CIO Unplugged : Executive Issues

Why Health Care IT Lags

Edward Marx — Tue, 17 Nov 2009 18:05:00 GMT

The views and opinions expressed in this blog are mine personally, and are not necessarily representative of Texas Health Resources (THR) or its subsidiaries. Last week, one of our hospitals went live on CPOE. My boss and I were there as part of the ribbon-cutting...(read more)

Best and Worst of Leading

Edward Marx — Tue, 03 Nov 2009 21:06:00 GMT

The views and opinions expressed in this blog are mine personally, and are not necessarily representative of Texas Health Resources (THR) or its subsidiaries. "It was the best of times, it was the worst of times; it was the age of wisdom, it was the age...(read more)

Work-Life Balance…Debunked!

Edward Marx — Tue, 06 Oct 2009 21:29:00 GMT

The views and opinions expressed in this blog are mine personally, and are not necessarily representative of Texas Health Resources (THR) or its subsidiaries. The first thing we boys did after disembarking the school bus was head north for the neighborhood...(read more)

The Politicalization of Health Information Technology

Edward Marx — Tue, 22 Sep 2009 20:26:00 GMT

The views and opinions expressed in this blog are mine personally, and are not necessarily representative of Texas Health Resources (THR) or its subsidiaries. Admit it. Health information technology (HIT) deployment is headed nowhere fast. Despite the...(read more)

The Lost Art of Mentoring

Edward Marx — Wed, 12 Aug 2009 14:34:00 GMT

The views and opinions expressed in this blog are mine personally, and are not necessarily representative of Texas Health Resources (THR) or its subsidiaries. Who taught you life skills? Did anyone coach you in the ways of culture and values? An uncle?...(read more)

Legacy Leaders

Edward Marx — Tue, 14 Jul 2009 23:31:00 GMT

The views and opinions expressed in this blog are mine personally, and are not necessarily representative of Texas Health Resources (THR) or its subsidiaries. How can so many of us hold the title of leader, yet never be remembered? Why do some leaders...(read more)

Social Networking: Why Every CIO Must Open the Gates

Edward Marx — Tue, 30 Jun 2009 14:56:00 GMT

The views and opinions expressed in this blog are mine personally, and are not necessarily representative of Texas Health Resources (THR) or its subsidiaries. As the printing press fueled a transition from the Dark Ages to the Renaissance, Social Networking...(read more)

Meaningful Meaningful Use?

Edward Marx — Wed, 17 Jun 2009 13:53:00 GMT

The views and opinions expressed in this blog are mine personally, and are not necessarily representative of Texas Health Resources (THR) or its subsidiaries. I ran a "night before vacation" errand to Lowe's. As I completed the purchase, the store manager...(read more)

It's Not About You

Edward Marx — Wed, 03 Jun 2009 14:40:00 GMT

The views and opinions expressed in this blog are mine personally, and are not necessarily representative of Texas Health Resources (THR) or its subsidiaries. I dreaded visits from Battalion HQ. Bravo Company operated fine without Big Brother coming down...(read more)

Facing Fear: A Key Performance Indicator

Edward Marx — Tue, 19 May 2009 23:02:00 GMT

The views and opinions expressed in this blog are mine personally, and are not necessarily representative of Texas Health Resources (THR) or its subsidiaries. I landed on the bottom of the ocean, staring up at the surface. Before I could process what...(read more)

Welcome, Welkommen, Bienvenu, Bem-vindo, Bienvenido, Vítaný

Edward Marx — Thu, 16 Apr 2009 00:56:00 GMT

The views and opinions expressed in this blog are mine personally, and are not necessarily representative of Texas Health Resources (THR) or its subsidiaries. My family will host our 6th foreign exchange student this fall. Anne will join us from Germany...(read more)

Why Dictators Burn Books

Edward Marx — Tue, 10 Mar 2009 20:04:00 GMT

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

IT performance and costs symptomized our health system's deterioration. The then-new CEO appointed me interim CIO with the following charge: "Immediately improve IT performance at a lower cost."

Success meant the job was mine. Failure would prove I squandered my opportunity.

Although I had several ideas to jumpstart IT in concert with the health system at large, my biggest obstacle would be the nature of our outsourced IT operations. Two years prior, we had completely outsourced to three companies who had formed an "unholy" alliance of sorts. All parties had competing agendas. I had to get everyone on the same page, fast.

We narrowed the outsourced parties down to two, then eventually to one manageable vendor. Deploying numerous strategies and tactics, we lowered costs and improved services. During this process, we identified and addressed the single biggest, critical factor: winning the hearts and minds of our staff. The outsourced vendor held allegiance to their stakeholders; the line staff was torn between their new corporate parent and the health system. We had to align allegiances and ensure everyone was of one mind and one vision toward the health system and its patients. This proved key to our success.

We achieved a modicum of success working with the vendor leadership, but it wasn't happening fast enough. So we started spending a few minutes of each staff meeting reviewing chapters of relevant books with the intent of getting everyone focused on doing the right things. For many, this was the first time they'd opened a book since graduate school. Some were transformed by what they learned.

Why did dictators burn books, we wondered?

Time pressures for our turnaround continued to build. We were improving services and reducing costs but had very little margin for experimental failures. We needed to do more. What if we provided books to all the staff and kindled a great awakening? Since we were already reaping moderate results from our leaders why not target all of IT? While applying pressure from the top down, couldn't we also encourage radical change from the bottom up, even create a revolution? I was confident that somewhere in the middle we would win hearts and minds and become one of the best leveraged IT organizations in present-day health care.

It worked. Fast. We offered four classes per quarter, and each filled within days of availability. We taught leadership, teamwork, customer service, change management, finance, and more leadership. Staff copied portions of their books, brought them to their managers and directors, and started asking questions, making suggestions. Some started covert studies of their own with teammates. They started changing their approach to work.

Revolution had begun, and nothing could stop it. We continued lowering IT costs while improving services. Our overall health system performance exceeded expectations. We were winning the local market. Wall Street took notice of our financial recovery and prosperity. But most important, our clinical outcomes ranked among the best in the nation.

Our book studies didn't end there. In fact, my greatest joy came during our 6th cycle when, for the first time, all four classes were taught by line staff. No supervisors, managers, directors, or VPs. During my four years as CIO, I witnessed the completion of over 30 distinct book studies and trained over 400 staff. We lowered apples-to-apples costs for IT by over 25 percent and quadrupled our externally validated customer satisfaction scores. Revolution at its zenith!

When I became CIO of my current health system, one of my first strategies was to deploy "book studies." I started with my direct reports, and today we hold four classes, 4 quarters per year. I taught the majority of classes the first year so I could meet as many staff members as possible and share my philosophies and passions with them directly. After one year, we had a complete quarters-worth of classes taught by non-leadership. Today, I continue to teach or attend at least one class per quarter to maintain my professional development.

Now you know why dictators burn books. They fear the power that comes through knowledge and enlightenment. They are afraid of how the written word can cause change, and, if done well, bring revolution.

From a practical standpoint, here is what seems to work well:

Charge a modest fee for the class. Return the fee for 80 percent attendance. Non-returned fees are donated to United Way.
Lead the first sets of classes yourself so you can model the process. Then delegate teaching to your direct reports. Expand to line staff as you find alignment between a person's passion, ability to teach, and the general need for the topic.
Classes early in the day seem to have the most traction.
Books with associated workbooks work especially well.

Here is a sample listing of the books we have leveraged through the years. While we have our reliable classics, we always scan for new books:

Purpose Driven Life
Hospital Management (inhouse)
First, Break all the Rules
17 Irrefutable Laws of Teamwork
21 Indispensible Qualities of a Leader
Emotional Intelligence
Innovators Prescription
Social Intelligence
Disintegration
Servant Leadership
Finance for Dummies
Financial Peace
Good to Great
Built to Last
360 Degree Leadership
Competing on Analytics
Human Sigma
The Leadership Challenge
How to Give a Damn Good Speech
Leadership (Giuliani)
Inside the Magic Kingdom
Leadership Secrets of Atila the Hun
Fish
Blown to Bits
The Heart of Change
The Fifth Discipline
Jack; Straight from the Gut
Now, Discover Your Strengths
Please Understand Me (Myers-Briggs)
21 Irrefutable Laws of Leadership
Developing the Leader Within You
Thinking for a Change
The Art of War
Lincoln on Leadership
A Message to Garcia
The Fred Factor
If Disney Ran Your Hospital
High Five
The No A--hole Rule (title edited)
Churchill on Leadership
Drucker on Leadership
Raving Fans
The World is Flat
Gung Ho!
Five Dysfuntions of a Team
Death by Meeting
Who Moved my Cheese
It's Your Ship
The Five Temptations of a CEO
The Four Obsessions of an Extraordinary Executive
Technical Stuff for Non Techies (inhouse)
Application Stuff for Non Apps (inhouse)
James and the Giant Peach
Several others...

No Pain, No Gain

Edward Marx — Thu, 26 Feb 2009 17:17:00 GMT

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

Sounds trite, I know. Some will accuse me of simplemindedness. Others will say this high school football-coach philosophy is dangerous. I agree, but still embrace.

In my thirties, I got back into playing tennis and started thrashing on the courts with some friends from work. As we verged on competitive levels, I realized we needed to pick up the intensity. A consistent first serve was the performance key. Reliance on the second serve would allow your opponent to take the offensive. Although a high, first-serve percentage alone would not make you a Wimbledon champion, you'd at least guarantee yourself a quarterfinal match. We practiced at 6 a.m. thrice weekly, but I showed up at 5 a.m. to serve buckets and buckets of balls. I'd chase them down and start over again. No pain, no gain.

Now in my forties, I'm taking on the challenge of perfecting the Argentine Tango with my wife. In addition to a weekly two-hour lesson and a monthly milonga, we practice. Even if for only twenty minutes, we practice every evening. We have to, because the Argentine Tango happens to be the most artistic, intellectual and difficult dance ever created by man. If I catch my partner's foot too late, we miss our sweep. If we're too far apart, one of us loses balance. I figure if we aim for expert, we might reach proficient by the time I'm eighty.

Like our dancing, my relationship with my bride of twenty-four years has been full of ups and downs. The overall trend slopes upwards to the right, but it's interrupted with numerous peaks and valleys. Some downturns take years to correct, yet we keep at it. Annual strategic planning vacations, numerous marriage conferences, lots of books, prayer and counsel. We've fought hard to reach the point we're at today, and there is more pain to endure, I'm sure. Had we chosen not to push through the pain during any of the valleys, who knows where our marriage would be? Certainly not growing, not gaining.

And what about a career? Can you ascend the leadership ranks by good luck or good looks? Not in my case. It took pain -- blood, sweat and tears. Which meant not taking shortcuts. Not submitting C-level work. Not shaving time here and there to start the weekend early. But it's so tempting!

I hear you. But do you want to reach the fulfillment of your calling? Then sacrifice. Love the pain.

A few years back, I had to spend a significant amount of time on the road. The librarian at Parkview Episcopal Medical Center (CO) supplied me with endless materials, from business books on tape to vocabulary-building materials. While driving, I'd listen to these resources over and over until they became part of my intellectual fabric. Would have I preferred to listen to U2 or another favorite band? Of course. But to grow, I needed to take advantage of every morsel of time. I also volunteered for everything in my path; some related to IT, others benefited the hospital or another department. Would I have preferred to go home early or have a smaller to-do list? Certainly. But to maximize my potential and opportunity, I needed to self-sacrifice -- so far as it didn't harm my family. Plus, it was only for a season. Every season brings different opportunities, which require fitting sacrifices.

Today, I've made sure we have a library of materials available for our staff to check out. Hundreds of books and CDs on tape. We have subscriptions for "book of the month," a concept I leveraged from the Parkview librarian. Just as serving thousands of balls to ghosts at the break of dawn paved the way to winning several tournaments, or investing the time and money to improving my tango to keep me on the dance floor, pain brings gain.

Don't expect to just show up on the dance floor and look like a pro. If you want someone to ask you to dance, practice.

No pain, no gain.

Other Duties as Assigned

Edward Marx — Tue, 10 Feb 2009 20:01:00 GMT

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

One objective of this blog is to give a transparent window into the life of a health care CIO. Certain aspects of being a CIO, which generally apply to the entire C-suite, are the numerous external "other duties as assigned." The list is by no means complete and only reflects what I've grown to understand from working at two large health care systems. But I suspect every CIO operates in one if not most of these assignments. (I will remain purposefully vague as to which role is current or former.)

Politics. Be involved. Get out there and shake hands to further the cause of health care and your institution. Sometimes this means attending fundraisers for a politician who represents health care or for your city or state hospital association. Take part in advocacy efforts and help educate our governing bodies.

Fundraising. Lead by example through the opportunities that come your way. Create margin in the household budget. In addition to established opportunities, we created our own annual IT fundraiser for a children's hospital that raised over $100,000 this last year.

Parties. Important social gatherings pop up often, and attendance is not always voluntary. I started out naïve; now I own a tux.

Appointments. Consider these an honor and an opportunity to give back to the larger community. I have held very formal state-level appointments as well as less formal city and county appointments on behalf of my employer. But don't be a wallflower. Speak up. Invest yourself to further the cause. Otherwise, don't bother accepting the position.

Boards. Many organizations are in dire need of talented people to help provide direction and ensure accountability. These boards can range from an international for-profit corporation to a local, not-for-profit homeless shelter. Always check for potential conflicts of interest first.

Task forces. Often times these are directly related to health care but in a broader community sense. For instance, you might join a task force to research the feasibility of a regional HIE.

Advisory councils. My all-time favorite was serving on the College of Design and Merchandising (fashion) Council at Colorado State University. I was the only non-model, non-designer asked to join the judging panel at the annual fashion show. Lights, models, cameras, crowds -- and me sitting at the runway's end with a tie that didn't match my suit.

Professional associations. It's critical to remain actively involved to advance our profession. I have served on several national HIMSS committees and as state chapter president (TN and OH). I have spoken on behalf of HIMSS and CHIME throughout the country.

Speaking and publishing. There is a healthy expectation that we add to the body of knowledge by sharing best practices, evaluated experiences and tangible results. I have spoken on behalf of and been published in and outside of health care. The bonus: It contributes to your growth.

The common thread among these "other duties as assigned" is what makes them so valuable and important and why you need to take an active role. They:

allow you to give back to the broader community at large;
provide a framework for you to help advance a specific organization or initiative;
enhance your own personal and professional development;
broaden your networking and social contacts;
enhance your organization's position in the community and profession;
force you to think outside of yourself; and
ideally make the world a better place.

CIO reDefined: CIO 2.0 Chief Innovation Officer

Edward Marx — Tue, 27 Jan 2009 23:25:00 GMT

The views and opinions expressed in this blog are mine personally, and are not necessarily representative of Texas Health Resources (THR) 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 Innovation Officer."

Neglecting science credits finally caught up with me my senior year of high school. I'd hoped to coast through my last year and focus on non-academic pursuits. Instead, I was stuck taking physics while friends took basket-weaving, underwater-firefighting and equivalents. Deep into the first semester, my grade sunk low enough to negate my eligibility for tennis and soccer. I became desperate. While negotiating with my teacher, he said if I came up with a unique physics project that would blow his socks off, he'd consider it extra credit worth one letter grade.

Partnered with a classmate in a similar predicament, I set out to demonstrate how human energy could be converted to electricity to power an appliance. For a couple of 17-year-olds with little experience and no formal instructions, this required some serious innovation. We found an old bike and welded it to a stand. We purchased a used car alternator, pirated a battery and "borrowed" an appliance. With some help from my classmate's dad, our prototype worked. We impressed our teacher enough to raise our grade and keep us in good standing with parents, coaches and our future universities.

Innovation is not reserved for youth. On the contrary, it is the price of admission for the CIO 2.0. We must have the talent to innovate, or at the very least, the vision for innovation. If we are unable to innovate, we must gather others around us who have this core talent, and then give them the freedom required for success.

I previously described an innovation that came about via a Glorious Mashup. We codenamed the innovation "CareTube" and trusted it would revolutionize training, especially for time- and pride-sensitive clinicians. It would also enhance our already high CPOE adoption rates. More recently, we worked with Microsoft and Infusion to create a new model for enhanced physician and patient communication. At a Gartner conference, our model was voted the most innovative application of technology. (For more detail, see ADVANCE's January 2009 print edition, page 30.)

For IT to become strategic and make a difference, IT leaders must innovate constantly. Remain decidedly against the status quo. Always ask, "How can this be leveraged or improved?" "What new use can be created out of...?" "What if...?" Change scenery regularly. Play games like Cranium or build with Rokenbok, anything that stimulates you to piece the world together differently. Read insatiably then set aside time to think, giving absorbed knowledge time to sift and settle. Understand when is the right time for the right innovation.

Are you innovating? If yes, model for others and replicate yourself. If no, then begin to or find and release those who are.