Technology is important, but the bottom line when it comes to success in any strategic IT endeavor really boils down to culture and leadership, two senior provider executives told their audience on August 17 at the Health IT Summit in Seattle, sponsored by the Institute for Health Technology Transformation (iHT2—a sister organization to Healthcare Informatics under the Vendome Group, LLC umbrella).
Suzanne Anderson, president of the Virginia Mason Health System (VMHS, Seattle), and Sajid Ahmed, chief information and innovation officer (CIIO) at the Martin Luther King Jr. Los Angeles Healthcare Corporation, both presented on topics related to leadership and innovation on Wednesday, at the Seattle Marriott Waterfront Hotel.
Anderson, who became the Virginia Mason Health System’s president on June 1, after serving as CIO and CFO of that academic medical center, spoke first, on the topic, “A Leadership Journey: Different Paths to Different Levels.”
“There are two different ways people get into senior leadership positions,” Anderson said. “One is that you take on a variety of positions and eventually are promoted. The other way is, in the IT world, you work your way up in a very technical way, through technical positions. I was CIO before president,” she said. “But am not technical. I started with a B.A. in English. So that tells you exactly how I ended up in IT, right?” she chuckled. “I got an MBA. Then I ended up in consulting. I knew that I wanted to continue to learn and move around. So I answered an ad in a paper, and joined a consulting firm. My mom was a nurse; that had been my only healthcare connection.” But, over the years, she said, she inevitably did learn a great deal about health IT, from the strategic, implementational, and process standpoints. And it was that broader understanding of systems of processes in hospital operations that led her to be a strong CIO and CFO before ascending to the president position, she emphasized; indeed, it was her strategic background and experience that led VMHS chairman and CEO Gary Kaplan, M.D. to bring her into the president role in the organization.
After asking for shows of hands from the audience of who was in technical IT positions and who wanted to ascend to organization-wide leadership positions, Anderson said that anyone who has a technical background in IT and wants to reach the CIO position or a similar position, needs to develop broader leadership and interpersonal skills, and above all must be able to convey what may be technical information, in very broadly understandable ways that can persuade diverse audiences within their organization.
In that context, Anderson offered ten pieces of career advice. Among them, she said, “Learn to hate the interview question, ‘What do you want to be doing in five years’! I hated this!” she exclaimed. Speaking of the early years of her career, she said, “II knew I wanted to do meaningful work, but didn’t have my career path prescribed for the next 20 years. Be more flexible. I think particularly in the IT world, where our technology is changing so rapidly, that as people change careers, and as you mentor people, flexibility is so important,” she said. “I never imagined that this is where I would be, 30 years ago. But I kind of like my circuitous route,” she added.
The key point, Anderson emphasized, is that it is the broader skills that will get an individual to the higher end of the professional ladder with a patient care organization, not the technical ones. In that regard, she said, “Understand how IT fits into whatever your organizational culture is. We spend 5 or 6 percent of our budget on IT, which is a lot. So, understanding how IT fits, but also how we can balance our IT needs with the other needs of the organization”—both of those are essential capabilities of anyone moving into senior IT leadership positions in patient care organizations she said.
Indeed, in that regard, Anderson said, “This one’s really important: what gets you to a middle management role in the IT world is not what gets you to senior management overall; it’s necessary but not sufficient.” In fact, she said, “I have conversations every day with leaders who are no longer middle management, but not quite senior management. And I say, you do a great technical job; a great job getting your teams aligned, and working out budgetary issues, etc. But what I really need for you to do in this case is to think about the organization as a whole, not your area; to think about how your words are perceived by your peers, because you have to work with others on this project; and for you to really understand those more general leadership competencies. Unfortunately in IT, we’re such a technical field that this isn’t necessarily what people have been educated on, or what you’ve worked on in your career, because you’ve been rewarded for layers of technical competence,” she said.
In the end, Anderson said, some of the traits most important to senior leadership in healthcare organizations have nothing to do with more technical competence and skills. Those skill sets related to potential success in executive leadership, she said, include “people and relationships; vision with an executable plan; balancing competing priorities; and, yes, keeping calm under pressure. One of the first things I really look for in people” who might be equipped to assume senior executive roles, she said, “is how good they are in people relationships, as well as not only how much strategy they have, but how they can execute on that strategy.”
Leadership and the building of an entirely new hospital
The subject of leadership came up in a different context in the closing keynote address on Wednesday, given by Sajid Ahmed, who shared with the iHT2 audience some of the complexity of the narrative of the creation of the new Martin Luther King, Jr. Community Hospital in Los Angeles, which opened in 2015. As its description on its website notes, “The hospital serves about 1.35 million residents from all over South Los Angeles including Compton, Inglewood, Watts, Willowbrook and Lynwood. It will also create more than 1,800 jobs in the area with approximately 900 directly at the hospital.”
As Ahmed shared with his audience, “The old hospital was a critical resource for an underserved community”—and in that context, he said, “it was such a big deal to have CMS [the Centers for Medicare & Medicaid Services] say, enough, this needs to close down,” he said. But the reality, he added, was that there were so many patient care quality problems at the old facility that “Police and fire refused to send their injured officers to the old hospital.”
So, when recruited, Ahmed told his audience, he threw himself into building an entirely new facility from the ground up; indeed, he noted, he was “employee number two”—the second executive hired to help plan and bring into existence the new MLK Community Hospital. In fact, he said, “People told me, don’t do it! It’ll kill your career. But we knew that we could do this as a new facility. We got the funding to help us do it, but our investors required us to open the hospital on time, which we did, a year ago.”
What’s more, Ahmed said, “New facilities are being built across California to meet the new seismic law requirements, but we’re unique” in creating an entirely new facility with new personnel and a revised sense of mission and purpose. And in that regard, Ahmed said, it was very important to get community input for how the new facility should be put together. So, he said, “We asked them what they needed. And it was very obvious: in the old hospital organization, care had been fragmented, and access to care had been very uneven. And from my perspective, I said, let’s see what we can do.” As a result, seven board members were identified by Los Angeles County, the state of California, and the University of California System. And those board members helped guide a process to rethink the hospital as the planning for the new facility was being created.
The new facility, Ahmed noted, is smaller in size, with a focus not only on inpatient care, but also outpatient and community-based care, and with a unique care delivery model, one that mandates that every inpatient receive case/care management beginning with their entering the hospital, and continuing through to their discharge.
Very importantly, Ahmed said, “We realized that launching the hospital and sustaining it, had to do with culture. Our biggest accomplishment will be the innovation on culture: how we work with people and with each other.”
What’s more, he said, committing to telehealth and coordinated care not only made sense for the patients at the new hospital; it also recognized the reality that hospital leaders had to thoughtfully rethink care delivery, especially given their payer mix, which is 85-percent MediCal (California’s Medicaid).
“We are in a public/private health partnership, which is unique,” Ahmed said. “And after the county gave us the money, they said, open this hospital, and then you’re on your own. We’ll contract with you for outpatient care, but you’re on your own. And we had and have unique opportunities to do telehealth. We went for it, and started using Skype to do our 5150s, with ED docs working up the patients and showing them on the screen, even though they were across the street from the inpatient hospital.”
Creating the IT infrastructure for the new hospital required collaborative planning, strategic thinking, and leadership, too, Ahmed said. “We went live with Cerner—55 modules simultaneously, and at the same time that we were hiring brand-new physicians and nurses.” In fact, he said, of the 1,000 employees hired so far, fully 300 were hired in a three-month time period prior to the new facility’s opening.
Both the IT go-live and the opening of the hospital were a big success, Ahmed said. “And now,” he said, we’re focusing on nurturing a culture of values and leadership, with collaboration and participation coming both from the bottom up and the top down.”
Was it difficult to prepare for the opening of the new hospital? Absolutely, Ahmed told his audience. “For six months, I held meetings from 6 AM until 2 in the morning. Everyone was on a different page at first. And what came out of all this was that if we didn’t do this together, we’re all going down together. And I put it out there,” he said; “I told people, you’re going to be at the top of the LA Times story.”
And the reality, Ahmed said, is that innovation can only emerge out of a specific kind of culture. “I’m a big fan of innovation,” he told his audience. “But I wanted to use that as a drive to create a culture of innovation. And part of it is not just creating new things and devices, but how to leverage processes, and improve things, especially culture.”
In the end, Ahmed said, “Trust and communication are the hardest things to do, the hardest things to build among people. Do everything you can to maintain them; that’s been part of our success. It’s not the technology’s ability to work, but the people’s ability to work the technology,” he emphasized. “Really,” he said, “it isn’t about the technology. I’m a technologist, I love technology; I launch technology initiatives. But if the doctors, nurses, and others, don’t like it, it’s not going to work.”
And, he added, “Here’s my advice. Let’s say that you’re in a meeting, or better yet, at a cocktail hour, and you’re not really paying attention to the conversation at the moment. And someone turns to you and says, ‘What did you think of that?’ when you weren’t actually listening to what the last person said. Here’s what I’d say: without having listened to what was said, you can just say, ‘It’s all about trust and communication.’ And they’ll say, ‘You’re right!’ Because it is.”
