John Bosco, CIO, North Shore-LIJ Health System
In the fall of 2009, North Shore-Long Island Jewish Health System made waves when it announced a monster deal with Allscripts to subsidize up to 85 percent of EMR costs in the offices of 7,000 affiliated physicians. More than two years later, the program is making progress, and although it isn’t moving along quite as quickly as the organization originally anticipated, that’s not necessarily a bad thing, according to CIO John Bosco. In this interview, Bosco talks about the massive educational efforts underway in the community and how North Shore-LIJ is dealing with the unique challenges facing small practices. He also discusses the organization’s efforts to deploy EHRs in a way that will enable them to achieve true value, why CIOs need to pay more attention than ever before to talent acquisition and retention, and the importance of projecting a positive image.
Chapter 3
- Preventing staff burnout
- “All hands” meetings twice a year
- The need for mental health breaks
- The importance of checking in with peers in the industry
- “It’s exhausting and exhilarating at the same time”
- The high level of respect among CIOs
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Bold Statements
I think there still is a concern and a challenge around burnout. And I think that with everything moving as fast as it is, there’s going to some amount of that. I’d be really surprised if anybody could be so organized and just have their act together so well that they’re not going to have to deal with that, because we could all use more people.
You might think you’re buried in a data center somewhere as a server or a storage engineer or that you’re only working on deploying a financial system or whatever kind of application it is, but we’re one group. We’re one team.
We make sure they know what’s going on with healthcare reform and transformation, what’s going on with all of this legislation, and how it’s playing out. We want them to know as much about what’s going on in this country as possible so that they appreciate that they’re playing an important role in it.
In terms of getting out to meetings with peers, I think that’s really important because I come from those and at least I know everybody else has the same challenges. And my thinking is not way off in left field because they’re thinking about the same things. They’re struggling with the same things.
Everybody watches you. You have to be on all the time. If I walked out of the room and I looked upset or mad or resigned or frustrated, then I’ve got key people all around me, including my own direct reports, who could get scared by that.
Gamble: That keeps coming up as such a huge issue in a lot of surveys that come out. I know that at HIMSS that was a recurring topic — finding good people, it’s something that a lot of organizations are dealing with. Now as far as staff burnout, is that something that’s become a big issue or do you think that the organization has been able to do a decent job of holding on to good people, whether it’s by offering education or just doing extras to keep people happy?
Bosco: Well I think you’ve got to do everything that you can. Sometimes I feel like it’s more of a social club than a business department. It’s amazing the number of things that we do with Super Bowl parties and decorating contests. Every little holiday that comes up is another reason to have some kind of a get-together, and we have retention programs and wellness programs for really key employees. You’ve got to do all of the stuff that you can, and even with all of that, I think there still is a concern and a challenge around burnout. And I think that with everything moving as fast as it is, there’s going to some amount of that. I’d be really surprised if anybody could be so organized and just have their act together so well that they’re not going to have to deal with that, because we could all use more people. There’s going to be some amount of that and there’s going to be some fallout from that. You do everything that you can to minimize it, but it’s not something that can be avoided completely.
Gamble: I think that’s a realistic point of view. And I like the Super Bowl angle — maybe if the Giants keep winning that will help staff morale.
Bosco: Right. I’m telling you, there’s no end to these things: pizza Fridays, etc. We actually have an employee activities committee, which is about four or five people that think of these things and coordinate and organize these things — even just doing all-hands meetings. We do all-hands meetings twice a year but we have 1,000 people, and so if we do an all-hands meeting, it takes a lot of effort to organize. We need a catering hall to house people, because 400 or 500 would be there in person. We also webcast it live for the folks that can’t get there. These things take a lot of preparation and a lot of effort, but the employees get a lot out of them, and we always try to do something really fun beforehand. At the last all-hands meeting we set up a huge room and we had every group in the department set up a table in that room that represented their group. They had pictures of their group and they have poster boards that describe what they do because we’re such a big department that not everybody gets to meet everybody and know what everybody does all of the time. A couple of people from each group stayed behind the people and the rest of the employees filed through and said hi to all of them, and then there was a raffle based on how many they got through.
You just have to think of everything that you can that will give the employees a little mental health break once in a while and get them out of the office for a couple of hours at an all-hands meeting. I think one of the biggest keys with employee satisfaction is making sure that they understand the role that they’re playing in what is probably one of the fastest transformations of an industry that’s happened in this country. And so I like to talk to them all the time about the fact that you might think you’re buried in a data center somewhere as a server or a storage engineer or that you’re only working on deploying a financial system or whatever kind of application it is, but we’re one group. We’re one team, and we’re in a place that’s very progressive and in the front of what’s going on in healthcare transformation as a system, and so you are all playing a leading role in something that’s much, much bigger. And you need to understand what you’re contributing to that and how it takes all of the pieces to make it all work.
And I hear that from some other CIOs. I think it’s really important because otherwise they’ll only be focused on what they’re doing. And so when we do our all-hands meetings and we get other opportunities, we make sure they know what’s going on with healthcare reform and transformation, what’s going on with all of this legislation, and how it’s playing out. We want them to know as much about what’s going on in this country as possible so that they appreciate that they’re playing an important role in it.
Gamble: I really like that approach of communicating the fact that this really is a historic time for the industry with everything that’s going on and it’s something that I think is going to be looked back on 20 years from now and people are going to be amazed. I think it’s great to remind people, ‘You’re part of this and you’re helping to make a difference.’
Bosco: You’re part of it, and playing an important role.
Gamble: Yeah. So the last thing I wanted to ask was, because you are putting in so many hours, are you ever able to kind of get away from work, or do you find that right now, you’re really in the mode where you’re just pushing through? Do you have to force yourself to get away from work once in a while or shut off the smartphone?
Bosco: Well I don’t ever do that. And everybody is different that way, but if I’m on vacation, I’m more comfortable checking in first thing in the morning and at the end of the day, and then if I know what’s going on and I know nothing bad is happening, I can relax the rest of the time. Maybe that’s just a type A personality; if I’m not really sure what’s going on, then I’m thinking about it at the back of my head all day and all night. But you have to force yourself to, and it’s hard, and you pay the price — every time you do take a day off, all that means is more work built up for Saturday and Sunday.
But in terms of getting out to meetings with peers, I think that’s really important because I come from those and at least I know everybody else has the same challenges. And my thinking is not way off in left field because they’re thinking about the same things. They’re struggling with the same things or they’re being successful with the same things, and so those meetings give you some validation that you’re doing the right thing. And vacation is something that if you don’t do it, you burn right out. I like to think that shorter, more frequent ones work better for me — I’m not the kind of person that takes a week or two very often or at all during the year, but you have to. It’s all part of it. CIOs are under enormous stress every single day and it just weighs on you seven days a week and so you got to have a break once in a while because there’s just so much going on.
And you know, we’ve only been focused on this conversation mainly on EMRs, but there’s so much more going on that health IT people are doing with extracting all the value out of those EMRs, building robust integrated analytics capabilities that none of us are used to but know need to be in place support all the reform that’s going on; patient experience types of things to reach out and make it more convenient and easier for patient to access care and access their records. It’s just everything all at once and EMRs are really only one of the pieces, but it’s exhausting and it’s exhilarating at the same time, and to me, that just says it all.
Gamble: I think that’s a good way of putting it and I know that there are so many other projects that you’re focused on right now just like everyone, when you talk about patient engagement, mobile devices, etc. We could go on for hours just talking about all of the priorities you’re dealing with.
Bosco: When I’m sitting in some of these conferences like the HIMSS conference or some other ones that are maybe more specifically CIOs — and I think at HIMSS the keynote there was something like 500 something that were there — I’m sitting in a room and I’m looking around and I know almost everybody in the room who is a healthcare CIO, and I think to myself, I’m proud to be associated with these folks. I look around and I think, this is a room full of people who are really at the forefront of everything that’s going on and they’re probably all working just as hard and they’re all just under as much stress as I am. And you walk away feeling like it’s a great group to be associated with and you have respect for everybody. If they’re being successful in their job as a CIO, then I have all the respect in the world for them because I know how hard that really is to do.
Gamble: It sounds to me like you have a really positive attitude and I think that that’s got to be critical right now. You can get swallowed up so easily so that I think it’s important to try to keep a good perspective.
Bosco: Absolutely, because everybody watches you. You have to be on all the time. If I walked out of the room and I looked upset or mad or resigned or frustrated, then I’ve got key people all around me, including my own direct reports, who could get scared by that. They too feel like they’re fighting every day to keep up and they just want to keep believing that’s it’s all going to work out great, but you have to do that together. And if the leader all of a sudden looks like he’s really worried about something or running around yelling or screaming about something, it just scares everybody.
Gamble: I agree completely. If you’re calm, they’re going to be calm. I think that there’s a lot to that. Well we’ve definitely touched on a lot, and unless there’s anything else that you wanted to add, I think that this has really been helpful, and I think it’s going to be really valuable for other CIOs to hear about everything that you’re going through at your organization right now.
Bosco: Great, I’m glad. I think we’ve covered a lot of ground; I think that’s about it.
Gamble: Alright, well thank you so much for your time, I really appreciate it. I want to wish you good luck.
Bosco: Okay, thanks a lot.
Gamble: Thank you.
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