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Flourish Sound Bytes: $14M Cost Reduction and Standing up the Next Generation with Heather Nelson

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Sarah Richardson: I'm Sarah Richardson, a principal here at this week Health where our mission is healthcare transformation, powered by community. This is Flourish Soundbites, unfiltered Conversations with healthcare leaders. Let's get real,

Sarah: Welcome back to Flourish. And I'm Sarah Richardson with today's soundbite featuring Heather Nelson, senior Vice President and Chief Information Officer at Boston Children's Hospital, when Heather joined Boston Children's from outside the org.

She faced a challenge. Many leaders will recognize establishing trust, credibility, and cultural alignment while driving major transformation. Over the past few years, she has led three restructures, optimize their epic environment, and guided a $14 million cost reduction. All while redefining it as a strategic enabler rather than an order taker.

Heather, welcome to the show.

Heather Nelson: Thank you so much. I'm honored to be here.

Sarah: I love that you're here because this is like just one lens of the world that you have created and live in. But I love the stories that you have told in some of these [00:01:00] spaces because you came into Boston Children's from outside the organization, a place known for deep history and high expectations.

How did you go about building trust and establishing your reputation early on?

Heather Nelson: that's a great question. And you know, every organization that I've come into or been part of, I think it's important to appreciate the history, to appreciate the culture, to appreciate where the organization is at the time, and.

Knowing that Boston Children's has such rich history academic success research, success, just a big reputation. I knew that I needed to make sure that I could get my sea legs and understand that. So I spent time listening. You know, I had a mentor that told me when I started this job.

For six weeks, just listen, don't say a word, but on the seventh week, have a plan. And that's really what I did is I tried to meet [00:02:00] with as many stakeholders as possible, whether that was a chief, a faculty member, an administrative leader, a clinician, you know what have you at all levels, including members of my team.

Just to understand what values were important to them as well as understand what it and the expectations of it meant to them. So that helped me to figure out what I needed to focus on first, second, and third. And. Also be able to put a plan in place that I could communicate and be transparent. As I stepped into this role and, uh, know, knowing that the strategies, some of the strategies had already been set in front of me.

So how would I execute on those? Understanding what was most important to my partners.

Sarah: It's hard to listen for six weeks and not try to go and just fix the things that you see out there. And yet that intentionality led you to thoughtfully be able to lead three [00:03:00] restructures during your tenure. What did you learn about bringing people along through much of that change?

Heather Nelson: Well, change is hard no matter what, what size, or you know who it impacts and. There was different reasons, you know, every restructure, every change that I needed to make or even continue to make, there was a different reason for that. And it was important for me to define the why and communicate the why to those that were impacted of, of course.

But as well as to have those sound bites, those, those talking points for the organization because. Many of these restructure was very visible external to my teams. So it was really important to me that I had those talking points and. Having that transparent communication is so important.

It's very important to me and to be consistent in that communication [00:04:00] also, it will, it was important for me to have that support from my human resource colleagues to make sure that I was staying within bounds, that I made sure that we had empathy as a forward. Process in all of this and building the new culture of how we wanted to be seen.

And it was hard. There was very hard conversations that had to happen. Some, you know. Having HR partnering with me to do this. And it wasn't just for instance, eliminating a role, it was also redefining a role and giving folks opportunities to learn something new. So when we think about restructuring, it's not a layoff, if you will, it's also thinking about.

How do I structure my team to be future proof? And that's the approach that I took three different times. You know, the very first time was leveraging our Epic implementation and [00:05:00] defining what my new target operating model was gonna look like, not only throughout the implementation, but more importantly now that we're live and been live now for almost two years.

Having the right people in the right seats.

Sarah: You've said that you can be the hero and the villain in the same sentence. How have you learned to manage that duality and protect the wellbeing of yourself and your team?

Heather Nelson: It's hard. It's not easy. I think that you have to find a balance of that strategic decision making with compassion and self-awareness,

there's times when I need to make a decision and I will bring people in to help me, whether that's my senior leaders, whether that's socializing with my boss and his peers. And then there's times when I just need to make a decision. So you have to find that balance. And I think all of us that either make decisions or have decisions made for us have a couple [00:06:00] options.

Either we're part of the solution and we support. Decision or we don't. And if we don't, then maybe this isn't the right culture for you. I know that there's an impact to the decisions that are made and making sure that I get the feedback and understand and create an environment where I get feedback on decisions.

Not every decision, but I think more recently in some of the restructuring, just hearing from the team on how they're doing, how are they getting, comfortable with a new leader that's been put in place or a new scope and here what works and what doesn't. And I afford that opportunity. I have monthly it town halls, uh, where we talk about these things and.

I have over 400 FTEs, but I've got team members that feel comfortable raising their hand in a meeting and, and asking the hard questions. And it's important for me to create an [00:07:00] environment and create a culture where constructive feedback and dialogue, can be had without the fear of.

People being punished by that. Psychological safety is something that we, we talk about here at Boston Children's. I think there's times, and there has been times even here at Boston Children's where I've made a decision that has been wrong. And I think owning that and going back and saying, I wish I would've done it differently.

But then being nimble enough to pivot and make a different decision. So, yeah. I am someone that's not afraid to make decisions. I've been told at times I have a strident, authoritative leadership style, and I think some of that is because I'm not afraid to make a decision in the absence of one, but I have to find that balance right of making sure I'm taking other thoughts and feedback into consideration.

Sarah: The thing that's cool though, about having a personality that like leans in and makes tough decisions, but also creates an approachable landscape for your team. It's actually appreciated because [00:08:00] they know where they stand with you all the time. Like you're gonna be hardcore. They can be hardcore back with you, and you can come to a mutually agreeable understanding or at least.

They're gonna hear the truth from you,

Heather Nelson: right?

Sarah: And when you don't know, there's too much ambiguity in an organization, you can't be nimble, you can't pivot quickly, people don't trust it. You've already established all those aspects and you report to the cfo they do. And you've achieved over 14 million a reduction through optimization and rationalization to a degree.

How do you ensure that it remains seen as a business enabler and not a cost center?

Heather Nelson: Well, I think, you've heard me say this, say this, Sarah. And my team hears me say this all the time. It we're not order takers. You know, we wanna be seen as a strategic partner. We want to enable technologies, we wanna do cool, creative, innovative things as much as anyone else.

And I appreciate that it will always be a cost center to some degree. But. It's important that I showcase the value of it, and there's a way to do [00:09:00] that. There's a way to do that through benchmarking. There's a way to quantify what we do, and it's, as you know, reporting to the CFO. I am put, you know, on notice, probably more so about my costs and where there's opportunities.

And I just make sure that as I'm approaching those things, that I'm staying in alignment, not only with my boss, but with our enterprise strategies. And I think that's important because. There's always gonna be cool stuff people wanna do that's maybe discretionary, but making sure that we're delivering on our promises, making sure that we're tightly aligned with the enterprise strategies and objectives, whether that's a new product like an ERP or an EHR, or.

You know, redoing our SLAs for how we support the environment, I think is important. And leading with data I think is important, especially in our governance models when we're making decisions as a leadership team, what's the highest [00:10:00] priority? I think is really important. I want. As many things to be operationally led and it enabled, and make sure that we're showing our value through that alignment and, making sure that my teams understand how much they're appreciated and at all levels.

Not just at my senior leaders that report into me, but at all levels that they're empowered to have a seat at the table, to have a voice, to bring options and to be the change that they wanna see. And that's also something that I reiterate with them on a regular basis.

Sarah: And you brought in a skillset exercise, which was a first for the organization.

What lessons did you take away about transparency, communication, and partnership through that process that made it successful?

Heather Nelson: You know, I think I had to start Sarah by shifting the mindset of my team to start, like, start with. Helping my teams [00:11:00] understand why we needed to do a skillset analysis.

Because again, we wanna make sure we have the right people in the right seats, and if there's gaps and you wanna learn, I wanna afford you that opportunity to get certified to go to training, what have you. So shifting that mindset within my department was where I started first, and then I could.

Showcase that with my peers, especially in the governance structure that we have to showcase that, to talk about capacity and demand to talk about it, strategic plans and showcasing those, sharing those, and then doing some of the building blocks. What are our SLAs? What are our KPIs that we're gonna hold ourselves accountable?

Because we can't ask the organization to call the service desk to put in a ticket if we're not. Responding to that ticket. So how do we [00:12:00] hold each other accountable and hold ourselves at, at very high standards? And that's what's been helpful. Is it perfect? No. Do we still have some work to do?

Absolutely. But as long as we are thinking about this and how do we show the value, I think this goes back to showing the value of it. We wanna be the best. Service provider in the organization. And, that's something that we agree on as a department, that's our mission. And leading with data and communicating with data, providing options is, and being consistent is what showcases our willingness to be a good partner.

Sarah: It goes back to building trust. When they trust you, absolutely. They trust you with the data on the human side. They're gonna trust you with the data on the quality and other outcomes side. Yes. And all of those pieces have to be true to move the organization forward. But you have overseen optimization efforts from Epic all the way through app rationalization.

You've reduced [00:13:00] your third party applications down from, I believe you shared 400 to 186. What were some of the guiding principles that helped you prioritize what state and what went knowing there's a tail on some of these application retirements?

Heather Nelson: Sure. And we're still dealing with some of those tails even now, but I think it's one.

Goes back to listening. Especially because many of those systems weren't just from a third party vendor, they were also internally developed. And to tell someone that developed an application that's, that's used for example in the department of surgery for 20 plus years, that it's going away because we're implementing a solution that has that just built into its architecture.

They were hard conversations, but. Listening and making sure that they understood why we needed to do this and where there was some gaps. Because it, you know, not everything is a one-to-one from, a custom bill [00:14:00] application moving to Epic. It's not always one-to-one what we talked about. Can we get 80% of the way there?

If we can get 80% of the way there and showcase that Epic can do 80% of what you were accustomed to. Let's decide that that's the right thing to do. Let's not focus on the 20% that it can't do, because that's where, just from a human nature perspective, we go right to that 20, well, it can't do this, so therefore it can't work for me.

So there was a lot of negotiation, a lot of listening. Bringing Epic to the table. We still still have Epic visit us and sit down with us and we focus on a few different workflows and get their buy-in and bring our partners, whether they're clinical or administrative or research to the table to be part of solutioning with our vendors.

And I think it's just gonna be ongoing. Yes. Do I think 186 may rise or may fall, maybe. Um, you know, as we kick off our ERP, you know, [00:15:00] modernization project, you know, there's gonna be some additional systems that we're gonna rationalize, but there may be a few that we add. So I think as long as we have the partnership, not only with our vendors, but more importantly with our internal partners I think we'll be okay.

Sarah: The app rationalization space is always such a hard one, to your point, that 20% and getting people over the hurdle. Yeah. A lot of it comes down to, I mean, empowering bold leadership and mentoring your team to also have those conversations with people. What is your approach to succession planning and developing the next generation of healthcare technology leaders throughout your organization?

Heather Nelson: it is something that I just have always done because as I was an emerging leader, it was important to me to understand what my potential could be, what my opportunities were, and, as you start early in your career, a lot of that's done for you or kind of to you. And as you continue to move up.

You gotta look out for yourself, right? The higher you [00:16:00] go up, the less amount of time people are worried about what's next for you. So you have to build, you know, what you wanna see. And I think for me, it's also imparting that as I come into Boston Children's, specifically with a new leadership team, is enabling them or empowering them.

To think about what are, what are your succession plans, you know, whether you're a VP or a director, we've done exercises and also having an HR leadership team here that also values that and bringing process and guardrails to do that, I think is where we didn't have that before. I think over these last couple years it's been a priority investing in our human capital.

Is one of our pillars in our, you know, enterprise objectives. And that's because we've been infused with new HR leadership, I think has helped. And, you know, I'm always looking out for that, maybe a little rough around the edges, but I see that potential and, you know, [00:17:00] offer them, you know, mentoring, uh, you know, whether that's with me or someone else.

And, affording them the opportunity to maybe color outside the lines a little bit. And I've done that with leaders, I've made decisions and brought in leaders that I thought would be great. And six months later, not so much. Being, being willing to be a little bit nimble and flex it is important, but I think for me, empowering my leaders to do that and take it as down as far as we can is important because I'm not as close to the work as my managers are, or as close to the team members in their day to day.

So it's important that I model that behavior, so that they can see how to do it.

Sarah: And it's amazing how far you can go an organization when you have a really good rapport with the HR team. Literally, like my previous HR VP and I are still very good friends and, actually we're all going on a trip in January because we went through a lot together.

You know, we did [00:18:00] restructuring, app rationalization, bringing in all kinds of new and different ways to get the work done, and that was always the first person I said, can we even do this? Like, what would it look like?

Heather Nelson: Right?

Sarah: Sometimes it takes a few rounds behind the scenes before anybody ever sees. What you've had to go through with that team.

But thank you for doing it for your organization because imagine how many people you have given an opportunity to that maybe didn't see it before you got there.

Heather Nelson: Yeah.

Sarah: Are you ready for speed round?

Heather Nelson: Love it.

Sarah: I always like it's the most important part of the, the conversation typically right here knows.

All right. Here we go. One leadership principle. You refuse to compromise on

Heather Nelson: consistency. Consistency.

Sarah: What's the consistency? It's a good one. Yeah. People know what you expect from you.

Heather Nelson: That's right.

Sarah: What's the hardest lesson you've learned about trust in leadership?

Heather Nelson: That sometimes even the most well-intentioned change or decision and it in in invertedly erode trust.

Sarah: advice for A CIO stepping into an unfamiliar organization.

Heather Nelson: Listen, prioritize your understanding of the culture after, you know, hearing [00:19:00] from whether it's your peers, whether it's your uplines, whether it's your direct reports, and then engage and stay engaged with those individuals.

And from my perspective, you'll find those folks that you can bounce things off of and get. Really good feedback. Whether Heather, you're completely crazy, or, oh my gosh, we need to do this. So yeah, listen and then have a plan.

Sarah: I love that. Listen, have a plan that actually works at home. Also, by the way, it depends on the scenario.

Heather, your story is such a testament to what it means to lead with integrity Through transformation, you've shown that credibility is not granted. It's earned through consistency, courage, and caring for your people. Thank you so much for being on the show today.

Heather Nelson: Thank you so much, Sarah. Always a pleasure.

Sarah: And for our listeners, if today's conversation inspired you, share it with someone navigating change in their organization, because as Heather reminds us, true leadership means balancing bold moves with lasting relationships. Thank you for joining me, and until next [00:20:00] time, keep flourishing.

Sarah Richardson: that's flourish soundbites, find your community at this week, health.com/subscribe. Every healthcare leader needs a community to learn from and lean on. Share the wisdom.

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