When Jim Noga was named CIO at Partners HealthCare, taking over for John Glaser, he was no stranger to the system, having spent 17 as CIO at Massachusetts General. A year later, he’s focused on moving the organization from a federated model to a true enterprise clinical system approach that will better facilitate initiatives like accountable care. In this interview, Noga talks about fostering clinical collaboration within the organization, the importance of having an effective mobile device management strategy, and how he has benefited from his experience in software development. He also talks about the challenges organizations face in managing security, why confrontation and conflict can sometimes be good, and what it has been like to fill Glaser’s shoes.
- Noga’s background
- A student (and teacher) of leadership
- Advantages and challenges of being promoted from within
- Following John Glaser
- The search
- New job, new boss
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I don’t think leadership is something that necessarily comes naturally. You may have the right personality traits to assume a leadership position, but I do think it has to be studied and learned; things like what is the decision-making style that your organization is going to use — is it going to be directive? Is it going to be consensus? Is it going to be democratic? Is it going to be participative?
What I think is really important in leadership is understanding that every person is an individual and understanding their perspective as to where they’re coming from to make sure you are all on the same page.
John Glaser used to tell me, ‘You’re the dean of the CIOs.’ So I think that helped, and even in my role at the MGH, I’ve always tried to be equitable in terms of my thoughts and opinions to really take not just a site perspective, but an enterprise perspective.
I would rather step into an organization that is less successful rather one that’s faltering so that you can take it to the next level. Because then you have a real struggle even to get up to a baseline where you can really elevate an organization into being truly innovative.
I always believe when you’re interviewing for a position, the organization is interviewing you and you are interviewing the organization to have some certainty that it’s the right move.
Guerra: You definitely know your technology. Your background is in software development, and your degrees are in biomedical computing and information processing and medical technology. Do you have a comfort zone? Would it be the technology stuff? Maybe you’ve worked to learn more of the clinical lingo and to develop rapport with physicians, because most CIOs who come out of the technical side have had to beef up their strengths in other areas. What are your thoughts around where your comfort zone lies and where you’ve had to really develop?
Noga: So actually I was recruited 21 years ago to Mass General as director of clinical applications because of my clinical background with medical technology and the laboratory and just a really in-depth knowledge in the area. So I was very comfortable in the clinical setting in terms of conversing and working with physicians, and I didn’t plan it, but obviously I had the education both clinically and technically, and then I also went onto a graduate certificate in healthcare finance in the graduate program at Ohio State.
Guerra: You’ve got it all.
Noga: Yeah, and it wasn’t planned. Often I’m asked, ‘Did you plan on being a CIO?’ And the answer is ‘no’. I love to learn and always just thought, ‘Hey, I want to do a good job and have decent results,’ and that sort of moved me through my career.
Guerra: So you’ve got the clinical, you’ve got the technical, and you’ve got the financial skills. What about leadership? Is that something that came naturally to you, or is it something you’re a student of?
Noga: I am a student of leadership. And in fact, I teach a course on leadership based on the Shackleton Expedition.
Guerra: I’ve read that book.
Noga: Yeah, it’s a very good book. I probably had over 400 students as well. I teach at the graduate school at Northeastern on the business of healthcare informatics, and I really do focus on governance and leadership and I don’t think leadership is something that necessarily comes naturally. You may have the right personality traits to assume a leadership position, but I do think it has to be studied and learned; things like what is the decision-making style that your organization is going to use — is it going to be directive? Is it going to be consensus? Is it going to be democratic? Is it going to be participative? Really thinking that through, and then really focusing on leadership because often, I think you can have a CIO that’s a very good manager but isn’t necessarily a good leader. It just is a different attribute. I actually, on a weekly basis, have a set of leadership principles that I review and say, ‘Okay, how did I do this week? Did I set examples? Did I treat people with respect? Did I reinforce the team message? Was I willing to allow people to take a risk?’ It’s a whole series of attributes that I reflect on and then build on that on a week-to-week basis.
Guerra: When you were mentioning, ‘Did I,’ I think for me it would be, ‘Did I lose my patience,’ or ‘did I react more quickly than I would have liked to with an emotional reaction to something?’ That’s a big part of it — keeping your cool. So many things come at you so fast, you don’t want to react and then just regret it 5 minutes later.
Noga: Well, that’s absolutely true and it’s important to understand how you react in various situations. So within Partners, at least when I was at MGH, they ran us all through this program called Personalysis and it really told you how you react in a typical situation and how you react under stress. And by ‘react,’ in other words, what becomes your focus — is it data gathering? Is it working with people? Is it being directive? And what I think is really important in leadership is understanding that every person is an individual and understanding their perspective as to where they’re coming from to make sure you are all on the same page. And that really is I think, understanding people as individuals and what motivates them and how they filter information.
Guerra: Your situation could be quite different from someone else in the sense that you’ve come up through the organization; you know everybody essentially that you’re working for and who are now working for you and who you’re working with. So you know them all — it’s not like you’re stepping this position coming from an organization in California. That’s a whole different ball of wax in terms of leading people when you have no idea what they’re all about.
Noga: Absolutely, because then there’s a start-up period. And I think coming into this role, having built those relationships and being knowledgeable of people’s personalities and traits allows me at least to have the organization move more quickly in terms of not having to have that whether it’s a year or two-year start-up just getting the lay of the land.
Guerra: There’s a challenge too in the sense that you used to work with — in terms of horizontally on the same level with — let’s say, Sue Schade, Scott McLean, and I guess Patricia George and maybe some others, and now essentially they report to you. So in a sense, sometimes it’s easier coming from the outside just because now this is the person and the position, as opposed to everyone having to think of you in a different light. Does that make sense — is that a dynamic you’ve had to deal with?
Noga: It hasn’t been difficult and I think we all had a great deal of respect for one another prior to me being in the role I am today, and I just think that’s really important. So I respect all of those people for their expertise and knowledge and I do see myself as a person that leads a team and not a group of individuals, and that’s gone very, very smoothly. Maybe it’s because I have been with the organization so long. And I remember John Glaser used to tell me, ‘You’re the dean of the CIOs.’ So I think that helped, and even in my role at the MGH, I’ve always tried to be equitable in terms of my thoughts and opinions to really take not just a site perspective, but an enterprise perspective.
Guerra: Let’s talk a little bit about John. I’m a big fan of John’s. I interviewed him a couple of times when he was at Partners and a couple of times now that he is at Siemens, and if you want to talk about one of the most respected people in the industry, that sure is John. So many people talk about him acting as a mentor to them over the years, and you never hear a negative word about the guy. So you had big shoes to fill—you’d almost rather follow a much poorer act. What are your thoughts about working for John and taking over his role?
Noga: Working for John was fantastic; our relationship had a lot of synergy. I think we both respected each other’s knowledge and could have really good dialogue. In some sense I learned from John, and I think in some sense he learned from me, and was extremely positive in terms of taking over that role. I would rather step into an organization that is less successful rather one that’s faltering so that you can take it to the next level. Because then you have a real struggle even to get up to a baseline and you can really elevate an organization into being truly innovative and looking at the next frontier.
So it’s been great in terms of taking over an organization that John obviously, over the years, had built into a highly innovative organization and taking advantage of that directionally. We’re moving more from the federated model to an enterprise model, but still being able to take the positive aspects of innovation forward into that enterprise model.
Guerra: When John announced to you he was leaving, did you immediately know that this was the position that you wanted to go for, so to speak, or did you have to think about it?
Noga: Yeah, I absolutely knew I would have an interest in the position from the get-go, as I really saw it as an opportunity. There are other opportunities; obviously, you get calls from headhunters consistently, but there’s no other organization that I would rather lead than the Partners HealthCare organization.
Guerra: Now I believe they did a full search. So tell me about that. Did you formally have to put in a resume and interview and all that type of thing?
Noga: Oh yeah, and appropriately so. With a position that important in an organization, there should be a formal search process. So yeah, I went through the process and I think it was invaluable to me and the organization — regardless that I had been there 20 years — really being able to meet a broad swath of individuals; some I’d been in meetings with many times but really never had the opportunity to talk about my vision and approach to leadership and IT. I always believe when you’re interviewing for a position, the organization is interviewing you and you are interviewing the organization to have some certainty that it’s the right move.
Guerra: Right, so it was a very formal process and you interviewed with some people that you knew well — did you have to kind of stay more formal than you might have in another encounter with them?
Noga: I don’t know if I’d say formal. I always try to be, as I would term it, professional but I tend to always try to be professional in the job environment.
Guerra: Right. So then you got the position, and now you work for Gary Gottlieb, who’s a physician and is president and CEO of Partners Healthcare. So you used to work for John and now your report to Gary. What’s the difference for you in terms of now reporting to Gary — are there different styles and different things he expects from you than John did? Everyone’s different; we mentioned that people are all different and when you get a new boss, they’re different. So how has that been?
Noga: Well I think it’s been positive, as Gary is very informed when it comes to information technology. He’s actually, I think, an RPI graduate, so he understands technology. Also I think what’s different is really hearing from Gary his vision and strategy. He’s done some organization in terms of how we function as leadership group. So being truly engaged in the Partners Healthcare Strategy on a day-to-day basis — that’s different. Obviously when I worked with John I got that information, but it was filtered through John, and I think he was very transparent. But it’s just a different feel when you’re working directly with the leadership team.
Guerra: Has there been a big change in the skills that you need to bring to the table from being the CIO of a single hospital to now CIO of the health system? Have you had to call on different skills or just have a different scope?
Noga: The scope absolutely is different; in terms of the skill, it really is streamlining decision-making and getting us all on the same page. As I said, I have a very bright group of people that work for me, and the skill really has been leveraging that knowledge; leveraging that expertise toward an enterprise mission, while at the same time respecting the needs for each of the sites. Now that, in some sense, I was very well prepared for, having been a site CIO and understanding that there are enterprise initiatives but there are still real site initiatives that need to be addressed. I do think we’ve had a shift as a team as to say that even on the side initiatives, we need to move toward standardization beyond the core clinical systems; as we look at departmental systems, we want to be opportunistic in terms of standardization.
Guerra: That’s very interesting. So you were able to harken back to your days at MGH and say, ‘This is how I felt when I was felt like the organization was steamrolling us as a site.’ So you have a little more sensitivity.
Noga: Yeah, I don’t know it was necessarily steamrolling.
Guerra: That’s my word there.
Noga: It’s striking that balance between the enterprise initiatives and the site initiatives and also part of my role is making sure that everybody has the discussions and there’s a general understanding of what’s going on throughout the network so that we can be opportunistic as to where we can standardize.