CIO Unplugged – 3/1/09

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

Why Dictators Burn Books
By Ed Marx

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 improve 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 healthcare.

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 VP’s. During my four years as CIO, I witnessed the completion of over thirty distinct book studies and trained over 400 staff. We lowered apples to apples costs for IT by over 25% 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 stand point, here is what seems to work well:

Charge a modest fee for the class. Return the fee for 80% 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 Drive 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 Asshole Rule
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…

Ed Marx is senior vice president and CIO at Texas Health Resources in Dallas-Fort Worth, TX. Ed encourages your interaction through this blog. (Use the “add a comment” function at the bottom of each post.) You can also connect with him directly through his profile pages on social networking sites LinkedIn and Facebook, and you can follow him via Twitter – User Name “marxists.”