Matthew Chambers, CIO, Baylor Scott & White Health, Chapter 3

CIOs often say that their experience in consulting played a key role in helping to prepare for an IT leadership position, but perhaps it was never truer than with Matt Chambers, who was called in to assess the IT strategy at Scott & White. That firsthand knowledge came in handy when he stepped in as CIO of Scott & White, then led the organization through a merger with Baylor. In this interview, Chambers talks about what it’s like to guide the IT team through dramatic change, the logistical challenge in leading a system with 40-plus hospitals, the clinical transformation layer cake, and why it’s critical to remember that time is money.

Chapter 1

Chapter 2

Chapter 3

• Shared vision for population health
• “You have to build a rapport before you can work effectively remotely.”
• Recruiting from other industries
• Lessons learned from consulting
• The value of making mistakes
• “Don’t let perfect get in the way of good”

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Bold Statements

I like to look people in the face when I’m giving them bad news or good news or tough messages. It may be ironic for the IT guy in the organization to say that there’s no substitute for human contact in relationships, but there’s not.

If I get run over by a bus today, the trains still get to work on time. The trains keep running because you’ve built an extension plan behind you, supporting you, where the next person in line just steps in and keeps going.

Many places in healthcare have been notorious for the analysis-paralysis effect where you might debate something for days and weeks and months because you’re trying to get it perfect, which is important. But one of the things that we’ve said is, don’t like perfect get in the way of good.

Our challenges are similar to many others in the industry. It’s just that they’re bigger because we’re bigger.

The goal of IT was to be cheap; that’s how it was governed and that’s how it was measured — by how much it cost. That equation has changed.

Gamble:  I like the layer cake analogy. I think that that’s a great way of putting it, and it’s true. The population health piece is something that so many organizations are working toward, but you have to have everything else in place before you can do that effectively.

Chambers:  Yes, absolutely. We’re trying to draw that picture on whiteboards around the organization so that people can understand the vision — what it is we need to do, and how we’re going to get there. Some people get it, and the great news is some of our physician leaders that are leading our population health will draw a picture on the white board and start talking to me, and it ends up being the same picture. That’s the great news; when you find yourself aligned with your clinical stakeholders, that’s very comforting.

Gamble:  You are in a unique position being CIO of such a large organization. I want to talk a little bit about logistically how that works. Is it something where you spend time at different organizations? And how important is it for you to have a strong staff and be able to delegate certain things? Talk a little bit about that.

Chambers:  Well, Sara has been looking into cloning laboratories for humans for me, personally. But in all seriousness, it is a challenge. It’s probably more of a challenge than I thought it would be. I like to look people in the face when I’m giving them bad news or good news or tough messages. It may be ironic for the IT guy in the organization to say that there’s no substitute for human contact in relationships, but there’s not. I think you have to be together to build a rapport and a sense of trust before you can start to work effectively remotely.

What we’re seeing is those forming, storming, norming phases going through fruition where the first time a group of people will work together — let’s say a northern and central leader in a specific area get together and spend a lot of time in person — over time, they’ll start to do more of that remotely. We’re spending a lot of time on videoconferencing and a lot of time on phone calls. In a lot of the organizations, it’s always been that way. I came up in large, multinational consulting firms and conference calls across continents were very normal. In healthcare, especially regional healthcare systems, that hasn’t always been the norm, but we’re adopting those habits very quickly. In terms of my logistics, I spend a lot of time on I-35, which is a major interstate that runs all the way from Canada to Mexico. I spend probably half my time in the northern division and half my time in the central division, and have offices in Round Rock, Temple, and Dallas. I try to get to all those.

But you talked about a team supporting you, and that is critical. I think a good leader doesn’t just have to be in all places at all times. A good leader, in my mind is one where, heaven forbid, if I get run over by a bus today, the trains still get to work on time. The trains keep running because you’ve built an extension plan behind you, supporting you, where the next person in line just steps in and keeps going. We’ve got an excellent, excellent team that I’m thrilled to have working for me.

I’ve recruited some folks that weren’t in the healthcare industry before and some life-long consultant types, because I really like that mentality. I have the mentality that every single hour of the day is costing money. When you grow up billing clients by the hour, you’re very, very cognizant of that, and that’s part of the culture that I want to introduce. The leaders that work with me understand that this meeting where we’re calling with 20 people in the room, this is an expensive meeting. Look at the salary, wages and benefits and the opportunity costs. We need to make the most of this time. Because of that, I think there’s always a sense of urgency, and goes into your thinking of do you drive to Temple for a one-hour meeting when you’ve got other things to do in Dallas? No, you don’t. You work through that, and you delegate. One of my key tenets to success is you always hire people that are smarter than you, and so, that’s what I’ve tried to do, and I’ve been pretty successful at doing it. You can delegate to those folks when you can’t be there in person.

Gamble:  That makes a lot of sense, especially as you’re talking about the clinician leaders. Their time is worth a whole lot of money too, and I’m sure that they appreciate that mentality of, ‘okay, we’re here. Let’s get this going,’ and really being cognizant of everybody’s time.

Chambers:  When it comes to our EHR implementation, that was one of our guiding principles, and it’s something that I’m careful to institute going forward. In my opinion, many places in healthcare have been notorious for the analysis-paralysis effect where you might debate something for days and weeks and months because you’re trying to get it perfect, which is important. But one of the things that we’ve said is, don’t like perfect get in the way of good. And a way that materializes is in these large projects like an EHR. I would say to the guys and girls around the table, we’ve got a large group of people, and there’s a very large burn rate riding on this project. We might be spending a million dollars a month or more in all the salary, wages, and benefits that we’re investing in this project. So if we want to put this decision off for two weeks and come back and revisit it again, we can, but it’s going to cost half a million dollars to do that.

The immediate response to that is what about patient safety — I’m never talking about sacrificing patient safety. That is the number one priority in everything we do. But if we’re talking about does this button need to be blue or green, come on, guys. Let’s make a decision and move forward.

Gamble:  Exactly. The final thing I just wanted to ask you was about making that move to health IT. It’s obvious that you’ve carried with you a lot of the things that you learned along the way, but just as far as making that adjustment, was that a tough adjustment? Were there people that you looked to for guidance just because it is a different apple being actually in the health IT world?

Chambers:  I don’t want to oversimplify it and say it wasn’t challenging. It has been challenging, but it’s been incredibly rewarding. Every client I ever worked with when I was in consulting and every company likes to think that they’re unique. Everyone’s like a snowflake. No two of us are alike. But the truth of the matter is, in many ways we’re more alike than we are different, and that was always true with our clients. While we do have some uniqueness in our clinical model at Baylor Scott & White, our challenges are similar to many others in the industry. It’s just that they’re bigger because we’re bigger.

To wax philosophical here for a moment, every person is a sum total of your experiences that shape you along the way. One of the things I always said is the reason why I was a good consultant wasn’t because I was smart and perfect and knew how to do everything; it’s because I probably screwed things up seven different ways. So I can come in and tell you these are the seven ways you don’t do this, and together we’ll figure out the right way to do it.

I brought a multitude of experiences outside of healthcare to healthcare. I worked for a long time in telecommunications. I spent some time in oil and gas and various industries, always focused on IT. One reason that I really, really enjoy healthcare IT is healthcare IT is behind the curve — or at least it has been compared to other industry verticals. If you look at the contribution and the help to IT in other industries like financial services or oil and gas, where information can drive competitive advantage and drive input to margin, there’s a huge investment in IT cost. Traditionally, healthcare spent less than 2 percent of revenues on IT. The goal of IT was to be cheap; that’s how it was governed and that’s how it was measured — by how much it cost. That equation has changed. Some of it is because of federal mandates. Everybody says IT budgets are going up. Well, the requirements on healthcare IT are going up. There was no such thing as Meaningful Use or ICD-10 a couple of years ago and now those are driving a huge amount of cost. That’s one thing driving up cost and driving innovation forward.

The other thing is we’re starting to now see innovation really drive improvement in the triple aim — individual health, cost improvements, and population health. Healthcare has become much more of a consumer-focused industry. The computerization and mobilization trends are really only taking hold in healthcare, and so it’s an incredibly exciting time to be in healthcare. Today is the Apple Worldwide Developers Conference in California, and I’m expecting the keynote is going to have a lot of discussion around healthcare.

There’s a rumor out there that I’m reading on the Internet about Healthbook, which is the new app. When you see someone like Apple that has such a huge mindshare in consumer electronics and driving the way that people interact with computing devices over the past decade, and they’re focused on healthcare, that tells you that there’s huge innovation happening there. It’s an incredibly exciting time. Of all of the industries I’ve been in, none of them are having the amount of innovation and excitement right now as healthcare IT.I feel blessed to be at this juncture at this time.

Gamble:  It definitely feels like the right place for you.

Chambers:  I hope so. We’re trying to make a positive impact and make it fun and enjoyable and give people a reason to come to work each morning and contribute. We hope we do that.

Gamble:  That’s great. Well, I don’t want to take up anymore of your time. I really appreciate you speaking with us and I’d like to follow up with you a little bit down the road just to see how everything is going. I feel I could talk to you about a lot more, maybe after some time has passed. Thank you so much for giving your time. We appreciate it.

Chambers:  It’s my pleasure, Kate. Check back in and if I survive, I’ll be happy to tell you how it went.

Gamble:  That sounds great. Thank you, and the best of luck to you.

Chambers:  Thanks so much.