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CIO Unplugged 5/26/10

May 26, 2010 Ed Marx 15 Comments

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

Office Without Walls

I remember looking out the window of my 1,500 square foot, extraordinary office in Cleveland, Ohio and thinking, This is the life. To the north, I beheld Lake Erie. To the east, our vast academic medical center campus — a doubly breathtaking view. Behind me was an expansive work area, ample space for my wall of self-adoration, and a private conference room. But more crucial for a workout fanatic like me, I had a full bath. These luxuries helped take the edge off the intolerable winters.

I’ve arrived! So I thought.

My soul couldn’t reconcile with the setting. On one hand, I loved it. On the other hand, I hated it. Too remote. Pathetically rich. Overindulgent. Excessively comfortable. I found myself increasingly disconnected from those whom I had pledged to serve. It is not about you.

While serving as an army combat engineer officer, I learned that the best place to command on the battle pitch was wherever my people were fighting — the front lines, on the flank, from the rear, or from the air. But never could I lead troops from some corporate office. Lessons learned from this experience transferred to my civilian career.

A resolve to lead by example, coupled with the advances in collaborative technologies, I adopted the borderless office. This is not a new concept to those outside of healthcare providers. Many progressive companies embrace this concept, and telework has taken off. Study after study has proved the plethora of benefits generated by this approach despite its manageable downsides. Interestingly, most who disparage teleworking have actually never teleworked.

Two years ago, I sacrificed my office phone. I haven’t had an office in eighteen months — and the view still rocks. I’ve traveled the DFW Metroplex and beyond, yet don’t waste my organization’s funds by requiring or demanding multiple offices. I’ve typed e-mails from cubicles at one of our fourteen facilities.

I’ve met with hospital presidents on their turf and often surprised the local IT staff with a personalized word of encouragement. Clinicians share their gratitude when I engage with them i2i. I’ve set up conference calls in Panera and taken calls on the road. And occasionally, my wife lets me set up shop in her kitchen where the coffee is free. (Thanks, honey!)

How is this accomplished? My office is my laptop. It goes where I go. A soft phone, video, and built-in wireless network have liberated me from the confines of four walls. With fourteen hospitals to serve, I embrace mobility. If it makes sense for me to begin or end my day at home or at Starbucks, I do so.

Some of my direct reports have followed my lead and done the same. We do have a collaboration center, which we use for vendor meetings and team meetings when face-to-face interaction is necessary.

As of May 2010, well over 50% of our IT team telework a minimum of four days per week. They may be at a hospital or their home — anywhere they can best serve the customer. I expect this number to rise to 80% as more people choose to this option. The vacated space will generate material revenue for our health system, which can be reinvested into patient care, not cube farms.

For the past three years, we’ve been recognized in the Computerworld 100 Best Places to Work. (Actually, in the top 50.) I firmly believe our office-without-walls approach to operations was a key factor in this recognition. And I perceive a direct line between this award and the external recognition and accolades we receive as a healthcare system for the quality of care delivered. To boot, the borderless office helps us recruit and retain top talent.

Sadly, healthcare provider organizations in particular struggle with this concept; hence the low adoption levels. We acknowledge that we must change and transform, and yet when opportunity presents, we resist and find reasons not to embrace. We deem telework OK for the analyst but not the manager since they need to be visible. Visible to whom? Their analysts are all virtual. This is one example of the false perceptions yet to overcome before we see widespread adoption.

After experiencing the value it adds to our customers and ultimately our patients, I’ll continue evangelizing this work style and its benefits. With the pace of today’s society, if you’re not moving forward, you’re moving backwards. I’ll never go backwards.

And I’ll take the view from my virtual office over a lake or artifact any day.

Update 6/5/10

My typical spot at home, close to coffee, food, and bathroom.


Explaining the BlackBerry functions to Marlon Brando. It was a casual day for me.

I appreciate the comments, pro and con, on “office without walls”. A few answers/comments.

Managing remote workers is fundamentally a leadership question. If you need to physically see employees to manage them, than your leadership approach might need tweaking or you have the wrong employee. With knowledge workers, I believe a leaders job is to set the vision and then allow the expert employee to figure out the best way to get there. You can help by removing obstacles and then staying out of the way. We do have a policy around remote working and it includes an “agreement” completed by employee and manager to set expectations.

We have deployed VPN and other similar solutions that provide secure tunneling on remote networks. I can’t share specifics lest someone tries to hack me. LOL. Seriously, we believe our tools and policies meet or exceed industry standards for responsible computing.

Dr. Know, it is lame that this concept would be considered provocative. It is a sad reality. If we do not write about it and lead by example, nothing would change. We are behind. We need courageous leaders in medicine, healthcare, IT, medical staff, etc. Encourage, don’t discourage, and we will get there faster.

As Lacey pointed out, you can have an office and be transparent, and at the same time, you can have a borderless office yet be hidden. That said, these are not mutually exclusive. You can have the best of both worlds, being transparent and out there with your customers. That is certainly my objective, albeit I have work to do.

Ed Marx is senior vice president and CIO at Texas Health Resources in Dallas-Fort Worth, TX. Ed encourages your interaction through this blog. Add a comment by clicking the link at the bottom of this 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.”

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Currently there are "15 comments" on this Article:

  1. I was a vendor consultant implementing a system with Ed’s group in Cleveland. I never met him, but received several notes of encouragement and appreciation from him….this was the client CIO personally recognising a member of the vendors team…amazing. I will say that did not occur from his replacement…

  2. Ed has got the right idea, that’s for sure. Too many CIO’s that I saw got their information in meetings, where the feedback is highly filtered for obvious reasons. The real data is out in the field, where the users live and breath and bang their fists against the devices. It would be simply AWESOME if more CIO’s followed his lead and got out from behind the desk and out of the conference room and remembered – IT’S NOT ABOUT THEM!! It is about the work that is done in the field – resulting in, hopefully and ultimately, improved patient care delivered better, faster, and cheaper (where possible). And, it right to remember that all the users of the system are there FOR THE PATIENTS. It’s really “all about them”.

  3. Is it possible that managers are hesitant to implement a remote office model, because they are unsure how to manage/control/monitor their staff? Did you need to implement new ways to monitor and manage performance in this environment?


  4. Ed,

    What type of connectivity foot print do you have? Are you finding there is a problem with connectivity? What type of costs are you looking at to start a solution like this?

    More importantly how do you address HIPAA, specifically what type of policies? Are you running a type of virtulization model to limit exposure risk?

  5. If an employer expects me to be able to do my job from home off-hours, to patch a system or reboot a server, and I have that functionality, then I should be able to do my job from home all the time. I have had a couple of jobs where I would go to my boss and say “Can I telecommute a few days a week?” only to hear “No – but on an unrelated note, I need you to dial in and do about 6 hours of work this weekend”. I left those jobs.

    I am 100% remote now and feel no less connected to my team. The job is exactly the same with a laptop and a cell phone as it was with a desktop and a landline. The only difference is that there is less managerial overhead for me. This is a polite way to say that I am no longer micromanaged. That is not specifically because of my work location, but it helps.

  6. Decades ago I started working at the company that later became Texas Health Resources. I had an office, then a cube, but now I have nothing… and am loving it. I remember arriving the first day of work at my new job wearing designer clothes including a sweater and jacket… but no tie.

    I also remember being told by no fewer than six people (including the then CIO) that wearing a tie was mandatory. The irony was clearly lost on the man sitting behind his expansive desk telling me about the necessity of maintaining a professional dress code, while at the same time wearing an ill fitting off-the-rack suit with a garish tie and socks didn’t quite seem to match.

    If you believe anecdotal tales are a substitute for facts or that the job of a manager is to control his/her subordinates rather than trust them, then a virtual office strategy is probably not right for your organization.

    You should also know that it takes little effort for this kind of thinking to morph into the belief that your employees will work harder if they start wearing uncomfortable clothes…

  7. I appreciate you being a living the example of how Healthcare IT employees and leadership can REMOVE walls, literally and virtually. Anytime someone vacates the Ivory Tower Office and relocates to the common grounds, it reminds me of the same actions taken by the greatest man ever to walk the earth. His adversaries lived in Ivory Tower Spaces, but He didn’t. Can’t think of one thing he accomplished in an “Ivory Tower” space, but I can think of many things accomplished by being among the “commoners.” Keep up the great work.

  8. Take down the invisible walls too. Our CIO allows people to speak with candor. He jokes around with us. I feel welcome to share my opinion even in large groups because he won’t come down on me or make me look stupid. In exchange for this comfortable atmosphere, I always report directly any activity that I think might put his face on the front page of the local paper. Politics? Forget it. He is more interested in open communication than by running all his comments through a political filter before opening his mouth. He can have his office and his walls. I have open access to him.

  9. Not sure what industry you are in Dr. Know, but out of necessity ours must be somewhat cautious since we are in a service industry that directly affects human lives. Maintaining the security of patient data is a major concern. I also differ with your assessment that teleworking isn’t an innovative concept:

    “Based on the latest American Community Survey data, just over 2% of the U.S. employee workforce (2.8 million people, not including the self employed or unpaid volunteers) considers home their primary place of work.”

    It’s true that there is broader acceptance of teleworking in some parts of the EU, but even there the average percentage of those with remote offices is around 13%.

    Our offices are currently 50% virtual. If we were a country we would best even Finland which, I believe, currently has the highest percentage of teleworkers at 39%.

    We’re getting there. The technology is available, the people are ready, and the savings are real… we just have to to a little gentile convincing.

  10. As I recall, this is similar to what Robert Townsend did in the ’60s then wrote “Up the Organization”, et. al… still one of the best and most inspiring books on innovative and solidly successful business leadership – no matter what industry.

    At that time, only he gave up the office (no email or computers then). When he became head of Avis car rental, he inherited one of those amazing offices, private elevator, limo for golf dates, company jet… and a company that was fighting for its life. He didn’t use the office or any of the rest of it, removed his tie and rolled up his sleeves to spend all his time in the trenches. He’d stop by his secretary’s desk now and then to check mail and write responses on the backs of letters. In that mode, he took Avis to the top levels.

  11. Hey Ed,

    How’s it going? I’m curious, are there any limits on how remote you allow your staff to become? Specifically, would you be okay with your leaders living in various places throughout the country (or world), provided the work was getting done?

  12. Ed – Great article. It’s nice to see telework catching on. I’ve led a remote workforce (spread out across the U.S.) for the past 12 years and from my experience, the pros far outweigh the cons. No coincidence, employee satisfaction is also high here. I’m willing to bet studies would turn up a number of similarities. Ok, I’m ready to co-write a book whenever you are. Until then, keep the blogs coming!

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