John Glaser, CEO, Siemens Health Services
As a former health system CIO, John Glaser understands the challenges that today’s leaders face. And it’s that experience that has helped guide him in his current role of CEO of Siemens Health Services, as the company works to grow its core products while developing an ambulatory solution to meet the evolving needs of care providers. In this interview, Glaser talks about moving away from a transaction-based model, how vendors can best integrate customer requests into their strategic plans, and the increasing importance of incorporating business intelligence and analytics into the overall strategy. He also discusses how Siemens has handled the healthcare IT workforce shortage, and why leaders need to remember what healthcare IT is all about.
Chapter 2
- Balancing vendor/customer roles and responsibilities
- Vendor flexibility (good or bad?)
- Leading Siemens — the road so far
- Securing internal investment
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Bold Statements
A good partner, whether it’s a spouse or a business partner, is willing to close the door and say, ‘Hey, listen, we have to change this’ or ‘you have to do this differently,’ or ‘you’re messing this up’. Sometimes the message stings and it isn’t always pleasant, but they expect that — particularly when the stakes are so high.
At times you’re going to get a customer that says, ‘I know that this is my hospital and this is my initiative and my money, but I need some help here because I may not have the technical talent. I may not have the clinical leadership. I may not have some of the project management bandwidth that I’d like to have.
It’s increasingly to the point where they say, ‘I don’t doubt the creativity of my clinical staff. But I’m not so sure we’ve got the expertise to do a particular pediatric order set or to know how to do this. Why don’t you tell me the best practice?’
Honesty is the right thing to do, even if the consequence is painful at times. So you have to go out there and tell them what you think. But if they say, ‘We hear you, but we’re not going to do that,’ and something less than desirable happens, at least you had the conversation and you did what you could do to make sure they took the right path.
There have been multiple times where we had to go back and say, ‘I’d like some money and here’s what we want to do.’ Those are hard conversations. They’re hard, not because they are crusty people who grumble a lot, but they’re business people. You’re asking for money; they want to know why.
Guerra: You mentioned the idea that a customer has to have a high performance infrastructure in order to support your applications that are going to sit on it. I’d like to talk about the dynamic of customer responsibility. Some of your competitors are well-known for requiring a lot of their customers, and that seems to translate into successful installs because they ensure that the customers are going to bring the right resources to the table. I think that obviously it makes a lot of sense. It could be taken be too far. But I wonder your thoughts around having that kind of dynamic within your sales process to ensure that the customer does what they need to do so you can be successful.
Glaser: I agree with the core philosophy that says at the end of the day, the improvement in care or the improvement of the revenue cycle is something that the customer does. We help them. But at the end of the day it is led by their leadership, led by their management, and led by their clinicians, so it is an organizational customer commitment that says ‘we’re going to go off and do this. These are our goals and aspirations and by the way, we’re going to work with Siemens to help us to do that.’ So I do think that clearly it’s the customer’s money, and it’s the customers’ objectives and strategies that we’re supporting, and they have an enormous amount of obvious accountability making that happen.
That being said, in terms of our relations with them, we should not view ourselves as a vendor; we are a partner. Now I appreciate that word is used all the time and it’s lost all kinds of meaning along the way, but it’s real. And by that, I mean that a good partner, whether it’s a spouse or a business partner, is willing to close the door and say, ‘Hey, listen, we have to change this’ or ‘you have to do this differently,’ or ‘you’re messing this up’. Sometimes the message stings and it isn’t always pleasant, but they expect that — particularly when the stakes are so high, and they are putting their ability to thrive in the years ahead in your hands to a degree. And they’re putting a good chunk of their operating and capital dollars in clinical and management bandwidth.
So I think the joint holding of accountability is a critical aspect of any implementation. I don’t care whether you’re a vendor or whether you have partners that are doing some internal development. In terms of how you chose to affect that, there are lots of ways you can say, ‘I’m going to assess your staff to make sure they’re competent or not competent.’ There are lots of different techniques you can use to do that. But I do think the notion of shared accountability and true peers is a critical aspect of what you do.
That being said, at times you’re going to get a customer that says, ‘Hey listen, I get that. I know that this is my hospital and this is my initiative and my money, but I need some help here because I may not have the technical talent. I may not have the clinical leadership. I may not have some of the project management bandwidth that I’d like to have. Can you help me with that — you, or a business partner or implementation or consulting firm that you work with. So at times they appreciate the accountability they have but actually don’t have the resources to do it, for whatever set of reasons. And so we have to be in a position to say, ‘Here’s how we can help you do that.’ And it can range, Anthony, from taking a greater role in implementation; it can range from where we manage the IT department for you; it can range from where we host your technology in our data center in Malvern; or we can take on some of the stuff, because our objective and our intent is for you to be fabulously successful. That’s how we look good, and that’s how healthcare gets better. So I think at times you have to determine — given the talents that we need; the skills and all that other stuff — what can we provide, what can they provide, and if there are gaps on either side, the discussion is how we fill them.
Guerra: In line with that, there’s a concept around flexibility with implementation methodologies. I interviewed a CIO who’s using a different vendor who said they offered a lot of flexibility on the departmental level to the way the applications were configured and structured in the workflows. He found that at the end that might have been the best plan, because the people in the departments who created these workflows weren’t happy with them after they created them. And then you have other vendors that say, ‘here is the recipe. This is what you will do,’ and that can rub people the wrong way. I don’t know if when you were at Partners, you would have liked that. So what are your thoughts around having your way, the Siemens way, which should be the tried and true and tested and refined way, and making clients do it that way because you know it will make them as successful as they can be, versus having some flexibility and saying, ‘Okay, so this is how you do it here. Let’s do it a little differently.’
Glaser: You know, Anthony, having been in this industry for a couple of decades now, I do think that over time, there’s been an evolution. If you went back 20 years ago, people said, ‘I want flexibility. I want to create my own order sets. I want to do my own workflows, reconfigure the screens, etc, and that was sort of critical—and not only because they wanted to express their creativity but it was also part of the buy-in process. That’s how you engaged the medical staff — having them put their fingerprints all over this stuff.
Since then, it’s increasingly to the point where they say, ‘listen, I don’t doubt the creativity of my clinical staff, for example. But I’m not so sure we’ve got the expertise to do a particular pediatric order set or to know how to do this. Why don’t you tell me the best practice? Because I don’t trust that I’ll inherently arrived that at all by myself,’ and, ‘gosh, you’ve got a big customer base. What are those guys doing here?’ So you wind up increasingly where a lot of folks say, ‘tell me what you think I ought to be doing here?’ And they say, ‘what are the right order sets’ or ‘what are the right documentation templates?’ ‘What other people using? How can I leverage the best practice that is occurring here?’
It doesn’t mean they don’t want to tune some of them or create some of them on their own, but they’re clearly much more interested in getting sort of the best thinking across the board. I think you have to be prepared to do it both ways. You have to have a set of content where you can walk in and say, ‘If you guys would like to do that, and there’s reasons to do that — it can be more efficient, it can be quicker, you can rely on the customer base center — we have a series of content to get you off to the races and get started. And I’m not sure I’m going to make you do it this way, but I’m going to tell you that if you do it this way, you’ll see your fingerprints in fewer places, but again, you’ll be able to leverage the work of others.
Or you can say to a customer, ‘listen, you can decide you want to do that minimally and really engage, for whatever set of reasons, your leadership and crafting and creating this, and we have the tools that allow to do that. Frankly, you have to do both and they’re really different trade-offs. One is lengthier but is more tailored to the organization, and is probably better at getting buy-in. The other is more efficient, quicker, and leverages the practices. And one of the reasons you want to do both is that even if you started out by saying, ‘tell me what you think I ought to be doing,’ one of the things you find with the technology is that after a while, people will really get the hang of it, and then they can see the next set of things that they want to do.
Two years after go-live, they’ll say, ‘Well that’s terrific, but we can see three or four things we want to do differently, and I appreciate that this is the best practice, but we want to do them a little differently.’ They want to have the tools that allow them to do that. So there is a proficiency that develops and a sophistication that develops in the customer base where they want to have the tools, even if they started with a preconfigured set of content.
Guerra: As the vendor and the partner, you want the best outcome for each install, right?
Glaser: Right.
Guerra: And it’s tough to sit there and have a customer say, ‘Well, we appreciate your advice but we’ll going to do X.’ And you’re sitting there thinking, ‘it’s not going to work.’
Glaser: Well that goes back to the partnership and if that’s what you’re hearing, you say, ‘I’m worried about that. I might have a different opinion, but I’m worried about that.’ That’s when you get to back to that model that says, ‘I have to close the door. We have to have a conversation here. I mean at the end of the day, it’s your call, customer, because it’s your organization and it’s your care delivery, but I have to be honest with you about what I see.’ So I do think that it’s not always the easiest conversation in the world, but you owe it your customer to tell them when you think they’re about to do something that is really not in their best interest.
Guerra: It still stings, though. And here’s how it plays out. You have a suboptimal installed because they didn’t listen to your advice, and then it’s out there in the industry and it’s almost impossible to then explain why one of your customers failed. You’re out there saying negative things about a customer like, ‘yeah, that didn’t go well because they didn’t listen to us.’ It’s a tough thing to when it plays out. So I could see an urge to say, ‘no, you have to do it this way, because you’re going to hurt our overall reputation.’
Glaser: Yeah, you never want to badmouth a customer publicly and even though I can say and we can both say that we’re partners, at the end of the day, they are the customer and they are making the decision. They are accountable for care delivery and we are not, in the course of doing things like these. I think it’s like honesty in general. Honesty is the right thing to do, even if the consequence is painful at times. So you have to go out there and tell them what you think. But if they say, ‘We hear you, but we’re not going to do that,’ and something less than desirable happens, at least you had the conversation and you did what you could do to make sure they took the right path.
So I hear you, there can be suboptimal implementation as a result, and odor that is released into the industry air as a result of that, but you do as well as you can. And presumably if you’ve done a nice job, and it’s not perfect, obviously, where they trust you and they realize that you know what you were talking about and you have your best interest and you suggest to them, ‘Why don’t you call these two other customers that we have and talk to them? Maybe you want to hear from someone who’s got a similar role to the one that you have.’ As long as you do all the things that you think are the right things to do in that context, then you’ve done as well as you can.
Guerra: I’d like to ask you a couple of questions about your role over at Siemens and some of the dynamics there. Let’s talk about some calls where you had to or were asked to make investments for the long-term that maybe hurt the bottom line now but you’re saying they’re necessary. For example, ‘here’s where we need to be in five years. We need to invest this money right now.’ So you need to sell that internally to whoever the higher-ups are; you’ve had to sort of sell your vision and it maybe it wasn’t the easiest sell in the world.
Glaser: What I found here, Anthony, is that there have been multiple times when I’ve had to go off and sell a vision that brought a price tag. Shortly after I arrived here, the plans for ambulatory were underfunded, so I had to go back and get funds for that. This summer, we had to go get funds to do the Mobile MD acquisition. So there have been multiple times — I mean three or four times — where we had to go back and say, ‘I’d like some money and here’s what we want to do.’ Those are hard conversations. They’re hard, not because they are crusty people who grumble a lot, but they’re business people. You’re asking for money; they want to know why. Does it fit with part of a longer-term strategy or nearer term strategy? How does it fit with the vision that’s unfolding both in the United States, and at times, oversees? And what’s the return? Do we think that you’ll sell a lot of these? Will customers really like it? Will it be critical? So you better have done your homework when you go into that, because they’re asking good questions, they are asking good business questions that you would expect out of anybody making an investment. And again it can be here at Siemens or it can be a CIO going to the hospital board and saying, “I want money to do A, B, and C, and if they’re a good finance committee or board, they’ll ask really good questions.
I’ve had to do that a couple of times. And what I’ve found is that Siemens has terrific financial rigor and so they make you work hard to gather all the data and do all the proof points. And they’re very willing to engage in both the business and the thoughtful conversation about how all of this is going to play out at the end of the day. And after a while, and I think I’ve been here long enough that this has started to accumulate, your track record speaks, and so you go in there and they say that the last couple of times they talked to you it worked out, and so you walk in there with a streak of credibility that goes with that stuff.
I do think we have and will continue to make investments because you have to in this industry, which is both moving relatively quickly in terms of changes in payment and in the regulatory landscape, but also moving quickly in terms of the technology, there will continue to be the need for investments. And we’re good enough that we’ve done our homework well that that isn’t a slam dunk; but, you know, we generally do pretty darn well in carrying forth the argument.
Guerra: Yeah, you don’t want the situation where they see your name on their calendar and they say, ‘Oh no, here comes Glaser.’
Glaser: Another handout, oh my goodness gracious. ‘I thought Halloween was in October — why are you back here?
Guerra: I think you want a dynamic where your customers know that you’re fighting for them — and when I say fighting, I don’t mean that in any sense Siemens is being tight-fisted, but you used the example of a CIO in a hospital, and as CIO of a hospital, you want the clinicians to know that you’re fighting to get all the resources you can. And I would imagine you want your customers know that you’re fighting to get the resources you can from Siemens’ overall parent company.
Glaser: You know, at the end of the day, the customers we have don’t care we fight or we don’t fight. They just say, ‘This is what I need, and are you able to deliver — and going back to one of your earlier questions — in a timeframe that works for me.”
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