Q&A with Cook Children’s CTO Steve Eckert: “The most important thing is to listen and observe.”

When Steve Eckert was presented with the idea of taking on the Chief Technology Officer post at Cook Children’s some four years ago, he had quite a bit of hesitancy. Although he loved the idea of returning “home” and working alongside CIO Theresa Meadows and CISO Aaron Wishon, his first instinct was that he’d be managing himself “right out of the role.” Fortunately, he chose to take the leap, and quickly realized that wasn’t going to be the case.

“It’s been eye-opening. There are a lot of similarities [with the CIO position], but there are also some key differences,” Eckert said in an interview with Kate Gamble, Managing Editor at healthsystemCIO. “It has given me an opportunity to learn and become much more well-rounded.”

During the discussion, Eckert talked about the evolution of the CTO “from being a very technical role to one that’s much more strategic,” and how his background in consulting has positioned him well. He also shared perspectives on Cook’s core objectives on the IT side, from cloud migration to reinvigorating project management; the importance of being in lockstep with other C-suite leaders; why formulating true vendor partnerships is critical; and why his work feels more like a “calling” than a job.

Q&A with Steve Eckert, CTO, Cook Children’s

Gamble: Let’s talk about the role itself. Certainly not every organization has a CTO, so can you talk about what the role entails from your perspective?

Eckert: My background is interesting because I didn’t follow a normal path. I’ve gone the opposite direction of a lot of other people coming from consulting. But I believe that fundamentally, the CTO role has changed. It has moved from being a very technical role to one that’s much more strategic.

That’s what [Cook Children’s SVP and CIO] Theresa Meadows and I first talked about with me coming on board. She had the foresight to say, ‘I’m looking for someone who can come in and help drive the strategy; someone who can listen to our customers, prepare us for the future, and help me to be strategically prepared for all things.’ That’s been my role since I joined, and it’s been a great experience.

To be candid, when I first took the job, I thought the CTO role was one where I’d be working to manage myself out of the role. But I’ve embraced it in a different way, and I really think that it’s an imperative role for an organization.

 

On working hand-in-hand with the CIO

Gamble: Can you talk about how the CTO and CIO work together and how those roles coexist?

Eckert: The CIO has a very distinct focus around making sure we’re following a corporate strategic direction, and making sure we have digital solutions available to be able to connect and make it easy to work as a health system. The CTO has to make sure that the underlying technology can support that vision and direction. They should be working hand in hand with the CIO, like I do with Theresa, to ensure we’re providing the best experience we can based on the vision from the top.

And so, my background, coming from consulting and helping health systems with strategic plans and decisions around which EHR vendor to select or to help them implement EHRs or ERP solutions, it really comes in handy in the role I’m in today. Because really, it’s a lot less about me talking and doing, and a lot more about me observing and listening to what the direction is and where we want to go. It’s about making sure that I hear the voice of our customers across the board and can translate that to make sure we can support the technologies that we invest in.

 

On Cook’s “smart cloud strategy”

Gamble: Great. Really interesting. So, at this point, what do you consider to be your core objectives?

Eckert: One of the main things we’re focused on now is our cloud strategy. We recently began our cloud migration journey by moving disaster recovery to the cloud [using Microsoft Azure]. We’re following a smart cloud strategy, which means we’re not going to take everything to the cloud or utilize all of our partners’ strategies or methodologies. But where it makes sense, we’re definitely embarking on cloud technologies to make sure that with all of our platforms, especially on the disaster recovery side, we’re able to secure them and make sure our resiliency is top notch.

On cloud touching “everything”

Cloud is one of the biggest pieces we’re looking at because it touches everything. When you start thinking about that, you have to really analyze what you’re going to do with storage. And so, right now, we’re embarking on a strategy around what storage looks like for us. Being a pediatric medical center, storage is really important because we have to keep records for a long time. We want to make sure we put our best foot forward and we have access to data as we need it, while also leveraging the technologies that we have in place.

 

On leveraging a ‘crawl, walk, run’ approach

Gamble: What has the strategy been in the past in terms of migrating to the cloud?

Eckert: Before I joined here, the organization had done a really nice job of investing in technology, both with our data center on the main campus and our fully redundant data center in Prosper, Texas, which is about 60 miles away from our main campus. We have a highly functional disaster recovery solution that’s a complete mirror of what we have in our Fort Worth main campus.

When we decided that it made sense for us to start exploring cloud technologies, DR was the first target, and so we’re taking a crawl-walk-run approach, starting with our Epic disaster recovery instance. From there, the next step will be analyzing production systems.

 

On providing a “snapshot in time”

Gamble: We know there are a lot of benefits to moving to the cloud, but what are the biggest drivers at Cook?

Eckert: One of the biggest reasons is that if we have some type of incident, whether it’s weather-related or something more nefarious like a cyber event, having access to our critical systems makes a lot of sense. Not only can we hold our partners more accountable to SLAs and protections and those types of things, but we also have confidence in the fact that they’re secure and readily available, and that we can quickly give clinicians access to data.

That way, if we have a significant event, we can at least give them a snapshot in time of that patient: here are the meds that were given, here are the lab results, all of those things that occurred at the moment we had a catastrophic event. Without this system, we would be 100 percent on paper. This at least gives us an opportunity to be able to reflect on what things looked like at that particular time.

 

On reinvigorating project management

Gamble: That’s exciting. What are some of the other really big priorities?

Eckert: In my role here, I have the Enterprise PMO underneath me. Since I joined, we’ve been rebuilding our PMO to make it more flexible and be able to take on more than just IS projects. Our goal is to build an Enterprise PMO for the entire organization.

That’s the long-term plan. Today, we’re focused on making sure we budget accordingly for our projects and that we have the bandwidth to take them on. Reinvigorating the PMO has been a big task for us.

On taking customer service “to the next level”

We’re also embarking on a big implementation of ServiceNow. That’s going to be a game changer for us as an organization. Right now, I think we do a really good job with customer service; whether it’s field engineering or our service desk, those groups do a really nice job of responding to customer needs and making sure we’re getting tickets to the folks who can actually fix those challenges. But ServiceNow is going to allow us to take that to the next level and offer tiered support. I think that’s going to be key for us to make sure that whenever someone submits a budget request or has a problem, that there is transparency within the ticket system and the ability to see where things are and what’s being done to solve the problem.

 

On Cook Childrens’ “significant growth”

Gamble: And Cook’s has seen a lot of growth in recent years, which I’m sure is part of the strategy.

Eckert: Absolutely. Over the last 10 years, we’ve grown from a single medical center to two hospitals. We have about 10 different companies within the portfolio, including home health, a health plan, and a network with about 500 employed physicians. We’ve grown to a $2 billion organization, and as a result, the technologies we invested in 5 or 10 years ago are struggling to keep up with the demand. We really needed an enterprise platform.

With ServiceNow, we have a system that can integrate not just IT service management, but also the broader organization. Whereas before we hadn’t leveraged a program management methodology and toolset across the entire organization, we’re now able to embrace technologies to make sure we’re delivering top service.

On providing a “Disney experience”

At Cook, I believe we have a really well-managed healthcare system. Our executive team has done a great job. But that requires us to make sure we’re leveraging our investments appropriately and that we are thinking really beyond typical service. Think of it like the Nordstrom or Disney experience. That’s what we expect for all of our customers. Whether those customers are clinicians, physicians, families, or patients, we’re going to make sure everything at Cook works the way it’s supposed to, and that we can quickly resolve problems that occur.

On keeping “eyes wide open”

My team works together to make sure that whether we’re walking into the medical center, a physician’s office or clinic, an urgent care center, or even one of our administrative buildings, that we have our eyes wide open. We want to make sure we’re looking around and making sure everything that should work is working in the best presentation. We always want to question things. If we see a kiosk that’s turned off, why is that kiosk turned off? Is there a problem? Is the workflow not working for the intake of that particular area? And if not, why?

On redesigning workstations in the ED

We’re always mirroring and shadowing physicians to see their workflows. Last year, we upgraded all of our physician WOWs (workstation on wheels) to accommodate a very specific need for the physicians at Cook Children’s. Our ED is very busy. As a matter of fact, it’s one of the busiest pediatric emergency departments in the nation.

As you can imagine, our ED is very large; it’s about 100 yards long. It’s L-shaped, but from one end to the other, it’s the size of a football field. And the impact on physicians is significant because they often have to travel a great distance in between patient visits. When you’re dealing with families and children, you want to make sure you’re providing the best care. And so, we needed to make sure they had 24/7 access to these particular workstations. We needed to make sure they are lightweight and easy to maneuver, and that the connectivity was rock solid.

That’s a challenge when you think about how they use them, because they’re going from one room to the next, which can sometimes be a pretty good distance. Typically, they document after leaving the room, which means they’re dictating using a microphone to create notes while walking down the hallway. We want to make sure everything works right; that’s our impact on patient care. We want to make sure physicians are able to comfortably treat patients.

 

On being in lockstep with the CISO

Gamble: You mentioned Theresa Meadows before. I imagine you really have to be in lockstep both with Theresa and [CISO] Aaron Wishon.

Eckert:  Yes. He and I collaborate quite a bit. As a matter of fact, I would say that Theresa, Aaron, and I work together on pretty much everything. As we’ve rolled out Microsoft 365, Aaron and I have partnered together on the entire project, from start to finish.

The same goes for our cloud strategy. I’ve learned so much working closely with Aaron. There’s so much that intertwines. With everything we do, whether its network and access, or new systems and technologies, Aaron and I are in lockstep.

 

On going from consulting to the provider world

Gamble:  So, you’ve been there almost four years. What made you want to go to the provider side? Like you said, it’s the reverse of what most people do. What drove you to make the move?

Eckert:  Throughout my career, I’ve had the fortune to work with some great people, whether it’s Ivo Nelson and Dana Sellers, all the way forward to Theresa and Aaron — some of the smartest, brightest people in the entire industry. When Theresa and I first talked about me coming into this role, the team was making a decision on WorkDay and I was helping to guide her along that path. I told her that my parents live in Fort Worth; I grew up in this town, and Cook has always been a special place to me. My youngest sister had special needs and was treated at Cook Children’s.

While I was a consultant, we helped Cook Children’s with some of their Epic implementation and training, and I helped with the WorkDay selection as well.

One day at the beginning of the pandemic, Theresa and I were talking and I told her I was considering moving back to Fort Worth to be closer to my parents. My wife also has friends and family here, and so, we decided that even though we loved Nashville, it was time to move. Theresa then made what I thought was a flippant comment that if I came to Fort Worth, I could be the new CTO (the previous CTO had just announced he was leaving). Sure enough, I called her a few days later and asked if she was serious about job, and she was. Next thing you know, I was at Cook Children’s.

On following his “calling”

To me, it felt like a calling. I’ve had a great career in consulting, but this was an opportunity for me to give back; to come in and to embrace what I’ve learned.  I’ve had the privilege of not only working with great leaders, but also with some great clients across the industry.

I’ve seen great CIOs and great execution across the board with other healthcare organizations, and I feel like I had a lot to offer. To be able to come back and step into this role and help Cook achieve some of the goals that Theresa and our CEO [Rick Merrill] had identified, was incredible. We’re rapidly growing, and being part of that has been an exciting opportunity.

 

Gamble: It definitely seems like it has worked out for the best.

Eckert:  I will tell you, it’s been the best move I’ve ever made. It’s been a lot of fun. I’ve learned a lot working alongside one of the best, if not the best CIO in the country.

What’s interesting is that some people have asked why I took a CTO role and not a CIO role. I can tell you that I fully believed 4 years ago that I could have jumped into a CIO role and done a great job. Maybe that’s true, maybe not. But given everything I’ve learned in the last few years, I’m really glad I didn’t, because it has been eye-opening. There are a lot of similarities internally but there are also some key differences, and there’s a lot that has to be learned around regulations, cybersecurity, HIPAA, and more.

I’ve had an opportunity to learn and to become much more well-rounded in this role. I’ve embraced it, and I’m very grateful.

 

On change management

Gamble:  What was the adjustment like when you took on the role? Were there challenges you didn’t expect?

Eckert:  I think my team saw me for what I am, which is someone who could enable them, provide mentoring and coaching, and help them move forward with strategic vision of the organization. Our biggest struggle was that the solutions the team had invested in and were proud of (and rightfully so), weren’t going to get us where we needed to go. For them, I think it was difficult when I came on board and wanted to go in a future direction and challenge what we had in place. I feel like they thought I didn’t appreciate the work they had done previously, or that I didn’t support the decisions that were made in the past. That was absolutely not true. The truth is I believe they made great decisions for where we were 5 years ago, but that we needed to make changes to support where the organization wants to go in the future.

And the team was able to embrace that. It took some time for me to learn how to communicate with people and listen and make sure they felt comfortable coming to me with new ideas and approaches.

 

On his advice for CTOs

Gamble: Well said. The last thing I wanted to ask is what advice you can offer for those who are aspiring to become CTOs. What are the keys to navigating this changing role?

Eckert: First and foremost, the most important thing is to listen and observe. See where the organization is going and make sure you’re building out technologies and you’re thinking strategically to be able to support where the organization wants to go.

Second, make sure you’re meeting with your vendor partners to understand where they’re going. The Epic User Group Meeting is really important to us because it helps us to see where Epic is headed and make sure we’re able to support that. My team and I made decisions after the recent UGM based on our understanding of where Epic is going with its Hyperdrive deployment and the technologies that we’ll need to leverage that. And so, make sure you know where your vendor partners are going and that you’re in alignment with that. If not, you’ll be fighting an uphill battle.

The third thing is to have your eyes open in the marketplace for new emerging technologies. Sometimes your organization isn’t going to know where it needs to go or where it wants to go. As CTO, you can be a change agent by bringing forth technologies that can enhance workflows. Those are three key things to keep in mind as you’re developing your strategies.

 

On having “a high bar”

Gamble: And for you, having that consulting experience seemed to help quite a bit.

Eckert: It did. It’s interesting because I have a very high bar for what I expect from our vendor partners as a result of me knowing what things look like on the other side.

A lot of people are reticent to share their vision and their strategy with vendor partners because they don’t want to get ahead of themselves, or they don’t want vendors to come in and sell to them. I look at things differently. I think it’s important for us to understand where our vendor partners are headed and for them to understand where we’re headed. That transparency helps make sure we’re in alignment as we go forward.

On what partnership means

I don’t want to work with a vendor who’s just trying to sell. I expect people to listen and to position themselves to make sure Cook Childrens’ best interests are at hand. Of course, we know and recognize that vendors sometimes need things from us. Having a partnership means we help each other out, and we’re certainly willing to do that. And so, I think it’s really important to be very transparent as to when we can actually move forward with a new product or solution so that everything is on the same page. Being transparent and understanding their needs will help us make sure we position ourselves well for the future.

 

Gamble:  A lot of really great stuff. I want to thank you for your time; it’s been really interesting learning about your path as well as what Cook Children’s is doing.

Eckert: Thank you, Kate. It’s been a great experience with Cook. There’s really not much of a higher calling than working for a pediatric healthcare system. It’s been a blast.