They say everything is bigger in Texas. But Memorial Hermann Healthcare—a system that certainly qualifies as ‘big’ with 11 hospitals and a large network of affiliated physicians and specialty programs—is trying to make healthcare better. One way the organization looks to change the game is by offering different organizational models for physicians and letting them choose the option that best meets their needs. In this interview, David Bradshaw talks about the challenges he faces in establishing connectivity between the hospitals and the various groups of physicians who work with Memorial Hermann, managing an application environment that includes multiple vendors, working with fiercely independent physicians, wearing different management hats, and competing with big oil for IT talent.
- Wearing three hats — information, marketing and planning
- Battling the HIT workforce shortage
- A vendor neutral archive for the image gateway, iPad integration
- Online appointment scheduling — “Can healthcare make the leap to what the airline industry has done?”
- The hard part — “Maintaining a sane, sensible workload for the team”
- Best practices for working with HR
- Career paths — opportunities for today’s sought-after CIOs
We have hit our all-time vacancy number. There are more open positions on our IT staff now than there have been in the 12 years that I’ve been at Memorial Hermann. There’s fierce competition for really good people
There are all kinds of technical skills or nurse informatics skills, but I really try to look at the talent side. Can you fit in a team and can you get work done? Do you want to work hard, do you want to play hard, do you want to have fun, and do you want to be part of building this new model of healthcare in Houston, Texas?
We’ve got a pretty aggressive technology agenda. And I think that we’re an organization that is large enough to be complex and pushing the edge, yet we’re small enough that everybody can get their hand into the critical elements.
It’s prioritization and maintaining a sane, sensible, appropriate workload to the team, because as a CIO, I do spend a lot of time worried that we’re just driving our people into the ground with the work that we’re trying to get out of them.
I think this is a great time in healthcare IT. I see the innovation coming from small companies—guys that are working out of their garage, inventing new software and new systems. At the same time, I see the Cerners of the world and the DICOM Grids and GE, and what they’re doing on a global basis.
Guerra: Let’s talk a little bit more about your career. You mentioned that about half of your day is spent in the CIO role, and half in the marketing and planning role. From talking to you, I’m guessing that you would really miss the marketing and planning. It sounds like you really enjoy that part of it.
Bradshaw: At my core, I’m a technologist. I graduated from Texas A&M University out of an engineering program and was hired into IBM, where I really learned a lot about technology and information systems and wrapping that into a solution to solve real problems. So at my core, I’m the CIO, and I got these other job duties just assigned to me—I enjoy them very much as well, but at my core, I drive the IT business.
Guerra: And what about your staff? Have you felt the HIT workforce shortage in some key positions?
Bradshaw: No question, Anthony. As a matter of fact, when I end this conference call, the HR guys are coming here, because we have hit our all-time vacancy number. There are more open positions on our IT staff now than there have been in the 12 years that I’ve been at Memorial Hermann. There’s fierce competition for really good people, and for creating an environment for those people to stay, and when they do leave, an environment where they realize the grass is not always greener on the other side of the fence. We welcome them back, and we’re very fortunate to get some of our good guys back.
Guerra: Give me a quick profile of your dream candidate. If someone walked in your door with three or four qualifications, what would they be able to do? What would some of their experience be?
Bradshaw: The first thing is cultural fit. We genuinely care about people—family and personal capabilities and personal happiness. I think that’s got to be at the forefront of it. The second is skill and talent. There are all kinds of technical skills or nurse informatics skills, but I really try to look at the talent side. Can you fit in a team and can you get work done? Do you want to work hard, do you want to play hard, do you want to have fun, and do you want to be part of building this new model of healthcare in Houston, Texas?
Guerra: A lot of CIOs I’ve talked to want someone with that clinical experience. They’ll say, ‘You’ve got to have some basic knowledge of IT, but we’ll teach you that stuff. If you’ve worked on the floor—if you’ve interacted with physicians and know the workflows out there, we’re dying to have you.’
Bradshaw: Clearly, we would love those people, and we need them, and we’re out recruiting for them. But I’ll tell you, I wouldn’t want to put one of them in front of the console of an Oracle cluster and ask them to do a copy-back of a 20-terabyte database and set up recovery to a secondary data center. The point I share with you on that is that it takes all kinds. And so clearly the doctors and nurses and pharmacists that are coming into the IT profession—we need them, and we need more of them, and we’re out working hard trying to recruit them and find them in our facilities.
And when you go live with as many things as we’ve gone live with over the years in our hospitals, some of those nurses and doctors and pharmacists and radiology techs just kind of pop up as being interested and very supportive of IT. And that’s where we’ve harvested a certain number of our IT professionals from our facilities that have shown aptitude and desire for go-live. But in addition, we’re out there on monster.com looking for DBAs and net engineers and interface programmers and the likes.
Guerra: So to find those pure technology people to handle that situation you described, is it also difficult to find those?
Bradshaw: Yes. In Houston, we compete against big oil. Exxon, ConocoPhillips, Chevron, Halliburton—they’re all here. They set a certain pay scale in the market place, and we’ve got to be competitive.
Guerra: Do you try and sell the angle that working in healthcare is more meaningful? Do you try to sell that angle?
Bradshaw: To the general technologist? Not really. What we really sell to them is: we’re driving. First of all, we’re not global, so we’re not going to send you to Africa. You can drive to all of our hospitals. And I think we drive a pretty state-of-the-art platform. We just brought up our second data center, and we’ve set up our own replication. We’ve got a pretty aggressive technology agenda. And I think that we’re an organization that is large enough to be complex and pushing the edge, yet we’re small enough that everybody can get their hand into the critical elements.
Guerra: Before I ask you a final question, I just want to open it up to you. Are there any other projects that you’re working on that you want to talk about, or any other thoughts that your colleagues may benefit from?
Bradshaw: Well, going back to the image gateway, we’re working with DICOM Grid now on a vendor-neutral archive—the ability to store all of those images in the cloud, moving beyond just image exchange. We are EMR-enabling our key EMRs with DICOM Grid’s Web browser so that the physician directly sees the images inside of the EMR.
Another key area that we’re working with them on is the mobility platform, so that we can get these images to an iPad, and an orthopedic physician can pull up the MRI of the knee on an iPad in the exam room and show it directly to the patient and say, ‘Here’s your meniscus tear, and this is what I’m going to do when I go in.’ Those are the types of services that we’re working on off of the DICOM Grid platform.
I think one of the other areas that we’re spending a lot of time in right now is the online appointment scheduling area, and really testing whether healthcare can make the leap to what the airline industries have done. So if you’re going to take little Johnny to the pediatrician and he’s got his four-month checkup, do you call the doctor’s office, or can you just go online and find the time that’s synched up with your pediatrician’s schedule and just book it online. That’s an emerging area that we’re starting to do some research and some pilots on to try to reduce the friction for access.
Guerra: I think every healthc arey would like that. That would be help for your consumer.
Bradshaw: So it’s a rich time in healthcare IT. It’s a target-rich environment of how to go apply IT to create the new the model. It’s a good time to be here.
Guerra: I like that expression. It is certainly a target-rich environment, right? There is no shortage of places to spend your budget.
Bradshaw: It’s prioritization and maintaining a sane, sensible, appropriate workload to the team, because as a CIO, I do spend a lot of time worried that we’re just driving our people into the ground with the work that we’re trying to get out of them, and managing that appropriateness with the business. If we’re going to drive this kind of a resource and budget schedule, then we can do this amount of work and those two things need to be synchronized.
Guerra: I have to ask you about that a little bit, because I’ve heard that from other CIOs. I asked one CIO, based on the pressure and the speed that you have to work and drive your team, are you going to lose good people? And he said, ‘Absolutely.’ So it sounds like you would agree that it’s reaching a point of unsustainability.
Bradshaw: Well, I think that’s the CIO’s job with his or her top management team, to not let it reach to that point. And that’s where when you have the credibility in the organization, and the partnership with the line operators, and the transparency, you have to have the trust that we can make sure these things are balanced together. I tell our CEOs from time to time, ‘Look, when you go open a new bed tower and launch a new imaging center site, you don’t do it with the same number of nurses. You go hire some new nurses.’ And we’re no different. If we’re going to invent EMRs in doctors’ offices; if we’re going to invent image gateways; if we’re going to drive CPOE into all 11 hospitals, we’re not going to do that with the same number of nurses. And so we just have to ensure that the appropriate resources are lined up to the appropriate work that we’re trying to accomplish.
Guerra: That is an excellent point. And I think a lot of CEOs and CFOs don’t see it that way. They think, ‘All right, just deploy the team, and they’ll come back when they’re done.’
Bradshaw: I’m not saying we’re clean and we’re perfect by any way. I had dinner last night with the two IT executives that work for me, and that was topic that we were talking through: balancing the demand to the resource so that we don’t put our people in a position where they just say, ‘I’m gone,’ or ‘I’m out of here.’
Guerra: Right. And I’m sure there are a lot of ways to do that—telling people they have to go home at 7 p.m. or saying, ‘You have to take this vacation,’ or not denying the vacation request when there are 11 things that you need them to do. It’s tough, right?
Bradshaw: That’s the art of management.
Guerra: Right, and then defending your team to the higher-ups, as you said, to the people who say, ‘Why can’t you get this done?’ Well you could if you drove your team to the ground, but as CIO, you have to say, ‘I’m not going to do that.’
Bradshaw: Well, I think when you take a service attitude and you’ve created the transparency, a great example is on Tuesday mornings at 8 a.m., we meet with the HR team. I don’t go those meetings, but there’s a solution partner, which is a role we’ve created inside of our IT organization that owns the relationship with HR. We have a resource calendar and I think on that team we have nine or 10 resources. And there is transparency to that line executive where someone will say, ‘Here is where those 10 people are dispatched. They’re on this project. They’re working on these service requests.’ We typically have to hold this number of FTEs back when we go through budgeted and benefit enrolments for work that comes up, and we give transparency to that line executive. And then when they want to bring the new thing in, it’s a trusting conversation that asks, ‘What do you want to give up? Do you want this to wait? Do you want to move this to a lower a priority?’ And you empower that line executive to really make those business choices.
Guerra: You bring up another great point, and I’ve written about how much the relationship between IT and HR has grown in importance with the shortage. You mentioned having more open positions than you ever had before. There is a real opportunity there to get have friction with HR and to blame the person, even though they might not be at fault, and just get frustrated and say, ‘Why aren’t you bringing me people for these positions?’ So you have that transparency and communication, and they tell you exactly what they’re doing to try and bring you people. Maybe you want to expand in that just a little bit.
Bradshaw: That’s a good point. Transparency works both ways. In the meeting I’m about to have, we’re going to be talking about our recruits. I trust they they’re going to come in with the plan and they’re going to tell us what the central recruiting team has been doing. And we’re going to get creative and we’re going to try to prioritize and I’ll say, ‘This and this are more important than filling these and these positions, and we might put a bonus on this one.’ But together, we’re going to create solutions to the problems.
Guerra: All right, I’m going to ask you one last question. You’ve been very generous with your time, so I’m not going to keep you much longer. And this is sort of tongue-in-cheek, but you were at IBM for 13 years and now, according to your LinkedIn profile, you’ve been at Memorial Hermann for 14 years. So does that mean you’re itching to go?
Bradshaw: Go where, man?
Guerra: I don’t know—back to IBM? Back to the consultant life?
Bradshaw: You know, the phone rings quite a bit. I’ve got friends all over the country. There was a core group of IBM guys together in the mid ‘90s—some of them are CEOs of publicly traded companies, some of them are partners at big-time consulting firms, and some came into the CIO ranks and have stayed here. We get together from time to time to talk about the different opportunities and different trends. I think this is a great time in healthcare IT. I see the innovation coming from small companies—guys that are working out of their garage, inventing new software and new systems. At the same time, I see the Cerners of the world and the DICOM Grids and GE, who we use for PACS, and what they’re doing on a global basis. So it’s a very good, worthy skill set to have. And plus, I always remind the HR guy here at Memorial Hermann that if he ever got rid of me, he’s got to hire two of me. He’s got to hire a CIO and then he’s got to go hire a chief marketing officer. So I always represent to him the value that I’m generating for the system.
Guerra: And don’t forget the planning role.
Bradshaw: Well, that kind of goes with marketing.
Guerra: So you might want to tell him that when they’re glomming on titles, they might want to glom on some salary.
Bradshaw: Yeah, I remember when I got marketing. They gave me a whopping three percent.
Guerra: Well, they always tell you, ‘this is an opportunity, you know.’
Bradshaw: Yes. It’s always an opportunity. But I’m very loyal to Memorial Hermann. I live about five minutes from our new headquarters. We got a great team. We’re well-positioned in the Houston Market Place. We have a very aggressive agenda, and we have an industry to change, man.
Guerra: Well on that note, David, I want to thank you so much for your time. As I said, you’ve been far more generous than I think you could afford to be today, and I appreciate it.
Bradshaw: Good talking to you, Anthony.