After years of taking on responsibility after responsibility, John Halamka, M.D., CIO, Beth Israel Deaconess Medical Center, found the increasing demands of his many roles meant one would have to go. Considering he’s a doctor fascinated by the challenges of accountable care, it’s not surprising the CIO role of Harvard Medical School wound up on the chopping block. In this interview with healthsystemCIO.com — during which Halamka begins to caution government organizations that the industry is being asked to change too much too fast — he discusses Meaningful Use, ACOs, ICD-10, CIO leadership, and much more.
- Leadership and staff management
- Crafting a sound work/life balance
- The Blog
- The challenge of being a CIO today — “There’s going to come a point in time at which the CIO role is untenable”
- Halamka’s future
The way that I lead is with joy of success, a non-punitive culture based on loyalty and trust and openness where you say, ‘Congratulations on your success.’ ‘Oh, something didn’t go so well? How do we change processes so it goes better in the future?’ And that creates a highly motivated work force.
We tend to look for people who have a personality and a work ethic more than we care about their specific domain expertise, because I can always train people in a new technology, but I can’t change their personality.
I use the blog as therapy. And in that way it’s never a burden because I reflect on the events of every day and I say, ‘There’s something that happened today that others could benefit from,’ or ‘this is a real challenge and I don’t know the answer.’
I think the challenge of being a CIO today is that the demands are infinite, supply is finite, and complexity is accelerating. There’s going to be a point in time when the CIO role itself becomes untenable.
The reason I stay at Beth Israel Deaconess is because it’s a wonderful platform for innovation at a state and federal level. I can test ideas here. As new federal legislation is created, we can be a pilot site. So I will look at the next couple of years as continuing to innovate, and hopefully having roles in state and federal policy making.
Guerra: Let’s talk a little bit about leadership and staff management. You’ve written about high-performing teams, you always talk about respect and collaboration, and many times you’ve mentioned not throwing each other under the bus and no blind CC’s on e-mails, things like that. For the readers and listeners, talk about your overall philosophy on leadership and being the kind of leader that people want to work hard for.
Halamka: Right. So there are two leadership strategies. And as a parent, I can tell you this, you can either create a joy of success or a fear of failure. And the way I parent and the way that I lead is with joy of success, a non-punitive culture based on loyalty and trust and openness where you say, ‘Congratulations on your success.’ ‘Oh, something didn’t go so well? How do we change processes so it goes better in the future?’ And that creates a highly motivated work force. The turnover rate at my hospital IT organization is two percent per year. So people are around because they like the culture.
Guerra: Well that made me think a few things. One is that you must be getting a lot of the right people on the team. So what can you tell us about your hiring practices? I would imagine you’re not interviewing everyone personally for every position. But have you put things into place that help ensure you get the right people on board?
Halamka: We have multidisciplinary interviews with people above and people below the position. Generally, what we want to do is have deep discussions with references and figure out what people have done in the past. I have this strong belief that past performance is the best indicator of future performance—as opposed to stocks where that’s never the case. And so if somebody innovated and created a wonderful application in the past, it’s likely they’ll be able to do it in the future. We tend to look for people who have a personality and a work ethic more than we care about their specific domain expertise, because I can always train people in a new technology, but I can’t change their personality.
Guerra: So you’re not looking for someone to come in the interview and say, “Listen, I haven’t done much but I’ve really changed.”
Halamka: Yeah. So if you have somebody who says, ‘I have a passion for healthcare because here’s my personal story of my parents and here’s why I want to work here. And I don’t know anything about this language, but I know these three other languages,’ that’s no problem. We’ll train you in the new language. You got the personality, you got the passion.
Guerra: Right. You talked about the non-punitive environment. Everybody makes mistakes in terms of getting the wrong people on the team. I’m sure you’ve had one or two of those. I can’t picture you getting mad. I don’t know why.
Halamka: That’s because I never have.
Guerra: You never got mad?
Halamka: Yeah. Yesterday, was my 27th wedding anniversary.
Halamka: And so I asked my daughter, ‘In your 18 years of life, have you ever seen mom and I fight?’ And she said, ‘No. I mean, you have deep discussions, you have adult debates, but you’ve never fought.’ And the same is true about my workplace. Because of the lack of caffeine or alcohol, I’m just sort of even all the time. Because of my emergency physician training, I know about triage and control of emotion. And so generally, what we’ve done is not hold people accountable for mistakes. We really look more at the processes that enable the mistake.
Except occasionally, there are people who have a personality or a consistent pattern of behavior that impedes the work of others. And if somebody sabotages—if somebody is Machiavellian and manipulates or is truly preventing others from doing their job, then they go.
Guerra: So you have no problem addressing if it’s got to be addressed?
Halamka: That’s true. If somebody came to me and said, ‘I accidentally formatted a hard drive and lost mission critical data,’ I’d say, ‘Okay, let’s figure out how we set administrative permissions that enabled that action to happen.’ It’s not, ‘you’re fired!’ It was a mistake; it’s an honest thing. If somebody, however, said, ‘I purposefully erased this stuff because it had conceivably bad information about me that would have hurt my career,’ well, that’s another problem.
Guerra: So you will address what needs to be addressed, but in a calm way, not in an emotional way.
Guerra: I read on one of your posts that you don’t inflict your own work schedule on any of your teams, and your last true day off was in the summer of 1984. My question is, what did you do on that day?
Halamka: Ah, this is pretty funny. So my wife and I were married in August of 1984, and what would the ideal honeymoon be if you could set any place in the world? Well, I decided, ‘Wouldn’t it be great to do ethnobotany with a former cannibal tribe in the Amazonian jungle?’ And so in August of 1984, we spent some time with the Shipibo tribe and I got cholera. And it turns out it’s really hard to run an IT organization from the Amazon with cholera.
Guerra: In 1984.
Halamka: Right. Now, it would be easier. But back then, not so much.
Guerra: Alright, so that was your last day off. Let’s talk a little bit about your blog. You’ve got a schedule. I believe you write regularly on different topics on different days.
Halamka: That’s true.
Guerra: So you have to produce. Do you ever feel like it’s a burden, or you’ve got nothing to say that day and it’s kind of slog to write something?
Halamka: Monday through Wednesday, I write about policy and technology, Thursday is something personal, and Friday is on an emerging technology. I use the blog as therapy. And in that way it’s never a burden because I reflect on the events of every day and I say, ‘There’s something that happened today that others could benefit from,’ or ‘this is a real challenge and I don’t know the answer.’ So by writing every day, it’s magnificent discipline to, in effect, record your lessons learned from every 24-hour period.
Guerra: Definitely. I write every week, and it forces you to think and clarify your thoughts, so it is a benefit in that way, right?
Halamka: Exactly. And I find that as I’m writing the blog, there is something about the action of writing that crystalizes your thinking. And you suddenly say, ‘Oh, here’s the path forward,’ or ‘here’s the best way to describe that problem.’ In fact, I sometimes think that if I could only lead by blog as opposed to spontaneous speech, it’d be so much clearer.
Guerra: Right. Do you encourage your staff to read your blogs so they know what you’re thinking?
Halamka: I don’t specifically tell them to read it. I think that many of them do. But the blog just turns out to be a great vehicle for sharing lessons learned across organizations, breaking down silos, and getting thoughtful feedback from the rest of the industry.
Guerra: In one post, you addressed some criticism you had received. Somebody said, ‘what are you doing blogging at three in the morning? You should be working.’
Halamka: The issue was fascinating. There was down time at one of my organizations, and I had published a blog that evening on my experience in Scotland tasting single malt. And so they said, ‘Wait a minute, we have downtime and you’re out drinking.’ And my point was in the blog, I actually wasn’t talking about drinking. I was talking about how in the culture that I was in, what are the kinds of beverages served, where are they served, why are they served, and what can you learn from them. And in this particular case, I was on a five-hour time difference, so the downtime and the blogging didn’t actually coincide. It was a misinterpretation of what I was doing.
Guerra: What made you decide to react to that? A lot of times we’re accused of things, we read things, and usually the best practice is to ignore it. But you chose to respond to that one. What was the thought process on how you went about that?
Halamka: Here’s the fascinating thing. Not that I particularly want a political office—I mean, being a politician today is probably not the greatest thing. But I have now posted 1,000 articles online with every opinion—opinions that are positive, opinions that are negative, when I was tired, when I was fatigued, when I was happy, when I was sad. So I have several million words that can be attributed to me and used against me. And so the question you sort of ask is, do you write a blog and filter it for the potential that sometime five years from now, a senate hearing will say, ‘So, did you really do this?’
Guerra: You were drinking whisky at three in the morning.
Halamka: Exactly. And so my answer to that is, as long as what you write is fair, I would say be as transparent and open as you want. Don’t close down. Don’t restrict. Don’t filter. Now don’t be mean and don’t become the National Enquirer. But as long as you’re fair and stay open and transparent, that’s the best policy.
Guerra: Correct me if I’m wrong, but you do not respond to comments that people leave on your post.
Halamka: I sometimes do.
Guerra: You do?
Halamka: The challenge is I get over a 1,000 e-mails a day. I’m running this multiple organizations. And the discipline required to actually respond to every comment is hard. So what I’ll do is when somebody has a comment that is of general interest, I will post a response to that comment, usually with a link to other resources. But it’s not that often.
Guerra: Is there anything you consider to be off limits? I know you write about personal things, you wrote about your daughter graduating, a very touching post about that. Is there anything where you’d say, ‘I don’t write about this’?
Halamka: Obviously, the world is filled with sometimes unusual people. And so I would not want to write about anything that could potentially harm members of my family. For example, ‘here is my daughter’s personal schedule.’
Halamka: But beyond that, I reflect on caring for my aging parents; on my relationship with my wife. You’ll see my post on Thursday is actually going to be lessons learned from 27 years of marriage.
Guerra: I’m going to read that with interest.
Halamka: Why has it worked? How is she tolerating me?
Halamka: So if I can share my anniversary message to my wife, not a lot is off limits.
Guerra: I’m five years in and I’m looking for all the help I can get. Let’s talk about rock climbing. That’s your big stress reducer.
Halamka: That’s right.
Guerra: There’s probably an element of danger there, but I guess you don’t mind. It seems like it’s very important for CIOs to have a hobby. It’s easy to become a workaholic in this line of work, but you make sure that doesn’t happen. How do you do that, or when did you know that was important not to become a workhalic?
Halamka: The great thing about rock climbing is when you’re 4,000 feet up on a 9-millimeter rope, you’re not paying a lot of attention to your Blackberry. Have you ever done Alpinism—climbing ice rock, anything like that?
Guerra: Not yet, but I’m open to it.
Halamka: Okay, so it turns out whether you’re five feet off the ground or 4,000 feet off the ground, really all you care about is the three feet around you. How do I get to the next handhold or foothold? So there are some marvelous concentrations when you’re focused on just the three feet around you and how you’re going to go to that next stage. What is the next step—the journey of 1,000 miles, one handhold at a time. So in a way, it’s sort of my form of meditation because it clears the mind and it creates focus. We live in a society with what I’ll call continuous partial attention. You got three mobile devices and you’re playing a game and you’re reading and you’re in a meeting at the same time. The focus on Alpinism enables me to have one singular purpose and really clears the mind.
Guerra: Before I ask my last question, is there anything you want to touch on that we haven’t addressed that you want to communicate to your fellow CIOs, or is there anything you’re working on that you want to talk about?
Halamka: I think the challenge of being a CIO today is that the demands are infinite, supply is finite, and complexity is accelerating. There’s going to be a point in time when the CIO role itself becomes untenable. And so at times, I do reflect on the industry we’re in and ask, when is it too much? And so you will see an increasing number of blog posts reflecting on how we can make our lives a bit more sane.
Guerra: I look forward to those. For my last question, for your future position or career, two things that I could see you doing is taking over for Dr. Farzad Mostashari at ONC, or becoming the healthcare IT czar of Japan.
Guerra: On that note, Dr. Halamka, I want to thank you so much for your time today.
Halamka: Thank you.
Guerra: And I hope to talk to you again soon. Have a great day.
Halamka: You too.