Leading or Inheriting a Health IT Team


Bill Russell / Mark Weisman

This Week in Health IT

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September 2, 2020: What do you do in the first 90 days of a new leadership role? How do you take over a new team? Mark Weisman of Peninsula Regional has moved into a new CMIO role and today he’s picking Bill’s brain on finance, people, operations, strategy and communication. The number one thing you’ll need is clarity. What do your constituents want and what do your employees want? Because they may not be the same thing. Are we giving them the tools they need to be successful? Healthcare IT is 80% people, 15% process and only 5% technology. How do we create a “Yes, And” culture instead of “But, No”.

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Leading or Inheriting a Health IT Team with Mark Weisman

Episode 298: Transcript -September 2, 2020

This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.

[00:00:00] Bill Russell: Clip notes is the fastest growing email list that we’ve ever put out there. And if you want to know why it’s, because it’s a great way to know who was on the show and what was said. One paragraph summary, key moments in bullet point format with time stamps and one to four video clips from the show right away for you to stay current, share insights with your team and maintain your commitment to their development.

During these extraordinary times, sign up at any episode, page or the easiest way to sign up, send an email to clip [email protected] C L [00:00:30] I P N O T E S. And you will get an email back from me with the link to get signed up with This Week in Health IT. My name is Bill Russell, healthcare, CIO, coach, and creator of This Week in Health IT a set of podcasts, videos, and collaboration events dedicated to developing the next generation of health leaders. This episode and every episode, since we started the COVID-19 series has been sponsored by Sirius Healthcare.

Now we’ve exited that series, but Sirius has stepped up to be a weekly [00:01:00] sponsor of the show through the end of the year. Special thanks to Sirius for supporting the show’s efforts to develop the next generation of health leaders. I got a call out of the blue from a friend of the show, Mark Weisman.

 He does the CMIO podcast. And he’s just been moved into a new role, inherited new staff. And he said Bill, I’d like to pick your brain.  What do you do in the first 90 days? How do you establish vision? How do you step it up? Just all the things that I do in my coaching practice.

And he had the [00:01:30] idea to record the show. And we’re going to air it on both channels. So on his CMIO podcast, you can hear this or you can hear it on This Week in Health IT and it’s just a discussion. Mark, mostly Mark asking me questions and me just responding on how I approached the first 90 days as a CIO for the health system that I inherited and just a little back and forth. I really enjoy doing it. I hope you enjoyed it as well. 

Mark Weisman: So welcome to the joint podcast today. You’ve got Bill Russell with This Week in [00:02:00] Health IT and Mark Weisman the moderator for CMIO podcast. And we’re doing something a little different today. This is going to appear on both of our websites, where they tend to be very complimentary anyway. We think we have a lot of overlap in our audience, so we appreciate you all joining us for this session. I called up Bill. I’m now in a new position, CMIO and myself from Peninsula Regional, we now have [00:02:30] 60 plus ahmad Epic analysts reporting to us. And so the topic today is taking over a new team, what that’s and we’re not the only ones in healthcare IT who are doing this. There are others who are stepping into leadership roles that are different. So we thought the topic would be applicable to a lot of people. I get to pick Bill’s brain for a little bit here on some of the things that he would do if he was taking over a new team and what are the first 90 days.

So  [00:03:00] Bill that’s where I think we should go with it. How about you? 

Bill Russell: Mark I’m looking forward to doing this. This should be fun. I, and by the way, happy birthday. So everyone who’s out there who has Mark’s email address, go ahead and send him a birthday. So you’re how old now? Am I allowed to ask how old you are 

Mark Weisman: For crying out loud? So it’s a big one. 

Bill Russell: 50 and that is a big one. 

Mark Weisman: They’re making a big deal of it here. I’m not going to show [00:03:30] you my office here, but they decorated it with all kinds of old age related things. 

Bill Russell: 50 is a big deal. A lot of different kinds of things happen when you go to your first clinic checkup and those kinds of things.

Yeah, the first 90 days, I don’t know why we picked 90 days. I think it was the government, right? S o  that  when the president comes in the first 90 days, it’s such a big, event. They say you can almost see which way the administration is gonna go based on the first 90 days. So they spent so [00:04:00] much time planning out what they’re going to do in those firsts 90 days of a  administration.

And I think it is really important for new leaders. And by the way, just another weird fact for you. I was talking to a CIO the other day, who was in contact  with a recruiting firm and they said they have 16 open healthcare CIO positions across the country. That’s a lot by the way. So you’re not going to be the only one going through this first 90 days thing. So this [00:04:30] is probably a pretty good topic. 

Mark Weisman: So let’s just touch on the first 90 days bit for a minute there’s a honeymoon period. I’m thinking that you get to screw up a little bit and they give you a little bit of leeway and then they start to ignore you. Or you go in and start making changes. What are the first 90 days feel like?

Bill Russell: A alot of it depends on what you’re inheriting, I had Daniel Barchi, CIO for, New York Presbyterian on the show. And [00:05:00] he said, and I asked him this specific question first 90 days. And it is his response. He said healthcare IT is 80% people, 15% process, and only 5% technology we could argue about the percentages, but that’s roughly, that’s generally what it is.

It really is a leadership and a people job. And you have to really take the temperature of the, of the room. What’s going on within your team. What’s going on within your peers? How do your peers feel about [00:05:30] IT and clinical informatics? Are we delivering? Are we giving them the tools they need to be successful?  Or is it a critical thing? The last CIO job I took over the data center had gone down eight times in six weeks. In that case. they’re looking at you saying, put out the fire. So you know, you really do have to take the temperature, but then there’s some basic things that everybody should really take a look at.

Mark Weisman: I agree that particularly the culture where I’m at healthcare IT in [00:06:00] general is risk adverse in my opinion. And we’re no different, we’re 120 year old hospital system. We don’t turn on a dime. YEt the CEO and COO approach, Theresa and myself to make some things different because they wanted to see different results in a different culture.

And I’m sensitive to that, but I think the first 90 days will be interesting for us and for any new leader, because you got to feel out what’s the what’s [00:06:30] what do your constituents want and what do your employees want? Because they may not be the same thing. And then how to start reconciling that.

Do you  recommend doing a road show, going out shaking hands and getting to know the operational leaders first? Or would you go more towards your own employees and your internal team finding out the strengths and weaknesses? 

Where would you go? 

Bill Russell: Yeah, the answer to that is yes. So I see it at fairness, I coach CEOs and a lot of them are new to the role and it really depends.

So one of the, [00:07:00] one of the people who’s been very vocal about the fact that I’m his coach is Lee Milligan. And when Lee came in, he’d been at the organization for 15 years. There’s no one in the organization that didn’t know who he was. Or what he was about. So it wasn’t a matter of him doing a road show, but it was a matter of him, having a different lens.

Yeah. It was just given a new lens to which to look at the organization. but again, there’s a handful of things that every CIO or every leadership team. So in your case, you have [00:07:30] CIO, CNIO CMIO, really operating as. a joint team going about it and Baptist Health, and Kentucky has a similar model of a CMIO and CIO and CSO, a chief information security officer who all act as peers and function together.

But either way, the first 90 days, you have to look at a handful of things, and those are finance around finance people, operations strategy, and [00:08:00] communication. And it doesn’t matter if you’re new to the organization or if you’ve been there forever, you really have to take a look at those things. If you want to go through those a little bit at a time, we can and then just unpack them.

Mark Weisman: Alright, so let’s go with, how about finance first? Because I think failure to show financial stewardship can lead to a very short career. I believe there’s a [00:08:30] need to show return on investment that yes, we can utilize the team to achieve the clinical goal that they’re expecting, but also how rev cycle reports to us now as well.

And that’s new. Our risk cycle team is very strong. I don’t need to rock the boat very much there, but would you think denial is something that the CFO is very interested in and that can be done through health IT. That there is a component to rev cycle management. That’s very [00:09:00] much health it related to focusing on that and improving that I think has immediate value and show up. Hey, we’re serious in what we’re doing and helping the organization, at least on the financial end, where would you go? 

Bill Russell: Yeah. So I’m going to talk about rev cycle under strategy, right? So no, because you’ve, so you just laid out and objective around it, which means it’s a project. And does the project take technology?

Is it process related? is it structured [00:09:30] related? what is it? but finance is really about fuel, you want, I, so here’s. Categorically true about every health IT organizations across the country. And you hate to speak in these black and white terms, but it’s absolutely true. Everyone outside of health IT who works for a healthcare organization, thinks IT gets too much money, period.

It’s just everywhere I’ve gone. Everyone will talk to it’s the health IT that we spend so much money over there and not sure we’re getting our value for it. So [00:10:00] a couple of things I say to people, it is fuel. And you can crash a plane in two ways. One is you can take on too much fuel over and over again and starve the other planes on the runway.

In which case the other planes figure out a way to make sure you don’t take off. so you want only them, the amount of money you need to deliver on the expectations and the objectives of the organization no more and no less, but you have to have enough because I’ve seen a lot of CEOs get let go after a period of time [00:10:30] where there their organization was underfunded for a number of years. So they weren’t able to keep up on refresh cycle. And they ended up with a lot of end of life equipment. They ended up with a lot of challenges, but they didn’t know how to make the case for a strategic investment or even a tactical investment in making sure that their equipment stayed current or their EHR stayed current, made sure [00:11:00] that they were on the latest builds, make sure that they were, doing all those things.

And then one thing you did touch on, which is really true is, in those first 90 days, I want to know, I want to know everything about budgeting. What’s the process, what’s the cycle and how do we report out? And then I know within our organization, what are the controls on spending? I want to know everyone who has the ability to spend money, because you know that you can easily get in trouble in that space if somebody spends money and [00:11:30] and essentially they report to you, but if they spend it in the wrong way, that could reflect on you.

So you have to understand those and most organizations have those in place, but sometimes there’s gaps. 

Mark Weisman: Sure. Sure. What do you think about culture though? Where does culture change, fit into. Is That strategy? Or is that its own bucket?  

Bill Russell: People . Culture, everybody wants to build a, an innovative culture, a culture of trust and what I found is. Yeah. One of, one of the foundations is [00:12:00] everyone knows what’s expected of them. And, and they know, and the organization, gives them something in return for what’s expected of them as long as they deliver on that. So in order to build that culture of trust and accountability, which by the way, I think is harder across three people than across one, because what you’re going to want to do is you’re gonna want to create clarity.

Clarity for people in terms of their roles. One of the things that shocked me after two years of being in [00:12:30] my position, I went out and did a survey and people. The number one thing we heard was people were unclear about what was expected of them and what their next role was in their career. And that creates a murky area. And so people, struggle if they don’t know what’s expected of them, it’s hard for them to deliver on it. If they don’t know what’s next, they don’t know what to hope for. They don’t know what the organization’s giving them in return, for their work. so that’s one of the, that’s one of the key areas.

I understand the job, [00:13:00] descriptions, the roles and map those out for people. And then get that integrated into the review process. Everybody understands it. And then some other basic blocking and tackling, there’s a, You have to listen and you have to create that rhythm of communication and the rhythm of listening.

how often are you hearing from your staff? Are you giving them multiple venues to talk to you some more personal than others? Some where they can, some are more town hall esque where, you’re really giving a [00:13:30] state of the. state of the situation and others are, I’ve heard like breakfast with the CIO kind of thing where, people can just, smaller group asks the kind of questions they want.

You have to give them all those kinds of ways to interact. But changing culture is it’s hard. It’s not something you do overnight. It’s something that is, has to be intentional. Identify that we wanted to create a meritocracy and in [00:14:00] our health system where I was the CIO. And so we wanted the best people to elevate to the top.

it was interesting cause as we learned as we went, one of the people I’ve promoted to VP didn’t have a college degree. that’s set a whole bunch of people off. But what we were trying to create was a meritocracy. And we did do that. People realized that if you do a really good job, regardless of your, your education status or, whatever else people [00:14:30] think gets the next role, what we communicated very clearly was, what you deliver, what you are doing today matters.

And if you deliver well on the things you’re doing today, we’re going to give you more things to prove yourself. You’re going to be able to get there. You’ve got to decide intentionally, what are you trying to create? And then reinforce that over and over again with communication. And then with, with action. Sorry. I’m doing a lot of talking.  

Mark Weisman: You’re good. You’re good. So I was going to ask you. We Keep finding that there’s a lot of pressure on the financial [00:15:00] side for it, as you mentioned. So that tends to create a very flat organization. There’s not a lot of vertical leaps that you can make in healthcare IT in our organization.

So I want people to be able to look forward. I want it to be excited about the future, but this is not that many. Lots that you can jump towards. Are you comfortable with training people that they’re going to be outstanding, but they may not be with you. I’m okay with that. I want them to be outstanding players and be happy in [00:15:30] life, but I want the book to retain them of course. What do you think? 

Bill Russell: Absolutely. Yeah. that was my promise to people is, if you come back into work tomorrow, I will make, we will figure out a way as an organization to make you more valuable, if you ever leave here. And so that’s the commitment I can make. I can’t commit to them that they’ll always have a job because markets come and they go and technologies change and those kinds of things, but, we’re going to invest in them.

And so we created a thing called IT [00:16:00] university and, all the leaders, all the VPs and above to teach a class, we brought vendors together to teach classes. We did a lot of creative things in that area to make sure we were passing along. Like I taught a class on  John Maxwell’s 21 laws of leadership.

I know that dates me and I know I’m old, but, there was a lot of good stuff to talk to about that. And our head of finance did a thing on creating budgets and then he came around and did a thing on, healthcare finance and how, how [00:16:30] healthcare systems make money and the different buckets of money, and the person in charge of, applications, went through a pro training class on governance and how to think about governance. Think about all those things. All those things made people more valuable, wherever they went. It didn’t matter what the next role was.

Mark Weisman: What about, I want to talk about communication for a second, if we could, because I know that’s a key pillar in the first [00:17:00] 90 days. I think that we’re communicating a lot to the end users. That’s where I need to be communicating cause I know our situation, there were unhappy positions and that’s what started to stimulate some of the change to happen here.

So there’s a lot of communication that needs to happen at the nursing and physician leadership. 

Bill Russell: Yeah. 

Mark Weisman: What do you think of what’s the best way that you’ve seen. Yeah. It’s not the board that I’m worried [00:17:30] about. it’s other physicians that can make or break a career here. 

Bill Russell: Yeah. It’s a, it’s the physicians with the pitchforks. Yeah, I’ve been there. And, when I took over the, yeah, our satisfaction rate with our EHR implementation was extremely low, which is a perfect time to take over by the way. I t’s hard if you’re there after year two and year three, you’re not doing your job, but.

So what we started with was a survey. I wanted to get as much. we had a physician, a big physician together, coming [00:18:00] up, and I wanted to fly around in every relocation and talk to everybody. you’re talking 16 locations across multiple States and whatnot. I didn’t have enough time. We put together a survey, we went through the COO.

And he got it out to all the physicians and we collected as much information as we possibly could, which formed the foundation or, my presentation to the physicians. And I was able to say, Hey, we hear this is, these are the questions we ask. This is what you’re telling us. And the [00:18:30] now famous quote, I think I’ve set up, I guess a couple of time times from one of the physicians we left a lot of like just, blank spaces that they could write stuff in.

And that was the most telling things, not just check boxes. And one of the physicians wrote, Hey, 1989, just called. They want their technology back.

Nothing encapsulated where we were at as a health system, the data center had gone down. The EHR was not well received. [00:19:00] We had, the same EHR in all of our hospitals, but it was different versions across the board. We weren’t sharing information each financial package was, each financial close was its own entity.

And then they had to roll up and, the system office would take the better part of 30 days to close each month. So the day they closed, they started the next month closed. And it was just an awful situation. But all I had to do. He was talking to one person. I could have figured that out.

That’s not the [00:19:30] point of it. The point of it was. To let people know that we’re going to create a culture that we want to listen. We want your input. If we’re doing bad, we want you to tell us we’re doing bad because we want to, we really want to give you the things you need to be successful. And, that’s a double edged sword.

It’s great because you create that ongoing dialogue, but then you have to deliver right on, on all those things. So I think it’s important to know what you’re going to be about and [00:20:00] then create mechanisms to reinforce that. So the survey was one thing, by the way, I didn’t do another survey for three years.

And the reason I didn’t do another survey for three years just cause we didn’t really need to. Cause out of that first survey, we create, I was able to identify who the champions were going to be. And who the physicians were that really made, that really had the influence within the organization.

And I brought them together. We created a multi year strategy, got that funded. and then I ended up working [00:20:30] real closely with them and they were the champions out in the field as we moved that forward. 

Mark Weisman: We’re going to do the class survey. We’ve done it once before. We’re going to do it again. At least that way we have the benchmark to go off of the culture that I’m looking to create is more, I don’t know if you’ve ever read the business book Yes, And instead of No, But.  That concept in IT, it tends to be we’re overwhelmed. So the answer is no. And [00:21:00] then it shut down on all the creative thought that happens after that. Yes. And we do need to think about, we’re going to have to put these other projects on hold or whatever else we need to do to fund it. I want to get to that kind of a culture in IT, and we don’t have that.

Now I’m looking forward to it. I’ve seen it done in other businesses where they’ve moved to that Yes, And culture. So you’re always keeping the ideas going and sometimes it’s Yes and we can’t get to it. That’s [00:21:30] okay. Yes, And. So I love that concept. It’s really a culture change that I’m hoping to instill into the people who are interacting with the end users.

I want the analysts to be closer. I want them to be connected to the clinician because I think that’s also missing in healthcare IT. Sometimes we’re a little, we’re a little too far. We’re in the cubicles too much. Get out of the cubicle. Get to the front line. Yes there’s COVID going on, [00:22:00] put your mask on and go out there. And follow a nurse around, follow a doctor around. See what they’re experiencing, see what the bill that you did. Is it really working the way you thought it would or using it the way you thought they would use it? And so I think we do need to bring that’s a culture change for it also to bring them closer to the clinical world where they, most of them came from and they want to be back there.

It’s just, they’ve been turning to tickets, cleaning monsters. And we [00:22:30] need to get away from that. We’re ticket takers and take the closers to, we are clinical IT we’re at your elbow, building the tools that are gonna make your life better so you can make the patient’s life better. That’s where I think we should be Bill.

Bill Russell: I couldn’t agree more, but I will say this, it’s your job to create the systems that allow people to do the things that you’re asking them to do. And so my example for that is the first 30 days or so I met with a lot of people from [00:23:00] internal IT and I was looking for those no answers. Those were keys. So when I say things like. Hey, is there any way we can bring on more  We had a. large clinically integrated network and I’m like, can we bring these on faster? I’m hearing from the business that we’re not bringing the it’s on fast enough. And they would say, no, there’s no, absolutely no way to do it. We only have this much bandwidth.

It takes this long to bring people on and those kinds of things. And I’d say, okay, no. And I’d circle [00:23:30] those things because they always gave me the things I needed to work on when they said, no, you can’t do it. That was an indication. And what that was an indication of was that our, our integration and data sharing practices were so antiquated, by the way, they weren’t wrong.

We couldn’t, I saw the spreadsheet, we had 110 clinicians waiting to get connected and it was going to take us better part of three years to connect up those clinicians. And that’s without adding any to [00:24:00] it. And, based on just sheer numbers and facts, they were absolutely right. So we sat back and said, all right, this, you said, no, we can’t do it this way.

So let’s explore a different way. And so we created a different way to do it, which we could onboard almost 10 or so a month. And so now we’re starting to crank. we could crank through those pretty quickly. and we’ve also figured out a way to accelerate the backlog.

So we were able to get through most of those. Once we got the new platform and the new stuff [00:24:30] set up, we were able to get through that backlog, almost within about six months. And, but those no answers up front. those are gold for you. No, we can’t do it because. because we don’t have enough servers.

We don’t have enough storage. I don’t have enough time in my day. those, those, the physicians don’t want us around during this time. They only want us around during that time. Those no’s are great as they give you the clues you’re gonna need later to, solve the problem.

[00:25:00] Mark Weisman: That’s good. That’s good. Good stuff to hear. I hear plenty of no’s. So there’s no shortage of work that you’ll be able to accumulate by that method. So let’s see, we’ve covered finance. You’ve covered people. We touched on. 

Bill Russell: Let me go back to that one thing, because here’s the other thing. and this is me giving health IT a little bit of medicine here. And there’s to say, our problem is we consider it a good [00:25:30] day if nothing went down and we sorta, we got our work done and nothing went down and the reality is every day that nothing went down and you got all your work done, you fell one day behind because at the end of the day, the whole world is changing.

But you’re standing still, if that’s your goal, then you’re standing still. And so when we talk about, on This Week in Health IT, when we talk about cloud and we talk about platforms and we talk about, [00:26:00] integration strategies and API APIs, people are like, Oh, that’s crazy. That’s Epic’s job. We don’t have to really worry about that.

And I’m like, yeah. that’s exactly how you can think but you’re just falling behind. EVery day you don’t look into those strategies. And whatnot. When it comes time to move a lot faster, you’re not going to have put the infrastructure in place so you can move faster. So when you say no a year from now, or two years from now is because you didn’t do your job too.

Mark Weisman: So [00:26:30] that gets the strategy. That’s very forward thinking. We’re looking at strategy in terms of the organization has its three year plan. We don’t have a three year it strategic plan. I suspect we should have one. 

Would you agree with that? That’s a softball question by the way. 

Bill Russell: Here’s the, it really, it’s interesting, back in the day, I would say that is absolutely the case. But if you’re a really forward-leaning health system, the system [00:27:00] strategy and the IT plans have gotten so integrated that you don’t need an IT plan in and of itself. Because one of the challenges we used to have is we had an IT, or we had a health system plan and we had an it plan and we had to integrate them, So we had to make those alignments and, and do all that stuff. Really forward-thinking health systems right now when their chief strategy officer. Or COO or whoever’s leading the initiative gets going. They understand that almost every initiative they’re doing as an [00:27:30] IT component. And that almost sets your IT strategy for the year. If not three years.

Mark Weisman: I agree with you that the system strategy has to drive the IT strategy. But I think many of us are coming from the point of, hey, we don’t have a cloud strategy. We don’t have a work from home strategy. We don’t have a digital front [00:28:00] door strategy. And so when you’re missing some of those key components, I think we’ve got some cacth up to do.

And perhaps those systems that are cutting edge and they’re already, they’ve already got those table stakes, then. They’re probably more advanced than they don’t have to worry about those things. I think there’s plenty of us out there who still have a lot of table stakes to build on. 

Bill Russell: Hey Mark. A majority, actually, I just had a conversation over the weekend with the CIO and we were talking about, we were talking about a platform strategy and he was saying, [00:28:30] he goes, I’ve never thought about this before.

Why do I have to think about a platform strategy? I’m like, you don’t. You don’t, you’re in a market where you have 60, 65 to 70% market share and there’s no Walmart’s coming in or CVS. Oh man. There’s you have that market share and you have a tied up for the next five years. You don’t. Yeah.

You don’t have to think about it, but that’s a majority of health systems don’t have those kinds of integrated strategies, at this point. So you are absolutely right when I went in, I said a five year [00:29:00] IT strategy and it was built around. I’m huge in marketing and communicating, right?

So communicating in a way that they understand. So it was the mantra was a data driven strategy back in two 2011, this was new talking data-driven strategy. Our mantra was free the data, share the data, apply the data. And I gave it those things. So people remember it and they still remember to this day, they crack me up cause they’ll see me. They go, Hey, free the data, share the data, apply the data. I’m like, yeah. So that was our analytics and [00:29:30] an app store strategy. That’s where we were going. And the other side was, we had two pillars, one was data-driven strategy and the second was move to the cloud. And everyone knew the reason we were moving to the cloud was not to get to the cloud. Cause it was the big thing. We were moving to the cloud for one thing, agility, we knew there was going to come a time where we needed to move really fast. And the cloud offers you agility and people are like, are you doing it to save money?

Nope. Are you doing it for new capabilities? Nope. We’re doing it for [00:30:00] agility. We want to be able to move fast. And we know that this fixed data center with the diesel generator outside that we have to fire every week or every month, to test and do all this other stuff, did not give us the business agility we needed to move into the future. And to be honest with you, I wasn’t sure how the system was going to respond. We said, here are the two pillars and here’s what it’s going to cost. And it was a lot of money and they looked at us and said, absolutely. And they funded it a hundred percent. 

Mark Weisman: I [00:30:30] think everyone who’s moving into health IT and taking over a team is going to be told part of the same thing, which is we want more agility out of IT.

And we want to reduce head count and do more with less, and we want the engagement to be higher. What else does it throw in there? those are the typical ones. And we do need as leaders to figure out how are we going to get there? And that strategic plan when presented [00:31:00] properly, I think to the other leaders in the organization, they’ll nod their heads and say, yes, We want you to be more agile.

We see how you’re going to get there. Take it there. That’s a good vision. We want to be with you when you go there. So that’s part of what I think we need to do as IT leaders is to, as you said, break it down into simple terms, but they’re probably not going to understand the difference between the Amazon web services versus what Google or Azure is offering, nor do they care.

They want on-hand. What do they get when they go to the cloud? What is so [00:31:30] magical about it? And. That’s where I think we have a responsibility to share that, manageable way, understandable way. Yeah. 

Bill Russell: I remember my data center operator coming to me and saying, we need $12 million for our data center. We need new crack units. We need new, PR use. I forgot what they were. I forget what the acronym was, but essentially it was power distribution, PTUs, power distribution units, and stuff like that. And I’m like, All right. I’m not asking for that stuff. [00:32:00] And he just looked at me. He’s we need it. The data center needs it.

I’m like, yeah. I’m not asking for it. I’m not going into a healthcare CEO with a bunch of doctors sitting around the room saying, Hey, we need some crack units and PTUs. He’s gonna think that we’re like throwing a party and we’re going to get higher or something. I’m like, I’m just not doing it. And that, and then I asked him the question, which I think made him shutter, which was, do we really need any data centers?

And he [00:32:30] just looked at me like I was insane. And I’m like, okay. No, it’s a valid question. We need to ask that question. Do we need any data centers? And, he said, I don’t even understand like the concept of noon Dunham. I’m like, look, let’s draw a circle around this building within 10 miles. How many data centers do you think there are within 10 miles of this building?

He goes that we can use? I’m like, yeah, that we can use, because I don’t think there’s that many. I’m like, I guarantee you there’s at least 10. He’s nah, there’s no way. And [00:33:00] we never actually did. I never actually found the numbers, but we did find like in Southern California at least, there’s at least a dozen and you wouldn’t think Southern California that there would be a lot of data centers since it’s earthquake zone.

There’s a ton of data centers we could use. And so the question remained, why am I going for 12 to $14 million for PTUs, crack units and stuff like that? When I could just go down the street and by the way, I’m not even talking cloud at this point. I’m just talking, [00:33:30] get out of the data center business, move my stuff into somebody else’s building and let them run the generator test, let them run the PTUs, let them do the crack units.

And what, if they don’t live up to their thing, we’ll move our stuff to a different data center. And that was the back in 2011. That’s how we were thinking. And we did, we got out of the data center business. But really where we wanted to go was we wanted to go cloud where essentially I can lease down to the compute level and to the [00:34:00] individual storage unit, those kinds of things.

There’s nothing like that in terms of agility. 

Mark Weisman: Absolutely. How are we doing on time? We’ve got time for one more topic. 

Bill Russell: Yeah. And if I’m frustrating you at all, if I’m too high level, feel free to dig in. 

Mark Weisman: Perfect. Perfect. I do want to talk about managing up because every new leader who gets into their role is going to want to know.

All right. What’s my first 90 days with my new boss. What should I be looking at? And [00:34:30] when we stepped into this role,Theresa and I, we sat down with the CEO and COO and they laid out very clearly. This is what we want to see. Made it very easy for us. They’re very explicit with that. I’m not sure everyone who steps into a new role, get that clarity.

Sometimes they’re just like, don’t go fix it kinda general like that. But sometimes you get that thrown at you. What questions or how do you approach that new boss of yours? If you’re taking over this new team [00:35:00] and getting at what’s important to them for what they want to see from you? 

Bill Russell: Yeah. I’ll tell you one of the interesting things with the CIO job I took in Southern California was a lot of the big name CEOs didn’t want the job because it did not report into the CEO. It reported into the, I think the COO at that time, which changed, it was eventually the President, but I never reported into the CEO directly, but I knew that relationship [00:35:30] was key and critical. And so what I asked of her was that we would get together on a monthly basis and that we would make sure that, that calendar invite never came off for whatever reason. And what’s interesting is what started out as a, I really need clarity from you. I need to ask you a couple of questions, and also I needed to figure out how to navigate, going past my boss to do his boss and meeting with her directly. and so I just made that part of the, [00:36:00] Hey, this is just what we’re going to do.

It started off as a, Hey, help me to understand some things. And she did that really the whole time I was there. But the other thing it ended up being was I started sharing articles with her. Every time I went to see her, I had an article with me that explained cloud computing that explained APIs, that explained platforms that explained because you know what she knew.

she knew us even back then, she knew as the leader of a healthcare organization that she was going to have to be able to speak [00:36:30] technology. She had to understand it, how it was going to be applied and how it was going to, and we’re seeing a lot of CEOs start to make that leap. And that’s part of my job.

I saw that as part of my job was educating her. But if you’re in a role right now where you don’t know what your expectations are or, if you’re delivering on those expectations, I, it doesn’t matter what job you’re in right now. I would give the same advice. If you were my kid, I’d give the same advice, which is go get clarity.

You cannot succeed without clarity. You just [00:37:00] can’t do it. You can’t even do that in your marriage for having to say, go talk to your wife. seriously, how do at least in baseball, When you go to the plate, what’s expected, Get on base, put the ball in play. Don’t strike out.

There’s a clear set of rules in athletics that sort of define this is what you’re supposed to do, but we get into the business world and we’ll operate for the better part of a year. or so not really knowing what our dictations are or we we think the [00:37:30] expectation is to make sure the data center doesn’t go down.

But the expectation really is to make the EHR more usable and to engage the community in health and to help our ACO partners, And we’re like, Oh gosh, I didn’t know. That was something that was expected of me. The CIO. I thought that was a clinical thing. Just ask, get some, get somebody who’s going to tell you what’s next.

And by the way, the expectations don’t just come from your leader. there’s the expectations of the physician community and the clinician community, [00:38:00] the nurses as well. that was critical because I knew every time the CEO went out on a visit to a hospital. She was going to hear, Oh, this EHR is hard to use and we don’t have access to the reporting that we need.

So if I’m not listening to each one of my hospitals and what their specific needs are, and I’m not coaching my team to be out there and listening, and they’re not in the huddles, identifying those challenges. And I haven’t empowered them with the [00:38:30] tools and the ability to make decisions that they can actually address those problems.

Every time that CEO goes out there, she’s going to hear the same stuff over and over again. And she’s going to go, you’re not doing your job. And she would be right.

Mark Weisman: Sometimes the unwritten expectations that are out there that it’s just a matter of having a high degree of emotional intelligence to understand not only what they’re telling you, they want you to do, but also the [00:39:00] understanding that. Yeah, you may be in charge of keeping the data center on and the lights on and the phones working, but people are expecting more from it.

They’re expecting us to be the strategic partner for that operational leader and to deliver with them. Hey, here’s some new ideas and thoughts and different tools that you could take advantage of that they’re not looking at, but they may not even know such things exist. They want us to be that partner.

It doesn’t mean we’re telling them how to do their business. We’re saying [00:39:30] here’s an option. If it interests, you let me know. We’ll help deliver it for you. And I think that’s a key component. That’s not in any job description. It’s not going to be on the phone. I’m going to come out and directly tell you, but everyone wants you to be a strategic partner.

Bill Russell: And we’re also dream killers when we say no on a consistent basis, we’re dream killers because not only do they think, Oh, they can’t do things, but they’re there also. when they come up, when we established a platform within the health system and we [00:40:00] had analytics and app capabilities, doctors were coming to me all the time saying I’ve got this idea and I think we could do this. And we can do this with the perioperative. admissions process. And we could do this over here. We can do this over here. To be honest with you. I couldn’t keep up the physician. Yeah, sure. So creative, they were just constantly coming up with, Hey, I could fill this gap with the EHR and I could fill this gap, in our PACS communication process with our patients.

And I’m like, to a certain extent, I created my own [00:40:30] monster in that, Hey, we want to listen and Hey, we want to enable you. And those kinds of things. But, again, that’s we want that problem. Like we have too many things coming at us rather than we have nothing coming at us.

We’ve killed the dreams of so many people. Cause they’re like, look, it can barely keep the systems on. I’m not going to ask him if, we can integrate via fire through an app so that I can create a better patient experience for, our peach patients with [00:41:00] cancer. 

Mark Weisman: Think about the different engagement levels though, that you just described with your providers, pinging you saying, I want to do more.  We want more capability as opposed to the disengaged providers, which are simply they’re torpedoing you don’t know it, but when the CEO goes on rounds and gets ambushed. You would much rather have to say, I am so excited to be working with the CMIO CNIO CIO team, [00:41:30] t han the no people.

Bill Russell: So Mark, you know this, know this better than I than anybody, and I’m painting this picture and I don’t want to paint a perfect picture here. Cause I had my share of physicians who wanted to string me up. You’re focusing on the future too much. And we need better stuff.

Our EHR was not a hundred percent. Our EHR, probably got to be great every year from the physicians and from some of them that got an F every year, it’s this is the worst thing I’ve ever had to deal with. I wish I was with another health system. How do you deal with [00:42:00] them? How do you deal with the people that are going to give you an F.

Regarding, you could give them the best EHR your class rating could be through the roof. And then there’s just that physician that’s sitting over here going. Yeah, I don’t like you people, you don’t know what you’re doing. We had this physician constantly gave us an F we actually put a physician champion at his elbow for two days and he’s things like helping them to customize it.

He customized the whole thing. Because he had never customized it. He had never [00:42:30] built it out, even though we offered him training, he didn’t go to the training even. What do you do in those cases? 

Mark Weisman: Yeah. So most of the time they’re right, is that if they’re struggling with something is intuitive, we didn’t build something the way that they wanted it to be. And sometimes they’re just being, yeah, they liked their paper charts, and that’s going to be a hard person to satisfy what I found that I can engage with them. I can sit down and with, put them in charge [00:43:00] of making that part better and they definitely be analysts and they get to develop it. It’s hard to complain about something that you’ve developed yourself.

So that’s a little bit of cooptation but sure. Letting them own some of that and that experience, if they’re willing to engage. If they’re so far disengaged, I’ll look at, okay, are they burnt out? Are they really disengaged for more than just the EHR? They disengage from their practice, their family, [00:43:30] their whatever else is going on.

So we put our psychology degrees on and we get tried to get in there. And this is where being that home for dinner program that I had helped create my previous organization, we got really personal with some of providers who were very unhappy and they’re expressing their frustration on happiness of the EMR, but that’s not it that’s the tool that easy to point to it’s part of you every day.

It’s where you throw your frustrations. Yeah. [00:44:00] There’s a lot that you can get as it’s underneath. And it sometimes takes another clinician, whether it’s another nurse with a nurse doctor, with a doctor or whatever it is that people will open up to people who they feel recognized and understand the pain they’re going through.

So that’s how we tackle that, is one on one, very up close and very personal.

Bill Russell:  I’m going to ask for the last word here because we’re coming up on our time and. the one thing I tell all my coaching clients, and I would say to you, this is an [00:44:30] exciting time when you typically get promoted because you were successful in your last role, but in your last role, you might’ve had a team of 10 people, 15 people, five people, it depends on the organization and where you’re coming from.

Now, you have 200, that becomes an extent what the expectation is and the opportunity. Is that what you were able to do as a single person in a team of 10 people that you’ll now be able to do across 200. And so it’s, [00:45:00] how do you lead through them as opposed to the individual contributor? How do you lead through them so that you have 200 people that are out there thinking, how do I make this? How do I make peninsula? one of the best EHR implementations in the country, one of the best it shops in the country, a place where we innovate, where we work together. To really know all those things that are in your head. You have to figure out how to empower your team so that they know that they can make a difference on a daily [00:45:30] basis.

Cause if you have 200 people making a difference, that’s 200 times what you could have done by yourself. 

Mark Weisman: That’s good stuff Bill. I want to thank you for doing the show with me. I think it’s going to have value for a lot of people out there who will be taking over 

roles, either kicking me out tomorrow or soon in the future and this will give a good foundation, whether that’s a CMIO, a CIO at CNIO, this applies to all. So a great [00:46:00] show and thank you always a big fan of your show. I always do listen in. Thanks for putting on good stuff. 

Bill Russell: Totally. I’m going to go hit golf balls right now and put your show on so I can listen to your last episode. That’s what I do. I put the headset on. I listen to some of these podcasts and I go hit golf balls. 

Mark Weisman: That sounds awesome. 

Bill Russell: All right, man, take care. That’s all for this week. Don’t forget to sign up for clip notes. Send an email to clip [email protected] special.

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