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- Welcome to the Becker's Healthcare Podcast, made
for the people who power US healthcare.
I'm Molly Gamble at Becker's,
and today I am sitting down with K Burke
to learn more about the representation of nursing
and informatics and leadership in the field.
Kay is the Chief Nursing Informatics Officer
for UCSF Health Informatics.
Kay, welcome to the podcast. Thanks
so much for being my guest.
How are you today? And where does podcast find you?
- Hi, Molly. Thanks so much
for inviting me to be your guest.
I am doing fabulous.
It's, it's a rare 70 degree day in San Francisco,
and so I am looking forward
to a beautiful, relaxing weekend.
How are you?
- I'm doing well. Uh,
we are about 30 degrees different here in Chicago.
Um, but , you know, we've had a very mild winter,
so I can't complain now.
Do you know what I mean? Um, yeah, we've had it pretty good.
You know, you mentioned San Francisco.
For listeners who might be less familiar
with UCSF Health Informatics,
can you share a few key facts about the organization just
to help our listeners better reacquaint themselves?
Yeah,
- Absolutely.
So, I'll, I'll start with sort of UCSF as an organization,
and then I'll delve into our informatics department.
Um, so UCSF, which I always assume everyone knows, stands
for the University of California San Francisco,
but just in case, wanted to kind of spell that out.
Um, so we're an academic health system.
We serve the Greater Bay Area
and, uh, UCSF has, uh, three core mission areas, um,
that includes health
or the clinical care delivery arm, which is
where I'm housed, uh, as well as research and education.
So we as an organization are really committed to ensuring
that those are all interconnected and aligned.
It's really part of who we are and what we do.
And, uh, we have several campuses across, um, San Francisco,
and we actually are expanding our
footprint, which is really exciting.
We just acquire two amazing community hospitals.
So that's, that's a bit about UCSF
and, uh, health informatics is, it's really kind
of a key function, I think, within the health system.
Um, we're actually part of information technology.
Um, that's our division though we work really,
really closely with, with operations
and the clinical departments.
And our portfolio has several verticals, one of which,
of course is nursing informatics, which is what I oversee.
Uh, we have a, an incredible team of informaticists.
We, uh, work very closely with the technical analysts, uh,
as well as, as I mentioned, our clinical colleagues
and, you know, not just nurses,
but, uh, nursing informatics supports,
advanced practice providers, including nurse practitioners
as well as allied health professionals such as pt, ot,
you know, speech register, registered dieticians,
social workers, and the like.
Um, and, you know, given that all
of these roles use digital tools
and information systems to do their daily jobs
and carry out their, you know,
respective professional practice, they,
they really require the support
and service of informatics professionals.
And we do a lot, you know, some,
some describe informatics kind of as the bridge
between clinicians and it,
and we, we have a, a leg in both worlds.
And, um, and
because of this, we understand the clinical workflows
and the problems that need, need solving, you know, whether
that's an electronic health record design solution
or, you know, user adoption
or the implementation of, of large scale projects.
And what we do is we help ensure that the,
the IT application experts really have the requirements
needed to, to build said solution.
And so everyone on my team is an rn, you know,
most are board certified in nursing informatics.
And, uh, so yeah, that's, uh, that's our story.
- Okay. I, you just covered that very concisely,
but UCSF, I mean, when you talked about some of the,
the three arms and then research being one of them, um,
the research coming out of UCSF is, is such a long list
of big milestones and discoveries.
I, I think chronic pain is a condition stems from UCSF
research, uh, so much advancements toward, uh, AIDS
and treatment and identifying symptoms of aids.
So, I mean, I encourage listeners if they're less familiar
to, to check in, look into that
because, um, you summarized it really well.
Kay. But behind the scenes, I know that it's a,
it's a really long roster of different achievements
and milestones from your research.
- Yeah, I appreciate you saying that.
I, um, I myself am incredibly impressed by,
and humbled by the body of research that comes out of UCSF,
the funding that we have been able to achieve to
perpetuate incredible research.
I always say that, you know,
it always feels like we're sort, you know, uh,
curing cancer in the backyard.
Uh, there are people that come from around the world
to be part of clinical trials and receive treatment at UCSF.
So I appreciate that, um, emphatic point that you made,
because sometimes I,
I undersell the research endeavors at UCSF,
and, um, I do think it's, uh,
it's worth noting. So thank you for saying that.
- Yeah, and I, I wasn't implying underselling at all.
It was more in recent conversations,
and I, I even undersell just now.
I mean, when I said advancements around treatment of aids,
I mean, UCSF co-discovered aids, so, um,
some landmark developments there.
But, um, you know, Kay, I wanted to dig into
and double click on your role with nursing and informatics.
Nursing long been underrepresented in the field
of healthcare informatics.
And then you have nurses playing such a crucial
role in patient care.
They have so many valuable insights into healthcare
processes that can go overlooked quite often in,
in the development
and implementation of informatics solutions.
How have you seen this change, either at UCSF specifically,
or if you take a step back in the industry at large?
- Yeah, I mean, it's, it's a very interesting observation.
Um, I certainly share it.
I, I have seen this change over the years
and, um, I mean, I'll share with you a little bit about my
personal, um, journey in the field.
Uh, so when I first got into informatics back in 2009,
often there were CMIO roles,
and in some cases, you know,
additional medical informatics leaders like associates,
CMIOs and directors of medical informatics,
but rarely, if ever A-C-N-I-O.
And this was the case when I started.
And, uh, while I was on
an incredible nursing informatics team,
there was not A-C-N-I-O at the organization, uh, you know,
doctors, nurses, pharmacists, we all worked
on EHR implementation projects together,
but the leaders were almost always positioned.
So when I first became A-C-N-I-O myself,
and this was in 2014, I was excited.
I was glad that the organization had A-C-N-I-O role.
I was thrilled to be afforded the
opportunity to be in the role.
Um, my role reported to the CMIO,
and, you know, while he was an incredible partner, the,
the org chart illustrated who's driving the
bus, so to speak.
And so therefore, to your point,
nursing was underrepresented, not just in the field
of healthcare informatics,
but in decision making that impacted nurses themselves
since there were not as many, if any,
at all seats at the leadership table for nurses.
Uh, so when I started here at UCSF, which was in 2017,
I was hired as the inaugural CNIO.
So there had never been A-C-N-I-O before.
Um, and subsequently no recognized, you know,
nursing informatics team.
And it took a lot as it as it does, right,
to build a program and a team, especially while also
educating the organization about the value
of nursing informatics.
And it is tough to constantly try to demonstrate value
of your role and your team's role
and building business cases for additional positions
and, you know, upskilling new hires
and delivering on key priorities.
Um, but I will say
now we are well positioned in the organization
to be at the table, right?
To help formulate decisions and best practices
and technology design
and partner with nurse executives to ensure
that our clinicians are well supported
and have the right tools and workflows to, to do their jobs.
Um, but I will say,
I'm gonna just say a quick story, if that's okay, .
Yeah, absolutely. It's actually, it's this torch
that I carry often, um, externally.
And, uh, so recently at a, at a conference, I spoke
to an audience of about a hundred plus or minus, uh, CNOs
and, and CE Chief nurse executive.
And at one point I asked for a show of hands, I said,
how many of you have A-C-M-I-O at your organization?
And most raised their hands. Mm-Hmm, .
And then I asked, you know, of you who raised your hands?
How many of you also have A-C-N-I-O?
And honestly, Molly most hands dropped. Mm.
And then I charged them all.
I said, it is very important
that you advocate for this role.
I mean, it is a matter of, of inequity at this point.
I mean, at any organization, there are more nurses
and allied health professionals than doctors, right?
So then I said, inequitable representation,
if not challenged by you, is perpetuated by you.
Mm-Hmm, . Mm-hmm. . And there was
like, certainly discomfort .
But, you know, at the end of, at the end of the conference,
there was a line out the door, you know, of CNEs
and CNOs who were, you know, wanting to talk to me about,
like how to justify the, you know,
how do you build the business case of, you know,
having A-C-N-I-O at your organization?
Mm-Hmm, . So, um,
and I actually did this one other quick, quick story.
I was actually a summit hosted by a vendor.
And, you know, the, the opening keynote was a CEO.
And he said he proudly introduced the first new ever CMIO.
So imagine what I did.
I caught him at the coffee break,
and I was like, congratulations for hiring A-C-M-I-O.
That's great. And I was like, so where's your CNIO?
And yes, rhetorical for sure, our little, little flippant,
but catch my draft.
It just, it doesn't, just doesn't make sense to me.
You know? So, you know, it's, it's an ongoing, um,
advocacy, I won't say battle 'cause 'cause it's not a fight.
I mean, I, I will say that, you know, partnerships
with medical informatics professionals, it's very key.
It's not an us and them, it's not Mm-Hmm.
binary, um, you know,
effective informatics teams,
teams rely on collaborative work and, and relationships.
Um, it just, uh, continues to be, um,
this journey that does not yet have,
uh, an end point.
But I think we c nios, nursing informatics professionals,
nurses themselves are all kind
of continuing to march the march.
So we'll get there. .
- I think that's such an important perspective. Kay.
You know, I think health systems
and hospitals, you saw, I mean, decades ago,
it was typically a hospital administrator right at the
top of the organization.
A lot of this has changed. Now,
the organizational structures and titles and positions,
and there's some that are fixtures, I think they're out,
they're, they're given at most organizations,
what I've always been more intrigued by is,
what you just touched on, is these roles that are emerging.
Um, some organizations, it starts off with just a few
and what, whatever the title may be,
but it's this sweet spot of time where it's not yet a given,
it's not yet widespread.
And I think, like you just indicated, there's a lot
of hard work there, um, in terms
of helping organizations move forward, progress and,
and better have representation for some really,
really key professionals in their organizations.
Um, and it also, like you said, it takes,
there's soft skills there that come up, whether it's,
you know, trying to help people
and bring them along in a way that isn't shaming them
or isn't, you know, tt
but helping them see that congratulations,
you have established the CMIO role.
That is a huge accomplishment now ,
you know, and keep it moving.
Right, . Yeah.
So I think it, it's really helpful that you touched on that.
Let's talk about leadership in, in your position.
I'm curious what you consider the special sauce, so to say.
Uh, I use that term because sometimes when I ask about
leadership, I, I'm striving to understand the traits
beyond those universally important ones.
You know, communication skills, listening, integrity.
Um, what leadership traits
or qualifications do you, are you really craving
and do you think really hold exceptional significance in
this position as CNIO?
- Yeah, I mean, I, I love the special sauce term
as an aside, despite being an SF for about six years,
I am a newly minted in and out fan,
and their special sauce is really worth pipe .
- I, I, you put that together. Funny
- .
Um, but leadership is special sauce.
It's, it is, I mean, all the things that you mentioned, it's
communication and, you know, integrity, authenticity.
Um, but I feel like a key characteristic
of a successful informatics executive is really change
management and relationship building.
You know, like there's this proliferation of technology
and digital tools in the clinical environment,
and there's often resistance,
or in some cases, fear, to be honest with you.
And nurses in particular don't want
to be technology experts.
It's not what they went to nursing school for.
They wanna take care of patients and new ways
or different ways of using technology or innovating to do.
So. It's, it's not always popular, right?
It's, it's, it's really incredibly important
to like empower nurses
and nurse leaders to be part of, of change.
And, um, so trust is, I think of, you know,
paramount importance
and building those trusting relationships is not
always an easy feat.
Um, it's funny, I know it sounds cheesy,
but I often start presentations with this quote from,
you know, Angela McBride.
And it's, it talks about, it says something like,
there's no aspect of nursing that will be untouched
by the informatics revolution that is in progress.
But I like it because people need
to be part of a revolution.
You know, they need to have avenues to contribute
to digital transformation.
And if you're, if you're A-C-N-I-O
or a nursing informatics, you know, professional, you need
to, you need to help create those inroads.
And so that's why I think number one is change management
and that relationship building
and being trustworthy, that's
probably the most critical secret sauce.
Um, for CNI os, I'd say on the heels of
that is, is strategy.
So like, I'm also, often in my role, I'm one step ahead
of the conversation, so I'm thinking proactively about the
problems I'm hearing and the solutions
that I can anticipate.
You know, so like this informatics is a bridge, right?
Between clinicians
and it, so when we hear from clinicians
or operations that, you know,
fill in the blank is an issue, right?
Uh, let's say an unfavorable quality trend
or a patient safety issue,
or throughput, bottleneck,
whatever you're hearing in different committees and councils
and forums, and then we can start to think through potential
interventions that might be needed to solve for, you know,
X problem that you just heard.
And, and so I think being strategic, it, it's not unique to
successful leaders right?
Outside of informatics,
but I do think it's particularly
important in A-C-N-I-O role.
So I would say two secret sauces.
One, the change management and relationship building,
and then probably, you know, being proactive
and strategic. Mm-Hmm.
- , what I'm also hearing there is when you
talked about the, the,
that great quote about the revolution, helping,
helping your team be proactive in how technology can fit in.
And they are more in the driver's seat of making those calls
and connecting those dots versus simply reacting, right?
I think so much of the anxiety around AI is
that it's gonna be put to use in ways that will surprise us,
or stun us or disappoint us, and we'll have to go back and,
and fix it and admit we might have been wrong.
But I think, Kay, what I'm picking up on you saying is
that if people are follow along with you
and thinking ahead in a similar way, they might be able
to better have ideas about how technology and informatics
and tools and AI can be adopted versus
simply reacting to them after the fact.
Is that, is that a fair read on things?
- Absolutely. I mean, I love how you said dot connecting
because, uh, I, I've heard
that informaticists are expert dot connectors.
Um, in fact, my CMIO, um, colleague
and very, very close trusted partner, uh, at UCSF,
he always says that we pour the coffee ,
so dot connecting coffee pours.
I think, um, it's also no one in a forum of
clinical or operational leaders are asking
for something like ai, right?
There's, there's a need to demystify
a capability such as ai.
So when you're, as I was saying,
you're hearing these problems
and then you try to think about
how you deliver solutions using, you know, a myriad
of capabilities including ai.
And so then when you come back with a suggested
or recommended solution,
and it happens to be ai,
you get the buy-in, right?
Because it's not like, okay, I'm gonna push AI
or deliver AI on you.
Mm. It's more I heard you
mm-Hmm, , I heard what you said.
I know this is a problem. This is a possible tool in the
toolkit to solve your problem.
It happens to be ai, you know what I mean?
We, we ensure that there is, you know,
ethical trustworthiness when we deliver ai.
And it's sort of like just being able to help bring along
your, um, your leaders at a healthcare institution,
uh, and, and kind
of essentially educating them along
the way. Mm-Hmm. .
- Mm-Hmm. - .
- Okay. It's been so interesting catching up with you.
And I, I really appreciate these glimpses
into your work and your role.
Do you have any closing thoughts for our listeners
or a message you'd like to leave them with as we wind down?
- Uh, yes. I just wanna say one thing.
'cause I, I often share this at the closing of,
of various kind of presentations with, certainly
as I mentioned, informatics, the way
that healthcare is digitally transforming
this environment requires
that we have nursing informatics professionals and teams
and structures and roles like mine.
But it also means that in addition
to having nursing informatics leaders
and specialists, we really need
to start thinking about building out informatics
competencies at the bedside to the professional nurse.
Like, we need to embed informatics principles in
undergraduate programs and graduate education.
Like we need to create fellowships or champion programs,
or whatever you call it, you know, communities of practice
and development opportunities to understand informatics.
Like it's not just about checking me,
I have A-C-N-I-O at my institution box.
It's, it's really about educating
and enculturating every single clinician
who touches a patient to be part of this sort of,
you know, new world order.
Mm-Hmm. of, you know, the future of healthcare
and, um, the revolution,
if you will, Mm-Hmm, .
So I do think it's more than just having nursing informatics
as a team or as you know, as roles, it's really kind
of infusing informatics competencies at all levels
of professional practice.
- That's a, that's a great note to add end on.
And I know that'll take the cooperation
and collaboration of numerous stakeholders.
You just hit on a few of them with higher education and,
and different training programs,
but a, a really important idea to close with.
- Great. - Kay, thank you so much for being our guest.
I hope we can catch up again soon.
This has been Kay Burke, CNIO
with UCSF health informatics.
Kay. I just wish you continued success in your role
and keep up the good fight with expanding
CNIs at health systems across the us.
I know it sounds like you're putting
a lot of effort into that.
And, uh, I hope you will continue
and others will join you in that effort too.
- Well, thanks, Molly. This has been super enjoyable.
I really appreciate the invitation to join you this morning.
- Likewise. Thank you so much. Kay.
- Thanks. Have a great day. Bye.