Designing for Health: Interview with Susan Snedaker [Podcast]

In the landscape of healthcare technology, understanding user needs and problem solving are paramount. Addressing the pain points of all technology users, from physicians to administrative staff, requires not only technical expertise, but also empathy, curiosity, and patience. By adopting an iterative approach to change management as well as being ready to take feedback and help users become experts in new workflows, organizations can address resistance and facilitate smoother transitions.

On today’s episode of In Network's Designing for Health podcast feature, Nordic Chief Medical Officer Craig Joseph, MD, chats with Susan Snedaker, Chief Information Officer at El Rio Health and author of Renovating Healthcare IT: Building the Foundation for Digital Transformation. They discuss her work at El Rio Health, the challenges of implementing features like single sign-on, and designing technologies for a wide gamut of users. They also chat about the importance of clarifying language when working with others, training teams to identify problems rather than just deliver ticket requests, and the importance of leaving one’s comfort zone to get a new perspective.

Listen here:




To learn more about Susan Snedaker’s most recent book, Renovating Healthcare IT: Building the Foundation for Digital Transformation, click here.

In Network's Designing for Health podcast feature is available on all major podcasting platforms, including Apple PodcastsAmazon MusicGoogleiHeartPandoraSpotify, and more. Search for 'In Network' and subscribe for updates on future episodes. Like what you hear? Make sure to leave a 5-star rating and write a review to help others find the podcast.

Want to hear more from Dr. Joseph? Order a copy of his book, Designing for Health.

Show Notes:

[00:00] Intros

[01:05] Susan’s background in healthcare

[06:33] Unexpected roadblocks in implementing new features

[13:40] Clarifying language in team problem solving

[21:48] Training problem solvers, not ticket-takers

[37:19] Leaving comfort zones to gain perspective



Dr. Craig Joseph: Welcome, Susan, to the podcast. How are you today?

Susan Snedaker: Thank you. I'm glad to be here and I'm wonderful. It's great to meet you in person and good to talk to you today.

Dr. Craig Joseph: And you're not the first person that thinks it's great to meet me in person. There's a lot of people that are very excited to meet me in person, and it's, it is an honor. I know, I'm not gonna, I don't know how else to say it.

Susan Snedaker: You've said it well.

Dr. Craig Joseph: Thank you so much. Let's start off with the books. So many books. So my understanding is you have authored 213 books.

Susan Snedaker: Not quite.

Dr. Craig Joseph: Is that accurate?

Susan Snedaker: Did you get that from ChatGPT?

Dr. Craig Joseph: My staff. My staff told me that you have written 213 books. Do I need to let them go, or at least a few of them?

Susan Snedaker: No, you just need to correct them.

Dr. Craig Joseph: Okay, so what is the actual number?

Susan Snedaker: Actual number is around 13. And I say around because some of them have gone out of print because they're old technical books. I've written four as the primary author and then contributed chapters or been the editor of others.

Dr. Craig Joseph: And your most recent one, just came out a few months ago or last month.

Susan Snedaker: Late November.

Dr. Craig Joseph: Yeah, yeah. Okay. So not that long ago. Yeah. And what is that book called?

Susan Snedaker: So that book is called Renovating Healthcare IT: Building the Foundation for Digital Transformation. And I wrote it because, as I was looking around IT and the post-pandemic world, everybody was talking about digital transformation. And then, of course, AI made this big splash, and things started moving quickly. And I kept thinking most healthcare IT departments that I know are not prepared to move into this digital frontier. There are just a lot of old systems, a lot of things that have been cobbled together over decades. And I thought, how do you fix this while you're still, you know, how do you build the plane while you're flying it? Right? Healthcare organizations have been struggling financially, so of course cuts go to IT to reduce operating costs. So how do you fix all of this while all of these pressures are happening? And I tend to, as with my other books, I tend to write the book I want to read. So when I go looking for answers, I go looking around, I, you know, search, and I don't find the information that I want. I find an article here and an expert there. And suddenly I find myself saying, well, you know, if I'm going to do this research, I might as well just write the book and share it with others.

Dr. Craig Joseph: That's awesome. So if I go back a little further than, just the last few months, you are the, CIO at El Rio. How did you end up a healthcare CIO? Is that something that when you were in second grade and your teacher asked you what you wanted to be when you grew up, you said, I would like to be a healthcare CIO. Is that accurate? Or is that also off that? I'm assuming, again, that my staff told me this.

Susan Snedaker: Yeah, your staff might need to tune up their research skills. Just a little bit. I'm of the belief that there are two kinds of people, those who pop out of the womb knowing exactly what they want to be when they grow up, and they become that thing. And then there's the rest of us, and I am one of those people that I didn't know, and I meandered, so went to college when I was 16, and because I was a little bit young, I was a little bit lost in terms of direction. So after a couple of years, I dropped out. I ended up in a tech program, which is how I got into IT. And then I subsequently finished my degree and got a bachelor's in management and a master's in business administration. so that's where I began blending IT and the business world. I worked for a number of companies. I started out doing maintaining large systems, large hardware systems, and then had a series of jobs along the way. I worked for Microsoft for a while, where I learned a ton about software and how that world actually operates, although I'm not a developer, and I worked for a software startup company after that that also gave me good insight into how software interacts with humans and vice versa. And then I had a series of opportunities to work for companies and then start my own companies and consult. So I feel like I've been the employer, the employee, and the consultant through all of that. And as a result, I think it gave me this broad view of things that's been super helpful in progressing my career. As a consultant, I got an, an engagement with, a healthcare system to kind of come in and rehabilitate one of their IT departments. Through that, I was then offered a position and I thought, healthcare’s IT is kind of an interesting space to be in. So I accepted the position, and then moved up the ranks there. When the CIO position here at El Rio was opened, it was also while the organization was undertaking an Epic implementation. And so I think I hit the sweet spot because I had been through an Epic implementation and I had all of those requisite skills. So I was fortunate to be able to become CIO here. And I've been here about three years.

Dr. Craig Joseph: Excellent. All right. And everything has gone along smoothly, it sounds like. And, no hiccups, no problems. All of your projects are on target, under budget, and outperform the goals. Is that also accurate?

Susan Snedaker: Here or in my career?

Dr. Craig Joseph: In your entire life.

Susan Snedaker: My entire life? That's pretty accurate, actually.

Dr. Craig Joseph: Well, you're good.

Susan Snedaker: But we've had, we've had a few missteps along the way, for sure.

Dr. Craig Joseph: So one, one story that, when we were preparing you told me about was single sign on. Now, for those listeners who are not experts in healthcare IT, it's convenient when you have to go from terminal to terminal or from computer to computer to not have to put in your username and your password and anything else that we need. And so single sign on is supposed to make it easy. I either take my phone and I wave it near something, or I take one of my ID cards and wave it near something. And so you were implementing single sign on solution, which is again, generally users love that because it makes their lives easier. But there were some problems.

Susan Snedaker: Yeah, it was interesting because, we had designed the project, to obviously to meet the user's need, which was the, the quicker sign on in, in, especially in, you know, hospital setting, that's pretty important to be able to tap in and out in all kinds of environments. We're working with the vendor, and the vendor was pushing us really hard to do a big bang rollout. And our clinical friends were also pushing for a big bang rollout because they said, well, we don't want to have one type of sign in here and a different type of sign in there, and it would be too confusing. And I do remember thinking, not that confusing, it's just more annoying if you have to keep, you know, putting in username and password, but it's not confusing. So that was an interesting lesson in use of language, right? and how things are portrayed in different environments. We listened to the vendor and we decided to go Big Bang. And about four days into it, it was clear that it was just blowing up in our faces. So I said, stop, stop, stop. So we paused and I brought the team into a big conference room, and I said, okay, we have a big mess on our hands. It's all fixable. So let's get down to why this is happening. What did we miss? What, you know, our operational folks miss? Who missed what? And how did we get there? And we had a lengthy conversation. And it turned out I think one of the key things was we shouldn't have done Big Bang. And we yielded to the pressures around us, despite some of our instincts to say that's probably not the right thing. So that was that was a good lesson, because vendors come in with good intentions and their expertise in other areas, but they don't always know some of the nuances of the organization. And so, you know, trying to balance what's the best practice versus what is our organization able to digest. So I think that was one really good observation, and our training was really not where it needed to be, partly because we had difficulty getting clinical people into training. And it's not that much training, but, you know, people missed sessions or skipped sessions or, you know, so we had this hit or miss kind of training going on. And we had all thought because we're IT people, we thought, well, it's pretty simple. You enroll your badge doing these three steps and off you go. That was another mistake, right? Because we know that, I always say here that we need to go from high tech to no tech, because we're, take a side road, we're a federally qualified health center. And so we deal with patients who run the gamut in terms of socioeconomic and educational. And so we have to make sure that our solutions work for everybody. And so this is one of those things where we had made this assumption. And I learned not to make that assumption, which is that, oh, it's just that easy. No, it's easy for an IT person. It's easy for a tech savvy person, but it's not easy for everybody. And so we had all kinds of problems with badge registration and user self-registration. So we stepped back and we said, okay, we need to not only do a better job training, but we need to have three methods. One is you can self-register, if you get it, go for it. we also had a guided registration where you could call somebody on the service desk and they would walk you through it. And then we had at the elbow, if you couldn't get either of those two methods, we will come and we will sit with you and we'll get you registered, because it really took five, ten minutes. But, you know, through across thousands of people, that's a lot of time. So, so we step back, got a better training program, and then we rolled it out incrementally. And then it was wildly successful and everybody was happy.

Dr. Craig Joseph: I love that story. because sometimes it is very easy when you're just walking through it sitting in a conference room. it gets more complicated sometimes when you're in the, what I dislike, but I call the real world. It's much better on the whiteboard than it is in the in the real world. Oh, and I had a similar experience, actually, with single sign on. we were, everything was great. And, our physicians were doing e-prescribing of controlled substances, which took us up a notch in terms of the security now, because now we have the DEA to deal with, and we needed multiple factors of identification. And everything was great. but then, someone, an emergency room doctor lost his prox card, his security card, his ID, and we didn't have a good solution for that because we didn't contemplate someone losing their card. And there was, you know, there was software that let us use other things to authenticate that person, to let them, you know, get them back in. But, for that shift, that ER doctor had to go to someone else and have him or her, right, prescribe their controlled substances. And so that was kind of interesting. it is, it is, kind of a life lesson, though, after those things happen that you do have to, just discussing it in a conference room, even if you have the right audience, which often we don't, but even if you do have the right audience, sometimes you really need to walk around and also think about, what about those ER docs that work at night? Or the hospital, you know, if you have a hospital that you're dealing with, the 24 hour deal, you're going to have employees.

Susan Snedaker: Right. I mean, I don't think you can really understand how technology is used without seeing it being used. And it doesn't mean that if you walk around and you observe all these things that you'll say, hey, what if this ED doc loses their badge in the middle of the night, right? We might still overlook some of those contingency things, but some of the obvious things are pretty glaring when you step out and you say, oh, well, so why is this prox reader, like, buried behind the monitor underneath the counter where actually you can't easily get to it? Why? Like, who installed it that way and why? Right? Those little things can be overcome just by serving.

Dr. Craig Joseph: Right. And a lot of times people know, oh, that one's been broken for six months. Oh, who did you call? I don't know, but. Yeah. So. Or I know we called someone, but they never come, right. So those are other things that you'll never find out from a series of reports from the help desk. Right? you're just gonna you're going to find that kind of walking around.

Susan Snedaker: Exactly.

Dr. Craig Joseph: I've seen, I've done these, these tours before where someone's like, why? Why is that that, essential piece of equipment not plugged into a, you know, an uninterrupted power source? Because the outlets were red for those, you know, and so. Oh, I don't I don't know, again, you're only going to find that out by walking around. You had another story talking about a monitor when you were in charge of biomedical engineering. Yeah. And I love I want to hear the story because I think it clearly talks about or, you know, kind of, clarifies some of the issues with, with language that, different people coming from the even from the same background have different ideas about what they're saying. And I'll just stop and let you tell the story.

Susan Snedaker: Yeah. So, as I told you, we had, I was in charge of the biomed department, and I had hired this woman to direct the department. She was highly competent, really smart, great person. and she'd been there maybe a couple of months, and she was in my office, and we were talking about something, and we started disagreeing about something, and I actually don't remember what it was, but it got more and more heated and she dug her heels in more, and I dug my heels in more and, and we kind of got to the stalemate and I'm thinking, okay, I'm the leader here. I'm her boss. So I have to resolve this situation somehow. And I thought, I need to take a different tact. Whatever I'm saying or doing isn't getting it moving forward. So I stopped for a second. I said, Carla, when I say the word monitor, I'm talking about the computer monitor and her face just kind of lit up and she said, oh, I was talking about the cardiac monitor. And at that moment it dawned on me that when we use shorthand like monitor, it's like, what exactly are you talking about? Because in biomed world, there are a lot of different kinds of monitors. And we were not talking about the same thing. And that was a really good lesson for me, because it was even though I had worked in healthcare IT by that point for, some number of years, 5 or 6 years, it really opened my eyes to the difference between a more clinical perspective, because she was bridging that world because she was high tech with all the biomed stuff, but she was still coming from a more clinical perspective. And I thought, okay, this is really important for me and for my teams when we're having conversations, when we're putting together project plans, to not assume that we have a shared understanding of different words. And really, to get super clear, because she and I were able to work it out. But I've seen a lot of meetings where people go away with either a sense of disagreement or, an actual disagreement because they don't get it. And so, you know, I've worked since then to, what I call myself, the translator in chief because, I sit in these meetings between clinical and business and IT and I have to translate and I seem to have this ability to listen to what people are saying and not saying and say, well, wait a second. I think what you just said, they just said only used different words. And being able to pull that together, I think is really one of the key jobs of a CIO today.

Dr. Craig Joseph: Yeah, I love that. And I feel like that's the job of a designer. You know, oftentimes they're the ones that have to kind of do that translation. and it's I think it's super hard for them. That's a hard job because you have to take what people are telling you what they want and what they need. And, and then, you know, you know, what you can deliver, which is often not what they, what they want and sometimes not even what they, what they really need it get them part of the way there. And so that that idea of being translator in chief, I think it's, it's spot on. I also feel like with the translator and chief job description, you're unlikely to be replaced by ChatGPT because an AI, that's probably not something that an AI is going to be able to grasp, that, you know, when the physician comes at this very same problem from one perspective and the nurse is looking at it from a different perspective, we're both looking at the, at the, the patient or the, the issue in front of us. We have very different, understandings of what's involved. I remember asking a physician when, when we were moving from, they were moving from paper in the hospital to, to an electronic health record. And I said to him, you know, how do you get a lab to be, done, you know, performed? How do you get? And he said, oh, it's very easy. I go over here to this, piece of paper in the chart, and I, I write the lab like CBC or said rate or whatever. and then I flag it to say that there's an act of order that needs to be addressed or, you know, seen by the clerk or the nurse. And then I, if I'm being good, I'll take that chart and I'll put it where it's supposed to go so someone sees it. He didn't say, the rest of which is often he's not that good. And then he gets upset because his order was never taken off or it wasn't done in a timely fashion. And most of the time it's because he didn't put it somewhere where someone could see it. But anyway, even if he did that, I said, okay, so that's great. So then what happens? And he said, well, I wait a few hours and the results in the computer. And I'm like, yeah. So how, like, what is your perception of how that happened? And ultimately, we both came to the same conclusion. It's magic. Right? It's magic. I don't he had no clue and nor did he care. it just it's magic. And I expect it to happen. And I know how long it generally takes, and that's as much as I wanted, but that certainly you can't have that kind of conversation about talking about workflow, designing a new tool or new software application with that kind of magic understanding. And you got to get it down into the, into, you know, detail where it's actually actionable and you can do something with it.

Susan Snedaker: Right? And, you know, a designer or even a, you know, an IT analyst is going to have to dig under those covers because they need to get at the root of what the physician needs, but they also need to then get at the root of what the nurse needs and what the phlebotomist needs and what the lab needs. Right? And each of those have to connect seamlessly. And that's, that's the beauty in the art and the challenge of, of the work.

Dr. Craig Joseph: So how did you, what, there was, you had an aha moment in this conversation, about the monitor. At some point you're like, wait, I, I think we're talking about different things, right. How, what any clue when you go back in your, in your mind, how did you come to that conclusion? Why didn't you do what I would have done, which would start screaming and say, do it my way, darn it. Which is again, hopefully I wouldn't have done that. But I have to say that would be my predilection. So, was there anything that made you like, why am I why am I arguing with her about this when I think it's obvious?

Susan Snedaker: I think for me, whenever I see disagreements in rooms, I stop and think something's not being understood. So I think my first instinct is to just assume there's a misunderstanding. Now, there are times when we will absolutely not agree, but there seems to be more clarity around real disagreements. And this didn't seem that clear. And I just kept thinking something's not lining up. And so it has taught me to, when things don't seem to be running smoothly, to step back and say, there's a there's a disconnect or a disagreement somewhere here that if we clarify a bit, we can get on the same page.

Dr. Craig Joseph: Okay. And this is something hopefully this was a learning lesson. It was clearly for you and also for, for the other person in the room I hope so, yeah.

Susan Snedaker: Hope so. She, she ended up being a great, great person and having a good career. So I would assume, yes, we didn't go at it too many other times after and when we did, we always would just stop and say, what part of this are we not understanding? because it almost became a joke between us because it's like, oh, yeah, I remember that time?

Dr. Craig Joseph: Yeah. No, that's, I think that's great. And your ability to kind of do the job that you're doing kind of requires you to have the, the option, the kind of the vision to, to find out what people need. And to make it even more specific. So I can imagine clinician aides or front desk staff or the chief financial officer comes to you and says, hey, IT person, I need you to get me this thing. And oftentimes that, sometimes that's right. They actually do need that thing or want that thing. but other times it's a little broader. And so how do you, either how do you, how do you kind of approach that or how do you kind of educate your staff who are a little less experienced in, in these ways instead of kind of being ticket takers and just doing performing what they asked for, giving them the software. but then not being, not understanding why the six months later, the person like, well, this is you didn't do a good job. And your response is, well, I did exactly what you asked me for. Right? well, don't do that ever again. Like, how do you go about kind of training that, or can you, is that just an innate personality?

Susan Snedaker: I think it's very trainable. And I think, you know, if you if you walked out on, in our, our area and you said to people, well, I think I need this thing and you brought a solution to them, I would guarantee you that at least 80%, I'm working on getting it to 100, but at least 80% of the folks out there would say their first thing would be, so what problem are you trying to solve? And that is what we train everybody. And that is our first question. And a lot of times what we'll get is not exactly the first answer being the right problem. Right? But it gets us along the path of understanding what they're trying to accomplish. Because I feel like when someone comes and they say, I need this thing or I want this thing, they have a perception about their problem, and they have a perception about the solution, and they are sometimes right and sometimes terribly wrong. And if IT sits there and just acts like the order taker, we will get it wrong at least 50% of the time. Guaranteed. Because, and users always have a legitimate problem they're trying to solve, but they're wildly creative. And so often by the time they come to IT, it's morphed into a couple layers of something different. And so we have to get in there and help unwind that and really just sit down and say, really what problem? And then use a little bit of the lean technique, ask the five whys and just keep saying, okay, so why is that a problem? Okay. So why is that a problem? And then we get to the place where they can actually describe the problem that they are having. And then we can redirect to the to the right solution. And maybe they did come with the right solution and maybe they didn't. And maybe we can say, you know, there's actually a fix for that. And then it's a training issue. Right? We find that a lot as well.

Dr. Craig Joseph: So asking and probing and kind of getting down, you say you've told me that it's important for your staff to listen very carefully to what's being said. Also important, to listen to what's not being said. What are some examples of information that you're lacking because they didn't say something?

Susan Snedaker: You know, I think it's usually, an awareness issue. So if somebody comes asking for a thing again, here's it. Right? The good example is because they don't know that this feature exists in the software. They miss training that day, or they forgot about it, or it was never shown to them or whatever. so they're asking for this thing to be fixed or the solution and they're not saying, I don't know how to do this thing. Right? So those kinds of things I find that, you know, in times of change, because I've gone through two epic goal lives now. So, the biggest change problem is that people lose their expertise. And I think that's the one thing that we really don't address very well. And we underestimate it. So people become experts at doing the thing they've been doing. They've been doing it for a year or for a decade or more. And suddenly we say, we're going to change the way things are. And the biggest fear is people losing their sense of expertise. And to me, that's the number one failure of almost every one of the IT projects that fail is that we don't address that, and we don't help people become more expert sooner, which is insist on demonstration of competency. And so we, you know, we send somebody to training and they say, yep, I got it. Or they passed a little quiz and off they go. No. Can you show me in the system how you do this thing? And then reinforcing that repeatedly until it becomes the new muscle memory, until they rebuild that expertise. And so the resistance to change in the resistance to using technology proficiently is the fear of losing expertise.

Dr. Craig Joseph: I feel like you're looking you're looking at me and you're looking through me, and, you're being kind, but there's the there's one group of, of your users who are the absolute worst at this, and that is physician. we're not good at acknowledging in front of, I'll get I'll grant it. I'll grant this this generally, it's in front of patients. We don't want to look dumb in front of patients because they naturally or maybe not fairly, but naturally come to a conclusion. Well, if you don't know how to use this technology, or whatever workflow we're talking about, then how do I trust that you know, how my heart is supposed to be working? Or you know why I have this strange rash? And so they kind of have to fake it, or at least go outside and try to figure out what's wrong. and so I, I find that, you know, physicians are okay in front of nurses, sometimes even in front of it staff to, to be honest and say, like, I don't I didn't go or I don't remember or maybe they never taught me I but I know there's got to be a way to do this thing. Right? and so yeah, that kind of that fear of losing our expertise, we were really experts, when we came out of residency in whatever either system we were using or if it was paper even being, you know, knowing that this is how the system works, because this is how I was trained. but kind of just popping into, a new system or, a new anything. And it's funny because they, they again, I'll say we physicians really don't want to go to training, right? Because it's a waste of time. It's not what they think it is. and we're pretty smart. We can figure stuff out. but, boy, they never would. We assume like, hey, well, I've got this new this new, saw for an ortho pod. Oh, I'll figure that out in the operating room. It's. Is it close to the source that I'm using now? Well, yeah, it's, I mean, it's got teeth and it's made up metal, so. Sure. Well, I'll figure it out. You know that that would never happen, right? but it often happens in with things like IT and, and, you know, other workflows. and we think that it's fine, but it's not fine, and it has it has repercussions throughout.

Susan Snedaker: Right. And, you know, physicians are users like everybody else in the sense that some are very high tech and some are very low tech, and they run the gamut in terms of their ease of use with technology and so we have to make sure that we're addressing people where they are, whether it's physicians or our patients. It's the same thing. You know, we were fortunate here when we were going through our go live to, to really focus on provider competency. And we had a great provider leadership team that drove that really hard. And that was one of the keys to our success in this implementation, because we had providers very well supported, very well trained, very well prepared to use this new EHR. and we had highest physician satisfaction of probably most epic customers right out of the gate. And to this day, for that reason, and we work now, you know, going back full circle to, to, you know, the design aspect. We work closely with our physician, leaders to look at how we can improve the use of the EHR. So we're constantly meeting and saying, how can we get rid of this click? How can we simplify this thing, does this workflow makes sense? so that we reduce pajama time, we review, you know, reduce documentation issues, we reduce coding issues, but more importantly, we improve physician satisfaction by getting rid of stupid stuff when we can.

Dr. Craig Joseph: Yeah. It's it is good. And, you know, sometimes, stupid stuff. It was not stupid when it was created. Right? Sometimes it is, sometimes it is. but often it wasn't at the time it made sense. But things have changed, and kind of going back and reassessing and, some folks will never actually complain about the stupid stuff because they just think it's part of the system. Right? And they don't realize that you can do something about it, or I've had I've gotten into, heated conversations, I'd say with some physicians about, the, the notes that they write. And I'll say, why did you, you know, you spent you seem to have spent a lot of time doing this. do you think this is important? Well, no, it's not important, but I have to do it for compliance or the regulatory. People totally have to do it. Like, yeah, 12 years ago. Yes, that was true. but that is that is no longer true. And, you know, they're very comfortable writing these notes they hate writing. Right? And they and even though I'm giving them the opportunity or encouraging them at least, this is really not a technology thing. Just saying, like, hey, you don't have to do this anymore. this is this is kind of stupid right now. You're doing it not because you think it brings value to you or to the patient or to the system. It you just you're doing it because it's something that you've been doing. And getting them to stop is.

Susan Snedaker: And they've gained expertise in doing it. So they don't want to let go of that.

Dr. Craig Joseph: I love that kind of view of it. because I just thought they were being stubborn.

Susan Snedaker: Yeah, some of them, I'm sure.

Dr. Craig Joseph: But yeah, they they've got expertise. I, I, and I'm rethinking now actually because of this, this new, opportunity you've provided me, about people who I've said, you know, I've watched them, do a particular workflow again in electronic health record. And afterward I've said to them in the way that I can, I don't recommend a lot of people say this, but I said, hey, you know, if someone asked me to design the worst possible way of getting this thing done that you just wanted to get done, how could I possibly do it with the most clicks, the most kind of mental energy? I couldn't have come up with what you came up with. It's. It's really great. Let me show you how to do that much faster. And this is something you do all the time. So this is really going to save you. And she didn't want to, was like, I'm happy with this system that I have. and it's yeah, I'm comfortable in it. I'm competent in it. In fact, I'm an expert in this really bad system. Right.

Susan Snedaker: And it takes extra brain cycles to erase that and to build a new groove. Right? And so people will maintain these bad habits just because they're more comfortable with them. Which is why I think change in healthcare is pretty difficult. And I think, you know, I think I don't know statistically. And I'll just throw it out there as a random statistic. I think like two thirds of the population is very happy with status quo, and about a third likes change. And so the third that like change, drive, change, and the other two thirds just actively resist. Yeah. And that's the dynamic that we face in IT and every place and it's within IT as well. but those are the kinds of things where we don't accept the fact that most people are change and risk averse, and we don't address how they can get through that change effectively, they won't. And they are very creative and very wily sometimes in avoiding doing the thing that they would really benefit them, but they just want to do what they understand and know. And I, I get it because if you have a complicated job, if you have a lot of brain cycles going elsewhere, the last thing you want to do is unlearn and relearn technology as it continues to evolve, because it just moves faster and faster. So it's an ongoing problem.

Dr. Craig Joseph: Yeah. I'm, I'm trying to think if I'm in the one third that likes change in the two thirds, that doesn't, like, change. And I would my answer to that question would be yes. Yes. because I, I'm a big proponent of change when I want something to change. but it's really dumb and horrible when stuff changes that I don't want to change. And I'm the only one that gets to decide. I am that guy. I am that guy. Darn it. Yeah, I think one thing that's kind of helped us is the, is the cell phone. because all of us now, I shouldn't say all of us, 99.99% of us, our cell phones are set to have our applications automatically update whenever a new update comes. And sometimes that's every week, and sometimes that's once a year. but most of the time the changes are minor and we're just like, oh, that, oh, that button's not there. Or that it's a different color or it's bigger or smaller. And I know I for one think that every time any of my favorite apps change, even in the smallest way, it's horrible. And I, I want to I want to go after someone and, I would love to see if I can get it back to the way it used to work. Right? And then about a week later, I get to the point of, I don't even remember what it was that I was so upset about a week prior. Because I do relearn, you know, that muscle memory kind of just goes away and, and gets regrown so much faster, right? And so I've actually changed my, my viewpoint about some of the change that we, we offer to clinical folks because we used to do it all at once generally, you know, like once every 12 months or 18 months. It was a big change. And now we push these changes out quarterly sometimes. Yeah. and it's not a big deal. And, and people get upset sometimes even though you tell them about the change then, but if you go back to them a month later, almost everyone's like, yeah, I don't even I don't even know what it was that I was upset about, but I'm sure I had a good reason to be upset.

Susan Snedaker: Right. Well, and I think it also goes back, oddly, to this sense of you know, expertise loss. Because if you're doing quarterly updates, which we will be starting this year, the changes are smaller, but they're frequent. And so you don't build experts around the thing that changes 18 months later. And so it's this continual minor change is a whole lot easier to accept. Because to your point about cell phones, you can gain that expertise much more quickly. These small little changes. I might be offended that no one asked me before they changed the button, but then I get over myself, and then I use the new button and I'm fine. And I actually realize that there's a lot more benefit to it, and I'm happy. And that process just repeats through those smaller updates. And I think that's actually one of the ways to overcome some of the resistance to change.

Dr. Craig Joseph: Yeah. and let me just be clear, if I'm unhappy with it, it's because it's wrong.

Susan Snedaker: Absolutely.

Dr. Craig Joseph: But most of us, it's just because it's a, it's a change and we're, we're a little bit scared. One thing I think that you've said has been, was part of your secret sauce is that while you have a gorgeous, IT area, with lovely cubicles and, great kind of, peers for all of your staff to kind of talk to and bounce stuff around, from time to time, you make them leave this very comfortable area and walk around. Right? So I can imagine some leaders saying, well, listen, I'm paying these people to answer the phone to, I'm paying these people to help us implement a new module or some to change some functionality. And having them go out, especially when no one's complaining, doesn't make a lot of sense. And so, you know what? Why do you do that? Are you specifically, not caring about the resources of the healthcare system for which you work? But let's just get it out right now.

Susan Snedaker: Let's get that.

Dr. Craig Joseph: Let's get it out. Susan, talk about let's be honest. You just don't care. Is that, is that fair?

Susan Snedaker: That wouldn't be incorrect.

Dr. Craig Joseph: That would be incorrect.

Susan Snedaker: Would be incorrect. Okay. when I worked at the hospital system, it was particularly interesting because it's a massive building with lots of hallways. And it kind of started with, you know, let's go take a walk. Right? Let's have a meeting while we're walking around just to get moving. And then I realized that some of the, for example, some of the infrastructure folks never left the server area, like, ever. And I was like, I would talk to them and say, well, have you ever seen a cath lab? Have you ever seen a hybrid OR? And they're like, no, I'm like, there's the coolest technology in these things. You have to come see them. And so we would go to these specialized areas, to the MRI machine. Have you ever seen an MRI machine? Have you ever seen, the cath labs are, of course, particularly cool. So we'd go check out all the stuff, and we'd go into an empty room and, you know, we'd point out all the cool technology and, and we talk about how does this connect to the network and where does this connect to the server, and how does this information show up in the air. And so start connecting the dots that way. And so I got the infrastructure folks first, who had been mostly locked in it to, to walk around the building and see these things. And then we went from the really cool stuff to the less cool stuff, like how does a nursing unit work? And, you know, somebody, let's go look at the ICU and let's look at how all the equipment in there is running on the network and why that's important, that we have good wireless coverage, that we have security, that we have all those things. And so it just became part of our routine to just go walk around and to look at stuff. And we would do these just little walkabouts. And on the application side, same thing. Of course we had informative. So they were out there quite a bit, but our builders were at that time they were two different teams. They would, the builders would sit in it, and they would build what the informatics just told them. And, and they thought everything was peachy. And we're like, no, no, no, no, let's, let's go out and watch this being done now. So you built this thing, the informatics said, this is what the nurse or the doctor or whoever needs. Now let's go look at it. Let's watch it in action so that when they build something, they say, oh, that's not going to work because they understand. They can see how the work is being done out there. And same thing is true here. We have clinics instead of, you know, nursing units. But the same thing. How are the patients being treated? How are they waiting in the waiting areas, the technology working for them? How are the receptionists and how are the MAs and the providers using the technology? What does that look like? Are people happy? Are they frustrated? Are they angry? because you can tell a lot just by observing the workflow, not sitting over somebody's shoulder necessarily, and watching them type on the computer. and so it's a really important part of it. And everybody here knows that that's an expectation to get out and about from time to time.

Dr. Craig Joseph: I love it. And I love the, the idea of, kind of just doing a walkabout. Not only do you learn. But, hey. Yeah. Like I had this idea of how it works, but now I'm actually seeing it in the real world. But you're also, you know, seeing the humans that are providing the care, right? And the humans that are getting the care. And, we all know, of course, when we're in healthcare that that's what's happening, but it's, it's a little bit different when you're actually watching it. and I feel also like, you know, I was I've seen sometimes when you do those things, people come up to you and say, and they yell at you. and sometimes it's not yelling, but it's like, you know, this is this is really not good. And, and they explain to you why and, oh, it's only a second or it's only two clicks, but I have to do it 100 times a day, and it's, you know, makes me less happy to come here, and to see that then you sometimes are like, okay, now I really need to fix this thing.

Susan Snedaker: Well, right. And, you know, I the other thing we always do is the first thing out of our mouths is thank you. Thank you for telling me. Right? Because to your point, if you're in the middle of a busy day and something doesn't work because we all do this, I do this right. Something doesn't work. I'm like, well, forget about it. I'm just going to pivot and I'm going to do this thing. I may never report it. I may it may happen all the time. It may annoy me every single time, but I'm busy doing other things. So when we're out and about and someone comes up and says, this thing isn't working, this is driving me nuts, I'm like, thank you so much. Did you tell someone so I can find out if it got lost in the shuffle or if it got delayed? But thank you. Tell me more. Because partly they need to get it off their chest, which is legit, but partly they have a problem that needs to get solved and if I don't hear about it, I can't do anything about it. So yeah, it's always a great opportunity.

Dr. Craig Joseph: Yeah, it's and it's not only great for your IT staff, but I feel like it's great for the clinical and operational folks that are providing the care. Oftentimes they kind of think of us as, I'm putting my IT hat on, as robots, or, you know, they think of the software that, that you support in the same way they think of Microsoft Word that they have at home, which is, well, this is how it comes.

Susan Snedaker: Right.

Dr. Craig Joseph: And so why should I complain? Because no one can fix it. Because I don't like this thing about Word. But I can't call Microsoft and have them make this thing better. I can either stop buying it or shut up and deal with it. And you know, this idea that there really there are IT folks, who, who actually have the same ID badge that you do, doctor or nurse or occupational therapist. and they work in the same way. And there are things that they can do. Not everything, of course, but there are things that they can do. And oftentimes just kind of realizing there's a human there, there's a human. When I call the help desk, these are humans. I know they're humans. I know they're humans, generally, but you don't. It's a different thing to eat lunch with them at the cafeteria or to shake their hand. Right? And now when I call, I'm thinking, am I getting that? Am I going to be talking to that person? I was just shaking hands with a month ago. Right? And if so, even deep down I'm going to. I may not think about it, but I'm I might temper my comments. So, you know, I might come with a slightly less, difficult attitude or be more understanding, which again, many of us, most of us want to do anyway. But it's a little easier when I know you versus when you're just a voice.

Susan Snedaker: Well, and the same thing holds true in it, right? We have notorious people who call us and are not the nicest people to us. And you know, we get out there, we make a point of getting face to face with them and putting a face to a name and building a relationship, because those relationships do end up helping you find, you know, we find that people's attitudes improve and the contentiousness goes down. And I also tell my folks, you know, if somebody is really cranky and in your face, they're only two things. One is they really have a problem that needs to be solved, or that's just who they are. And we can't fix the second one, but we can certainly fix the first one. And if we fix the first one and they're still that way, then we know that they are the second one. So problem solved. Either way.

Dr. Craig Joseph: Yeah, yeah. That's great. I don't ever encounter those people. because I am that person, so, I just scare everyone off and, Yeah, no one complains to me. That's not accurate. Well, Susan, we have come to the end of our time. I appreciate this conversation. I have learned, now I have got to go. My worldview is changing.

Susan Snedaker: Excellent.

Dr. Craig Joseph: Because of this kind of competence model that you're, you've developed and thrust upon me today. That's great. I'm going to I'm going to think about that. And everything else that you've, you've laid upon me. thank you. And I definitely appreciate your time today.

Susan Snedaker: Thank you. I had a great time talking with you, and I really appreciate the opportunity.

Topics: featured, Healthcare, podcast

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