Edward Martinez, SVP & CIO, Miami Children’s Hospital
Earlier this year, Ed Martinez received the 2012 Innovator of the Year Award from CHIME for his efforts in leading the mHealth program that is transforming the way care is practiced at Miami Children’s Hospital. But Martinez’s innovation goes beyond that. In this interview, he talks about his unconventional methods for winning over naysayers, the enormous role that process improvement and change management play in a successful implementation, why his organization chose Cerner over Epic, the importance of taking risks, and what all CIOs need to keep in mind during a sales pitch.
Chapter 2
- Managing massive projects
- “Part of being a CIO today is knowing when to say, ‘Enough is enough, we can’t go any further’”
- The daunting revenue cycle system change
- Making the big calls, taking risks
- “I’d rather have the discuss with the board about why we made a certain mistake and how we corrected it, then why we didn’t do anything”
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Bold Statements
We’ve hit the peak right now, and we’re waiting for it to die down a little bit, and then we can keep going. If you try to push forward, yeah, you’ll get it implemented, but you’ll have a lot of failures in the process and maybe a lot of people quitting on you and a lot of unhappy campers.
Part of being a CIO at this level is knowing when to say, ‘enough is enough. We can’t go any further.’ And even though you’re getting pressure from the board or from your CEO, you have to go back and say, ‘We just can’t do this right now, and here are the reasons why.’
Now you have to take a big step back, bring that person up to speed, get them comfortable with the strategy, change the strategy wherever necessary based on this person’s opinions, and then be able to move forward again and get their buy-in. Because it’s critical I’m not the one standing up to the board by myself.
The slower we take this current state-future state analysis, and the slower we take the change management process, the more efficient and the more effective we’re going to be, and I think the more successful we’re going to be in the end.
When we can go full-force forward, we go full-force forward. And if we make a mistake, which we will, we react quickly enough, and fix it and move forward. But standing still — that’s the death. If you just stand there, you’re waiting to get killed.
Guerra: What these things require are skills. You have to understand how you have to do this and the amount of time. Sometimes that doesn’t speak well to how rushed things are these days with the Meaningful Use stages — these deadlines in the sand. Talk about the time these things take to do properly, sit down with the physician, have another meeting and another meeting, and break down this resistance versus the speed at which things have to happen right now.
Martinez: That’s a great question. The best way to answer that is to tell you our real-world situation. We were supposed to go live with phase 2 of this project, which is the financial systems, or start the implementation in May or June of this year. We have held off. We’ve made changes in the plans. We understand the implications. We also understand that for us, it’s a lot more important that the clinical side of care is handled correctly. So we have postponed the decision to move forward with the implementation of phase 2 until we feel comfortable that most of the docs are on board. And we’re getting very close, actually. We’re probably at 96 to 97 percent adoption. We’re close to a 100 percent CPOE rate right now.
The extra three or four months, from an IT and a project planning perspective, you would think, we should be able to plow through this. What we did was, I changed the strategy and said, okay, rather than build right now, let’s spend time analyzing the current state and future state of the finance areas. So we’re not sitting around waiting. We’re doing other things in anticipation while we’re still trying to work with the docs that are somewhat resistant and get through that level of change that needs to occur. And at that point, I would say within the next 30 days or so, we’re going to be in a lot better situation and then say, ‘okay guys, are you ready for phase 2? Because this is what it means to you.’
If we tried to introduce it sooner, I think it would have a detrimental effect on the project. So part of this is knowing when to pull back and saying, ‘we can’t go any further. The organization just can’t absorb any more right now.’ That’s a big blunder a lot of times in implementations. What is the ability for an organization to absorb this kind of change all in one shot? We think we’ve hit the peak right now, and we’re waiting for it to die down a little bit, and then we can keep going. If you try to push forward, yeah, you’ll get it implemented, but you’ll have a lot of failures in the process and maybe a lot of people quitting on you and a lot of unhappy campers. So why go through that?
There is a cost to delaying the project three or four months, and I’m very well aware of that. We presented that to the board and we said, ‘look, here’s the situation. If we move forward, we could be risking a lot greater. This is a hundred million dollar project. So we lose a little bit of cash, but we gain a lot more credibility. We gain the respect of the physicians. We gain their acceptance. We gain their trust, and then we move forward with the rest of the project.’
Part of being a CIO at this level, in this day and age, is knowing when to say, ‘enough is enough. We can’t go any further.’ And even though you’re getting pressure from the board or from your CEO, you have to go back and say, ‘we just can’t do this right now, and here are the reasons why.’ Thankfully, we have a fantastic board and our CEO is an ex-GE Healthcare executive, so he understands, and they understand the nature of this beast. The fact that we’re 31 years out of a system that has never changed in this organization is an added concern because there’s a lot of unknown that we don’t know we’re going into in the finance world. In the end, I think we’re going to get everything we want within or very close to the timeframe we expected, but with gaining the respect, and like I said, the acceptance and everything that goes along with working hand-in-hand with our clinicians and physicians.
Guerra: I think what you said about putting the brakes on is brilliant, and I believe it 100 percent. I don’t hear it a lot, so I think that is a key differentiator if you want to separate out CIOs to different classes — the ability and the willingness to put the brakes on a major project and have that discussion with the CEO and the CFO and the board and say, ‘we just can’t handle it right now.’ I think that is sort of stepping it up to the upper levels and I don’t hear that a lot.
Martinez: Yeah, and that’s unfortunate. I think from an IT perspective, we can take it on. I bring in consultants. I do this, I do that. I can always manage around having to beef things up, but you can’t do that to the people who are out on the floors. The guys who are taking care of the kids, the nurses, and the frontend people — they think differently, and each one of these individuals have a different perspective on this. So that’s what the change is about. It’s about knowing when to put the brakes on, knowing when to proceed, knowing where there’s resistance, and knowing how to break it down. And if we can put it all together, we get a successful implementation.
That’s what we’re in the middle of right now. We’re past phase 1, we’re happy, and like I said, I think we are at 100 percent CPOE rate pretty much, except for maybe one or two docs. That’s better than we anticipated. We expected 54 percent by the end of this year, and we’re at 100 percent so great. So that’s working out. Anesthesia, which is an area of resistance initially, is working correctly. ED is working well. Everywhere that we thought we were going to have bottlenecks are now starting to operate.
Now we start focusing on the deadliest part of the organization in terms of survivability — the money. How do we transition from a 31-year-old financial system to a new state-of-the-art system without losing money and revenue in the process? I’ll tell you something — it is daunting. The clinical side was tough, but the financial side is even tougher for this environment. Usually it’s not, but in this case it is because we had a lot of processes and a lot people that went along with this. How do you tear that apart?
And now we have a new CFO on board helping us to do that. He’s learning the ropes too. Talk about a reason to put the brakes on. A new CFO comes into the picture, and he’s not comfortable with any of this stuff. He’s missed two or three years of this. So now you have to take a big step back, bring that person up to speed, get them comfortable with the strategy, change the strategy wherever necessary based on this person’s opinions or what they want to do, and then be able to move forward again and get their buy-in. Because it’s critical I’m not the one standing up to the board by myself saying, ‘here are the reasons why we lost revenue this month,’ but we’re doing it together as a team. That way, he has my back and I have his back, and together we’ll succeed if we have any problems. So all of this is a good reason to just take a deep breath and say, ‘hey, let’s hold on for a second, let’s see what we can do better and how we can do better together,’ and that’s where we’re at today.
Guerra: Maybe it’ll make you feel better to tell you I do hear that a lot in terms of CIOs and organizations being very reluctant to mess with the financial systems and anything having to do with the revenue cycle. It just scares the heck out of everyone.
Martinez: No doubt about it, I’m telling you. We took one giant step last month or maybe 45 days ago. We decided to make one massive change to physician billing, which is just a small, $20 to 30 million dollar side of the house for us, and that was incredible. That allowed us to see clearly what we’re getting ourselves into. And we have a better idea how big of a monster it is. It’s scary because a lot of these financial systems have been bastardized for many years and they’ve been modified to tweak certain things and do certain things and process payments this way.
And now here you have a 31-year-old system that has never been looked at closely and we’re trying to decipher what we did for 31 years. We can’t get a straight answer because it has been so bastardized. So the slower we take this current state-future state analysis, and the slower we take the change management process, the more efficient and the more effective we’re going to be, and I think the more successful we’re going to be in the end.
Guerra: You’re referring to the CareCloud project?
Martinez: Yes, that’s absolutely right. So we went live with CareCloud. We’re live, as of a week ago, on CareCloud. To get us from ground zero to live in 45 or 48 days, whatever it took, was an act of God. It literally was an act of God. We took a little bit on the chin here because people were questioning why the CFO and myself made decisions based basically fast-forwarding this and getting it implemented. Well, you’re bleeding $10 or 11 million dollars year in revenue in that area. It’s an easy decision to make, basically taking a 45-day hiatus in that area and saying, ‘when we come back, we’re going to be performing on all cylinders and revenue is going to be generating like it should be. We’re going to be in good shape.’
For me it was a breath of fresh air hearing a CFO say, ‘I’m going to take the risk, let’s move.’ At the same time it became a risk proposition, because if you drop the ball and you don’t execute and you don’t work this effectively, then it becomes a big risk for the organization. Thankfully, knock on wood, the CareCloud folks were fabulous. Everything we thought we were going to do has come to fruition. We’re live on CareCloud. We moved that whole physician building out of that facility, and oddly enough, with very little issues I’d go live.
Guerra: You can’t be a CIO without having some courage and some guts to make these types of calls, right?
Martinez: You have no choice. You’ve got to take risks. I always tell my staff, ‘measure twice, cut once,’ just like a surgeon does. But when you cut, you cut. And if you cut the wrong artery or the wrong vein, just like a surgeon, you fix it. You react quickly and you fix it.’ I’ve always led my career like that. I think that once you make a decision, you move forward. And as you move forward you’ll find out whether the decision was the right one or the wrong one. Sometimes you can see it clearly, sometimes you can’t. As long as you’re moving forward, you’re making progress, and if you have to change something, you change it, and you ultimately go where you need to go. But if you just sit there and you wait and you wait and you wait, we’ll be talking about this three years from now.
That’s where organizations become stagnant — when decisions can’t be made. You see that in large health systems where one decision is overruled by another decision is overruled by another decision, and what normally should have taken one month takes two years. That can’t happen when you’re trying to grow a health system like in our case. The demand for the growth is at five or six percent per year for the next four years. That’s staggering numbers. How you keep up with that is you’ve got to make decisions.
It goes back to what you said — I have to know when to hit the brakes and say, ‘we can’t go to any further.’ And when we can go full-force forward, we go full-force forward. And if we make a mistake, which we will, we react quickly enough, and fix it and move forward. But standing still — that’s the death. If you just stand there, you’re waiting to get killed. It’s just not good.
Guerra: That’s really the essence of leadership, right? It’s laying your cards on the table, making a decision, and not continually postponing it for review and reexamination.
Martinez: Absolutely. The way I figure it is if you don’t make the decision, somebody is going to make a decision for you. Whether you’re here or you’re not, but someone’s going to make a decision for you. I’d rather have the discussion with the board about why we made a certain mistake and how we corrected it, then about why we didn’t do anything. That’s just not a good discussion to have. And so I’ve always felt that interest or that focus has been very successful for me and other CIOs that have been successful in this field.
Guerra: We had our little hurricane in New Jersey recently — we stole one from you, and I remember Governor Christie during the storm said a great line, which I’ve heard before, but it really resonated. He said, ‘better to ask for forgiveness than permission.’
Martinez: That’s correct.
Guerra: I thought that was an excellent line. It’s a great way to lead and to even lead your IT team or your company.
Martinez: Absolutely correct. I tell my directors all the time, ‘you’re paid to make decisions; make them. I’m going to support them. If you’re wrong, we’ll talk about it and we’ll figure it out.’ You don’t want to be wrong too many times, but you want to be able to take the initiative. I think that’s the focus here. Take the initiative. Don’t sit just around, focus on being successful and look toward the future. Use the tools that are in front of you. Use the lean methodologies. Use the change management processes. Look at good project management, get the right teams in place, and make sure you get total buy-in or close to total buy-in as you go through these projects so you’re not the one guy standing up in front of everybody saying, ‘here’s what happened.’
You’re there as a team and we can all say that the team failed together. And that’s okay, mistakes happen. The biggest governments in the world and the biggest companies of the world make mistakes, but every once in a while, they also hit a home run out of the park. So that’s where we’re at. We’re risk takers. We’re innovators. We believe we’re a very big innovation company in this time of age in healthcare. Innovators are going to take risks that sometimes aren’t going to be fruitful, but every once in a while you’re going to hit that home run and that’s where we’re hoping that we’re going to hit that home run.
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