Perhaps the biggest benefit in taking on a new CIO role is the grace period that comes in those early days. Jamie Nelson took full advantage of this window by tearing down the old governance structure at HSS and establishing a culture where IT is viewed as a strategic focus, along with creating steering committees to improve processes and increase transparency. In this interview, Nelson discusses the challenges in getting private practitioners on the same system, why academic medical centers are moving away from best-of-breed strategies, and the line CIOs must walk in fully leveraging IT solutions without impeding clinician workflow. She also talks about the guiding principles she learned as a consultant, the times when CIOs can’t just say “no,” and when she knew she chose the right industry.
- From acute care to surgery hospital
- Missing the “intensity and excitement” of NYC
- Lessons learned from consulting
- CIO’s new role — “Marrying together IT & hospital strategy”
- Reflecting on the days of block scheduling
- Choosing healthcare — “It was like a light bulb went off”
- Kierkegaard’s philosophy
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When you’re in a hospital where you’re serving your local community, the population on the fringes that could go to other hospitals are the people that you want to make sure that you get as repeat customers, so it’s a whole different environment.
The fundamentals we learned at FCG in terms of discipline around project management, reporting things in a structured manner, making sure that people all knew how to do things the same way — those are things that really carry you through all different organizations.
Our jobs have become extremely complex. Now we’re not only worrying about IT, but more and more we’re pulled into the senior leadership of a hospital. We have to think hospital strategy as well as IT strategy, and marrying those two things is complex and exciting.
The executives around me are very, very smart and I’m constantly learning from them. To be 30 years into a career and say you’re still able to learn from the people around you is pretty terrific and very stimulating.
I had both hospital operations and management consulting in my experience. Having those two paths, number one, allowed me to choose the path I was more comfortable with, and number two, gave me great insight and experience.
Gamble: Prior to being at the Hospital for Special Surgery, you were a CIO at Norwalk Hospital for about five years or so.
Nelson: Yes, that’s right.
Gamble: Can you just talk from your standpoint about some of the key differences in going from an acute care hospital to specialty hospital?
Nelson: Well, it’s interesting to be at a hospital where there is a single focus. It’s a very different dynamic; it’s a very different intensity when you have just one thing that you’re working on. The requirements are so different. At Norwalk we were thinking about accountable care organizations. I had an ED where we had to think through how to integrate the patients coming in there through the rest of the record — that’s the front door to the hospital.
There are a lot of things that in an acute care setting you don’t have to worry about. In a special hospital, I don’t worry too much on the weekends, because although patients are here all weekend and continuing to receive care, it’s not the intensity of having an ICU or an ED. It’s a different level of intensity. It’s a more focused intensity versus Norwalk, where you had so many different things to worry about at the same time from an IT perspective.
But it’s interesting because at Norwalk we did have a single vendor, Cerner, and we were actually at a higher HIMSS Analytics level then we are here at Special Surgery. So although I’m in an academic medical center in the New York City environment, I still had some catch-up to play in terms of getting to a certain level of automation.
Gamble: That’s interesting. The timeframe when you were at Norwalk seems to have been such an explosive time in the industry with so many things going on, namely the introduction of Meaningful Use. I’m sure that you went through some pretty big changes during that time period.
Nelson: We did, but actually, we got Meaningful Use. They attested just as I was leaving a year ago, so I was very proud of that. We were already at HIMSS Level 6 when I left, and I was very proud of that as well. Norwalk is in an extremely competitive environment. It’s a community hospital that’s surrounded by some other very high quality community hospitals. So every patient was somebody you had to think about and had to give your very best to, because you want that patient and their friends to come back. Of course we do the same thing here, but it’s a different type of environment since we’re a referral specialty hospital and people are coming here because of the excellent reputation. It’s different; when you’re in a community hospital where you’re serving your local community, the population on the fringes that could go to other hospitals are the people that you want to make sure that you get as repeat customers, so it’s a whole different environment.
Gamble: Oh yeah, sure, I can imagine. What was part of the draw that led you to the Hospital for Special Surgery?
Nelson: Certainly the reputation of the hospital; being in a hospital that’s number one in what they do is just a very stimulating environment. I also am from New York originally, and as I mentioned, I had worked at Memorial Sloan-Kettering and at New York Presbyterian. I also had been a management consultant with First Consulting Group and Ernst & Young, so I had worked in many of the New York City hospitals as a consultant. I was looking to come back to the intensity and the excitement of being in Manhattan.
Where we’re physically located, Kate, we’ve got Hospital for Special Surgery, Memorial Sloan-Kettering, New York Presbyterian Hospital, NYU just down the street, and Mount Sinai up the street. So when you think about the level of healthcare that’s provided on this island in the Upper East Side, it’s just amazing. It’s a really stimulating, exciting environment.
Gamble: Sure. I would think that it is an interesting thing too and almost more pressure when you think about it, that you do have such high-profile people. You’re getting players from the Giants and the Mets, and so I guess it kind of raises the bar for everyone to make sure that they’re on their game.
Nelson: There’s no down day here. You’re constantly doing your best. I love that the people here are so smart. They are so good at what they do that everybody wants to be excellent all the time, so it raises the bar for everybody. It’s a really exciting place to work. And I’ve worked at very excellent institutions. I have no regrets of anywhere I’ve been and I’ve learned everywhere. But this is a totally different level.
Gamble: You mentioned that you worked with FCG. How do you think that you benefited most from that experience in coming back to the provider side?
Nelson: It’s really interesting. One of the people that worked for me that I hired at FCG is now the CIO down at Bellevue and Metropolitan Hospital, so he’s got a good job. And he sat here with me and said that the fundamentals that we learned at FCG in terms of discipline around project management, reporting things in a structured manner, making sure that people all knew how to do things the same way, repeatable processes — those are things that really carry you through all different organizations.
There was a certain level of professionalism on how we did things that I still use here. We had a great term at FCG about changes being consistent and sustainable. I still use that with my own team — that if people are going to make a change internally, that change has to be something that is consistently done and sustainable over the long term. That’s a guiding principle I picked up from FCG and still use in all aspects of life.
Gamble: Yeah, this is pretty good guiding principle.
Nelson: But we really did work with some excellent clients and really pushed ourselves. There’s a whole bunch of FCG alum around who are really top-notch professionals and great to be able to network with.
Gamble: Yeah. As far as the industry itself, you’ve been in the industry for many years.
Nelson: Thirty years.
Gamble: Thirty? Okay, very impressive. Obviously, you’ve seen some pretty significant changes and evolution in the industry. Right now, what do you think is the most challenging aspect of being a CIO?
Nelson: I think our jobs have become extremely complex. Now we’re not only worrying about IT, but more and more we’re pulled into the senior leadership of a hospital. We have to think hospital strategy as well as IT strategy, and marrying those two things is complex and exciting. We are managing systems that have impact on clinical care and patient lives, and that’s something that is different than CIOs in other industries. You allow things to happen that can impact clinical care negatively, and that has a whole different set of ramifications. Keeping up with the changing regulatory environment, the changes in the healthcare technology, and in the clinical practice — these are all things that really add to the complexity of what we have to do and really keep us on our toes all the time I think.
But it’s exciting. I can remember starting at Memorial. It was actually my first job out of graduate school. I managed their outpatient clinics and the big question of the day was, ‘Where’s the record? Oops, it’s in the trunk of the resident’s car. He took it home last night and forgot to bring back in.’ We’re in such a different environment now. We had block scheduling, all on paper — patients came either at nine o’clock or at one o’clock, so days have certainly changed and automation has really I think helped make the patient experience much better, along with the clinician experience.
Gamble: I like how in answering that you talked about the most challenging part about being a CIO but then also pointed out how that’s created so much more opportunities by having a greater role on that strategic team.
Nelson: Absolutely, and it makes the job more exciting. I think it’s a different breed of CIO today than maybe 10 years ago, because the technical understanding is of course important, but being able to effectively manage people, manage change, manage the executives in the C-suite, manage relationships with clinicians — these are important things where you really need a different level of leadership. You need high emotional intelligence. You need to have really different leadership skills.
Gamble: Some have told us that it’s a continuous learning process. That certainly seems to be the case.
Nelson: It is, and actually one of the things I love about this organization, which is still new for me, is that I’m constantly learning. First of all, I’m learning about orthopedics as I never knew I would, but I certainly am. But the executives around me are very, very smart and I’m constantly learning from them. To be 30 years into a career and say you’re still able to learn from the people around you is pretty terrific and very stimulating.
Gamble: Yeah, it keeps it interesting.
Nelson: It does. I love my job. I get up in the morning and I’m so thrilled to be here and be in this profession. I consider myself extremely lucky.
Gamble: It really does seem like such a fascinating time to be part of this industry. I’m sure it has been for many years, but I think that now in particular, it’s a really interesting time.
Nelson: When I think about being in business school — I went to Cornell for my masters in business and most of my friends were in marketing or looking at investment banking or accounting, and here I was with my little healthcare degree and my MBA. Who knew that 30 years later I’d still be doing it and it would be such an exciting, important part of the economy and what’s going on? I somehow made a good choice. I didn’t know it back then. But it was interesting to me. I guess following something that interests you and you’re passionate about it is always a good choice.
Gamble: Was there a specific moment or time that you really started to become more interested or just knew that healthcare IT was a path you wanted to follow?
Nelson: I can tell you about healthcare. I was in my senior year of college having no idea what to do with my physical anthropology degree. A friend said that she was thinking about hospital administration, and Kate, it was like a light bulb went off. I guess you’re probably much too young to remember this, but there was a show called Medical Center that I watched as a kid. I think there were too many nights of watching that. But I felt, wow, what a great thing to do, and so I started to look at programs and decided that an MBA would probably be better than an MPH, because if I didn’t like healthcare, I could probably use my MBA in another industry. But I never left it, and then when I was at Sloan-Kettering, I moved to finance when we were putting in a patient accounting system. So I was on the team as a staff person. That was my start with IT, and I never looked back.
Gamble: You chose the right positions.
Nelson: I did. There’s Kierkegaard who was a philosopher who said that life is lived forward and understood backwards, and I think this is a great application of that quote.
Gamble: The one final thing I wanted to ask is, looking back, knowing what you do now, would you still take the same path?
Nelson: Absolutely, because I love what I do, and I think that’s the most important thing in a career, if I can offer some career advice. I have three children and I tell the three of them, whatever you pick, you must love it. Have something that you’re passionate about and interested in. I was lucky because I had both hospital operations and management consulting in my experience. Having those two paths, number one, allowed me to choose the path I was more comfortable with, and number two, gave me great insight and experience. I’ve had an excellent run, and again, I consider myself lucky in the choices I’ve made and the opportunities that were given to me.
Gamble: They say that if you don’t think about it as work, and you love what you do, you’re not really working.
Nelson: And I do. Actually, I was emailing the CEO about a project we’re working on last weekend. I think it was Saturday morning when I emailed him and said, ‘Is it Monday yet?’
Gamble: That’s a good sign.
Nelson: It is a good sign. Not that I don’t love my weekends — I certainly do, but I was so excited to get back in. After 30 years, I think that’s a good thing.
Gamble: Yes, definitely. Well we’ve talked about a lot of great stuff. Unless there’s anything else you wanted to touch on, this has really been great and I appreciate your time.
Nelson: Oh good. I appreciate you reaching out to me. I look forward to seeing what you put together about what I’ve said.
Gamble: Thank you again, and I hope to talk to you again in the future.
Nelson: Thanks so much, Kate. Take care.