Expanding Universes

For many senior executives, the title of chief information officer emerged in the late 1980s and early 1990s as their historical role as IT managers was becoming more executive and strategic and less technical. Now, the current shift into an even broader and more executive-level role is feeling like nearly as great a leap as the earlier one had been.

In addition to all the traditional IT areas already reporting to them, industry-leading CIOs have been adding numerous other areas to their portfolios. Consider the following:

At Northwestern Memorial Hospital in Chicago, Tim Zoph transitioned last year from the title of vice president and CIO to senior vice president, administration, and CIO, to reflect the vice president-level management of design and construction addition to his portfolio.

At the two-hospital Heartland Health in St. Joseph, Mo., CIO Helen Thompson now oversees biomed, as well as the health system's innovative new regional information exchange entity.

At the eight-hospital Carilion Clinic, based in Roanoke, Va., senior vice president and CIO Daniel Barchi has acquired biomedical engineering (called clinical engineering at Carilion), as well as a brand-new team of EMR implementers who report to him but are members of a corps and are separate from day-to-day IT operations.

At the four-hospital Methodist Health System based in Dallas, senior vice president and CIO Pamela McNutt has had both biomed and telecom come under her in the past four years.

And at Yuma (Ariz.) Regional Medical Center, Gene Shaw, R.N.'s title changed to vice president of value transformation and CIO to better reflect the fact that the areas of quality, process redesign, performance improvement, peer review, and patient safety came under his aegis. Shaw's clinical background made the augmentation a natural, as the 333-bed community hospital shifted into a higher gear on performance improvement.

And while each of these seven CIOs has a unique personal background, and each hospital organization has a different history and operational profile, the fact that these seven - and many more nationwide - are seeing their management portfolios grow significantly is no coincidence. Rather, say industry observers, the expansion of CIO governance has its roots in several factors which have all reached a confluence. These include:

• The rapid acceleration in the advancement of information technology of all types - especially clinical - in hospital organizations, to the point where IT is a part of nearly every process, and is merging with previously discrete operational areas. In fact, IT touches areas such as HIM/medical records, biomedical engineering (as virtually every medical device is to some extent computerized), and facilities planning (as IT device and infrastructure considerations now pervade construction and renovation planning).

• What's more, industry observers and CIOs note, the demands being made of healthcare delivery on the part of public and private purchasers and payers - for documented care quality and patient safety, accountability and transparency, cost-effectiveness and care management innovation - all require intensive data collection, reporting, and analysis to support their success. Thus, CIOs are increasingly being drawn directly into performance improvement, patient safety and care quality improvement, and other areas once exclusive to clinicians and other quality professionals.

• In addition, members of the current generation of CIOs have proven themselves highly capable as healthcare executives in general, demonstrating their leadership across broad capital-intensive initiatives. As this generation has accumulated executive experience, their leadership, strategic planning capabilities, and management skills have become more widely recognized by the C-suites and boards at hospital organizations nationwide.

As a result, more areas are coming under the CIO - most commonly HIM/medical records, biomedical engineering, and facilities management, as well as a broad range of other areas, depending on the individual experiences of the CIOs involved and the diverse needs of their hospital organizations.

Secrets to day-to-day success

And in the process, CIOs with expanding portfolios are finding that it takes a complex combination of skills, abilities, and management conditions to make it all work. Just ask Baylor's Muntz, who now supervises more than 600 people. Among the critical success factors, Muntz says, are excellent strategic planning skills and execution, project management, well-executed staffing, and mental flexibility. “The challenge of dealing with all the elements of the job at once includes handling the strange combination of minutiae involved, such as, ‘I've got a broken PC,’ and the big-big-picture issues, like being able to answer the question of where healthcare reform is going. And it requires an ability to deal with very technical people and represent their interests to the board level; and then to reverse that and be able to explain to very technical people the broad, strategic issues involved,” he adds.

At the foundation of all this, Muntz emphasizes, is achieving consensus at the outset in terms of the broad principles that everyone in the organization, and on one's multi-faceted team, are working toward. In that regard, he says, “When I came to Baylor, one of the first things I did was not so much to make changes in how the group was organized, but instead to develop a set of principles, and put those principles down on paper, in order to figure out how we would govern, so that we could do what customers wanted and what management expected.”

What's more, he notes, he and his team continue to make almost-daily use of that eight-page document. “In fact,” Muntz says, “when we say we're ‘on the same page’ here, we mean it literally. We literally will reference specific passages in our statement of principles,” he says, in order to make sure that what everyone is doing really is supporting the principles of the organization. For Muntz, having such reference points are essential for any CIO who governs a complex, multi-partite organization.

What are the critical success factors?

CIOs managing multi-partite portfolios, and industry experts, agree that there are a number of critical success factors involved. Among them are the following:

• An overall concept of the strategic goals of the hospital organization, and of the IT organization, along with clear operating principles, in the mind of the CIO, and shared via consensus, with the CIO's direct reports, for how things should be run, and what should be done.

• A top-notch cadre of direct reports for all areas working under the CIO.

• The ability on the part of the CIO to step back and allow those crack direct reports to “let go” of the details of day-to-day management, in favor of concentration on broader strategic, planning, governance, and executive and board interaction responsibilities.

• A good grasp of the basics of the areas coming under the CIO, though a detailed technical 'knowledge of each area is not necessary (though it can be helpful at times).

• Strong support from the other members of the c-suite, and the board.

• Excellent communications on the part of the CIO, and really, everyone else, around organizational changes, will be absolutely necessary.

• What some CIOs call “mutual education” between and among the different groups working under the CIO, must take place and be strengthened.

• Cultural change is inevitable, and must be anticipated.

• Overall, an excellent organizational culture is strongly required for success.

Northwestern Memorial's Zoph has not only achieved a high profile within his own organization, a leading academic medical center in the hyper-competitive Chicago healthcare market, but has also become well-known nationally in CIO circles, partly through his involvement as a leader in the CHIME CIO Boot Camps (sponsored by the Ann Arbor, Mich.-based College of Healthcare Information Management Executives). For him, setting parameters around one's own day-to-day level of involvement in management decisions is critical as well. “It's really important to gather around yourself a talented team of people who can manage the operations of the organization in the way you used to; and then you have to let go,” Zoph urges. “That's the toughest part for many people, to let go of what they used to do.”

What kinds of CIOs will receive opportunities?

While many CIOs agree on the need to surround themselves with good people and to empower those people to handle the day-to-day operational issues as the CIO position becomes more strategic and global, how that expansion is happening depends on a variety of variables. Not surprisingly, every hospital organization's individual history, and every CIO's different background, plays into the equation.

And in most cases, the growth of the CIO portfolio has been a very natural and organic one. For example, Orlando Health's Schooler says, “My fellow execs knew my background. In fact, before I had come into health care in 1991, I had managed areas outside as well as within IT. And then some key people left, and we did some realignment, and it just made sense to put those areas under me.”

Most of the rearranging, he reports, occurred about four years ago. And, to be clear, Schooler says, “I still spend about 70 percent of my job on IT and informatics areas.” Schooler has quite a large group reporting to him - 571 people in all, encompassing information services and clinical informatics, materials management, distribution and group purchasing, and biomedical engineering.

As to what kinds of CIOs will see these opportunities fall into place, Schooler says, “Clearly, you have to be a credible, proven executive. People have to know and understand that you know the business. Secondly, you've got to demonstrate the business acumen for the areas under you. Do you ‘get’ biomedical engineering, or telecom, which in our case is under biomed. And do you ‘get’ medical records, if that's under you, and so on. So you've got to be credible to other executives.”

Another critical success factor, says Linda Hodges, vice president and IT practice leader at the Oak Brook, Ill.-based Witt Kieffer, is that, “If CIOs come to have supervision over all these different areas, they have to have a very strong office of the CIO for good day-to-day management.” That being said, Hodges, and her colleague Arlene Anschel, a consultant in the firm's IT practice, are seeing more and more expansion taking place as a natural evolution in the CIO role. Among the areas that Hodges and Anschel see most commonly being gathered these days under the CIO are biomed, HIM/medical records, and business intelligence/data reporting, in addition to the telecom area, which has been under IT in some hospital organizations for decades.

Cultural challenges come with the territory

Bringing non-IT areas under the CIO isn't an automatic managerial “slam-dunk,” either. Just ask Helen Thompson of Heartland Health. Thompson has spent several years massaging the cultures of biomed and IT together in order to make the “marriage” work. In fact, she says, “I think this was one of the most difficult cultural changes, that I've had to lead. The training and the education of a biomedical person is totally different from what my information technologists are trained in. And bringing those two skill sets and cultures together has been a real challenge. The biomed folks are typically hourly employees, and your IT folks are typically salaried. They just have a very different way of thinking about the work they do.” Demographically, too, Thompson found, the two groups were quite distinct, at least at her hospital organization. Most of her biomed people had originally come out of military backgrounds, while her IT professionals were the typical laid-back techie types who thrive in informal, collaborative cultures. But the logic of bringing biomed and IT together was obvious to Thompson and her colleagues at Heartland, just as it is becoming so in hospital organizations nationwide. So, Thompson says, “I've spent four years trying to help them work together and to meld culturally, and after four years, I think I've finally nailed it.”

Lesson learned? “I would say to my peers,” Thompson reflects, “don't underestimate the culture change that has to occur” as diverse (and often very different) groups of professionals are brought together under the CIO's aegis. “Remember,” she says, “culture eats strategy.”

Kopetsky of Lucile Packard Children's Hospital at Stanford emphasizes another aspect of the changing world of today's CIOs. “We're now interacting much more directly these days with the clinicians, and you've got to understand the processes around delivering care. That's a big issue.” In addition, “understanding the legal and policy aspects of privacy and confidentiality” will be vital, he says. In other words, CIOs, regardless of the specific areas being brought under them, are having to think more and more like all the other members of the C-suite - senior executives with a broad grasp of the core operations (clinical care) of their hospital organizations.

Takeaways

• More CIOs are seeing broad new areas being brought under their supervision, from biomedical engineering to HIM/medical records to facilities planning, among other areas.

• For CIOs, having a strong, consensus-created strategic vision and set of operating principles, is very important. Making sure everyone in the organization is on the same page about direction and priorities, at a broad level, is crucial to success.

• These shifts are changing how CIOs spend their time: inevitably, the focus becomes more strategic and less day-to-day-operational. The CIO's profile with regard to the C-suite, board of directors, and even community, is virtually always elevated over time.

• To a large extent, broad changes in the operational landscape of healthcare are helping to dictate these changes to CIOs' portfolios. CIOs need to plan carefully and execute beautifully in order to make a success of their broadened scope of responsibility.

Such considerations become paramount when, as in the case of Daniel Barchi's hospital system, a CIO's organization shifts its strategic and even identity focus, compelling the CIO to think as broadly and strategically as possible about IT in that organization. In the case of his eight-hospital, integrated health system, the organization changed its entire focus a few years ago. “We transformed ourselves from Carilion Health System to Carilion Clinic, in the model of the Mayo and Cleveland Clinics,” Barchi notes. “Everything is driven by patient needs and driven by physician decision-making now,” he reports. “And as CIO, I'm very much of the mindset that I'm not an IT guy. I'm responsible for making sure that IT meets the needs of our clinic,” which, he says, is a very different way of looking at things.

And, as organizations shift strategic focus over time, and as more areas are brought under the CIO, Methodist's McNutt says, “There's also a big element of mutual education” that becomes increasingly important for everyone working under the CIO. For example, she says, “We can bring resources and knowledge to the biomed people - and training on networking and transport mechanisms, and HL7 data exchange standards. This is what we can bring to the table together.”

Inevitably, these changes also mean strong shifts in how CIOs spend their time. Says Heartland Health's Thompson, “Four years ago, I spent about 50 percent of my time on the operations of the organization, and 50 percent on strategy. Today, I spend about 20 percent of my time on operations and 80 percent on strategy, and figuring out what the next thing is. So it is a different kind of world that we live in.”

In the end, though, the logic of some of this change is inevitable - and welcome, for CIOs with the right skill sets, temperaments, and preparation. “I really believe the disciplines and strategies are applicable across areas,” says Northwestern Memorial's Zoph. “And IT has a lot of visibility around change. It has to have disciplined execution, and those skills are transferable.”

In other words, let the mapmaking begin.

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Healthcare Informatics 2010 April;27(4):12-17