healthsystemCIO.com Survey Shows Many CIOs Stymied By Broken Governance

With more projects than ever on their plates, just under 50 percent of healthcare CIOs are struggling against faulty governance processes to get them done, according to the January healthsystemCIO.com SnapSurvey. Specifically, 35 percent say their governance structure is “too convoluted to handle the volume and pace of new issues that must be evaluated and executed,” while 13 percent say it’s “too streamlined to receive and consider input from key constituencies.” On the bright side, 91 percent say they have ample room, after receiving marching orders, to exercise strategic influence, and 70 percent are able to make sense of those orders, receiving what they describe as “clear direction from management.” In news that will make patients happy, the majority (65 percent) say their organization’s number one priority is providing high-quality patient care, though just over a quarter say revenue considerations carry the day.

(SnapSurveys are answered by the healthsystemCIO.com CIO Advisory Panel. To see a full-size version of all charts, click here. To go directly to a full-size version of any individual chart, click on that chart)

1. Which individual or entity is dominant in setting your organization’s strategic direction?

CEO

• While new to the position, he has been effective in setting a strategic direction.

Board and CEO

• We also have a very strong strategic planning vice president who does much of the leg work.
• In addition to our IT Steering governance.
• The Board is very involved in overall direction here.
• All senior leaders participate.

Other

• Our CEO leads the way, but it has become very much a group effort. We will be having a full day planning meeting which includes folks from the hospital, city and county leadership, local business professionals, area education leaders (grade school and college), etc.
• CEO, board, board ad hoc committee, Cabinet (six direct reports to the CEO), President’s Council (all executives at senior most level – 19 people)

2 Do you receive clear direction from management regarding its strategic goals?

Yes

• The issue is that there are still a number of strategic goals requiring IS support, so prioritization continues to be necessary.
• I am directly involved.
• Direction is normally clear, but there are always the “corrective or altering” decisions that muddy the waters.
• We have a strategic business plan, refreshed annually.

No

• Strategic goals are primarily around growth which leaves many areas of strategy untouched.
• We receive “stated direction” and I’m sure sometimes management thinks it is clear but it really is not, and it falls off dramatically at the line-staff level.
• Being new at this organization, there is a clear void between what is set at the top and what we hear about… and I don’t report to the CEO like past positions, and it is not a good thing…

3. Which factor is paramount in your organization’s strategic decision making?

High-quality care/Patient safety

• In addition to gaining market share.
• All of the above would have been the selection if the choice was available.
• A close second is physician satisfaction.
• If you do well in this area, everything else will fall into place.
• Obviously, quality is job #1. But to provide quality, we must have physicians and staff engaged, grow the business, and cut cost. All these things are required to achieve the goal.
• All of the above – we refer to several “pillars” for certain key elements – e.g., quality and patient safety; physician relationships; market growth; org transformation; etc.
• None of these options represent the factors for our institution. The closest is patient safety, but ours also includes quality/effective research and education.

Increasing revenue in general

• You made me pick one and all are important but growth is a constant and of high priority.
• All of the above are key goals / drivers for us, but revenue wins the day.
• We are one degree back of sustainability in survivability mode. This dramatically impacts the priority of your actions.

4. After receiving your priorities from management, and learning departmental wishes through an IT governance process, do you have any room in which to exercise strategic influence?

We have room to exercise strategic influence

• We have a little room, but just a little. Many of our goals are primarily tactical, and I am constantly looking for ways to squeeze in more strategy.
• We do not have a good governance process for departments to note their priorities. As a result, I have the ability to exercise strategic influence.
• Just completed new governance structure that will hopefully improve on this.
• A little, but sometimes we’re brought in way too late in the process.
• We have some room, but it will take good execution of a crafty plan to change our culture.
• Ideally, we should not only be “receiving” priorities but also influencing and participating directly in strategic direction setting. That’s a reason why CIOs are generally better off reporting directly to the top.

5. Your IT governance process is:

Too convoluted to handle the volume and pace of new issues that must be evaluated and executed

• We are currently revamping our IT Governance process from a project prioritization orientation to a strategic orientation. Time is being spent on discussing strategy and long-term planning vs which project should be done first.
• We’re currently trying to revamp it, but it is a big change to make.
• Well designed but routinely ignored by the resident “executive in charge of transformation.” Poor support for excellent processes is analogous to an expert marksman shooting targets in a darkened room.

Well-balanced and effective

• I pick this with the hope that our new process will accomplish this goal. Ask me again six months from now.
• Solid multi-disciplinary team that’s committed to IT Governance.
• More balanced than not, but plenty of room for improvement.