Q&A with CIO Nicholas Szymanski, Part 1: "IT Really Does Touch Everything Now."

Nicholas Szymanski, CIO, Richmond University Medical Center

So much of what IT organizations do – what leaders do to help remove barriers – is about processes. In fact, it’s second nature for IT folks to look at things in a consequential matter. Much of troubleshooting is rooted in knowing what steps to take to remedy a certain situation.

“Everything we do is a process,” says Nicholas Szymanski, who recently took on the CIO role at Richmond University Medical Center. That mindset enables teams to break a problem down, take a step back, and ask why it’s happening.

It’s a philosophy that has served him well, both with his current organization and in past lives. But it can’t happen unless leadership has established a rapport with individuals at all levels, and built trust. In this interview, Szymanski talks about how his team is working toward the ultimate goal of a unified platform, what they do instead of saying ‘no,’ and why he hates the word ‘interface.’ He also discusses what it was like to be RUMC’s first CIO, the importance of transparency, and why he’ll always be a sponge.

Chapter 1

About Richmond University MC
RUMC’s first CIO – “It was a learning experience for me and for the organization.”
CIO as a business partner (not just the ‘IT guy’)
Benefits of “bouncing around”
Back to basics
“IT really does touch everything now.”
EMR optimization – “It shouldn’t be stagnant.”

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Bold Statements

There was my perception and their perception, and organically, we met in the middle. But there were times where there was definitely a difference in terms of what that role was thought to be and what the responsibilities were.

I get to be the nudge, and hopefully, portray myself more as a business partner instead of just the ‘IT guy.’ That was a big change at first because historically, as a CIO, you’re IT — you’re the one they call if a computer is broken. That’s not what this role is anymore.

Whether it’s building a new wing, buying a new practice, or implementing anything, IT needs to be there. It should almost be instinctive that the first person you think of is IT. That’s what I’m trying to hammer home here.

Kate Gamble: Thank you for taking some time to speak with us. I think the best place to start is by talking about the organization, Richmond University Medical Center, which is not located in Virginia.

Nicholas Szymanski: It is not. It’s commonly believed that it is, but we’re actually in Staten Island, New York. We’re one of the two hospitals on the island.

Gamble: What do you have in terms of hospital bed size and some of the other care offerings?

Szymanski: We’re licensed for just under about 500 beds, and we offer a range of services, including behavior health, ER, pediatrics, and med surg. We’re a stroke-certified center as well, so we really provide the full gamut of services. Again, being one of two hospitals on the island, it’s pretty important that we offer those services, especially in the case of emergencies, and so we carry a wide range of services onsite.

Gamble: Are you an independent hospital or do you have affiliations? How does that work?

Szymanski: Right now we are a community hospital, and that comes with its own unique challenges and benefits to a certain degree. But yes, we are a standalone — one of the few that are out there, and we are the only standalone on the island.

Gamble: You took on the CIO role in November of 2017, and you were the first CIO the organization has had?

Szymanski: That’s correct. I was very fortunate to be the first. But I was not new to the organization; I had spent a little over two years here before in my first stint a few years back. Then I went elsewhere and then I came back for this opportunity. So yes, being the first was exciting, although it did come with its own set of challenges.

Gamble: When you were with the organization the first time around, what role did you have?

Szymanski: I started as a financial analyst, and then moved up the ranks until I was director of IT. A lot of my growth has taken place here over the years. I’ve seen the different levels and different roles and how they impact the organization, and I’ve learned greatly from each one of those roles.

Gamble: Sure. I imagine the fact that you were familiar with the organization factored into your approach as CIO.

Szymanski: It’s interesting because it was my first time being a CIO, on top of everything else. Coming into an organization that never had that specific title — and not having held the role myself — I felt was very unique, and would bring challenges as well as opportunities. The reason I say that is because I came into this role with my own thinking, based on what I’ve seen, of the CIO roles and responsibilities. And so I thought I had a good sense of what my duties would be, but when you go into an organization that never had that particular player at the table, you have to mesh the two worlds.

And so I’m learning what that role should be, while also trying to help guide the rest of the leadership team into understanding what my role is, and how I can help them and facilitate things. It was a learning experience both for me personally and for the organization to bridge the gap to where I understand what I need to do, and am more confident in what that is. It’s also helping the rest of the team to have a clear expectation of where I come into play and what my role is.

It’s a very unique situation, and it allowed for flexibility because there were unknowns all around. There was my perception and their perception, and organically we met in the middle. But there were times where there was definitely a difference in terms of what that role was thought to be and what the responsibilities were. It’s been a whirlwind, but a positive one for sure.

Gamble: It seems like you’ve really been able to define the role.

Szymanski: Exactly. The other benefit is that I have a great interest in learning more about operations and what happens outside of IT. And so I get to be the nudge, and hopefully, portray myself more as a business partner instead of just the ‘IT guy.’ That was a big change at first because historically, as a CIO, you’re IT — you’re the one they call if a computer is broken. That’s not what this role is anymore. This opportunity allowed me the freedom to be that nudge and ask questions and say, ‘Hey, can I sit in on that quality meeting? I want to understand what’s going on here. Maybe we can even help.’

And so as I’ve bounced around in different areas, it hasn’t just been informational for myself; it’s been equally beneficial for other departments. Now I can say, ‘I think we can help make this a little bit quicker.’ Having that opportunity and that freedom to bounce around hopefully has paid dividends for everyone. It certainly has for me personally and for my own growth.

Gamble: Since becoming CIO, have you made changes to your leadership style or evolved in the way you manage?

Szymanski: For sure. When I first came here, I went back to basics. That was a benefit of knowing the organization had a best-of-breed model where a lot of areas work well, but organizationally, we might not be operating at the level we want. My challenge was, instead of adding bells and whistles all over the place, to go back to the foundation. To use the house analogy, our foundation had windows left open, and we’re asking to build another wing to the house. We can’t do that right now. We need to go back and really solidify a lot of areas and get them running well, and then we can look to enhance. That was my first big challenge; aside from identifying and defining what my role was, that was first action plan that I worked on.

Gamble: What do you think motivated the organization to name a CIO? Did it have to do with wanting to move away from a best-of-breed approach?

Szymanski: I think in the back of their minds it probably played a role. Again, not having had a CIO here before, I don’t think there was a set list of, ‘Here’s what we want this position to do. We want this and this.’ And that allowed me the opportunity to grow and be the nudge. But when I communicated to them where I felt the gaps were and what they needed to shore up in certain areas — especially when I met with them about coming back to the organization — it definitely seemed to be of interest.

At the end of the day, it’s all about the patients. If IT can help solidify their support to the end users — the caregivers, that ultimately gets passed down to the patients, which is the end goal. That was the message I had sent, and I think it really resonated with them. I think the other piece is that IT really does touch everything now. You need a point person to say that it’s not about fulfilling requests like, ‘I need two new computers’ or ‘I have a printer jam.’ It’s determining what this looks like for a long-term strategy, and especially in regard to cybersecurity and having a solid posture. I think they saw that it was time for the role to evolve and grow into what it has become today.

Gamble: Right. In terms of how things look now, what would you say are some of the key priorities for your team?

Szymanski: There are about three or four. One is moving away from best of breed and going to unified platforms whether it’s the EMR, telecommunications, or anything really. The goal is to consolidate and unify so you have a solid process and can eliminate a lot of opportunities for error.

Two is getting everyone to understand that IT needs to be at the table, regardless of the project. Whether it’s building a new wing, buying a new practice, or implementing anything, IT needs to be there. It should almost be instinctive that the first person you think of is IT. That’s what I’m trying to hammer home here. It’s almost become a joke, because what happens a lot is there’s a grand plan that’s put together, and then two weeks before go-live, someone will say, ‘Where’s IT? We forgot them.’ Then we come in and say, ‘This is not how we would have done it.’ Culturally, getting that change in place is on the action items and to-do lists, as it has been and will continue to be.

The other thing again is really ironing out the basics, and I stress this all the time: what separates good teams from great teams is doing the basics consistently, and consistently well. Even something like responding to service tickets—you do it in a timely fashion and you communicate consistently with end users so you can manage expectations. These are basic things, but if you do them consistently and well, that’s what ultimately is going to provide better service to our end users, and ultimately, the patients.

The other part we’re focused on is optimization and trying to improve patient satisfaction. With the optimization piece, I’m referring mostly to the EMR. The EMR should continue to evolve over time — it shouldn’t be stagnant.

We put a lot of framework in place and will continue to do so to get the EMR up to speed and where it needs to be, get efficiencies put in place, get the correct data, and get one source of data. That’s another challenge dealing with multiple sources of data.

And also, it’s looking at where are the opportunities for IT to help with quality scores and patient satisfaction. What can we provide to the patient or the patient’s family that will either help them during a difficult stay or keep them up to date with their care? Those are the main areas we’re targeting, as well as cybersecurity, which is another big one. I’d be surprised if every single IT person didn’t say that, because it’s always evolving and you’re always playing catch up as new threats are identified. Those are the big things keeping us busy, never mind the day-to-day stuff.

Chapter 2

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