What I Wish I’d Known Before … Taking my First Hospital IT Executive Job

That shifting organizational culture takes time and patience. When you actually succeed and the culture starts to change, your employees who were barriers to change will start to leave the organization.

That budgets are boring and the software in the space doesn’t help. Where’s the digital disruption in the budget planning space?

How political and backstabbing a faith-based healthcare system can be. And how adeptly a CFO can play the game.

Hospitals still may not value the role of IS leadership. Control of budgets can be limited to the point of requiring approval for PC purchases and everyone in the department is viewed as a help desk function. Strategic vision and focus on critical topics such as information security are lacking. In those cases, your role as an IS executive is to prove your department’s worth and role in the organization and drive cultural change. This effort takes many years with seemingly slow progress.

That even as a physician executive, my clinical credentials would be a point of debate among all the physicians with whom I had to interact. They challenged my authority constantly because I didn’t see as many patients as them, didn’t see as sick of patients as them, didn’t see patients in their specialty, etc. They had a host of excuses for why they shouldn’t listen to me and unfortunately our senior leadership wasn’t willing to tell them they were full of bull and needed to just get in line. I had the last laugh though when I led the (successful) initiative with the operations side of the organization to change their contracts to require compliance with EHR use and tied it to their bonuses. Surprisingly, they all got in line after seeing a drop in their bonuses once the new contract was in place.

Not much because I did a consulting project for them before they offered me the position. So I had a pretty good idea what I was up against and how long I would want to work in that type organization. I also made it clear that if they did not agree with the recommendations in my report, they shouldn’t hire me. I’d recommend that approach (if available) to others to minimize unknowns.

That the same projects I rolled out quickly and successfully (1-2 weeks) in the mid-sized physician office where I was the boss would take months to years to complete in a hospital-owned ambulatory setting. Change management is easier when everyone is on the same page, but much harder when duties are dispersed over multiple locations and individuals with varying skill levels. Partnering with a strong operations administrator with experience helps ensure success.

Healthcare IT is messy. Gaining physician cooperation in institutions where they are not employed (which is the majority) ranges from tough to nearly impossible. Healthcare economics are messy.

As a CIO, how much of my job would be pure politics, trying to placate high-production specialties practices and physicians whose productivity (and income) was negatively impacted by EMR implementations. That and the realization to whatever lip-service we received from the rest of the C-suite regarding “innovation” and “investing in technology to improve patient care,” IT was always viewed as a cost center, and when the inevitable cuts came, IT is at the front of the line. Having said all that, given all of the challenges, discovering how rewarding it could be when you accomplished despite the obstacles.

Most hospital CIOs are politicians, and as such, are reluctant to measure the value of their projects, like ROI.

Existing politics and relationships can be your death knell. When you arrive to your first C-suite job, be mindful about these two items. If you are not, it can put you in a very bad position. My advice is to use the two ears-one mouth ratio to listen and observe to figure out what is what. There are many reasons the team you just joined is there. They have most likely figured out how to keep their high-paying, high-perk jobs and they are not about to let the new person on the team mess that up.

Real power does not always lie with the obvious titles. Try to become aware of who is really running the show and who the CEO really relies on. Also, some CEOs promote politics more than perhaps they should. It then becomes high-stakes gaming where you, as the newbie, will lose if not careful. It is a harsh reality of many C suites, but it exists. I have worked in six organizations with various levels of C-suite politics. Four of them were fraught with really messed up, toxic behavior. Two were not.

Even with that said, I would not trade any of those experiences as it has helped prepare me for the job I have today. In my current role, while I have our office and company politics fairly figured out and know when to speak up and when to duck, it is a constant part of the job to help ensure I am not a casualty from an ill-timed or ill-placed remark or taking a stand when I could have just let it go. It is truly an art at this level and takes a lot of practice, observation, willingness to not die on every hill, and of course a bit of luck.