Dennis Sato, Interim CIO, Hawaii Health Systems Corporation
Dennis Sato took over as interim CIO at Hawaii Health Systems Corporation with one goal in mind: to select and implement an enterprise EMR system that meets everyone’s needs. But with a health system that includes 13 hospitals on five islands—each of which has its own board of directors, a task like that is easier said than done. For some, the idea of dealing with five separate entities that each has its own IT strategy may seem like a nightmare, but Sato is determined to make it work, even if it means making unpopular decisions, and finding victories in the smallest places.
Chapter 2
- The fine art of navigating political waters
- How to say things, “Without getting everybody too mad”
- Implementing unpopular policies and procedures
- Beacon Partners for consulting help
- “They have done a good job, and I’m not the easiest guy to work for”
- Finding success in Hawaii
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Bold Statements
Yes, you have to be a politician. But you have to be someone that’s going to build team work; a collaborator, and I think that’s one of the main things. You also have to have the business acumen in order to navigate through the challenging times.
I had CEOs call me up and challenge me, and you know what? You have to take that stance. If you don’t, not only are they going to not only walk all over you, but you’re not doing what’s right for the organization, and the long term effect is not going to be good.
RFPs only tell only one side of the story. I had to use some of my knowledge of the industry to say, ‘Hey, these people are not that bad. Look at their references.’
With most of the consultants that come over here, I actually spend a few days to give them a little culture of the makeup of Hawaii, the people, and their beliefs and their work ethics. Because with some people, if you make them mad, they’re not going to show up for the rest of the month.
Guerra: I’ve interviewed quite a few CIOs, and often we’ve talked about the political part of the job—you’ve got that times 50 from any CIOs I speak with. You have to deal with political aspects and navigate the waters of personalities and where people’s motivations are coming from. It must require a lot of savvy.
Sato: Well in my background, I’ve been on health care boards. I’ve been participating and I’ve been an elected official. Right now, I’m on the Northern California HFMA and the Northern California HIMSS chapter, and I also participate in some of the national things in addition to CHIME.
But you know, that just gives you a lot of technical knowledge and some leadership ability. But you’re going to really have to negotiate the job of being a politician, and the way to navigate is probably just as important as leadership, because if you get in these situations, and the new CIO, as I look at is able to do all of this stuff, that’s really important. When I was in Oregon helping them up there, I was on the physician quality committees and I was on the other committees. You need to be able to be able to negotiate that. You need to be a politician and say things without getting anybody too mad. Everybody is not going to agree with you. When I first got here, one of the regions was saying, ‘We’re going to do what we want to do, and it’s none of your business.’ This is from a physician that was on the board. And he also said, ‘Do you want me to pass everything? If I need a fax machine; if I need to do anything?’ And I said, ‘Yes. Anything that has to do with technology and is going to impact not only in your hospital but others needs to come to this committee.’ So I negotiated policies and procedures, actually made definitions as to what we are we talking about.
Guerra: Right.
Sato: But he said, ‘Well, you got to give me a list.’ I said, ‘I’ll give you a definition.’ And so, when I first got there, it was not easy. You know, when you get that from a physician that is bringing business into your facility that’s talking and is on the board, that’s not easy.
So yes, you have to be a politician. But you have to be someone that’s going to build team work; a collaborator, and I think that’s one of the main things. You also have to have the business acumen in order to navigate through the challenging times, and I think I brought that. This is my sixth job as a CIO. People have recruited me to go and try to help them do things—places where they never did that before.
Guerra: It’s easy to say yes, right? That’s the easy part?
Sato: Oh yes.
Guerra: They’ll say, ‘We’ll do what you want. We’ll work your way. But, you know, you just made a point that when they said, ‘Are you telling me everything has to come through you,’ and you said, ‘Yes.’ So sometimes you have to hold the line and let them know that they’re not going to walk all over you.
Sato: Well, that’s what I established at day one when I came in here. Right now, I’m the interim CIO, because we had a new president, we had an interim CEO, and an interim CFO. And so my thing was that they wanted me to come in and to assess the organizations and I felt that I had to do the right things, even if people are going to be after my neck, which happens all the time. But I needed to take that risk in order to make it successful. Because, prior, everybody said, ‘Yes, yes, yes.’ But I had CEOs call me up and challenge me, and you know what? You have to take that stance. If you don’t, not only are they going to not only walk all over you, but you’re not doing what’s right for the organization, and the long term effect is not going to be good. And so yes, you may get fired. That’s part of politics. But if you don’t take that chance and that risk, you’re never going to get where you want to be.
So I guess I have enough confidence in my ability. And yes, I may not be the most popular person, but I think if they see the results, which I think they’re starting to see in a lot of these things we do and the coordination of all of us working as a team for all the reasons, I think they will have some confidence in me and respect. And that’s what my main thing is, building respect, confidence, and the ability to be accountable and to execute.
I think those are the ingredients of a good CIO or any leader.
Guerra: Right. Let’s go back to beginning a little bit. So, you come in and you see a largely paper-based system, a little bit of McKesson MedSeries in there.
Sato: It’s Series—they call it McKesson Series.
Guerra: Okay. And I know at some point, you decided to bring in Beacon Partners as a consultancy. So, take me through that. Did you know right away that you were going to use a consultant, and how did you go about selecting Beacon?
Sato: Yeah, what happened was the interim CEO called me up and said, ‘Help us make a selection of a consultant.’ They already knew that they were going to bring someone in to help them with this process. So I came in and kind of helped generate the RFP to go out there. We have some very strict procurement laws here now. So we did that process and spent about three months looking at everybody out there and scoring them and bringing the finalists and all that.
And, unfortunately, not everybody in Hawaii knows all these firms. When they looked at RFPs, RFPs only tell only one side of the story. I had to use some of my knowledge of the industry to say, ‘Hey, these people are not that bad. Look at their references.’ I know most of their references and I know most of the executives of most of the major consulting firms, because I’ve dealt with them in the past. And I said, ‘You have to get past what you think you’re reading.’ And so I helped them through the process.
Beacon, who I never worked within the past, was actually in the finals. So they came over here and told this story and they had some very good answers as to how they were going to help us get to where we want to be. And so they were selected to the process by a selection committee, and that’s just not me. We brought Beacon in around July and they’re still here.
And they’ve been taken through the RFI process and the RFP process. We’ve had, I would say, hundreds of people involved with the requirements definition of what we’re going to get. Because we didn’t want it to come from the executives; we wanted to go down to the workers to help us develop requirements. And so, we’ve done over and over for all the regions, actually. We brought them together and went through requirements and prioritizing what we thought the needs were. So Beacon has actually done a very good job, and I’m not the easiest guy to work for when you want results, I have to say. Because everybody has their own kind of method, what they use on, for example, the Mainland. I said, ‘This is a different environment.’ So I talked to their senior executives and I had Charlie Anastos, Beacon’s executive vice president, come here and sit down with all the executives, and they said, ‘This is Hawaii. These are the things you need to know about our culture. This is how you work with our individuals and this is how you’re going to be successful.’
We’ve had a lot of consultants come over here in the past—good consultants carrying brief cases. But we just don’t work like that over here. And they were selected and they’re still here and helping us through the process, and we’re down to the wire now.
Guerra: What were some of things, the cultural things, that you told them? You said being in a suit and carrying a brief case doesn’t really work. Are those things really important to where a consultant has to take that part to heart to fit in better?
Sato: That’s exactly right. When you come to Hawaii, you have to fit in, you know.
And how you fit in is to, first of all, understand a little bit about the culture and about the people—what are their beliefs, how are they with their work ethic, and then, what works best; how do you work best with them. It’s not the way that some consultants will come and say, ‘Well, this is way we’re going to do it. This is how we’re going to be successful. We’ve done this in many other states.’ It’s not like that. You have to sit down very detail-wise and explain what we’re going to do. And so with most of the consultants that come over here, I actually spend a few days to give them a little culture of the makeup of Hawaii, the people, and their beliefs and their work ethics. Because with some people, if you make them mad, they’re not going to show up for the rest of the month. This has happened before.
And we’re a heavy union state here. Most of our employees are union workers. So you have to be sensitive working with unions with what you can or cannot do. I think that’s one of the main things. And yes, you have to come here and wear a Hawaiian shirt and eat some of the malasadas and some of the local food, and kind of integrate or assimilate into their culture. The ones that do that, once they have the confidence, they’ll work with you and they’ll do everything you need. And that’s where a lot of consulting firms and vendors do not know the difference, you know. They come here and think, ‘It’s just another island; it’s no different than in anywhere else.’ But it is a big difference.
Many of the people we hire—the CEOs that come over here—their families cannot adjust to the educations, and they cannot adjust to the culture. And eight months later, they’re gone. And this will happen over and over and over. So, yes, you have to sit down and tell them, ‘This is how you act. This is how you conduct meetings. This is how you get everybody involved.’ Because a lot of people will say nothing during the meetings, and I say, just because they say nothing, it does not mean that they agree with you. So you have to continue to work with them and bring out that feedback. And it’s both ways. Once you do that, then you understand what they’re talking about, and they understand you. Otherwise you leave the meeting and everybody says, ‘Well, we’ve accomplished everything,’ but that’s not true.
Guerra: Right, right.
Sato: So those are some of the differences. And I think a lot of the consulting firms and vendors would like to come out here to learn this because there are a lot of real communities on the Mainland. But we’re in a global economy now. So you have to learn how we deal with it, and you have to deal with the people that are here and where they came from.
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