Published September 2022
George T. “Buddy” Hickman has been “very, very involved in health IT,” as a CIO for the past 24 years, and in other capacities. Now as the chief strategy officer with First Health Advisory, a global risk management and digital transformation advisory firm, he imparts his vast industry knowledge to others as part of his daily job.
In this episode of healthsystemCIO’s Partner Perspective Interview Series, Anthony Guerra, founder and editor-in-chief, picks Hickman’s brain on how he sees new trends affecting CIOs, particularly the latest title of chief digital officer. Is it important to go after this title? Hickman says it depends. Sometimes, it’s just a matter of a new trendy name for the same CIO job. But if a CIO is a trailblazer, drastically driving change at his or her enterprise, it might be right to assume this new title. And by the way, don’t expect the role to come without conflict, as that comes with the territory for any C-suite IT position. Hickman offers some ways to work with it and win, along with a host of other career gems in this interview.
“I sit back and look after the many years I’ve been doing this, and I always think about the fact that the CIO has always been doing transformative things. It’s just that transformative things are branded differently these days.”
“So when you say you want to do digital health differently and have it be a strategy, my view is governance and role clarity are probably the two most important things.”
“If you think about 12 different conflict styles being tasked- or people-based, only four of the 12 are healthy. So by the human element we’re likely to possess or encounter unhealthy conflict styles.”
Guerra: Buddy, thanks for joining me.
Hickman: Anthony, it’s always a pleasure. Good to see you.
Guerra: All right, let’s start off. Tell me a little bit about your role and your organization, to which you are very new.
Hickman: Well, first let’s talk about First Health Advisory. First Health is a digital transformation advisory managed services firm that addresses security and privacy, technology and really leads on the whole digitally across the health industry. First Health does that through offering managed solutions, methods-based approaches, infrastructure modernization, all for the sake of assuring that its clients can securely and digitally transform. My role as chief strategy officer at First Health is to support our customers and our team in the development of digital health strategies, assuring better tech governance leadership and navigating through paths of an optimized portfolio to realization.
Guerra: Just about everybody knows you, Buddy. A lot of people know Carter (Groom, First Health Advisory CEO). But for the few who don’t, do you want to give us just a very brief review of your work, just some of your positions that you’ve held?
Hickman: Sure. Well, at this point – including a couple of interim CIO roles that I’ve held over the last year and, most recently, I’m still at Harris Health System in Houston, Texas – I’m now at about 24 years sitting as a CIO in the health industry, most of those years in academic health settings. I’ve also served dually as a chief analytics officer. I spent 12 years of my work life between PricewaterhouseCoopers and Ernst and Young, eventually becoming a partner with E&Y, initially working in Pittsburgh, and eventually in Philadelphia in those markets. And my origins began as a young engineer working in a Catholic Health System. I decided I wanted to work in healthcare, specifically in the healthcare provider sector, as things evolved there, and I got very, very involved in IT.
Guerra: Excellent. From a digital point of view, what are you seeing at a big picture level in terms of digital transformation going on out there? If you want to address that chief digital officer role. And what are you seeing that’s working? And what are you seeing that maybe isn’t working so well?
Hickman: Well, certainly the chief digital officer name brand has been around only in recent years, especially in healthcare. We wonder how it came to be in healthcare. I can tell you one story from maybe five, six years ago, I got invited to the CHIME board strategy meeting during the summer. I think Marc Probst was maybe the chair at the time, and one of the discussions was that of our feelings with the fact that we were talking CHIME CIO 3.0, should we also be playing a role and promulgating that chief digital officer title in healthcare? I don’t know if we helped to do it, or we went along with the fact that it’s happening. But certainly we are seeing the chief digital officer role as a role that’s actively being named across organizations, as you know.
As to what’s going well with it, “well” is a relative term. I’d say it plays out as many ways as there are leaders, personalities and organizational cultures. I can give you a few examples of how I see the chief digital officer evolving if you’d like me to do that and maybe from that we can stimulate the conversation. One situation that is probably the least disruptive but also the least often in happening is that the CIO asks for and is given the chief digital officer title. In those cases, the inclination may be that the chief digital officer title is what’s in. And there’s not an expectation that there’s a notably different role change. But there’s a respect for the chief tech person in that organization, and the boss maybe sees it as a reasonable way of giving the CIO what some of us call psyche income.
A second way it might take shape would be that the leadership of the organization wants or needs something different than what the CIO is bringing. Thus, a part of the re-articulation for the role of the CIO is to rebrand and rename the role to make that expectation palpable. The CIO might remain in a more traditional role in that organization, while a CDO is brought in to give, say, a more transformative agenda.
Oddly, though, I sit back and look after the many years I’ve been doing this, and I always think about the fact that the CIO has always been doing transformative things. It’s just that transformative things are branded differently these days. Now, a third situation is, perhaps the organization is truly on a path of digital transformation and wants that to be a directional thing, needs an individual with that named role, to specifically work at creating a shared organizational vision and direction by and with her, his or their colleagues. In that case, the role might be assumed by the CIO. It could be the CIO is rebranded as both a chief digital and information officer, I’ve got several friends out there who are holding both those titles. But I think the idea is there’s a clearly recognized expectation of something different again.
I believe in the best organizations we’re seeing an onset of all kinds of titles, Anthony, chief digital officer, chief data officer, chief technology officer, chief applications officer, the CMIO, the CNIO, and so on. I think it’s happening, really, in the best places, because there is increased scale, there’s increased sophistication. And as I said, the best health organizations, they also have the ability to grow and invest in technology and digital. And they’re putting more investment into people with roles that can make those things real. I’d also, regarding placement on the org chart, there should at least be a proximity in those roles. By that, I mean you’ve got people who are managing like competencies, and they understand each other. If they’re not reporting directly together, something else should tie them together.
Guerra: I’ve just been thinking as you’ve been talking that, we try and give some advice for our readers and listeners. So you can take a few different scenarios. If you were a CIO at a health system, you don’t ideally want them to create a chief digital officer title and give it to someone else, do you?
Hickman: Probably not. For most people I know, they would say no. That’s not what you want to happen.
Guerra: Let’s say you’re a CIO, and there is no CDO role at your organization. Would you want to proactively make sure you’re doing things in that area? Demonstrate you’re doing things –trying to head it off at the pass. So what would your advice be to that CIO who doesn’t want that to happen? What would they do?
Hickman: Well, my advice depends on the standing of the CIO in the C-suite already, right? Because that’s where that decision is going to be made. I can name chief digital officers around the country who are already, as CIOs, creating shared vision continuously as part of what they do. So it’s a natural offshoot for them to continue to dialogue, to say, is it possible to have that additional brand associated with what I’m doing? If indeed the C-suite has that process, especially the boss has that trust, that can happen.
I had the circumstance happen with me, from a chief analytics officer perspective, because I was working as a CIO. It didn’t happen because I asked for the title or by thinking it will be given to me initially, it happened because of working closely with the chief operating officer first. And then with other colleagues, we built out a significant data analytics capability that became very highly regarded, even to the point that it would be very unusual to sit through any significant leadership meeting, or even a board meeting, and not have someone go up to the podium, open up a visualization or some other application and use it to guide the discussion on a data-based basis.
So the way it happened with me is the CEO came into my office one day and was applauding the work that I had done in that area. And that led into a conversation around, would this additional title make sense? In addition to my information officer title. And the answer was, yes. And, you know, the rest of it comes with, as you say, Do I get a pay increase too? But, you know, it increased my circle of influence in the sense of the things that I was doing both there and also out in the industry.
So I think that’s where your question is going. It is a matter of portfolio, how much that CIO can really do with the portfolio. How much the work that has been done indicates or pre-sells the fact that there’s a title that should follow, not necessarily a title that comes first. But if I were a chief information officer who wanted that chief digital officer title, there’s no reason not to have that proactive conversation, the proactive conversation can only help and if the answer is not yet, then the question would be, well, then can we come up with some ways to agree as to what I need to do with expectations and delivery, whereby you would consider giving me that title?
Guerra: And I’ve talked to some CIOs who are doing the work and are indifferent about the title; they don’t seem to care. But again, I don’t think they want that position popping up and going to someone else. Right?
Hickman: Yes. You know, I would say, even echoing back to the same conversation I mentioned, with regards to Marc and CHIME. I remember sharing a comment that CFOs, CEOs, COOs – they’re not having a title crisis and their jobs have changed continuously over the years. Why is it that we’re rebranding? And to me, I really believe that the rebranding came with outside influence. There was that expectation of newer tech digital expectation expansion. But I think talent acquisition firms, new tech companies, and probably global markets, where titles can be greatly different, had influence on how we saw the change come about here in the US.
Guerra: So for the CIOs who have taken on the CDO title, they’re doing the work, and now they’ve got the title. Do you see any concerns if they been given the title and no other changes have come along with it?
Hickman: Well, so if we give the individual the chief digital officer title, there is some expectation that we create real clarity about what that means. Right? It’s not just the title. Some might say, “Well, now you’re expected to be the lightning rod for all things digital Health.” Okay, yes. But what does that mean if we really own the business inside the business units, whether clinical or business based. So clarity of expectation is important. I would say role clarity on the whole across the C-suite is key to defining what the chief digital officer’s role is beyond what you have the CIO doing.
Guerra: Role clarity. Let’s talk a little bit more about that. That can create serious problems and dysfunction. That has to be fixed at the top, right?
Hickman: It certainly needs an understanding at the top. It requires clarity with everyone sitting as colleagues in the C-suite as well, not just a top down, so I can take you down the path of governance. And let’s talk about that in a second. But, as for the role stuff. You know, if you believe that the chief digital officer has a role that’s all about creating clarity around the digital portfolio that does need to be cooperated with the rest of the tech portfolio, right? Everyone has a stake in that portfolio, whether it’s existing or future, regardless of the C-suite title. So when you say you want to do digital health differently and have it be a strategy, my view is governance and role clarity are probably the two most important things.
Role clarity, because we need the assurance of how we’re going to play together, where our boundaries are, who have the authorities to pull the trigger on whatever the matters are, and have those triggers being pulled on an informed basis.
Think about it, a digital health portfolio has to cooperate with 85 to 90%, or more, of your existing portfolio that you’ve already invested in, right? So you can’t just run off and not look at what you’re sitting on and assure that you’ve got all of the elements of integrations, like architectural circumstances, cybersecurity, and the other boxes checked. So having that cooperation is key; everyone in the C-suite may not have that understanding. And so yielding some of that authority to guide that discussion to a chief digital officer and chief informational officer – one or the other – is going to be key.
I mentioned governance because I’m seeing through several of my colleagues that – whether you call it digital front door, digital health or virtual health – many elements of the portfolio are popping up in a distributed way across the organization’s structure. If you don’t have a chief digital officer who has been commissioned to pull those elements together, they run with their own energy; rely upon the same common IT infrastructures, many times the same common IT sourcing, but there’s nothing keeping them in balance deciding where the priority is. And in fact, I had one colleague tell me, ‘We’ve got three different units working on the same thing, and they didn’t even know they’re doing that, given the number of overlaps,’ because it was an organization of scale.
I think that also comes from people with ambition, you know, and many of us have ambition. So we want to have our thing; that thing we’re working on, be the one that’s looked to as a symbol. Yet, at the same time, if you’re in a provider organization, typically you’re going to have diminished resources or managed resources in terms of how you’re able to fund. So it is absolutely necessary that we have some ways of assuring that the investments balance to all those appetites while you’re picking your direction.
Guerra: So maybe going at it another way, what would your advice be to a CIO who is being offered the chief digital officer role? What would they need to be successful besides the title?
Hickman: All right, so some of that is circumstantial to the internal organization, culture and the personalities within the various C titles, no doubt. So any advice, first of all, has to be thought of through that filter. And then my first piece of advice would be to that CIO, think about that first. Think about those people who do come along with you, that you have the best and cooperative relationships with and those that maybe you don’t and let that also then inform you as to how it is that you begin to lay out expectations for a dialogue with the boss about what that looks like. It could be that you ask the boss.
First off, we look at any PMO as part of the governance structure, the qualification process and how we say yes, which has a lot of elements to it, if those be items that the CDO, the chief digital officer, have a strong say in, sit in oversight with, if not also sometimes manage. Because some chief digital officers have equal responsibility, some don’t, it’s ok as long as the cooperation is there, and there’s a strong voice that can work. But without that voice, it’s difficult.
There would need to be the ask that if the organization does have digital health spawned across the org structure, that there be some amount of order, not in a way that causes you to lose your ability to be facile and agile, but enough so that you know, with clarity, that you are making the right decisions, you’re taking it through the right paces to assure those decisions are sound. So you would want to definitely have a large voice in how that governance process occurs.
Guerra: Let’s talk about biomed. Where do you think it fits best in a health system?
Hickman: Sure. Well, I’m fortunate to have had biomedical engineering as a part of my portfolio for a lot of years. And I guess I’m somewhat fortunate to be an engineer in that regard. Because I have some general understandings of it, because I’ve worked in healthcare, I truly get how it is so integral to the clinical organization. And integral in ways that moments of failure are not tolerable; you really have to be able to deliver.
My bias is likely that I’d want to see biomedical engineering be a part of a CIO or chief digital officer’s portfolio. And I further that bias by saying it’s because so much of digital health has to do with connecting more and more devices to an infrastructure, now that they’re all interconnected, right?
The problem will come in the form of cybersecurity breach, and/or the form of performance and unavailability, both of which bring significant concerns for the organization. So I would have a bias there. But honestly, I’ve also seen it report well sitting inside of the clinical organization, oftentimes still inside the facilities organization, whereby tradition, the fact that you had hard assets being managed by the facilities leader, they’ve had biomed, as well. The best facilities leaders do this; they really do understand it and get it. I’m in a circumstance right now where I’m working with someone like that. And there’s a true cooperation in the dialogue between the CIO, the CISO, and the VP that has the biomed areas. So again, it does come down to personalities and cultures in the end, as much as it does just the reporting relationship.
Guerra: Let’s talk a little about security and the CISO role. To whom do you think the CISO should report?
Hickman: So first of all, I just want to say that if cybersecurity is not being strongly considered in a push toward clinical health, the organization’s at risk. We understand how big the problem of cybersecurity is. High performing health organizations understand that cybersecurity requires attention from workforce members to board members. And the best digital health portfolios assure InfoSec by reviewing every digital initiative before it can get in the door, before it can be contracted for. So yes, that gate, I believe is a very solid and important gate.
Again, Anthony, I’ve seen reporting structures that vary greatly. I know CISOs who would like to report to the CEO. I smile about that, personally and professionally. Because if I were a CEO, that is not something I would want to get myself deeply involved in managing, for a lot of reasons, okay. There are some CISOs who report through, say, to the chief compliance officer. And, again, I’m working with one who does that right now. In those cases, it does create a separation for the CISO to have a different voice, a voice that’s Switzerland, in terms of being able to offer a position, and offer it without bias. That also can be done, practically speaking, by having that individual reporting to a solid chief digital officer or chief information officer.
In fact, for the last several years, in my last academic post, I had a collaboration with the chief compliance officer whereby the CISO, the chief compliance officer and I met on a routine basis with a prescribed agenda to assure the balance of what was occurring. And as the CCO said to me, I’ll paraphrase what he said: ‘There are certain compliance things I need to make sure that we’re doing. So I need the ability to understand that, see that transparently, and so on,’ he said, ‘But honestly, I don’t have the skill set to manage the tech side of that. I don’t understand the tech side of that. That’s where you come in, I think you can more strongly manage the delivery. And as long as we have that transparency with each other, in terms of how we sit with the CISO, I’d rather see the CISO reporting to the CIO.’
Guerra: Yes, it’s really interesting. You mentioned the word personalities a couple of times as we’re talking about reporting structures and things like that. So it makes me think that many structures can work. Right? It doesn’t have to be one way.
Hickman: Well, yes, in the C-suite, everyone needs to get along. In healthy organizations, I believe there is the idea that you co-exist, and you get along, yet you’re also able to have conflict. You understand that conflict comes naturally with the human element. And since we’re going to experience some we have to know what to do with it. There is a particular conflict assessment tool that for now, a couple of decades, I’ve shared it with my direct reports. That tool allows the individual to look at their own conflict style on a circumplex of 12 dimensions, 12 different conflict styles. If you think about 12 different conflict styles being tasked- or people-based, only four of the 12 are healthy. So by the human element we’re likely to possess or encounter unhealthy conflict styles. And the reason I teach that, and I do the same thing in bootcamp, is because we have to be able to see ourselves and then see the dynamic, you know, that’s the whole emotional cue thing that’s going on with the other party. And think about, truly think about what we want to do with it, feel what we want to do with it, and hopefully try to create something healthy with it, right? So that’s one way to think about the soft skills.
I once worked in an organization, early in my career, brand new CIO. Very green. And I remember sitting with the CEO of the organization, probably my first week in. I had a 10-minute audience with this health system CEO. He had two things he wanted to say to me about my role and what he wanted to see done. And the third thing was this: “I hire the brightest and best. And I do not believe in team. I believe in the law of survival. I hire the best I can, I put them on the chessboard, I expect you to compete, the best thing will emerge for the organization. We’re done now.” And that was the leadership principle of that CEO.
Guerra: Okay. That’s about all we have time for today, Buddy. I’m going to frame up a last question for you. We’ve got a lot of people we’re talking to here. We’re talking to CIOs, the chief digital officers, the chief information security officers. Can you offer them any advice?
Hickman: Well, you know, if I give advice to CIOs, CISOs CDOs – any of us that sit in a senior IT leadership role, my advice goes something like this: Continuously evaluate yourself, and your work life circumstances. Remember that you and your work life experience are like the seasons, you’re constantly changing. And whatever they are, good or bad, they’re going to change again; you have to change with it. That means you have to be in touch with yourself to do that. It also means you really have to be connected and in touch with everyone else around you. That means to me, and maybe to you, that you need to always work on maintaining your circle of influence, which gives you permission to use your voice and leadership.
I’d also say assure you’re doing everything you can do to avail yourself of people and tools that make you a better leader, a better leader in your C-suite, and a better person for all those that rely on you. And maybe, Anthony, all that sounds a little bit philosophical. In practical terms, I think it’s very relevant to digital health governance and portfolio management, and all those places and things on which we spend our lives every day.
Guerra: Listen, the work life balance is no joke. These jobs will eat you alive. Am I wrong? If you let them, they can.
Hickman: They can be challenging. I was texting with a CIO this morning and congratulating him on his one-year anniversary at a big place. And I said, “I can’t believe it’s been that long.” And he said, “Yeah, I can’t believe it either. And boy, this job’s hard.”
Guerra: Buddy, thank you so much. That was an incredible interview, incredible talk. I think it’s going to be very valuable to our readers and listeners. Thank you.
Hickman: Anthony, thank you. It’s always a pleasure seeing you. Look forward to seeing in San Antonio.
Guerra: You got it.