For CIOs, the concept of doing more with less is hardly a novel one. But as organizations continue to grow — and enhance their digital presence — the ability to drive change without “becoming a bottleneck,” said Ash Goel, MD, CIO at Bronson Healthcare, is becoming more evasive.
“We want to grow, grow, grow, but that comes at a cost,” he noted during a recent panel discussion with Cara Babachicos, Chief Digital & Information Officer at South Shore Health, and Tom Barnett, Chief Information and Digital Officer, Baptist Memorial Health Care.
And when it’s time to offset those costs, the finger is often pointed at IT, according to Tom. Therefore, “making sure we’re getting maximum miles per gallon with those investments is absolutely imperative — not only to our department, but to the organization as well.”
“Under the microscope”
It’s a sentiment shared by many, including Babachicos. “Everything is under the microscope right now. We have to be very creative about our decision-making,” particularly on the heels of a major EHR implementation, as is the case with South Shore. “It’s about leveraging the investment and making sure we’re enhancing the user experience as much as possible.”
It’s no easy feat, particularly given the rising costs leaders face on everything from hardware to licensing costs — not to mention the price of keeping the lights on, which isn’t discretionary, according to Barnett. What is discretionary, however, is the percentage of the budget that can be allocated toward business problems. “That’s where governance comes in — making sure we’re selecting the right business case, applying those dollars appropriately, and holding both the project team and operations accountable to delivering those results.”
Adding to the challenge is the fact that governance models have evolved significantly, noted Goel. In the past, leaders knew in advance how much they had to spend based on strategies that had been outlined. Now, however, business propositions are rapidly changing due to growth that comes from either new partnerships or growth models. “That has required us to pivot in much shorter timeframes, which has led to competing resources both for dollars and people,” he said. “And so, we’ve tried to find better ways to create visible methodology for both the operators and my partners in the senior executive team to understand what’s the highest value for their dollar spent.”
“Advise and advocate”
It represents a sea-change from traditional models, Goel noted. Instead of letting processes decide how IT dollars are spent, CIOs can work with other leaders to determine strategic objectives before roadmaps are created. “My role is not just to be the backroom computer guy,” he said. “My role is to change how technology is used in the organization. And that comes from me being part of that higher leadership group.”
It’s a fine line that needs to be walked, according to Babachicos, who has adopted an “advise and advocate” approach. The non-negotiable areas such as system maintenance, hardware replacement and cybersecurity measures tend to gobble up a lot of discretionary capital, leaving many departments to fight for a small piece of the pie.
That’s where the advocacy piece comes in, she said. “I try to leverage senior leaders to advocate for what they think is most important for their strategy and for the overall organizational strategy.” By communicating their needs with each other, representatives from different departments can better understand limitations on resources.
CIO as “chief explainer”
It can also help leaders more accurately forecast needs and present a realistic “run rate for keeping us in business and keeping everything operational,” said Barnett. “I don’t want to be in a position where I have to lobby or advocate for why something needs to be replaced because we didn’t expect that cost, or because I thought we have more discretionary dollars.”
The right governance structure, Barnett noted, can act as “the decision-making body to help with the competing priorities for these narrow, and in some cases, dwindling dollars that can be put toward new initiatives.”
As part of that, leaders must be able to explain technology initiatives in business terms and demonstrate a solid understanding of the operational pain points. “If you come at it from a pure technology perspective, it doesn’t gain traction. It becomes a different conversation.” As the “chief explainer,” CIOs need to be able capable of translating in relatable terms. “That’s the genesis and the crux of governance from my standpoint.”
Another critical element of assessing customization and development requests is to ensure a purchase is necessary, noted Barnett. At Baptist Memorial, his team utilizes an exercise that asks three simple questions: Does the current vendor already do it? If not, is it on their roadmap for the next year or two? And if not, can we look at a third-party package?
More often than not, the problem that a third-party bolt-on promises to solve has already been addressed in the core platform. “It’s probably something we’ve already paid for, but there wasn’t awareness,” he said. “We need to make sure we’re explaining that and keeping the dialogue open so that we can raise that level of awareness and maximize our miles per gallon.”
Of course, making sure organizations are getting the most from systems should always be a priority, especially ones that come with a hefty price tag, said Babachicos. “We’ve gone back and optimized our ERP so that it’s not just turned on and functioning, but we’re getting the top reports we need each month, and those reports are credible.”
The willingness and ability to extract as much value as possible from investments is becoming increasingly vital, she noted. But it’s not easy. “The hardest part of IT is supporting the change management and the transformation that needs to come. The reason people don’t push on ROI is because it’s not as simple as turning something on. It’s about changing someone’s job. It’s about creating standards that can create disruption for the organization.”
For example, implementing open scheduling can be a big satisfier for patients, but to providers, it can be problematic. One way to avoid pushback in cases like these, according to Babachicos, is to be transparent from the start. “In order to dig deep and get that ROI, it should be called out from the beginning. It should be a change management plan that accompanies the IT project plan,” she said. “It should be IT partnering with other executives to be very clear on what success should look like.”
“Only ask what’s feasible”
Finally — and perhaps most importantly — leaders need to avoid biting off more than they and their teams can chew, which has becoming increasingly difficult, according to Goel, who believes flexibility is critical. “You need to be selective about what you’re committing to, and make sure your teams are engaged in the right work,” he said. “Teams never recover when can’t meet organizational demands. As leaders, we can only ask from them what’s feasible and not burn them at both ends.”
Barnett agreed wholeheartedly, encouraging leaders reassess priorities to “get back to making sure we’re doing what we should be doing for the health system,” and that the burden hasn’t increased exponentially. The focus, he noted, should be on “rationalizing applications and hardware, managing costs, and making sure we don’t spin up more than we need.
“We need to have open dialogue with the business side, making sure we’re taking those discretionary dollars that we have and collectively applying them to the right spot, at the right time, and in the right way.
To view the archive of this webinar — Doing More With Less: How to Run an Efficient IT Shop in Tough Times — please click here.