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CIO Unplugged 12/7/11

December 7, 2011 Ed Marx 10 Comments

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

Transformation Through the Written Word

12-7-2011 6-56-55 PM

My nephew Jordan, at the time a high schooler, was thinking about careers. Spring Break of 2009 found him shadowing “Uncle Ed,” exploring healthcare. He awoke with me each morning for 5 a.m. workouts and remained engaged until we returned home for 6 p.m. family dinners. Free time was spent developing content for an innovation workshop he would help me lead for one of our hospital leadership teams.

We nailed the workshop. The hospital president was so impressed with Jordan’s facilitation techniques that he offered him a job upon college graduation. We left that Friday session exhausted but high, ready for a Starbucks reward! Immersed all week in healthcare and spending time with physicians and leaders, his career decision crystalized. After graduating as class valedictorian, Jordan began an eight-year journey as a University of Colorado Medical School BA/BS-MD student, one of only ten chosen in the nation.

An elite runner, Jordan serves me humble pie each time we connect. We met up a couple months ago and put in a few hard miles. A college freshman, he asked me for my views on Gawandi’s The Checklist Manifesto and how it has influenced our culture. A month later he asked me about Johansson’s The Medici Effect; What Elephants and Epidemics Can Teach Us about Innovation.

We met up recently in Denver, and, during this run, he wanted to know my views on Johnson’s Fire in the Mind; Science, Faith, and the Search for Order. “Uncle Ed, where does science end and religion begin?” He loses me on the hill. Is this my nineteen-year-old nephew?

The more I learn about his medical school program and curriculum, the more impressed I am. They have something special going down at UC School of Medicine with their focus on stimulating personal and professional growth through book studies. Every other week, these future physicians tackle another book and debate.

Book and debate reinforced my IT department’s approach. I was not a reader in my youth, but as my hunger grew for leadership, I began devouring the written page. A causal correlation emerged. The more I learned, the more effective I became.

I asked my direct reports to read with me, and I observed the same causality. If these book studies were helpful for my teams, then what about my entire organization? Twelve years and counting, my desire to be a continuous learner has not abated. I have seen the transformative impact on my organizations. Hearing about Jordan’s medical school inspired me to continue pressing forward.

Many people stopped learning the day they graduated. Having book studies in the work place carries numerous benefits. Studies remove excuses and make learning convenient. The studies bring a cross-section of individuals together who might not otherwise meet each other. Cohorts ensure accountability, and nobody shows up to class unprepared. Relationships form. Engagement deepens. Leadership is honed. New ideas stimulate innovation. Sometimes we invite our strategic partners. Learning happens. People grow.

How to develop a program in your workplace:

  • Charge a modest fee for the class. Return the fee for 80% attendance. Unreturned fees are donated to United Way.
  • Lead the first set 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 have the most traction.
  • Books with associated workbooks work especially well.
  • Meet weekly and run each class 6-8 sessions for one hour.
  • Offer a variety of classes quarterly.

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. And yes, we have gone digital:

  • 17 Irrefutable Laws of Teamwork
  • 21 Indispensible Qualities of a Leader
  • 21 Irrefutable Laws of Leadership
  • 360 Degree Leadership
  • 5 Dysfunctions of a Team
  • A Long Obedience in the Same Direction: Discipleship in an Instant Society
  • A Message to Garcia
  • Accounting for Non-Accountants
  • Application Stuff for Non Apps
  • Axiom
  • Blown to Bits
  • Built to Last
  • Business Etiquette for Dummies
  • Checklist Manifesto
  • Churchill on Leadership
  • Clever: Leading Your Smartest, Most Creative People
  • Competing on Analytics: The New Science of Winning
  • Computer Factoids
  • CPHIMS Prep Guide
  • Creative Whack Pack Deck-Book Set, Success Edition
  • Cyber Warfare
  • Death By Meeting
  • Developing the Leader Within You
  • Disintegration
  • Drucker on Leadership
  • Emotional Intelligence
  • Finance for Dummies
  • Financial Peace
  • First, Break all the Rules
  • Fish
  • Getting to Plan B: Breaking Through to a Better Business Model
  • Good to Great
  • Gung Ho!
  • Hardwiring Excellence
  • Heart of Change
  • Here Comes Everybody
  • High Five
  • Higher Standard of Leadership
  • Hospital Management
  • Hospitals: What They Are and How They Work
  • How to Give a Damn Good Speech
  • How to Listen to God
  • Human Sigma
  • If Disney Ran Your Hospital
  • Innovators Dilemma
  • Innovators RX
  • Inside the Magic Kingdom
  • IT Risk
  • It’s Your Ship
  • Jack; Straight from the Gut
  • James and the Giant Peach
  • Judgment: How Winning Leaders Make Great Calls
  • Kick in the Seat of the Pants: Using Your Explorer, Artist, Judge, & Warrior to Be More Creative
  • Lead with Luv
  • Leadership (Giuliani)
  • Leadership Lessons Learned
  • Leadership Secrets of Attila the Hun
  • Lincoln on Leadership
  • Making Teleworking Work: Leading People and Levering Technology for High Impact Results
  • Medici Effect: What Elephants and Epidemics Can Teach Us about Innovation
  • Now Discover Your Strengths
  • Orbiting the Giant Hairball
  • Outliers
  • Overcoming the 5 Dysfunctions of a Team
  • Please Understand Me (Myers-Briggs)
  • Raving Fans
  • Redefining Global Strategy
  • Safe Patients, Smart Hospitals,
  • Same Kind of Different as Me
  • Servant Leadership
  • Social Intelligence
  • Strengths Finder 2.0
  • Sustained Innovation
  • Technical Stuff for Non Techies
  • The Art of War
  • The Big Switch: Rewiring the World, from Edison to Google
  • The Black Swan
  • The Element: How Finding Your Passion Changes Everything
  • The Fifth Discipline
  • The Five Temptations of a CEO
  • The Four Obsessions of an Extraordinary Executive
  • The Fred Factor
  • The Future Arrived Yesterday
  • The Future of Management
  • The Innovator’s Prescription (Innovator’s RX)
  • The Leadership Challenge
  • The No Asshole Rule
  • The Power of Pull
  • The Purpose Driven Life
  • The Shallows: What the Internet is Doing to Our Brains
  • The World is Flat
  • Thinking for a Change
  • Today Matters
  • True North:  Discover Your Authentic Leadership
  • What Difference Do It Make Stories of Hope and Healing
  • What Got You Here Wont Get You There
  • What Were They Thinking
  • Where Good Ideas Come Innovation
  • Who Moved my Cheese
  • Wikinomics
  • Wild at Heart

Our next family reunion is in Seattle during the summer. If I want to keep up with Jordan, I’d better keep reading!

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.

CIO Unplugged 11/9/11

November 9, 2011 Ed Marx 20 Comments

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

The No Nice Guy Rule

I interviewed with University Hospitals on November 23, 1998. I recall the date for two reasons. One, it was my birthday. Second, I encountered Zoya (name changed to protect her privacy), an analyst on the employee interview panel.

Zoya embossed herself on my memory with her questions. She pitched hardballs, fastballs, and curveballs while the nice people on the panel tossed softballs. Although professionally polite, Zoya hovered on borderline offensive. I was taken aback by her persona, yet her disruptive approach was about to make me a strong leader.

Let me explain.

My first day on the job, Zoya walked into my office and welcomed me. Before I could hang my coat, she asked if I had time to talk. She was alive with ideas and energy and aspired to transform the IT culture and increase our value to our customers. Although overwhelmed at first, I appreciated her hunger to influence and shape our organization.

The customers loved this analyst. If no one kept watch, some customers would bypass our intake process and go directly to her. She tackled the most difficult assignments and notoriously challenged our processes. Zoya took great pride in consistently delivering results and delighting her customers. A workhorse! And … she was tough to manage.

While the customers loved Zoya, the team did not. One by one, each complained to me about her, and their observations had merit. 

I recall Zoya’s first review. She gave herself a perfect score. In discussing career goals, she stated her expectation to be the best analyst in the world, but agreed she hadn’t reached that goal. Nevertheless, her drive to be the best showed in her outcomes, which inevitably raised the bar for the other analysts.

I invested in Zoya, an immigrant from Russia. She and her husband had packed up their kids one day and sought a better life in the USA. Sympathizing as a person of European descent, I coached her. I pointed her toward specific changes and how to better handle situations. I sent her to a speech pathologist to help her communicate more clearly. She made headway, slowly.

Still exasperated, the team now came into my office as a group to lay out complaints. I listened and then asked: Who can tell me the names of Zoya’s children? Silence. Who can tell me the names of her dogs, whose pictures she had plastered all over her cube? Silence. Who can tell me her passion (Russian folk dance)? Silence. Who can tell me her defining moment? Silence. Who can tell me her background and why she left Russia? Silence. Who can tell me what drives Zoya? Silence.

My response: Once you’re able to answer these questions, we’ll revisit Zoya’s future with us.

I endeavored to kill the notion that every instrument in the band had to be a clarinet. Collegial yes, but as long as behavior did not violate organizational values, every employee had the freedom to express themselves uniquely. Sure, it’s cozy when the team can sing Kumbaya in harmony, but who thrives under constant coziness?

I’d rather work with a team of challenging personalities that adds value to the business than a team who liked one another, but performed with mediocrity. I would argue that the conflicted team—dare I say disruptive and non-complacent—produces superior individual and team performance. Iron sharpens iron.

Better to celebrate individual differences than succumb to the tragedy of nice guys. Which reminds of a scene on conformity from Dead Poets Society. I want people and leaders who walk their own path, even if it’s not nice.

The team never came back with another complaint. Instead, they engaged Zoya on a personal level. Mutual understanding and acceptance grew. They became a team. They gleaned from her, and although she never sang Kumbaya, Zoya did learn to be more collaborative and collegial.

The team developed into the shining star for University Hospitals IT and launched me to where I am today. Thanks to FaceBook, many of us remain connected after all these years.

Not all of my experiences with my teams have been positive. I’ve made mistakes. A couple of times I invested energy into helping a staffer turn the corner and be successful, but that person refused to change.

Before you think I’m endorsing dirty players, let me balance my message. Consider the bestseller, “The No Asshole Rule”, by one of my favorite professors, Stanford’s Robert I. Sutton. You also have to protect your team. Get to know the fine line between a “not nice guy” and an asshole.

Yes, Zoya rocked our world and made us uncomfortable. But it didn’t surprise me when our team rallied around her after she was diagnosed with Stage IV cancer. We cried together over her death, for she had left a legacy in her own unique way.

Thanks Zoya, for not being nice, but for being true to yourself.

Update 11/12/11

Thank you for your responses (yes, even “Marxism”).

I don’t mind Marxism’s character attacks, but I would disagree with the implication that excellent leaders work only at the largest organizations. Great leaders can be found in organizations of any size. The size of the organization is not important. The size of the leader’s capabilities is important.

Finally, the story of Zoya is true. For those of you on FaceBook, you can see the positive responses left by some of Zoya’s former team.

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.

CIO Unplugged 10/19/11

October 19, 2011 Ed Marx 5 Comments

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

This is the fourth in a short series of posts on “The CIO’s Best Friends,” those BFFs who are critical in ensuring CIO effectiveness. This time we cover the CNO – CIO relationship.

Got Clinicians?

The CNO and I started our jobs about the same time. We knew we needed one another to be successful. With an electronic health record implementation looming, our partnership would be imperative.

As organizational rookies, we became kindred spirits. We commiserated, encouraged, and partnered. Through my CNO’s coaching, I learned we needed more clinicians inside of IT. “Got clinicians?” he prodded often. “If you don’t, you should.”

I wondered how many credentialed clinicians a healthy IT department should have. I now think 25% is a good target. Whatever your starting point, push to raise the percentage. Include a mix of MDs; RNs; radiology, medical, and pharmacy techs; pharmacists; therapists; and a smattering of other less common specialties. While many organizations have a CMIO, equally critical is a CNIO.

My CNO taught me that once you have clinicians on your team, you’ve got to ensure their successful transition into IT. Here are some things to think about in order to succeed.

Challenges for Clinicians Moving Into IT

Adapting to the office environment

  • Cubes vs. nursing station reduces the sense of teamwork
  • Use of meeting rooms is equated with loss of casual social interaction
  • Taking work home
  • Going out to lunch vs. grazing between patient care tasks

Difficulty recognizing accomplishments/results

  • Need to understand the bigger picture (see beyond the patient)
  • IT systems are configurable with gray areas; reduced workflow focus
  • No more rapid results (average patient LOS is three days)
  • Used to implementing changes quickly
  • Giving up precision and timing on tasks

Loss of familiarity generates stress. The clinician must:

  • Learn new tasks, find new resources, and create a new employee network
  • Learn basic IT software (no more IVs)
  • Fight pressure to already understand IT on the first day of work
  • Assimilate IT language/acronyms

Facilitation skills are not in the typical nursing repertoire

  • Scheduling appointments
  • Creating agendas
  • Taking minutes
  • Using a meeting room to solve problems instead of on-the-spot interactions

Common Conflict Areas and Issues of Concern for Clinicians

  • IT staff is generally unaware of clinician’s former environment and the required adjustments
  • Lack of training for clinicians in IT subjects
  • Clinicians are expected to already know what to do
  • Downtime scheduling affects issues regarding patient care
  • Clinicians have an inherent desire for more testing on software applications (like testing a drug before giving it to a patient)

Bridging the Gap and Investing in Clinicians

Preceptor program

  • Increase depth of typical IT orientation
  • Pair new clinical staff with experienced IT person; identify future clinician leaders
  • Document and publish referable guidelines
  • Create Web-based training on IT tools
  • Ensure clinicians don’t get sucked into traditional IT mentality

Project management training

  • Create project management processes that nurses can relate to
  • Help clinician visualize the big picture and break it down into tasks

Professional development

  • Develop a facilitation/leadership class
  • Provide continuing education credits (CEU)
  • Create internal training opportunities specific to clinical IT
  • Develop clear development pathways, like a clinical ladder
  • Clarify the position’s responsibilities

Spend time with your CNO. Actively partner. If you can’t afford a CNIO to bridge the nursing and IT gap, assign another clinician as a part-time liaison.

Over the years, we moved from 5% clinical staff to nearly 25%. I believe one reason we successfully implemented and adopted clinical applications was due to our staff mix.

Embrace the significance of melding clinicians with IT. Be intentional with it, maximize the value, and encourage further adoption. A healthy mix leads to a high-performing healthcare IT organization. I’m so glad I listened to my CNO.

Got Clinicians?

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.

CIO Unplugged 9/7/11

September 7, 2011 Ed Marx 6 Comments
The views and opinions expressed in this blog are mine personally and are not necessarily representative of current or former employers.

IT Chargebacks: Yes or No?

Chargebacks or not, the real conversation settles around value. Value is a balance of costs and service. If you deploy chargebacks, simplicity is key.

I am a proponent of elegant, yet simple chargebacks tied to service levels. Costs and services are adjustable levers that create the value defined by the organization.

Having served community hospitals, academic juggernauts, and for-profit health systems, I’ve employed a variety of methodologies. Every institution is unique, with culture, strategy, profitability, and leadership all playing a role in determining best practice and overall value. There is no one-size-fits-all answer.

Gartner identifies seven common chargeback approaches. They do a great job of summarizing the pros and cons of each. I will skip the detail.


I avoid approaches that have significant maintenance costs associated with the operational mechanics. At one organization, I spent significant resources maintaining, defending, and negotiating our detailed chargebacks. We were able to charge back to the end user level, but with 300+ applications and associated hardware, we hit a point of diminishing returns. From an academic perspective, this looked beautiful, but costs eroded the benefit.

At another organization, we applied no chargebacks. Demand became insatiable. This led to the tragedy of the commons. All parties were unhappy. When demand went unchecked, services were perceived as free and IT costs spiraled out of control. Although clearer than a blue sky, the cause and effect cycle still became irrelevant due to a lack of associated sacrifice (cost to business unit) and defined value. Normally, a commons environment renders effective governance models impotent.

My preference: a simple model where costs are correlated with service levels at an enterprise level. Take total IT operational expenses and allocate costs on a single, rational, and easy to measure metric, i.e. the number of employees or number of end-user devices. Despite the limitations of these metrics, they are measurable and have a basis in logic. I do not go to the application level (per drink) or hardware cycle methodologies, where the complexity increases exponentially.

In the fictitious example below, the allocation of $1,000 per user comes with a negotiated service level of 4 on a 1-5 Likert scale. The service level is measured and the performance reported routinely. If the enterprise demands a higher service level, then there will be a negotiated fee increase. If the enterprise demands a price decrease, a revised service level is negotiated. Therefore, the service level becomes the lever for any discussion related to IT costs for the same basket of goods.

This model works well for demand management and governance as well. If the enterprise wants to make IT-enabled investments, the business case is developed. The business case includes a section on IT costs. In continuing the fictitious example, let us assume the enterprise wants to add an EHR at a cost of 25M annual operating expense. Using the model, IT costs increase from $1,000 to $1,250 per user at the current service level of 4.

During the EHR approval process, the enterprise understands and accepts that IT costs per user will increase and the allocation goes up. The elusive “business and IT convergence” is enabled at this intersection where strategy is executed knowing IT implications to include costs and service levels.

COST OF IT/SERVICE LEVEL 4 3% $3,000,000
END USERS/COST PER 3,000 $1,000
TOTAL COST IT   $3,000,000
COST OF IT/SERVICE LEVEL 4 3% $3,750,000
END USERS/COST PER 3,000 $1,250
TOTAL COST IT   $3,750,000

To execute this model, you must nosse te ipsum. You must be well organized and have a published service catalog. You must know your costs and be able to measure and report your service levels.

Most importantly, you need to execute to those agreed-upon services and levels while keeping your costs in line with your enterprise commitment. There is the shared value.

No perfect solution exists. Work with your enterprise leaders. Pick something. Experiment. Adjust. You will know when it is working. Until then, keep refining.

(I will go into service levels as they relate to chargebacks in a subsequent post).

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.

CIO Unplugged 8/17/11

August 17, 2011 Ed Marx 79 Comments

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


One thing that differentiates top performers from peers is neither skill nor experience — it’s talent. One key talent is compassion. Top performers connect their skills with compassion. They link their hearts to their brains. Connection is the difference maker.

As a leader, how do I help make that connection for my team? How do I create an environment where we can cultivate compassion? How do I help them view their job as more than a paycheck, but as a contribution to a patient’s life?

A motivational speech might spike emotions for a day or two, but I need something with a longer half-life. I need an approach that transcends mental understanding, a connection so strong that synapses will rewire and link the brain to the heart and infect the soul. Forever.

The single most effective method I have leveraged is what I term Connections. I have employed Connections for eight years, at two different organizations. The remarkable happens when you remove the physical barriers between clinicians and those who support them.

A programmer’s heart changes when he sees the impact of his code on a patient. When a service desk agent sees the face of the physician she’d helped navigate through the electronic health record, her heart expands. Sympathy awakens in the data center engineer when he learns from a nurse that patient outcomes improve because of the technology delivered with zero downtime. And an administrative assistant understands the urgency of communication when she personally witnesses the life and death stress.

Our brains tap into our hearts. Compassion-infused work follows.


  • The clinicians who are shadowed learn more about technology. They learn that we care and that they have this incredible support structure surrounding them. This aspect is almost as beneficial as the Connections themselves.
  • Relationships develop and then are cultivated, creating a family-oriented culture.
  • Respect from operational leaders increases because they see that you care enough to take such action.
  • While not scientifically validated, there appears to be an overall correlation between organizational outcomes and Connections.
  • As Connections form, employee engagement rises, creating and nurturing new talents.

Employee Transformation Testimonies

  • “I must admit, I hated this idea but did it because I had to. I have worked here for 20 years and for the first time I realized we have patients. Of course I knew what we did as a hospital but really, this was incredibly impacting and I will never be the same.” (Programmer)
  • “I am not the same today as yesterday.” (Network Engineer)
  • “I volunteered to observe in the OB unit. With clinician and patient consent, I witnessed the birth of twin babies. I never realized all the behind the scenes coordination required and it opened my eyes to a whole new world.” (Admin Assistant)
  • “I never saw myself as part of the patient care process until now.” (Field Support)
  • “My life is changed. I always wanted to be care giver but didn’t like blood so chose a different path in technology. Now I tell people I am both.” (Application Analyst)
  • “I run marathons. I was more exhausted shadowing a nurse today. I never knew.” (Project Manager)
  • “In one day I witnessed the joy of healing and the pain of death. I now see how critical IT is and why we need to be the best that we can be to support the front lines.” (Business Analyst)
  • “I am a nurse and did not see why I had to take part in Connections. After today, it was like I was hit by a ton of bricks! Wake up call! Thank you, thank you, thank you.” (Application Analyst)
  • “The experience is another reminder that the bigger picture of our health system, being a body of entities, departments and individuals, come together for the patients to have one more beat of life.” (Data Center Operator)
  • “The experience was one that I am very thankful to have participated in and I can’t wait to do it all over again next year.” (Application Manager)
  • “Patient care was the core focus of every area. It was really great to see the patients and what we really work for. Connections reminds us of what is truly important and why we do what we do (Security Analyst)
  • “There is a lot of new technology on the floor and it’s cool to see how all the parts fit together to make the whole. People working with people and technology involved to make health care better.” (Business Analyst)
  • “This is my second Connections, and every time I get a much more vivid idea of how my contributions and duties make a difference and reaffirms the promise to our community and the people we serve.” (Data Center Operator)
  • “Clinicians are the reason we all have jobs, and I thank them for all of their hard work.” (Business Applications Manager)
  • “It was very educational for me to see what the nurses and physicians do and how they use technology in their environment. It’s always a good thing for people working in technology to understand the business they support. Glad I had the opportunity. (Data Center Manager)
  • “I have worked at 4 different health care organizations in 3 different states and this is the first time I have seen a program like this. I am proud to work here.” (Application Analyst)
  • “Given what I saw I can’t begin to imagine how stressful their work must be. We need to do everything we possibly can to make it less so.” (Vice President)

I love a great speech and giving out raises and bonuses. But evidence suggests these have fleeting influence on performance and certainly do not develop compassion. In fact, some studies indicate the enthusiasm over a raise lasts two weeks.

I speculate this is because money only engages the brain. Conversely, transforming a person’s way of thinking and view of themselves results in long-term effects and a new person. Even the hardest of hearts and the most gifted intellectual will begin to view things differently. Once they’ve Connected.

***Leave a comment and I will send you a simple 10-step process for successfully setting up your own Connections program at your organization.

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.

CIO Unplugged 7/20/11

July 20, 2011 Ed Marx 10 Comments

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

PoléPolé (Slow Slow)

7-20-2011 8-30-21 PM

3:21 a.m.

Zero degrees and our Camelbacks turn to ice 2,000 feet below Kilimanjaro’s summit. Five days of steady marching behind us. Almost home, but struggling.

Team chatter is eerily silent. Heads hung low and lamps dim, distraught climbers from other groups turn around short. Fear and doubt slither through our minds. Can I make it to the top? Will I be the one who fails?

“Angels We Have Heard on High” pierces the silence. Sensing our internal turmoil, the guides sing a familiar melody that shatters our foreboding. The crescendo of “Gloria” generates a second wind. Spirits lifted, we proceed with renewed vigor towards the prize.

7-20-2011 8-29-02 PM

Panting with joy, we crest Stella Point at sunrise. We pause on the volcanic rim, a mere 750 feet from the peak. We will make it. All of us. After a brief round of hugs, we persevere towards the summit.

Without a word, the four founders quickly move out and up the line of march. We conquer the final stretch together. Kilimanjaro was our collective idea, our blood bond, thus important and symbolic to finish together. After more hugs, high fives, and requisite pictures at the peak, I cry, hard.

Thirty-six hours later, we shower and settle in at the Arusha Hotel bar to celebrate. Debriefing over beers, we relive the climb, tell stories, and share leadership lessons learned. I gladly share them with you:

. Mental toughness is only honed via trial and refined by fire. No amount of mental gymnastics can prepare you like reality can. Don’t throw in the towel in tough circumstances. Put one leg in front of the other and move forward.

Training. A person rises to his level of training, not to his expectation. No exceptions. If you don’t make the time to train, you don’t make the team – period. Over the year, most climbed smaller peaks in preparation.

Gear. Reaching the top requires the right gear. No amount of training or exhortation can close the distance between success and failure when you are ill equipped. Invest in yourself and the team. A lack of gear equals climbing failure.

Vulnerability. We threw out titles before taking the first step. Administrators, presidents, physicians, and teens were now peers. Spending 24×7 with strangers requires a rapid adoption of transparency. The first day, we peed from a distance and behind some trees. Come day two, we’d grown beyond these formalities.

Encouragement. Maximum performance is nearly impossible without a pat on the back from a friend. Kind words work like salve on a wound.

Nutrition. You can fake your way and run on adrenaline for a day or two. But without sustained energy, you will collapse. Leaders must replenish themselves routinely.

Attitude. Zig Ziglar’s adage proved true: “Attitude, not aptitude, determines altitude.” No one benefits from listening to naysayers. Good leaders present good attitudes, even when they feel like vomiting.

Teamwork. Individuals caring for individuals, together. Shared hardships hasten lasting bonds.

Planning. Although the journey took only seven days, we organized over seven months. Anything worthwhile requires diligent strategic and tactical planning.

Support Team. We had an incredible support team comprised of friends and family. On the mountain, we had guides and porters.

Two lessons I’m still trying to internalize:

Climb High, Sleep Low. Reaching new heights requires giving up some ground. We spent a couple days where we gave back more elevation than we conquered. Although ‘straight up’ seemed the shortest distance, a sheer, vertical route would lead to breakdown. Every mountain has its peaks and valleys. Embrace these.

PoléPolé. To reach the highest summits, take time to acclimate at various heights and simultaneously build endurance. If you rush, the odds of success diminish exponentially. Sometimes you must go slow to go fast. Be in the moment. A leader must shrink the gap between frontrunner and laggard without losing sight of the ultimate objective or compromising passion.

7-20-2011 8-32-36 PM

We unveiled our corporate flag in front of the summit sign. This band of ruffians brought together 11 individuals and over the course of planning and execution built a team. The Kilimanjaro success rate is 60-70%, but we achieved 100%. Success demanded leadership and followership.

That rock taught us a lot. Changed us. Did someone say Everest?

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.

CIO Unplugged 6/29/11

June 29, 2011 Ed Marx 14 Comments

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

Why We Need Transformational Leadership

The labor and delivery room filled quickly with physicians and nurses. The walls turned inside out, revealing sterile equipment. The transfiguration from birthing suite to operating theatre was complete. I figured this was not a good sign.

Despite numerous inducements, my wife’s body refused to give up the gift inside. I went from active coach and participant to frightened bystander. Moved aside, I worked my way behind my wife, out of the path of clinicians and equipment, yet close enough to stroke her hair, hold her head in my hand, and whisper prayers in her ear.

While I wasn’t familiar with all the technology, I knew to keep an eye on the fetal heart monitor. Fluctuating wildly, the bottom kept falling out until the heart rate eventually registered as zero — and stayed there.

Seconds passed like minutes, minutes like hours. After cutting, vacuuming, forceps, and physical manipulation, our baby appeared. “We’ve got a floppy,” the doctor announced. He handed the bundle over to his partner, who whisked our child to a nearby table for resuscitation.

Nightmarish thoughts invaded my mind. Instead of returning home and rejoicing over a new life, would I be planning a funeral? Picking out a tiny casket? Mourning? Wondering if it would be worth trying again? While clinicians huddled around our daughter, we changed her name from Kirsten to Talitha.

Seven forever minutes later, a nurse displayed our child, swaddled in a blanket and breathing on her own. “Here’s your daughter,” she said, before they took her down the hall.

Talitha is an Aramaic word used by Jesus in the Gospel of Mark. A father chased after Jesus and pleaded for Him to heal his recently deceased daughter. Impressed by the man’s faith, Jesus went to his house. Upon seeing the lifeless body, He commanded “Talitha Kuom” (translated “young woman, arise!”). The girl awakened. Ours did also. Miracles still happen.

Talitha slept in isolation in the newborn intensive care nursery. We could look at her, but not touch. Strep B had caused the trauma, but she was also fighting pneumonia and a hole in her stomach. Physicians forecasted long-term physical and mental damage.

In our shocked state, we reviewed options with the clinical team. We signed releases, willing to assume any risk that might help Talitha survive. Our church pastors loved on us, praying for wisdom and healing. We gave thanks for the hospital and dedicated clinicians.

The biggest decision lay ahead. Should we undertake a risky “flight for life” transfer from our hometown hospital Level 3 NICU to a Level 1 NICU 90 minutes away? Adding complexity, Julie was not physically well after the trauma, and I did not want to separate her from Talitha. The receiving hospital specialists said they could consult remotely if there was an automated way to collaborate. But this was the early 90s.

I had been serving as the physician relations coordinator for this hospital. A year prior, I had been given an additional responsibility related to IT. The IT staff was struggling with physician adoption of a clinical system application module that allowed them to dial in (on a 2,400 baud modem) and have real-time access to clinical data. Because of my track record in working with physicians, I took the job of evangelizing this tool to the medical staff. We went from 5% to 90% adoption in one year.

What if?

What if we gave the consulting physicians direct access to the clinical record and they could treat my daughter from afar? Two hours later, they had access. Care coordination and collaboration began. This defining moment made my calling and career crystal clear. I knew I was to combine my leadership talents with my technical skills and apply them to healthcare information technology.

Eight long days later, Talitha was released, albeit on oxygen. The strep was treated, her pneumonia was resolved, and her stomach had healed itself. No physical impairment. Today, because of her high IQ, no one could ever know of the fight Talitha endured to be a part of our family. (Well, perhaps with the exception of her “Goth” period around age 14. LOL.)

And Julie? She, too had a miraculous recovery. The quarter-sized hole connecting her uterus and bladder (caused by a 9.5 pound baby) closed without surgical intervention.

This story is one example that illustrates the power of technology when it’s paired with leadership and harnessed to share clinical data. As we mash up transformational leadership with emerging technology, we will hear many more stories like Talitha’s that inspire us to do greater things.

This fall, we’ll celebrate our beautiful daughter’s 18th birthday. She is the reason I serve in healthcare information technology. I can’t imagine having any vocation outside of healthcare. I am a direct beneficiary, and it changed me forever.

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.

CIO Unplugged 6/15/11

June 15, 2011 Ed Marx 6 Comments

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

To BE Innovative, YOU Must … Be Innovative

No one can avoid the term "innovation." It is the holy grail of the 21st century, the hope for modern-day business. 

In his 2011 "State of the Union" address, the President stated, "… the first step to winning the future is encouraging American innovation." Walk into any bookstore or library and the shelves are stocked with books and magazine articles on how to make innovation happen.

Yet despite the resources available and the attention given, innovation still eludes leaders. According Rick Kash and David Calhoun in their book How Companies Win, one trillion dollars was invested last year in the name of innovation with little return. Why?

As with many companies, ours touted innovation as key to growth and culture, yet the concept remained more of a dream than a reality. Then things started to change. Transformation began with a small group of individuals that discovered in order for their company to be truly innovative, innovation had to start with them. You see, to BE innovative, YOU must be innovative.

This evolution has given us national recognition for innovation. Disruptive business models and clinical discoveries have exponentially increased.

How does innovation begin?

First, come to terms with the fact that innovation does not happen by copying a genius like Steve Jobs or Leonardo da Vinci. Nor does it happen by copying the culture of 3M or Google. These men and companies are outliers. You cannot replicate results by cutting and pasting their experience. Gladwell’s latest work, Outliers, highlights this phenomenon brilliantly.

Innovation is organic and personal. This is why innovation begins with you.

Second, while I believe we are born innovative, the cumulative effects of societal norms have rendered the bulk of us innovatively impotent. To release the innovation inside of us will require significant effort. Start by purposefully casting off the well-meaning restraints put on you from parenting, schooling, and work policies. Retrain yourself to walk in freedom and creativity.

Ninety percent of the fuel required for a trip to the moon is expended at lift-off, as the spacecraft breaks loose of the gravitational chains holding it captive. It’s the same with the innovation journey. Balls to the wall.

Nine methods you can leverage to BE innovative:

  1. Embrace mentoring. Step away from the parental type of mentoring, where you’re paired up with someone reportedly “older and wiser.” Instead, pair up with someone younger, who looks, dresses, and talks in ways that might make you uncomfortable. The more uncomfortable and stretched you are, the better.
  2. Active passion. Passion stokes the fire of innovation. Exactly what brings out your passion doesn’t matter. Just find something that brings you life and energy. Painting, gardening, dancing, big wave surfing, or jujitsu, whatever. Passion provides content and context for innovation mash-ups and convergence.
  3. Leverage technology. Innovation drives technology, so it is critical to play in this area. Taking on technology forces you to become a continuous learner. Studies have shown that the more we push the boundaries of learning, the more our brains neuro-connections increase and retain their elasticity. Nicholas Carr provides an excellent overview in his book The Shallows. The converse is true; not pushing boundaries negatively impacts a person’s ability to exhibit innovation.
  4. Experience > observation. Go and experience the world. IDEO Partner and Stanford Professor Diego Rodriguez says, “Experience the world instead of talking about experiencing the world.” Stop watching "reality TV." Rather, go and make your own reality. Increase your diversity of experience. As with passion, this will increase the content and context for innovation.
  5. Disruption enables innovation. The fainthearted are not capable of innovation. You’ve gotta be courageous and take risks. Baby steps are for babies. Go big. Man or woman up.
  6. Practice exorcism. Time to get rid of the devil’s advocate inside you and inside your organization. Ban the phrase and practice. Dissent is encouraged in the context of collaboration, but self-proclaimed “demons” have no place in your organization or life.
  7. N2 > N. Adopt a systems-like approach to help you manage ambiguity, variation, and change. While the world is increasingly complex, you can cut through it all and maintain clarity. Embrace complexity on your terms and leverage for greater innovation.
  8. Eliminate broken promises. Innovation without execution is a broken promise. As they say in my adopted home of Texas, don’t be “all hat, no cattle.” Failure to follow through zaps your innovation.
  9. Embrace failure. Start celebrating failure, even reward it. In the smoldering ashes of failure, innovation rises. When you fail, be public and positive.

By following these nine steps, we were able to become innovative. Once we became innovative, our organization began to be innovative. No magic formulas or mimicking of other people or cultures will work.

Begin with the person in the mirror — you.

Update 6/28/11

Thanks for your comments, most of which focused on the exorcism of the devil’s advocate. Clearly you must have a culture of encouraging rigorous debate and contrarian opinions. Iron sharpens iron and it is during these times of challenge that ideas get honed or put to appropriately put to death.

What I am talking about is people who are not constructive, but always are the first to shoot down ideas, hiding beneath the “devils advocate” defense without offering anything new.


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.

CIO Unplugged 5/18/11

May 18, 2011 Ed Marx 7 Comments

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

This is the third in a short series of posts on The CIO’s Best Friends, BFFs who are critical in ensuring CIO effectiveness. This time we cover the vendor account executive–CIO relationship.

Don’t Fudge the CIO–Account Executive Relationship

I was new in my role as a director. For that matter, I was new to managing a vendor relationship. I was getting by, but only because the vendor account executive (AE) took pity and mentored me in how to manage such a relationship.

I had a responsibility to implement new applications to make our hospital easier to use than the competitor down the street. We had significant success, but it had little to do with my abilities. It was the AE.

I nearly ruined this relationship.

I set out to leave the office, looking forward to a family vacation the next morning. I don’t recall the infraction, but I said something unfair and unkind to the AE. I knew I was wrong and felt awful. I fired off an e-mail apology,  but I wanted to do more. My time was scrunched.

On my desk laid two large, wrapped boxes of fudge from the famous Rocky Mountain Chocolate Factory. An AE from another company had shipped these to me as a thank you for hosting a site visit for a prospect. I set aside one box for my team and intended to open the other. In my haste to demonstrate remorse, I repurposed that second box, taped my handwritten note to it, and sent to the offended AE. Damage repaired, I left for vacation.

I posted previously on maximizing vendor relationships, which I prefer to call partnerships. Strong relations in this area are instrumental to the success of provider organizations. The AE is the face of the partner and is as critical to the relationship as any product or service provided.

Partners use unique approaches and generally assign one or two AEs to the provider. I prefer one AE. Some partners have multiple AEs representing specific products and services, which I find suboptimal and challenging to manage. Others call their representative an AE, but those are only a salesperson in disguise. Some are assigned exclusively to healthcare, while others are assigned to diverse industries but have some exclusivity to specific accounts.

I’ve experienced many approaches. What trumps any specific structure is the AE themselves. A strong AE can overcome the weakest structure. Conversely, a weak AE can ruin the reputation and business of the most progressive vendor.

That said, here is what I have found works best:

  • Single AE. I can’t handle multiple relationships with multiple partners. But a single AE with a handful of partners is doable. Have you ever bought a car and had to work with the salesperson, and the manager, and the fleet director …
  • Formal structure. See link.
  • Relationship. We don’t have to like each other, but it doesn’t hurt if we do. Clearly you can’t allow a friendship to trump business judgment. I tend to keep a safe distance for the protection of all parties.
  • Transparency. I have yet to meet one AE who did not appreciate brutal honesty. It took some getting used to, but it was a freeing experience. Being transparent allowed for honesty, so I also knew the truth of what a vendor could or could not do. Don’t BS me with jargon — give it to me straight.
  • Identity. Who do you work for? I prefer an AE who makes me feel as if they work for me. Obviously they must remain loyal to their company, but bravo to those who master the identity question.
  • Accountability. Do what you said you’ll do, and be timely.
  • Accessibility. If I need you, be there. I’ll do the same for you.
  • Value-added service. Go the extra mile to help me with my business.
  • Empathy. Give me an AE who cares about what I need, not about what they have on the dock to sell. Understand our world and our challenges. Skip the clichés — relevancy makes a difference.
  • Integrity. I need to work with someone I can trust and solve business problems with.
  • Post-sale support. Service and support after the deal is sealed. True relationships continue long past the initial sale. Maintain communication after the big sale and provide service that allows both parties to learn and continually improve.

I asked my partner AEs for their perspective. Their key success factors proved similar:

  • Alignment. Beginning with the end in mind. Have a clear understanding of the alignment between strategic business initiatives, IT’s role in supporting those initiatives, and being able understand the relative priority of the active projects for the organization as a whole.
  • Questions. If brevity is the soul of wit, the ability to ask good questions is the soul of a successful AE. Questions indicate a desire and willingness to help as well as a tacit admission that he or she doesn’t know all the answers — but they’ll work on your behalf to find others who might.
  • Listening. Contrast this with an AE that does all the talking and simply discusses features and benefits or licensing arrangements. They make little effort to learn your business, and they’ll never learn your business while they’re doing all the talking.
  • Relationships. Work “with” rather than “around” IT leadership to build relationships with the lines of business. Excellent AEs collaboratively develop relationships, think strategically, and have a network of partners and friends who can help you. They include you in those relationships, and conversely you are able to return the favor. Having a long-term view of the relationship helps navigate through the tactical day-to-day issues that may surface.
  • Communications. Talk through expectations at a personal and organizational level. e.g. what do you want from your AE and what do you want from the vendor? Meet regularly to update both organizations on goals and strategy. Ensure accessibility and responsiveness on both sides. Have frank discussions about what’s working and what can be improved. Set agreed-upon and mutually shared goals.
  • Trust. Built over time through the experience of working together.

The benefits to all parties are measurable: More innovative ideas to help the company improve its market position. More revenue generating and clinically effective solutions. More cost savings proposals. More vendor stability for the account, reducing personnel turnover. Success for both organizations and, by association, the AE and CIO.

Following my vacation, I returned to the office and found a note from the AE I had offended. “Ed, thank you for your card. Apology accepted. And thank you for the box of fudge. FYI– next time, you might want to make sure there is no note inside of it (from another partner). I am glad your demo went so well! I had a good laugh, and all is forgiven.”

Embarrassed and humbled, I put my tail between my legs. But I did learn many great lessons through that AE. So remember, if you receive fudge from me …

What are your ideas on what makes for a great AE relationship? I would love to hear from both AE and providers.

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.

CIO Unplugged 5/4/11

May 4, 2011 Ed Marx 11 Comments

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

Taking a one-post break from my short series, “The CIOs Best Friends,” BFFs who are critical in ensuring CIO effectiveness. Next time we cover the Vendor Account Executive – CIO relationship.

Where Dreams and Fear must Collide*

What is your biggest dream? What’s been in your heart but never attempted?

Fear keeps most people from pursuing their dreams, or even speaking about them. Three years ago, I completed my first Ironman. A physical feat for sure, but also lessons for work and play.

Ironman accelerated my personal and professional growth and to this day serves as a vivid reminder that one can accomplish great things where dreams and fear are allowed to collide. I never thought I could be an Ironman until life events dictated otherwise. My manager actually envisioned me and encouraged me to pursue despite my fears.

These videos explain the story for those interested.

If you’ve followed me for any length of time, you know I view each of life’s parts as one continuous journey. I integrate all aspects of living in order to maximize time and opportunities. Crossover is key to accelerated and sustained growth.

Here is what I learned and how it applies to our careers.

  • Training. Many CIOs believe no further training is necessary once they’ve reached the top. To the contrary, requirements increase with elevation. Continually equip yourself or you’ll be passed along the way.
  • Embrace change. During Ironman, a racer encounters unforeseen circumstances. Strong winds. High tides. Flat tires. No one is exempt from trials. Do you accept change and make the most of it, or do you spend energy fighting elements you cannot control? Adapt to curveballs thrown your way, and then thrive.
  • Guts. It’s not merely the most fit who finish Ironman. It’s also those who want it badly. Crave it. I surpassed colleagues in my career who were brighter than I because they lacked fortitude, desire, and focus to push through challenges. Painful things will happen that tempt you to quit, so harness the power of passion, for passion creates guts and drives success.
  • Bust boundaries. A 5K run was a long distance. Running a marathon struck me with fear. Today, however, 10K is a warm-up. Ironman busted boundaries I believed invincible. As CIO, we must continuously bust boundaries lest our organizations become complacent and visions dim. Test boundaries, then break through and grow to the next level.
  • Planning. No one wakes up and decides to do Ironman that morning. It takes advanced planning and years of transformation to see grand dreams achieved. Plan similarly for your career and your organization. Proper preparation preludes proficient performance. No greater euphoria will seize you than crossing the finish line – a plan fully executed and realized.
  • Rest and refueling. There is a science to Ironman, which includes rest and refueling. Continuous activity leads to burnout. Take time for nourishment and you sustain your energy. Constant action is not synonymous with effective action. Build in time for rest and refueling.
  • Followership. Be sure the person you are following has the vision and stamina to keep you on the right track. Great leaders help you overcome fear. “Followership” is a critical talent for reaching dreams.
  • Two are better than one. By riding in a pack, you gain 40 percent efficiencies over riding alone. Teams accomplish more. Pushing and pulling together, a team outperforms the loner. Surround yourself with positive people dedicated to your success. They will get you through the loneliness and pain of challenging times.
  • First break all the rules. Sometimes you’ve got to shake things up and not do the same things over and over, especially if they’re not working. Focus on strengths not weaknesses. I made the choice to strengthen my strong bike over my weak swim, and it paid off.
  • Bigger picture. As a leader, do you have a significant purpose? Put people first. Seek to serve. Dedicate your efforts to others. My Ironman was inspired by and dedicated to cancer victim Ellen. She kept me in the race. In health care, the Ellens are the ultimate endurance athletes running a race that nobody should ever have to run. We are there for them.


5-4-2011 8-12-46 PM

An update for those who watched the videos. Ellen traded her earthly rags for a robe of righteousness on July 26, 2009. I will never forget the energy she gave me during my training and our time together at the finish line. She helped me overcome fear and reach my dream. My bike still bears her name.

Pam is in complete remission.

5-4-2011 8-11-30 PM

You can’t tell by his energy and attitude, but “Ironman” Sam is still fighting. I hope to accompany Sam on his first triathlon this September. He will be 8 years old. I will help him overcome fear and fulfill a dream.

*Where Dreams and Fear must Collide. “Let me Fall”, Cirque du Soleil, Quidam

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.

CIO Unplugged 4/20/11

April 20, 2011 Ed Marx 4 Comments

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

This is the second in a short series of posts on “The CIOs Best Friends,” BFFs who are critical in ensuring CIO effectiveness. This time we cover the CFO – CIO relationship.

The CFO – CIO Relationship

When asked to take on additional responsibilities, I inherited our financial applications team. This scared me. Not because of the expanded scope, but because I’d have to deal with our CFO, a person feared in the halls of IT.

During the first week in my new role as corporate director, the CFO demanded an update on the troubled decision support project for which my team was responsible. I gathered players and facts and cautiously took my seat in the arena … I mean, in his conference room. He was not happy about the multiple delays and lack of concrete plans for resolution.

My project manager struggled in her responses. The CFO’s gaze then landed on me.

I don’t recall if my summation came across as eloquent or suspect, but my speech carried a mix of service compassion and urgency. I ended with, balls to the wall. The CFO smiled. I made a connection — one free pass for the new guy to facilitate resolution.

No C-suite relationship has changed more this past decade than that of the CIO – CFO. As technology influence becomes increasingly strategic to success, wise organizations are evolving. CIOs are crawling out from under the CFO’s shadow and taking their rightful seats at the executive table.

Regardless of whom the CIO reports to, the relationship with the CFO remains essential. I have worked with several over the years, a mix of old school and new school. Here is what I discovered as keys to both personal and organizational success.

Connection. You have to establish a relationship that transcends organization boundaries. Something unique happens when you break bread together. Get out of the office with your CFO at least monthly for breakfast or lunch. Or, if you both enjoy working out, then a few-mile run or a one-on-one basketball game may be the answer. The point is to get out of the office and get acquainted on a personal level. A healthy foundation sets the tone for a thriving work relationship.

Collaboration. One way to supercharge the relationship is to join forces on an initiative or project, ideally one that benefits the organization and is important to the CFO. Welcome proactive ideas on taking costs out or leveraging technology to increase revenue. i.e. redesign processes to enable a faster month-end close or any technology to accelerate cash collection. Suggest working together to ensure Meaningful Use achievement. Don’t wait to be asked. Be the first to anticipate and reach out.

Knowledge. Learn everything you can about finance. Take courses and read what the CFO reads. I attend HFMA conferences and read their periodicals. Participate in finance webinars. Speak their language and understand what is important to them. How do they measure their success? What are the key benchmarks, and are they up or down?

Execute. Do it well. Never undertake anything halfway. With finance, precision is the standard, and you cannot afford to miss a commitment. If you cite a number or percentage, hit the mark exactly.

Trust. Be good stewards of your finite resources. Be transparent and accountable. Have a finance person on your team to assist with budget oversight. Ensure that your governance process has a closed loop process where you measure baseline and ROI achievement, and then report on it. If you say a new application will reduce costs or increase revenue, then ensure the specific budget is updated to reflect this. Conduct a zero-based budgeting exercise and review every budget line item with your managers and finance. Trust takes time and relationship.

Shared Vision. Once you establish the relationship and build trust through collaboration and execution, you can then arrive at a shared vision for the role of technology in your enterprise. You need the CFO’s support to be successful, and he or she needs yours. Give the CFO every reason to be enthusiastic about endorsing the direction of IT to ensure a commitment of resources available over multiple years.

The benefits of a strong CIO – CFO relationship are many and lead to a stellar organizational ROI. I have multiple examples of how the support of the CFO helped me fulfill the shared vision and positively impact the organization’s quality of care, patient safety, and business growth. Everything from financing critical infrastructure, implementing EHRs, obtaining Meaningful Use, or starting new businesses.

Some of you may be saying, “But you don’t know my CFO. He starves me deliberately.” Actually, I’ve worked with both types, the backward-thinking and the progressive. I feel your pain. But don’t let the die-hard keep you from making your best effort. If nothing else, your character and strength will improve. Be proactive for the sake of organizational success. Be relentless and keep developing the relationship.

That intimidating CFO? He turned out to be quite personable and of excellent character. I was so impressed that I asked him to be my formal mentor. He accelerated my growth. He pushed me to new heights personally and professionally. I moved from corporate director to CIO because of his influence.

Leverage these ideas and ensure your relationship is not sub-optimized. Accelerate quickly at full throttle. Balls to the wall!


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.

CIO Unplugged 4/6/11

April 6, 2011 Ed Marx 6 Comments

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

The CIO’s best friends. This is the first in a short series of posts BFFs who are critical in ensuring CIO effectiveness.

The CMIO/CIO relationship: Lennon and McCartney Minus Yoko

The magic key to the Beatles’ success was the convergence of songwriting talent and musical genius from John Lennon and Paul McCartney. While individually gifted, together they created one of the most celebrated musical teams ever. I grew up on these guys and I think I have their entire catalog memorized. My family indulges me in Beatles-themed Rock Band nights. Below is my version of Lennon and McCartney as healthcare heroes.

CIO: To be successful, I need a physician who can innovate and sing tight harmonies with me. I want someone who will tell me when I’m off the beat or flat. Depending on our audience, I might need this person to take the lead, or just play bass. For sure, I need someone I can trust who shares the vision. And I have to have a physician I love to be with. Meet Dr. V.

4-6-2011 7-06-06 PM

Dr. V:  Foundations of a great friendship are the hallmarks of a strong and effective CIO-CMIO relationship: mutual respect and trust. Ed and I work well together because we have a deep understanding of and respect for what each brings to the relationship and to the organization.

CIO: How do we accomplish this rich relationship? Spend time together in and outside of the workplace. Our families should mix virtual and physical. Common interests are bonus tracks be they World Cup Soccer, Starbucks, or shared faith. In the workplace, we do interviews together, rigorously debate strategy, lament losses, and present together. We’re to the point we finish each other’s sentences and sometimes ideas. At other times, work is plain fun, like the 45 minutes we spent posing for pictures for a magazine cover. We bantered about taking more photographs together than we had with our wives during our wedding ceremonies. Our diverse backgrounds, talents, and skill sets provide opportunity for creative mash-ups that lead to innovation.

Dr. V: Thanks to a level of transparency only attainable by best friends, we know each other’s strengths and weaknesses intimately. Like brothers, we support one another.

CIO: We fight, too, which makes us more effective in the end. Sometimes it’s over silly things. For example, during video chats, he’ll shut off his camera because his hair is not perfect (I don’t have hair issues). But mostly, our arguments are serious, i.e. the adequate deployment of resources to support the medical staff. Only after a significant debate can we push our organization into new genres. Our sound is not always welcomed, but eventually we’ll even win over the crooners. Synergy at its best.

Dr. V: As healthy friends should, we hold each other accountable for our decisions and for performing at the highest level of our abilities. This sometimes means challenging the other to live up to his full potential, even if that requires putting up with uncomfortable changes.

CIO: To have an effective relationship, we have to lower our guards, be vulnerable, and deliberately set aside time for nonsense … not something typically easy to ask of a cardiovascular surgeon and a Type-A personality. We’ve gotten to the point where we know we won’t be judged for our voices cracking on a high note or for forgetting lyrics. While I receive kudos for use of social media, much of that came from him relentlessly pushing me to try new rhythms and styles. I also know that in a moment of weakness he won’t take advantage of me. Rather, Dr. V will lift me higher. And I do the same for him. I’ve got his back.

Dr. V: A good example of a challenge: Ed encouraged me to assume a matrixed reporting relationship to another leader in the organization. While a logical path to follow, I questioned the wisdom. Ed and I have a great working relationship. Why risk it? Trusting Ed’s vision, I acceded. In retrospect, it was one of the best decisions I’ve made to advance my personal development.

CIO:  Without a doubt, my CMIO makes me stronger. Together we have made an impact larger than either of us could have accomplished on our own. My CMIO gives me confidence that our clinical staff is taken care of and protected and that their interests are heard and acted upon. He gives the clinical staff a voice, and when mixed and played back, it’s music to the ears of our patients.

Dr. V: As the song from the ‘80s goes, “That’s What Friends Are For

Tips for Building That Foundational Relationship

  • Have families over for dinner and parties (significant time together)
  • Follow each other on Twitter
  • Share on a personal level (requires honesty and transparency)
  • Create and give presentations together
  • Conduct joint interviews
  • Maintain trust by following through on commitments
  • We’re still planning trip to Rome together

And like brothers and good friends, we don’t always agree on everything. Case in point: just like the Beatles, only one of us has an affinity for Apple.

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.

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.

CIO Unplugged 2/2/11

February 2, 2011 Ed Marx 85 Comments

The Lost Art of Mentoring

Who taught you life skills? Did anyone coach you in the ways of culture and values? An uncle? Your grandma? The television?

The movie Gran Torino with Clint Eastwood gives a genuine, raw portrayal of mentoring. In a nutshell, Eastwood attempts to teach the immigrant neighbor boy how to be a man. He starts by teaching Thao the skill of carpentry: how to hold a hammer and which tools to always have on hand.

Then he comically endeavors to educate the kid on manly talk and how to act like a man. Eastwood verbalizes it, then demonstrates it, and finally observes Thao doing what he’s learned. The mission took time, money, energy, and the forging of a relationship, but it was worth it.

Some of us wish we had an Eastwood-like character in our lives. Speaking from experience, we all need mentors. When I became CIO of a large, prestigious organization in my mid 30s, I was both elated and scared. Mostly scared. What gave me comfort and accelerated my success were my mentors. Even today, despite the 10 years’ of experience under my belt, I can’t grow without a mentor.

Dictionary.com defines mentoring as an ongoing, planned partnership that focuses on helping a person reach specific goals over a period of time. Unfortunately, the art of mentoring has rarely caught on in the business world, healthcare included. We see this reflected specifically in the graying of existing leadership and the lack of succession planning.

This type of one-on-one interaction — lost somewhere after the apprenticeships of the pre-industrial age — has been replaced with short-term, focused leadership programs. These programs attempt to turbo-charge management education by cramming years of collective wisdom into a one-week synopsis. For example, the College of Healthcare Information Management Executives (CHIME) offers an excellent leadership development program entitled “The CIO Boot Camp” that cannot keep up with the demand for enrollment. Why is it so popular? It fills the mentoring void in today’s organizations.

Is mentoring beneficial in healthcare? Yes, when done right. Committing to mentor another person is an investment in the long-term success of an organization, a selfless act of service for the sake of the profession and the future of healthcare.

This type of partnering also offers something a person might not get directly from their supervisor: broader experience, organizational perspective, and new skills. Let the CFO or CNO mentor an IT professional. If the CNO teaches the info specialist leadership skills, that will broaden the mentee’s ability and understanding.

Determining the appropriate mentor. Examine your strengths and weaknesses. Match up a clinician with a CFO in order to gain key insights into the healthcare financial world. Cross-pollination does wonders to promote teamwork and connectedness. (Mentors from outside of the organization or healthcare might offer a level of anonymity and broad perspective, but they would lack the context for key elements of discussions.)

Mentoring programs and recruiting. Job candidates respond favorably when they understand that the organization cares for their professional development and will enable them to achieve career success. Over time, as the mentoring program becomes a major differentiator in recruitment efforts, your organization will become an employer of choice. Gallop has statistically demonstrated that an organization with a high level of engaged employees significantly outperforms non-engaged workforces in areas including customer satisfaction and financial results –  both employee and employer win. Clearly, such programs lead to improved health in the corporate setting.

Partnering exposes you to new insights and understanding. One academic medical center I know sends its IT leaders on annual short-term mentoring assignments to all of its clinical departments. The CIO began routine rounds with physicians and residents. In each case, the mentor allowed the IT leader to experience the specific clinical care setting, answered questions, and discussed the critical intersection of IT and quality patient care. Each IT leader came back with a new sense of purpose and motivation. They in turn made immediate changes to IT systems and support to help ensure a higher quality of care.

Mentoring develops future IT leaders. Given the limited pool of emerging leaders, mentoring is more critical than ever. Identifying and growing talent within our organizations is imperative. Our leadership effectiveness is not so much based on formal education and rigorous reading, but in real-life, on-the-job experiences.

Restoring the lost art. We are the sum of our collective inputs. I credit my success to my mentors. I have been deliberate in this process. On even years, I mentor someone. On odd years, I am mentored. I require each of my direct reports to do the same. I’ve been formally mentored by health system CEOs, COOs, CFOs, CMOs and hospital presidents. I have mentored many who have since moved into positions of authority. Check out the many resources available on establishing quality mentoring programs.

A personal board of directors. At this stage of my career, I have had so many mentors that I consider them my board of directors. In fact, just today, I needed help in specific situation, so I called up a former mentor and met him for lunch. I left that meeting ready to conquer the world — or at least my personal struggle.

Resources. Anyone who posts a comment, I will send to you a simple one-page mentoring contract you can use to facilitate your own relationships. I will also send to you a list of “golden nuggets,” the bits of wisdom I have learned from being both a mentee and mentor.

Update 2/8/11

Thank you for the many responses. By now, everyone who posted should have received the Mentoring Contract and the mentoring Golden Nuggets.

Quick answers to some of the questions.

I do not recommend mentoring any person in your chain of command. That is one reason for mentoring across disciplines. This is hard to avoid at the most senior levels, but can be accomplished by having a mentor outside of your organization.

Your chances of landing a willing mentor are exponentially increased if you disarm them first by telling them it is for a fixed period of time at regular intervals not to exceed one year, that you will handle all logistics and work around their schedule, that the relationship will be confidential, and you have a contract where you will define objectives. Genuine flattery helps — I have never been turned down.

Don’t wait on your organization or be a part of a weak mentoring system. Do what I call grassroots mentoring. Find someone who would make a strong mentor and ask them. But how do you identify a mentor? Observation. Look around you. Who do you admire or look up to? What disciplines do you need help in? Who inspires you? Who are you attracted to?

Finally, while I believe in diversity, I choose only males to mentor and mentee. Personal preference.

On the vendor side, those were some tough questions. To the extent possible, carve out the time for mentoring and make it untouchable. Because I often mentor with executives, I normally pick a breakfast slot. One, breaking bread is intimate. Two, you are less likely to have interruptions and tardiness. Three, everyone has to eat.

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.

CIO Unplugged 1/24/11

January 24, 2011 Ed Marx 10 Comments

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

CIO Unplugged … Unplugged

“Aim high, aim for something that will make a difference, rather than for something that is safe and easy to do.” – Peter Drucker

How are you wired? Have you studied yourself lately, or are you busy dissecting others in order to increase your worth? (Like right now. What are you thinking as you read this blog?)

Experiences give shape to character, meaning experiences bring out what’s already inside — the genuine you. How you and I react to life’s events, both good and bad, determines whether we will find success or failure. You were created to succeed, but have you chosen to be less?

“Leaders are honest, forward-looking, competent, and inspiring.” – James Kouzes

Honest. As a college freshman, I’d hit rock bottom. A 1.6 GPA. A bank account depleted by the party life. Friends? Not sure. Family? Far away. An empty, haunting, painful experience. I saw where I was headed, and I wanted none of it.

With nothing left to lose, I got on my knees and made the decision for the greatest adventure of all — a new life, set free at last. My junior year, the adventure accelerated. I married a woman. Not just any woman. Julie was — and is — valiant, vulnerable, and scandalous, yet she keeps my feet on the ground. We said “no” to the safe life, and our journey continues 26 years and counting.

Say “no” to simply existing. The easy life makes zero difference on humanity. Healthcare IT does not need more technology or more talk about the bits and bytes. We need bold leadership!

Inspiring. A great adventure is full of thrills and danger. Climbing mountains, swimming in oceans, preparing for war, and competing at the highest levels. I’ve done these things, and I’m telling you about it without shame because I worked my butt off to reach each goal. I take roles that stretch me and then ask for more, trembling. Standing up to bullies takes guts, but someone has to do it. I will, and I have. I’ve pushed the guardrails of employers. How else can a company grow?

In June, I will lead an expedition to Kilimanjaro. We’re funding and building a medical clinic. With Tanzanian government collaboration, we will open and operate the clinic. Is this safe? Hell, no. But it’s worth the sweat and sacrifice to help a sick child.

Three times I’ve faced death. Reprimands wait for me around every corner. I’ve questioned myself and my motives. I fail, but I bounce back. I am a target. So why do I keep going? Because I understand who I am, what my purpose is, and why I was created. I take the downside knowing the upside is rewarding. The safe life is not worth living.

My five years of blogging has brought rewards and criticism — not a safe pursuit. Some find my posts offensive, and I do not apologize. While most comment to debate the merits of theories or ideas expressed, which makes us all better, others attack character. I am accused of many things: narcissism, motivational pundit, etc. (I am a work in progress and continuously developing).

Attacks come with the “unsafe” territory I’ve chosen to inhabit. I encourage debate. If you want to attack character, I am open to that as well, but I will only receive it if you engage me personally. Connect with me. Where is the credibility in taking personal shots from afar? Only cowards take the safe route.

Looking forward. My mission is to “Leverage information technology and leadership to improve health of people.” My vision is to “Develop information technology leaders who impact organizations.” Blogging on leadership from the angle of CIO is one strategy to make this mission and vision a reality.

The amount of feedback I have received over the years helps measure this. People send me stories that would make you cry. Others would have you shouting for joy. Stories of readers taking a stand. Stories of readers rising to their potential. Stories from vendor and hospital CEOs, from clinicians to the young and old, the payor, and the provider communities.

Modeling and encouraging leadership influences more people than does commenting on technology. That’s why I do it. I’m wired to lead.

The significant way to transform healthcare is to speak less on technology and instead be a leader with a bias for action. You can learn about cloud, networks, or virtualization in school. Leadership, on the other hand, is caught, not taught. I will not waste energy rehashing Computers 301 when I can challenge and inspire you to be more of who you were created to be. A success!

This blog is me unplugged. This is my background and my motivation. Do you have a defined purpose? How do you measure your results? What motivates you?

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.

CIO Unplugged 1/13/11

January 13, 2011 Ed Marx 20 Comments

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

Crisis Reveals Leadership

I finished my first week as CIO exhilarated. I slipped out early and headed for a haircut (I had hair back then). The grating buzz of the “emergency broadcast system” disrupted WTAM’s sports update. A power outage that began in the Northeast had hit Ohio. This was not a test.

Out the window, I watched traffic come to a halt. Electricity stopped, rendering signals colorless. I called my family and staff, but cell networks were overwhelmed. I returned to the office.

They say nothing in life is certain except death and taxes. I differ. Crisis is a sure thing. By definition, life is a series of crises, and a showcase of our ability to react. Death, sickness, raising teenage daughters….

Life and career choices determine the number and severity of crises you might experience. But one thing remains true: you will have them. Great leadership will minimize the volume of crisis, but every leader will encounter one. Preparation and execution determines how healthily you emerge.

No course, audit, or survey can tell you as much about your leadership than a crisis. If you want a test that shows what you are made of, crisis will reveal your abilities. Those who aspire for greater responsibility must understand that to whom much is given, much is required. The higher your position — be it family, church, community, or work — the higher the probability that you will be leading in crisis. Be prepared.

I have mishandled some crises and led well through others. In each case, I came to terms with my abilities. Failures and successes totaled, here are things I learned. Master these so they become part of your core leadership abilities.

Take Responsibility Immediately

Do not blame a vendor or an employee. You are the CIO. Crisis happened on your watch. Take responsibility and focus on resolution.


  • Chain of Command. Ensure everyone knows chain of command, especially when multiple teams are involved working on solutions. Given sleep cycles, you do not want lack of clarity to slow progress.
  • Battlefield Promotions. Expend your energy working with the motivated, not trying to motivate the worker. Make on-the-spot promotions as needed. Now is not the time for staff development.
  • Fit Leader. Sometimes a crisis can span multiple days. You have to be fit to be effective. Don’t argue with me, argue with science. Most can perform well for 24 hours, but notable performance degradation begins thereafter.
  • Visibility. You must be on site. Make a point to lead all customer calls (except on sleep rotation) and walk the floors of impacted hospitals. Walking floors is mandatory for all the command center commanders (my directs).
  • Deploy Listening Posts. During a crisis, it may appear that the sky is falling. You’ll hear exaggerated reports. Your plans will be incongruent with reality and spread panic and fear. Having your own listening posts will help discern reality and lead to quicker resolution. Another reason why personally walking the floors is critical.
  • Ask the Right Questions. We live in an instant society with on-demand entertainment and microwave food. We often don’t have all the pieces necessary to solve a problem that might arise. The delta between the immediate need for an answer and the time it takes to find the right solution frequently generates stress. In this scenario, stress begins to ebb when you finally start asking the right questions and start getting the right answers. And, like any good jigsaw puzzle, the pieces naturally begin to fit together… as they were intended to.


  • Operations. I am most familiar with ITIL. The operational process you choose to leverage is immaterial, but having established and routine processes is a key success factor during a crisis. You do not have time to reinvent the wheel.
  • Downtime Procedures. Again, establish and practice.
  • Disaster Recovery/Business Continuity. Most organizations have a DR plan, but few have BC drills. Conduct BC drills quarterly. This enables you and your staff to better handle the stress and drama of an actual crisis before it happens.
  • System Access. Avoid single points of failure. In an emerging world of ubiquitous electronic health records, you must have devices and systems pre-deployed to ensure access to data in a catastrophe.
  • Business Resumption Plan. While key to focus on solutions, you must also direct your staff and customers on business resumption planning well before the solution is in place.

Practical Logistics

  • Food. Assign someone to ensure a steady food and coffee supply. Let your key people focus on tasks, not noisy bellies.
  • Sleep. Have a rotation for rest, like airline pilots on international flights. Have comfortable places for people to sleep and nap if staying on premise.
  • Command Center. Stand up a center within one hour of calling a disaster and staff it 24/7. Should stay open 2x length of actual event. Do not shut down prematurely.
  • Assist Customers Impacted. Constantly ask, “How can we serve you? What else can we do?” whether IT related or not. I deployed staff to delivering water supplies and purchasing fans. Double or triple the number of staff on site. Visibility in crisis is crucial. Keep high staffing levels until the customer signals enough. I saw firsthand how our clinicians reacted to seeing a significant presence on the floors with questions like "How is the system working? How can I help?" This reassured our clinicians that we were taking the crisis seriously.
  • Communications Plan. Strong communication fills the void that otherwise gets populated with incorrect messages. Helps develop customer allies in solving crises, as opposed to antagonists. Publish your cell phone number. Start all communications by highlighting your organization’s mission. This serves as a common rally point for all involved. Be consistent in your messaging. Key messages might include accountability, transparency, action, calm, and hope. Execute your plan as published. Leverage multiple venues such as conference calls, e-mails, collaboration tools, portals, etc. Embrace corporate communications. They are experts in communications and can help you develop, adjust, and execute your communications plan.

Profit from Crisis

Document throughout, and take history of all actions and issues. This is critical in averting future crises. Resist the pressure to return an organization to status quo so you can profit from the crisis. Not seeking opportunities or pursuing the underlying cause of the crisis might leave your organization open for future conflict.

  • Wiki. Open a wiki and encourage staff and customers to post notes real time. Use these for practical insights during the crisis to document key lessons learned.
  • Document Lessons Learned. Encourage all customers to take notes during the crisis so they can make adjustments to the processes.
  • Downtime Procedures. These may never have been exercised. The best time to make real world adjustments is while downtime procedures are active.

Engage Outside of IT

  • External Expertise. It is a sign of strength to reach outside of your organization for help. If I sense the crisis is longer than two hours, I am on the phone calling peers and vendors.
  • Guru Council. Set up a council of advisors to make sure your plans are logical and nothing is missing. Council members are not in the heat of the battle and can provide unstressed ideas.
  • Vendor Management. Do not hesitate to escalate early and often. You have no time to dally. Let the level of severity determine when to go to the CEO.
  • Engage Senior Leadership. Do not hide what is happening. Engage senior leadership immediately and keep them informed. Bring senior leadership directly into the loop with vendor senior management. This ensures your crisis will receive appropriate attention.


  • Take care of your staff. Keep everyone focused on solutions not blame. Share all positive feedback as received.
  • Have multiple teams working on multiple solutions. On two occasions, the primary plan failed to bring about resolution. Fortunately, secondary plans already underway saved the day.
  • Ask for ideas from staff not associated with the crisis.
  • Levity. Despite the crisis, you must work hard to ensure a calm atmosphere. Staff will think more clearly when you de-stress the environment. I recall Day Two of a crisis when someone began playing Christmas music and a sing-along started. It alleviated an otherwise tense situation.

Ending Well

When the crisis is over, the work begins.

  • Send a Thank You. Personally acknowledge all those impacted, first your customers and then your staff. These might include nurses, medical staff, and practices.
  • Root Cause Analysis (RCA). Figure out what happened and what can be done to avoid this same crisis. Do not skip this. Publish the RCA and include action and mitigation steps. Monitor for execution.
  • Assimilate all lessons learned, downtime procedure modifications, etc, into enhanced processes.

We are all healthcare IT leaders, and my hope is that some might profit from the ideas posted. What ideas and tips do you have that I failed to cover? We will send a “crisis agenda” template to all those who post a new idea.

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.

CIO Unplugged 12/27/10

December 27, 2010 Ed Marx 41 Comments

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

Why I Fired and Then Rehired Myself

The capstone of holiday seasons past has been The Plunge: leaping into the icy waters of Lake Erie wearing nothing but swim trunks. Each New Year’s Day, we Cleveland Triathlon Club members gingerly — if not insanely — worked our way across the snow and ice then charged into the lake. Once we reached waist-high water, we crowned our feat with a head-first dive. Like an arctic baptism, the Plunge symbolically washed away the old and welcomed the new.

A few years back, I used this event as the demarcation point for firing and rehiring myself. I plan to do the same as we head into 2011. I think we all should give ourselves the pink slip.

A few years ago, Intel was losing market share and profitability. Consequently, the company floundered. Knowing it was a matter of time before the Board would take mending actions, the leadership (Grove, Moore) discussed a particular phenomenon they’d observed. Nearly every time a company or division installed new leadership or brought in consultants, their outcomes improved.

Their conclusion: the new leader came in energized and with a fresh pair of eyes. Knowing they were being evaluated, he or she took their responsibility more seriously than the former, uninspired leader.

Subsequently, Intel’s old leadership had a brainstorm. Why not fire themselves and come back to the job as the new leaders? They said:

If existing management want to keep their jobs when the basics of the business are undergoing profound change, they must adopt an outsider’s intellectual objectivity.

They fired themselves over a weekend. After shifting markets (from memory chips to microprocessors), Intel became the clear leader in a very competitive market.

At that time, I worked for University Hospital. Although neither the hospital nor IT were in dire circumstances as Intel was, we needed to guard against complacency. I challenged my leaders to follow my example and take time over the holidays to reflect. Pondering how you would approach your position as a new employee is a healthy and worthy assignment.

Look at yourself as a potential candidate for your position. How will you evaluate the talent, change processes, and adjust the service mix? Should you alter your interactions with customers, your personal engagement, or your attitude? Will you embrace ideas you formerly rejected or feared? What strategies and tactics will you deploy to ensure business and clinical convergence with the health system? Do you have the fortitude to remove employees who add no value? Are you stretching the boundaries of innovation? Do you demonstrate courage despite resistance? How will you be a better servant…? The variations are endless.

To survive, you probably won’t need to change anything you’re doing. But to thrive means constantly reinventing yourself and operating differently. As a team, we embraced change, adopted an innovation-oriented culture, and began to walk in the fullness of our authority. What Got You Here Won’t Get You There.

Several other UH leaders fired and rehired themselves that New Year’s Day of 2007. The result? We experienced a dramatic shift moving from transactional to transformational services that had a net impact on our business and clinical operations. Our business, quality, and service metrics shot up to new heights. I experienced exponential growth, both personally and professionally.

Since I no longer live by the Great Lakes, I have to find a new point of demarcation. By the time you read this, I will have hang glided over the Swiss Alps (JungFrau). At the moment I leap off the mountain into the alpine chill, I will fire myself as CIO. An internal shakeup. I’ll let the present perceptions of my role plummet to the icy depths.

By the dawn of the New Year, I’ll find innovative eyes to view the future. Only then will I rehire myself.

Are you willing to give yourself the pink slip?

Update 12/30/10

Thank you for the comments, both positive and negative. I really liked the idea about being re-interviewed by your staff in this sort of process…have to incorporate that somehow going forward. Clearly I can’t respond to every comment, but as always, readers are welcome to contact me directly where we could further exchange ideas. Happy New Year!

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.

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