Lots of ink has been spent on the increasing complexity of the CIO role and the new attributes needed to be successful in the job. Similar amounts have been dedicated to how to cope with these demands. Perhaps it’s presumptuous to consider my habits effective, but these have been the core planning categories that have sustained me in my three-plus years as CIO of Newton-Wellesley Hospital and as a Corporate IS Director at Partners Healthcare. The following elements are the titles of my Outlook subfolders and some of the current items of focus. These are regularly running through my mind.
1. Staffing – I joined GE in the mid-eighties when Jack Welch was still in his early years as CEO. In those days he was vilified as “Neutron Jack” because of the personnel cuts he made across the company. What has become clear in his retirement as he writes books and speaks is that he placed great emphasis on hiring and developing the very best people. While many CEOs might have their CFO as their right hand person, Welch talks about his VP of HR as being of ultimate importance.
I am always on the lookout for the best talent and working hard to reward and recognize my high performers. Welch, Jim Collins (Good to Great) and others have written about employee differentiation and helping low performers either improve or move out of the organization. Our hospital practices this basic framework and it forces me to make sure we are always raising the bar on expectations of staff. We give them the tools to grow and we expect them to be increasing their contributions over time.
The employees’ well-being is the first thing on the agenda for all of my direct reports and in my leader meeting. I expect annual reviews and career growth conversations (both are documented) to be done on time. Open positions are filled as soon as possible with contacts we know from our own company, other providers or my professional society. Right now, we are fortunate to be fully staffed.
2. Budget – I don’t like that budget is second, but one can’t do much of anything without a budget, so it sneaks in before the strategy category. Because some of my infrastructure services are provided by Partners, the budgeting process can be quite complex. On the operating side, I get my allocations (corporate taxes) from the Partners budget, then load them into my hospital budget. As both organizations work through the budget processes, reductions need to be made from my local spending and from corporate services like network engineering.
A common lament of hospital-based staff is that we can’t do that much to affect the corporate allocations, so it’s difficult to add staff locally. In any case, the annual budget must be secured to cover our labor expenses and for any growth in maintenance contracts, utility usage and more. Since automation goes part and parcel with process redesign, IT expenses rise. Hospital budgeting processes don’t always account for such increases, not to mention initiatives like Meaningful Use or 5010/ICD-10.
For capital, our hospital begins the process in December and approves by the end of March, halfway through the fiscal year. Clearly, much of the year I need to keep my attention on the budget process and align resources with demand.
3. Strategy – I have three things in the strategy bucket right now: Meaningful Use,
Common Clinicals and Studer. Like everyone, our Meaningful Use strategy is to get the maximum stimulus at the earliest possible time and avoid all penalties. We have a project plan to meet that goal and are waiting for the final rule to see if there are more gaps.
Our corporation is considering a more common approach to clinical systems, so we are evaluating how our hospital fits into that framework, what gaps exist and how that might compete with achieving Meaningful Use.
Finally, Studer refers to Quint Studer from The StuderGroup – we’re disciples of Quint’s principles at our hospital. We are undergoing an evaluation of how we can improve our processes and become the best service department we can be to contribute to the overall organizational excellence goals of the hospital. Most of the focus here is on reducing the support burden to increase project throughput.
4. Governance – for the past three years we’ve had an IS Steering Committee composed of interdisciplinary administrative and clinical leaders to prioritize big projects. Our Clinical Applications Advisory Committee (formerly CPOE Steering) is made up of physicians and nurses and is used to make decisions around clinician workflow and use of systems. This committee is being reformed into our Meaningful Use Steering Committee and will be co-chaired by our CMO and CNO. I also keep track of our IS Project Management Office, a bi-weekly meeting of our project managers and IS leaders where we monitor health of major projects and arbitrate resource conflicts.
5. Operations – fortunately, we’ve been experiencing relative stability in our network, telecommunications and data center operations. Some of these things are managed by corporate groups – network engineering and Help Desk for example – and we are responsible for our nightly MEDITECH backups and other servers.
On my operations list right now is the conversion of our data center operators, computer technicians and systems administrators to corporate groups. Because of deeper penetration of enterprise applications, a more complex environment and career growth opportunity for staff, we are aligning more of our local folks into corporate groups. We will experience some bumps as we work out standard operating procedures and learn to work within our corporate matrix.
6. Users – I have several subfolders for hospital departments and clinical chiefs. One item at the moment is that our Chair of Medicine is in Italy and wants us to filter out some emails while he’s on vacation. Another item involves a large physician practice needing access to our MEDITECH system in their office and access to their EMR in the hospital. All the regulatory and legal items are clear, now I need to make sure it happens smoothly and the physicians know how to use the systems.
Our hospitalist group is adopting a web-based “sign-out” system for internal clinical communication. The implementation is pretty simple, but we need to help them navigate some email, desktop and firewall settings. It’s a small project that will greatly contribute to their efficiency and happiness, which is nice because our focus on fiscal/administrative projects over the past three years has left the physicians wanting.
7. Vendors – our relationships with vendors always need care and feeding. My technical manager handles most of the infrastructural and telecom vendors while I deal more with MEDITECH and our other large vendors. At the moment, we are negotiating to purchase a physician documentation module that is needed for Meaningful Use. Our Department Coordinator also gets the pleasure of triaging the many calls that come to the CIO from staffing vendors and other un-qualified calls.
I did technical sales with GE, so I’m sympathetic to many of the salespeople who are trying to make contact. On the other hand, I think people often don’t realize how many calls and emails come in for things that I just won’t be making a decision on or really influencing in any way. Sadly, many of those have to go unanswered.
8. Administrative/Professional Development – like everyone, I have the many hospital and corporate level IS committees on which I serve and contribute. Right now our hospital is also adopting an electronic leader evaluation tool, so I need to make sure my goals and those of my managers are in alignment with the hospital. We are also launching an IS Newsletter to help users understand more of what we are accomplishing and to help stave off the bad karma around the number of times we have to say “no.”
For professional development activities, I’m finishing up an Advisory Board Fellowship program for executive healthcare leaders. I have to report on my practicum for the class which has been around our direction for next generation clinical systems. I’ve also recently been elected to the HIMSS and IHE-USA Boards, so there is a lot of reading and prep materials for upcoming meetings.
There is much to keep track of, but I find this framework helpful for weighing and staying on top of priorities. My biggest challenge now is to get these categories out of my head while watching our son’s baseball game or sitting in church.