CIO Unplugged

Talent Rules!

2008-05-12T14:48:00Z

The views and opinions expressed in this blog are mine personally, and are not necessarily representative of Texas Health Resources or its subsidiaries.

Unlike Hillary, we landed at Pristina International Airport in Kosovo under relative calm. The unmarked military aircraft that flew us in resembled a corporate jet more than government transport. Army soldiers were awaiting us on the tarmac, and we had no fear of danger. It was near Christmas 2004, and the Army had asked my CFO and me to join a handful of generals, politicians and business leaders on a morale trip to encourage our activated Guardsmen stationed in Kosovo. I was honored to be selected.

Upon deplaning, we were greeted by a chiseled young soldier. "Welcome to Kosovo, sir!" Army Sergeant Jeff Masters punctuated his greeting with a crisp salute. Something about him impressed me.

Sgt Masters was assigned as our purser, if you will, our guide to make sure we got from point A to point B without getting lost or killed. He went out of his way to see that our party was comfortable; he answered all our questions and pointed us to the mess hall and latrine. Polished and confident, Sgt Masters' passion for service was evident.

The first evening, we sat in on an awards ceremony that confirmed my impressions of him. Sgt Masters was being decorated for superior performance. Generals sang his praises.

I turned to my CFO and said, "We've got to hire this guy."

Sgt Masters was an Army National Guard Combat Medic when on duty and a carpenter's apprentice when off duty. He had zero technical experience. This did not matter to me because I knew that just about anyone, if willing to apply himself, could learn technical skills. Sgt Masters possessed the one thing that was near impossible to learn: service passion and leadership talent. As I observed him that week in Kosovo, my desire to hire him grew. Once he was discharged from duty, I offered him a position.

I've never been big on résumés. I suppose this was in part due to the battle I'd fought to land my first "professional" job. Armed with a Master's degree and modest experience, I knew I could do the job, but I never got the chance. Citing either my lack of experience or my education as reasons not to hire me, recruiters would overlook the one feature that hinted at my aptitude to succeed: talent. My talent -- a healthy work ethic and a passion to move mountains -- had been developed through a huge chore list growing up and having to work my way through college.

When I finally did enter the workforce, I found little correlation between experience, education and actual performance. Undoubtedly, the ideal is to find a high performer with requisite degrees and experience, but by no means is a robust resume a guarantee for success. Time taught me that success rode in with the talented candidate, the one whose natural reoccurring behaviors and thought patterns saturate the air with songs of a winner.

Although I was slow to land my first professional position, I owe much of my career acceleration to leaders who embraced the philosophy of "Talent Rules!" Each had taken what traditional managers might have perceived as great risk in offering me opportunities for which I did not have the requisite experience or education. They accepted me based on my talent. (I am forever grateful to you: Mary, Mike, Jim, Tom and Kevin.)

My personal journey lent wisdom to my future recruiting and hiring decisions.

Jeff Masters joined us after his tour of duty ended in Kosovo. We assigned him to manage a challenging project that was fraught with disorganization and poor leadership. By the end of his first year, he had successfully helped wrap up the project and yield promised benefits. Mr. Masters worked closely with our technical division, developing field engineering skills along the way. He took on a leadership role.

By the second year, he had moved into the clinical application realm and supported our CPOE system. He brought a fresh level of enthusiasm to the team, which was languishing on a legacy application. As well as bringing organization, Mr. Masters also learned to support clinicians using CPOE -- a complicated world in itself. It gave me joy to see him flourish in using his talents. Today, he is a manager, coordinating the innovative application of technology in a new hospital. I have confidence that this apprentice carpenter combat medic will continue growing and achieve great things for those whom he serves.

Side note: The overseas trip came with a bonus. My deputy CIO had been voluntarily activated a few months earlier for a tour of duty in Kosovo. Late one night, he surprised my CFO and me with a don't-ask-for-permission-lights-out flyby terrain Blackhawk excursion. What a rush! I believe my deputy was pushing the allowable flight envelopes, trying to get me sick; surprisingly, the sickness bag stayed in its pocket. My CFO on the other hand...well that was another story.

Culturally Relevant Leadership

2008-04-30T01:52:00Z

The views and opinions expressed in this blog are mine personally, and are not necessarily representative of Texas Health Resources or its subsidiaries.

One of my favorite things to do as a youth was to visit my dad's office. To get into the French Army compound unnoticed, I had to be smuggled, cloaked in an air of mystery and suspense. I'd hide under the dashboard of our military sedan as French security forces saluted our vehicle through the gate. Once inside, my dad would park the car in front of the U.S. Forces headquarters and, when given the clear signal, I would run inside where I savored a free existence among the U.S. military and civilian officials.

As my dad worked, I would pull up a chair to the massive wooden conference tables and desks and play office. I toyed with paper clips, erasers, pens, rubber stamps and other office paraphernalia. I loved using the electric typewriters and placing my classified papers into filing cabinets that filled much of the hallway space. I made pretend phone calls to other consulates and raided whatever candy jars were available.

Fast forward...

In recent years, I have entered ex-IT leaders' offices to discover that not much had changed since my youth! Searching desk drawers, I was surprised to unearth rubber stamps, legal pads and stickers. (Remember those gold stars teachers used to put on report cards?) With the exception of computers, these offices were even equipped with yesterday's furniture. Although digital automation was functioning, you'd never know it by the amount of documents printed and processed via historical methods. Despite all the digital storage media available, I'd speculate that we still store more paper than ever before.

We have an aging leadership issue, and I'm not necessarily referring to chronological age. Evidence supports the likelihood that our antiquated styles and methods are creating hindrances in raising the next generation of IT leaders. These future leaders need our wisdom; but are our succession plans hip enough to give us credibility? I am not the most avant-garde CIO out there, but I am cognizant of my need to continuously update my team and myself lest we become irrelevant to those whom we lead and serve. So I push myself. I still have a long way to go.

If I have offended you thus far, check your desk drawers before you reply.

Cultural relevance manifests itself in many ways: how we dress, lead, talk, use tools, interact with staff, innovate, etc. Assuming you already have the requisite IT skills, endeavor to keep up with cultural trends. What was relevant when you graduated is not so for today. Here is a test. Bring your father into your office. If he is comfortable with the tools you use on a regular basis, give yourself an F!

How to stay culturally current:

Hire and promote it. Do not be afraid to hire new blood right out of school. Promote talented individuals even if they don't have years of experience. If they're talented, they're teachable.
Hang out with culturally current people. Having had two teenagers in our home has acted as a catalyst for me. I have also created advisory groups to keep me on my toes. The best one was made up of second-year residents who gave me advice. I first learned of wikis and the power of blogs from them.
Experiment. If you don't already have a LinkedIn and MySpace account, you are way behind. Bonus points if you conduct business via SecondLife.
Hang time. Set up monthly after-work parties at the local watering hole, where people will be more likely to let down their guard and deepen relationships on a different level. You'll reap the benefits back at the office. I even had a foosball table in my office that helped eliminate intimidation and similar barriers.
Cross-pollinate. Avoid spending your conference investments solely in health care. Attend non-healthcare venues and get to know people who don't look like you or share the same points of view.
Wardrobe. Honestly, how old are your suits and ties? I picked the sharpest dresser in my IS shop and had him stop over to my house. He systematically eliminated about 75 percent of my work wardrobe. He then took me shopping -- and not where my dad shops.
Read voraciously. Read blogs! Read from non-traditional sources of media. Gain fresh perspectives on everything from innovation to leadership. Managing Gen X requires different diplomacy than Gen Y, which requires completely different techniques than do baby boomers.
Speak and write. This process will force you to differentiate and expose yourself to new ideas, vocabulary and trends.
Reduce e-mail. Email is from the 90s. As my kids say, e-mail is for when you want to send a thank-you to your friend's mom for having you over for dinner. Push the limits with IM, txt msg and video.
Furniture. My office furniture has no place to store paper. There is no table, except for coffee. There is no trashcan. There is no printer. Everything (phone, projector, tablet) is wireless. We are tearing down several cubes in favor of contemporary design that encourages innovation and collaboration.
Music. Hey, I love 80s music. But I do my best to mix it up with the latest in sound. Listen to all -- yes all -- that your employees listen to, from Mozart to Moby. Admittedly, I still struggle in Texas with country.
Phones. Do you still have a flip phone?

Being culturally current cannot be delegated. Be proactive, otherwise you'll end up only attracting employees who like to stamp documents and store them in mammoth filing cabinets. Candy jars are acceptable.

Who are Your People?

2008-04-22T20:09:00Z

The views and opinions expressed in this blog are mine personally, and are not necessarily representative of Texas Health Resources or its subsidiaries.

As I sat down to blog, I had every intention of going back to a non-Ironman-related post. My attempts to post on matters more closely associated with health care IT failed to excite me. If I can't be passionate about one of my own posts, my readers will pick up on that, and I will have failed to connect in a meaningful way. Not to mention that many of you have e-mailed me asking about the Ironman Arizona. So indulge me one final time and glean from the lessons that can apply to both leadership and life.

APRIL 10, THURSDAY-- I pulled in a few days early to acclimate to Tempe and to finalize preparations. Though it was a long haul from Dallas, I chose to travel via car so I could bring everything I wanted, plus keep control of my bike. You can better guarantee success by having the right tools and by making sure they stay in optimal working condition.

FRIDAY/SATURDAY-- No grand feat, whether it's a major race or going live with CPOE, is performed well if attempted alone. Surround yourself with people who lift you up. One of my employees, Don, stopped in my office a few weeks prior to inform me that he had started running for the sole purpose of praying for me. He timed his April 13 run to coincide with the start of Ironman. Another employee, Aaron, flew out after the race to help me drive back to Dallas. I welcomed both their embraces.

My son, also an experienced triathlete, flew in from college on Friday to assist me with the final prep and provide counsel. As a film major, he shot all aspects of the race -- a potentially interesting YouTube feature this summer. We attended the Iron Prayer event to connect with other like-minded athletes. My wife and daughter, whose support I consider invaluable, arrived the day before the race.

RACE DAY-- Athlete #1345. I awoke at 3:00 a.m. to begin the nutrition phase. I consumed a few hundred calories then slept again. Waking at 4:30 a.m., I mixed my drinks and headed down to the transition area. My son was filming and helping carry the specialized bags of equipment. By 5:30 a.m., my body was marked and my bike tires were pumped one last time. I found a spot under a tree and lay down to rest for the next 45 minutes. Appropriate preparation and planning can allow time to rejuvenate while others around you are scrambling to meet the deadline.

T-MINUS 30 MINUTES-- Under the scrutiny of the camera, I changed into my wetsuit. After final interview, I jumped into the lake with the other 2,299 Ironman wannabes. I remained unusually calm, partially because I did not shortchange my preparation. When the cannon fired, I was physically, mentally and emotionally ready to race. Proper preparation preludes proficient performance. (Say that 10 times...)

SAM-- Climbing out of the water, I picked up my bike bag and ran into the transition tent. My first transition was dedicated to Sam, the young son of one of my employees who got hit with cancer last autumn. I pulled out the handwritten card with his name on it and placed it on the ground before me. I prayed for him as I put on my bike gear. His fight to the finish line would far surpass mine.

112 MILES in 6+ HOURS-- The strong head winds and the 95 degree weather were killing my expected biking pace like a defunct router on network uptime stats. Complaining wasn't going to change it. I had to make the best of it. Persevere. Keep focused on the bigger picture. I loaded up on fluids and consumed 400 calories per hour, a total intake of 3,000 calories, partly to prepare for the marathon ahead. Combating an urge to keep rolling, I made myself stop and reapply lotions to keep from chaffing. It would pay off later. At mile 80 -- my last time up the wicked hill -- one leg started to cramp, and I realized I had yet to urinate. I forced down more drinks and salt tabs and the cramps subsided. At last, the final 15 miles were downhill and flat. Relief engulfed me.

* During the last lap, the cameraman passed me backwards on his motorcycle, which meant the Ironman leader was right behind me. I sped up a little so when the scene unfolded on TV, it would look like I was in second place! That lasted about 3 frames as the leader made me look like I was standing still.

PAM-- The transition from bike to run was dedicated to Pam, who had breast cancer, the wife of one of my employees. I placed her name card in front of me and voiced prayers as I changed. Only a marathon to go, and I would be an Ironman. But how many marathons of treatments did Pam have left? My suffering paled in comparison. Thanks for your strength, Pam and Sam.

DEDICATED PLAYERS-- Ironman staff had trained an abundance of volunteers to assist at every stage. At the first transition, volunteers stripped me out of my wetsuit while others applied sun lotion before the bike. As I ran down the middle of the bike compound, someone was at the end waiting with my bike. When I returned to the transition area, one volunteer took my bike while another handed me my run bag. I was again rubbed down with sunscreen before the run. Planted along the run route were hundreds of signs created by race families in support of their athlete. My family had made 3 to help focus me on my purpose in doing the Ironman. Surround yourself with people dedicated to your success, positive people who will encourage you despite the circumstance. They will get you through the loneliness and pain of challenging times.

STRENGTH vs WEAKNESS-- In training, I deliberately chose to concentrate on my strengths: bike and run. I had invested a combined total of 353 hours on these two events. Had I invested extra time on the swim, I might have gained 5 percent in overall time. By concentrating on my strengths, I gained an estimated 20 percent. Twenty years ago, I almost made the mistake of returning to school for a technical degree. Realizing my strength was in leadership, I opted to develop those skills instead, and it paid off. What I might have learned in technology would have already been lost -- and outdated. Don't misallocate precious resources by strengthening weaknesses.

FIRST, BREAK...THE RULE-- I violated a cardinal race rule, which warns to never ingest something during a race that you have not used in practice; it could make you sick. Following a fellow Ironman's suggestion -- that he declared had saved him on the run -- I indulged in a flat Coke. The sugar-caffeine high juiced my battery. Picking up the tempo, I cruised along with renewed vigor. Sometimes you've got to shake things up a bit and not do the same things over and over, especially if they are not working.

THE END-- I remember spotting the 26-mile mark on the marathon, but the last few hundred yards were a blur. Roaring crowds lined the grandstands. Officials held out the Ironman finish ribbon, and I raised my hands in triumph and received my medal. It was over. I had held nothing back. There is no rush like that of a mission fully completed.

Yet my eyes were searching for my family. My wife and I cried as we hugged. While my son continued filming, I embraced my daughter. This had been a long journey of very early mornings and regular sacrifices. A journey that took over our bathroom and kitchen with a plethora of Ironman gear and foods.

WHAT'S YOUR BIGGER PICTURE?-- At the end of the greeting pen was Ellen, the person for whom I had run this race. I had given her all my medals from the events leading up to Ironman with high hopes that in some small way they would be an encouragement to her and to her family. Throughout training, I had focused prayers against the cruel disease that had invaded her body. I desired that, through the providence of God, those prayers would improve Ellen's quality of life. I presented her with the Ironman finisher's medal, and we both put up brave fronts for the camera though tears were streaming down our faces. Ellen does an Ironman daily, especially on chemo days.

As a leader, do you have a significant purpose? Or is it solely about the money and the new house? Put people first. Seek to serve. In health care, the Sams, Pams and Ellens are the ultimate endurance athletes running a race that nobody should ever have to run. We are there for them.

FYI- the last 20 weeks' training log:

Swim 111 hours (lost count)
Bike 235 hours 4230 miles
Run 118 hours 944 miles
Lift/Stretch 76 hours n/a

I did get the Ironman tattoo which was nearly as painful as the Ironman itself.

CIO reDefined: Chief Interpretation Officer

2008-03-25T20:37:00Z

The views and opinions expressed in this blog are mine personally, and are not necessarily representative of Texas Health Resources or its subsidiaries.

The roles of a CIO are as varied as the companies and sectors they serve. Even within these roles are multiple combinations and permutations that are expressed according to circumstance. The moniker "CIO" itself is not limited to "Chief Information Officer." No, to be effective in our calling we must stretch the traditional definition beyond this commonly accepted interpretation. This post continues a series on how the "CIO 2.0" will push the boundaries of conventional thinking surrounding the role. We continue with the "Chief Interpretation Officer."

2:45 p.m. Hong Kong, the place of "sweet streams." After two days of acclimating, covert training sessions and pretending to be tourists in Kau-lung (known to westerners as Kowloon), we take the bus to Lo Wu, the border city into Shenzhen, China. It's our honeymoon. We split up, taking different routes into customs in case one of us gets caught; we have vowed to not put each other in jeopardy, for we are both carrying contraband.

Traveling undercover, I move with the flow of tourists and natives past uniformed guards carrying machine guns. Since we were just married, my wife's passport still has her maiden name. Therefore, if they stop me, my detention should not bring attention to her. I still worry about her.

My bags are inspected, and the officials are blinded to the contraband. But now I can't find my bride. On the China side of this bustling customs center, I sit on a bench, praying, and devising a one-man rescue operation. Then I realize I cannot read any of the character-painted signs to guide me to where she might be.

A pokerfaced customs officer walks quickly toward me, gesturing for me to follow. I do, sweating, dreading. He introduces me to another young American also traveling alone. Little did he know the beautiful young woman was my wife! We play along until the official is satisfied, and then we head to the taxi stand. The Chinese phrases I learned in training mingle on my tongue with German (my native language), and I cannot communicate with the Chinese driver. "Canton," I repeat several times. The driver shakes his head and shrugs. My wife sweetly says "Guangzhou," the Chinese translation for Canton, and thus begins our four-hour journey to the city where we will smuggle 130 Bibles to the underground church.

We get to the hotel and prepare the bags for the drop off. The expected message arrives: a name of a street. As instructed, we go downtown and walk the street. Toting our rolling luggage full of goods, we pretend to be tourists, as practiced in Kau-lung. Before long, two elderly Chinese women come alongside of us and put their hands over ours. Hearts racing, we release the handles, move to the side, and hope these are the right people and not interceptors. No words were spoken for obvious reasons. We turn away, overcome with a sense of relief, as the women disappear into the night. Despite language and cultural barriers, we have completed our mission. Next time, however, I'm hiring an interpreter.

The late Peter Drucker, father of modern business, described hospitals, academic specifically, as the most complex organizations in the world. It can feel as if health care is a multiplicity of cultures speaking different languages and trying to complete a common mission. That's because it essentially is. It's a melting pot of clinical, business, academic and technical languages uniting in the service of patient care. The technologist might feel like he is facing a squad of armed soldiers when he's trying to present his case to the administrators. The businessperson may shake her head and shrug while trying to see value in the clinician's argument. Opportunities are lost.

With the emergence of CIO 2.0, a dramatic shift has been taking place. No longer a technophile, the new CIO can speak and understand multiple languages, interpreting and synthesizing messages among related complex cultures. This CIO often comes with a varied background of clinical, business and technology skills overlaid with the requisite leadership talents. With clinicians, the CIO speaks clinically; with businesspersons, she speaks business; and with technologists, he can communicate equally well. In each case, the CIO must interpret what he/she hears in the language of the speaker and translate that message to all the stakeholders. Conversely, if the CIO cannot communicate technical innovations or challenges to the clinician or businessperson, outcomes will be substandard.

There are multiple ways for a CIO to learn and sharpen these skills. I have found the following helpful.

Mentors -- Purposefully include administrators and clinicians as formal mentors. When meeting with CEOs, COOs, CFOs and CMOs, ask questions, listen and then apply the constructive lessons that will enhance your success. Be a doer, not just a hearer.
Rounding -- Round routinely with physicians and nurses. They have much to teach those who have eyes to see. Every time you round, you will deepen your customer understanding.
Reading -- Read journals for administrators and clinicians, and stay current in technology. Learn their languages and cultures and apply them when possible.
Hire it -- Surround yourself with and imbed in your department individuals who have business and clinical backgrounds. By introducing their languages and cultures, you'll collapse relational walls, create a common language and generate an environment where interpretation is no longer needed.
Listen -- When visiting with administrators and clinicians, practice deep listening. Once you gain insight into their challenges and opportunities, you can then respond with technology-enabled solutions in a language they can understand.
Conferences -- At conferences, try to attend sessions outside of the technical domain. Acquaint yourself with the top issues facing administrators and clinicians, and see if there are answers that can leverage technology.

In an institution of mixed cultures and languages, everyone speaks but few understand. It is, thus, imperative for us to be multi-lingual and honoring of the multi-cultural surroundings in which we work. Begin by gaining understanding, for these are skills that can be learned and mastered. You probably won't be on the other side of the globe interpreting languages and signals to complete a mission, but you might feel at times like you are. Mastering languages and bridging the cultural divide is no longer optional. It is required to be a successful Chief Interpretation Officer.

Chief Ironman Officer Update: Leadership Lessons Learned from Champions

2008-03-10T20:42:00Z

At the time of this post, I am 30 days out from my Ironman. I am a mix of nerves, enthusiasm and fear. Am I fit enough? Have I trained enough? What if I get injured before race day? What if I miss the swim cutoff time? (I'm a snail swimmer.) What if I flat more than twice? What if...

...And why am I doing this?

Ah yes, now I remember. It's not about me. This Ironman race is about something much bigger than myself. See 01/02/2008 post.

To facilitate my training and to familiarize myself with the racecourse, I recently attended a "multisport" camp. The camp was run by former professional athletes who have organized many Ironman events. One of them, Paula Newby-Fraser, had won 26 Ironman titles including eight world championships. To this day, Paula has recorded the fastest finish among women. My first day at camp, I ran a warm-up 5K with her and gleaned all the wisdom possible regarding the course, the Ironman and running in general.

After an initial day of a short run, a short bike, and a long swim, we settled down for a hearty dinner. Camp leaders announced the cycling ride groups for the next day, which were formed based upon predicted finish times. I was selected to be in the fastest group led by the #1 ranked woman Ironman in the world. Fear struck me like a bolt of lightning, and I considered putting myself in a slower group. Michellie Jones, Miss #1 Ironman (my assigned group leader), happened to be sitting across from me at dinner. I promptly confessed, "I can probably hold my own at 20mph for five hours, but that's my max."

She no doubt heard the fear in my voice, yet still replied, "You'll be fine with that."

I didn't believe her.

She added, "I like to start off slow and finish fast."

God save me!

Apprehensive about the ride, I woke up three times that night. I wanted to drop to a slower group, and yet I couldn't shrink from the challenge. Finally, I decided if I got dropped I'd just slow down and wait for the other ride groups to catch up.

That sounded like a reasonable backup plan until my ride group gathered that morning. Of the 10 riders, five were professionals; of the other five -- mortals like myself -- I was the only virgin Ironman. Talk about a clay blob among marble statues. Their bikes and aerodynamic outfits were three times as costly as mine was, and I was the only soft body amongst hard bodies. This was going to be a long day.

We set off at a blistering 26mph pace. Despite a fitful sleep, I had fairly fresh legs and was able to stay steady for the first 40 miles. In search of hills, we headed off the Ironman course and found some rollers with lengthy inclines. We had already lost two mortals; I was determined not to be the third. I was sixth in the draft line, and I noticed the cyclist in front of me falling off the pace, which meant I was falling off the peloton as well. At first, it was just a couple yards, but that stretched to ten yards, and I knew we were in trouble. We wouldn't be able to push back up to the pack.

Lesson number one: Be sure the person you are following has the vision and stamina to keep you on the straight and narrow. "Followership" is a critical talent for survival.

The turnaround point for our hill excursion was coming up, and I managed to get back in the line. I understood clearly that the key to my survival was drafting closely, if not right behind the leader, in this case Michellie, Miss #1. I stayed slightly to her left with my front wheel overlapping her rear wheel by an inch or two. I drafted well, and during this stretch, at about 28mph, I was smiling, having the ride of my life. I was drafting behind the world's best! My legs felt fresh again, and my confidence reawakened. About mile 80, we started to hit a gradual incline. As the last surviving mortal, I slipped to third position, then fourth, and was soon passed by the peloton. Heading up the incline, they stayed steady at 25mph, but I was too far off to draft. I ended up facing the wind resistance alone. Despite increased physical effort and motivation, my speed dropped to 18mph. I was alone in the desert. I could do nothing in my own power to reach them.

Lesson number two: Riding in a pack you can gain 40 percent efficiencies over riding alone. Teams can accomplish more. Pushing and pulling together, a team outperforms the loner every time.

A few miles down the road, I was saved by the refueling vehicle that carried extra drinks and food. As we resumed, I took 2nd position behind Michellie and did not let go. I was smiling again. No more inclines, all flat terrain. The closer together we rode in the peloton, the greater the "eddie" we produced, which helped propel Michellie forward. A truly symbiotic endeavor. As we reached the 90th mile, however, I was riding on empty, and Michellie razzed me for the umpteenth time about inadequate hydration. She made me a concoction out of two of her bottles, and we finished in a flourish. By the time we coasted into the finish lot, I was cracking up. I had just ridden over 100 miles with the Michellie Jones. And this woman led no patsy ride!

Lesson number three: Sometimes it takes sheer grit and hunger, but you can push yourself to do amazing things. Test your boundaries, then break through and grow to the next level. Just do it!

Throughout the camp, someone kept saying, "It's about performance, baby!" One definition of performance: the efficiency with which something fulfills its intended purpose.

Last year's trophy looks nice on the shelf. I have a few of my own, including work-related awards. But their beauty is fleeting. Their intended purpose has stagnated. Sitting back and bragging about yesteryear's accomplishments is fruitless, inefficient. At some point, the past no longer matters. It is about what you're going to do in the next race. Sponsors aren't seeking out racers because they were yesterday's champ or because they'd been doing Ironman for 20 years. They're searching for the continuous quality, or excellence, of a racer -- the guy who keeps pushing himself to perform and improve. The same should hold true in our health care careers.

Lesson number 4: You can coast for only so long in the draft of a trophy, but when you cease pedaling, you will fall over.

I'll wrap this up with bullets of wisdom gleaned from champions:

Teamwork
Followership
Sheer grit
Breakthrough
Performance
Even gifted leaders need a coach

See you at the finish line!

The views and opinions expressed in this blog are mine personally, and are not necessarily representative of Texas Health Resources or its subsidiaries.

CIO reDefined: Chief Interception Officer

2008-02-22T01:11:00Z

The views and opinions expressed in this blog are mine personally, and are not necessarily representative of Texas Health Resources or its subsidiaries.

Earlier this week, I had the privilege of attending the annual Davey O'Brien awards dinner, honoring the year's best college quarterback. For the 2007 season, the honor went to the University of Florida's Tim Tebow, who added this hardware to his Heisman Trophy. Highlights of his talents were shown and much of the Gator's success was attributed to a low interception rate. In football, the interception is often considered a game-changer. A momentum-killer. One team has the inertia and is headed for a likely score. Victory looks certain. Then an errant block, a pocket that collapses, an ill-advised pass, and the opposing team catches the ball. That catch not only snuffs the scoring drive, it discourages the intercepted team. Keep that concept in mind as you read on.

The Second Law of Thermodynamics states that everything moves from order to disorder. A shrewd CIO can learn to intercept strategies, projects or activities that perpetuate this law before they take hold. It takes about 10 minutes to identify an organization that lacks a Chief Interception Officer. In fact, you don't even have to meet this person; just look at his/her application portfolio and the core technology mix. For further validation, review the number of FTEs per adjusted occupied beds or similar benchmarks. The more complex the environment and the larger the staff on a comparative benchmark basis the more probable the defense is out of sync.

To complement a solid offence, the primary defenses of the Chief Interception Officer are a visible strategic plan and an enforceable IS governance process. A large body of work already exists on IS strategic planning, thus I will simply touch on some of the less-reported aspects. While a strategic plan must be aligned with the business objectives of the larger organization, make sure it directly supports all key performance indicators. Ask key stakeholders what drives their personal and departmental incentive plans then call out those specific objectives. Develop the plan in collaboration with key stakeholders without excluding anyone from providing feedback. As a final play, gather stakeholder signatures to signify that they have given adequate input and are endorsing the plan. Let the signature page be your initial slide in your overall plan. I keep a framed copy in our IS lobby as a reminder to those we serve and their commitment back to us.

Though it is a newer concept, a large body of work also exists on IS governance for your reference. The governance process exercised by most organizations tends to be soft. Executives pitch projects of great promise (ROI, quality, etc.) and obtain funding. Yet no one ever circles back around to measure the actual outcomes. Thus, I will illustrate two notable strategies often overlooked: the need for end-to-end accountability, and the elimination of ambiguity.

To ensure quality progress, I implemented the following governance strategy. One year after a funded project achieved go-live status, I sent the designing executive back through the governance process to present the outcomes. This discipline reduced the number of project requests by 60 percent -- and those executives that did present had put their project through a rigorous analysis knowing that they would be held accountable to promises made. Projects that passed saw an increase in on-time, on-budget performance, and, more importantly, on value realization. Did you notice my purposeful use of "executives" that presented projects? I changed the players from IS to operational sponsorship for all but highly technical projects. Finally, IS governance must be firm in allowing only two possible outcomes. Funded or not funded. Anything apart from this reinforces the Second Law of Thermodynamics.

For an organization to bring about an efficient and effective application of information technology, the Chief Interception Officer must create the proper environment. While primarily on offense in leading an organization, exploit the defensive plays in your handbook. Heroically intercept misguided short passes and long bombs before someone puts points on the board that are difficult to reverse.

Why Offshoring Works

2008-02-11T18:53:00Z

The views and opinions expressed in this blog are mine personally, and are not necessarily representative of Texas Health Resources or its subsidiaries.

I feel fortunate to have relocated to a community with a thriving HIMSS chapter. Recently, I was honored to participate in a DFW-HIMSS luncheon meeting as a member of the CIO outsourcing perspectives panel. On the panel with me were two giants in the business, which enriched my experience. Rather than rehash what was said, none of which was particularly new, I want to give you a unique perspective on outsourcing. In particular, offshoring.

To lay a foundation for my perspective, I will acquaint you with my past experience. I had worked for years in a system where operations were entirely outsourced, and 25 percent of my staff was offshore. In other environments, I employed selective offshore sourcing for routine and project-based work. I have collaborated with top global sourcing firms. More recently, I visited India and toured the universities and factories of select firms. Perhaps the greatest insights gained however came from hosting dinner parties in my home for the rank-and-file offshore staff as they completed mandatory onsite rotations. Breaking bread at the dinner table created the single most effective time for listening. Why? When you minimize formalities and distractions, people tend to be more transparent.

As a general observation, offshore staff has provided a higher quality of service. Couple this with the price, and the value equation speaks for itself. Not only have I found this true with traditional offshore services, such as application support and interface development, but with our service desk as well. More important than reducing costs, our key service desk indicators improved, including overall customer satisfaction.

What was the key to this offshore success? Hunger.

From the analysts to the executives, my offshore staff had one thing in common. Hunger. Many of their American counterparts simply did not display the same intensity and desire. Yes, the offshore men and women were highly educated, but they also possessed an insatiable desire to further themselves through service and develop themselves professionally. The emphasis on quality and the execution of it proved far superior. While visiting some of the facilities, I sat back in amazement, asking myself, "What if we had this pervasive focus in America?" I had the offshore staff teach us continuous quality improvement and share their processes and best practices so we could adopt them locally.

In some cases, Americans have become complacent. We've taken for granted our prosperity and competitive position, and many have adopted an entitlement mentality. Rather than confronting the realities of the global economy and the increased competitiveness, we've rallied for protectionism and bantered "Buy American!" It wasn't always like this, of course. I believe the Greatest Generation had this hunger, which enabled us to reap the benefits. In order to sustain our prosperity and position, we must rediscover our hunger.

How do we develop that appetite? I am at my hungriest after a vigorous workout, after maximizing muscle hypertrophy and sweating off pounds. It is almost self-perpetuating: Work hard, build hunger, nourish and repeat. As leaders, we must develop and perpetuate this ethic within our organizations. We must ensure that support systems, like exercise equipment, are in place to cultivate hunger. Remove barriers and allow staff to perform at their best. Instead of relying on crude formulas based on education and length of employment, we must hire people with talent and attitude.

As we do this, the disparity between offshore and onshore will decrease, and we will find ourselves competitive again. Hunger will replace lethargy.

Faces: The Toughest Aspect of Being CIO

2008-01-21T17:07:00Z

The views and opinions expressed in this blog are mine personally, and are not necessarily representative of Texas Health Resources or its subsidiaries.

In answering an often asked question -- what is the most challenging part of being CIO? -- several dated situations came to mind. Losing a data center when the electric grid went down in the northeast. Personnel matters. Providing champagne service and applications on a beer budget. The weight of my responsibilities while knowing patient lives are at risk. Facing down angry physicians. A multi-million dollar project gone bad. These situations ranked as tough, but not toughest.

I think back to Zarema, a woman on the staff interview panel when I came through as a candidate. While her peers tossed softball questions at me, she played fast pitch. I loved it! I respected her glasnost approach and assertiveness. A recent immigrant from Russia, Zarema spoke with a thick accent and held to cultural mannerisms that sometimes clashed with our health system's progressive environment. Nevertheless, as a tireless and productive employee, she evolved into the go-to person of our division.

Before I left that division and eventually became CIO, Zarema confided in me that she was ill. I stayed abreast of her condition. She was very private, but over time, she received my prayers and support. Then, one day, I got the call. Disease had stolen her life. I lost an exemplar employee. Despite being sick, she had demonstrated how to strive for excellence, for she never settled for less than 100% on her yearly review.

"I still see your face, Zarema."

A couple of years later, our IS Division underwent an incredible transformation, and much of the progress was attributable to our Field Engineering team. We suffered "ticket tennis" issues, meaning service requests were lobbed between internal teams while the customer's needs remained unmet. By combining the silos of Desktop Support, LAN Admin and Network, we adopted a Field Engineering concept that encouraged and rewarded collaboration, which resulted in higher velocity and customer satisfaction. Dale was one of our young field engineers and a solid performer. Outside of work, he engaged in another passion: his motorcycle. One morning, tragedy came at him fast, and he was killed while riding his cycle to work. That week, the funeral was packed, and the majority of our field engineers joined me in attendance. Listening to them share words of support to the grieving family I gathered morsels of this man's passion and added them to my treasury on life.

"I still see your face, Dale."

I recall "Bill," the husband of one of my direct reports, taking ill. After a few days in the hospital, his wife told me that he had tired of cafeteria food. (Imagine that!) My son and I snuck tastier cuisine past the nurse station then hung out for a little bit and prayed with him. His death devastated me, as he left behind an infant daughter and a young wife. He was brave; he fought hard. And he reminded me how life was too short to not live it abundantly.

"I still see your face, Bill."

Most recently, another member of my division passed away suddenly. I regret, given my short tenure, that I did not have the time to get to know "Maggie." Co-workers shared that she was a dedicated employee and a wonderful person, someone I would have appreciated. During a moment of silence at an all-staff meeting, I studied this woman in a picture on power point. I imagined visiting her at her desk, and I wondered what wealth of character I might have gained from knowing her.

"I still see your face, Maggie."

So what is the most challenging experience as CIO? Identifying with tragedies that befall my department: lives taken prematurely; the impact of death and disease on families and communities. A good leader will mourn with those who mourn and rejoice with those who rejoice. I have attended many wakes and funerals to console grieving staff who lost children, parents, grandparents, spouses and other loved ones. I have kept some in my contacts and scheduled their birthdates to chime annually on those bitter yet beautiful days.

I still see their faces.

CIO reDefined: Chief Ironman Officer

2008-01-02T15:59:00Z

The views and opinions expressed in this blog are mine personally, and are not necessarily representative of Texas Health Resources or its subsidiaries.

The roles of a CIO are as varied as the companies and sectors they serve. Even within these roles are multiple combinations and permutations that are expressed according to circumstance. The moniker "CIO" itself is not limited to "Chief Information Officer." No, to be effective in our calling we must stretch the traditional definition beyond this commonly accepted interpretation. This post begins a series on how the "CIO 2.0" will push the boundaries of conventional thinking surrounding the role. We begin with the "Chief Ironman Officer."

The photo that serves as my avatar melds two of my passions: delivering technology innovations to improve the patient experience, and triathlon. In the foreground is my laptop. In the background is my tri-bike with associated gear. My dress is a mix of business and triathlon attire. Needless to say, the typical business picture idea bored me.

The avatar picture's conception is rooted in my Army Basic Training at Ft. Dix, N.J., 1982. Despite my varsity high school accomplishments and the recruiter's assurance, I failed the Army Physical Fitness Test. I lacked the strength to perform the requisite push-ups, sit-ups, and run. Humiliated, I promised myself that I would pass the final test. I decided right then to never let anything I had complete control over compromise my ability to influence.

In the end, I passed. From that point forward, I consistently ranked with the top 1 percent of American soldiers in fitness for the rest of my military career.

Because of my avid enjoyment of sports, not to mention my early Army failure, I pushed my son too hard to "be like dad." As a result, he not only rebelled but maneuvered down the fast track to obesity. As an overweight middle schooler, he found team sports unpalatable -- too much mocking and ostracizing. Thus, we toyed with multi-sports. Triathlons, biathlons and duathlons. A short time later he would become a routine podium finisher and eventually he ranked No. 4 in the country in duathlons. Our entire family had gotten involved, winning numerous races. My son and I in particular were hooked and have completed over 50 multiple sport events since then, including 2 half-Ironman events in 2007.

A full Ironman had not initially made it on my list of objectives. When a friend of mine was suddenly diagnosed with cancer early last year, I elected to battle the cause with her in my own way. All current training is carried out in honor and support of her fight. My time logged in preparation is sprinkled liberally with prayer for her and for the clinicians and researchers, that a cure might be found. In grooming for the Ironman (April 2008), I completed my first marathon in December (3 hours and 43 minutes). That's a lot of prayer sprinkles.

While I am not advocating that all CIO's should become an Ironman, I want to illuminate the profound lessons that apply to our profession:

Training. Many CIO's believe no further training is necessary once they have reached the top. To the contrary, the requirements only increase with elevation. Continually equip yourself or you'll end up being removed from the race for taking up precious space. Like riding a bike, you can coast for a little bit but if you stop peddling, you will fall over.
Shape. To the extent it is medically possible, stay in shape. The people you lead take their cues from you. Leaders bear the burden of visibility. Would you go to a pulmonologist who smokes? Or an orthodontist with crooked teeth? Studies have proven a correlation between physical and mental fitness. CIOs work long hours, which requires great stamina. You don't have to be an Ironman, but I encourage you to, at a minimum, follow the fitness recommendations of the American Heart Association.
Embrace change. During triathlons, a racer faces many unforeseen circumstances. A strong wind. High tide. Or worse, a flat tire. No one is exempt from these trials. Do you accept the change and make the most of it, or do you spend energy fighting the elements you cannot control? Adapt to the curveballs thrown your way, and then thrive.
Guts. It's not merely the most fit who wins Ironman. It's those who are fit and who want it. Crave it. I have surpassed colleagues in my career who were much brighter than I, but they had neither the fortitude nor the focus to push through all the challenges. Painful things happen that will tempt you to quit. Develop and harness the power of passion, for passion will create guts and drive your success.
Boundaries expanded. Early on, a 10K seemed like the ultimate race, an Olympic challenge. I never imagined attempting a marathon. Today, a 10K is a walk in the park. Ironman is busting the boundaries I originally believed invincible. As a CIO, you must continuously bust boundaries lest your organization becomes complacent and your vision dimmed and potentially lost.
Planning. No one simply wakes up and decides to do Ironman that morning. It takes advanced planning and years of transformational steps to see grand visions achieved. You must plan similarly for your career and your organization, analyzing both from short-term and long-term points of view. No greater sensation will seize you than when you see a plan fully executed and realized. It will fuel you to carry the journey into the future.
Rest and refueling. There is a science to Ironman which includes rest and refueling. Continuous activity leads to burnout. If you do not take the time for nourishment you will run out of energy, perhaps even collapse. Constant action is not synonymous with effective action any more than eating junk food is nourishing. Build in time for rest and refueling.

Some may scoff at how, and why, I have portrayed the Chief Ironman Officer. Others will complain about the limitations, physical or otherwise, and to why this post is irrelevant. Yet thinking back, I recall events in which the blind, the aged, the amputee, even the quadriplegic passed me along a course and encouraged me to keep going. I never thought I would say it, but I am thankful for my experiences as a 17 year-old basic trainee and for Drill Sergeant Moultrie screaming at me to eek out yet another push-up and run another lap. It is not so much about the physical act that inspired me but the leadership insights I internalized. Little did he realize the impact he would have on my life and career.

Or did he? Thank you, Sergeant Moultrie. Now, get out there and race!

Taking Control of Your Destiny

2007-12-17T17:18:00Z

The views and opinions expressed in this blog are mine personally, and are not necessarily representative of Texas Health Resources or its subsidiaries.

The capstone of holiday seasons past has been the Plunge -- leaping into the icy waters of Lake Erie, wearing nothing but swim trunks. Each New Year's Day, we triathlon club members gingerly -- if not insanely -- worked our way across the snow and ice then charged into the lake. Once we reached waist-high water, we crowned our feat with a head first dive. Like an arctic baptism, the Plunge magically washed away the old and welcomed the new.

Another holiday tradition my family has practiced for many years is a strategic planning retreat. From the oldest to the youngest, we'd evaluate and polish our personal plans. I first learned about the power of planning while studying business in graduate school. Later, in my first few jobs, I observed how leadership teams carved out time yearly to develop and hone mission and vision statements, which included values and objectives. These teams jetted off to exotic locations offering sunshine and sand or posh mountain lodges. Liberated from work distractions, they rated their company's performance against these plans and made adjustments for the following year.

Literature searches provided ample evidence that businesses with a solid planning process significantly outperformed their non-planning peers. I soon asked myself, "Could these planning principles be applied to my life? My marriage. My family?"

The Marx family's strategic planning adventure started modestly. Short, inexpensive, trips away from home reduced distraction and stimulated creativity. These trips eventually morphed into more elaborate excursions, but the focus always remained on strategic planning.

Since beginning this process, we have experienced dramatic increases in the quality of our careers, relationships and life. Even as preteens, our children possessed a solid knowledge of who they were, where they were going and what they needed to accomplish in order to fulfill their calling. We signed our plans and lived by them.

I could share numerous examples, but I'll share the one that had the most memorable impact. My son, age eight at the time, took a ruler and pointed to the values section of our "family strategic plan," which hung prominently in our family room. "Dad", he asked, "was that honoring mom when you yelled?" Seven months prior, while deciding which six values needed improvement that year, he contributed the word "honor." He was now calling me on it.

We were living what Rick Warren calls "The Purpose Driven Life." Decisions on how to spend our time, energy and resources were based on those planning retreats, which are documented and kept in binders. I could go back through 15 years of documentation and show you at least one significant event that happened each year in my career, marriage and family.

Could you?

I'm astonished at the number of organizations, divisions and individuals not guided by a written plan. What is the standard by which they measure success? What foundations and principles are ensuring their sound investments and decision-making? What is the vision that brings out their passion and gives them sense of purpose? Do they know the end game? Which values are serving as beacons to ensure integrity?

Earth-moving ideas existing only in a leader's head are not enough. He/she must write them out. Teach them. Actualize them. Moreover, there is nothing worse than going through planning exercises merely to have the plan collect dust. He/she must create a living vision!

Plunging into end-of-year processes and preparations for the upcoming year, my encouragement to you is to spend thoughtful time planning. If you don't have a strategic information systems plan, or one that is embedded in the overall business plan, then get out your calendar today. Block out time to work with your staff and key stakeholders and initiate this critical process. You cannot effectively lead your organization without one. The old must go so the new can thrive.

On the personal side, pack up your family, get out of town, and spend time in a setting where beauty can inspire you. Arctic baptism not required! Just a place free of distraction. Design a mission and vision together. Let the kids submit values by which all can live. Help them develop lifelong strategies and objectives, as opposed to New Year's resolutions that have the shelf life of unrefrigerated eggs. Envision your gang. Commission them. Then watch them rock not only your world but also the world around them.

My Journey to CIO

2007-12-03T15:30:00Z

The views and opinions expressed in this blog are mine personally, and are not necessarily representative of Texas Health Resources or its subsidiaries.

As a 16-year-old sanitation engineer (they called us janitors back in the 80s) working the evening shift at the 21st Medical Group Clinic at Peterson Air Force Base, I never envisioned myself having a health care career. I was more concerned about adjusting the volume on my new Sony Walkman than how dirty the floor looked. That is, until I met Tech Sergeant Samuelson. Samuelson worked in the ED where I signed in and out for each shift. He loved his job and it showed in his smile. He had a passion I did not. Unknowingly, Samuelson seeded my vision to serve in a profession where I could impact the lives of people -- as he did mine.

The summer prior to college, I enlisted in the Army Reserves and became a combat medic. Although I had limited opportunity to serve others in an actual crisis, I relished the time I spent training soldiers for the worst. It was more than a job. As my university studies progressed, I left the medical corps to be commissioned as a combat engineer officer. I enjoyed the challenge, but I missed giving shots and driving an ambulance. In a job that appeared to be a diverging footpath in graduate school, I gained an appreciation for technology and its ability to enhance processes and enable transformation. Consider it another experience that laid another slab in the foundation of my future. The question was how my passion for health care would meld with my emerging interest in technology.

As providence guided, I landed a position at a community hospital as an anesthesia aide. I had applied for dozens of senior positions, but because of my lack of relative experience, I couldn't land any interviews. As an anesthesia aide, I honed my clinical experience and learned more about patient care processes. This season was key to my future. I developed relationships with clinicians and administrators and was eventually offered a position in administration. Unlike the traditional CIO, I rose up through the business ranks while attaining both clinical and technology experience. In leveraging these three divergent disciplines, I discovered my niche but, moreover, I allowed my vision and passion to move me forward into my calling.

My career soared and afforded me many cherished memories of institutions and people about whom I will write. I have served as a leader in academia, single hospitals and IDNs, for-profit and not for profit, the last 5 years as a CIO. But what stokes my fire each day is knowing in my heart of hearts that what you and I do as professionals in health care information technology has a significant impact on those whom we serve, primarily our collective patients. Stay tuned to "CIO Unplugged."