Building Empathy into Revenue Cycle Management: The Tegria Approach
The Tegria Blog Feb 05, 2021
There’s a saying in IT: “Go-live is just the beginning.” Tabitha Lieberman knows that better than most.
As Senior Vice President of Clinical and Revenue Cycle Applications for Providence, Lieberman shepherded the country’s second-largest Epic EHR installation for over 70 hospitals and 1200 ambulatory clinics. Drawing on decades of health technology experience, she managed a system-wide application rationalization program, deploying new digital tools while working to assess and modernize existing technologies.
Impressive technology transformations like this one are exhilarating. But Lieberman is just as proud of her accomplishments on the human side of IT. During the Epic project, she led a highly engaged workforce with turnover rates well below industry norms. Prioritizing listening, transparency, and employee engagement helped her sustain a strong, resilient team and maintain momentum during the pandemic, she notes. “The human factor is what makes or breaks your projects.”
Recently honored with the HIMSS Most Influential Women in Health Information and Technology award, Lieberman still makes daily time for authentic connections with her team. “I had a very nontraditional path to get here,” she says. “I started out on my own at 16 with $100 to my name. … I am a female nonclinical executive leader in healthcare IT. I never mapped out a leadership career ladder, but I gave it my all and stayed passionate about my work. If I want to share anything, it’s do what you love, be authentically who you are, and take chances.”
Here, Lieberman shares how listening, transparency, and engagement help her manage both the technological components of her projects, and the people who bring tech to life.
You have an impressive record of starting highly ambitious IT projects from scratch. What’s something you can share about generating buy-in, consensus, and momentum to get IT projects off the ground?
I’d start by saying that pretty much every project I do is in service of the healthcare organization, our caregivers, and our patients. That’s part of why I can get consensus, because the work is in service of bettering the organization.
The other part is having the confidence to facilitate the vision: To say, ‘Yes, we can do this. Yes, it will be hard, but this is what it will look like when we get to the other side.’ It takes equal amounts letting them see the value, letting them share in the experience, and also being very transparent.
Can you share an example of what that transparency looks like?
I’m clear that it takes a lot of effort, not just from IT, but across an organization. I’m very clear about the level of engagement that’s needed. There’s a saying that ‘Go-live is just the beginning.’ There will be dissatisfaction, because change is hard. These projects impact every part of the organization. You are poking at a lot of things that people have been comfortable with, which means the organization has to have a North Star that makes the effort worth the change management.
There will be a lot of things that come up and we’ll have to say, ‘Do we really want to address this, when this will make our clinicians unhappy for a period of time?’ Knowing that the organization believes in the value is what makes the difference. If we don’t have leaders’ support, it won’t be successful. A few areas you have to be completely clear on include potential revenue cycle needs, staffing needs, provider engagement, and that it won’t all be perfect—at go-live or six months beyond.
You’re known as a leader who is skilled at managing not only the technological components of ambitious IT projects, but also the “human” side of technology implementation—how the technology will ultimately impact clinical workflows, interactions, and outcomes. How can leaders build IT teams and systems that recognize and prioritize not only innovation, but the people affected by IT advancements, and maintain these values as changes are scaled across an organization?
Thinking about my team first, the reality is that a leader is nothing without their team. It is the people who make the difference in bringing these projects to life. The best project plan is just that; it lives by itself. It’s the people who make it a reality. When you step back and realize nothing happens without the people, the human side is easy.
For those that we work with, the biggest piece is listening. I used to think if I just worked a little harder, if I planned a little better, if I communicated a little differently, I could get past the change management challenges—and I learned that it doesn’t work. In general, people need to go through the change management process, and you need to be there to support them. You need to listen, you need to accept that people process change in different ways, and that sometimes means leaving them alone, sometimes it’s training, and sometimes it’s adjusting your project. There is no one way to communicate that is going to fully address the human change process.
It also comes back to: Why are we doing any of this? A great example is our Community Technologies implementations. The first time you see a patient transfer from a site that wasn’t integrated previously, and you now see how that patient is immediately taken care of with all their information available, the value to the patient and the value to the community is front and center. Taking that a level up, being able to show these stories and the ways we can care for caregivers, patients, and community—the reason we do this becomes crystal clear.
Lieberman is an accomplished baker—pre-pandemic, she was known to celebrate new implementations by creating elaborate treats to share with her teams.
How do you prioritize accessibility and maintain availability for listening to the people in your team?
What am I without the people on my team? Honestly, much of my time involves being in meetings, working on budgets, and future planning. The real work, the accomplishments, and the progress we make are through my team. If I’m not available to them, I feel like I’m not doing a core part of my job. Throughout my leadership career I have always prioritized listening to and learning from the people on my team. Now that I’m virtual, one of the many things I do is schedule open office hours, so anyone can schedule 15 minutes with me, whether they’re a new hire or a leader.
Your commitment to mentorship is admirable. How did you determine to make it a priority?
I’ve learned a lot. I was someone who didn’t have mentors, or think I needed mentors. I basically observed and picked out things I liked and didn’t like based on what I saw around me, but I never reached out and asked for a mentor. As I got older and further along in my career, I realized that I had more to learn from others. I thought I would lead by example, and be available, and that was really my core strategy. At one point, I realized that I was doing a lot of problem-solving versus listening. When somebody would come to me with a list of issues, I was sure that it was my job to solve all or most of them. The reality is most of the time, people already have great solutions and ideas. They just need you to listen and offer encouragement and support.
How did you make that transition from problem-solving to encouragement? That’s a challenge for a lot of leaders and seems like it would require a very intentional shift.
It was, and still is a journey. I still get into problem-solving mode: you are struggling, so I need to go fix it. Now, I’ll take a step back and ask people, ‘Do you just want to vent, or would you like me to take action?’ I’m careful to ask first, because I can still be very protective of my team and rush to action. I’m more self-aware now about figuring out ‘what does this person want from me?’ and asking, but it is a lifelong journey.
Going back to your own journey with mentorship, did you find the mentors that you needed?
That may always be a gap for me—how do I go to someone and have a conversation about getting the help I need, and not see this as a weakness? Growing up, I was never a fan of team projects, and I wasn’t the one asking for help or guidance. As a leader I know that asking for help is not a sign of weakness, but it’s easy to think that it’s for someone else, not for me. I’m continuing to work through that. They say that if you’re the smartest one in the room, you’re in the wrong room, and I do believe that. As I’ve moved from a place of ‘I need to know everything,’ to ‘I’m leading through people,’ I’ve learned that I don’t need to know everything—I need to ask people for help.
How have the events of the past 18 months shaped your approach to the human aspect of change management as well as the adaptation of technology in healthcare?
On the people side, the last 18 months really pushed us to understand what people needed on my team. We were already 65 percent work-from-home, so remote was not new for us. What was new was working from home when you have kids at home, or you’re taking care of your elderly parent, or have no support system. There was no single HR policy to meet people where they are.
We’ve also tried to prioritize maintaining human connection in an isolated world. Working from home, we’re connected, but we can still be isolated. We’ve experimented with a lot of virtual activities like virtual happy hours and scavenger hunts to maintain that human connection, well beyond the work we do from home. We are still learning what works best.
On the technology front, in a crisis, the team shines beyond belief. We were able to put in place many things that ranged from COVID screening, to being able to bring up tents for COVID testing in a matter of days, to bringing 7K providers to telehealth in a couple of weeks. It was exhausting but rewarding, and it was driven by asking ‘What do people need to be able to take care of patients?’
The majority of the technologies that we implemented were the same as what you’d find across the country and world. The speed and scale were unique, because we had the first COVID patient and we were really high census early in the pandemic, so we had to move and scale faster than other areas.
We clearly saw that when an organization has a singular focus, you can get a lot done. It feels good when you have a single, shared purpose that aligns with your core strategy.
The pandemic didn’t change my key priorities, but it did rearrange some of them. It also highlighted the importance of standardization and modernization. In some other areas where we weren’t standardized yet, the efforts were much harder, whether it was implementing a new tool or communicating with our patients. So now we’re really doubling down to get to that single standard.
In your opinion, what’s something that many leaders underestimate in their approach to a large IT implementation?
Not to repeat myself, but the human factor is what makes or breaks your projects. The post go-live needs are also often underestimated. Tools take time to adopt and understand. I would say the work you need to do is to support the ongoing learning of your people. When an organization thinks about going live with a technology project, they’re often underinvesting in the post go-live needs. Whether you’re implementing an ERP, a CRM, or EHR, you need a continual level of investment to get the value out of it.
Can you share a key priority for healthcare IT leaders in 2021 and beyond, and how you’re addressing this priority in your own work?
My key priorities are application rationalization and employee engagement. Like other organizations in our space, we’re starting to see an increase in industry hiring and an increase in turnover, and we’re trying to understand what our employees’ priorities are coming out of the pandemic. We are in the middle of that right now, but we’re seeing an impact.
There’s not a major shift in what projects we’re working on. We’re working on increasing our telehealth footprint, but we would have done that anyway. I feel blessed that there is nothing on my plate that the pandemic made irrelevant. It re-emphasized some of our work like application modernization, so now we’re revving that back up to full speed.
What would you like to share about being selected as one of HIMSS Most Influential Women in IT?
I want to emphasize that opportunity is available to anyone! I had a very nontraditional path to get here. I started out on my own at 16 with $100 to my name. My first job was making $4.25 an hour in a hamburger restaurant to pay my rent. I went to college the long way, at night while working. I am a female nonclinical executive leader in healthcare IT. I never mapped out a leadership career ladder, but I gave it my all and stayed passionate about my work. I see people, especially woman, doubt themselves and not take chances. If I want to share anything, it’s do what you love, be authentically who you are, and take chances.
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