Q&A with Brian Lancaster, Part 1: “Consumerism Is a Key IT Strategy.”

One of the most compelling challenges facing CIOs today is in translating the organization’s mission and values in a way that makes sense — and is relevant — to the entire staff. It may not seem that difficult, at least on the surface, until you’ve tried to explain to server managers how they’re helping to transform care. It’s a message that has to be delivered in just the right way, and one that requires a completely different skillset than the traditional CIO role.

Luckily, Brian Lancaster isn’t a traditional CIO “by any stretch of the imagination,” he said in a recent interview. It’s hard to disagree. Having spent far more time on the vendor side (18 years) than in the provider world (5 years), Lancaster offers a fresh perspective on issues like the communication barrier between IT and end users, and what transformation really means.

In this interview, he talks about the six strategic goals that are driving IT initiatives at Nebraska Medicine, what it takes to facilitate collaboration after a reorg, and the mistake leaders make when it comes to coaching.

Chapter 1

• About Nebraska Medicine
• Partnership with UNMC to “transform lives”
• Moving to a shared services model – “It gets complicated quickly.”
• Priorities driven by business, not IT
• Reducing burnout through optimization
• The “golden thread” tying mission to IT objectives
• CIO’s role as translator

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Bold Statements

It’s not ill will. It’s just that thinking of, ‘That’s a clinical issue; that needs to go to the clinical team.’ You don’t want to step on someone else’s toes. But when we all share a network, and we ask patients to traverse in that network, it gets very complicated.

If you see a problem and you know how to solve the problem, don’t call a meeting to talk about the problem — just solve it. Even if it’s a clinical problem and you’re an academic or support person.

Consumerism is a key IT strategy. It really talks about how to use technology to transform how we teach, how we do research, and how we provide care.

When you don’t have connectivity, it quickly becomes a strategic objective. How do we make sure our wireless network has the appropriate bandwidth across every location? How do we make sure it’s going to enable future innovations around location services?

When our CEO or chancellor talk about transforming lives across the region through education, research, and patient care, it’s hard for a help desk person or a person working on a server to really understand that — ‘How am I transforming care by managing the server?’ So we try to draw that line.

Gamble:  Let’s start with some information about Nebraska Medicine. Can you provide a high-level overview of the organization?

Lancaster:  Sure. We’re located in Omaha, Nebraska and basically support the surrounding region with our two hospitals and 40 clinics. We have an academic partner, the University of Nebraska Medical Center, with whom we share a visionary and lofty mission to lead the world in transforming lives for a healthy future through our educational programs, innovative research, and extraordinary patient care. We’re a $1.8 billion academic health system. We provide care across all specialties and are known for our quaternary care.

 

Gamble:  And it was pretty recently that the partnership came together?

Lancaster:  Nebraska Medicine has had many different names over the years; at one point it was Clarkson Regional Hospital, which was located across the street from the university hospital. Then in the late 90s, through the vision and collaboration of key physician leaders, the two decided to join forces and developed a great relationship.

 

Gamble:  From an IT standpoint, how is that structured? Do you report to the vice chancellor?

Lancaster:  So, up until 2018, we had two different IT departments with two different CIOs. I had a colleague on the academic side, and I focused most of my time on clinical needs. We collaborated quite a bit. Then in 2018, the CIO for the University of Nebraska Medical Center retired, and our chancellor and CEO decided it made sense to create a shared services model.

I was charged with leading the joint effort, and so now I have responsibility for both the academic side, which includes our educational and research missions, and then supporting clinical care missions for both UNMC and Nebraska Medicine. It gets complicated quickly because we’re also affiliated with the broader university system. The University of Nebraska has three campuses — in Lincoln, Omaha, and Kearney — but one CIO with whom I’ve been collaborating; that’s a relatively new change for them as well.

 

Gamble:  It’s easy to see how it can get complex quickly, and how important it is to tie all of that together.  

Lancaster:  There’s a lot of commonality in terms of servers, networks, and things of that nature. You really understand the difference between what a researcher is trying to do, what a physician is trying to do, and what a faculty member is doing to teach a class — and what happens when those three roles are done by one person.

If you look at the academic health system, we have individual leaders who go from teaching a class to providing care to doing research, while also serving an administrative function. How can we make sure we’re serving them and ensuring they have the same flawless experience when doing research as they do when providing care? That was a lot of the thinking behind consolidation. When you have a separation, there’s a general belief that certain types of issues must be solved by certain people, and so you don’t have that mentality of working together in that mindset.

And it’s not ill will. It’s just that thinking of, ‘That’s a clinical issue; that needs to go to the clinical team.’ You don’t want to step on someone else’s toes. But when we all share a network, and we ask patients to traverse in that network, it gets very complicated to pinpoint whose problem it is, and how we can collaborate across all of our disciplines to solve that problem. We’re not there yet, but I think we’ve made some great progress.

And I think fundamentally, that progress was starting to build the mentality of ‘see a snake, kill a snake.’ If you see a problem and you know how to solve the problem, don’t call a meeting to talk about the problem — just solve it. Even if it’s a clinical problem and you’re an academic or support person. I think that type of thinking has come a long way.

 

Gamble:  The first steps are sometimes the hardest ones when it comes to creating a new mindset, right?

Lancaster:  Absolutely. It’s talking things through, building relationships, creating new processes, and educating on processes that were in place but not necessarily being followed. All of that is key in starting to make those changes.

 

Gamble:  Sure. What do you consider to be your biggest priorities right now?

Lancaster:  From my standpoint, I try not to have IT lead those priorities, but instead, make sure IT is aligned with the business, and our priorities reflect them. A lot of that comes down to understanding the priorities for the health system and the academic medical center — for example, eliminating patient harm, cultivating trust and well-being, partnering across the region to create a clinically-integrated network to better serve the needs of those in our community, creating an engaging experience for our patients and employees, and driving best practices.

Those are some of our core strategies, which we then translate into something that resonates with IT. That way, if you’re working on a server, writing code, or troubleshooting a problem, you understand what our objectives are and how they match up with those of our CEO or chancellor.

We have six strategic objectives. The first is consumerism. To me, consumerism is a key IT strategy. It really talks about how to use technology to transform how we teach, how we do research, and how we provide care. The big buzzword we’re hearing is digital. But I’ve always wondered, how is digital any different than rolling out an electronic medical record? It wasn’t until I really understood the consumerism strategy that I had an ‘a-ha’ moment and realized that an EMR rollout isn’t really automating the current process. It’s very, very important, but not transformational. It doesn’t really change the way care is provided.

We have a digital strategy that we’re coining ‘consumerism’ and it really does cross all three missions. Now, researchers can get service through a portal; they don’t have to work with IT to get infrastructure needed to do a genome sequencing compute model. From an educational standpoint, lectures are now available in a digital format on the iPad, which means this can be done outside the classroom, and the class itself can be more hands-on. It creates a digital campus — that’s a flavor of consumerism. From a healthcare perspective, it empowers patients to become healthy through things like telehealth and the digital front door.

Another key strategic objective is optimization. Basically, it’s looking at all the systems we deploy and asking, do they work as intended or how we need them to? Again, that goes across all three missions, but top of mind is physician frustration with our electronic medical record. Many of us are guilty of trying to do 2 or 3 years of work in 12 months to get to Meaningful Use. Now, we’re focused on how to optimize those workflows — do we have the right order sets? Do we have the right documentation templates? Do we have training? Optimization is a huge strategic objective for us.

We’re also looking at connectivity. It may not sound like a strategic objective on the surface, but when you don’t have connectivity, it quickly becomes a strategic objective. How do we make sure our wireless network has the appropriate bandwidth across every location? How do we make sure it’s going to enable future innovations around location services? How do we prepare for 5G? That’s a key strategy as well.

Another strategic objective is economics — how do we make sure we’re being as cost-effective as possible with our technology decisions? How do we consolidate platforms? How do we decommission systems that haven’t achieved the value propositions they might have had, or truly are one-off use cases? Economics also gets into what’s most commonly referred to as innovation. Can we use technology to generate new revenue streams into the organization, by deploying our electronic medical record to smaller organizations, or offering app development resources?

The last two objectives are probably very tightly related: security and identity management. We need to be investing in modern, state-of-the-art, automated technology to protect data, whether it’s a next-generation firewall or another solution. Lastly, we have identity management; not just making sure we have an identify management system in place, but one that’s delightful and secure. By delightful, I mean we know when a physician is acting as a researcher or teacher versus providing care, and can create a custom experience for them that can reduce clicks.

Our general approach is to start with those buckets. We have a compelling vision, mission, and set of objectives. From there, we build strategies and tactics — those are really what you’d consider projects. This creates a golden thread tying everything together.

When our CEO or chancellor talk about transforming lives across the region through education, research, and patient care, it’s hard for a help desk person or a person working on a server to really understand that — ‘How am I transforming care by managing the server?’ So we try to draw that line matching the enterprise strategy to the work we’re doing to virtualize our entire infrastructure with the push of a button. And that gets into the strategy and tactics.

The simple way of thinking about it is, there’s a connection between the vision, mission, and objectives, and the strategic/tactical work. It’s my job as CIO to make those connections in a way that people can understand it. It also allows us to direct our tactics. Oftentimes, people create action plans, not strategic plans, because we’re so focused on the project and not really understanding how it’s actually going to move the meter.

Part 2