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CIO Unplugged 12/13/10

December 13, 2010 Ed Marx 8 Comments

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

Fit to Lead

What to do? Our flight left Jackson Hole way behind schedule. Sitting next to me was a colleague from our cross-town rival. We both grew anxious about the possibility of missing our connecting flight out of Chicago. We landed late.

Within 20 minutes, we had to traverse O’Hare to catch the commuter to Hopkins. Conference fatigue might have been a factor, but before we exited the jet bridge, evidence suggested that we were not going to make it to the departure gate. At least not together.

New Year’s is fast approaching. This is a traditional time for reflecting on the past and setting a vision for the future. Crafting plans. I do this annual exercise for myself, my career, and with my family.

Need a new challenge?

Consider making 2011 the year of managing energy and getting fit. If you can’t do this for yourself, then do it for others. The people and communities you serve and influence deserve the best you can give (not to mention your family).

Energy is our most critical resource, yet most of us fail to manage it effectively. Year after year, leaders are asked to do more with less, be more productive, and remain fully engaged. If our bodies are not trained to handle the stress load, then the demands on our energy will exceed our capacity. This state of poor health results in lower productivity, disengagement, unfulfilling relationships, and compromised leadership.

I want to live a satisfying life. But am I willing to do what it takes to get there? Are the benefits worth my effort, my sacrifice? According to my wife’s trainer, “You’re never too old to see changes.”

The resources are out there, so ignorance is no excuse. I like the American Heart Association model, and I urge everyone to take their short The Simple 7 assessments. I was shocked to learn that less than 1% of the US population meets The Simple 7 criteria. Retired Generals and Admirals recently sounded another alarm bell this year with their treatise on Too Fat to Fight.

Casual observation suggests that healthcare leaders are not immune. How can we get to accountable care without first living it ourselves?

Ample evidence shows positive correlations between fitness and energy levels and performance and life satisfaction. The Human Performance Institute offers a course for the corporate athlete, which I recommend. In their holistic approach, which encompasses the physical, emotional, mental, and spiritual aspects of life, the Institute reported the following results amongst graduates:

  • 75% report they are more engaged with life
  • 62% report they are more engaged with their family
  • 65% report they are more engaged in taking care of their health
  • 48% report improvement in self-confidence
  • 57% report they are more productive at work
  • 42% report they get better sleep
  • 61% report they are more likely to take positive action to make changes in their lives

Being fit provides other benefits. I worked for an organization that gave health insurance discounts based on compliance with one or more of their five measures of health. I worked to meet each criterion, and my health insurance costs were zero!

If I want to keep up with my wife, I’ve gotta be fit. She reminds me that someday we will have grandchildren, and she wants to be able to run and play with them. Heck no, I’m not going to be left to sit on the playground bench. At family reunions, my nephews love to play soccer and touch football, and I’m determined not to be outdone…by too large of a margin, anyway. I have significant interests outside of work, and I know I could not perform any of them well let alone attempt them without adequate energy management.

I had a choice to make that day in O’Hare. Stay with my colleague and watch our flight depart without us or leave him behind. I decided that making it home to spend time with my family was more important than time with a rival. I moved along and made the flight just as they were closing the door.

Yes, that is a silly story, but how many connections do we miss in life because a lack of energy? We’ve all missed personal and professional flights — and regretted it.

New Year’s is upon us, so make a resolution: 2011 — The Year of the Fit Leader.

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 11/30/10

November 29, 2010 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.

Go to Grow

In 2007, I dropped off my oldest child at Biola University in LA. We arrived a few days early so Brandon and I could attend the student-parent orientations. In the name of father/son tradition, we also squeezed in some workouts and ate bad but tasty food.

After we got his belongings organized in his dorm, we huddled for a final prayer and blessing. We embraced, shed a man-tear or two, and then I left. Sitting in my car in the parking lot, I watched him walk to the final student orientation.

Leading up to this point, I had planted seeds: encouragement to grow, encouragement to test his personal boundaries, and warnings against complacency. Brandon was officially beginning his journey into the future and to independence. The results of my optimistic seed planting were soon to blossom.

What happened next surprised me. As I drove down the Pacific Coast Highway, I began to wail. From the depths of my soul, I cried so hard my stomach convulsed. Wheezing in breaths, I mourned my treasured son’s rite of passage. Then mourning turned to dancing, and I rejoiced for Brandon and his future. I can only imagine what the drivers in the cars next to me must have been thinking of my spectacle. I pretended to be singing.

Three years later, Brandon graduated. We’ve seen amazing growth in our son — growth that could not have occurred had he stayed home. Despite an enriching and loving environment, his potential would not have been fully realized without a dramatic change and challenge. Part of us would have loved to have him stay, but we knew and accepted the truth that he needed to go to grow.

My career has been much the same. I can’t think of a single employer that I have ever wanted to leave. Yet with each one, I knew at some point I’d need to go to grow. Indisputably, my former employers offered ample career growth and challenges. But to gain exponential growth, I had to enroll myself on a journey of sorts. I had to break out of my comfort zones and push the envelope of security.

Each successive move has pushed me out of man’s natural bent toward complacency. They’ve shaped and sharpened my abilities. The breadth and depth of divergent experiences have broadened my skill set in an extraordinary fashion. My talents have gained a sharper focus and my leadership quotient has multiplied. I have become a better servant. I attribute my personal and professional growth to pushing my boundaries and circumventing the traditional career path.

Naturally, we need to create internal opportunities and have career ladders — something for every kind of employee. Yet at some point, the best thing for some will be a new environment, a place that challenges them to accelerate to the next level. I believe it is a leader’s imperative to fight complacency in the workplace and encourage others to go to grow. If it benefits our children and ourselves, then we must be willing to encourage subordinates and peers to do the same.

Sound inconceivable? Untraditional? Scary? An exceptional leader is not afraid or insecure to give away their best.

I have helped some of my best go. I have brought them opportunities for external advancements and served as their reference. At each departure, I felt the loss of their daily presence, skills, and talents. I cried in secret, yet I never regretted a single endorsement. I’ve stayed in touch, and what a thrill it is to see how they’ve grown in ways far more enriching than the opportunities I or my employer could have given them. They had to go to grow, to reach their fullest potential.

I recall a sunny afternoon run along the San Diego harbor with one of my colleagues, the president of a well-known hospital. We spoke about “go to grow” and the fruit we have seen in careers as a result. He resigned a short time later, citing this conversation as the catalyst for him to leave a secure position and take on a new growth opportunity leading a health system on an opposite coast. Catching up recently, he shared that it was the best career decision he had made. His growth has proved exponential.

Are there people in your life and work who need to go to grow? Does complacency have a hold on your organization? Are you selfishly clinging, or do you have a heart to see the best opportunities made available? (Picture the able-bodied forty year old still living at home).

If one of your staff has significant potential but circumstances are such that you can’t fully exploit that, do you give that person the freedom to advance elsewhere? Are there other staff members who need you to encourage them to leave for these same reasons but who won’t on their own out of fear?

We only have one year left with our teenage daughter. We will cherish every minute. But we’ll also do our best to prepare her mind to take on challenges and enriching opportunities. In love, we will push her to learn from the past and fail forward, to maximize the present in preparation for the future. Ultimately, the time will come when she will go to grow, just like her brother.

Now it’s your turn. Go to grow!

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 11/15/10

November 15, 2010 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.

How Opaque is your Transparency?

All humans desire relationship. Solitary confinement is the greatest torture. A psychologist would tell you that no person can mentally survive being alone for long periods.

Even the entertainment industry knows this. One reason for the long-term success of the television hit Cheers is that the producers and writers tapped into our human need. Their theme dwells in the show’s chorus.

Be glad there’s one place in the world,
Where everybody knows your name,
And they’re always glad you came.
You wanna go where people know,
People are all the same,
You wanna go where everybody knows your name.

Leaders talk of transparency and its many forms — from quality outcomes to business performance to personal. Many opinions on the level of transparency arise, especially when it comes down to personal revelations. How open should you be with your manager, peers, and staff? Does familiarity really breed contempt? How much is too much information? Should there be a wall between professional and personal?

As I began my career, I wondered what it was like to be a manager or director, vice president, CEO, etc. I wondered how they prioritized, how they managed their time, and how they dealt with challenges. This was always a great mystery, and I wanted to know more. I longed to observe, learn, and understand the essentials and what it took to get there. Therefore, as my career journey unfolded, I elected to be as transparent as I hoped my management would be.

I recall the advice Captain Davies gave to us impressionable 2nd Lieutenants on this topic at our army engineer school. “I am all for hanging out with troops after hours. But once the conversation gets into work matters, I take leave.” I believe personal transparency carries more benefits that costs. I acknowledge the risks and am careful not to violate necessary confidences. And, like Captain Davies, I avoid discussing work matters.

One benefit of personal transparency is a friendlier work environment. When people see that you’re a genuine person and that you want to get to know them, you’re breaking down the walls between management and staff. Once people see your heart and understand your motives, they’ll be more compelled to follow.

Your authenticity will expand your level of influence. Over time, your proactive interest in others will increase their level of engagement. The fact that your manager knows you and cares about you can speak louder than an annual raise. People also enjoy the recognition that comes with the investment and gift of your time.

Another benefit is the opportunity to model appropriate behavior. Many emerging leaders have not seen management up close and may not know the protocol for social and business contexts. This can help remove the fear of interfacing with executives and understanding etiquette. 

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I employ the following to ensure a level of personal transparency:

  • Host annual wine, cheese, and chocolate parties for emerging leaders and significant others (my wife also helps spouses see the genuine human side of an executive).
  • Host annual Christmas parties at my home with leaders and their significant others.
  • Host in-home parties for teams to celebrate accomplishments.
  • Attend almost every event I’m invited to, including parties, weddings, and my favorite — RockBand jam sessions.
  • Attend funerals of an employee or his/her spouse.
  • Yammer (micro-blog) daily on my agenda and other items of interest, and sometimes offer an impromptu lunch.
  • Accept Facebook invites and Twitter followers from co-workers.
  • Participate in all work events, such as fundraisers, contests, and celebrations (dancing, sumo wrestling, etc).
  • Organize and participate in sport events.
  • Volunteer my home and time for work-related fundraisers.
  • Send handwritten notes saying “thank you” or “good job”.

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This open approach has greatly accelerated the development of relationships with my leaders and staff. Something magical happens when you put aside the pretenses and trappings of the formal work environment, let your guard down, and be who you truly are. Create a place where everyone knows your name and you also know theirs.

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 10/28/10

October 27, 2010 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.

Innovation is Leadership

After 30 years of procrastination, I finally did it. I got braces. Yes, the shiny stainless steel that contributes to the bane of fragile teenage egos.

Sadly, the technology related to braces has not changed. Take, for instance, the cosmic gap between my two front teeth. The doc glued the brackets to my teeth and pulled wire through them. He will now tighten them — a slow torture lasting 2-3 years.

After the recent painful, nanometer adjustments, I lamented the fact this technology has experienced little innovation in the past fifty years. While there are magical products to make the appliance less visible, nothing has actually evolved in the clinical efficacy — a gap I liken to the size of the one between my teeth.

Best practices is a regression to the mean. Wouldn’t you agree? Our love affair with the term “best practices” is really another way of embracing the average. We are desperate for improved and enhanced ways of doing things, yet the best most of us can manage is copy someone else — a slide towards shared mediocrity.

Either innovate or perish.

Plenty of scholarly evidence exists to substantiate my critique. You cannot pick up business literature, electronic or otherwise, without reading about the dearth of innovation in our country. And I think healthcare is as fertile a ground for a good outpouring of innovation as any other vertical.

Innovation takes on many forms, from technical to transactional to cultural. Most readers should already be familiar with Christensen’s works, the Innovators Dilemma, and Innovators Solution. More recently, Christensen applied his innovation concepts to healthcare with a landmark piece, The Innovators Prescription. It’s a mandatory read for my leaders.

What can you and I do to spark innovation in healthcare and in our organizations? First, we start with our own lives; and second, our span of control.

Career mimics persona. If you are innovative, it will reflect in everything you do — work, play, relationships, etc. To stay or to become innovative, you must embrace a matching lifestyle. I don’t mean the old pat-on-the-back hug, but an embrace of lovers reunited. Do you select hobbies that wreak creativity and imagination?

One reason I’ve immersed myself in the Argentine Tango is because there are no right or wrong moves. Instead, I can take the 2-4 count patterns learned and arrange them according to the feel of the music or mood. That means I have to think afresh for every song, yet maneuver in a way that allows my partner the space to be equally artistic. Triathlon is credited for its many transformational improvements in cycling, clothing, and accessories that other sports have adopted. The sport itself continues to evolve.

The above hobbies work for me. Clearly, there are thousands of choices that can cater to your personality and ambition. The point is to pick something that stretches you. If I ever grow comfortable, I know I’ve hit stagnation. My career will imitate my life.

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At work, you must be boldly intentional. While I do a fair amount of speaking on a variety of leadership-related topics, the most common request I receive is on innovation. After speaking as a keynote at the recent Computerworld’s SNW Fall Conference , the audience enthusiastically embraced the innovation message.

Innovation doesn’t just happen. You have to promote it with sound processes to help those yet uninitiated. You can have innovation portals that showcase processes and how to get involved. Set up reward systems as encouragement. Hold contests where all submissions have to be done via video, which is a creative process in itself. Recruit judges from your C-suite to ensure high visibility.

Host a Tedx event. This is a new program that enables local communities such as schools, businesses, libraries, neighborhoods, or just groups of friends to organize, design, and host their own independent TED-like events. Or pick a technology that you think has potential and invite a wide variety of participants to brainstorm. This mash-up could lead to some amazing outcomes that transform clinical care.

The most pioneering ideas will come from people who are closest to the action and who are given a forum for their voice. The leaders’ function is to act as the catalyst and create an environment suitable for originality.

No single idea will transform your culture into one of innovation. Nevertheless, as you begin to mix in such ideas, processes, and events, you will have an impact, and transformation will begin to take hold. Anticipate resistance — and view it as positive feedback. If you don’t encounter resistance, double your efforts.

Live in such a way that no person could look back at your career or your life and say, “Not much changed.” Kind of like the battle between my teeth and stainless steel.

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 10/13/10

October 6, 2010 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.

Healthcare Passion Refueled

My passion for healthcare began in high school while working in environmental services at an outpatient facility (they called us “janitors” back in the 80s). From that point forward, different encounters have renewed that passion. The most dramatic experience was personal.

A Journey Home

Four years ago this month, my mom traded her earthly rags for a robe of righteousness. After a courageous four-year fight against the ravages of ovarian cancer, Ida Wilhelmine Marx bid us farewell. The entire experience had a profound impact on me not only as a son, but also in my profession.

My mom and I were tight. As I blindly plodded my way through adolescence, she represented mercy and grace. When I shoplifted, got arrested for joy riding (at 14 years old), set the house on fire, partied excessively, and flunked junior high, she was there. I’m convinced that if it weren’t for my father’s discipline balanced by my mother’s care, I would not enjoy the successes of today in my education, career, and family.


Mom suffered much from illness her entire life. She took the cancer in stride: eight rounds of chemo, two rounds of radiation, and a couple of surgeries. Her sole desire before transitioning from this life to the next was to celebrate her 50th wedding anniversary. When we transferred her to hospice, it became apparent that she would be a few weeks shy of reaching her goal. With my parents’ permission, my brothers and sisters planned an early 50th anniversary party and vow renewal — the final celebration of Mom’s life. Knowing our world would change the following day, that night we put on a heck of a celebration.

Hollywood could not have written a better script. Hospice physicians agreed to give my mom life-sustaining nutrients and fluids through the big day (normally not allowed). They arranged for a “Sentimental Journey” pass: a limousine (ambulance) service for my mom and dad to the picturesque Cheyenne Mountain Resort in Colorado. Two paramedics waited in the background just in case their services were needed (they weren’t). They quipped how special my mom was because the only other person who ever received two paramedics as an escort was Dick Cheney when he came to town.

All seven of us children attended, plus all 15 grandchildren. My parents invited their closest friends. With the backdrop of the Rockies and all the majesty of a traditional wedding ceremony, I had the privilege of walking my father to the front. My oldest brother Mike had the honor of escorting my mom in her wheelchair to join my dad at the altar. She looked ravishing. My sisters had dressed her to the “nines.” Her dream was unfolding in real time.

Each of her children had a part in the ceremony, as did each grandchild. Assigned to deliver the sermon, I decided not to use notes, but instead prayed that God would intervene and deliver a message that would bless my parents and set vision for successive generations. The primary message: my parents had created a legacy of marriage that would impact not only the first generation (my siblings and me), but the grandchildren, and their grandchildren, and so forth. The fact that my parents stuck it out and endured a lifetime full of sickness and health is a testimony to the world: “Yes, it can be done.”

The ceremony ended with the exchanging of vows. A co-worker of mine had arranged for a Papal blessing of the 50th milestone as well, which touched my parents deeply. We printed the blessing in the renewal program. Unity candles, songs, prayers, and standing ovations lent to the evening’s incredibleness. But this was only the beginning.

One Heck of a Show

We then entered the adjoining room for a superb five-course meal. Taking advantage of the live music and dance floor, Dad rolled Mom out in her wheelchair to dance. My parents are fantastic dancers, and seeing my dad wheel my mom around was moving. Throughout dinner and beyond, we danced to our hearts’ desires. All four sons danced with my mom, who was clearly delighted. Even my son Brandon danced with her, to which she commented, “You’re not dancing. You’re just shaking your ass!”

Next came toasts, the garter ceremony, and all the similar accruements of a fine celebration. At that point, Mom addressed the room with loving words. Dad tried but fell apart. As a finale, guests and family formed a tunnel by joining hands. Dad wheeled Mom through as we hugged, kissed, cried, and spoke blessings.

Returning to her limousine, she was still beaming. My dad shared that as he laid Mom in her bed that evening, she said, “We sure gave them one hell of a show tonight, didn’t we?”


During her illness, I flew out often to visit her. I wanted to be at her side when she transitioned, just as she had been at my side so many times. I missed by eight hours, but that was OK. Over the years, I’d left no doubt in my mother’s heart of my care, admiration, appreciation, and love for her. Arriving shortly after her passing, I supported my brokenhearted father and assisted siblings with the funeral arrangements.


My mom had taken her last breath shortly after midnight. Two of my siblings and my father were at her bedside and described that, while painless, her body struggled for every last breath. As a result, her mouth was stuck wide open. The hospice nurse explained that, given the timing, the mortician would be the only one able to close Mom’s mouth. My sister-in-law, an ICU nurse manager, validated this.

Meanwhile, my dad knelt at Mom’s bedside and held her frail body, the first time in months where he could hold her without causing her pain. He kissed her lips. Wept over her. Sometime in the next two hours, while they awaited the mortician’s arrival, Mom’s mouth closed…and she smiled. Comfort permeated the room and reinforced our belief that she had indeed transitioned to a happier place.

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Passion Fueled

My mom’s battle allowed me to spend considerable time in various care settings. I observed the processes, evaluated technology, and pondered how things could be improved to benefit caregiver, family, and patient. The clinicians treating my mom lacked the communications and clinical decision support needed to deliver the highest quality of care. I was shocked by the lack of access to critical and timely clinical data. The wasteful amount of paper utilized and manual processing disappointed me.

I ended up creating medication reconciliation lists and pulling together charts. I swore it would never be this way in my work environment. As I took mental notes from the perspective of patient and family, my passion to leverage technology and transform the clinician and patient experience was renewed.

It’s this passion that drives me in my daily work. This is why I’m tenacious in advocating technology, why I continually innovate and collaborate with clinicians, and why I blog. This is why I advocate for stronger IT leadership. It’s the heartbeat behind why I spend more time with my people on leadership, customer service, process, and passion than I do on virtualization or cloud computing.

Until my people have a heart for patients and are in a position to empathize with their plight, the technology platforms, while critical, will be limited. The full potential of technology in the delivery of high quality healthcare comes with a transformed heart.

Thanks, Mom, for refueling my passion as a leader of healthcare technology.

What fuels your passion? What stokes your fire? Leave a comment below.

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 sitesLinkedIn and Facebook, and you can follow him via Twitter – User Name “marxists

CIO Unplugged 9/22/10

September 22, 2010 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.

Tool Time

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This is a picture of my home workbench. I think you can tell from it that I’m not a productive handyman. I learned some time ago that power tools were not my thing. I leave that work to those who have a passion and talent for it.

What does stoke my fire is leveraging IT to enable improved clinical and business outcomes. Thus, I have a much greater interest in my career “workbench.”

What follows is what works for me. Perhaps it will inspire some new ideas for you. Either way, share what works for you in the Comments section.

A common thread throughout my life is the principle of simplicity. Hardware, software, or systems that are robust, yet easy to use,are my tools of choice.


Texas Health is a Microsoft strategic partner and my applications largely reflect this. I use the Office suite exclusively, including OneNote. Everything is integrated and I can easily move in and out of these apps without any format or compatibility challenges.

I use Office Communication Server (video, voice, IM) as my communications tool for all of the aforementioned reasons. It is very simple and easy to have all of my primary business applications on the same platform.

Two exceptions include Yammer and Mindjet Manager Pro. Yammer is our internal collaboration software, often referred to as “Twitter for Business.” The use of Yammer has helped our enterprise in some incredible ways, including responding to emergencies (H1N1, power disruptions) and leveraging the wisdom of the crowds.

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Mindjet is a tool to help me organize my thoughts for presentations, meetings, and yes, my blogs.


Texas Health is also a HP strategic partner and my device is my office, so I currently have a ProBook 5310. I love that my video and communications devices are all built in. No air cards, phones, or cameras to mess with. It’s all included and very lightweight for travel. Because I like to mess with people’s minds, I have an Apple logo affixed to the black casing, which causes people to scratch their heads.


I’ve had a BlackBerry for years and do not plan to change anytime soon (sorry, partners). I upgrade each year and currently have the Storm2. On more than one occasion, I have gone without my ProBook and just leveraged my BlackBerry. I am trending this direction as a permanent solution, albeit I think we are a couple of years out.

What I absolutely will not carry around is a laptop and a mobile and something akin to an iPad. This is way too many devices. I know people who function like this and in some cases, add a pager and/or office phone to boot. That’s just plain silly and gives IT a bad vibe. If you use more than two devices, your life is unnecessarily complicated.


Since I operate within a virtual office, another key tool is my leather briefcase. People make fun of my soft-sided manbag because it is worn and weathered. Well, there’s good reason for its scuffed look — I’m always on the go, visiting my team and my customers. It is practical and durable.


The least tangible but most important of all the tools is what I call “systems.” A system is a well-established routine that you no longer have to think about that enables your highest level of productivity. You can have the greatest tools in the world, but you hamper your effectiveness by not automating manual and routine processes. Sound familiar? Think EHR/CPOE.

One of my “systems” is to have everything I need for the next day’s adventure ready and updated the evening before. When I wake up, I am out the door and driving to the gym in five minutes. Manbag included.

What about you? What’s on your workbench? What tools work best for you?

Update 9/27/10

Thank you for your comments and input on tools that work for you. There is no single perfect tool for everyone, but it is critical that you find one that works best for you.

There were some great suggestions on HIStalk for mind mapping-like software. You should certainly give one of these a try and see if it helps you organize your thoughts and work.

As for “where’s the beef?” as one reader asked, I have posted on more technical subjects like cloud computing, mobility, and virtualization, but I tend to focus more on leadership oriented topics. In my journey, I have found plenty of great technical expertise in our industry, but believe what is lacking to make us more strategic is fundamental leadership.

My focus is on leadership, service, partnerships, and strategy. I will sprinkle in a few thoughts on the more technical side, so stay tuned and keep letting me know what you would like to see.

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 9/8/10

September 8, 2010 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.

Does IT Matter: Six Years Later

In a 2003 opinion piece for the Harvard Business Review, Nicholas Carr threw a grenade on the IT dinner table. Carr argued vehemently that IT no longer mattered. He leveraged this high-profile editorial into a best-selling, thought-provoking book in 2004, Does IT Matter?

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Carr’s central argument states that the strategic importance of IT has diminished over time; that IT has become nothing more than a commodity providing little competitive advantage. Consequently, according to Carr, companies should rethink their investment in IT. He also laid out his agenda for IT management, examining implications for business strategy and organization. Carr’s thesis was both embraced and vilified.

Written in the IT boom years, post-Internet “bubble,” does the economic downturn change the game? What about healthcare reform implications? Are we any different?

As I observe and research, I see fatalists and opportunists at odds.

The fatalist has accepted Carr’s pronouncement as fact and has become complacent, allowing the administration to marginalize IT. Opportunists, on the other hand, see the circumstances as the tipping point to reinforce, or for the first time, to position IT as strategic.

I interpret Carr’s compelling arguments as a call to action.

During these dour economic times and the uncertainty of healthcare reform, IT has a heroic opportunity to be a catalyst for prosperity, a key differentiator. This means I cannot sit back and accept current fate, allowing IT to dissolve into a simplistic commodity or back-office function.

To advance my organization, I hunt for and seize strategic opportunities. The economy will not determine my destiny if I choose to leverage it as a clarion call and make every effort to expand our services while lowering costs.

Our department reaches out to select vendors, changing our value proposition from transactional to transformational relationships. I shared this in-depth in Maximizing Vendor Relationships. It’s not about broad generalizations. Success is about the individual organization; its circumstances; and ultimately you, the IT leader.

As organizations look to cut spending, IT is not immune. Continual across-the-board expense reductions will underscore IT as a commodity and a cost center to be managed — Exhibit #1 for Carr.

Call me competitive, but I believe that companies that lay low and marginalize their IT will have a much lengthier recovery period. Especially when it comes to seizing the initiative on healthcare reform dynamics that are fundamentally changing the value equation of cost, quality, and revenue.

In contrast, those companies that seize the opportunity and invest in IT strategically will not only perform better, but will do so at the expense of their competitors. Some of our current work is going to change the competitive dynamic.

Think. Brainstorm. Mashup. Research and develop strategies that will propel your organization forward. Even if your company is panicking and relying solely on expense reduction tactics, present ideas that demonstrate bottom-line reduction, improve clinical outcomes, and support top-line growth. Innovation that will set your organization apart in dealing with the nuances of future payment and care delivery models. Insist on having your voice heard. Demonstrate ROI through IT’s transformative and innovative power.

For competitive reasons, I cannot share details, but we are doing these things. A risk-free example from my past happened at a community hospital. Our historic 45% market share in this two-hospital town was starting to plunge. Our cross-town rival was replete with cash, given their enviable position as part of a regional health system. Our board decided that the best antidote was not to reduce expenses, but rather to make strategic investments in IT.

One year after the implementation of affiliated practice-based EMRs, clinical inquiry application, and software to link referring physicians, our market position flipped. We saw a 20% swing, especially in our target areas of hearts, births, orthopedics, and neurosurgery. We were featured nationally.

I have additional career examples, but I believe the point is made. Yes, the economy is tough. Healthcare reform is a bit fuzzy still. Fatalists seek to marginalize IT. But the time is right to forcefully lay hold of this opportunity and (re)establish IT as strategic and foundational for your organization’s long-term success. IT is not back office!

Demonstrate the strategic power of IT.

It matters.

Update 9/14/10

Good debate on IT value. My leadership team just started on our next book, also by Carr, entitled The Big Switch…Rewiring the world from Edison to Google. Whether you agree or not with Carr, it is healthy to debate his ideas and come to grips with his messages. Is IT strategic? Will cheap utility-supplied computing change the game? Does the Internet take away our ability to think deeply? Are we losing our capability for concentration and reflection?

I still maintain that we can leverage even the most common of tools in a strategic fashion. It comes down to culture, risk, vision, innovation and leadership. Give me two organizations that each implement the identical EHR and I can show you two radically different approaches…and executed well, one can be a strategic differentiator over the other.

I do not agree that IT is purely a support function. Sounds good on the surface but, short sells the innovation and passion we have been endowed with. I have been fortunate to work with incredibly talented individuals who have taken common tools and developed these to improve patient safety and increase the quality of care. I have also witnessed similar gains on the business side. As a by-product, these have helped grow IT and proven to help us differentiate ourselves from competitors.

Not everyone will adopt or deploy it as strategic, nor should they. But it can be done.


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 8/25/10

August 25, 2010 Ed Marx 87 Comments

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

A Sacred Calling

“The Human contribution is the essential ingredient. It is only in giving of one’s self to others that we truly live.”

— Ethel Percy Andrus

Someone asked our chief medical information officer, Ferdinand Velasco, MD, why he would leave his skyrocketing career as a cardiac surgeon at New York-Presbyterian to become CMIO at TexasHealth. I will never forget his answer: “As a heart surgeon, I could help about 200 people per year. As CMIO, I am helping the 6.2 million people in our region.”

Whether we give direct care or support someone who does, we are fulfilling a sacred calling — touching human lives. Don’t discount information technology because it’s only computer stuff and nobody really knows where cyberspace is anyway. You could’ve practiced IT in any industry, yet you chose healthcare. Or perhaps healthcare chose you.

Sacred callings come in various forms. Although healthcare IT is nothing unique in itself, the element of sanctity is why I stay. If we want to live a life of significance, we must understand the depth of our calling and then perform as if our work matters. Grasp the privilege of serving humanity with your skills and talents. That is sacred.

In using our hands for work — answering service desk calls, pulling cables, creating order sets, managing projects, developing strategies, creating apps — we are helping care for the patients and clinicians. We’re telling them, “You are important to us and we value you.”

Stop for a moment. Re-read the above paragraph then hold your hands in front of you. While studying your hands, reflect on what they do each day that contributes to caring for the health needs in your community. Seriously. Have you not chosen to bless others through the work of your hands?

Wherever people are involved (life), challenges and frustrations exist. Healthcare is beset with issues. What can keep us focused during those difficult circumstances is remembering our purpose.

Let me share with you one recent technique we developed to maintain the heart-to-head connection.

Blessing of the Hands

It is not unusual for hospitals to conduct non-denominational “Blessing of the Hands” ceremonies. Here is video example from MetroHealth in Cleveland.

I had seen this done for clinicians at one of our hospitals and it got me thinking. What about IT? What we do is no less critical to the healing process. Our hands may not touch patients, but they do touch their lives in ways unseen. Arguably, IT is the only segment that touches the entire healthcare continuum.

 8-25-2010 6-09-02 PM

I contacted our chaplains, and they were excited about the concept. For the first time this spring, we conducted a Blessing of the Hands ceremony exclusively for IT. The chaplains first shared with our team the sanctity of what we do in serving people and the impact we have on the lives of both patients and caregivers. They prayed over us. They prayed a blessing over a special vial of oil then used it to anoint our hands.

8-25-2010 6-10-05 PM

One at a time, we rose from our seats and approached the chaplains. While we held open our hands, they anointed them and gave us each a verbal blessing. I sat back down and simply soaked in the moment. I imagine many others encountered the same refreshing.

All I can say is that it was a holy moment for all who chose to participate, regardless of their religious orientation or belief system. We emerged inspired and empowered. We walked out of there knowing that we were making a difference in lives every day.

No matter what your area (supplier, payor, or provider), I highly encourage you, the leader, to make this voluntary ceremony available for your teams. You’ll witness a demonstrable impact and you’ll be reminded that what you do is significant. Your calling is sacred.


Here is a sample Blessing of the Hands prayer. A simple Bing search will bring up other samples.

· Blessed be these hands that have touched life.

· Blessed be these hands that have felt pain.

· Blessed be these hands that have embraced with compassion.

· Blessed be these hands that have been clinched with anger or withdrawn in fear.

· Blessed be these hands that have drawn blood and administered medicine.

· Blessed be these hands that have cleaned beds and disposed of wastes.

· Blessed be these hands that have anointed the sick and offered blessings.

· Blessed be these hands that grow stiff with age.

· Blessed be these hands that have comforted the dying and held the dead.

· Blessed be these hands that develop applications that improve quality of care.

· Blessed be these hands that answer the phone and empathize while solving issues.

· Blessed be these hands that reprogram the broken network.

· Blessed be these hands that enable life-saving technology.

· Blessed be these hands, we hold the future in these hands.

· Blessed be our hands for they are the work of Your hands, O Holy One.


Update 8/29/10

I appreciate all the comments. Thank you.

The point I do not want readers to miss is to know that what we do in healthcare IT is significant, impacting the health of our communities and nation.

You can broaden the definition of spiritual to include your overall sense of purpose and mission. For me it is birthed in my faith. For others it will take on a different look, but either way I maintain that healthcare IT is sacred work.

As long as your views are not forced on others or go against the values/culture of your employer, I see no reason not to allow for individual expression. I happen to work for a faith-based health system and enjoy the freedom this brings to everyone, regardless of religious or secular orientation.


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 8/12/10

August 11, 2010 Ed Marx 112 Comments

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

Confessions of a Reformed Multitasker

I was wrong. Multitasking is overrated. It’s the thief of our times.

8-11-2010 6-25-00 PM

New Years Eve 2008, on a plane en route to our Marx Family Annual Strategic Planning Retreat (above), I read Chasing Daylight. The author, Eugene O’Kelly, was the CEO and chairman of KPMG. At 53, he was diagnosed with a terminal brain tumor. He quit his job to settle accounts with friends and family and write a book to convey what he learned through the experiences of life and death.

Based on the principles espoused in the book, I added the following to my personal strategic plan:

  • Live in the Moment
  • Energy > Time
  • Consciousness > Commitment
  • Create Perfect Moments

The above principles originated from research done by the Human Performance Institute. I attended their “Corporate Athlete” training, where these concepts, and related evidence-based theories, took on renewed meaning. The idea of energy management struck me. I will post on energy management and the fit leader this fall.

Bottom line: if you desire high performance, then don’t multitask. Avoid a multitasking lifestyle if you care about the personal message you are sending people.

Gulp. Seriously? Guilty!

It had to start at home. Almost every evening, I’m home for dinner by 6 p.m. That’s a sacred time. But now, no BlackBerry, no checking messages, no calls, no social media, no vendor meetings. My energy and focus are on my family. Love is a verb. I show my love by giving them my undivided attention. Emotional energy is a relational factor that surpasses time. I don’t tell them, I show them that they are more important than my vocation.

In fact, the stronger the family relationship, the stronger I am as an employee. I find that leading others is a rewarding honor, and by definition, a CIO must give energy to those he serves. I have stopped multitasking where face-to-face encounters are involved.

8-11-2010 6-29-21 PM

I still multitask as described in Green Standard Time (above), but never when I’m with people. What message does it send when I’m not fully engaged?

Has your manager ever multitasked while you share your ideas or answer a question? How did it make you feel? Have you had to repeat questions or respond to duplicate inquiries as a result of someone multitasking? How about during conference calls when you call on someone only to get silence…and their phone isn’t on mute. (Guilty)

I wonder how many people I have inadvertently frustrated by having to revisit subjects previously discussed because I’d been trying to juggle tweeting, e-mailing, and preparing a presentation? Was I genuinely in the meeting to begin with?

After observing a leadership meeting, one of my favorite docs admonished the group for focusing more on e-mail than on the discussion. Kudos to him! How much productivity had been lost?

I am a huge advocate of technology and for displacing paper and paper-based processes with automation, but we must exercise balance. Use your iPads, mobiles, tablets, and laptops to conduct business, but be disciplined and remain focused on the subject and people, not your e-mail or twitter feeds. Make time for that later.

For those who still believe they can effectively multitask while still giving appropriate attention to family and staff, try this simple test from the New York Times. A Google search will reveal numerous scientific studies to support my thesis that high performance and multitasking are mutually exclusive. In fact, Stanford researchers found that multitasking may degrade our ability to think clearly, to separate relevance from irrelevance, and to remember and learn. They conclude by saying, “By doing less, you might accomplish more.”

The way I spend my time and invest my energy reveals what I believe most deeply.

***For those who have an interest in strategic planning on a personal basis, please leave a comment. We will send you a copy of my one-page personal strategic plan that contains the principles mentioned above and will provide you with a template from which to create your own plan. I have one-page plans like this for my career, marriage, and family. UPDATE: due to the large number of requests, the plan has been made available for download here.

Update 8/12/10

Thank you for the feedback. Clearly I was not alone in this journey! I will savor the overwhelmingly positive comments because future posts may nor resonate so well.

I do plan to tackle the challenging subject of the fit leader this fall. Good thing I was a soccer referee for so many years. I can handle the crowd when they don’t like my call.

Samantha Brown asked a couple of good questions. First, do I really make it home each evening by 6 p.m.? When I am in town, the answer is yes 98% of the time. I only have one routine after-hours meeting. It is a physician leadership dinner meeting that takes place bi-monthly. I am able to attend the meeting “virtually” from a hospital close to my home. As long as I am back in time for our weekly Argentine Tango lesson (a few doors down), the world is in harmony.

Finally, I did differentiate two types of multitasking. I am a proponent of multitasking, just not when it involves people directly. Are their circumstances when you are with people but you do not need to pay attention? Sure, but I would ask myself, “Is this the best use of my time?” If the answer is no, don’t be part of that meeting.

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 7/26/10

July 26, 2010 Ed Marx 6 Comments

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

The Authentic Leader (Death to the Cliché)

Summer of ‘86. The gas chamber awaited me.

This time, I made sure my protective mask was on correctly. Four years prior, at basic training as a seventeen-year-old, I had panicked and failed the test. Today, during the final days of training before being commissioned as an officer, I entered the tear gas chamber and approached the awaiting officer. Removing the mask, I stood at attention, mostly. Dry heaves bent my body in half.

The commander yelled, “Cadet Marx, do you have what it takes to lead your troops in difficult situations?”

“Yes, sir,” I gasped. Do. Not. Panic.

“Do you really have what it takes? They need courageous leaders, willing to lead by example.”

“Yes, sir!” The stinging gas closed my eyes to slits. Mucous cascaded over my lips and chin.

As if he knew my struggle, he kept me longer. “Cadet, I want you to sing the national anthem.”

Crap. I gave it my best shot. I’m certain I missed a couple of lines. But as I ran out the exit and filled my greedy lungs with fresh air, I emerged a leader. I now had an authentic story.

I’ve tried to never ask a subordinate to do something I would not do, or haven’t done. I’ve scrubbed toilets and worked factories with the best. Those leaders who pontificate on theories they don’t practice get zero respect from me.

If you say, “Go to where the puck is going,” do you know the precise nuance of that statement? Have you played hockey or just watched it?

“Pace yourself. It’s a marathon, not a sprint.” How many can relate to the effort it takes to sprint or run 26.2 miles? Probably few.

Although I hate clichés, I’m guilty of using them. I do my best to speak from direct experience. The difference between telling your own story and using a cliché comes down to credibility of message and messenger.

Where I work, our strategic plan is centered on climbing a mountain, to include base camps and a summit. At first, I thought I understood the immensity of what it meant to conquer a mountain, though I struggled to articulate the concept. I’d never done it. Sure, I walked a trail to the top of Pikes Peak in my youth. But climb a serious mountain?

I asked my fellow leaders if any of them had executed a technical climb. None had. So a few of us got together and planned a climb.

During our nine months of preparation, we lost 60% of our team. We invested, we studied, we sacrificed, we trained. Boy, did we train.


On July 17, 2010, five tired but exhilarated officers summited Long’s Peak. There, we unfurled our organization’s flag, a moment we’ll cherish for years.  

“Climb a mountain” took on an entire new meaning. We realized the sweat it takes to reach base camp. We faced the risks involved and the saw value of the teamwork required. When we speak with our respective employees, we can genuinely convey the energy it takes to reach a summit — genuineness based on experience.

By definition, leaders are in front guiding by example. Leaders explore. Just like in mountain climbing, leadership is risky, which is why so many stop actively showing the way. Sadly, some become active antagonists. I’ll save that for a future post.

Practicing visionaries. I believe a CIO cannot rely on how he or she operated 20 years ago or even one year ago. Don’t just talk about social media, live it. If you personally don’t tweet, yam, yelp, blog, etc, then don’t bother preaching about social media. You’re only lowering your credibility.

Patient care is shifting to the home setting, which means the virtual patient has arrived. Are you virtual, or are you still tethered to a landline in an office?

Do you discuss Mobile Health, HIE, Connected Health or Cloud, yet not actually deliver? I’ve encountered CIOs who talk HIE at length and could exchange information tomorrow, but they refuse to take action.

Your presidents face P&L pressures. Have you run a P&L center to make yourself aware of their challenges?

The healthcare industry has adopted electronic health records and has transitioned to a paperless environment. Are you still reliant on paper?

I wonder how many leaders grasp the double standard they communicate to their people. We talk about patient accountability, but is our physical fitness and lifestyle up to par with our vocation?

Finally, list the modifications you’ve made to your leadership style in the last two years. How have you adjusted to the emergence of multiple generations in the workplace? When you pass people in the hall, do they whisper, “He’s old school”?

Leading via clichés might make communication easier, but our people deserve more. The next time you hear grandpa’s hackneyed truism come out of your mouth, take it captive. It’s time to develop your own experienced-based story that will increase your credibility. Allow a cliché to catapult you to try new things and live your own genuine story.

Ever thought about climbing a mountain? Pick the peak you need to summit, and elevate your authenticity.

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

CIO Unplugged 7/13/10

July 12, 2010 Ed Marx 5 Comments

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

Strategic Plans — Getting to 2.0

I recently met up with a friend I hadn’t seen in a decade. After breaking the ice, we shared deeper life stuff. As I tried to understand the aura of weariness and apathy hanging on my friend, I realized with sadness that he had no focus for his future. No vision.

He was going nowhere and getting there too quickly. Opportunities crossed his path, but he didn’t take them or he had taken notice of them too late. I dreaded to think how many regrets he’ll face on his deathbed.

As you know, this bankruptcy of success doesn’t just occur with individuals. I listened to a guest speaker ask a leadership team to cite the enterprise vision. The audience fell silent! A departmental vision? she said. More silence. Personal vision? Silence. The group was wandering, but you’d never guess that by reading their strategic plan. A plan written but not lived out is an epidemic tragedy.

In a 2007 post, I shared my thoughts on “Taking Control of your Destiny,” encouraging readers to have a carefully crafted plan for business and for life. The number of businesses and individuals who wander through time without connecting to their purpose is frightening.

Try this test to see if your organization has an effective plan. Ask staff members to cite from memory your mission and vision. Could they explain how strategies are aligned to clinical and business imperatives? Ask them to tell you the one thing that provides focus. A failure to pass this test reveals a failure of future success. It’s time to act.

Moving on …

For those who have past the above test and have a functioning plan in place, what’s the next level? As you would imagine, I’m a deliberate planner, forever exploring creative and innovative approaches. Here is one.

This spring, the IT leadership teams of Texas Health Resources and Pier1 met for an all-day strategic planning session. In the morning, my team and I presented the Texas Health strategy and dived into the IT components. In the afternoon, we reversed roles.

Together we rolled up our sleeves and challenged one another throughout the presentations. We shared experiences and best practices, offering unique perspectives as consumers and patients. We poked holes and pressed buttons and then commiserated. What we learned from one another added value not only to our corporations, but to each individual.

The big takeaway for us affected our approach to (clinical) business intelligence. Recognizing that we were headed in a direction sub-optimal to our potential, we heeded their experienced-based counsel and immediately changed direction to avoid significant future pain. In fact, Pier1 CIO Andrew “Andy” Laudato now serves on our business intelligence committee.

Another takeaway tactic I intend to employ: if Pier1finds an IT-related expense in the organization that’s not currently part of IT, they move it to the IT budget immediately. Even though this causes a negative budget variance, it allows the organization to understand the complete cost of IT and provides them control in the future. Simple, but profound.

This fall, we’ll have another exchange, this time with Radio Shack. I had lunch with their CIO Sharon Stufflebeme this week to hammer out details. Our teams are psyched. I’m hoping to celebrate a Le Tour victory when we visit their headquarters.

How do you make this happen? Look for innovative CIOs outside of healthcare. I serve on the Texas Christian University advisory board, and when I first joined, Andy (Pier1) presided over the board. Fascinated by his leadership and accomplishments, I made an appointment. While visiting in his office, it became clear to me that Pier1 would be a good match for my team.

At another time, I was speaking on a panel with Sharon from Radio Shack. Her leadership style differed from mine, and she was very successful. On the panel, we worked as contrarians, and I benefitted from that diversity. I have great expectations for the impact she and her team will have on our planning and thinking. We need people to rock our world, business and private. Iron sharpens iron.

You might be asking, Why doesn’t he have these exchanges with healthcare providers?

Good question. In specific areas, we tap into peer organizations on topics ranging from cost allocation methodologies to enterprise PMO. For example, we belong to excellent think tanks like Scottsdale Institute that enable exchange of ideas. Although these are helpful, they carry limited value, for if we restrict ourselves to healthcare peers only, IT will continue to lag. So we reach out beyond our protective covering to break free of the chains binding us to lack of foresight and preventing the fulfillment of our purpose.

Avoid the epidemic tragedy that plagues present day IT. Encourage your subordinate units to develop plans that support the organization so you have complete line of sight from top to bottom. As a bonus, encourage them to create personal plans. They’ll thank you for it. Remember: living without purpose is the greatest invisible tragedy that’s never perceived until the end. And then, it’s too late.

Update 7/16/10

Thank you for the feedback to my recent post on strategic plans — Getting to 2.0. I am pleased that some are finding the ideas and concepts helpful. One of the first questions I ask when I see a floundering person, division, or company is for a copy of their plan. I have never met a person or company with a well thought out plan who is floundering, but the inverse is true 100% of the time. Those who flounder have no plan.

I am sorry for Hamon Tower Patient experience. As articulated by HHS in the MU announcement, transforming healthcare delivery with technologies such as EHRs and RTLS is a journey and that we are continuously working with our caregivers to improve their experience and that of our patients. In the spirit of continuous improvement and openness to collaboration, we would welcome the opportunity to connect with you offline to learn more about your  experience. Please send me an e-mail directly and I will set something up.

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

CIO Unplugged 6/23/10

June 23, 2010 Ed Marx 9 Comments

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

The Secret to Successful CPOE Adoption — Revealed

Before revealing the secret, let me establish credibility. I first implemented electronic health records in 1995. A few years later while CIO at University Hospitals, we achieved a 95% CPOE rate at our academic medical center.

Presently, with 12 of our 14 hospitals implemented at Texas Health, we are averaging over 85% CPOE. Remarkably, 65% of these are entered via standardized order sets. What makes the Texas situation particularly unusual is the lack of executive mandate. The all-voluntary medical staff made it happen.

We garner national attention because of this success. We were recently recognized as a CIO 100 for our EHR benefit realization. We host high-profile organizations from throughout the country (on site and virtual) who want a closer look. We tell our story through various media so we can share best practices.

Although I had little to do with the CPOE successes, I did learn the secret.

Organizations will spend millions on consultants, hoping to tap into some sort of magic sauce that they can liberally apply to ensure significant adoption. The majority of these consultants will have had no direct professional experience implementing or supporting the technology. The secret to successful CPOE adoption rides not on a specific firm or one silver bullet, but many.

You can do better than a consultant. Here’s how.

These 21 factors, when in synch, will bring your institution success with CPOE. You must excel at 18 or more of these to forge the secret.

  1. Senior Leadership Engagement. The CEO must actively promote and reinforce. They must receive regular reports. They should base enterprise incentives on CPOE adoption levels.
  2. Hospital Leadership Engagement. Presidents need to be visible and articulate. So do their direct reports.
  3. CMIO. This rare individual can bridge the gap between IT and medical staff. In IDNs, I recommend a multiple CMIO approach. It’s not an expensive tactic in the big scheme of things.
  4. Project Leadership. They must walk on water and they must be clinicians. They are the face and brains of the operation. Surround them with grace and all the resources they ask for.
  5. Project Team. The majority should be clinicians. The team must have 90% of its members actively engaged. The road is long with many winding curves. Build up staying power.
  6. Clinical Staff. You can’t be successful without engaged physicians and nurses. You must facilitate their engagement if they are initially resistant.
  7. Culture. Culture eats strategy every day. Set up literal shared incentives for success. In IDNs, the culture must acknowledge but transcend individual hospitals.
  8. Relationships. Relationships cover a multitude of sins. Develop relationships with everyone from clinicians to support staff to leadership.
  9. Visibility. Key leaders must be visible during and after go-live. Most of our leaders participate in go-live support, even if just to answer phones.
  10. Agility and Velocity. Have a pool of highly trained staff who can respond to crisis at a moment’s notice. This team should report to the CMIO.
  11. Build. Lay a solid foundation from the onset to withstand the continual storms. Design must include clinical staff for usability and acceptance.
  12. Standardized Order Sets. Present CPOE as the ultimate tool to drive transformation, clinical quality, and drive out costs.
  13. Governance. Set up an effective decision-making body on two levels: a senior executive team for strategy and a larger team for tactics and operations. Assign clinicians to key roles.
  14. Change Control Process. Control application evolution at a rate that introduces new features while maintaining an acceptable learning adaptation curve.
  15. Implementation. Keenly organized, with additional staffing at the physician’s elbow.
  16. Marketing and Communication. Have a multi-dimensional, targeted strategy that includes actual customers. Don’t limit yourself to traditional media. Be innovative and leverage social networks.
  17. Training. Use multiple venues — traditional methods blended with modern ones, such as our video vignettes. Make access to applications dependent upon completing training.
  18. Support. Post-implementation support must be impeccable and ubiquitous.
  19. Vendor Connections. The best relationships start at the top, with C-level execs exchanging strategy and vision. Establish escalation paths to solve issues quickly.
  20. Infrastructure. Monitor and tune to ensure optimal uptime and response speed.
  21. Software. Select a seasoned application. Test and retest enhancements and patches prior to releasing to clinicians.

If you can’t deliver on the majority of the above factors, stop your project. Take the hit early where impact is limited rather than when you are too far down the tracks where a collision will occur.

We took a three-month hiatus because our standardized order sets were suboptimal. We retooled. We’re hitting the 85% CPOE and 65% order set numbers I gave above.

A final point to remember. None of these factors is a one-time event. Each requires continual care and feeding. Indefinitely. Implementation is just the forerunner of optimization.

Want more? Follow our CMIO and Medical Director on Twitter; ftvelasco; Isaldanamd

Update 6/28/10

Thanks for all your responses. When you have great success, it becomes easy to take some fundamental things for granted. This includes a stable technical infrastructure and all the non-clinical analysts who make things hum. So if I ever rewrite this, I will add that point.

I will take issue, however with Ex-CMIO. While computers are a commodity, successful EHR implementations are not. A gap exists because of the relative immaturity of the EHR experience. This will change over time and that gap will close in the next couple of years. We are all learning and the lines between the silos are blurring.

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

CIO Unplugged 6/11/10

June 11, 2010 Ed Marx 5 Comments

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

The Staff Retreat: Boon or Boondoggle?


The staff retreat. I love getting away with my staff or peers to kindle enthusiasm for the upcoming year. I thrive on the challenge of a ropes course and then reminiscing the near falls while feasting that night. Call me sentimental, but I get warm fuzzies singing Kumbaya. I’ll soak up the euphoria through to the end, and by the final night, the world seems good.

But then Monday hits.

Think about it. How many retreats have you attended about which you could later declare, “That was time and resource well invested”? If we evaluate the staff retreat ROI the same way we do personal investments, would we eliminate them? Do the qualitative intangibles carry sufficient weight to support the expense? Let’s be intellectually honest about this.

During my first two years at Texas Health Resources, I reorganized my staff, and then we got our strategy, tactics, and operations under control. After all the hard work, which paid off in great advancements, my team and I were ready to go deeper. This year, we opted for a new approach. What transpired during our two days alone was worth the time, money, and emotion. (You can see video of the retreat here.)

I asked our IT training leader to coordinate and facilitate our retreat. He spent six months participating in my direct report leadership meetings, observing and interviewing.

Thanks to his facilitation, the self-revelation and discovery proved transformational. After he led us to the point of openness and honesty, we called out every elephant in the room, banning any sacred cows. No unmentionables were allowed and no secrets, which was rough.


As we let it all hang out, emotions ranged from anger to peace. We cried and laughed — executive therapy unsurpassed and revolutionary. Gestalt. My team told me some tough things like ‘make more clear decisions’, ‘appreciate diversity of styles,’ ‘have more respect for those in operations,’ and ‘tone down expectations.’

I needed to hear this. When I came home, my wife corroborated each one.


Learning that we all struggled with similar issues helped us build trust and respect. To avoid slipping back into old patterns, we created new team operating principles. We redesigned our meeting structure and reworked our communications. And we agreed to have our facilitator regularly check up on us to ensure accountability and make refinements. We left exhausted, but balanced by hope.

When and why should you conduct a retreat? They say that a key differentiator between a good team and a great team is the quality of professional relationships connecting members. A retreat can help with this, especially as you first form a team, or when you feel the team’s effectiveness has plateaued. Every team has a dysfunction (or two) so you will never be short on content.

I’ve set out to do an annual retreat if for no other reason than to keep us from going backwards. A retreat, done right, can be the catalyst for pushing the team to the next level of effectiveness faster. If you focus on prescriptive methods that target specific areas for improvement, you can reengage on what is most important. Artfully creating a transparent atmosphere leads to discussing difficult issues and even to broaching the unmentionables. Ideally, you’ll find a cleansing of the souls, and people will focus on what’s important rather than personal agendas.


These are the keys to success within the leader’s control.

Situational Leadership
Understand the fine line between running the retreat and contributing as a participant. At certain times, I expanded on ideas and offered opinions and feedback. On other occasions, I sat back and observed, allowing the team to speak and interact freely. A pre-session discussion with the facilitator taught me when to contribute and when to back off so the participants wouldn’t shut down. To aid the process, he facilitated the meeting, soliciting responses and redirecting discussion.

High Tolerance for Ambiguity and Patience
in order to uncover and discuss the significant issues on a progressively deeper level, the facilitator follows a certain process. As CIO, I had to have faith in this process and patience for it to unfold in an appropriate manner. Occasionally, I wanted the retreat process to move faster especially during the initial topics. The participants, however, had to be brought to deeper levels systematically; otherwise, they would not be transparent enough in the latter part of the agenda. I had to exhibit positive behavioral attention and body language to demonstrate my approval of the process.

This was tough. I had to exhibit a willingness to draw out and hear feedback, both positive and critical. Success depended upon my authentic desire for improvement. This behavior cannot be forced. It’s either within the CIOs behavioral acuity or it’s not. If not, other objectives will need to be identified for the retreat to prevent further damage that can occur at the team level.

A higher degree of transparency will bring a higher degree of retreat success. Although the CIO does not (and should not) become a completely "open book" during this session, the more sharing of his work, priorities, strategy, and thought processes, the better the outcome.

A CIO must exhibit a strong level of confidence in his direct reports and faith in their skills and abilities. Recognize their willingness to improve and keep in mind that all people learn and improve at different paces. And believe that the retreat process will make a difference if completed well.

Continuing Commitment to Growth
The CIO must understand and embrace the reality that improvement on an individual and team level is a continuing process. A retreat alone will not create a lasting behavioral change, so commit to on-going professional development.

Expectations Identified 
Make your expectations clear. That is, the purpose of the retreat is to help move the team to the next level of performance (or whatever objectives the CIO has identified). Leave no doubt in the participants’ minds about what the retreat is to accomplish, how success will be measured, and what the subsequent steps will be. 

Of course, in all these steps, success is equally dependent upon the skill and experience of the facilitator. The more experience the facilitator has, the higher the level of success. Michael Cholette served us brilliantly and was a key contributor to the content of this post.

Do you have what it takes? Got courage? You’ll need it if you want to see a revolution happen from the inside out at work. So step out of the box and try something new. Redefine your retreat. Boon times ahead!

Update 6/17/10

The retreat was held specifically for my leadership cloud. Save for requisite HR stick-and-box org charts, we use more of a protean organizational structure that allows for greater flexibility and agility. In this case it was my CMIO, CTO, and leaders representing applications, value realization, and our hospital IT clouds. So to Dr. Stein’s point, we did have the only MD engaged that is in my cloud.

My strategy was to begin with my cloud first. If we could nail it and get results, we would extend outward. Early returns are strong. As pointed out, we are blessed with an IT training manager who was an executive coach prior to joining our organization. Remember, he spent six months (!) with us observing before we had the retreat. That familiarity and comfort was a key to success.

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

CIO Unplugged 5/26/10

May 26, 2010 Ed Marx 15 Comments

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

Office Without Walls

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

I’ve arrived! So I thought.

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

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

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

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

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

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

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

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

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

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

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

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

Update 6/5/10

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


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

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

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

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

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

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

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

CIO Unplugged 5/12/10

May 12, 2010 Ed Marx 37 Comments

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

Maximizing Vendor Relationships
By Ed Marx

Vendor management can frustrate even the most elite organization. You can love ’em or hate ’em, but you can’t live without them.

Over the years, I’ve learned to take a proactive approach that allows both the organization and the vendor to achieve their goals while providing maximum benefits for the health system. Here is our simple structure.

Categorize Vendors

First, stratify vendors into four categories. You may find a better framework than what is presented below, but the point is to define how you team up with each vendor. The following categories and principles work for us:

Strategic. Out of hundreds, the vendors that qualify as strategic can be counted on one hand. Elevate these relationships to partnership status at an enterprise level. Consider them health system partners, not merely IT strategic partners. Our C-suite partakes in the selection and then personally invests time in relationship maintenance. Strategic partners identified: transformational, high-dependence, high-cost exposure vendors, and those with whom we wish to increase business. As CIO, I’m the primary relationship manager. I devote my time and energy exclusively to our strategic partnerships.

Tactical. We work with two dozen tactical suppliers. We’re similarly intentional on how we screen and invite these vendors. Tactical suppliers are typically smaller in cost and exposure and are transactional, yet they’re critical to the success of our organization. My direct reports divvy up ownership responsibilities for these important, exclusive relationships.

General. Given the existing business relationship, there’s nothing negative about this category. On average, however, these vendors supply commodities that provide little opportunity to differentiate. Therefore, we spend less time and energy with them. While we expect to maximize this relationship, we continually remind general vendors that maximization will not reach the same level as with strategic / tactical vendors. Our managers and directors own these general vendor relationships.

Emerging. This finite category of vendors has a small initial presence that we expect to build over time due to great potential. Emerging suppliers may come from our tactical or general relationships or may be a net new entrant. My direct reports manage these relationships closely.

Identify Vendors

As a Baldrige-oriented organization, we have a recognized and practiced process by which we discriminate between vendors.

  • Supplier scorecards – service metrics, relationship, business model, technology, pricing
  • Business technology alignment – opportunity, potential, direction, vision
  • Deeper dive – presentations, discussions, research, vision
  • Business technology meetings – share process, share strategies, mutuality, outcomes
  • Tactical committee review – presentations, price models, benefits
  • Strategic committee review – presentations, cultural fit, vision
  • Decision – responses collected, responses aggregated, scorecard, decision

Manage Relationships Proactively

Each strategic, tactical, and emerging relationship is managed intentionally and includes formal controls. We also have codified rules of engagement:

  • Relationship owners meet quarterly with strategic partners and conduct an annual, formal score card evaluation of both parties
  • We arrange meetings between CEOs
  • Strategic partners meet collectively once a year to review our organizational and IT strategic plans, working together to develop solutions. We meet offsite at locations that inspire creativity and innovation. This year we met inside Cowboys Stadium.
  • We hold monthly follow-up meetings ensure we advance the collaboration.

(click to enlarge)

Next month, I will lead members of our C-suite on site visits to our strategic partners’ corporate headquarters to enhance the executive relationships. My hope is to bring about opportunities that will help fulfill our mission and vision. Although we are unable to devote equal amounts of energy to all suppliers, we do scorecard every strategic, tactical, and emerging vendor annually.

Measure Outcomes

To measure benefits differently for each level of supplier, consider the following: quality of product and service, shared value, maximization of investment, branding, influence, price points, and innovation. Assessed annually, these outcomes are part of the scorecard process as well as topics of discussion among executives on both sides. This forum for transparency and accountability leads to a win-win collaborative approach.

On a practical note

Suppliers persistently seek the CIO’s attention. I wish I had the energy to meet with each one. Having a structure and proactively managing vendor relationships allows me to treat all vendors fairly and frees me up to focus on what matters most.

By concentrating exclusively on our strategic partners, I can ensure that we exploit both investment and commitment. The described process above values vendor interests while optimizing benefits for our health system, clinicians, and patients.

To encourage comments, I will send a generic version of our strategic partnership framework to all who post. The framework contains significantly more detail.

Update: Response to Comments Posted Through 5/14/10

I appreciate the richness of the responses!

A couple of comments. As stated in the post, we work with hundreds of vendors. By definition this implies that we do not have a single vendor solution. There are so many variables to consider and it comes down to the uniqueness of each institution and culture. For us, we have found that a hybrid approach works well. A handful of broad based vendors and BoB. That said, the point of the post was not a position on either but rather the advice that you must maximize your vendor relationships. One way this can be achieved is with structure. It is not a new concept, but it is yet largely unpracticed.

With vendor partnerships, especially with those that are considered strategic, you need to build in formal controls so that the relationship does not go sideways and either party gets scarred. These controls and rules of engagement address things like kickbacks and do not allow for discounts for “talking up vendors”. I touched on this briefly and those of you who left your e-mail, you will get more detail shortly via the generic framework.

In fact if you like what you receive, let HIStalk know and I will send out our very detailed scorecard and review system. It is hard for me to believe that vendors and customers do not sit down together at least annually and score one another. It leads to some tough conversations that are crucial for shared benefit and success. You are what you measure.

I happen to agree with the sentiment that healthcare IT is so far behind and other industries are more customer-centric. You need to read my post Why Healthcare IT Lags.

One of the things we analyze when considering a vendor relationship is the leadership. I believe our strategic partners have had the same CEOs in place for many years. We look for consistency in leadership, so we have not hit the revolving door issue that someone asked about. All of our strategic, tactical, and emerging vendors have made these reciprocal relationships. If they don’t, it is not a relationship and we will end it.

I smiled when I read the comment that our vendor framework is flawed for lack of physician input. I am fortunate to have three physicians in IT and, trust me, they are not shy and I am thankful for this. In fact, they are one of the main reasons we have been so successful with leveraging IT. We have an IT governance council made up of many other clinicians and our C-suite includes an additional three docs.

I am wise enough to know that customer input is a key success factor. I shed my office 15 months ago so I would not become too comfortable. Instead, I spend more time with my customers in their environments. You don’t know me. Keep reading and you will.

You know, I am not sure on the question about inadvertently creating an internal hierarchy based on which vendor you might work with. I can see the point. None of my team has mentioned this as an issue, nor have I seen any behaviors to be concerned with. But I also know that despite my direct team engagement, I can be sheltered. I will need to watch out for this.

So for my IT colleagues, either manage your vendors or be managed. For my vendor readers, if your customer does not have a framework, recommend one. The benefits are mutual. We need one another. I am fortunate to work with many incredible vendors and feel good that we have a fair and equitable framework from which we can build on.


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

CIO Unplugged – 4/15/10

April 15, 2010 Ed Marx No Comments

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

Do You Have What it Takes?
By Ed Marx

Interestingly, yet not surprisingly, my most popular posts are not on healthcare technology but on leadership. Evidently, industry challenges and solutions are secondary to the primal importance of management execution. In other words, you can have great ideas and vision but if you lack leadership, “Fergeddaboutdid”—as Johnny Depp humorously mimicked Al Pacino in Donnie Brasco.

We’re born questioning our existence, and many of us spend a lifetime searching for answers. Some of us never find them because of our insecurities that skew the process. While wrestling with my own fears, I’ve always asked this one question, which I believe is universal:

“Do I have what it takes?”

Athletes wrestle with the same question, especially right before an event. During my first Escape to Alcatraz, I sensed the vibrant energy flowing from the participants on the boat heading toward Alcatraz. We discussed race strategy, weather conditions, currents, and the great deals we got on our technically-advanced wetsuit. But as race time approached, an eerie silence took over. Some would call it the sound of focus. I’d argue it was the deafening throb of introspection. Do I have what it takes?

Last fall, I completed my first extreme adventure race. 40 miles of technical mountain bike trails, 13 miles of kayaking, 1 mile of river swimming and 20 miles of running, all integrated via traditional map and compass. Before the starter pistol fired, I listened to people sharing battle stories from the adventure race season. As the minutes wore down, I began to grasp the reality of my latest endeavor. Traversing unmarked trails, my three-man team would be on its own, finding the way with no support other than what we could carry. Do I have what it takes?

When I held our first child. When I first spoke in public. When I first led troops. When I took on my first CIO role and faced numerous challenges, I asked myself the question. I’ve tried to live in such a way that I can answer in the affirmative. I realize that having what it takes revolves largely around preparation, which breeds confidence. And, I’ll tell you what. When you’re floating two miles off shore between San Francisco and the frigid, shark-infested waters of the Pacific, you’d better be able to answer the question positively. Otherwise, fergeddaboutdid.

Simply put, we don’t rise to the occasion, we fall to the level of our preparation.

Where the athletic pursuit boasts physical demands, leadership carries the challenges of high stakes, decision-making, and time pressures, to name a few. I’m compelled to do everything within my control to be ready for whatever work throws at me. Some things I can’t prepare for, such as the perpetual supply of surprises, disappointments, crises. Nevertheless, I want to be equipped and confident to answer the ultimate question.

May 2nd of this year, I’m diving back into the frigid San Francisco Bay. I will ask myself the question. And despite my fear, I will put my face in the water and push one palm back after another. Same at work. Between the ACO, meaningful use, and the ever-evolving tech advances, I’m equipping myself.

Are you?

(Otherwise, fergeddaboutdid!)

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

CIO Unplugged – 4/1/10

April 1, 2010 Ed Marx No Comments

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

Why Healthcare Innovation Sleeps
By Ed Marx

“That’s against the rules.” “We don’t allow that here.” “Were you this much trouble where you came from?” “You have great potential…if only you’d follow the process.” “That’s not the way we do things here. Who gave you permission to do that?”

Thoughts of preschool and kindergarten bring back fond memories. I spent three years attending French schools while living in Southern Germany. And I recall the schoolmasters’ many rules as they attempted to shape us into well-behaved and homogeneous boys and girls.

Thankfully, I didn’t turn out too homogeneous. I kept coloring outside the lines and still survived with my dreams and aspirations intact. Originality is an inexorable part of my DNA.

Apparently, I’m not alone.

Innovation is the rage today. More books on innovation exist than ever before. In the last few months, I’ve spotted at least a dozen major magazines with innovation in the headline. Organizations intellectually understand that they must innovate to achieve competitive differentiation and drive customer preference. Yet, creativity still sleeps, especially in healthcare. Oh, we talk about transformation with gusto. But we resist taking action on our dreams, which puts our survival at stake.

As mentioned, many books and articles offer explanations for the lack of innovation in healthcare, so I won’t repeat those. Rather, I’ll focus on what I believe is the primary reason for innovation sleepiness in healthcare—the systematic elimination of creativity in the very people we expect to innovate. We desire it. But once we see it, we fear it. Our fear turns into control. We either chase the innovators out or force them to conform. For those who stay, their passion is laid to rest.

This type of mental programming starts when we’re young. Rules and societal norms are forced upon us. Generally speaking, rules are important for reasons of safety and perhaps developing positive relations with peers. But in a quest for conformity, we inadvertently squelch the creativity in our children.

Some who survive this programming with their imaginations intact are labeled outcasts. Others with artistic talent find careers that suit their gifting (music, theatre, arts). A smaller number of survivors are those inspired scientists, businesspersons, and engineers who either seek out innovative firms or start their own. And any progressive firm that embraces the fusion of creative arts, business, and science doesn’t fit the programmed norm.

So, back up. Where does that leave the remaining survivors—those that end up in non-innovative industries and firms? I’ll apply the following opinions to healthcare. (As if you didn’t see that coming.)

Rather than rushing to embrace, healthcare organizations create innovation adverse environments to control innovation. Control innovation? Isn’t that an oxymoron? Consider the following as a few examples of this type of absurdity: designing identical and rigid performance evaluations for clinical staff and businesspersons alike—ignoring that each role requires different skills, talents, and models for success; requiring uniform décor and attire to the point offices and employees lack distinct character—and working styles are ignored. We expend more energy and resources on developing Policies and procedures than we do on innovation.

We call the above programming “fairness.” But is it? Rabbits might like carrot sticks for a reward, but the bear needs raw meat. And the innovator needs freedom.

Tension between innovation and conformity is necessary to bring progress to an organization. Challenge must never stop. To reestablish the needed balance in tension, we’ve got to wake up and tip the scales towards creativity.

Waking up from our slumber involves disrupting the current patterns. Some practical ideas:

Encourage Innovation

  • Discuss innovation in every leadership message from CEO down
  • Lead by example and innovate yourself
  • Allow for and encourage respectful dissent
  • Surround yourself with creative talent
  • Actively participate in collaborative approaches
  • Have both informal and formal outlets and fund it

Change Culture

  • Allow Non-Conformity
  • Embrace self-expression
  • Reduce the burden of policy on policy
  • Make accommodations for creativity and break rules
  • Reward employees based on their role and contribution
  • Allow for different compensation and incentive models
  • Shelter innovators from political and administrative distractions
  • Expect innovation from all clinical and business leaders
  • Hire and reward for innovation
  • Create cross generational and cross functional teams

Embrace Failure (non-patient care)

  • Advocate merits of risk
  • Remove fear and shame of failure
  • Expect failure (to enable growth)
  • Celebrate reasoned failure

Recommended Resources

Goffee & Jones on leading your smartest, most creative people in Clever

Kelly covering IDEO‘s strategies for beating the devil’s advocate & driving creativity throughout your organization in The Ten Faces of Innovation

Moore on how great companies innovate at every phase of their evolution in Dealing with Darwin

Buckingham and Coffman discuss why they do not hesitate to break virtually every rule held sacred by conventional wisdom in First, Break all the Rules

By the way, the quotes I used to open this blog post are not from my Kindergarten teacher. They’re from a collection of quotes I’ve received in the work place, an unconscious attempt at programming.

So I encourage you, press on with disruptive innovation and power ahead to transform healthcare.

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

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