It’s one of the most overused buzzwords in the industry, but when it comes to understanding what ‘big data’ actually entails, Kirk Kirksey believes there’s a gap the size of Texas. “If you want to see big data, come here,” says the CIO, who shares his thoughts on the ‘holy trinity’ of high-level analytics, the model UT Southwestern is developing for academic medical centers, and why he believes we’ve just scratched the surface of big data. In this interview, Kirksey also discusses what his team is doing to provide IT support for the organization’s three missions — education, research, and patient care; being an early Epic customer; what he believes we can learn from history; and why “culture eats strategy for breakfast.”
- Learning from the Aztecs
- “Culture eats strategy for breakfast.”
- The dangers of starting too big
- “You’re only going to be a partner with me if you want to assume risk.”
- Vendor negotiation
- Balancing “lively discussion” with respect
- Passion for teaching — “There is such a misunderstanding about what health IT is”
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You need to assess in your own mind what the culture will allow you to do, how far you can push the culture, and what you can change and what you can’t change.
I started too big. I didn’t start in small enough steps. That hurt us in the beginning, but then we figured out what we could change. You can’t change 45 clinics in one sweep, but you may be able to change two or three at a time.
You’re only going to be a partner with me if you want to assume risk, and by that, I mean money risk. I ask people not to use the word ‘partner’ unless they want to throw in some money or include a financial penalty in their contracts.
A vendor that will stand with you and help you and maybe not refer back to the literal words of the contract and throw that into your face — that’s the kind of vendor that you want to deal with.
I try to build an environment where when we have problems and we discuss things, we are peers in that moment, and anyone can challenge anyone else. Now, once we come out of the room and we have decided on a direction, I expect everybody to tow the company line.
Gamble: I think you’re right, it seems like they’ll be a buzzword that’s used for a while, like ‘governance’ or this or that. But there isn’t one solution that’s going to help everyone.
Kirksey: When you say technology, you assume that technology, whatever it is, has a certain phenotype. And if you go back in history and you look at technological accomplishments and you study what happened there, they have nothing to do with computers or IT. If you take an objective look, there’s a common thread that successful technologies execute and the ones that fail, failed to execute. I think studying history is a valuable exercise in trying to free your mind that this is an information technology problem. I don’t think it is. I think it’s much wider than that.
Gamble: It’s a different kind of thinking that’s needed, right?
Kirksey: If you go back to the Aztecs that built Mexico City on a lake, they had to invent and utilize really sophisticated technology of fluid dynamics and building dams and stuff like that. If you read that, it’s pretty amazing what they had to do with their administration and their culture and their workflow and things like that. And so I think it’s not necessarily just an IT problem; I think the pathology of it is not just limited to information technology.
Gamble: You just brought up culture. I had looked back to a couple of your Tweets, and like I told you before we started recording, I just kept going from one to the other clicking on links and everything. One of your Tweets read, ‘Culture eats strategy for breakfast every morning.’ I love that. I think there’s a lot to be said for that, and I think sometimes culture isn’t something that’s looked at enough ahead of time or considered enough before a project is implemented.
Kirksey: I think that’s exactly right. You need to assess in your own mind what the culture will allow you to do, how far you can push the culture, and what you can change and what you can’t change.
Gamble: In your experience with something like bringing on different hospitals, are there any best practices or lessons learned that stood out to you as far as maybe something you would have done again, or something you thought you did well as far as really trying to address the cultural issues before making a change?
Kirksey: We made plenty of mistakes, don’t get me wrong. I could go through a whole session of the mistakes. Initially when we started — and it was me; it was my responsibility — I started too big. I didn’t start in small enough steps. That hurt us in the beginning, but then we figured out what we could change. You can’t change 45 clinics in one sweep, but you may be able to change two or three at a time, and you can disprove the common arguments — ‘the EMR is going to tank our business.’ ‘We’re going to lose 50 percent of our revenue.’ ‘Our patients are going to hate us.’ But if you do three or four at a time with people that support you, then that works out better. That sounds obvious and self-evident, but it was a hard learning experience.
Gamble: Right — not necessarily doing it slower, but in a way that slowly builds up that support.
Kirksey: This will sound extremely mercenary, but with these new technologies, there’s a community of people that, number one, can’t or don’t want to learn it. Then there are people that just have a vested interest in the old way of doing things — sometimes those people change, but sometimes they don’t. You have to deal with that environment sometimes, which is always unpleasant. It’s always unpleasant.
Gamble: One of the other topics that comes up a lot when we speak to CIOs is vendor management. I wanted to get some of your thoughts on this because we’ve had more than a few people say that they get frustrated with what you termed ‘vendorese.’ We’ve heard things like that before from others — do you think there’s hesitancy to just cut through the muck? And when words like ‘partnering’ are thrown around, is that frustrating from your standpoint? Would you just rather, like we said, cut through all the stuff?
Kirksey: I was a vendor for a long time. Vendors have very, very hard lives, and they’re very, very necessary. My hat is off to the good ones because this is a very difficult thing to do to deal with people like me and my species. The ‘partner’ word I hear a lot. You’re only going to be a partner with me if you want to assume risk, and by that, I mean money risk. I ask people not to use the word ‘partner’ unless they want to throw in some money or unless they want to include a financial penalty in their contracts, which most of them do not want to do.
On the other hand, I know CIOs are people who are very proud of their negotiating skills and will say, ‘We got a vendor down.’ It’s good for your vendors to make a profit — a fair profit; not an unfair profit, and not an obscene profit. Negotiations have to be a win-win because you want ongoing support. In a way, you are a partner with your vendor, especially small vendors. I’ve made many mistakes bidding small vendors down who were hungry but they couldn’t make a profit, and it turned out badly for all of us. I have a lot of respect for vendors and I want them to come here and be happy working here, and I want them to make a fair but not an obscene profit. But that’s just part of being capitalists in my view.
Gamble: Right. I think it’s key to understand what they’re trying to do as well, and it benefits everyone in the industry to have vendors that are doing well. Maybe the key is to try and develop that relationship, but before you have the relationship developed, that’s when it gets kind of dicey because everyone is feeling each other out. I can imagine that being one of the tougher parts.
Kirksey: Yeah, once you’re established with the vendor and you have a good relationship with them, you always have to be firm and fight for your position. And the vendor is an inanimate object — what you need is a human being; a carbon unit that you trust and that you know that will step up to the table when there are problems. I don’t really judge a vendor by their standard delivery product. I judge a vendor by how they respond to a problem.
Gamble: That’s what you need in the long run. That’s a lot more important.
Kirksey: You’re going to have two or three crises a year. A vendor that will stand with you and help you and maybe not refer back to the literal words of the contract and throw that into your face — that’s the kind of vendor that you want to deal with. And there are vendors like that out there.
Gamble: One of the last things I wanted to touch on is staff management — and more than that, actually being able to recruit and hire and hold on to good people. This is an issue a lot of CIOs and other leaders are grappling with right now. I just wondered if you had any best practices in terms of finding good people, and more importantly, holding on to them.
Kirksey: This is a binary question; certain skill sets are more in demand than other skill sets. Right now electronic medical record is hot — anybody you have with that skillset can walk out and get a job fairly quickly, so it depends on which areas you’re talking about. But in general I think what I’ve learned again the hard way is that we’re dealing with a false dilemma. That’s the name of my blog, and it’s an idea that I’m obsessed with. False dilemma means you don’t consider all the options that you’ve got; you consider a few options and you believe those are the only options, when in fact there are others.
What I’ve learned the hard way — and again, this sounds very, very trite — is that you just hire the best people you can. When you manage those people, there is a period of time when you need to be peers. You need an environment where people feel very free and open to express ideas, even if they challenge what I believe. A lot of people, especially young people, are very hesitant to do that. That comes with confidence and maturity. But in my own organization, I try to build an environment where when we have problems and we discuss things, we are peers in that moment, and anyone can challenge anyone else. Now, once we come out of the room and we have decided on a direction, I expect everybody to tow the company line, but I really value smart people that are not afraid to have what you might think as outlandish ideas and aren’t afraid to bring those forward, because they’re a lot smarter than I am, and they bring ideas that are just incredible that I could never have thought of.
Gamble: I like the point you made about being able to challenge leaders, obviously in a respectful way. You don’t want to be surrounded by yes men or yes people. That doesn’t really help anyone move forward, right?
Kirksey: That’s the kiss of death. I believe you can’t have a conversation without etiquette. How you present yourself respectfully is important, because once you violate that you begin to isolate people, and that’s not productive. So this idea of a conversation with etiquette is important to me. Not that we don’t have some very heated discussions — when people believe deeply in what they’re saying, it can get lively.
Gamble: Sure. As long as it’s done right, it can be a good thing. So there is one more thing I wanted to ask you about, and that’s the work you do as an adjunct professor and instructor at University of Texas at Dallas. This is interesting to me not only because I can’t imagine you’ve got that much spare time, but also because I’d like to know how this has benefited you. Why you take the time to do this?
Kirksey: Well, that’s a great question, and I bet you after this call, I’ll think about that more. I teach in two programs out there. I teach an executive master’s program called Advance Management Education, which is mostly for physicians who want to become administrators. And then I teach a master’s course that is a partnership between UT Southwestern and University of Texas at Dallas where we take our talented mid-manager employees and offer them the chance to enroll in a master’s program after hours and earn a masters degree and go on to an MBA.
The reason I do it is because I think that information technology touches everything. All of the people that take this course are going to end up on a committee. They’re going to end up having input into a system selection or how a system is configured or how you buy systems. They’re going to be leaders that will manage information technologies in their career. I think that there is such a misunderstanding about what health information technology is, and if I can contribute to a deeper understanding — the balance between the technology, the bits and bytes, and what an executive or a high-level manager needs to know about IT and how to manage your IT department — I would like to help convey that. So that’s a lot of the reason why I do it. And I enjoy it. I learn probably more than I give; each time I teach one of these classes, I’m always amazed what people come forward with in their projects and their experiences that they’ve had. It’s a real treasure for me to get to do it.
Gamble: It’s almost like a leadership education and that’s something that’s so important because it’s hard to teach that. Just learning about the bits and bytes, as we know, isn’t enough. It seems like that’s a good relationship because it’s good for you and obviously the students benefit from it as well.
Kirksey: I hope so.
Gamble: Honestly, I could talk to you for another couple of hours. There’s so much interesting stuff, but I don’t want to take up too much more of your time. So unless there’s anything else you needed to touch on, I realize I do have to let you go soon.
Kirksey: It’s been a real pleasure. Thank you for letting me do this.
Gamble: I’ve enjoyed it, and it’s great to be able to go off into some different areas and hear about your experiences. Thank you for taking that time, I appreciate it.
Kirksey: Okay, I hope you keep in touch.
Gamble: All right, will do. Thank you.
Kirksey: Thank you.