One-on-One With Seattle Children's Hospital CIO Drex DeFord, Part III

June 24, 2011
Seattle Children’s Hospital serves as the pediatric referral center for Washington, Alaska, Montana and Idaho. The organization’s facilities include

Seattle Children’s Hospital serves as the pediatric referral center for Washington, Alaska, Montana and Idaho. The organization’s facilities include 250 inpatient beds, a Level IV Infant Intensive Care Unit, Surgical Unit, Pediatric Intensive Care Unit, Inpatient Psychiatric Unit, and Rehabilitation/Complex Care Unit. HCI Editor-in-Chief Anthony Guerra recently had a chance to chat with CIO Drex DeFord about his work at hospital and industry trends.

Part II

AG: Your career path came up through the IT side?

DD: Yes. My career path is pretty interesting. I enlisted in the Air Force and was a data center operator help desk guy. I went to school at night. My education was commissioned as a Medical Service Corps Officer, a hospital administrator, where I did everything from supply chain to CFO to human resources in smaller facilities. I eventually tied my IT background into my job in the Air Force, as a hospital administrator and became a CIO at the Air Force School; a WCIO at the Air Force School, healthcare sciences. Then the Air Force offered the opportunity for me to go back and get a Masters in Health Informatics. I had a Masters in Public Administration already, and I went and did that for two years and was a regional CIO in the Air Force Medical Service, and then finally was a Chief Technology Officer for Air Force Health Worldwide Operations.

And, in 20 years, I said, “Really, I’m not kidding this time, I’m getting out of the Air Force.” Military healthcare, Air Force healthcare, actually, is incredibly similar, almost identical to the issues that we face in civilian healthcare. So the transition from that job at the Pentagon to Scripps Health, as the corporate vice president and CIO there, was really pretty easy. Then the transition from there to here, obviously, has also been a very smooth transition. So I come from an IT background, but I have done healthcare administration over a lot of different areas; I have a pretty broad background as far as that goes.

AG: Assuming that most CIOs, like yourself, have come up through the IT side, one of the skills they would have to add is around budgeting and finance. Do you think, one, that budgeting is something CIOs have had to learn along the way, and is there any advice you can give your colleagues who may not feel they’re as strong in this area as they should be?

DD: It would be more difficult for me to believe that someone could get to the position of CIO without some skill and background in budgeting. So I guess I would start there. But if I were a manager in IS, or a director in IS and I was aspiring to be a CIO somewhere down the road, I would take the, “I don’t know everything about everything, I need to learn as much as I can” approach to life and my career. That is, if I know that I’m weak in numbers, I have to school myself in that, and that may mean I have to spend a little extra time and take somebody from the finance department out for dinner, and have them explain some things to me, and do some one-on-one education on the side, or find a mentor in that area that can help.

In many of my past positions, I realized that there was no way I could have universal knowledge, so the best thing I could do was figure out my weaknesses, try to make myself as strong as I could in those areas, but then also hire teammates that can cover those areas that were strong there, but maybe weak in what I can do well. I’m always telling the team, all of us are smarter than any one of us, and that’s really how I think a good team has to be built. You’ve got to figure out how to cover yourself, and that’s why I’ve always had a financial analyst on the staff, because while I’m okay with numbers and budgets, I’m not great. I can explain where I want to go, I know what I want to do, I know how to negotiate contracts. Maybe I’m better than I think, but I’m always skeptical about how much I know and, if I can get help, I get help, I ask for it.

AG: In good times, people can probably get by with basic knowledge, but in lean times, when your budget’s really going under the microscope, it helps, it’s important to be savvy on understanding those numbers and how those spreadsheets lay out. Is that correct?

DD: Yes. I agree with you completely and, again, I think if you did a really good job in building a budget in the first place, and you had to defend it in the original process, and you had to aggressively defend it in the original budgeting process, then it becomes much easier to defend in lean times.

AG: Let’s talk about the role of consultants. A lot of hospital IT shops are fairly lean and don’t have the core skills needed to roll out enterprise-wide clinical applications. Our guess over here is that the consultant money is one of the first areas to get cut in a downturn like we’re seeing now. We think that could result in more implementation failures. Does that make sense?

DD: I think you make a really good point there, depending on the size of the hospital and the expertise that a particular IS department has. Again, I think if you need to ask for help, you need to ask for help, and that may be in the form of consultants. I’m not a big over spender when it comes to consultants, at least I don’t think I am. I use them when I need them and, when I see that I chronically need a consultant in an area, that’s when I think everyone has to look at that and say, “I think maybe we really just need that skill in house,” and you work on that.

It does worry me a little bit that if it came to the big system implementations, one of the lines to be cut back is spending around how to roll out that application, especially if it’s a facility that’s never had that application in place before. I think it makes logical sense to me that if you do that you begin to raise the odds you’re not going to be as successful as you would have been, if you would have had the right expertise on hand.

But every situation is different and there are many places where you can say, “Cut the consultants, we’ve got the expertise in house,” but you need help because of a surge in that area, so you cut it back and you run that piece of the business a little bit slower than you would have otherwise. But I understand what you’re saying and, yes, that definitely immediately comes to mind. I’d hate for us to get more black eyes because we decided to spend less on the services that we need to implement something.

AG: So you might find organizations shooting themselves in the foot just to try and save a few dollars on a multi-million dollar suite of software.

DD: Well, if you think about it in another way, you may very well be creating a situation where you save money in the short term, but in the long term, the implementation is poor, or you lose goodwill because of the bad implementation, and the system winds up costing way more than it would have if you had just put the effort in upfront. I like to put a lot of time into planning so that my implementation goes smoothly. I don’t like to make my implementation into the planning process. It costs a lot more that way, so put the money in upfront.

AG: And certainly this is one of those examples of a situation where you only get one shot. If you rollout something in an inefficient way, you lose the buy in and good will of some of your premier clinicians and you may not get another shot.

DD: Yes, I think you’re right. That loss of goodwill and willingness to participate and be involved is a big part of making something successful. Your customers have to be involved, they’ve got to be tied in and, if they can’t get the help they need to be successful, then you’re going to have a hard time trying again later.