The Delicate Art of Balance

My father was a man of many talents. While he built his career in Psychiatry around advocating for mental health in some of the most underprivileged regions of the world, his real passion, as his friends and family often maintained, was philosophy.

One of my dad’s favorite mantras (he had many) was:

“Strive for balance in your life. Always, always strive for balance. An excess of anything is rarely ever good.”

Growing up, I had gotten so used to the statement that its words barely registered with me after a while. In my teenage years, I would often respond with humorous “what if” scenarios of how a surplus of a random item could be wonderful, egging him on. He would chuckle and move on in the conversation. Often, he would expand on his ideals of balance with: “You cannot appreciate times of happiness without first having gone through sorrow. And often you’ll experience times of joy and sadness simultaneously in different parts of your life. You cannot let just one facet paint your approach at large. Life is complicated. You must navigate it thoughtfully.”

Even through my early-adulthood, I did not fully understand the true scope of these words; the idea that to be most effective, you must be multifaceted. That you must not address a problem, task, or interaction from a biased perspective; your approach must be a balanced one. That things are rarely ever black and white, so you must understand grey, make yourself at home with it, and assume always that you will have to navigate a million shades of it.

The truth is, humans are complex. Therefore, so are our interactions. Hence, to approach a problem that arises from such a complex environment in a binary way is often counterintuitive. Aiming for this delicate balance, ironically, has now become my life’s work. In fact, I now consider it a hallmark of a good leader; the ability to pause, take in a situation with all its complexities, and move forth with the most balanced approach (for your organization, staff, resources), while shedding one’s own biases in the process.

Leadership, after all, is a balancing act in itself. You’re constantly balancing your time with your commitments, your resources with your goals. In the world of healthcare technology, this is magnified many times over, because you’re dealing with how care is being provided. You’re directly affecting human lives.

As my organization goes through its technological metamorphosis (akin to almost all other health systems around the country at the present moment in time), I find myself constantly balancing between many strategic variables. I’d hazard a guess that every healthcare CIO deals with this on a daily basis.

What sort of complexities, you ask?

For the sake of illustration, let’s say a typical healthcare CIO is dealing with only 3 variables at a high level at any given point (I know, wishful thinking, but bear with me): time, staff, and dollars.

That is to say, the Information Technology/Information Services (IT/IS) division of a healthcare org has a set amount of time, with a limited staff, to do all their work on a planned budget (pays for: operations, maintenance, licenses, hardware, and any new planned capital projects). Keep in mind that each variable would usually have some effect on the other in real life. For example: by increasing the budget by the right amount, you might be able to gain some time by purchasing needed tools or contracted resources. But, these relationships between the factors can be complex; push any of them too close to a threshold and no amount of money or additional staff or time can redeem a downwards spiral.

Anyhow, back to our scenario: in a given year, let’s assume that roughly one-third of these resources are used for operational tasks; tasks that allow the organization to function on a day-to-day basis, also known as “keeping the lights on.”

Another third is utilized within pre-planned Capital projects (e.g. application or infrastructure upgrades, new implementations). These are often strategic initiatives, planned months/years in advance with meticulously calculated timelines and contracts. Some of these may support the organization’s business or clinical functions directly, while others might be planned to meet milestones set forth by government policy.

Yet others might be implementations of technology in a yet-unrealized and innovative way. The tricky thing with the latter is that the true scope of resources required isn’t always known up front. In our simplistic scenario, factoring these in leaves the IT/IS division with about one third of their resources for everything else.

And “everything else” can include hundreds of requests and initiatives that originate from various avenues, both internal and external, on an ad-hoc basis (e.g., a new system specific to a medical specialty or integration with an external entity). Not to mention any adverse events (such as unplanned downtimes, natural disasters, cyber-attacks), that can halt normal operations and take up a large chunk of resources. Each of these on their own could easily eat away at our remaining third rather swiftly, until all our resources run perilously low.

Luckily, none of this happens in a vacuum. That is to say, the entire time things are moving forth, CIOs have their eyes on the road ahead (most often as far ahead as having a set of rolling 1-to-5 year strategic plans), anticipating bottlenecks. He or she is constantly negotiating and campaigning with internal governance groups, organizational leadership, the executive board, end-users/customers, and vendors to balance the demands on IT/IS staff and resources with business needs. This sometimes means things have to be pushed; some items may drop in priority, while new ones are added. A balance is achieved temporarily by fine-tuning available resources, until the environment is altered again.

Lastly, while the factors listed above appear as mere resources to be managed, one of them, in reality, is the most crucial asset an organization has: people. Human beings, each with their own work/life balance, morale, skill-sets, wants and needs. If they are treated as nothing more than a number, a leader risks losing their trust and their ability to perform at their best. This can be catastrophic, for actively disengaged staff members have an adverse effect across the board, on all the variables.

It’s evident that leading an IT/IS division tasked with keeping the lights on, implementing new technology, and dealing with ad-hoc events/initiatives simultaneously is a constant act of re-evaluating your situation and resources. It should come as no surprise then that some may find the role of a healthcare CIO to be an onerous one, with this continuous and exhausting balancing act.

However, there are many who revel in it, and in the new challenges it brings on a daily basis. The idea that you’re dealing with tech that provides healthcare to thousands and impacts the surrounding communities in a meaningful way. That you’re responsible for people who have entrusted you with their livelihood, their careers, and their well-being. And that your organization relies on you to safeguard its ability to operate by striving for that ever-elusive balance on its behalf, often times with the intent of predicting a future landscape many years hence.

I personally consider it a privilege to work in such an environment, where things are rarely dull and you evolve to be a better, more balanced leader each day. And I’m eternally grateful that my father’s lessons, unbeknownst to either of us at the time, had been preparing me for this, however minutely, for the better part of my life.

Author’s note: The impetus for this article lay partly in the timing of the anniversary of my father’s passing; my father passed away today, 8 years ago. And another catalyst lay within a recent LinkedIn article by Ed Marx which really struck a chord with me; I frequently find myself referring to my dad’s imparted wisdom in my day-to-day activities. It catches me by surprise, these glimpses of his personality and philosophies in how I approach things. And I believe this to be true for us all; our parents/teachers/mentors impact us in ways that aren’t always immediately visible, but manifest themselves over the course of our lives.

This piece was written by Saad Chaudry, Executive Director and Associate CIO at Anne Arundel Health System, a role he has held since July of 2017. Prior to that, he was Director of Healthcare Data Integration at Johns Hopkins Medicine, and served in various roles at provider and vendor organizations.