Home » Ed Marx » Currently Reading:

CIO Unplugged 3/23/11

March 23, 2011 Ed Marx 18 Comments

The views and opinions expressed in this blog are mine personally and are not necessarily representative of current or former employers.

Leadership Equations

After receiving my diploma and officer commission, I headed to the Army Engineer School. Next to aviation, engineering was the most sought after Army career. The other 120 lieutenants in my class were either academy or engineer school wunderkinds. What was I, a psychology major, doing here?

The first week of evaluations earned me a pass to engineer “reform school.” Because of a mix-up in orders, I never got there; I stayed and clung for dear life. To make a long story short, I studied my rear off learning a few fundamental equations and applying logic — meaning I forewent partying with the wunderkinds. I eventually grasped the theories and their practical applications …

Fast forward …

i2i. The department chairman of emergency medicine, University Hospitals Case Medical Center, phoned me. “Ed, this is Dr.Michelson. Do you know what is going on in our emergency department right now?” He was so upset I thought I was on speakerphone being broadcast all through the pediatric Level1 Trauma Center.

I politely ended the call. As a new CIO, I did not want to have impersonal relationships. I wanted to talk face to face.

When I arrived, Dr. Michelson was directing traffic and evaluating patients. One of the IT applications had failed and was wreaking havoc on their process flows. Investigating the situation, I realized we could alleviate some of the cramped conditions by updating their technology. Although it took a couple of hours to restore the application, the next day we gave back additional space to the ED. Simple things, like replacing monitors, PCs, and multi-function devices.

The next day, I received a call from the chief medical officer. “Ed, I heard what happened yesterday. Nice work. That is the first time a CIO ever left the ivory tower and walked the walk.” The story went viral, and the benefits to an eye to eye approach become clear. I soon coined the term i2i and encouraged its adoption by all in IT. From that point, I stopped handling serious matters by email or phone.

Another rise in the growth curve. I also began to use i2i in crucial conversations and confrontations.

We had a physician executive who routinely abused anyone standing in his way. Because he produced results, his behavior was tolerated. After exhausting escalations with chain of command and human resources, I took matters into my own hands. Over coffee, I mustered my courage and laid out the situation to this senior officer. He hid behind his coffee cup, but we connected i2i, and my message landed. That was the last time he abused my staff.

p3. I met up with some docs to talk CPOE and how to amp adoption. As hard as I tried to connect, they weren’t buying. My points were valid and my objective admirable, but no progress. I took another run at these influential physicians, this time with my CMIO, and he got it done.

Those docs never disrespected me. They were simply more open to advice from a peer with experience than some suit administrator with a theory. In many of my medical staff interactions, I leverage the strength of having a physician speak to a physician. I engage to learn and support, so I think of it as p3. The situation transcends physician to a physician to the next power, where you have physicians collaborating with physicians and administration. As a result of p3, we have seen our CPOE reach maximum levels.

e4e. I received a call from the medical director of our newborn intensive care unit (NICU). This NICU consistently ranks in the nation’s top five. After several attempts to get resolution on technical matters, the medical director had become exasperated with IT. Out of 20 mobile carts, only two were operational. She stated that nurses and physicians were standing in line to update charts and enter orders to take care of these beautiful babies. I was aware of this escalating over a few days, but was certain we had resolved it. I told her, “I’ll be right over.”

I had our field services manager and three technicians meet me at the unit. I could not believe what I saw. Nurses and physicians were waiting around to use the two available carts. The sides of the halls were littered with unusable carts as if a tornado had passed through.

What if my child were here? I became indignant. As I approached the medical director, I saw the tears of frustration. All I could think to do was embrace her. We both cried. Frustration, anger, compassion. Someone cared. Now it was time to execute. It was critical to meet emotion for emotion, or e4e.

We borrowed carts from other units. Within 30 minutes, we had 10 working. Others were replaced or repaired within 48 hours. When I returned to our IT offices and found my director and VP of operations still chatting about how to fix the problem, I replaced them.

i2i, p3, and e4e have become part of my nature. While there is no formula to leadership, these equations make up the framework from which I operate. At the end of the day, nothing demonstrates care and commitment like looking someone in the eye, identifying on someone’s level, weeping with those who weep, and laughing with those who laugh.

Technology is the easy stuff. Knowing technology can never make you a better leader.

Oh yeah, and engineering school? I learned the basic equations and graduated near the top of the class.

Update 3/28/11

Thanks again for your readership and comments. Dr. Lafsky is correct on my English — thanks for pointing this out!

I like the idea that several shared along the lines of walking in the customers shoes. Early summer, I hope to share some of our success in this area that has helped tremendously.

As for Blah, I embrace him/her and would enjoy the opportunity to chat sometime. His/her facts are incorrect, but I hold no ill will towards him/her. I have made many mistakes, some of which I described in Biggest Blunders. I will make more. Ideally never the same ones. Let the person who is without fault cast the first stone.

Ed Marx is a CIO currently working for a large integrated health system. 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.

HIStalk Featured Sponsors


Currently there are "18 comments" on this Article:

  1. Well done Ed!

    We have some similar programs, one is called:
    Walk a Mile in Their Shoes
    where we have our team members spend time working with their customers to see things through their eyes and how what we do impacts them (whether good or bad).
    For many it’s quite an eye opening experience.

    Keep it up!

  2. Wow. I wish you had worked at facility I’ve ever worked at. CIOs never left the tower. Ever. I love your approach and your hands on, get ‘er done attitude. Sometimes that is all it takes to make a work place better. What got me is your NICU story. IT people just talking (the last place I worked IT wasn’t even on the campus grounds) and the rest of us suffering. My first month in the private sector I casually mentioned to one of our IT guys that a tool that did such and such would be great. I had it in an hour. In any facility I worked at it would have been a) never or b) a year minimum. I hope you really are that special and the people who work under you understand how rare it is (sad to say).

  3. You are amazing, Ed! This was a great article and a great lesson, applicable to all of us. Can I come work for you?!!!!

  4. I am so encouraged to know there are professionals like you. In my 40 years of health care, you are one in a million. Please get yourself replicated, repeatedly. Thanks also to Mr. HIStalk for making your posts public and promoting them.

  5. What a nightmare your operation seems to be. Glad to see you making some inroads.

    3 day Citrix downtimes.

    Docs resorting to broadcasting phone calls to the CIO to get things fixed.

    People crying with frustration because 90% of the carts were broken and the CIO having to fix it. How on earth did it get like that in the first place? In a NICU? It must have happend over quiet some time.

    It’s great that you fixed them and all, but the quality of service you describe is the worst i have ever heard.

    No wonder you are so focused on staff development.

    I wonder just how prevelent these kinds of things are, to this extream extent? Anybody have any stories like that? I must have been lucky to work in organizations where these kinds of things would never happen.

  6. I’ve had to relearn the i2i lesson over and over; your blog helped me see the value in context; thanks!

  7. Question: I don’t doubt the value of i2i, and for the CIO to experience the pain of his “customers” but wouldn’t it be more important to create an IT support organization that is structured to do that, rather than to rely on intervention by the CIO ?

  8. @Blah

    Congratulations on Working at a place where downtime never happens and customer service is perfection.

    I am sure you, your 3 employees, 4 systems and 6 customers are very happy with you!

    Here in the real world where we run 300+ applications, 500 servers and 5 to 10 thousand customers, things break, things go down and customers complain and when they do you have to be responsive.

    You keep up the great work at your clinic.

  9. Well done. Should be required reading by all in IT. It doens’t have to be the CIO that gets up and goes to visit the customer. I hope our CIO never gets these kinds of calls, but if so I bet a personal visit is always in order.

  10. At the end of the day, nothing demonstrates care and commitment like looking someone in the eye, identifying on someone’s level, weeping with those who weep, and laughing with those who laugh.

    This is, in fact, how I was taught to practice medicine.

    Too many hospital executives, IT personnel, and physicians too – forget, or never learned, these basic principles!

  11. Texas CIO, sorry I couldn’t respond yesterday I was working.

    Let me assure you the organization you described is small fry. I generally work at the biggest teaching institutions in the country.

    Nice try though. But again it show your willing to use excuses to cover up incompetence.

  12. Ed, thanks for the inspiration!

    It’s far too easy to fall into the email trap, thinking it’s an expeditious way to understand and correct. Wrong! Sometimes we all need reminders and tools to help us focus on the right thing. You have provided some easy, memorable ways to operationalize these important concepts. I’m sharing with my ISS Leadership Team as well as our Senior Leadership Staff.

    Have a great weekend!

  13. Good stuff again. I learned i2i and e4e when working for Marx. I challenge antagonist “Blah” to heed Marx advice and instead of pot shots, man (or woman) up and make direct contact. Different opinions are one thing but your comments are not furthering the profession. At the end of the day actually, I think you just need a hug…h2h

  14. @blah – it might not be unreasonable to imagine that the problems described happened at different times and places over the span of a career and that some of the problems were inherited.

    Ed, i2i is beautiful and is the shortest and clearest path to e4e. It is the most effective way to increase effective communication, build trust and empathy, and flatten the organization. Sadly, it is all too rare.

    I’ve seen a similar approach where people took short assignments shadowing business partners in other departments (and even different fields) and the improvement in communication and understanding was amazing. Such approaches can completely change the culture of your organization.

  15. That was the best of your pieces so far. One thing, though in e4e–the word you wanted is exasperated, not exacerbated.

  16. Ed, I look back to when I was at “My Hospital”, and so many of the things that you write about, I tried i2i and e4e and p3 were big for me… I remember going toe to toe with a beligerant Anesthesiologist in defense of my staff, and I think that did more to improve my staff’s attitude, and the perception of our users than anything else I could have done… It pays to be bold …

Text Ads

Recent Comments

  1. Care from the "Home Care" industry, housecleaninig, companionship, etc, is trying to move into the Hospital at Home space, but…

  2. There are many validated and published studies on patient satisfaction with "hospital at home" models, along with individual statistics presented…


Founding Sponsors


Platinum Sponsors






















































Gold Sponsors









Sponsor Quick Links