
Joe Bengfort, CIO, UCSF Medical Center and Campus
Want to know the secret to being CIO at a large academic organization? Fear. “If I wasn’t a little bit worried about being able to deliver what the institution needs, it would mean I’m not paying attention,” says Joe Bengfort. But that, of course, is just part of an equation that also includes a confident knowledge of IT functions, a willingness to engage in the business side, and an ability to apply lean methodologies to situations like consolidating IT departments. In this interview, he talks about UCSF’s clinical enterprise strategy — and the infrastructure required to support it; his team’s “incremental approach” to analytics; the challenge academic organizations face in securing data without stifling creativity; and how he believes the CIO role will continue to evolve.
Chapter 3
- Keys to change management — “Move swiftly.”
- “Transparency has everything to do with trust.”
- Working with Ross Perot
- From consultant to CIO — “It scared the hell out of me.”
- “High stakes” at UCSF
- Evolving CIO role — “The infrastructure aspect has to be automatic.”
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Bold Statements
Transparency has everything to do with trust. And even when the news is bad, people need to know. They also need to know that you’re going to be fair and you’re going to give them time to understand the facts and give them the time to make decisions based on facts and not on fear.
Being in a system like UCSF, you’re really inspired by the mission so much. You get exposed to it almost every day and it’s extraordinarily motivating. You just don’t want let these people down because they’re doing such incredible work.
That’s been a challenge to look at these people who are doing these incredible things and say, ‘You have to do these things differently, and here’s how we’re going to do that. I’m going to put some technical controls in place that may drive you crazy and I’m going to work like crazy to get you acclimated to this so it’s second nature. That’s been a very difficult part of the job, but we’re making great progress.’
So much of the innovation is going to happen in the departments with very pointed technologies, and we just need to put people on our staff that can engage in those departments and work with the people that really understand the business. That’s the shift that I’m trying to make.
Gamble: I can imagine that was challenging in a lot of ways, combining two different IT departments. What was your approach as stepping in now as the CIO of both? That’s such a huge change management situation
Bengfort: Yeah, I have some advantage in this, in that I grew up in the outsourcing industry. I worked for Ross Perot for many years, and my job was consolidating IT organizations through outsourcing arrangements, some of which were successful and some of which I bumped my head on quite substantially, but learned a great deal.
The biggest thing to this is first to move swiftly. You don’t want this to go on for a long period of time because once people know that we’re consolidating and this is going to be a material change, there is a certain degree of productivity loss that you realize, because people spend a great deal of energy worrying. So you want to get through this with some purpose in terms of speed.
The second thing is that transparency is extraordinarily important and oftentimes hard, because in a consolidation, there’s some good news, but there’s usually some bad news. ‘Oh, I don’t need two security officers. I don’t need two CIOs, and I don’t need two network managers.’ There’s pain there and it is just extraordinarily important that you are transparent about what some of the changes are going to be. And if you can’t be transparent about the specific changes, you need to be transparent about the process that you’re going to follow to get to the endpoint, so people understand the pace that we’re going to move, the kinds of things are going to happen and the method in which we’re going to make such an important trust builder.
Trust is the number one thing in a process like that. It is in general, for that matter, but when you’re going through an organizational change of that magnitude, you can lose trust quite easily and people become a bit paranoid and they stop as much working for you and more working against you or in spite of you. So transparency has everything to do with trust. And even when the news is bad, people need to know. They also need to know that you’re going to be fair and you’re going to give them time to understand the facts and give them the time to make decisions based on facts and not on fear, and you just have to communicate an extraordinary amount. It takes a great deal of effort. It can’t be the last thing on your to-do list; it has to be very near the top.
Gamble: Yeah, I can imagine it was interesting going through it in the CIO role, whereas you had gone through it before from the other perspective, seeing the two departments combine. And not having that consulting perspective, but a different one — I’m sure that that was really interesting.
Bengfort: I have been so very pleasantly surprised at being inside of an organization as a leader versus coming in from the outside as a consultant or as an outsourcer. I had a great career at Perot and enjoyed it tremendously. Pretty much everything that I’ve learned, I’ve learned through to the 25 years that I spent doing that kind work, much of which was in the healthcare space. But being on the ground, a part of the organization, and being embraced by the people and the leaders really wanting to help you be successful versus being almost afraid and not all that embracing. This has been a very pleasant experience. I would say that in my past, my motivation has been largely motivated by the inspirational leader that I had. Ross can be quite impressive and impactful — nothing like what you saw in the campaign, by the way. And here, we certainly have inspirational leaders but being in a system like UCSF, you’re really inspired by the mission so much. You get exposed to it almost every day and it’s extraordinarily motivating. You just don’t want let these people down because they’re doing such incredible work. It’s very, very different and very satisfying.
Gamble: Yeah, I can imagine how interesting it must have been to be around Ross Perot, somebody who’s accomplished everything he has and has what seems like a very interesting personality.
Bengfort: He’s fantastic, cares about people first in every way. I think that’s the key to his success. It was wonderful to learn from.
Gamble: Now, as far as making that move to the provider side, did you have any hesitancies about that, especially being so many years with Perot?
Bengfort: It scared the hell out of me. In fact, this is still an intimidating job, and I think most CIOs, especially those that have only been doing it for a handful of years, if they don’t tell you they’re somewhat intimidated, they’re probably not being transparent with you. I work in an organization where not only are the stakes high for our patients, but the stakes are high for society in terms of the cost of healthcare, in terms of the research and the diseases that we’re trying to mitigate. And the level of people that you work with in an institution like this, I literally stopped Googling the names of people that I was going to meet with when I first got here because it’s extraordinary to read what these people do and you walk in the room and say, ‘I just don’t think I can contribute to you.’
Gamble: Right, the best and brightest, and you see their resumes.
Bengfort: Yeah, you see their resumes and oh yes, there was this Nobel Prize thing, but that’s no big deal. You almost have to not think about that and focus on how in the world can I help you. The hard part in a place like this and this goes to one of the bigger challenges that we deal with is, there are some aspects of the culture that are unbelievable and they’re unbelievably good, and other aspects that create risk.
So in a very creative environment like this, security is not exactly the first thing that comes to people’s brains. As a matter of fact, independence is the first thing that comes to the brain, and so it becomes a challenge to try to modify the culture and to do it in way that is more safe for the institution, but doesn’t stifle the creativity and productivity of the organization. And certainly, information security is one thing that definitely requires culture change — not just at UCSF, but at every health system and certainly every academic medical center in the United States, because the stakes there are now quite high as well.
That’s been a challenge to look at these people who are doing these incredible things and say, ‘You have to do these things differently, and here’s how we’re going to do that. I’m going to put some technical controls in place that may drive you crazy and I’m going to work like crazy to get you acclimated to this so it’s second nature. That’s been a very difficult part of the job, but we’re making great progress.’
Gamble: I can imagine it isn’t easy being the person who has to have those conversations.
Bengfort: Well, no one’s throwing darts at pictures of me or anything like that, but they do keep their eye on me fairly close.
Gamble: Yeah, sure. Okay, I guess the last thing I would just ask is, in this really rapidly changing industry, in an organization like yours, how do you see things continuing to evolve for the CIOs and for the CIO role?
Bengfort: It’s definitely moving quickly, and in fact, if you look in the healthcare marketplace at the kind of people that are in CIO positions, at least I have seen a mix. There are some organizations that have made a conscious decision that they want a physician in that role. There are some big pluses to that and there are some minuses to that. And others have decided, ‘you know what, I just need somebody that understands technology and can work with the departments and the physician community very well.’ And there are pluses and minuses to that, too.
I think regardless of the kind of person that’s in the job, the job is changing in a few ways. First off, the infrastructure aspects of this are always going to be excruciatingly important, but they have to just be automatic. And the degree of focus and attention that the CIO pays to running the data center and the network and the service management process and all that is very important, but it has to be automatic so that you can spend time engaged with the business in so many different ways, from a financial perspective and administrative perspective, and certainly from a clinical perspective.
You have to surround yourself with people that have business contextual knowledge. You need people that look a lot like clinicians that also happen to know a lot about technology. I think that trend will just continue. In fact, and we see this here, people talk about shadow IT and things to that nature. I don’t really like that term. I think shadow IT has a little bit of a negative connotation. Technology is moving closer and closer to the business every day, and it’s impossible for a central IT organization to understand at a granular enough level the business processes and business issues and how to apply technology to those things. So I’m very much trying to support a greater engagement with the business, not to say, ‘hey, you guys don’t do this tech stuff, just tell us what you want and we’ll do it.’ I’m trying to establish where it’s, ‘look, you guys have to get in the technology business.’ There’s lots of devices and apps, databases, applications, etc, that you need and you need to move on very quickly. We just want to be engaged in the process.’
Over time, I would suspect that the central IT department is going to be more focused on assisting the departments and digitizing every workflow that they have and making sure the data they create is integrated and well-defined and is an institutional asset and not a siloed departmental asset. So the data is going to be probably the most important thing to make sure that as departments become more and more savvy in IT, that they don’t just create silos.
The second part is that the applications, and again, the data that they create, hang well with the rest of the institution that integrate appropriately. So integration is a big part of what central IT will always have to do. And security, clearly. Departments are going to not have this on the top of their brain, and in fact, we’re in the process of cleaning up many security issues associated with departmental IT, because historically, we haven’t been engaged enough. So security again is something I think the central IT department is always going to have to own and collaborate with departments.
And certainly, the core infrastructure things and then from an application front, the really big systems of record, like the medical record system, the ERP system, some of the research administrative-type systems, the student information systems, those kinds of things. Those would be important things to operate centrally, but so much of the innovation is going to happen in the departments with very pointed technologies, and we just need to put people on our staff that can engage in those departments and work with the people that really understand the business. That’s the shift that I’m trying to make. I think that takes a few years to make that happen, because it’s retooling either the people that we have or getting different people.
Gamble: Really good thoughts on where the role is going and it’s going to be interesting to see.
Bengfort: It does require a very different mindset. Of course, it’s been changing quite a lot for several years, so the old adage of you got to get out of the data center and go engage with the business is kind of an old thing, but it is essentially what the message is.
Gamble: Not the easiest role in the world, but it seems like it’s one that you found the right role and found a place that feels like home.
Bengfort: It feels good, other than the days that I’m scared to death. But if I wasn’t a little bit worried about being able to deliver what the institution needs, then it would mean I’m not paying attention.
Gamble: Right, well we’ve covered a lot of material, and I really want to thank you for talking about the work you’re doing and passing along some of these best practices for CIOs who read and listen, so we really appreciate it. Thank you so much.
Bengfort: Well, I hope it was helpful and just let me know where the process goes from here.
Gamble: Yeah, I will, I definitely will. And I’d like to catch up with you again down the road, I’m sure we have more to talk about.
Bengfort: Okay, that sounds just fine. It’s been a pleasure. Thanks, Kate.
Gamble: All right, thank you so much. I’ll be in touch.
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