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.
- Prioritization challenges
- Avoiding ‘no’ – “We say when and how we can do it.”
- IT as supporter: “Everything we do should tie into where the organization needs to go.”
- CIO’s role as “translator”
- Common misconceptions – “Not everything can be interfaced.”
- Meditech in the hospital, athenahealth in clinical practice
- Understanding the ‘why’
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I have to be a translator. My job is to explain why it’s happening and what the efficiencies are. I have to be able to communicate, in a straightforward and transparent way, that yes, this is going to set you back, but we’re all in it together.
It helps set the table and set expectations so that people don’t walk away thinking it’s going to do a million things it can’t do. When that happens, you’re just setting everyone up for failure. No one benefits from that.
Our focus isn’t on training as much as getting people to understand the importance of having an appropriate structure for implementations, including buy-in and governance.
If you have those ingredients, the team will get behind things. They become invested, which leads to a higher-producing team. You’re producing more, you’re producing better quality, and more importantly, those people feel a sense of pride, a sense of ownership. They’re in it.
Gamble: How do you manage the prioritization piece when there are so many things that need to be tended to?
Szymanski: I think a lot of places, including us, struggle to pinpoint that prioritization, because IT being a service department gets 20 requests thrown at them daily. And so the first thing is to understand as an organization what is we’re going after — what is our plan? What initiatives should take priority? Anything that centers around patient care immediately takes priority. From there, it’s managing the mid-level projects that range from three to six months.
That’s where it’s imperative that you have very clear communication with the team, and with other department managers and teams to say, ‘We’re not going to say that we can’t do this. But based on what we have, this is what we can do and how we can do it.’ That’s a phrase I always use with my team: ‘we never say no; we say when and how we can do it.’ It’s all about managing expectations.
Going back to your question about prioritization, everything we do should tie into where the organization needs to go and wants to go. That immediately takes precedence. And again, anything centered around patient care is of utmost importance. That’s my philosophy. I bring that back to the team, and when I hear other leaders say they’re struggling with something or looking to improve quality scores, we sit down and think about what we can do to help them. It’s like a trickle down or trickle across approach. It should stem from where the organization as a whole is going and how we best can support that.
Gamble: It sounds like a lot of this goes back to that first objective of getting to a united platform, because it’s the foundation for so much that needs to be done.
Szymanski: Correct. The other thing is that getting to a united platform — and I’ll use the EMR as an example — really closes a lot of gaps and addresses a lot of wants. People may not see that, understandably, and so it’s my role to say, ‘I know that using this individual system, you might be operating at an 8 or a 9 out of 10, but the organization is running at a 6. If you were to come to the unified platform, your department might drop down to a 7, but the organization as a whole will go up to a 7.’
That’s where I have to be a translator. My job is to explain why it’s happening and what the efficiencies are. I have to be able to communicate, in a straightforward and transparent way, that yes, this is going to set you back, but we’re all in it together, and the organization is absolutely going to benefit. As I said, it closes gaps and addresses wants. If you have disparate systems, you’ll go into a meeting and hear people debating why X and X process takes so long, and you have to say it’s because the systems don’t talk to each other. And then they’ll say, ‘Let’s create an interface’.
Well, it’s not that easy. Not everything can be interfaced, and if you’re on a unified platform, you don’t have to worry about this. And so yes, those are some of the obvious benefits in going to a unified platform. My role is to explain why it should be mission-critical and why we should sit down and take a good look at whether what we’re doing makes sense, and weigh the positives and negatives. Oftentimes, people go into this with a preconceived notion — ‘It’s not going to be as good as what I’m doing now.’ Then they’ll say, ‘I didn’t know I could tie this and this together.’ One of my responsibilities is to get these people to the table.
Gamble: Right. So open communication is a really important part of your strategy.
Szymanski: I can’t stress that enough. It really helps set the table and set expectations so that people don’t walk away thinking it’s going to do a million things it can’t do. When that happens, you’re just setting everyone up for failure. No one benefits from that. At the end of the day, it’s about the patients. If they’re not going to benefit from an initiative, I don’t see the point.
Clear communication and managing expectations is a huge piece of the CIO’s role — and that applies to any service department leader. When am I going to get this report? When are we going to get this implemented? You have to be honest and open with them. But at the same time, you can’t be negative and say, ‘We can’t do it’; but rather, ‘We’re going to do it where it makes sense. Here’s how and when.’
Gamble: Sure. In terms of the EMR, what systems are you using at this point?
Szymanski: Our main EMR is Meditech. We’re trying to get everyone on board with that, and we’re moving to athenahealth in our clinical practices. We have a lot of initiatives all the way around with those two components, in terms of getting more areas on board with Meditech, and also moving to a unified ambulatory and clinical platform.
Gamble: What are the approximate timelines there?
Szymanski: The big piece is we’re going live with Meditech in the ED by the end of this year. The Athena implementation also will be completed by that time. And then there’s our other projects. You can see where our time is being spent.
Gamble: With the go-lives coming up, is there a lot of focus on training?
Szymanski: Our focus isn’t on training as much as getting people to understand the importance of having an appropriate structure for implementations, including buy-in and governance. I think that in years past, there’s been a tendency to kind of slap things in place and call it a day. The methodology for implementations has become much more refined. Another part of my role is to get people on board with that and provide the right project management structure. We’re focused on that, and on getting people in the right positions to make both implementations highly successful.
Gamble: Right. Those are two very big initiatives, and you also have the day-to-day things that come up. With this in mind, can you talk about the leadership style you’ve adapted to help build a strong culture and help enable teams to perform at a high level?
Szymanski: I have to say, I’ve been incredibly fortunate to have great mentors that really took me under their wing, and not just in IT. That has paid major dividends. I still have those contacts, which really helps because I get to bounce ideas off various folks and get different viewpoints. What I’ve learned, and what I try to do, is to be very transparent.
In regards to the team, there are a few ingredients I try to make sure everyone has — or at least the team as a whole has — and that’s understanding what is the mission, what are we going after, and more importantly, why are we doing it.
It’s not enough just to say, ‘I need to implement this ER component to the EMR.’ You need to explain why. For the team to be successful, they need to understand what the mission is, and even more importantly, why we’re doing it. They need to know the benefit, so they can have buy-in.
The other thing I try to do is make sure everyone has each other’s back and understands that we’re all in this together as an organization; we’re all one big team, not siloes.’ And so if someone needs help, whether it’s with buying a PC, looking at a problem, or building something, that’s important, because you’re able to establish camaraderie, which helps build a strong team. Accountability is part of that as well. To a certain degree, the team is self-governing, and so I try to make sure there are clean and clear lines of accountability; that people know the expectations, and there are no surprises.
And again, this ties back to transparency. It’s needs to be across the board, and it needs to apply to leaders as well. The big thing is to lead by example. I can’t say to someone, ‘You should have handled this situation a certain way,’ if I then go into a meeting and do exactly what I’ve asked people not to do.’ It can’t be, ‘Do as I said, not do as I do,’ because you won’t get respect as a leader that way.
If you have those ingredients, the team will get behind things. They become invested, which leads to a higher-producing team. You’re producing more, you’re producing better quality, and more importantly, those people feel a sense of pride, a sense of ownership. They’re in it. They know why they’re in it. They’re not bored with it, and so that’s why I try to instill in them.
Gamble: It’s so important for people to really feel like they’re engaged, like they’re invested. It just leads to better outcomes all around.
Szymanski: Absolutely. The other thing is they challenge each other. They even challenge me at times. ‘What do you think I should do here? What do you think I should do about this?’ I always tell my team I’m not a fan of the old school dictatorship of ‘you do this, you do that.’ There are different roles and responsibilities, but ultimately we’re a team. And I learn just as much from them as they learn from me.
There’s a balance between working hard and also having a little bit of fun. All these things sound basic in nature, and they are, but it also ties back to one of my previous statements, which is doing the basics and doing them well. There’s no magic wand here. It’s really not that difficult if you know exactly what you’re trying to accomplish.
The last thing in terms of my role is to help clear any hurdles the team may face. We actually open our meetings with, ‘What are you facing, and how can I help you?’ It might be someone who isn’t responding or individuals who don’t show up at meetings. Whatever it is, I need to know, because that team member or team is going to become frustrated; they won’t be able to do what they’re being asked to do because of forces outside their control. That’s my job.
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