Montefiore Medical Center prides itself on being a forward-thinking organization. The Bronx, N.Y.-based system began implementing an EMR in the mid-90s, and was closing in on full CPOE just a few years later. But although the organization has always embraced innovation, CIO Jack Wolf believes what is just as important is maintaining a sound strategic plan. In this interview, Wolf talks about the weighted decision of whether to transition to a fully-integrated system, the need to be able to seamlessly connect the acute and ambulatory worlds, and how he dealt with being blindsided by a vendor decision. He also discusses Montefiore’s participation in an ACO program, the health IT workforce shortage, and his thoughts on MU Stage 2.
- Battling the HIT workforce shortage
- Managing staff to avoid burnout
- The benefits of cross training
- Staying positive and remembering what’s important
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We’re finding it very difficult to hire the right people and enough people to satisfy the needs that we have with all the projects going on. I think we’ve got about 65 open positions now. And that’s larger than 10 percent of our staff, so that’s significant.
You’re improving the healthcare of a population of patients. And when you can get people into that mindset and they start to understand the strategic plan for the organization and they start to become part of that, then you can start to create a bond with the organization, and that’s the only way that you can be successful.
We’ve got a lot of cross-training and a lot of awareness of different areas. What it created, which was a byproduct that I think is just fantastic, is so much more collaboration among my senior group that I had never anticipated, and it’s just phenomenal.
We are on the leading edge of technology in the healthcare world. Advances in science are just happening at a faster pace than ever before. We’re also on the forefront of information technology breakthroughs, and you get to do something that really makes a difference.
You have to look at what we’re actually doing and step back from the trees and look at the forest, and you start to realize that this is pretty cool. That’s the way you have to look at our job — yes, it’s stressful, but it’s pretty cool.
Guerra: Let’s talk a little bit about leadership and staff management. I moderated a roundtable at HIMSS; basically the concept of the roundtable was to talk about how a lot of CIOs are overwhelmed with all the requirements being thrown at them. The issue that really took over the discussion was the HIT workforce shortage — the talent shortage — and having to really overwhelm or overwork or stress out your existing staff and avoiding burnout and management. That really took hold as the topic that people wanted to discuss. I wonder if you wanted to talk a little about whether you’ve had a lot of open positions and if you’ve been able to fill then and find the people of the caliber you need, and then we’ll talk a little bit about is your team stressed. Is there a lot on their plates, and people are not able to take the time they need off? Just talk about that a little bit.
Wolf: I’m going to throw a real curved ball at you here. In 2000 into 2001 at Montefiore, we decided that we needed a way to kind of offset our IT costs. At that point in time, we took our IT organization and formed a wholly-owned subsidiary of Montefiore, a for-profit subsidiary called Emerging Health Information Technology, and we started to provide similar services to other provider organizations in the tri-state area that we were providing to Montefiore, and that took off very quickly. We started doing implementations of electronic medical record, hosting, help desk, problem and change management, all kinds of activities — infrastructures, support implementation, networking. It was very lucrative and it was moving well. And the concept was if we could take what we did for Montefiore and provide that for other healthcare organizations, we would extend Montefiore even further than just the four walls of Montefiore, and at the same time we could reduce our costs by offsetting costs of our central services and economies of scale kicking in where we have a larger base to build off of.
I guess it was around 2007 to 2009; in that three-year period, we started experiencing that shortage and we really had to cut back on that outside business and focus only on Montefiore. We just could not hire people fast enough to fill the positions that we needed to fill to keep moving forward. And here we are today; we’ve shrunk down the subsidy Emerging Health. We provide hosting, network management, problem and change management and some other services, but for the most part, we’re focused totally on Montefiore now, aside from the hosting and computer facility stuff. So even in that, we’re finding it very difficult to hire the right people and enough people to satisfy the needs that we have with all the projects going on. I think we’ve got about 65 open positions now. And that’s larger than 10 percent of our staff, so that’s significant.
Guerra: And I think the concept people need to grasp is that right now, your team is doing the work that actually 65 more people should be doing.
Wolf: That’s correct, and there’s no slowdown in the deadlines.
Guerra: You’ve been doing this for a while; tell me about managing a staff that is experiencing that kind of strain. Is there anything you can do to make sure you keep people? I mean, there‘s probably five or six key people where you say, ‘if I lost any of these people, I’d really have trouble sleeping tonight.’ So is it taking care of those people, or is it just in general, teaching your managers that work for you to keep an eye out for people that are about to crack and give them a day off or something?
Wolf: Well it’s a difficult environment because hospitals are facing difficult times in terms of revenue, and costs are going up rapidly. And certainly the IT costs are also going up rapidly and holding on to key staff is becoming very problematic. You’ve got to create a good spirit within your working environment. You’ve got to create a collaborative sense among your employees.
One of the things that we focus on at Montefiore is understanding exactly what it is that we do. So within our IT organization, we go to great pains to help them to understand that you’re a healthcare provider. You might be a DBA or you might be a network specialist or you might be an applications programmer, but you’re a healthcare provider. And at the end of the day, you’re doing something that really counts. You’re improving the healthcare of a population of patients. And when you can get people into that mindset and they start to understand the strategic plan for the organization and they start to become part of that, then you can start to create a bond with the organization, and that’s the only way that you can be successful. Because if you’re doing it by saying, ‘I’m going to increase salary; I’m going to pay a bonus; I’m going to do this and I’m going to do that; I’m going to help with your education,’ the next provider organization down the block that has a big project that needs core group of people, they’re going to take that individual away from you very quickly.
Guerra: And it’s not just the providers. There are vendors, consultants, analysts — for someone who has some experience implementing clinical systems and interacting with clinicians, the opportunities are endless.
Wolf: Right. I just lost my chief technology guy to a vendor.
Guerra: I’m sure for a bit of a pay raise, right?
Guerra: You can’t match the dollars.
Guerra: And that might have been one of those people I was talking about that’s give you a little trouble sleeping at night.
Wolf: Well, it’s very important that you get some cross-training going on. We did something very interesting a few years ago; I guess we’re three years into it now. I took each of one of my director reports and I shifted them from one position to the right.
Guerra: Tell me about that.
Wolf: The guy who was in charge of my infrastructure is now running my financial services group. The person in charge of our project management office is now running my clinical systems group. The clinical systems person is running a project management office. And we added one new body to the group at the senior director level, so we’ve got a lot of cross-training and a lot of awareness of different areas. What it created, which was a byproduct that I think is just fantastic, is so much more collaboration among my senior group that I had never anticipated, and it’s just phenomenal.
Guerra: So you would recommend that, what you’ve done, as something maybe for your colleagues to think about doing?
Wolf: I highly recommend it. I think the outcome was phenomenal.
Guerra: I would imagine you had some pushback from some of the individuals who said, ‘no, I like what I do. I do what I do; I’m not interested in that.’ Or was it pretty much where everyone thought it was a great idea?
Wolf: There were some individuals that said, ‘you’re out of your mind.’ And there were other individuals that said, ‘you know, I’ve been doing what I’ve been doing for so long that yes, I’d love to take on a challenge like that.’ So there was a mix, and I think at the end of the day, everyone embraced the challenge.
Guerra: That’s definitely an interesting concept and, I think, a good takeaway for some of our listeners and readers. I wanted to ask you, just as a final question, is there anything else that you wanted to add? We covered a lot of ground, but is there anything you want to add or final comments for your colleagues about what I would consider the extreme stress that many of them are under. Certainly not many have been doing it quite as long as you, so maybe you want to give us some advice.
Wolf: When you’re having your worst day, you got to sit back in your chair and you have to say to yourself, ‘who’s having more fun than me?’ I’m absolutely serious, Anthony. We are on the leading edge of technology in the healthcare world. Advances in science are just happening at a faster pace than ever before. We’re also on the forefront of information technology breakthroughs, and you get to do something that really makes a difference. So when I’m on my rocking chair in my 90s sitting on the front porch, I’m going to be able to look back at my career and say, ‘I really made a difference. For the people in the Bronx, the fact that I was here was a good thing.’ And I contributed and I added a lot to the Montefiore organization. I helped it grow over all those years. I was always getting exposed to new technologies. I was always reading about and getting involved with physicians that were at the leading edge of their areas of expertise — clinical research, translational research, and moving that into the care provider world, reshaping healthcare through this period of time.’ You have to look at what we’re actually doing and step back from the trees and look at the forest, and you start to realize that this is pretty cool. That’s the way you have to look at our job — yes, it’s stressful, but it’s pretty cool.
Guerra: I think that’s a wonderful statement; I really do. And Jack, I want to thank you so much for your time today. I’ve really enjoyed our chat, and I’m sure our readers will.
Wolf: Nice talking to you, Anthony.
Guerra: I’ll be in touch. Thank you.
Wolf: Okay, have a good day.