One Year In, Sharp HealthCare's Couts Says Restructuring Governance Was the First Order of Business
Podcast:Play in new window|Download(Duration: 38:05 — 34. 9MB)Subscribe:Apple Podcasts|SpotifyTerri Couts, RN-BC, MHA, SVP/Chief Information Digital Officer, Sharp HealthCareSharp HealthCare’s Couts details. . .
Podcast:Play in new window|Download(Duration: 38:05 — 34. 9MB)Subscribe:Apple Podcasts|SpotifyTerri Couts, RN-BC, MHA, SVP/Chief Information Digital Officer, Sharp HealthCareSharp HealthCare’s Couts details the decision-rights overhaul, capacity heat map, and 1,400-application load defining her first year in San Diego. Watch below or on YouTube. Restructuring governance topped the agenda when Terri Couts took over technology atSharp HealthCarein October 2025. That work came ahead of new systems, AI pilots, and the innovation Sharp built its reputation on. Couts, SVP and Chief Information and Digital Officer, spent her early months asking what the organization needed from information services and what it had quietly stopped asking for. Sharp operates 10 hospitals (five acute and five specialty) alongside affiliated medical groups and its own health plan. Roughly 350,000 capitated lives sit under management. That structure, she said on a recent episode of the healthsystemCIO Show, produces a dynamic environment in which every entity her department serves carries a different set of needs. She describes the organization as a house under continuous renovation. Rooms kept getting added while the foundation underneath them got less attention. Sharp’s environment now carries more than 1,400 applications. Maintaining that volume absorbs staff who would otherwise be doing grow-and-transform work. Reducing complexity, in turn, reduces downtime and reclaims analyst hours, so application rationalization sits alongside governance in the same category of foundation work. Innovation had been the organization’s strength for years, and the supporting layer beneath it simply had not been revisited at the same pace. Sharp has been running full capitation for two decades, with strong physician leadership and consistent investment in systems. The Epic implementation of a few years ago, however, still gets discussed internally the way people discuss COVID, as a line separating before from after. Her team had absorbed that account and carried a sense of responsibility for how the organization remembered the deployment. Getting ahead of it became an early objective. Her stated goal is that Sharp talks about Epic differently by next calendar year. Decision Rights Replace Advisory StructuresOne of Sharp’s three core strategic imperatives is to unify, which requires standardization across systems and across how those systems get used, so the resulting data can actually drive change. A large set of advisory committees had grown up around the Epic install, as it typically does at go-live. Those bodies still feed ideas into what information services should be working on. Decision authority, meanwhile, moved to people positioned to commit resources and close a question. Every request now runs through the same sequence. Should the organization work on this, and can it, given the resources available? What outcome is the work driving, and how will that outcome be measured? Is this the right thing at the right time, and what does it support in the strategic plan?Saying no, or not now, was the capability the organization had been missing. “They felt like they needed to serve the organization, which meant they were more like order takers, and we didn’t have the ability to say yes or no to one or the other without this governance process,” Couts said. Speed remains a design constraint. Governance that becomes the bottleneck stops getting used, so the process has to keep moving without collapsing into analysis paralysis. For example, requests that clear the feasibility question move forward instead of waiting for a subsequent meeting. Capacity Data Turns a No Into a Trade-OffGovernance only works when the capacity numbers underneath it hold up. Sharp recently began tracking analyst time against task, a practice Couts distinguishes from timekeeping. If a team allocates 30 hours a week per analyst and the task data shows 35 hours of committed work, the organization is over capacity before the next request arrives. That data feeds a heat map now in development, which translates a request into the specific resources it consumes and shows where those resources are already spoken for. The conversation shifts accordingly. Does the work need to start today, or can it wait until September? Business leaders make that call with the numbers in front of them. The dynamic moves information services out of doing something to the organization and into a working partnership. Getting her own team to supply the data proved the harder part. Analysts already tracked time, and the new granularity asked them to break work down by skill and by project, including projects that consume two hours one week and nothing for the next month while someone else finishes a dependency. They had to see what the practice returned to them. She ran the same tracking atThe Guthrie Clinic, her previous organization. Governance there eventually came down to presenting the heat map, after which the operators made the decisions themselves. What it returns is leverage. Benchmarking IT staffing in healthcare is difficult, since work volume measures that suit nursing hours, for example, do not map cleanly onto a system service. As a result, the internal data becomes the reference point. Imaging volume grows and radiology groups expand while ISD headcount stays flat. Couts can then produce the evidence explaining slower response times. The same data supports cross-training decisions and shows which open positions should be refilled as-is and which should be redirected toward a skill the organization is consistently short on. Rounding Keeps IT Close to the WorkRelationships carry the rest, and Couts rounds consistently and pushes her staff to do the same. She does not feel that everyone belongs back onsite full time, provided the work happens across core hours. She does require that staff understand the problem being solved. They also need to see whether a given technology enables care or obstructs it. Highly technical roles are not exempt, since cloud architecture and security controls affect clinicians at the bedside as directly as a workflow change does. Rounding also corrected the negative story her team had been telling itself. Staff who came along heard pain points, certainly, but they also heard appreciation for work that clinicians rely on daily. Sharp’s first in-person manager meeting since before COVID, held shortly after she arrived in October, produced the same effect at scale. Take it AwayMove decision authority out of advisory committees and seat people who can commit resources and close a questionRun every request through feasibility, measurable outcome, and strategic alignment before it enters a queueTrack analyst time against task and skill, and use the resulting heat map to make trade-offs visible to business ownersTreat application load as foundation work, since maintenance headcount is capacity unavailable for transformationRound consistently, and bring staff along, so the team hears appreciation alongside pain pointsApplication work of that scale will run for years, and it is the kind of effort Couts counts as innovation. “Innovation doesn’t mean buying something new,” she said. “Innovation is taking something existing and making it better, transforming the work. ”Related ArticlesApplication Rationalization Is Necessary Work, but Sometimes the Juice Isn’t Worth the Squeeze, Panelists Say— July 16, 2026Sharp HealthCare’s Korn Says Spatial Computing Gives Clinicians Superpowers, But Demands a Strong IT Foundation— March 26, 2026Leaders Break Down Keys to EMR Optimization; Warn Unaddressed Friction Speeds Burnout— March 24, 2026IT Execs Seek to Tame Application Sprawl Without Stifling Innovation Through Shared Governance— Feb. 17, 2026CIOs Discuss Creative Strategies for Dealing With Ever-Greater Expectations— Dec. 9, 2025