Dirk Stanley, M.D., M.P.H., has been chief medical informatics officer at the 140-bed Cooley Dickinson Hospital in Northampton, Mass., for over five years. In some ways, Stanley, whose clinical background is as a hospitalist and a nocturnist, is typical of an emerging generation of younger hospital CMIOs, physicians who combine strong backgrounds in both informatics and medicine. He recently spoke with HCI Editor-in-Chief Mark Hagland about his on-the-job evolution over the past several years, and the implications of his learnings for his fellow CMIOs and for those who work with CMIOs. His comments here can be compared to those of CMIOs interviewed for the April cover story of Healthcare Informatics, which is about to be published. Below are excerpts from Stanley’s interview with Mark Hagland.
How long have you been in your job?
Five years now.
The CMIO role, with leadership, is now more than ever about people, right?
Yes, and I’m doing more and more operations work than ever. I think a lot of CMIOs start off with projects like, “Does this iPad feel right?” and that sort of thing. But since then I was hired, my role has increasingly become helping leadership to understand what kinds of operational adaptions need to be made to support our EMR. I often explain, an EMR sets off a wave of accountability that will impact your entire organization, whether you directly use the EMR or not. So it’s not just the doctors and what tablets they use; it means helping people actually understand what their role in the organization is, and how their function impacts the use of the technology. And so it becomes a really big role.
As a result of this expanding role, I think a lot of CMIOs have somewhat awkward reporting structure. Personally, I report to our CMO, but don’t have anyone reporting to me, so I’m essentially an internal consultant. This is why, to be effective, I coach a lot of people in our organization on technology - From the president of our medical staff, to the chairs of our committees, to our CMO, our CNO, etc.
Some organizations, of course, do hire external consultants for the same purpose – But I think my advantage is working inside the system. An external consultant might take a year to figure out where the implementation issues are. Because I still work as a physician, I’m able to spot them much faster and know how to respond.
What is your relationship with your CIO?
Really good. Recently, my hospital partnered with Mass General [Massachusetts General Hospital, Boston], so we are gearing up for changes that will bring. Like many smaller community hospitals, we looked to partner with a larger organization to develop better economies of scale. Our CIO is currently in transition, but in the meantime, we have a Director of IT who’s essentially filling the role right now.
What have been your key learnings about your interactions with all those people in your organization?
I blogged about this recently at dirkstanley.com. What I’ve learned in the last five years is that if you’ve made a really good brick, you don’t really have to worry about the engineering of the house. I feel like when I started, I was worried about the engineering of the house. But if the little processes are the best they can be, then the big problems go away. So now I’m doing a lot of process improvement.
My career path has made me uniquely adapted to the role. I started working in IT in high school at age 15, doing UNIX administration. My undergraduate degree is in business management, and after college, I thought I would end up working back in IT - But I ended up doing database design and statistics for the Westchester Medical Center, and ended up in healthcare. Eventually my curiosity brought me to medical school. But now, my statistics and business management backgrounds help me a lot with the process improvement work I’ve been involved in. So this is why I now believe in making really good bricks. (smile)
What would you say to those CMIOs who come to the role with strong medical backgrounds but not the other skill sets that you’ve brought to your position, particularly the IT, statistics, and business management backgrounds?
I would say that there is a lot more to the job than first appears evident. It’s important to open your mind to how the information flows in your entire organization, both the clinical and administrative sides. The two are tied together at different points, so you can’t understand one without understanding the other. So it’s really important to understand organizational structure in healthcare, which is really unique.
I think that getting to a granular level with those types of issues is very hard for a lot of clinical people, because they’ve never had to pay attention to process so closely before.
Yes, exactly. It’s all about design and processes. I’ve come to the conclusion that a good deal of the cost of healthcare comes just out of process issues. It’s so important to understand process improvement. As I like to remind people, Starbucks isn’t successful just because they make a good cup of coffee; they have the best consumer research, the best branding, the best hiring practices; and to manage all that, you need the best policies, the best leadership, the best merchandising. And that part of running a practice is daunting for a lot of doctors, who are usually focused on only giving the best care.
So that’s why I explain the Starbucks analogy – People get it. Everyone wants to give great care. Nobody wants to turn out a bad product. But there’s a lot more that goes into making Starbuck’s successful than just making great coffee. The same applies to healthcare – You can’t just focus on giving the best care – You have to focus on everything.
So actually enjoying being a process engineer will be a key success factor for CMIOs going forward?
I think so. After five years of doing this, my eye is good enough that I can see that metaphorical crack in the sidewalk in front of the hospital and how it relates to the cost of care. You start to notice little things that not everyone notices. I have family in Europe, where there’s a philosophy that if you have one broken window in your neighborhood, you have to fix it – If you don’t, eventually people will stop caring, and slowly the entire neighborhood will fall apart. So a lot of my work is putting systems into place to fix those metaphoric windows. And I try to explain why doing things in an organized way will lead to organized process improvement.
I’m not sure if I can really credit it with any of my success in this field, but I noticed something curious. I grew up in a binational, multicultural, bilingual household – American and German. My mother is a German immigrant, and my father was a military interpreter before he became a high school language teacher. So growing up in my house, we had a lot of dinner conversations about the relationship between language and culture. So curiously, I’ve noticed that some of the strongest CMIOs I’ve met are also people who grew up in different cultures. I’m not sure if there is a strong correlation with bilingualism, but I feel like I do a lot of interpreting in my job – Between the IT and clinical worlds. It seems that a lot of CMIOs are familiar with the perils and challenges of crossing cultures.
Certainly, effective CMIOs are effective interpreters between clinicians and IT, clinicians and management, and so on.
Yes. And I feel just like I do when I go to Europe to visit family, and have to translate for my wife who is American. You have to be very careful about language and words when crossing cultures. The only difference is that in my CMIO role, everyone is technically speaking English, so it’s not as immediately obvious that we are, in fact, crossing cultures when having Health IT discussions. Because we lack a cognitive and linguistic framework to conduct these discussions, a good CMIO can help serve as an interpreter and cultural guide.
And it’s also cultural interpretation, right?
Absolutely. This is why I remind people that Starbucks didn’t just become successful because they make good coffee. If docs just want to focus on the best care, then to be successful, someone else has to focus on everything else. So I help docs and administrators to focus on the broader process issues, which a constant challenge - It means someone has to help serve as their interpreter and cultural guide so they can cross over cultural boundaries many times a day.
