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 2
- “I’m not a traditional CIO by any stretch of the imagination.”
- Value of “soft skills” in leadership
- Leveraging Kanban to prioritize and manage capacity
- Coming to the provider side: “I wanted to understand the last mile.”
- Vendor’s finish line/IT’s starting line
- Rose-colored glasses with previous roles – “You forget all the daily troubles.”
- The “Interesting opportunity” for leaders w/ strategic and technical skills
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Bold Statements
People who grew up working in the data center or writing software may struggle with soft skills, because it gets so nebulous to say, ‘how do we write a strategic plan that’s meaningful to both IT and to the business?’ That’s harder than writing a line of code or managing a server.
It’s frustrating when someone comes to them with a solution and it’s clear they didn’t really do any vetting and didn’t understand what may already be in place. I think they do that because we haven’t always made it easy for them to interact with us.
I always tell people, ‘These aren’t IT decisions. These are business priorities.’ We can lay out priorities and suggestions, but we need a unified decision on why we’re doing this versus that.
Once you make the decision to do something, the clock really starts, and that last mile starts — now you have to deliver and you’re on the hook to create value.
If you look at everything happening with data, analytics, and mobility, healthcare organizations are looking to service providers based on the technology experience they can deliver. That’s a very different place than 20 years ago.
Gamble: Back in the fall, you gave a presentation at CHIME about how IT drives strategic value. It’s such an important concept. But I’m sure it’s not an easy thing to change how IT is viewed.
Lancaster: It’s certainly not, and I would be disingenuous if I said it has completely changed. I think people see more value in IT, but they still say inappropriate words when something goes down or they can’t get connected.
I think my background enables that to some extent. I’m not a traditional CIO by any stretch of the imagination. After college, I went to work at a technology company, and spent several years working on product management and strategies from the standpoint of, ‘how do we create technology that can solve a problem for the market.’ Then I had an opportunity to come here and I started to apply those skill sets to IT. I think people who grew up working in the data center or writing software may struggle with some of the softer skills or abstract skills, because it gets so nebulous to say, ‘how do we write a strategic plan that’s meaningful to both IT and to the business?’ That’s harder than writing a line of code or managing a server.
I never would’ve thought this until I had a chance to experience both roles, but I believe it’s that innovation skillset that affords leaders the ability to take what’s needed from the academic medical center and match it with technology. Seasoned IT pros will tell you that it’s frustrating when someone comes to them with a technology solution and it’s clear they didn’t really do any vetting and didn’t understand what may already be in place. I think they do that because we haven’t always made it easy for them to interact with us. How do you build confidence that we can help solve problems instead of being a barrier? Once the problem is solved, we’re able to show that we can use those innovation skills. We can navigate the marketplace and find the right solution. I think innovation skills are key.
I also think coaching is important. How do you motivate your superiors and your peers as well as your teams, and also have the organizational mindset and the expertise to understand the business and be able to proactively suggest things? That’s fundamentally different from IT leaders of the past. Now, it’s a more risk-averse mindset.
It’s also about management, and creating a structure and governance model that allows you to execute appropriately. Because if I focus too much on innovation and coaching, and I’m selling more than delivering, pretty soon I’ll be seen as a snake oil salesman — someone who promised great things but never delivered. Coming from the product side of healthcare IT, I’m cautious about creating that balance between safe, repeatable delivery — which is traditional ITIL and IT operations — versus the cool, innovative, and transformational things we do.
Gamble: I don’t know if there’s a perfect combination. There are so many different versions of the CIO role. But I can imagine a big part of it is in having the right governance structure.
Lancaster: That’s key. We have a forum where we can provide updates, drive decisions forward, and make sure those decisions are transparent. I always tell people, ‘These aren’t IT decisions. These are business priorities.’ We can lay out priorities and suggestions, but we need a unified decision on why we’re doing this versus that. To be honest, it’s probably taken a couple of years just to get inventory of all the demands for IT services. Once you start to quantify those, you can start to run them through processes like Kanban or others that use sequencing. That enables us to say, ‘based on our current levels of funding and our current levels of resourcing, we can do 10 of these 100 tasks. And we think it should be these 10. Do you agree? If not, which ones do you want to do?’
That’s been really empowering, because if don’t do that, many people think you’re just not delivering; that you’re either unable or unwilling to deliver what they need. I think there’s a common fear that if you quantify it this way, people will see that you can’t execute all 100 tasks. My finding is if you show incremental progress, they create that balance between delivery and vision, which is the difference between vision and hallucination. But it is a constant battle, because we have more interest in IT services than capacity.
Gamble: Coming from the vendor side, what was your approach to the CIO role? And what are some of the ways in which you’ve benefited from that experience?
Brian: When you’re on the product side, there’s a commonality in terms of not enough supply meets the market demand. And so I developed processes to create a compelling vision and strategy as to why a particularly product is going to solve a problem. And actually, we actually never called them products. They were solutions, because solutions are the intersection of products, the market and engineering. It’s that holistic view of what is needed to create a solution. It’s learning processes and methodologies that enable you to paint a five-year vision of where we are today, and what decisions can be made over the next few years to move toward that vision and accomplish it. That gets into several of the methodologies being applied to different areas in software development — agile, lean, etc. How do you set a direction where you don’t get bogged down trying to define everything you need for five years from now? How do you distill that into the next logical step? And of course, you don’t talk about step 2 until you deliver step 1. When you deliver step 1, you reassess where you are and determine whether step 2 still makes sense.
As a product manager, you start to see how you can create a compelling vision, create a value proposition, and make steps toward that. Coming through traditional IT, people are sometimes nervous to show that future, because they’re thinking about whether it can be delivered in a way that doesn’t disrupt the enterprise in terms of availability or downtime. You have to deliver in a way that’s stable, but at the same time, you can’t let the unknown be terrifying. And so I think that visioning skill and incremental management are two of the key things I learned from my time on the vendor side.
Gamble: What was it that drove you to make the transition to the provider side?
Lancaster: I spent about 18 years on the vendor side and now five on the provider side, which is amazing, because it seems like it’s only been a year or two. What drew me here really was looking at the last mile; the difference between achieving an outcome and creating technology innovations for someone else to achieve an outcome. What I mean by that is, when I was on the vendor side, we did a great job of understanding the market. We created all these really compelling new features, but a lot of those features would sit on the shelf because of the effort it took to install, implement, train, and support new upgrades and new software.
And so I really wanted to understand that last mile — how can we go beyond creating technology that allows others to get meaningful outcomes, and become change agents and transformational agents in healthcare? To me, it meant really focusing and learning what it takes.
Another interesting thing is, if you were to ask me six years ago when I was still on the vendor side if I know academic health systems, I’d say, ‘Sure.’ And I’d give you a long list of people I’ve worked with. When I got here, I realized I know nothing about how these places really work. Learning how healthcare leaders make decisions and what they value in the decision-making cycle is critical. Once you make the decision to do something, the clock really starts, and that last mile starts — now you have to deliver and you’re on the hook to create value. That’s been an interesting transition for me.
I remember talking with some of my vendor friends who worked with us here at University of Nebraska Medicine. When they land a deal or go live, that’s the starting line for us, whereas in my former role, it would’ve been the finish line. But there’s so much that happens after that. It’s like that expression — ‘Be careful what you wish for’ — because that last mile is really long.
But I wanted to get a different perspective. And to be completely honest, I think it was also to supplement my vendor skill sets with provider skill sets so I could have a more well-rounded arsenal. Now I understand both how to develop products, manage products, and deliver innovations from the vendor side, and also how that needs to be packaged, delivered, and implemented on the provider side.
Gamble: I’m sure you had some of those moments where you thought, ‘Did I make a huge mist?’
Lancaster: It’s like anything in life. Sometimes when you look back on experience you have that romantic view, right? You think it was easy; you forget about all of the daily struggles. And so naturally, there are going to be times when you wonder if you made the right decision, but I’m very happy with what I’ve accomplished. It’s been really exciting to learn so much more about healthcare. The next step is, ‘how do I start to apply this at a larger scale?’ Now that I have confidence in IT, how do we really take that turn to drive healthcare forward as a technology company? Because I think that’s where it’s going. If you look at everything happening with data, analytics, and mobility, healthcare organizations are looking to service providers based on the technology experience they can deliver. That’s a very different place than 20 years ago, and I think that creates really interesting opportunities for people like myself who can combine both strategy and IT skill sets.
Gamble: Very well said. Things are moving in such an interesting direction, both quickly, and in some ways, not so quickly. It’s a really interesting industry to be part of.
Lancaster: Absolutely.
Gamble: Well, that should about wrap things up. Thank you so much for your time, I really appreciate it.
Lancaster: I appreciate it as well. Thanks for the opportunity.
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