When it comes to playing a key role in developing and executing strategies, CIOs are finding that an organization’s reporting structure isn’t as important as the relationships among its leaders. While some CIOs feel their opinions are highly valued, others believe IT is being put in a corner.
According to the September healthsystemCIO.com SnapSurvey, 38 percent of CIOs answer to the CEO. Of those who don’t, 30 percent believe who they report to isn’t important; what matters is that they are able to participate in decision-making and do their job “without interference.” As one respondent wrote, “a good CIO will be influential in the organization regardless of reporting structure.” In terms of decision-making, the vast majority (79 percent) believe they are active players. For those who are not, however, it can get dicey. Some feel that their input isn’t valued — or that they can’t express negative opinions, while others say not having a seat at the table hinders their ability to plan and budget.
One relationship that is absolutely critical is that between CIOs and physicians. “At the end of the day, docs can, and will, make you or break you,” wrote one respondent. Although most CIOs (85 percent) believe physicians have a clear understanding of their role, some struggle with the issue. One CIO noted that physicians refer her as “our computer lady.” The key to a successful partnership, according to respondents, is in “ensuring physicians are part of the solution.”
(SnapSurveys are answered by the healthsystemCIO.com CIO Advisory Panel. To see a full-size version of all charts, click here. To go directly to a full-size version of any individual chart, click on that chart)
1. Who do you report to?
- I would not work for an organization where the CIO does not report to the CEO.
- Best boss I ever had.
- I have a CIO/Director title, so I am a C-suite who isn’t really.
- I report to the CEO for strategic planning and to COO for operational issues.
- Chief Innovation Officer – a new position, essentially equivalent to reporting to the CMO.
- SVP Health System Operations – dotted line to CEO.
- COO and CMO – It is an odd reporting relationship. However, I report into what we call our Clinical Enterprise, which includes our hospitals, all outpatient sites, and business integration team.
- Board of Directors
2. If not the CEO, should you report to the CEO?
- There is so much that I know I miss being part of. I get information secondhand or not at all and cannot influence as well I could (based on my last two jobs reporting into the CEO).
No, it doesn’t really matter to me because the person I report to is great. If they weren’t great, it could be a problem.
- At first, I wasn’t sure of this structure, but now that I have experience with it, it’s fine. I like the dotted line to CEO. If I didn’t have that, then I’d express concerns.
- A good CIO will be influential in the organization regardless of reporting structure. If you have to rely on who you report to in order to get things done, it may not be the right organization for you.
- Reporting on the physician side is more appropriate and better positions and enables me to be effective.
No, who I report to is just not a big deal
- I work actively to have full relationships with CFO, COO, CEO, CAO etc. It is a must. I must be at the table as a member of administrative team.
- My perception is that CIOs are too focused on this question — that anything but working for the CEO is some sign of indignity. The CIO ought to work for the person best positioned to propel the strategy forward. Some CEOs don’t like lots of direct reports. In many ways, as a CIO you “work for” the whole executive leadership team.
- As long as I can do my job without interference, I don’t care who I report to.
- The COO is the right person for me to report to in this organization.
- I do report to the CEO; however, in prior positions I have reported to other folks. I would suggest that the CIO position is most effective for the organization when reporting to the CEO. IT is expensive (CFO focused on dollars). Too much of the “future” of healthcare is dependent on the strategic successes (COO focused on today), and it is too universally important to be tossed in an area managed by a shared services EVP or the like. The position is too complex to have others carry our message to CEO.
- I treat my job as if I have about 100 bosses. The CIO needs to work collaboratively with the entire management team. If I ever feel I am relying on “positional authority” (the fact that I report to the CEO), I am on shaky ground. The CIO exists in the “white space” and needs to be a collaborator and a consensus builder.
3. Does the individual you report to appreciate the value that technology can bring to healthcare?
- We’ve worked together for a number of years.
- She is energetic and interested, and now with MU, we’ve become a revenue department! CFOs love that.
- He is a physician and was the CMO. He was the Chief Quality Officer as well, so definitely knows the importance of technology.
- Although, try as they might, at times they still underappreciate the complexities to plan and execute.
- To a degree. My CEO understands the value, but has a tendency to oversimplify the complexity behind it. It is my job to educate my boss and peers to make the IT “black box” more transparent.
- He understands the value yet does not appreciate the advantages of strong governance and thoughtful, consistent application of the technology. He does not appreciate the value to be achieved if technology and work processes are effectively melded together.
- Yes, but man, they sure DON’T get the BI opportunity we have even after developing a strategy and hitting them over the head with it.
- The entire senior leadership team is supportive and collaborative. I have a great working relationship with the CEO, the CFO, the COO and the CMO.
4. Do you truly have a seat the decision making table or are you informed of decisions after the fact and expected to execute?
Yes, I have a seat the table
- I am part of the senior leader team.
- I have a seat at the table. However, the reality of the rapidly transforming healthcare business is that decisions do at times get made that I have to swim upstream to execute.
- This is not to say it is perfect all the time. I can’t be everywhere a decision is made, and there are times where the technology implications of a decision made by others are not well understood. This doesn’t happen often, but when this happens, the going-in assumption is one of good intentions by all involved, and we work things out. It takes continuing education. Things have gotten progressively better and continue to do so.
- There should be a category embracing “sometimes a seat at the table.”
- We look at technology as a core component of all strategies.
- I have input and influence over all decisions that concern or are involved with technology in any way. I am not consulted, for example, on the business and clinical merits of purchasing a particular specialty practice of offering a specific clinical program at a community hospital. This makes sense to me. I am not seen as “just” the person who “makes the computers work,” but there are clearly areas and decisions that are outside of my expertise. I am informed, but not consulted.
No, it’s formalized that I don’t have a seat at the table
- This can be a problem. Things seem to be improving, but not truly being a peer with, for example, the CNO, is a challenge because you can’t truly say what needs to be said sometimes because you aren’t at the same level.
- If “table” means inner circle. I really did not want to pick any of these as most decisions that impact IS are not made without my input. The biggest issue is not being able to forecast appropriately based on my understanding of what IS can offer.
- No one makes decisions without my input.
- And it sucks. It sucks every day. And it is a pretty big dissatisfier. With the right phone call, I am most likely out of here. But until then, we continue to play ball and work hard at this.
No, it’s informal, but seems decisions are arrived at in discussions or meetings at which I’m not present
- My boss has a very good understanding of technology and its value to operations. He understands how it impacts the workflow of the departments, and that the departments need to take ownership. Unfortunately the other execs do not get it and do not want to get it.
5. Do the majority of physicians you interact with have a clear understanding of your role in the organization?
Yes, and they respect it
- Too many absolutes in this question to make it interpretable. I answered yes and yes, but the answer is more nuanced. We have a CMIO and CNIO who share my leadership accountability in the team sport that is health care IT. Do they respect it always? They respect ACTION. They respect SOLUTIONS. There are barriers, both real and self-made, to action and solutions. And therein lies justified frustration.
- It varies. Many understand and respect it, some do not.
- Being honest, I would say it is mixed depending on who we are talking about.
- I have acted as a CIO and CMIO prior to hiring the CMIO so I have a great relationship with the medical staff.
- I would suggest this to be one of the three most important activities successful CIOs must execute on. At the end of the day, docs can, and will, make you or break you.
- I am lucky to work in an organization where a great partnership exists. This has taken lots of candid conversations to set expectations, and delivering on commitments. Part of the trick has been ensuring physicians are part of the solution to the challenges we face. That creates ownership and better collaboration.
- You need a radio button that is between respect and not respect. Certain physicians – I’d say the majority – know and respect my role in the organization. A significant percentage of physicians do not. They tend not to respect anyone that doesn’t have MD after their name and often don’t seem to respect their peers.
Yes, but they do not respect it
No, they do not truly appreciate that my role is more than to just make sure the computers work
- In fact, some of the doctors refer to me as our Computer Lady.
- IT is put in a corner like Baby. We are paying the price for a failed upgrade three years ago and now our Epic install is “not an IT project.” So we take our moments and move the agenda forward, even if it is at a glacial pace.