There’s been a lot of debate on what’s needed to help propel healthcare forward, and to find ways to more effectively leverage data to improve outcomes and consumer engagement. If you ask Ed Marx, he believes what we need are more double black diamond skiers. By that, he means leaders who are willing to venture out of “safe zones” and take risks.
And it’s not just talk — Marx recently took on the role of CIO at Cleveland Clinic, knowing that the organization had plans to move to a “completely agile environment.” Despite having little experience in the space, he accepted the challenge, much as he has done in previous roles. In this interview, Marx talks about his first few months at Cleveland Clinic and why he chose to “hit the ground listening,” and the key priorities on his plate. He also talks about what he learned by working in the public health realm, the value of “reverse mentoring,” and his approach when taking on a new position.
- The “perfect fit” with Cleveland Clinic
- Benefiting from different experiences
- Strategy to ‘hit the ground listening’ as new CIO
- Executive rounding
- Patient experience: “It’s part of the fabric of who we are.”
- IT strategy & the “layers of maturity”
- 3 years at NYC Health & Hospitals — “I went in with eyes open.”
Grab as many different kinds of experiences as possible, because they build on each other. They make you more well-rounded, and they expose you to a lot of different things that you otherwise wouldn’t have experienced if you stayed in one particular vertical.
The influence the Cleveland Clinic has around the world is just amazing, and so when I had the opportunity to be part of this organization, I knew I had to take it.
We’ve created a ‘patient first’ culture, and so it makes sense to have a Chief Experience Officer. It really helps inform and shape who we are. And we’ve made it a point to include patients in many of our committees and governance councils.
It was an interesting situation with the politics and the press in New York City. That was a draw for me, because I had never dealt with it at that level. I love being challenged.
Gamble: Hi Ed, thank you, as always, for taking some time to speak with healthsystemCIO.com. Congratulations on your first six months as CIO at Cleveland Clinic.
Ed: Thank you. I’m very humbled and honored and thankful for the opportunity.
Gamble: What was it that attracted you to this particular role?
Marx: There were several things. One of them was that I’ve always been a planner. In terms of my career, I’ve always had a one-page plan that included mission, visions, strategy, and objectives. When I was crafting the initial plan, one of my mentors taught me to grab as many different kinds of experiences as possible, because they build on each other. They make you more well-rounded, and they expose you to a lot of different things that you otherwise wouldn’t have experienced if you stayed in one particular vertical. I wrote in my plan that I wanted experience in not-for-profit world, the for-profit world, in community hospitals, in academic medical centers, in public health, and in faith-based organizations.
Over the course of my career, I’ve been very blessed to have served in those areas. As I was finishing up my time in public health, I thought about what I wanted to do in perhaps my last role, and where I could best serve. And when I looked back at those different areas, it was academics that taught me more than any of the other particular verticals. So when the position became available at the Cleveland Clinic, which has a three-part mission with research, innovation, and of course the provider side, it was like a dream come true.
When I think about the healthcare organizations that are looked upon as models, there’s a very select few at the top. To be part of the Cleveland Clinic and its storied history and reputation of delivering quality care, it seemed like the perfect fit.
Another thing is that I love to learn. I want to be in an environment where I can learn from my peers, from the people I serve, and from management. And even though there’s been a leadership change since I arrived [Tom Mihaljevic, MD, took over as CEO in January, succeeding Toby Cosgrove, who serves as Executive Advisor], we haven’t lost any ground. I’m still able to interact with Toby, who is an icon in healthcare, and to learn from Tom, who is an amazing leader. They’re both mentors to me. It’s one of those cases where iron sharpens iron.
Gamble: Those are some pretty compelling reasons.
Marx: The other thing I want to mention is that the Cleveland Clinic is global, which I find very exciting. We already have a fairly large global imprint, and that will likely expand further. The influence the Cleveland Clinic has around the world is just amazing, and so when I had the opportunity to be part of this organization, I knew I had to take it.
Gamble: Sure. Now, clearly this wasn’t your first CIO role, but every opportunity – and every organization – is different, and needs to be approached in a different way. What was your strategy during the first 120 days?
Marx: My primary focus has been on developing relationships and developing my team. I set out on a ‘hit the ground listening’ tour, where I met with more than 100 individual leaders in the organization, from hospital presidents to institute chairs to my peer group and key influential leaders. I did a number of presentations where I wasn’t speaking, but rather, getting feedback. That’s how I spent my first 60 days.
At the same time, I was focused on developing the right team, which meant assessing the current team; determining what, if any, adjustments needed to be made; and then going through the ‘forming, storming, norming’ process. I’m happy to say as of day 109, we had completed the process. Our team now includes a healthy mix of leaders who have been here for some time and understand the history and culture of the organization, as well as individuals with outside experience who can help us as we move into our future state.
Gamble: And by having that team in place, you’re building a foundation.
Marx: Yes, and that’s critical, because the third thing I focused on is our strategy going forward — understanding how IT fits in with that strategy and enables it. And an important part of that is factoring in the input I received while I was hitting the ground listening. That’s how we’re working to develop a strategy going forward.
Gamble: Looking at that go-forward strategy, I would imagine one of the priorities is improving the overall patient experience.
Marx: It is. We were the first in the country to make the patient experience officer a senior-level position. We’ve created a ‘patient first’ culture, and so it makes sense to have a Chief Experience Officer (Adrienne Boissy). It really helps inform and shape who we are. And we’ve made it a point to include patients in many of our committees and governance councils. For example, we have a patient serving on the IT advisory council, which is our senior governance council. So we’re doing a lot to include the voice of the customer.
Another thing we do, which I find very helpful and eye-opening, is executive rounding, which is also done through the office of patient experience. A number of other organizations are doing that now as well, and I think it’s a good practice. We do it on a monthly basis, and we’ve made it mandatory. There’s usually a theme. We all meet in an auditorium, make sure we understand the theme, and get assigned to different units. When we come back, we debrief one another on what we learned, and what we can do in the future to continue to enhance the patient experience. Patient experience is something we take very seriously — it’s part of the fabric of who we are as an organization.
Gamble: You talked about creating a strategy. In past conversations we’ve had and in pieces you’ve written, you’ve emphasized the importance of making sure IT enables the organization’s strategy. I imagine that’s been the case in your new role as well.
Marx: I like to describe it as layers of maturity. In the first layer, you have no strategy and you’re not aligned. The second layer is where you have an IT strategy that’s aligned with the organizational strategy. The third, which I seek to achieve, is to create convergence so that there is no IT strategy; there’s no need for it because it’s the fabric of the organization’s overall strategy.
We’re in the middle. This year, we’re developing an IT strategy that’s very closely aligned with the organization’s strategy, just to get us all on the same page. Because we have several other key initiatives taking place at the same time, so in order to keep everyone focused and be clear about the direction in which we’re heading, we developed a plan. But we did it in collaboration with our customers, and made sure it aligns with our overall strategy.
Now, I imagine that a year from now, we’ll have our feet underneath us. We’ll be in our new operating model. We’ll have some successes under our belt. We’ll no longer have a separate IT strategy, but it will be melded into the overall organizational strategy. We already have all that architected; we just need to get through this transition.
Gamble: Right. And I imagine population health is a significant part of the strategy for Cleveland Clinic. What are you doing in this area?
Marx: We’re doing some amazing things. One of our early successes was launching, along with a payer called Oscar Health, a digital toolset focused on patient engagement. The response from the community has been three times what we expected. We’ve had many enrollees, and so now we’re scaling to meet that. It’s very exciting that one of our first official forays into population health under our new program has been very successful.
We’re all about patient engagement. Another thing we do is offer virtual consults. If we can keep a patient from having to come in and find parking, and spend 2 to 3 hours on what should be a 15-minute consult, we want to do that. We want to make it as easy as possible to engage with patients.
Gamble: Switching gears a bit, I’d like to talk about your previous role at NYC Health and Hospitals. How long were you with the organization?
Marx: Almost three years.
Gamble: I read a blog in which you wrote that the experience with NYC Health and Hospitals opened your eyes to the critical role of public health. I can imagine that was very powerful experience for you.
Marx: It was. If you’re used to serving in a non-public health setting, there’s a difference in terms of physical plants, simply because of the finances around public health versus other types of healthcare. You see that in the physical plant, and you see it manifest itself in several other ways. One of the things I loved about New York City Health and Hospitals is that our CEO was adamant that despite being public health, and perhaps not as well funded as other prestigious organizations in the city, we would provide the same quality care, if not better. I loved that attitude, because it is a little more difficult when you have financial constraints, and when you have to deal with politics with the press. But we worked through it. The opportunity to serve in that capacity and help the underserved receive high quality healthcare was really important to me. I have great admiration for my colleagues and others who work in public health.
Gamble: Do you believe you achieve what you had set out to accomplish at that organization?
Marx: I believe so. I came there because I had a calling there to fulfill a promise my father had made. During my tenure, I was asked many times to take on other roles with other organizations, but I declined, because my service there hadn’t been finished. At the two-year mark, there were some big milestones we had hit. I felt that our team had turned things around and set the organization on the right trajectory. And so after an implementation went tremendously well — which was a testimony to leadership on the ground and the caregivers in the hospital — I felt I had accomplished my objective. So when the Cleveland Clinic called, I talked to my father and my wife and felt that I’d done what I was called to do and was free to pursue this dream opportunity.
Gamble: What was your approach going into a role like that, which you knew was going to be challenging?
Marx: When I was asked to serve New York City Health and Hospitals, I was given a lot of insight by well-intentioned people who had experiences there, and so I went in eyes wide open. I knew it would be particularly challenging because of the distrust that might have existed within IT. There had been a lot of change. And of course it was an interesting situation with the politics and the press in New York City. That was a draw for me, because I had never dealt with it at that level. I love being challenged. So when people said things that might cause hesitation, I saw that as another motivation.
And as it turned out, I loved it. I loved working with city hall. I made many friends there and learned a lot about the inner workings of government in perhaps the greatest city in the world. I learned so much. I was exposed to so many things, and so I’m thankful for that experience.
It was the same with the media. We had a very aggressive press core that would look for anything negative to write about, personally or professionally. It was interesting navigating those waters. Again, I’d never had to face that before, so I took that on as a challenge. We did very well, and we proved them wrong. There was a lot of satisfaction in doing that, for our team and for the organization.