the communication out early, it allows everyone time to ask questions, get rid of the nerves, and work through the process. So, by the time we actually started to recruit, there was excitement generated. So, communication is key.  

But I think coming from leadership is very important, because it tells those that are your end users, whether it is physicians or staff, that you support it and you are there and are going to help them get through it. 

Sobol: Yes, and I assume your approach has been crafted over the years from a lessons learned perspective. Certainly, EHR implementation is quite a journey. I’m sure you drew upon experiences from the past from other large implementations, whether they be technology or not. What stands out to you, around the project that you just went through with Expanse versus some others? And what were those lessons that you applied? And then, how did things go? What is your overall assessment? 

Hargrave-Thomas: The project went so well. I am so proud of my team here, my MEDITECH team, our staff, and our physicians. Certainly, we could not have done it, if we did not have the right partners. I cannot thank CereCore enough. Bob and his team, and Surgery Partners.  

We had all the right people at all the right times to help us work on this. And the great thing was, I could pick up the phone and call someone at CereCore and get an answer. I could pick up the phone and call Surgery Partners and get an answer. From the top down, between Surgery Partners and CereCore I just cannot thank them enough and say enough great things about the relationship that we developed and how invaluable it was to do this. So, I think that is a big lesson for me.  

It really takes a village. This is nothing that can be built in a vacuum. Any EMR, whether it is Expanse or a different product, there is just so much work behind the scenes that goes into it that you just cannot do it in a vacuum. You need resources. You need people. You need help to get it done. 

Sobol: They are large implementations for sure. And I think everyone brings a different perspective to the table and different experiences you get by building that team structure that includes all of those. You are certainly better off. We talked a little bit about this, but there is a myriad of decisions that have to be made from various stakeholders. You have mentioned a bunch of them, including clinicians through administration and change management is absolutely critical. You touched on a little bit around communication and getting that started. 

So, as a CEO, what was top of mind for you, during the transition from Expanse? And particularly, when it comes to those difference makers that made things as smooth as possible for a project like this. Tell us about when it comes to that change management and dealing with the right variety of stakeholders you had to deal it.  

Hargrave-Thomas: Yeah, I think it was getting organized. And at the top, while tedious for most, I have to admit, I was someone who thought, “oh, do we really have to go through this exercise?”.  

But in the end, it provided us with everything we needed to go forward. And that was developing the structure — putting it down on paper.  

You know who are the appropriate committees, all the needed stakeholders. It wasn’t timelines. But it was just between Expanse, between CereCore, between Surgery Partners, my own team, my leadership, some staff. It is just getting all those pieces down on paper and determine who we were going to use to do this change.  

You really have to do that exercise. And we also took the time to figure out how many hours at the very beginning each person we would be pulling away. Including my own time. Those of leadership, those of CereCore, those of Surgery Partners and what the time commitments would look like moving forward. 

And, by doing all those exercises, while they seem, how is this going to help us? It really made a difference in the entire project going forward.  

And again, I just cannot stress enough how important communication is. We started early. We kept it up throughout the project for everyone. This included communication with the physicians, every end user it included, all of our clinics, the office managers, and just everyone.  

We really relied on CereCore and Surgery Partners to help us with some of that communication and upfront planning to pave the way for an incredible go-live that we did have. Again, the experience that they both brought to the table was truly invaluable on our project. 

Sobol: Yeah Anne, you dropped a little nugget in there. You started out the communication, but you kept it up throughout the entire project. All the best intentions and good starts, but as you get into the project, that discipline tends to wane. I think you hit the nail on the head when you made mention of the fact that you kept up that discipline, and that certainly does make a big difference.  

A lot of our listeners are our CIOs or healthcare IT leaders. They are keenly interested in what the senior executive of the hospital or health system has top of mind. And so, perhaps you can share and maybe start within the context of the EHR. But, what is a CEO of a hospital, or a health system, really concerned about that the IT leadership should be made aware of? 

Hargrave-Thomas: I think for all of us in this day and age, it is protecting our PHI. I cannot think of healthcare without thinking — how do we protect it? With all the hacking, the phishing, all the security threats to everything we do on a daily basis. I mean, there are just days you feel like the cyber criminals get better and better every day. And for us, we are a smaller hospital, so trying to stay ahead of that can be daunting, from a financial side as well as having an EMR, that will help protect us. So, that probably is always top of mind — for me, anyway. 

Sobol: That is something that is a constant. You cannot turn on the news or open a publication almost on a daily basis now without hearing about the latest and greatest issue. So, it is something that everyone is paying attention to and having the support of senior leadership from an IT perspective in and around that is always very, very critical.  

Hargrave-Thomas: So, what I would like to add is that moving to Expanse actually provided us with robust and enhanced security features, which we did not have before. From sign on, to communication, to all the things we are all doing on a daily basis to try to keep our healthcare data safe. 

 Sobol: Yes. 

Hargrave-Thomas: So, it really gave us some good security features. Our previous one was very clunky. It did not have a lot of capabilities. We were kind of at an end of life with it. So, moving to Expanse definitely gave us a more robust system. 

Sobol: Anne, you made a great point. So many times, people look at EHR modernization program as something that you do for added capability, added functionality, and certainly all of that does exist. 

But, in many instances, to your point, there is also that critical component, which is the newer platforms are just more secure.  

Hargrave-Thomas: Yes. 

Sobol: And so, that is something that I do think gets overlooked and I greatly appreciate you bringing that up here. Technology is certainly growing and changing more rapidly now, more than ever. 

What is your perspective of technology and how it can help fuel and support the growth that hospitals, health systems, and Surgery Partners in particular are seeing? 

Hargrave-Thomas: I am very excited about Surgery Partners and OakLeaf. I think we both collectively have had a lot of growth, which is always exciting. So, we need to improve our technology and it is always a subject of discussion for us. I think it is an incredible tool. And I personally view technology as one of my must-haves for dealing with the daily operations of the hospital.  

When appropriately developed, the technology and the amount of data we can get is just vast, allowing me and my teams to make better decisions for quality, growth, and everything related to operations. Technology, I truly believe, can help us be better at what we do on a daily basis. As long as we get accurate information, it will be a key to successful outcomes for us.  

Sobol: It makes great sense. You have invested, right, in that modern platform that is going to give you that baseline and capability to do that. What are some other things above and beyond that potentially you are looking at or that you envision your new EHR MEDITECH Expanse helping improve from an operational standpoint, going forward? 

Hargrave-Thomas: I anticipate — we are only 30 days in from our go-live. So, I need to let everybody know that.  We are still in the infancy. We are doing well. But 30 days in. I truly anticipate as we continue to move through to 60 days, 90 days, and further out that our users will become more proficient. This is ultimately going to lead us to improved integration, streamlined documentation, and information management.  

The nice thing is my MEDITECH team here on the ground can continue this momentum that we built because they are able to tweak and continue to optimize the Expanse platform for our staff and physicians. 

And I must say my physician's staff and the end users are not shy about letting us know what they need. But the great news is my team has the ability to go in and truly optimize. Right now, we are still working on ensuring that everyone is exceptionally proficient in it, but it is a robust system. It is going to do a lot of wonderful things for us, as far as our information management and patient management. 

Sobol: Anne, you stepped perfectly into my next comment and actually answered my next question, which is perfect. I love it. We see it so often. Organizations get go-live burnout. They go-live and they take that deep breath and they go, “okay, we made it.” Well, you have made something, but I do not know that “it” is it. So, I love hearing that you have built this culture of learning and growth and continual improvement and optimization into OakLeaf. Because that is so critical going forward to really take advantage in the long run of an investment in a modern platform like MEDITECH Expanse. 

So, the challenge is for a lot of organizations is keeping that up. And so, I think as a leader, how are you going to encourage the teams to continue down that path? And what are some of those nuggets of wisdom that you could give to others that might be struggling with that? 

Hargrave-Thomas: Again, I think it really comes down to communication and maintaining that communication. As we did our go-live, if you can imagine during a go-live there is a lot going on. We had the command center with 30 people in it. It included CereCore, Surgery Partners, my own MEDITECH team, and physicians. We had a command center with every computer you could find was there. But the beauty of it was that we had huddles in the morning, and we had huddles in the evening, and we also cultivated super users.  

So, those were the individuals that were exceptionally proficient on the Expanse program. They have helped us continue that momentum of keeping the rest of our end users, physicians and staff engaged and wanting to use the system. Because they are able to show them, this is what it can do. Also at the end of our go-live, we had lists of things we can already optimize, which is exciting. 

 So, staff brought them in, and we started to put them on a list. It just gets people excited, and we communicate that out and that just helps.  

It is just all part of the process. Everyone is still excited. No one has thrown up their hands and everyone wants to know, “how soon can we get this piece optimized?” Well, we have got a long list, so we are slowly working through it, but it is going well. 

Sobol: That is great. It is great to have the list. And for those of us who live off them, it is great to celebrate when you get to cross one of those things off the list, too. And be able to see the return and what that means, when you can say, yep, we got that piece of optimization done and here is what that is now doing for our physicians or clinicians or our inpatients. And celebrating that, again, through the communication channels that you have set up so that everyone can celebrate along with you. So, that is certainly great. 

Well, Anne, as we wrap up, I always like to ask one final question, and given that you are the CEO of OakLeaf, is there anything that we have not covered yet today that you would want to give our listening audience? Again, most of which are on the IT side of things. Any sort of insights or perspectives about what the office of the CEO is thinking about? And then, what those IT leaders should be thinking about from the top-of-mind standpoint to help support you? 

Hargrave-Thomas: I think from a CEO perspective, once you have decided on an EMR, be involved. Stay involved. That is key. Your people want to see you involved, and I know for large institutions and organizations, having worked for them, that is a very difficult thing to ask.  

But whatever the leadership structure is, whatever the top leader is — be involved and be visible. I think that was the key. They truly understood that I was just as engaged, which kept everyone else engaged. They want to see that flow down. 

I think for the CIOs on a project like this, it takes a village. We were never afraid — meaning my IT people and my MEDITECH people — to ask questions. Because there are just so many incredible resources including CereCore and Surgery Partners.  

We collaborated, we worked together, we got ahead of the problems, we talked about them, we met. Getting those teams together, those core teams — it is just critical to the success of a project. Because I don’t know what I don't know. Surgery Partners and CereCore brought so much information to the table because this is what they do, and it really helps.  

But again, it just goes back to communication and bringing in all the right resources. 

Sobol: Yes, I completely agree. Well, Anne, again, it has been a pleasure. I know our team has thoroughly enjoyed working with you, your team, and your staff as well. And I know and I speak for Bob and his crew. Thank you for your engagement, involvement, and support. 

We know that — I know you are only 30 days out. We certainly know that you are going to be very, very successful with your new Expanse platform and we certainly look forward to continuing to support you in any way, shape or form that we can. So, again, thank you for that and thank you for your time today on the podcast. 

Hargrave-Thomas: You are very welcome and thank you.