In today’s health IT industry, there’s a lot of talk about the need for knowledge sharing among leaders, particularly CIOs. But for Tim Zoph, who was recently named chair of KLAS’ Interoperability Measurement Advisory Team, it’s more than just talk. When he was asked to share some of the most valuable lessons learned during his 30-year-career (which includes 22 years as CIO at Northwestern Memorial Hospital), he was happy to oblige. In this interview, Zoph offers perspective on the areas of utmost importance to health IT leaders, including talent management, operational excellence, work/life balance, and being a partner in the industry. He also discusses the new expectations of the CIO role — a hybrid of change agent, senior leader, and innovator; why teaching CHIME Boot Camp has been so rewarding for him; and what’s next in his journey.
- 22 years at Northwestern
- First corporate CIO — “We needed better information.”
- New expectations for the CIO
- Taking on non-IT tasks — “It helped my credibility as a leader.”
- Early automation challenges
- Building trust — “I’m not walking away until this is right.”
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Northwestern recognized that in order to really have a strategy, in order to be able to have the level of leadership it needed, it needed a member of the executive team that was a recognized technology leader and CIO.
They needed your perspectives and expertise on technology, but as much as anything else, they were looking for you to help lead the business and be a true senior manager. The concept was that if you’re a senior manager in the organization or an executive leader, you ought to be in a position to not only run your own domain, but be knowledgeable about the business.
I would look to my peer leaders to say, how do I get better engaged? What can I learn from you? How can I understand our business better? I really looked for ways that I could demonstrate my leadership beyond technology, and I believe ultimately that helped my credibility as a leader.
We came to the conclusion that there was no way to get there on paper, that we had to really double down our investment and our adoption in technology, and that the pathway to quality was through technology.
You have to recognize that it’s very difficult to get it right the first time. You have to really engage talented people throughout the organization that you trust, that will give you critical feedback, and that recognize that you’re in it for the long term.
Gamble: Hi Tim, thank you so much for taking some time to speak with healthsystemCIO.com.
Zoph: Pleased to be here, Kate.
Gamble: When you and I met briefly at the CHIME, we talked about doing this and talking about some of what you’ve seen in your career as far as how the CIO role has changed, but I wanted to talk first a little bit about your time at Northwestern. You were there for 20 years or so?
Zoph: Yes, 22 years and 20 years as a health system CIO.
Gamble: I can imagine some really big changes occurred during that time period. When did you first start?
Zoph: I started there in 1993.
Gamble: Were you hired into the CIO role?
Zoph: I was actually hired as the first corporate CIO executive, so I was the first technology leader and CIO that was the member of the senior management team. Before that, it was a director level role.
Gamble: So the thinking behind that was to prepare for what needed to happen as far as the EHR journey?
Zoph: Where Northwestern was, and I think this is where a lot of the industry recognized it needed to be, is that technology was beginning to get on the radar screen of academic medical centers and leading health systems in the early 90s. We recognized that adoption of technology was going to be required for us to be a leading health system. It was clear that from both the academic research standpoint and being a knowledge-generating institution, we needed better information. But it was also clear to us that the healthcare enterprise, not unlike other leading service industries, was beginning to adopt digital technology quite rapidly. Northwestern recognized that in order to really have a strategy, in order to be able to have the level of leadership it needed, it needed a member of the executive team that was a recognized technology leader and CIO.
One of the things with Northwestern — and I think this is true with leading health care organizations — is we’ve benefited from great governance. We had leaders in the city of Chicago that were members of our board and actually members of companies that had used technology successfully and were beginning to use it in their own businesses, and recognized that they too needed to coach Northwestern on how health care could position itself for being a leading industry using technology. One of the initial responses of course was to make sure that they had a peer on the senior executive team that could advance the strategy, build a team, and think about this from a long-term perspective.
I think the other piece of it was that we had made a commitment in early 1993 to build one of the more advanced healthcare facilities in the country, so our commitment back to 1993 was we recognized by the end of that decade we were going to build a new 2-million-square-foot medical center. And that medical center, which turned out to be Galter/Feinberg, needed to be positioned for the 21st century, and we had to make sure that that building was not only advanced clinically but advanced technologically — that was really an important goal for how that building would be built.
So it was really the confluence of those things, and recognizing where healthcare was — it was behind and it needed technology leadership — and the idea that we were going to build a building for the 21st century. And there was a belief by our academic clinicians that, in fact, technology was a way to improve efficiency and quality in healthcare. Although there were very early adopters back then — some leading academic centers that had really gone down the path of self-development and began to prove this out — we really had a commitment amongst our medical staff that, in fact, embracing technology was a better way to provide care to our patients.
Gamble: So it was the organization recognizing that the CIO kind of needed to have that seat at the table. I imagine that it was interesting for you being that trailblazer, at least at your organization. I’m sure it was interesting to kind of figure out maybe how to negotiate that or how to really establish yourself as part of that team?
Zoph: It was, Kate. And as I look back on my lessons learned from this, I think there were a couple of things. One is they needed your perspectives and expertise on technology, but as much as anything else, they were looking for you to help lead the business and be a true senior manager. The concept was that if you’re a senior manager in the organization or an executive leader, you ought to be in a position to not only run your own domain, which in my case was technology, but be knowledgeable about the business so that you understood what it was that the technology was really going to be used for.
If they were going to trust you with something that important — and technology today that even back then was seen as a risky venture — they wanted to really understand that you were a leader that got and understood the business. For me, I understood and had over a decade of experience of being a technology leader. One of my early challenges was to establish myself as a peer senior manager and really demonstrate that I understood the nature of healthcare — the care we provided and the services that we offered — and be in a position where I can contribute not only just with the technology, but as a functioning member of the senior team to really run and advance our business.
Gamble: How did you approach that challenge in establishing yourself as peer manager?
Zoph: Well, I actually looked for opportunities to lead outside of my own domain. Early on, I would take clinical calls. I would look for opportunities to lead committees, to lead process improvement efforts. I chaired our capital committee for years, so really I would look to my peer leaders to say, how do I get better engaged? What can I learn from you? How can I understand our business better? I really looked for ways that I could demonstrate my leadership beyond technology, and I believe ultimately that helped my credibility as a leader.
And I still think that’s true today. I do think that technology leadership is one of those areas where you have such great visibility in the organization because technology now is used everywhere. People want your knowledge not just about what the enabling technology brings; they want your knowledge as an improvement leader, as a manager, as a talent developer — all of those things that are attributes of a senior leader.
Gamble: You talked about how the organization was ripe for change, but I don’t imagine that necessarily meant that the change management piece was going to be easy. Can you talk a little bit about how you dealt with this pretty significant change in how people were going to do their jobs?
Zoph: If I look back on that initial decade at Northwestern and a lot of the industry, we were really trying to figure out how to commercially evolve systems — particularly clinical systems — that would be effective in patient care. A lot of that was very early automation of the enterprise. I think what really was the catalyst for deepening the adoption of technology was quality. It goes back to the Institute of Medicine reports in the early 2000s when we really recognized that we were not as good as we all thought we were, that there were real issues in managing the quality of care and healthcare. And we came to the conclusion that there was no way to get there on paper, that we had to really double down our investment and our adoption in technology, and that the pathway to quality was through technology.
For us, it was the simultaneous creation of a culture of quality around process improvement, recognizing that measuring what it is we do and holding ourselves accountable for our performance, and creating this culture of safety throughout the organization — that really gave further energy to our overall information technology plan.
When the day is done, it’s like everything. When you study technology in other industries, it’s never really about the technology. It’s about recognizing that you have some other imperative in the business that is why you’re doing it, and the technology becomes one of the essential elements for change. For us it was quality and safety, and recognizing that automating our care processes, having the knowledge of the data that we captured as a byproduct of those care processes, and working toward holding ourselves accountable for our performance really pushed the technology agenda further and faster than it had gone that initial decade.
Gamble: So it’s really speaking to what really drives people?
Zoph: Yes. I always say that people will never climb the mountain for technology alone; it has to be about something greater. In healthcare, ultimately it comes back to the care of the patient, so anything that provides the level of, if you will, strategic imperative, ultimately comes back to the care and treatment of the patient. And so in our organization, and I think this is true for others, the reason that organizations got so behind the technology strategy early on was a recognition that we couldn’t get there from here; that paper-based systems were not good enough, and in fact, that technology was going to be a requirement — a survival strategy for organizations that really chose to provide the highest quality care.
Gamble: Right. As you got deeper into the journey, I imagine some of the challenges were different in nature. Is there anything you can recall as being another real lesson learned as the organization progressed down that path?
Zoph: There are a few things I learned from. One is, you have to recognize that it’s very difficult to get it right the first time. You have to really engage talented people throughout the organization that you trust, that will give you critical feedback, and that recognize that you’re in it for the long term.
I recall several evolutions of working to get our emergency department systems right. I had a great leader in Jim Adams, who today is the chief medical officer for the health system. I remember sitting down with Jim, who was very passionate about quality and efficiency and really making sure our emergency room was great, but the tools we had early on were good but not good enough. And my commitment to Jim was to say, ‘look, if we’re going to do this project, we’re going to install this version of software, but we’re going to learn from it. And I’m not going away until this is right. We’re going to walk away when in fact your outcomes are what you needed to be.’
I think it’s important that CIOs have the same success and incentives that the clinical leaders do. It’s not good enough for us just to install and walk away. Our measures of success have to be the same measure of success of the organization, and we have to be focused on value and outcome and what it means for patient care. As a CIO, you can’t have measures of success that are different from the organization.
It’s important to me to be a trusted partner because I knew very early on that in fact the solutions we had needed to improve, that they were not good enough. And what you gain in that trust is you say you have the same goals, you have the same measures. As a CIO, you’re a person who gets it, and you stay with it. And for the emergency systems, we went through several versions — several years, and I’ll tell you they’re probably still working on it today. But the leaders in the organization understand that the technology folks are not there simply to do projects. They’re there actually to deliver value to the organization.