Jim Noga, CIO, Partners HealthCare, Chapter 3

When Jim Noga was named CIO at Partners HealthCare, taking over for John Glaser, he was no stranger to the system, having spent 17 as CIO at Massachusetts General. A year later, he’s focused on moving the organization from a federated model to a true enterprise clinical system approach that will better facilitate initiatives like accountable care. In this interview, Noga talks about fostering clinical collaboration within the organization, the importance of having an effective mobile device management strategy, and how he has benefited from his experience in software development. He also talks about the challenges organizations face in managing security, why confrontation and conflict can sometimes be good, and what it has been like to fill Glaser’s shoes.

Chapter 1

Chapter 2

Chapter 3

• Setting expectations
• Working with John at Siemens
• Conflict, friction, and leadership
• Is the industry being asked to do too much, too fast?
• Maintaining a sound work/life balance

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I have more of a technical background and will ask detailed questions about technical initiatives in addition to business and clinical initiatives. Some of it is curiosity, some of it is really trying to push people to think more and more about where do we really need to be in three to five years, and not just what are we going to accomplish today.

Some of my best vendor relationships are ones where the CEO or the COO and I have had knock-down, drag-out discussions around either their product or their ability to perform. And that’s because of a mutual respect in saying, ‘All right, we have a problem. How are we going to possibly solve this together?’

Confrontation and conflict, when well-managed, move an organization forward. What can’t happen is you can’t get personal. It should stay professional. And that’s what I tell my folks as a leadership team: I want confrontation. I want the naysayers.

So it is a lot, and what it sometimes says to people — or what it looks like — is, ‘is my agenda being set by the external environment rather than internal need, and how do I balance that?’

I think anytime you take a new role, the intensity of what you’re doing and the time you need to commit is a bit out of balance until you are able to really assess the organization, understand that the players, and really understand where you can delegate.

Guerra:  I’d like you to take two constituencies — employees and vendors — and tell me what you would like them to know or what they should know about your style and expectations that might be slightly different from the way John operated. So if you want to take your employees first and then maybe the vendors.

Noga:  I think with my employees, first and foremost I demand that people respect one another, that’s sort of number one. And that’s not respect for me; that’s respect for each other as individuals understanding everybody can contribute. I always use the story of Lyndon B. Johnson visiting NASA and walking through the hallways when we were trying to put a man on the moon and there’s an environmental services worker mapping the floor and he said, ‘So what are you doing today?’ And he said, ‘Mr. President, I’m putting a man on the moon.’ You have that shared vision and shared respect in that no matter what someone is doing in an organization, it’s important, because I think only then can you really build in terms of a team focus. In terms of differences from John, I probably have more focus on keeping the trains running as well as trying to look forward with what we need to do in terms of enabling strategies, and that likely is because I have more of a technical background and will ask detailed questions about technical initiatives in addition to what I would call business and clinical initiatives. Some of it is curiosity, some of it is really trying to push people to think more and more about where do we really need to be in three to five years, and not just what are we going to accomplish today. We talked about mobility, so we really need to be thinking now about how do we deliver applications to devices and not get caught flat-footed when that becomes a necessity to have a different method of application delivery.

In terms of vendors, I think I’m a very fair person. In terms of developing what I would call expected service level agreements, I do expect people to perform. I don’t see vendors in terms of their products. I view vendors in terms of partnerships and relationships. Not getting into specifics, some of my best vendor relationships are ones where the CEO or the COO and I have had knock-down, drag-out discussions around either their product or their ability to perform. And that’s because of a mutual respect in saying, ‘All right, we have a problem. How are we going to possibly solve this together?’ Obviously sometimes that doesn’t work, but I think that generally speaking, if you go into it as a partnership rather than a purchasing arrangement, you’re more likely to have a positive outcome.

Guerra:  Are there any unusual or challenging aspects to the Siemens relationship now that John is over there? Does that make it different than a normal relationship would be?

Noga:  Honestly, no. I can pick up the phone and call John; with the majority of the vendors that I work with, I can easily pick up the phone. And now he has to wait outside the office to talk to me, rather than me waiting outside, but besides that, no. John and I have a really good relationship. We both have a good sense of humor, but we also understand our roles when we come to the table — that they are different now. He’s a provider of services to Partners, and I’m a consumer. We do have a partnership and we can have very open discussions in some sense, which probably helps in turn of being able to have those discussions fairly openly. He isn’t going to hesitate to tell me what’s on his mind, and I’m not going to hesitate to tell him what’s on my mind.

Guerra:  I guess as a CIO, you can’t be one who’s reluctant to have confrontation, right?

Noga:  That’s actually one of my leadership principles.

Guerra:  Explain that. Tell me what you mean.

Noga:  Well, I am a firm believer that people who avoid conflict and confrontation can’t move an organization forward. In physics, there’s potential and kinetic energy, and unless you have friction, you can’t generate heat and energy. That confrontation and conflict, when well-managed, move an organization forward. What can’t happen is you can’t get personal. It should stay professional. And that’s what I tell my folks as a leadership team: I want confrontation. I want the naysayers. You can’t take it to a personal level, but keeping that to a professional level is positive for an organization. So maybe that’s one of the qualities as you move to a leadership role. You have to be willing to understand that and understand that sometimes that’s going to take people out of their comfort zone.

Guerra:  Right. You need people that can handle that kind of leadership, too. I mean, they have to know that just because they’re being questioned and challenged, it doesn’t mean you’re not pleased with them, you’re just trying to make your point and see how they come back.

Noga:  Right, so I’m a New England Patriots fan. We all saw have Tom Brady and his coach have a confrontation, right?

Guerra:   Yes, we saw that.

Noga:  On Monday, they both said it had a very positive outcome.

Guerra:  Even right after the game, Brady was calm and composed, and said it was all good.

Noga:  And so there’s an example of confrontation that is a necessity, and my guess is it didn’t get personal. While it may have been heated, I’m guessing it really was about what happened on the field, and it wasn’t a personal attack on one another.

Guerra:  Right, that was interesting. That was a certainly an interesting exchange. Let’s talk a little bit about the industry overall. One of the biggest things I’m hearing from your CIO colleagues is that with everything that’s going on — Meaningful Use, ICD-10—it’s just too much, too fast. People are just completely overburdened at shops, and the rate of change is too fast. Do you agree with that?

Noga:  It is fast. I actually put together a chart three years ago that had ICD-10 on it and had healthcare reform — it wasn’t specific necessarily ACOs. We had a new building going on and we knew Meaningful Use was coming. So there is a lot going on and I think where CIOs need to be careful is with things like Meaningful Use — you really want to do it right. If you’re going to go through the effort of things like HIPAA security, you want to do it right. You just don’t want to be checking the boxes. It is a lot, and it’s coming at us very quickly, but I don’t know that it’s unique to healthcare. It’s like the Sarbanes–Oxley Act — when the finance industry went through that, that was very burdensome. With ICD-10, I think the challenge in some of these areas is there are dependencies on other players; it’s the same thing that 5010 and the payers and CMS obviously saying the enforcement won’t take place until March 1 as sort of recognition of the complexity of 5010.

So it is a lot, and what it sometimes says to people — or what it looks like — is, ‘is my agenda being set by the external environment rather than internal need, and how do I balance that?’ Because you’re right, some days I think CIOs are feeling like, ‘Do I really need to do planning, or is the external environment going to tell me what my plan is?’

Guerra:   Yeah, I couldn’t agree with you more. I’ve written before that the government is essentially taking over everyone’s five-year strategic plan, which I don’t think it’s the right way to go.

Noga:  Yeah and again, that’s not strategic; not in my view. They’ve taken over the tactical plan, which might hinder what you might want to do strategically.

Guerra:  Right, definitely. Let’s talk a little bit about work-life balance. You were CIO of one hospital, now you’re CIO of many hospitals and many other things. There are probably not too many bigger jobs out there in the healthcare CIO space. You also do the graduate program in Health Informatics, so you have that, and I would imagine that’s something you enjoy. Are you good at keeping a work-life balance or are you a workaholic and have things gotten more intense? And then there’s always the period of ramping up when you take a new position. I always find it takes a year to get your arms around things, and when I’ve taken new positions, I’ve always worked far in the first year and was able to kind of get everything under control, but give me your thoughts around all that.

Noga:  I think anytime you take a new role, the intensity of what you’re doing and the time you need to commit is a bit out of balance until you are able to really assess the organization, understand that the players, and really understand where you can delegate, and that does take a year. So it’s been pretty intense this past year. But in fact, I’d say that in the past month or so, despite everything we’re doing, I’ve been able to get more of that work-life balance. Am I a workaholic? I’d say I’m very dedicated to what I do and that I find time for family, but in healthcare IT, at leadership level, even when I was at the MGH, it’s 24/7. And in some sense, I think it’s reflective of healthcare, more than just healthcare IT. Healthcare is a 24/7 operation, and I always joke that I was in a process improvement committee at Mass General in the 1990s. It was surgeons and anesthesiologists, and we literally met at 4:30 a.m. Fortunately, I was only in the committee for about three months; it sunsetted. I just think healthcare brings a different set of expectations in terms of your availability and as well as healthcare IT, in terms of availability of systems versus other industries.

You can talk about business continuity planning, you can talk about disaster recovery and they’re very, very important, but the bottom line is that our providers have become dependent on healthcare IT systems. Twenty years ago, if you did results reporting, you probably had some devices on the care units and it really was adjunct to the paper record, and if the electronic results reporting went down, people said okay, and they went to the paper record. Now the paper records are not on the floors anymore, and there’s just this absolute dependency. So when systems go down, appointments get cancelled and care processes are interrupted. There really has to be that 24/7 view, and yes, you can have people on call and respond, but you can’t delegate the responsibility entirely.

Guerra:  Right, and I don’t know what smartphone you carry — you don’t have to tell me if you don’t want to, but I’m an addict. I check that thing every 30 seconds. It’s like a condition. I’m sure I’m not the only one. Are you pretty bad with that?

Noga:  No, I’m actually pretty good. I’m not that Pavlovian about this phone, and I know some people tend to be. It’s interesting, when it comes to email and phones, I turn off any of the vibration or any of the sound that indicates a message has arrived. I want to look at messages when I decide I want to look at messages, rather than having that Pavlovian response.

Guerra:  So is it the phone for you, where the critical people have your number and then they’ll call you and you pick up?

Noga:  Well, I’ll tell you that I still carry a pager and people know that if something really needs to be addressed, that’s what you do. It’s an interesting study. I probably get four to give pages a month and there’s merit to those pages. I truly need to talk to you, or there’s truly an incident that needs to be addressed. So there’s a lot of noise and email. And again, I think if you really know what you’re focusing on, often you’re responding to emails that, in fact, aren’t moving the organization forward. I think it’s almost a mindset like a game: ‘I need to respond to these emails now.’ As I said, it’s almost Pavlovian.

Guerra:  And sadly, I’m Pavlovian, and I think I need to work on that. But anyway, that’s about all that I had for you today, Jim. Is there anything else you want to touch on or add that we didn’t discuss?

Noga:  No, I think we covered a pretty broad swath of the landscape.

Guerra:  Yeah. Well, I very much appreciate your time. It’s great to talk to you, and I hope we can chat again in the future.

Noga:  All right. Take it easy.

Guerra:  Thanks so much, Jim. Have a great day.

Noga:  You too.