As a former health system CIO, John Glaser understands the challenges that today’s leaders face. And it’s that experience that has helped guide him in his current role of CEO of Siemens Health Services, as the company works to grow its core products while developing an ambulatory solution to meet the evolving needs of care providers. In this interview, Glaser talks about moving away from a transaction-based model, how vendors can best integrate customer requests into their strategic plans, and the increasing importance of incorporating business intelligence and analytics into the overall strategy. He also discusses how Siemens has handled the healthcare IT workforce shortage, and why leaders need to remember what healthcare IT is all about.
- The healthcare IT workforce shortage
- Hiring for success
- Remembering why we’re in this business
- Sending behind-the-scenes staff on installs
- How CIOs can deal with today’s overwhelming work burden
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It’s ongoing. You still have to work hard at keeping the talent level up, offering the right pay, and making the job is as interesting is it can possibly be, and once they’re here, making sure you educate them, train them, and give them the career opportunities.
These are real people getting real care. So I think it is important that as we work hard at delivering code and work hard at backing up servers and have these conversations about the business aspects of this thing; that we never, ever forget why we are really here.
What we are doing is exposing you to the real setting that is going on here; the reality of implementation. You can be writing code and not know what it feels like at 2 in the morning when the stuff is going in and people are adjusting.
It’s not as if you’re the only who’s feeling the pressure; the whole organization is feeling the pressure, and so there might even be a broad leadership team conversation that says, ‘We need everybody to be energized, healthy, and focused for a long period of time. Let’s talk about how to do this.’
The role that CHIME, HIMSS, AHIMA, AMIA and AMDIS play becomes increasingly important because you need that colleague network to talk about ‘how did you handle this’ and ‘how did you address that,’ and maybe avoid you having to repeat some mistake or do something one way when it could be done better another way.
Guerra: Talk about the business load versus the talent that you were able to acquire. One of the things you said is you want your customers to know, or your customers deserve to know, that you’ve got the best people you can get behind the scenes, in front of the scenes, everything. So have you been able to staff up to the point that you need to with this—I don’t know how real the health IT shortage is on the ground, and then you can dovetail that into talking about how maybe it’s a good problem to have, but you don’t want to take on more business than you can deliver.
Glaser: In the last 12 months we’ve hired 500 people, and we have another 250 openings right now that we’re recruiting for, and there’s another wave to come. So a couple of things: one is that Siemens is willing to invest in growing the staff. You want to grow at a pace you can absorb. You don’t want to undergrow but you also don’t want to overgrow because bringing in too many people too quickly can actually set you back in lots of ways. It is a tight market out there and there are a lot of interesting people who have deep clinical IT implementation experience — it’s the vendors, it’s the providers, it’s the consulting firms. It kind of reminds me of sort of Web talent scramble of a decade ago and the ERP talent scramble of two decades ago. So it is a tight market out there.
That being said, we’re actually doing pretty well. Our turnover rate is six percent, which is a good number. It’s stable; we’re not seeing big exits of people. There’s one of these awful ratios of for every 200-250 applications we get, we hire one. So there is a lot of interest, and we’re in a position to be pretty darn selective about that. Still, it’s an ongoing set of work. You still have to work hard at keeping the talent level up, offering the right pay, and making the job is as interesting is it can possibly be, and once they’re here, making sure you educate them, train them, and give them the career opportunities — all the stuff you have to worry about and will always have to worry about.
We also do find from time to time that we’re more effective working with partnerships — with consulting firms and other implementation houses, or other vendors who have a particular expertise in a particular application area. So you don’t have to own it all. You want to own enough to do your core stuff, but you also want to recognize that you’re frankly better off with working with others who can deliver a service or a product both to the market faster and maybe better than you can, despite however good you think you are.
I think, Anthony, it’s going to be a talent challenge for the duration of the decade. One of the other things we do that is perhaps not common in vendors is we have about 25 percent of our workforce overseas. It’s in India, it’s in Romania, etc., and to a degree, we do that because the wages can be lower, and hence your products cost less or are less of a burden on the customer’s wallet, and to a degree, you do that because you can work around the clock. So while people here are sleeping, obviously people in India are working, but actually the more important reason is you have global reach of talent. And talent is not strictly a US phenomenon. There are some incredibly talented people all over the world, and so you have the ability to get to them and to leverage them and not truly be confined to a US market, although obviously we remain a great interested in the US market.
Guerra: Have you injected any of your philosophies into the hiring process? Have you met with your HR manager and said, ‘I just want you to know what matters to me. Forget about specific roles; let’s talk in general. This is something I want considered highly in the hiring process, because over my career, this is what tells.’
Glaser: You do that, Anthony, directly and indirectly. We talk about the need to go back to people who believe inherently that you have to raise bar all the time; for example, people who inherently believe that this is partnership rather than a supplier-purchaser type of relationship. Fundamentally, you look for two things: the spark and the passion, as I call it. The spark is that there’s just a native IQ that’s serious, and also a real intellectual curiosity — they want to learn. One of the ways you can tell is that you’re not doing the interviewing; they’re interviewing you. They keep asking questions, and they just want to learn. And the passion means that the things they work on, they just get so excited about it that you can see the eyes widening. They care about their work. They care about what they’re doing. They can’t stop talking about it, which makes you say, ‘I’m never going to have to motivate you — I’m going to make sure you take your vacation. That’s going to what it’s like with you here.’
So you look for those two core attributes to go on here and I guess the last thing is to just make sure that both those who we recruit and those who work here remember why we are here. At times you can get into this conversation, and you have to from time to time, of topline growth and margin and all that stuff. And we’re a business, so that’s part of our vocabulary and that’s part of our reality. But the point is that right now, there are real caregivers in Soarian customer sites who are taking care of real people who are sick, who are ill, who are scared, who are in pain, and who might be dying. And our job is to help those who deliver care to be as terrific as they can be because of what they are doing, and that all the people we talk about in an abstract of being patients, those are people we love. Those are our parents, our spouse, and our kids. These are real people getting real care. So I think it is important that as we work hard at delivering code and work hard at backing up servers and have these conversations about the business aspects of this thing; that we never, ever forget why we are really here. And so that is part of the thing that you want both people who are coming in the door and people who stay here is to never forget.
Guerra: That’s great and well said. For a big company, what’s the best way to do that? Is it retreats or messaging in the halls? I mean, how do you keep it front and center so people stay motivated and they don’t sometimes forget and just get caught up in code, because that has to be actively done.
Glaser: Sure it does, Anthony. And there are lots of ways you do it. At full staff meetings, I take the opportunity to remind people, and I send a weekly email which reminds people of that in different ways. One of the things we started to do is if you’re staff here, we’d love to have you on an install and to fly out for a chunk of time and be part of the implementation team. Now we’re not billing the customer for you; what we are doing is exposing you to the real setting that is going on here; the reality of implementation. You can be writing code and not know what it feels like at 2 in the morning when the stuff is going in and people are adjusting. It’s hard; I had to experience that.
We’ve also started a program that essentially is going enable folks to take a field trip; to spend a day at a hospital or a day in clinic and talk to the nurse, talk to the doctors, see them use your stuff, ask them about this, that, or the other — we make you leave the campus here and see what goes on. And it’s not the same as being a doctor or a nurse, and we have people who are doctors and nurses, but it’s to give opportunities, whether on implementation or whether in a day field trip, accompanied by messages that I might sent or others might send that provide an ongoing re-energizing of this message and reminder of this message.
Guerra: I’d like to ask you a question and ask you step out of your Siemens’s hat and put on your incredibly well-respected, long time in the industry hat. If I were to define the main trend today, it’s people being completely overwhelmed; people in the CIO position being completely overwhelmed with everything on their plate, with ICD-10, Meaningful Use, ACOs, and everything that goes with all that stuff — talent shortage, lack of funds to bring in the consultants they need sometimes to help them with these installs. I think there are people out there working 12 to 15 hours a day, six days a week. It’s getting to be a lot. So one of the things I think people will appreciate from you is if you can offer any advice — is this overwhelming as I’m describing it, and if you can give them anything to take away.
Glaser: Well it is overwhelming and you could even say, ‘By the way, Meaningful Use right now is voluntary,’ but it is hard to skip that check that is sizeable for the organization. I think it is overwhelming and it’s not only because of the stuff of the federal government is bringing to the table — Meaningful Use, ICD-10, and payment changes that are coming along the way — but also obviously the organization has plans that it wants to carry out. It’s doing more than just the federal agenda, so to speak.
So I think it is overwhelming now, and my belief is it will be overwhelming for the rest of the decade, and so one of the major pieces — and this is to a CIO colleague who is also a person — is, settle in for the fact that this is going to go on for a period of time. I can’t know all personal situations, but find a balance in there, because it’s not one of these things where you cram for the exam and it will all be over in 24 hours. You have to get into a work-life balance pace that you can hold for a long period of time. That’s a friend talking to friends about the need to do that.
And it’s not as if you’re the only who’s feeling the pressure; the whole organization is feeling the pressure, and so there might even be a broad leadership team conversation that says, ‘We need everybody to be energized, healthy, and focused for a long period of time. Let’s talk about how to do this.’ And a very business-like way, we also mean making really hard choices about what we invest in and what we don’t, at what pace we will operate and what pace we will not operate.
It also means I think that a CIO who is now a customer turns to us or turns to whoever is their major supplier and says, ‘how are you going to help me? What can you do in the way of resources to help me with ICD-10, for example?’ And those could be IT resources, those could be coding resources — for example, ‘I need help with getting coders up to speed on how to use this new terminology.’ But I also think you to reach out to those who supply products and services to you and say, ‘how are you going to help me get through this in a reasonable fashion?’
I also think it points to the incredible importance of the professional community at this time. I’ve always, as you know, been a huge believer in CHIME and the role that CHIME, HIMSS, AHIMA, AMIA and AMDIS play becomes increasingly important because you need that colleague network to talk about ‘how did you handle this’ and ‘how did you address that,’ and maybe avoid you having to repeat some mistake or do something one way when it could be done better another way.
I don’t think this is temporary; I do think this is long-haul. So personally, figure out the right rhythm here, because you got to need to put up with this for a while. Reach out to those who are your suppliers and say, ‘I need your help’ and ‘talk to me about that.’ But also reach out to your network of colleagues, because you will need the collective strength feedback, and frankly, at times, emotional support to get through this.
Guerra: I think that’s fantastic advice, really good. Those were the main things I wanted to hit on. Is there anything else that you want to talk about that we didn’t touch on?
Glaser: No, I think maybe just summarizing of the stuff we said earlier. I think we are in for a remarkable decade. I think the decade in front of us has no parallel. In this industry, in this country, you have to go certainly back to the 40s to see this. And it’s going to be really challenging as we try to change the payment mechanism as a means to get care quality up and cost down. It’s a lot of uncertainty, and a lot of experimentation will go on — it will be volatile, maybe even a little chaotic at times. And so I think we’re in a rare moment. And I hope to God, Anthony, that it all works. I hope that you and I sit here and have our chat at 2020 and the care is better because it’s not obvious that all things we’re doing are going to make that happen.
We as a company, I think, have some good plans, some good products, and some good services that will help people do that, but I also think we as an industry have to come together and do all that we can do to help the healthcare system in this country do well in the years ahead. Because what isn’t terribly helpful is that if we stand here in 2020 and say, ‘You know what? Despite all that money spent, it’s not any better,’ or frankly, it might even be worse. And we have not done what we need to do, both as members of this industry but also citizens of this country, and that would be more than a significant disappointment. That would have been something where we would not have left those who succeed us with the world that we want to leave them with.
Guerra: That was wonderful, John. I want to thank you so much for joining me again. I’m really enjoying these annual talks.
Glaser: Well Anthony, we can talk in between.
Guerra: Alright, I’ll see you at the show and again, thank you so much.
Glaser: Always a pleasure. You take care.