Theresa Meadows, SVP/CIO, Cook Children’s Health Care System, Chapter 2

Though running a best-of-breed shop presents some unique challenges for the hospital IT department, Theresa Meadows says the big benefit is being able to give clinicians the exact tools they want. So the answer is no, she doesn’t envy her single-vendor-for-all colleagues. To learn more about how Meadows is melding her Meditech and athenahealth environment, healthsytstemCIO.com recently caught up with the Texas-based executive.

Chapter 1

Chapter 2

• Staff management
• Solid lines versus dotted lines
• Reporting to the CMO
• Turning an IT shop around
• Creating a career path for technical folks
• The importance of a sound cultural fit

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BOLD STATEMENTS

Traditional biomed years ago was really just a pump and a system and there was no connectivity, and now pretty much everything they do has an IT component.

Those are the things we’re really trying to avoid, those mishaps, so we don’t buy something and realize we didn’t buy all the pieces we needed to make it successful.

… to be honest, when I first arrived, the perception wasn’t that great. It was, “IT doesn’t really care about the clinicians, and they don’t understand our needs.”

Guerra: What kind of team do you have reporting to you for the IT department?

Meadows: I have a team of 170 people, which is all of infrastructure, telecommunications, all the applications infrastructure, the program management office for the organization reports to me. I know I’m leaving someone out – all the clinical and financial and vendor contract management report through our IT organization. And then we have a dotted line reporting structure, so we have a biomed team within IT that is more of the liaison with biomed. Biomed doesn’t report to me, but we have a structure where it’s a dotted line.

Guerra: Practically speaking, when it comes to the actual relationship, have you found that a solid line turns into a different relationship than a dotted line? Does it matter?

Meadows: I’m not sure that it matters. I think it’s all about communication, and that’s the one thing that we’ve really tried to work on, is to work better together and to really communicate the structure of biomed, and now the technology going forward. Traditional biomed years ago was really just a pump and a system and there was no connectivity, and now pretty much everything they do has an IT component. We’ve really tried to create that structure where we’re at the front end of the purchasing process and the selection process and really weighing how that’s going to impact our infrastructure, and this pseudo hybrid dotted-line reporting has worked for us, but it’s all about the communication and the structure that we put in place.

I could see where it would break down if you ever try not to have that consistent communication, but that’s really been how we’ve been able to address it. I’ve never had biomed report to me, so I’m not sure if I can speak to the other side of the coin. I could see where you could just say, “Go do it,” but that doesn’t really work in our culture, here that doesn’t really work. We’re more of a collaborative culture, so the dotted line works perfectly fine.

Guerra: Can you imagine someone holding up an org chart to you and saying, ‘Listen,  I’m only dotted line to you, you can’t tell me what to do.” J

Meadows: Yeah, it seems ludicrous, but I’m sure that’s happened before.

Guerra: We need definitions, like a glossary of terms – solid line means you must attend a meeting when the person at the other end of that line calls one, etc.

Meadows: We don’t make a big deal out of the reporting structure, it’s more, “Let’s work better together,” because we’ve had mishaps with our biomeds, some of our biomed installs, and it’s because we weren’t communicating. We didn’t know the requirements for a server or a certain network configuration or those types of things. Those are the things we’re really trying to avoid, those mishaps, so we don’t buy something and realize we didn’t buy all the pieces we needed to make it successful. That’s really our goal.

Guerra: How many direct reports do you have?

Meadows: It changes on a regular basis, but today the CTO reports to me, our Chief Technology Officer, our Chief Medical Information Officer reports to me, and then the Program Management Office Director and the Applications Director report to me, and that’s it.

Guerra: How many is that – about four or five?

Meadows: Four.

Guerra: That sounds like a good number.

Meadows: It is.

Guerra: I’ve heard double that, even more. That sounds like a lot.

Meadows: We’ve worked on that structure over the last two years. Once we had our CMIO on board and we had our CTO on board it was easier to start delegating different things to those guys because they’re really strong and have good operating minds, so it’s easy. Our CTO actually manages all the infrastructure and those types of things, the traditional CTO job, but he’s also in charge of business intelligence. He’s very analytical and the business intelligence team reports to him. It’s a unique structure, but it seems to work for us.

Guerra: The CMIO position is interesting, still evolving I think. Certainly, in org charts you’d find it all around the place.

Meadows: Sure.

Guerra: Do you feel like having the CMIO report to you works well? Do you think that could be a best practice, or do you think it could work any number of ways?

Meadows: It works for me only because we have an interesting structure here — I actually report to the CMO. So I think it’s a very interesting organizational structure, so to have the CMIO reporting to me in this organization I think makes sense because we report directly to a physician. We have a lot of synergy in our group, I think, because of that perspective and a lot of credibility because everyone knows we report to the highest physician in the organization, and so I think that helps us out.

I think both models can work, but I personally like having it in IT. I think our role in informatics is more than just the technology, it’s being able to work closely with the clinicians and showing that synergy that we’re actually on the same team, and that we’re all here trying to deliver the same amount of functionality, and we listen to the clinicians. I think it gives us credibility that he’s on our team. I personally like it. I think he likes it as well. He enjoys being part of the IT team and having access to the people he needs anytime he needs them, and so I think that’s very helpful. But can another model work?  Absolutely, if you have the right structure to support it.

Guerra: I’ve heard of CIOs reporting a lot to the CEO, some to the CFO, some to the COO, not too many to the CMO. Do you know if that’s widespread?

Meadows: I think I’m an anomaly. I have not met another CIO that reports to the CMO other than me. It’s interesting, and it works here. It seems odd, but for the clinically oriented things that we have going on, it seems to work.

Guerra: Did you know that going in?  You said you’ve been there two years. Did you know you’d be reporting to the CMO?

Meadows: I did. I did know that coming in. At first, I was a little worried about that because the literature you read indicates that the CIO has to report to the CEO for that credibility, but I haven’t felt that at all here. I’ve gotten the support that I’ve needed and, if the CEO needs something, he know where to find me. I’m involved in major decision making and I’m part of the executive team, so I haven’t really felt that it had to be one way or the other. I was a little worried at first, but it’s been great.

Guerra: I would imagine, specifically in your case, you wanted to really talk to the CMO and make sure that IT was being perceived in a way that you were comfortable with because it is an unusual reporting structure. Were there some questions that you wanted to have answered before you got on board there?

Meadows: Sure. I was concerned about the perception of IT and, to be honest, when I first arrived, the perception wasn’t that great. It was, “IT doesn’t really care about the clinicians, and they don’t understand our needs.” Those were some of the hurdles that I’ve really had to work through, and having Dr. Cunningham’s support through that process has been very helpful, because he can also say, “Meadows is a nurse by trade, she understands your workflow, she is not just a technical person who is trying to cram something down your throat.” That’s been very helpful, having that type of support, but that was something we’ve had to overcome and we’re still working on it, especially as the technology moves closer and closer to the patient so it’s critical that it’s working 100% of the time. Having that trust is very important, and that’s something that we’ve worked on over the two years that I’ve been here.

Guerra: We don’t want to disparage your predecessor, but I guess the perception of IT wasn’t that great when you came on board. Anything specific that you think brought that about?

Meadows: I think it was mostly just how we responded to the customer, and did we listen. I think the primary thing was they felt like we weren’t listening. It takes a lot of ground work and the things that people say are true; the biggest thing you have to do is form those relationships, and I think some of that just didn’t happen in the way that it needed to initially. So we had to go back and really start from ground zero and then make some changes that were visible to the end user.

Some of the things we changed were our help desk or our service desk and how that group interact with customers, and then how our directors and management team interact with customers, because a lot of our managers, before I got here, really didn’t ever meet with end users, which I found unusual. So just getting the IT folks out of their cubes and seeing people and talking to people and listening was the main thing that we did. It wasn’t a huge thing – I hate to take credit for it because it’s not a huge change but it is something that people would say, “You know, we never really saw IT folks before and now we see them all the time.” Just those little changes, I think, make a huge difference in perception.

Guerra: Now there are some IT folks who are very good at what they do but you don’t really want them talking to people.

Meadows: Absolutely, absolutely, and we hope those aren’t our managers, we hope those aren’t our managers and our go-to people, but occasionally they are.

Guerra: I had an interesting interview a couple of days ago with a CIO and what we were talking about was those people still need to be appreciated and promoted, but not into positions where they’re going to be managing people or having extensive meetings with physicians. But those people with those deep technical skills are valuable and need to be paid and retained.

Meadows: Absolutely. One of the things we’ve done in the last couple of years is we’ve put together career paths for that exact reason. In our Business Analyst Career Path there’s an entry level analyst and then there’s a senior analyst. And then, at the senior level, we have a split, so that there is a lead business analyst — and the lead business analyst is someone who you think would want to go into management — is good with the customer and moving up that management track. And then we have specialists who are very good technically and may be experts on the particular system, but they’re not really the ones that you want to go out and meet with the customers and do those types of things, but they provide as much value as somebody in the lead position.

We’ve created that career path for the more technical folks to go in the specialist route, and the people who are more people oriented or want to be in management and move down that career path now have the lead career path. We’ve done that in almost every one of our career paths to be able to allow people a choice.

One of the things we’ve said to folks is, “You may decide you want to go down the lead path and then once you’ve done it for a while, you’re like, ‘I don’t really like this.'” So there is a crosswalk from the lead to the specialist so that people can move back and forth, and it could be that somebody who’s highly technical is very good with the customer and they realize, “I really miss that interaction and I want to move in that other direction.” So we’ve given people the ability to do that. Whereas, before, everybody was just the same with no career path or no growth opportunities, and so we’ve tried to build those avenues for people.

Guerra: So you’ve really thought that whole problem through and come up with a nice solution for it.

Meadows: I hope so. I hope it works. We’ve spent a lot of time thinking about it because we have a lot of highly skilled technical team members who we don’t want to lose, and we want them to progress and have growth opportunities because the competition is fierce for good IT people. My goal is to keep as many of our staff that we have and hopefully they’ll be happy and want to continue to stay here.

Guerra: Did you find, when you came on two years ago, that you needed to make some changes to the team? Maybe some people weren’t interested in the program you were trying to instill.

Meadows: Yeah, sure. We certainly made changes. We’ve made organizational structure changes, we’ve changed up the teams, and we continue to do that as we look at the things that aren’t working or need adjustments. One good example is our PMO director position – a business intelligence officer reported to the PMO and that logically didn’t make sense, so they reported to me for a while until we kind of figured out what we wanted to do with that team and now they report to our CTO. We’ve evolved over the two years I’ve been here and made changes. We’ve made some changes in our application teams and how we actually do support to our customers. Yes, it’s a gradually changing thing, and we’ve had people leave because they didn’t like the changes we’ve made, but then we’ve had a lot of people stay. It’s just what you’re willing to live with and what you’re not.

The goal that I’ve set is our customers are the reason we’re here, and that’s how we’ve got to learn to support them and be here for them, and if you don’t feel that you can do that, then this may not be the place for you. We’ve had good success.

Guerra: You said that some people have left. I would imagine that some people had to be asked to leave.

Meadows: Sure.

Guerra: What do you see in someone that makes it clear they have to go?

Meadows: Here, specifically, it’s a cultural fit. So we are – I don’t know if this is just a pediatric thing – I came from adult healthcare before, but it’s really how people communicate with others and how they fit into the culture. At Cook, you’ll hear people say that a lot and usually it comes down to a couple of things. One is the amount of communication and how you’re communicating as things are going well or as things are going bad, and how you manage issues and manage our customers. Two, just your willingness to be part of the team, and those things you can pretty much see early on. We have had some cases where you have that conversation and people are like, “I didn’t realize I was that way,” and they go out and they improve their communication style and they do well. But most people, if you have issues in those two areas, either with communication or management of issues or just overall perception, then you’ll probably be in a short-lived position here. Because I’ll get calls from people who say, “You know, their communication style is (not great). Yes, they managed that project well but they ran over everybody in the process, and I just don’t think I can work with that person.”

The cultural fit is very important, at least here in this organization, whereas other organizations that may not be as high a priority, but that’s been the method that we’ve looked at — the communication style, the skills, how they’re interacting with their customers and what their customers think play a big role in that.

Chapter 3 Coming Soon …