Dan Howard, Site CIO, Loma Linda University Health, Chapter 3

As site CIO at Loma Linda University Health, Dan Howard’s goal is to strike the right balance between helping facilities meet their individual needs while ensuring that they align with the health system’s overall strategy: kind of like the old bumper sticker saying, ‘Think locally, act globally.’ Not an easy job, but one he hopes to accomplish, particularly as the industry transitions toward a value-based reimbursement model. In this interview, Howard talks about how Epic CareConnect is helping to position the organization for population health, why hospitals sometimes need to act more like a vendor, and how payer incentives are changing the game. Howard also talks about how he’s able to leverage his experience in project management, and the question CIOs should constantly be asking.

Chapter 1

Chapter 2

Chapter 3

• Promotion to site CIO — “I like to keep things fresh.”
• Getting “a foot back in the door” with project management
• “Quick wins” to build trust
• Open-door policy
• Staff engagement: “Are you doing what you want to do?”
• Transformational leadership program
• The “double-edged sword” with value-based reimbursements

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Bold Statements

It took a little while to gain trust. When I showed up here, there were a lot of things that kind of came in sideways and on fire, so I had the opportunity to get some very quick wins in my win column, and that helped build the trust pretty quickly.

I have had situations in the past where individuals were not happy with their role, or they liked it but wanted a larger role in some of the strategic projects. And I think giving people the chance to voice what they’d like to do, being transparent, letting them know ‘this is what I can do for you’ — that goes a long way.

When I’m looking to hire somebody, I honestly will look for a passionate attitude over skills because I always feel you can teach someone the skills, but someone who has that passion and attitude, that is much more important in my book.

As we all move toward value-based reimbursements, it’s sometimes a little bit difficult to have those conversations, because you’re going to have to make a significant investment in doing so. So it is definitely a double-edged sword in terms of managing the expectations from a financial perspective also.

Gamble:  You’ve been in your current position for a few years now?

Howard:  Yes, I’ve been out here a little over three years.

Gamble:  And had the position of site CIO already been created at that point?

Howard:  For San Gorgonio, there was already a CIO that was here at the organization, and that individual had left. And so it was probably, by happenstance or dumb luck that I got sent out here. I say that in jest, because Mark [Zirkelbach] has always come to me and said, ‘Hey Dan, I have an opportunity for you.’ Sometimes they’re opportunities disguised as problems, which is fine. That’s my personality — I like to keep things fresh and makes life easy for me.

Gamble:  Right. Was it an adjustment to take on the site CIO role?

Howard:  Yes and no. My previous organization I came from was a little bit larger in terms of team size and budgeting. So when I came back to Loma Linda, I was out of healthcare for a while — at least acute healthcare. And so I took that project manager role thinking, okay, I’ll just get my foot back in the door and I’ll get back up into management. And so in terms of managing team sizes and budgets, no, that hasn’t been challenging.

I think probably the biggest challenge — and I’m speaking specifically for San Gorgonio — was with me coming in as really a consultant. The affiliation talks between the organizations were still ongoing and so there was a lot of unrest. People weren’t sure if this was a hostile takeover, or what was really happening. And so I had to kind of play on both sides of the fence in terms of being here as a consultant from Loma Linda but also working on the affiliation efforts and supporting the hospital from an operational perspective. But that probably waned off within the first six months, and it is nice to be involved with the different various partners and affiliates, because you get to see different things that maybe we miss at Loma Linda because we’re so large.

Gamble:  So has that become more of an official affiliation?

Howard:  That’s a politically-charged question. The affiliation efforts are still ongoing, but there is very close alignment between the organizations. We do have facility services management, IS management, construction management, and we also have some of our physical therapy and PT students that round through the hospitals for the curriculum here. So there’s a lot of tight integration already between both organizations. And so from that perspective, we are partnered at this point, and there are efforts to further define what that will look like going forward.

Gamble:  Right. Now, did you have to kind of earn their trust coming into that type of unique role?

Howard:  Yes. Because at this facility, I report to the CEO, and so I think he got my name from the previous CIO because I knew the previous CIO. He got my name from them and through the conversation at Loma Linda, and so it was already a warm introduction that was done, but I came out here and had a discussion with him and kind of took it from there.

As with any relationship, it took a little while to gain trust. When I showed up here, there were a lot of things that kind of came in sideways and on fire, so I had the opportunity to get some very quick wins in my win column, and that helped build the trust pretty quickly.

Gamble:  That’s true. They say that’s one of the best things for team chemistry is winning.

Howard:  Yes, exactly.

Gamble:  So in your current role, but also in some of your other roles, what have you found to be the keys to being an effective leader and getting the most out of people?

Howard:  What has always worked for me is being transparent. My leadership style—not to be cliché — really is open-door. Whether you’re a direct report to me or a report to one of the directors on my team, my door is always open. And so I see my goal in terms of interfacing with staff is, number one, do you have the right tools and resources to do your job correctly? My goal for each of the individuals on my team is I want them to be passionate about what they do. If you can get them to be passionate for what they do and excited about it, then everything else is easy.

The best way for me to get that person to be passionate is find out, are you doing what you want to do? I have had situations in the past where individuals were maybe not happy with their role or they liked their role but wanted a larger role in some of the strategic projects. And I think giving people the chance to voice what they’d like to do, being transparent, letting them know ‘this is what I can do for you’ — that goes a long way.

Gamble:  Right. And besides having that passion, which is obviously really important, is there anything else you look for in people that you want to mold a little further or just identify as people with strong potential?

Howard:  We have at Loma Linda a transformational leadership program, and I’ve been involved with it for about the last five years. It started out of information services as a way to work with the different people with IS and to identify the next level of leaders within the organization. And a lot of it was focused around book reading and a lot of group talks. It’s a pretty extensive nine to ten month program that they have to commit to go through. I went through it myself and then became a mentor and sponsor for other individuals. I’ve sent multiple people through this program. I’ll go on occasion and do a guest lecture, but that whole process is one of the things that we use to really identify sort of the next level of leadership in the organization, or the stars.

The greatest thing about it as the program has grown, it’s blossomed to outside of IS and so we’re now touching other areas like revenue cycle or nursing or other operational areas where those individuals are also being put through that program, and we’ve also extended that to some of our partners and affiliates. We’re getting a much wider swath of individuals in this collective leadership program, and so that has been very beneficial.

Gamble:  I like what you said about making sure people have the right tools because I’m sure that you’ve come across situations in the past where somebody seems to have potential but all of the pieces just aren’t there. And that’s a critical thing because you don’t want to miss out on someone who could really be a high performer.

Howard:  You’re exactly right. When I’m looking to hire somebody, I honestly will look for a passionate attitude over skills because I always feel you can teach someone the skills, but someone who has that passion and attitude, that is much more important in my book. 

Gamble:  Right. Okay, so the last thing I would ask — and this is a broad question — but really when you look at how the health IT industry is evolving and things are changing so rapidly, what do you think are some of the most significant changes we’re going to see in the next year or so? Where do you think we’re really going to see the biggest changes?

Howard:  From a technology perspective, I think the industry will be much more consumer-oriented in terms of how we interact with patients. I think there’s going to be a big push toward having the patient be more involved and having more of a skin in the game in terms of the management of their own health.

I’ll give you just a quick example. Within Loma Linda, we’re also pushing the use of these mobile devices. So when a patient is discharged, we can send them home with a mobile device, whether that be something as simple as a medication container that will track if they’re actually taking their medications on time or Bluetooth-enabled devices to take different levels of vital signs or blood glucose and have that information uploaded back up so someone could take a look at it in real-time. So I think that’s going to be the next push over the next year or so. But again, as we all move toward value-based reimbursements, it’s sometimes a little bit difficult to have those conversations, because you’re going to have to make a significant investment in doing so. So it is definitely a double-edged sword in terms of managing the expectations from a financial perspective also.

Gamble:  Right. Do you find yourself reaching out to other CIOs to just talk about the challenges and how people are dealing with them?

Howard:  All the time. I’m fortunate enough to be able to attend several CHIME events per year and usually HIMSS, so those are always great venues to talk with your other counterparts about what are they experiencing and what are their challenges, because definitely we’re collectively in this all together. So I’m not out to recreate the wheel at all; I’d rather learn from someone else’s experiences.

Gamble:  Right. This seems like an industry where there is so much collaboration right now, so that’s very encouraging to see. Well, that covers what I wanted to talk about. I really appreciate your time and I know you have so much going on, so thank you for putting aside some time for us.

Howard:  Thanks, Kate. I appreciate your time also.