Friday, November 2, 2007

It's not a job, it's a lifestyle

I'm often asked, "What is your job?"

Some may think that being a CIO is all about bits and bytes, buying the latest technology and keeping up with all the three letter acroyms of the industry (I use WPA over EAP instead of WEP on my wireless network, what do you use?).

The technology portion of my job is about 15% of my time. The bulk of what I do is organizational, political, and customer relationship management. With hundreds of projects, thousands of customers, and millions of dollars, how do I keep it all straight?

My approach is 4 fold:

1. Strategy - The Information Technology department in every organization should not make the business strategy, that is up to the Board, CEO, and stakeholders. The IT organization should provide the tactics necessary to execute the organization's strategic plan. For example, if the strategy is to improve quality, the information technology organization can implement e-Prescribing, provider order entry, bar coded wrist bands, and incident tracking systems. Every year, I approach the strategic planning process by meeting with the CEO, CFO, COO, Chief Medical Officer, Chief Nursing Officer, and Chief Academic Officer to understand their strategic imperatives for the year. The next month, I meet with their direct reports to understand the operational implications and challenges of these strategic imperatives. I then produce an "IS Operating Plan" (note, that it is not a strategic plan), which is placed on the web for all stakeholders to review and presented to my IS Steering Committees. I have a Steering Committee for inpatient applications, outpatient applications, critical care applications, Operating Room/Anesthesia, Laboratory systems, Radiology systems, and Health Information Management (Medical Records). The chairs of each of these committees plus clinician representatives from the Medical Executive Committee serve on the enterprise wide Information Systems Steering Committee which ensures coordination of resources among all the projects. Once these committees approve the priorities for the year, we ensure the operating and capital budgets are aligned to do the work.

2. Structure - Once the operating plan is in place, I ensure the structure of the organization is arranged to support the projects to be done. Over the past 10 years I've done several mini-reorganizations to respond to changing technologies, customer needs, and governance issues. Note that the ideal structure is defined before taking into account the existing staff personalities and skillsets. To build an organization that delivers reliable service over time, I try to avoid single points of human failure, distributing work across many individuals rather than relying on a "lone genius", since reliance on one person is ultimately unsupportable.

3. Staffing - One the structure is in place, I ensure we have the best staff possible to populate that structure. I'm a strong believer in training and we try our best, given limited budgets, to hire talented people and continue their education so they remain world class experts. I'm also a great supporter of co-op programs for college students, bringing in new graduates, training them and hiring them to ensure a constant supply of new talent entering the organization.

4. Processes - Finally, once the staffing is in place, I work on the highly repeatable processes that support our workflow. The organization functions most smoothly when policies and procedures are well known by all internal and external to the organization so that I can monitor the performance of known processes, rapidly identifying areas where we can improve service delivery. Metrics I review include infrastructure uptime, electrical consumption, help desk call abandonment rates/time to problem resolution, budget performance by manager, and performance against project timeline milestones.

At the beginning of each day, I ask myself if the strategy, structure, staffing and processes are as good as they can be. At the end of each day, I mentally review the issues of the day affecting each of my direct reports and offer mid course corrections, which are most often organizational and political. I also try to communicate broadly via town meetings, email broadcasts, weekly leadership meetings, and monthly 1:1 meetings with each of my direct reports.

Finally, I try to reserve 50% of my time each day for the important issues of that day. Explaining to a customer or IS employee that I cannot respond to a critical issue for weeks because my calendar is booked far in advance does not work. If I can do today's work today, my calendar has the same number of meetings, but I become a real time responder to issues before they escalate. Having a Blackberry strapped to my belt 21 hours a day also helps me use my time efficiently and ensures I am not the rate limiting step in any decisionmaking process.

Of course I have a family life, personal time and outside interests, but being a CIO is a lifestyle, not a job. I'm connected to the strategy, structure, staffing and processes of the organization 24x7x365.


Mark Turuk said...

Out of curiosity, how does BIDMC manage projects? What tools are you using? Do you have a PMO in place?

Do you try and follow methodologies, like Six Sigma or PMI's PIMBOK?

Thank you and Regards,


Anonymous said...

Good summarization on how to do the job from another healthcare CIO. Appreciate your willingness to share your method.

Anonymous said...

So that's what you do . . . .