Paul Roemer, Managing Partner, HealthcareIT Strategy.com
On NPR I listened to an interview of the man whose job is to ensure the reliability of the electrical grid for the northeastern US. As you might suspect, the country’s power plants are all interconnected. That way, if there’s a problem with one, power can be rerouted and we can still make our cappuccinos. There are built-in backups and redundancies. Most times it works—most times. A few years ago a technician did something to the grid in Ohio, and managed to take out the electricity to several states in the northeast for many hours.
The interviewer asked the individual to describe his job. His answer, “Most people have no idea what I do. Typically it is weeks and months of simply going about my business, interrupted by occasional sheer panic. Usually, I’m either ignored or criticized.”
Sound familiar? It should. That describes how many CIOs view their situation. Your C-suite peers often have little or no understanding of what you do. There are weeks and months of going about your business, interrupted by occasional chaos. The end result, you are either ignored or criticized.
It can be a circular pattern. Oftentimes, those doing the criticizing are the same ones who if push came to shove could not write two paragraphs to explain the mission or responsibility of the CIO and the IT department. I have worked with CIOs for about thirty years. Some are great technologists, others are great managers—some are both.
A large number of CIOs, regardless of industry, are thought of by their C-suite peers as people who have a much better understanding of technology than they do of the industry they serve. I think this is part of the reason there are so many Chief Medical Information Officers popping up. This type of position—a second set of eyes—sort of a functional CIO to compliment the technical CIO—is unique to healthcare. There are no Chief Retail Information Officers, no Chief Manufacturing Information Officers.
IT is all too often viewed as an order taking repository, people who do the bidding of those who see themselves as having a better understanding of the business.
There doesn’t seem to be much middle ground. CIOs are often measured by their “peers” on three highly visible metrics—deadlines, value, and cost control. Did the CIO deliver what was expected, when it was expected, and for the agreed upon cost? That same peer group, those who could not write the two paragraphs, are quick to take credit for IT’s successes, and quicker to absolve themselves for their contribution to perceived failures.
The peer group—the one who credits themselves with having the best grasp of the business—is the same group who too often withholds their business expertise when it is most needed. When is that? When it is time to contribute their resources’ knowledge to define requirements and business processes, to plan change management, to be trained, and to participate in user acceptance—a sure recipe for failure. Whose failure? IT’s, naturally.
The CIO hears phrases like:
- Who will pay for my people to work on your project
- My people have their real jobs to do—as if your job is some obscure hobby
- I can probably free up someone to attend a one hour meeting every now and then
There are very few CIOs who actually need an EHR, yet EHR is often viewed as their project.
Since nobody is going to change the perspective others have of the CIO and IT, the CIO and IT must facilitate change for themselves. Instead of always being on the receiving end of project orders, one way to change perspective is to sponsor efforts to the C-suite that solve business problems defined by IT.
For example, instead of coming to the table with an idea for implementing social media or patient relationship management (PRM)—solutions looking for a business problem to solve—come to the table with a business problem or better yet a business opportunity whose solution lies in social media or PRM. IT can take the initiative to:
- Inventory and document the business processes and business rules.
- Determine which processes create waste, which ones are redundant, and which ones add nothing to the bottom line.
To be thought of as someone at the table who understands the business at the same level as the others at the table, come with initiatives that pay for themselves; those that make the business more effective, more efficient, reduce costs, and increase revenues.
Jorge Grillo says
Paul:
I tend to agree with your assessment. Strangely no matter how much we tend to educate or inform, most of what we do is still “magic” to many of our peers. Interestingly as I get ready to transition out of my current role, many of the peers have wondered if — since I have so much knowledge about all the non-IT based processes like patient registration, billing, and clinical informatics — should my successor have these too. That got me to thinking about the true role of the CIO and how most of my day is not filled with technology decisions but rather facilitating process changes and implementing strategic direction. I then thought about the last time I even entered my data center and was surprised that it had to be 6 months or more.
To me, that means the role of the CIO, although centered around IT, is much broader. In my case, I also have executive responsibility for a third of the corporate revenue-generating areas via LAB and DI. In interviews it came up time and again how that was really just an expansion of the CIO role and added greater overall value to the organization. In terms of what you posted, it is still just: inventory and document the business processes and business rules while determining which processes create waste, which ones are redundant, and which ones add nothing to the bottom line. Again, IT is not about technology in itself, but a tool to enable business. That makes the CIO a business consultant or strategic enabler.
J
flpoggio says
Excellent article Paul, I particularly liked the statement:
For example, instead of coming to the table with an idea for implementing social media or patient relationship management (PRM)—solutions looking for a business problem to solve—come to the table with a business problem or better yet a business opportunity.
If I may paraphrase…solve real business problems. However in order to do that you really need to understand the nature and some details of the business you are in. As a former CIO and CFO from a teaching hospital I know that takes a lot of work, time, communication, and effort.
There was a very good article in the Wall Street Journal on May 24, 2010, entitled ‘Why CIOs are the Last Among Equals’. Basically it stated that CIOs that are not equal are usually missing one or more of these broad management skills:
1) Leadership
2) Strategic thinking
3) Synthesis skills
4) Communication skills
5) Influence skills
6) Relationship skills
Most of us are more than familiar with this list and their importance such as leadership and relationship. The one that jumped out at me is ‘Synthesis skills’. This is where not only having the technical acumen but also the in-depth domain knowledge is critical. In order to deliver the right tools to solve a business/ clinical /medical problem you have to have a good understanding of the underpinnings of the problem. Otherwise all you end up doing is temporarily alleviating the symptom. Of course, the involved line executive must also have an even greater understanding of the causal elements, but the CIO has to understand those and translate them to technical solutions.
Although I do not think you need to be an MD to be an effective CIO, it behooves the CIO to learn about the practice of medicine and its underpinnings. Much the same way a good commercial CIO should have a solid understanding of the retail or travel world. Unfortunately it is easier to understand the retail or travel business than medicine. Particularly when in my opinion fifty percent of medicine is science, and fifty percent is art. Think about it, as a species we have been trying to ‘reverse engineer’ the human body since we first stubbed our toe. When we came into this world we did not come with a spec sheet or maintenance manual. Airplanes do.
CIOs in the health and medical field have unique challenges that make it even harder for them to be considered ‘equals’.
Frank Poggio
President
The Kelzon Group