Most agree that behind every successful CIO stands a supportive CEO, one who sees IT not as a cost center, but a strategic enabler. James Mongan, M.D., president and CEO of Partners HealthCare (founded in 1994 by Brigham and Women's Hospital and Massachusetts General Hospital) seems to personify this concept. Mongan was recently one of the individuals presented with a “CEO IT Achievement Award” by Modern Healthcare and HIMSS. Recently, HCI Editor-in-Chief Anthony Guerra talked with Mongan about his approach to information technology.
AG: Why do you think you won the award? What is it about your style, your approach towards technology that you think got you recognized?
JM: Modestly, I would say I really think it’s probably a tribute to the work of the organization rather than a tribute to me personally. I think that Partners has been noted both because of John Glaser and his team’s great work on the IT side, and the fact that we’ve got some very involved and interested clinicians. I think we’ve been viewed as an organization that has had a leadership role in this area and I certainly try to encourage and facilitate that.
AG: You just used the words “encouraged” and “facilitate.” Can you expand on that? Obviously you’ve created a climate where these people that you mentioned can flourish, and they at least have the leeway and the budgets to do what they want to do. So tell me more about that climate you’ve created.
JM: Well I would say that there’s probably two insights, if you will, that our leadership team (and it has been a team effort) has had over recent years. I’ve been here about five years now, and I think Partners is about 13 years old, and I think we’ve been struggling during that period of time with really trying to get a clear vision of what a healthcare system is, as opposed to individual hospitals. Now I think that the first insight we had as a leadership team was that, in a way, the major physiological element of a healthcare system is its IT linkages and its common electronic records. I have told people it’s the same thing as how 50 years ago, what defined a medical group practice was that doctors had their office in the same building. Now I think what defines a healthcare system is that we’re all linked on the electronic medical record. I would say that that insight led indirectly to saying, ‘Well, the way we will develop and build ourselves as a healthcare system is to build out this robust electronic record that links all of our practitioners and components.’
And then I would say the second insight that went parallel to that was that it was never just about IT; it was about having clinicians and practitioners use the information technology to advance clinical medicine. So we spent a lot of time shaping what we called our high-performance medicine initiatives, which were five or six ways that we directly tried to demonstrate the linkage of the electronic records and clinical care. For example, one of those ways was to demonstrate how we could monitor quality better across the system by having the electronic records and the ability to draw the data. So we did a lot of quality tracking that we’d not been able to do before. We were able to move disease management forward by being able to identify our most chronically ill patients and plug them into the programs. We were able to work on cost and efficiency issues by trying to devise algorithms and prompts that would move people towards generic drugs or more efficient imaging procedures. And then looking towards the future, we were also saying, ‘How can we link this electronic record to the developments in genomics that are going on in our research centers to begin to really move us towards personalized medicine where the electronic record would have the genomic data encompassed also.’
The fact is that IT is the definitional element of the healthcare system and, secondly, that it’s not IT for IT’s sake, but to demonstrate to everybody in our system how we can and should harness that to change clinical medicine.
AG: Do you think some organizations that are putting together health systems through acquisitions fail to understand just how much it takes to integrate different hospitals?
JM: I would say that it’s difficult. And I’ve also looked at this issue, not just from my viewpoint here at Partners, but I’m chairing this commission Commonwealth Foundation has on high performance medical systems. We’re trying to look around the country at how various organizations are dealing with these issues, and I’d say that there’s two problems. In general, the first is that these systems are very costly and consequently very difficult for smaller hospitals or independent practice groups to do. To do this well, you almost have to be aggregated into larger groups.
I would say the second issue is as you try to aggregate into larger groups, you’re often pulling together a couple of different legacy systems and that leads to a bunch of difficulties and decisions about what do you pull out of the old systems or which ones do you pull out? How do you integrate them and those sorts of things that are not easy undertakings?
AG: I’d like to talk a little bit about the CEO/CIO relationship and some best practices that you’ve identified in that relationship. Tell me a little bit about the dynamic you have with John Glaser, your CIO. Is it often that you’re talking about direction and then tells you what is or is not possible based on the technology side?
JM: I would say that’s often a clear characterization. John clearly is somebody who’s been an outstanding leader in the field for some time, so I would say that his status within this organization is — I don’t quite know how to say this but — probably somewhat higher than the typical CIO. I mean, he’s built up through the years respect not only from the other administrative leaders but the various clinical chiefs of these large teaching hospitals. So John is somebody who comes with a fair amount of, as I say, “throw weight” into any conversation. My main contribution when I came was to support putting even more money behind the dissemination of the electronic records and trying to really spur John and the team to move forward with it, and if anything to move forward with it faster than had originally been planned. In that part of the relationship, I would say that I was clearly supporting the direction that he wanted to go in initially and, if anything, encouraging him to go even quicker and providing the funding to do that.
I would say the second, and the most important, aspect to that relationship is that it’s not just having the IT, it’s getting the docs to use the idea, actually, use the electronic record, and to use the algorithms and to use the disease management programs that we built. So we spent a lot of time talking about how you translate the capabilities of the record and how you modify the capabilities of the record so that they do adhere to the clinical capabilities that you want to put in place and make real.
AG: I’ve had CIOs tell me about two general types of CEO. One would be the CEO that you appear to be, which is one who values IT as creating patient safety. And the other views IT as a cost center. As a CEO, is it important to have a real balance?
JM: I think that’s a fair characterization. I think there are a lot of people who do fall into that latter category and, in fairness to them, a lot of times it’s because, A) we have the advantage of having a reasonable base of resources here at our institutions. We’re not the wealthiest in the nation, but we’re certainly well beyond the kind of situation many other hospitals in the country are in, like the public hospital I ran for years. We do have the resources here, but there are a lot of CEOs that are really pinched for capital, and they’ve got a lot of other demands for radiology equipment and new space and that sort of thing.
So I think there is a focus and concern on the economic impact, and I think there is also some skepticism out there, which is understandable and in many instances appropriate, about the real value of these clinical applications. I’ll tell you the reason that I’m understanding of that is because it really takes both electronic records plus the ability to shape the culture of clinicians. Now we’re in a reasonably better position to do that because we’ve got these physicians who have strong loyalties to the system, so they’re willing to work with this team and adopt EMRs. That’s a lot tougher in the community hospital where you’ve got scattered community practitioners who don’t necessarily feel that kind of link or loyalty to your culture and to adapting to the guidelines and algorithms that you’ve got in your electronic records.
AG: Let’s say John left the organization. What would you look for in a new CIO? What are the most important qualities?
JM: Well I would start with the generic qualities that I’d be looking for, whether a CIO or a CFO or a chief nurse. I mean, those generic qualities in my mind have always started with judgment, and it’s one of the hardest one’s to get out of a resume, but you want somebody who’s judgment you can be fairly confident of. I don’t mean to sound defensive, but somebody you can be reasonably sure is not going to make major mistakes or anything. So I usually start with judgment and intelligence, experience. I’m more likely to look upon somebody who’s done a similar thing in a smaller organization or something of that sort. So I would say judgment, intelligence and experience.
And then, two, other generic things are the ability to work with other folks, people skills, and then communication skills because these are large organizations where you have to be able to speak and write to get your message across to others. In terms of things more specific to the CIO’s world, again you’d want somebody who is fully versed in the field and the technical knowledge. Now, my finance officer by definition knows more about finances than I do, and the nursing officer knows more about nursing, but even to a greater extent I’d say the potential language gap or knowledge gap between the CEO and the CIO can be larger, so you want a confidence that they understand the technical aspects of the field. And then the second one is the ability to relate to and work with these clinicians and understand that the record is not just about the records itself but it’s about allowing better medical care. So I think somebody who’s very open to dialogue and consultation is another important thing that I would look for.
AG: What about budgeting and forecasting abilities? Seeing as CIOs can have responsibility for huge budgets, how important is that skill?
JM: It very much is important. I guess in a way I encompassed it within experience, but I think clearly to identify those specific things is entirely appropriate. I mean they are large parts of an institution to splice, so somebody who’s familiar with and experienced with budgeting, and then with managing to a budget, is something you would be looking for.
AG: And talk to me a little bit about the reporting structure you have there. Oftentimes we see CIOs reporting to the CEO, but then there’s quite a few that report to the CFO. Tell me about what you do there and what you think would be a best practice to make the CIO effective.
JM: Well, again, I think each organization is a little bit unique. The role, I think, has grown in recent years. What we do here, technically, is John reports to the Chief Operating Officer Tom Glynn and myself, but the way Tom and I have worked it, I meet with the top six or seven people on a weekly or every-other-week basis. Tom then also meets with them and is free to join my meeting when he wishes, so it’s kind of dual reporting in a sense.
AG: Does the org chart matter much or is it more about access?
JM: Well, it matters to some extent because organizational charts have some meaning or they wouldn’t exist. On the other hand, I think obviously the personalities and relationships and track records becomes as important, if not more important, than the organizational chart over time. You’re always looking at people who can produce and making sure that they have the opportunities that they need.
AG: Can you tell me your thoughts on board involvement in IT spend?
JM: I think it’s important that our board committee has been very helpful working both with myself and John. They’ve not gotten into micromanagement in particular purchases or expenditures, but they’ve been very helpful in looking at overall priorities like how much of our investment is going to go to administer the system or clinical systems, and what order we are going to do. So I would think in those kinds of strategic and theoretical bases, I think they’ve been extraordinarily important to us.
AG: How would you define being an effective leader?
JM: I think that to be a good leader you have to have the vision thing that the first George Bush used to refer to, “If you don’t know where you are trying to take the organization, you’re not going to be very successful in the end.” I think you have to have the ability to communicate that vision. I’ve often said that if the leader is too far in front of their troops, he will lose them, and if he’s too close to them, he’s not really leading. You’ve got to be far enough ahead but not too far ahead, and then you’ve got to be communicating enough that you can keep the connection with the team. Then I think the appropriate attention to details and being able to obviously not micromanage every issue is key. But you also need to scan the environment for when something comes up that needs some extra attention and being willing to roll up your sleeves and get into it. I think it’s also an important feature.
AG: What do you enjoy most about your job?
JM: I mostly enjoy the variety of fascinating issues and really spectacular people I get to work with. I mean, any day can encompass anything from political issues down in Washington, to something going on in genetics research, to working with John on IT, to building a new facility. I think that the range of issues and the caliber of people I’m privileged to deal with are the things that I get the most satisfaction out of.
AG: Any overall advice you can give to our CIO readers that will help them be effective?
JM: I guess the main advice would be that they should recognize how critically important their field is going to be to healthcare over the next decade or two. But balance that with a recognition that resources are going to be, I think, increasingly constrained over the next few decades. Therefore, the ability to make wise investment decisions and operate efficiently is going to be very important as we go forward.
