Chuck Podesta Shares His Perspectives on CIO Leadership and Current Challenges

Chuck Podesta, CIO at UC Irvine Health, the integrated health system at the University of California-Irvine in Orange County, California, spoke on Friday, Nov. 11 at the Health IT Summit in Beverly Hills, sponsored by Healthcare Informatics. At the Sofitel Hotel Los Angeles at Beverly Hills, Podesta delivered Friday morning’s keynote address, entitled “Partnering with the CIO: Views from an Expert Healthcare IT Buyer.”

In his speech, Podesta spoke very bluntly about the challenges facing CIOs in interacting with some in the vendor and consulting community, emphasizing that CIOs have very little time, and that many of the maneuvers that certain vendor and consulting firm representatives make can actually alienate CIOs in terms of wasting their valuable time. That said, he also made it clear that he is looking for smart vendors and consultants to partner with him and his team at UC-Irvine Health, to take on the challenges facing their organization and all patient care organizations in the current operating environment in U.S. healthcare.

Afterwards, Podesta, who has spent more than two full years now at UC Irvine Health (he joined that organization in September 2014), sat down with Healthcare Informatics Editor-in-Chief Mark Hagland for a discussion of some of the top challenges facing CIOs in the current moment. Below are excerpts from that interview.

Given the dizzying pace of change right now and the many challenges facing CIOs, this is a time involving unprecedented pressure on healthcare IT leaders. What would you say to CIOs and other healthcare IT leaders about the present moment?

Yes, the times are changing faster than ever. And what I say to CIOs is, I ask them, who are you using to help you with all of this? Who are the people you’re using—other providers, as well as vendors—to help you with all this? The other part would be to start breaking down some of the things that are on our IT strategy roadmap right now. One example would be security. We know that the presidential election won’t change what’s going on with security at all—that’s a given. And nothing will change in terms of the analytics needed for population health. And even if they were to throw out the ACA [Affordable Care Act], the commercial payers are all focused on population health and moving towards risk, so the analytics need will be important anyway. And I don’t believe that the value-based aspect of career and payment—high quality and low cost—will go away; that’s a given. And the private insurers have bought off on that. So I don’t think the clock’s going to go back on any of that.

Chuck Podesta speaking at the HIT Summit

Given how much is going on, it seems clear that prioritization is going to be a huge issue for CIOs, along with IT governance and project management. Your thoughts?

The first analysis you need to participate in is this: of your top 25 things on your list, what are the 15 things you can let go of. Now, you need consensus in your organization, of course. So you’ve got to go to your governance, and then make the hard decisions. What’s happening in organizations is that they’re not letting go of anything on their plates, but instead are adding new items based on new demands. But again, your partners can help you.

And that group will include consultants, vendors, associations, and other partners?

Yes, absolutely. I’ve been telling consultants, the best that could happen would be the uncertainty of this election result, because there’s chaos, and you guys as consultants thrive on chaos. And now we have great uncertainty.

You’ve been at UC-Irvine Health for just over two years now. And you’ve made progress in numerous areas. What critical success factors have been involved in your progress so far?

Because I’ve been in the industry so long, I’ve seen what not to do as much as what to do. So when I go into a new organization, I ask, how does the help desk function? How is their PMO [project management office]? What is their IT governance? And in many cases, all three areas are lacking. And in 72 hours, I can tell them, we need to put those things in place. And I’ve done it before, so I can do it again. But if you haven’t done it before, you need partners. And partners can help you be successful. Because you’ve got to have those things in place. You’ve got to have the day-to-day things functioning at a high level, so you can have credibility when you go into the executive suite and not come in out of crisis. Then you can be a trusted adviser. After 8 or 10 months, the c-suite people can say, we trust you, because you’ve established yourself as a CIO, through excellent operations management. That’s what I did here, I knew I had to reorganize and provide strong management and leadership. And that’s what I did, bringing in a mix of internal and external people to build that team. And a lot of CIOs are afraid to rock the boat, to do that reorganization. Some of the managers are liked by the staff, maybe. But if managers don’t have the ability, if you don’t move them out of the role, then that reflects on you. Six months or a year later, if you haven’t done that, then the c-suite looks at you, and you’re not new anymore. And then you can go have lunch or play golf one afternoon, or do a speaking engagement like this one.

In terms of the policy-, payment-, and industry-driven demands on CIOs, what do you see happening in the next year or so for CIOs as a group?

I think there’s going to be more churning of CIOs. You have the retirement aspect, but also, you have the CIOs who aren’t cutting it because they’re not really strategic. And as things change in the industry, that’s where you will see more churning, because if CIOs can’t be trusted advisors, then they’ll churn. And with mergers and organizations, there will be fewer organizations and fewer top CIOs. And that will continue. So if you want to be one of those top CIOs, you’re really going to have to do your homework and be strategic. The other thing with CIOs is that if you’re a CIO with a successful track record, you’ll be highly, highly valued. And CEOs understand the importance of the top CIOs. You’ll see some CIOs being seven figures and up in some of the top healthcare organizations; it’s already happening. There will be this gap between some of the higher-level CIOs and others.

When you look at CIOs who have tried to make the transition from being technical people to being true organizational leaders, what do you see as making the difference in terms of who is able to successfully make that leap, and who is not?

When you’re a CIO, you’re 80 percent strategy and 20 percent operations; the opposite is true of directors of IT. And there are a lot of people who can do the director of IT thing beautifully. My director of IT operations is perfect in that. Now, I’ve seen so many people who are directors of IT who want to make that leap to CIO, but within a year, many of them are gone. How many CIOs like that do we know? They’re micromanagers, and they remain operational people, and now they’re in the wrong job. To be a leader, you need to think and ponder. If you’re a micromanager running day to day operations, you’re not doing that leadership position. I’m lucky in that I’ve bene able to make that transition. And you don’t just go in as a strategic CIO; you come up. You’ve got to break that thinking where you’re managing day-to-day operations. It’s no longer, what am I doing today? But rather, what am I going to be doing in a year from now?

What would your advice to your fellow CIOs be, with regard to the tumultuous waters that all healthcare CIOs will have to navigate in the next few years?

I would speak to two areas. One, on the patient safety and quality side, keep doing all that. Make sure your organization continues all its initiatives around quality and safety. On the cost side, cash will be king. This is going to be chaotic, and you need to say, I’m going to help put my organization, because we don’t know exactly what’s going to happen, but we need to be prepared to invest in things. So build up cash reserves. Look at non-labor first, look at your benchmarks across the industry. Maybe things with pharmaceuticals, med supplies, keep going back at that. And look at your labor side. One of the exercises you need to go through is around span of control. There should be any more than five levels between the CEO and the person sweeping the floor. In private industry, that’s becoming the standard. And analyze how many managers you’ve got.

So you need to look across your organization in terms of who you have as managers and how many managers you have, relative to what needs to be done. See who you have for managers, and anyone they have reporting to them. And any less than ten, can this person manage more people? And you can do some of that through attrition, or over time. But that whole span of control analysis is so important. Because otherwise, you end up with staffing creep. And you’re dealing with management, not staff. And that message is a little easier around management than staff. And to be honest, some CIOs like castle-building, which is a problem. And the reality is, at some point, as a CIO, you’re going to be benchmarked in terms of your staffing levels; and if you’re over-staffed, then there will eventually be some kind of bloodletting.

How do you lead through change, and build a confident organization, one that isn’t driven by fear?

Every organization has natural leaders. In our organization, I’ve got Adam and Curtis. And if I go to a meeting and say, what do you think about Curtis? And everyone says, ohmygosh, he’s wonderful! Take those people and elevate them> And once you elevate those folks, it shows the organization, hey, he knows and sees talent, and gets it. And those guys will perform even better, because they’ll be empowered. And then you have to move some people out. And people will get that. OK, he’s brought those people up who deserve it, now he’s having to focus on people who aren’t so strong. And We had a culture at UCI that was very insular. So the people I brought in and moved up were all customer-service focused. And the CFO called me up and said, I don’t know what you’re doing, but you’re doing something great. And that’s what you’re hoping for.

Is there anything else you’d like to add?

It’s going to be a bumpy ride for sure. But you remember when Obamacare started up, everyone said, ohmygosh, this is going to be crazy and difficult. But it was fun. And new approaches and technologies were developed because of it. Again, chaotic times sometimes can be fun times, too, as long as it’s organized chaos. So put your big boy and big girl boots on!