My Management Philosophy on Feedback

Recently, we got a glimpse into internal emails sent by Steve Jobs and Bill Gates.  They were both to a large audience and both were critical of internal efforts.  I found these to be reassuring in that they seem to echo my own personal philosophy regarding employee feedback:  Be candid, tell people (individually or collectively) when they do a good job and tell them when they don’t meet your expectations.

I prefer to give feedback direclty to the people, even if there are levels of management between us.  To some people this may be a bit of a shock.  In my experience many managers have trouble giving people negative feedback.  But I believe people need to understand what is expected and how they need to improve to meet expectations.  Hearing it directly from me has additional weight and ensures nothing is lost through intermediaries.

Of course there are a number of amazing things being done at Affinity and Ministry every day.  I try to thank people for their extraordinary efforts.  It is hard to recognize all of the good work.  It is one of the most challenging things in a division of 200+ people.

Failure

My person approach to IT management centers around success.  Most IT projects fail.  Some quite spectacularly, but most in a quieter way.  I believe these are the three leading contributors to failure:

Poor Project Plans and Resource Allocation

My personal experience is that most IT departments do not have a good sense for the amount of time they have to spend on IT projects.  All of the data I have collected since I have been studying this suggests that only 15% to 25% of total staff time is available to work on new projects.  If organizations take on more work than they can complete, everything proceeds at a snail’s pace and nothing ever truly gets done.

The only way to manage resources in a large organization is to have detailed plans for every project and to look at the resource requirements across all of your plans.

Vendor Performance

Just as IT departments over-allocate their resources, so do vendors.  Vendor performance issues are usually more related to them not providing services in the time expected (or not having a common expectation with the vendor) than bad software.  However, sucky software is still an issue.

Lack of Clear Expectations

If someone’s goal is just to implement some software than, in my opinion, they have failed by default.  Each IT implementation should have clear business benefits and those benefits need to remain insight throught the effort.

Am I missing other common contributors to failure?

Super Users

The Most Super UserThere is a role for super users to provide just in time training and to serve as moderators of user groups. However, there is a tendency for folks to believe that the super user is the person that handles anything above the most routine use of the technology. Having super users cannot reduce the expectations of the rest of the work force. Every employee must be tech savvy and leverage the tolls provided in order for us to have any hope f achieving a return on our very expensive IT investments.

What do you think?

CIO Job Description

I know that there are folks out there looking for a job description for a healthcare CIO. So, I am posting mine to aid those people in their search. Feel free to leave a comment if you have any thoughts or questions.

POSITION DESCRIPTION

SCOPE OF RESPONSIBILITY

This leader is the Chief Information Officer (CIO) for the Ministry Health Care System and will lead the transformation to a centralized Information Technology (IT) service through an Information Technology Shared Services Organization. The CIO will provide technology vision and leadership for developing and implementing information technology initiatives. This individual is responsible for the planning and execution of an information technology vision, goals and initiatives that support the long term objectives, mission and vision of Ministry Health Care (MHC) across North Central Wisconsin and at each of its sites. This leader will collaborate with leaders at the highest level of the organization and manage a team of professionals who are accountable for the delivery of all information technology services in the System. This position will be located in Central Wisconsin, in Wausau, Weston, Stevens Point or Marshfield. The CIO will report to the Senior Vice President and General Counsel. This individual will work in a manner that is consistent with a tax exempt Catholic health care organization that supports the mission of the Sisters of the Sorrowful Mother.

PRINCIPAL ACCOUNTABILITIES

IT Governance and Portfolio Management

  • Lead a governance structure that aligns IT initiatives with business priorities while balancing resource constraints (human and fiscal) to optimize IT investments (The IT Portfolio). This governance process will produce an annual IT plan and budget that is integrated into the system planning and budgeting processes.
  • Responsibility for the selection, acquisition, development, installation, maintenance and support of information technology for Ministry.
  • Manage, in conjunction with other leaders, the project approval and selection process.
  • Ensure that all initiatives in the IT portfolio have clear business goals and success metrics.
  • Monitor and report on the performance of the IT portfolio including actual vs. expected results, budgets and project duration.
  • Perform an ongoing assessment of IT capabilities of employees and contractors and IT performance on behalf of entities across the System. Evaluate performance and skill against Ministry needs.
  • In conjunction with other leaders, understand and establish the working relationship with the Project Management Office or similar business unit responsible for organizing the timely completion of Ministry projects.
  • Oversee relationships between Ministry’s IT resources and external entities (e.g. government, vendors, researchers and other health care organizations).

SSO Development, Operations and Technical Support

  • Management responsibility for all IT activity under a matrix reporting structure from the date of hire and thereafter in accord with the structure of the Shared Services Operation (SSO).
  • Develop the Information Technology SSO and develop a permanent reporting structure and a service delivery model for the SSO. Establish processes and metrics necessary to make the SSO successful.
  • Understand application architecture and technical infrastructure (including Marshfield Clinic components) of MHC information systems and regularly assess the MHC vision and direction.
  • Develop a strategy and plans for the technical infrastructure and application architecture for MHC and execute the plan. The plan shall include standards and protocols for data exchange, communications, software and interconnection of information systems.
  • Develop a service level organization that establishes service standards for corporate office and each entity served by the Shared Services Operation. Capture the service level commitments in a Service Level Agreement between each entity served (including corporate office) and the SSO.
  • Establish and maintain a service orientated, customer focused IT function that supports ongoing operations that drive efficiency, quality, customer service and growth. Develop service level agreements and manage to agreed upon performance levels for application availability, response time and network performance.
  • Ensure that enterprise information systems operate according to internal standards, external accrediting agency standards and legal requirements.
  • Ensure the protection of IT assets and the integrity, security and privacy of information entrusted to or maintained by MHC.
  • Develop and maintain a business recovery plan to ensure timely and effective restoration of data and IT services in the event of a disaster.
  • Oversee the negotiation of all IT contracts.
  • Identify and implement formal training and education as needed throughout IT in conjunction with the Education SSO.
  • Complete Talent Reviews and development plan for IT personnel.

Clinical Transformation

  • Work with other leaders to identify the role of the Office of Medical Informatics and the roles of the Chief Medical Informatics Officer (CMIO) and other medical informatics leaders and their relationship to the CIO.
  • Assess existing efforts, initiatives and successes in working to establish an electronic medical record, lead the initiative to establish a new vision and strategy for a platform to support the provision of clinical services and execute the identified clinical information strategy.

Communication and Collaboration

  • Provide advice and counsel concerning IT issues and industry trends.
  • Communicate to Ministry’s business leaders the plans for continued standardization efforts of information technology (IT) across the system and collaborative efforts with Affinity Health Care. Clarify their role and the need for collaboration across the system to achieve standardization. Provide methodologies for working together toward standardization. Assign resources to areas where standardization is being achieved. Re-direct efforts that lack a system-wide approach.
  • Conduct IT planning in conjunction with the Marshfield Clinic to facilitate co-dependency and appropriate alignment between the organizations.
  • Develop positive relationships with MHC leaders by understanding business priorities and IT enablers.
  • Participate in the strategic planning process and share in the development of Ministry vision, goals and initiatives.
  • Frequently and effectively communicate the IT vision and plans throughout Ministry. Use targeted communications that are appropriate to the various stakeholders. Build excitement around the planned changes and understanding for the selected priorities.

Mission Integration

  • Work in a manner that reflects the mission and philosophy of MHC and the Sisters of the Sorrowful Mother, including but not limited to compliance with the Ethical Decision Making Process.

Other duties as assigned.

  • Under the supervision of the Senior Vice President, perform other duties as assigned.

EDUCATION AND EXPERIENCE REQUIRED

Education:

  • Bachelor’s Degree in Information Systems, Engineering or related area from an accredited institution is required. A Masters Degree is preferred.

Experience:

  • Demonstrated experience with IT systems and IT management as a senior level with a sequence of increasing responsibilities in large and diverse business settings. Familiarity with health care or health care related organizations is expected.
  • Experience with and understanding of strategic and business planning methods, tools, and processes.
  • Experience in working through major organizational change

Specific Qualifications:

  • Familiarity with the health care industry – its critical issues and major challenges
  • A track record of working in a geographically diverse complex organization
  • A track record of successful large project implementations
  • Demonstrated business savvy to work effectively with other Executives to achieve key business and technology goals.
  • Demonstrated project management skills.
  • Lean Six Sigma experience a plus.

PERSONAL AND PROFESSIONAL ATTRIBUTES

This individual will understand and have a commitment to the philosophy, mission, values, and vision of Ministry Health Care. The individual will be able to demonstrate these values with his/her leadership practices. This person will possess personal and professional integrity, strong communication skills and an excellent professional appearance and presentation. Strong analytical and decision-making skills along with considerable tact and diplomacy are important considerations. The individual must possess strong leadership and managerial skills, strong interpersonal skills, a good sense of humor, high energy level and a positive outlook. Other attributes include the following:

  • Is respectful, honest and demonstrates integrity and ethics.
  • Listens effectively, shares ideas and information openly and facilitates relationship building by establishing trust.
  • Experience in building a new model to serve the IT needs of a complex organization
  • Has functioned at an operations level and in a complex multi-facility environment.
  • Interested in serving as a mentor to others.
  • Possesses initiative, good judgment and the ability to problem solve.
  • Possesses strong business acumen with proven experience in thinking strategically and implementing tactically.
  • Has handled demanding workloads to meet objectives.
  • Is customer focused/service oriented, and has effectively affected change.
  • Works effectively with physician leaders and, in particular, a chief medical informatics officer.
  • Broad IT infrastructure and application architecture knowledge.
  • Experience in portfolio management
  • Is driven, compassionate, and creative.
  • Embraces positive conflict.
  • Team player.

PHYSICAL REQUIREMENTS

  • Moderately quiet office environment.
  • Ability to travel, sometimes overnight, by auto or small plane.
  • Occasional lifting of 10-20 pounds.
  • Sufficient vision acuity for routine computer use, and moderate to heavy reading and writing responsibilities.
  • Position requires walking, sitting and standing at moderate levels.
  • Stamina able to be maintained to manage a work level that normally exceeds 40 hours per week.
  • Position requires a high level of all forms of communication skills: written, verbal, listening.

Modern Healthcare Online – EHR and Physician Anger

David Burda’s piece on physician anger with Electronic Health Records is interesting (Alexis Polles is the original presenter).  Modern Healthcare’s Daily Dose suggests these frustrations are related to poor design and poor training.  Of course excellent design would minimize the need for training.  I agree with that take.

However, the original speaker seems to indicate that some physicians are unable to adapt to this way of practicing medicine.  Our experience is that 1 to 2 percent of doctors may have trouble embracing clinical IT (regardless of design and training).  As you prepare to roll out your clinical IT systems I think it is critical to know how you will handle that 1 to 2 percent.  I hear a lot of people talk about a “lack of senior management support” with clinical IT efforts.  I think we put senior leaders in a tough position when the checks are signed and the physician problems beginning to pop up.  If you have that conversation in advance and agree on the course of action, we will find senior leaders more support.

It will be useful to discuss some real uncomfortable scenarios.  What if the one physician hold-out is your top admitter?  What if you are experiencing 10% physician resistance?  Too often we sugar coat these challenging projects.  That will really cause a lack of senior leader support when your EHR or CPOE effort turns out to be something other than the bed of roses it was portrayed.

I report to General Counsel

Over the years there has been a lot of debate regarding where the CIO should report. Most of the noise comes from CIOs that determine their self-worth by reporting to the CEO. I know this, because I used to be this way. But, the CEO is not always the best person. I now strongly believe that this is dependent on the organization and the leaders. There are very few generalities one can apply to this topic. The best example is here at Ministry. I report to the General Counsel. Now, this is very mis-leading. Our General Counsel, Ron Mohorek, is a top executive that just happens to be lawyer by education. Because of that background he is naturally in charge of legal matters. But, his greatest contribution to the organization is his ability to be strategic and tactical. This is where he spends most of his time.

Legal and IT matters are very similar. In both disciplines there is a temptation to hand over a business matter to the lawyer or the IT guy. In both cases this usually results in disappointment, especially when the business leader is not clear on what they are trying to accomplish.  Ron’s understanding of this greatly advances my cause to keep the accountability for IT initiatives out of IT (except the technical stuff).

At Affinity I do report to the CEO. And, this seems to be the best fit for that organization. I would love to hear your thoughts.

Healthcare Blogging and Web 2.0

Bob Cofield has written an amazing summary on “Healthcare Blogging and Web 2.0” and posted it to his blog. I found it because he linked to this blog (thanks for the publicity). Unless he asks me not to, I intend to use the content to educate our leadership on these topics. In general, I think healthcare leaders lag behind the top of the technology adoption curve. I suggest other healthcare leaders consider using this content to improve the tech savvy of their leadership.