• 02:31 Managing Teams and Expectations
• 09:57 Technology in Healthcare
• 12:38 CIO Role and Market Dynamics
• 20:21 The Importance of Building Coalitions
• 26:25 Handling Global Events as a Leader
• 31:22 Empathy and Connection in Leadership

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Newsday: CIO Turnover: Leadership Challenges in a Fast-Paced Era with Laura O’Toole

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I'm Bill Russell, creator of this week Health, where our mission is to transform healthcare one connection at a time. Welcome to Newsday, breaking Down the Health it headlines that matter most. Let's jump into the news.

I will be in Atlanta for a city tour dinner. By the time people hear this, that will be in my rear view mirror. We will have that on Wednesday, and this will probably air on Monday, so we'll be we'll hear what Drex hears in Boise, Idaho. How are you guys doing?

Laura O'Toole: I'm doing fabulous.

I'm in Greensboro, North Carolina today, and the weather is gorgeous. It's beautiful. I think I could live in this state actually. I really like it.

Bill Russell: North Carolina. Yeah. North Carolina was one of the places I wanted to go, but it was a little too cold for my father-in-law. So and he did get a vote in where we moved, so we ended up in Florida.

Laura O'Toole: exhausting and I've got a bunch of open positions and I don't know who's gonna fill what job. I don't know. Yeah, the list would be long, bill. It'd be very long.

Sarah Richardson: I think, bill, I would just say that the misalignment between leadership, vision and technical reality is probably exacerbated by budget constraints and some of the impossible mandates.

We always used to joke that better, faster, cheaper was a thing, but it used to be a cheeky thing, and now it's more like a thing thing. A real thing. A real thing. Pointy thing.

Bill Russell: It was almost kind of comical. because I talked to three CIOs this morning in a row and each one of us said, Hey, how are things going at your health system?

And they all said the same word, and the word was

Laura O'Toole: busy, exhausted. Oh,

Bill Russell: We are so busy. Oh, it's amazing how busy we are. And then they proceed to tell me, it's like, yeah, we're doing, you know, we're doing our EREP implementation, our go live. It seems like a lot of go lives are scheduled for this fall.

Sarah Richardson: lot. Yes.

Bill Russell: You guys have both managed large teams before. I mean, what's the role of a leader when you know that the pace at which things are gonna be moving is so rapid? One of the things I'm concerned about with healthcare leaders is that this pace hasn't abated since

the pandemic. I mean, it's been a pace that's been just ongoing and you know, implementations mergers and acquisitions , you name it, it just seems to keep coming a significant clip. I'm curious what, I mean, how do you approach that as a leader? I mean, what do you see your role as Laura?

I'll start with you. I mean, what's your role when the team says, you know. Man, that's, we have an awful lot on our plate. Is it to help them to see that it's really not that much? Or is it to help them to manage that?

Laura O'Toole: Well, it's going on all the time and we're hitting it right now. I think we have several clients that have major testing events going on, coming up in

To redirect, reprioritize, but I think it's about holding accountable and really empowering them to go do their job and get out of their way. And because they're busy and because there's so much going on, so now you feel that there's more risk that something might go wrong to hold yourself back and not insert yourself get in there when maybe it's not the right time for you to

Bill Russell: wow.

Sarah.

Lessen some of the burden that they have with maybe bad decision making. And so when you not only support them from a personal, professional perspective, to Lauras Point, you're like, tell me what you need. Because your job as that leader is to remove barriers. Yeah. They're smart enough to know how to manage the resourcing of the team.

In that same context. They need to come to you and say, Hey, I need two people extra for this for a contracted period of time. Or Here's why there's this gap analysis on this team to produce this level of work that's anticipated for the organization. So all of those things need to be true, but if you believe you can run your organization at a burnout level all of the time, that's where you will see the failure.

Bill Russell: Yes,

Laura O'Toole: absolutely. Absolutely, and I agree with you, Sarah. I think you do need to set expectations not just with your team, but with your clients or in, and you know, as an example for you guys with your partners or with that next event, whatever it might be. If people don't step up the way they need to.

Bill Russell: it's interesting. Most people get to the CIO role because they are the chief problem solver, right?

So you were in some role and you solved some major problem and somebody promoted you and then you get to another role and you solve some major problem and they go, man, you can really solve problems. You're amazing. So they move you to the CIO role. Now the challenge becomes when you move through those roles and you get to the CIO role.

Is, you know, is it just a continuation of what you did in your last role or is it a completely different role? I would argue it's a completely different role. And the challenge is a lot of CIOs don't make that transition of, oh, I'm an executive leader now. I'm focused on a different set of problems.

don't want my CTO fighting political battles. I want my CTO fighting technical battles. I want them figuring the, I want my security officer fighting security battles and that kind of stuff. And so it's when they say, Hey, we're not getting adoption from the physicians. That's my role. My role is, all right, we're not getting adoption from the physicians.

I'm either gonna work with the CISO and we're gonna come up with a program, or I'm gonna work with the executive team and say, look, this is a priority. The board says it's a priority. You know, I need your help, or whatever it happens to be. But the role. It definitely transitions when you get to that CIO.

How do I get them the right resources? How do I make sure that it is funded? I mean, your battles are really about budget. It's about people, it's about culture. It's also identifying those things that they are potentially doing wrong. I think you know, it, it's when the team comes back to you and says, you know, Hey, we can only migrate 20 physician offices this year, and you have a backlog of 120 physician offices.

That's the point of which you sit down and go, maybe you're not solving this problem correctly. And it's because they don't realize how far, how much leeway they have to like, oh, we can invest in something. Oh, we can do something different than we did it last year or the year before. And you sit there and go, yeah, you know, I think we can ramp this thing up to 50 to now.

And they go, oh yeah, I didn't know we could do that. Oh yeah, you can. So, I don't know. It's interesting to me how many organizations I'm hearing the word busy from, but that's true for all of us, isn't it? Like if I asked you how are you doing? Busy is probably one of the top five words you're gonna say, isn't it?

Laura O'Toole: I think I just talked to you on Friday night and you said, how are you? And I said, I'm busy, but I'm great. I personally like being busy, but so I think you're spot on there and I agree with you completely. Part of our job as leaders is to help people think outside of the box, we don't have to keep doing things the same.

But we have to continually push people to think outside of what's in their head and think outside of the box and think about the art of the possible because. That's where I think the innovation comes

Bill Russell: Is technology part of the solution, or is technology the problem? I mean, is, are things accelerating at a pace where it's like, Hey, you know, this is unsustainable.

Laura O'Toole: I would say technology is a part of the solution if you use it the right way. I think just throwing technology at something to see what sticks.

Without understanding what the processes that you're trying to solve is a waste of technology. So I don't think it's an or I think it's an and,

Bill Russell: But Sarah, we haven't seen that kind of stuff happening in, in the health IT world where people just try to throw projects against the wall and see what sticks, or buy certain technologies and see what sticks and

Yes, we deal with the politics as the senior leader, and there's an identified group of people on our team that are our successors. And so appropriately you bring them into those political environments because politics is a little bit of everywhere, and the ability for them to see things in action or solve some of those bigger problems.

And so who are your two or three successors on the team that need to have that exposure? As appropriate, and this is something that I learned from Joe Scarlet and you reinforce Bill, is that being busy is one thing. Being productive is another. Exactly. And so ensuring you maximize the efficacy and the impact of your time that is spent, because I don't care who you are, you got 24 hours in a day.

But we have so much tech debt that every once in a while I used to represent it as anchors on a boat. Start cutting some of those anchors off so that things are more effective. But when you really dig into the ability to improve the way things are done, and they'll let technology be the enhancement factor, to me, that's where it all meets the road.

But you need all of those things to be true. Strong leaders who can get the work done, understanding what really. Brings value and delivers it to the org. And then where technology really fits in that learning those pieces alone helps you be a better CIO.

Bill Russell: I agree with everything that I'm hearing, which is unfortunate becuase I like to disagree on things and argue things.

Right now, I'm not even talking CTO or digital officer or AI officer. I'm just saying this, the traditional CIO role. You know, this person was rattling off the number of roles, and I'm like, oh, you didn't cover the children's hospitals and oh, you didn't cover. The academics that we know of, there's at least two academics that we know of that don't have a CIO right now.

Percentage wise, it's not a huge number, but. You know, you wouldn't think there would be that much that much turnover. Is this a it, do you think this is indicative of the role changing?

Do you think this is indicative of what we just talked about, that the pace and the expectations on the role are changing? I mean, what do you think's? Or is this just normal? You know, we just happen to be at high tide right now, and it's gonna, it's gonna roll back.

Sarah Richardson: Well,

Laura O'Toole: I'll, you wanna start Sarah, or you want me to start?

Sarah Richardson: I want you to start because I like following your acumen for sure.

The other piece is I think there is a movement and you know, it's like an N of three or four that I've heard, but I have a feeling right now some of these open positions are staying open as long as they have, because I think the leadership, at Especially some of the large health systems are really trying to figure out what does that CIO or that CDIO, or is it a now a CTIO role need to look like and are we really clear and crisp on what that job description should be and what we want people to actually bring to our organization and task them with.

Driving and I think there's some unrest right now in the market about that, what that really should look like.

I'm like, okay, great. You only get to ask so much in the interview discovery process. And when you get there and you say, it's going to take this, and they go, wow, that's awesome. And no. And so you think about versions two versions, three versions, four, it doesn't mean you expect carte blanche when you go into a role.

What I've heard from. Colleagues that are going into some of these opportunities, they feel like there's a little bit of the bait and switch perspective of really what's being asked versus what's being delivered or given to them once they arrive. And you may be a traditional CIO, but most people are going for that CDIO, but you really have to have that broader scope of digital strategy, patient experience, and innovation.

Yeah. So. I had one of my dear friends also leave a recent role because they said I spent more time educating new members of the C-Suite than I did actually getting the work done. But then I was still held accountable for the work getting done, and they're like, it's like this impossible hamster wheel.

In some cases, that's not gonna be true for everybody. However, that is more of a common thread that I am hearing than it has been in the past.

Bill Russell: There's part of me that would like to follow a CIO as they're doing the interviews. And the interviews themselves are just as silly as they can be. You know, it's like, well, we're gonna have you talk to 22 people in our organization. Well, there's no 22 people in any organization that are gonna agree on what the role is.

And you know, when you line up 20 some odd people, they're just not in agreements. It's like, well, you know, one of your primary roles is gonna be to make sure that the technology is addressing physician burnout and, you know, and you're doing this and this, and then you're gonna come over here and the compliance officers gonna say.

Well, you know, I mean, your primary role is to make sure we don't get breached and security is the job number one. Then you're gonna go over and talk to the chief operating officer who's gonna say, look, we have a bunch of initiatives that we have going on, and your primary objective is, you know, and by the time you're done, you have, well, the CIO role has 20 primary objectives.

Can you do that? I can't do that.

Laura O'Toole: No, not well, no. And you know, it's interesting. I think that as a CIO, and I've said this before and I've even talked about this on the podcast before, I think the job is harder than it has ever been. And I see our CIO friends and colleagues and I actually like, feel for them like I.

A great CIO. You have got to be a connector. You have got to be able to connect the right people at the right time with the right message. For what you're trying to drive for the organization. And if that's not coming from the top down, and if you're saying Sarah, you know, you see people leaving, they make relationships, then someone leaves.

And I think part of the core skillset is they've gotta be a really good connector. And you'd be surprised you have a conversation with somebody about coloring books. How many people just skip those, connect the dot pages. And I just think it's a core, core capability that you've gotta be comfortable in your own skin.

You've gotta be comfortable saying, I don't know, and I need help. to really connect and get what you need for the organization. I think that's a core skill and it's overlooked.

Bill Russell: I think the patron saint of CIOs is Dwight de Eisenhower. I mean, think about the coalitions he had to bring together.

Yeah, I mean it, the allied forces and the number of egos and things. I mean, that is a much harder job than the CIO what he was able to pull off during World War II in terms of relationships, right? He had to keep everybody happy, including his generals and including you know, essentially the leaders of the world, powers and whatnot.

I mean, your job is not to be liked by everybody. Your job is to build coalitions that gets things done. And so that is communication is obviously very key discernment. Like, you know, not everything that's in your head needs to be said at that time. Maybe it needs to be said over time, but doesn't need to be said at that time.

So , there's a discernment, there's a relationship building. There's a you know, there's a rallying you know, if you watch some movies about the interaction of Churchill and Eisenhower, I mean, there were times where he like snapped at him and there was times where he put his arm around him and said, you know, I understand what you're going through, and that kinda stuff.

I don't know, I'm throwing that out there. I don't know what you guys think. I

Sarah Richardson: We talk about having three or four versions of a plan, but also the backup just in case all of those things failed. He's like, you can have 10 plans in place. You better have 'em all planned out, but just plan for all of them to fail and still know what to do.

So there's that ability to like think on your feet and get things done. That comes with experience, that comes with going through really hard gross projects and then getting fired or getting transferred or getting moved or having things happen like that all of the time. Going through the pandemic, going through all kinds of different things that have really probably cut our teeth on the experience factor.

When things are going poorly, you take on all of that responsibility. That's not that common anymore. Like I feel like, I don't know what the shift has been. There's lots of ways you can theorize it. But the ability for people just to say, Hey, that was my fault, or, Hey, this is what's happening. It's really fascinating to see the amount of energy that is put into deflection.

Yeah. Versus just saying, this is on me and I'm willing to, I'm willing to get fired if it doesn't go well.

Laura O'Toole: Right. And owning it. Owning it, and not being afraid to fail. I mean. Sometimes you're going to fail. You have to have a backup plan. But I think when we have failures and when our staff has failures, you have to use it to the advantage of getting them to the next level and getting them better.

And that's

Sarah Richardson: a generational aspect though too, because I'm not gonna say we, we sugarcoat any generation, but there is some fanatic, some fantastic books written about generations. There's one author , Jean Teague that I've really liked. But when you think about groups of generations that. Had helicopter parents or got a soccer trophy for participation, like fell down, we're allowed to go outside and play.

Like, we didn't come in until the lights came on and you know, if you fell down it was like too bad. There's, you know, there's a bandaid. Makes me feel like I age myself sometimes, but we're resilient and so if there's a there, there's something I would hire for today. The number one thing would be resiliency.

Yep.

Being with clients, but still having to get your job done. because he had to go down to Miami on Tuesday, whatever. He gets back, we had dinner and he's working like late into the night getting all his other stuff done. And he is like, you know, it's really important. But you'd be surprised how many people just don't figure it out.

Like they just don't figure it out. It's mind blowing to me. And you know. I'm proud of the fact that I raised my kid that you will be resourceful, you'll be resilient, and you'll be a hard worker. And if you're not, it's gonna be a big problem for you. And, but I agree with you. It's amazing how many I don't wanna call my son a kid, but he's a kid today.

Bill Russell: you sure it's fully developed? I

Laura O'Toole: really think he's almost 27. I think it's fully developed. I don't worry near as much as I used to.

But to see him juggle all those things and do it well and then come back and work hard to get done what he, you know, because he was traveling the whole day and couldn't get to X, Y, Z. It's some days you gotta do that and you've gotta be willing to work hard too. I think that's part of it.

Bill Russell: Well, your two leaders, I respect. Let me ask you this question. This is a little harder scenario, which is the last couple weeks have been hard in terms of like the news that's being bombarded, right? So you had the Ukrainian woman who was, attacked. And then you have the assassination last week.

Or do you like ignore it? I mean, how do you approach that? And Laura we'll start with you because Sarah wants me to start with you on that one.

Laura O'Toole: Well, so for me it's pretty basic. It's just about humanity. I think you have to meet people where they're at. And if you see that somebody, and I had some folks on both of those spectrums, you know, and even, you know, things like the chat GPT article where it actually helped talk a kid through suicide, right?

No matter what it is, that is catastrophic, that gets brought to the forefront. It's about humanity. For me, it's, you know, I don't get into the political landscape. If I have an employee that is deeply affected by something, they're my employee and I care about them, and at the end of the day, that's all it is.

Bill Russell: So you'll handle those things. Do you'll handle those one-on-one? Not with any kind of global thing, unless it's like a nine. A nine 11 would be something I probably,

Laura O'Toole: I mean, I do a Monday note every Monday morning to my entire company.

Every Monday morning I send a note. I typically share some things that I've done through the weekend or I might share of a success that we have with a client or might something that might be coming up that week or if we had an employee. You know, that had a baby, whatever it might be. It's just a personal note from me.

And, you know, and I will say in situations like this, I know it's been a really challenging time for our country in general. Please, you know, if there's anything you need or anything you want from us, you know, let us know that, you know, I'll say things like that. For me, it's just about being present for people that need it, regardless of what they need.

Sarah Richardson: a hundred percent what Laura shares and for the record and probably everyone saying, oh, it's Laura and Sarah get along on everything.

We actually do a lot of debating on different conversations too. We appreciate that. But when you are tied to someone's ethos or you have similar perspectives on humanity, that's how friendships are formed as well. And so that important aspect of. I know that if I had a concern about something happening globally, I could call Laura.

I could also call Sue Shade or others because they would listen to and appreciate my perspective. So I say all that because it goes back to those one-on-one relationships you have with your teams. And I spend an inordinate amount of time getting to know my teams, like everybody at an appropriate

Bill Russell: level.

You do. My gosh, I remember when you went to Tivity and you told me it's like, I'm gonna meet individually with every employee. I was like, that's insanity. But you did. Yes.

Sarah Richardson: So even tomorrow night I'm having dinner with people I worked with at two previous companies that were all on my team who said, I'm just being honest.

And that's why I love having multi international teams, because you learn a little bit about the perspectives of the world. From people who aren't even from the us and having that ability to understand either culturally, you live here and you are, you know, whatever your background is, or you're from another country.

I always wanted to create a safe space for people because I wanted them to be able to do a great job. And that could be something happening in the universe. It could be something happening at home, right? But my goodness, the amount of information I know about people that I don't share, right, as much wonderful things they want shared so you can sponsor their brand appropriately.

All of those things come into play and it's important to just be able to listen. To what people are saying and let them know they matter no matter what.

The political spectrum really doesn't matter. I bring it down to that basic and to Sarah's point, it is probably, you know, one of the reasons we get along so well because it's about connecting with people. And, you know, I once had someone ask me this, a young leader who is a great leader but was young in his career, and he actually said to me, Hey, all these people that work for you, how do you.

Make them think that you care about them so much. I'm like, and you do.

Bill Russell: I do. I'm

Laura O'Toole: like, because I do. And I really do. That doesn't mean I don't hold them accountable. And just because I'm nice doesn't mean that, Hey, I have expectations. And I think if I'm not holding them accountable, I'm doing a huge disservice to them.

Bill Russell: How do you pull the wool over all their eyes? How do you make them think that you care about them? It's like, because I do.

Sarah Richardson: Yeah, but you can't fake that and so No,

Bill Russell: you can't. You absolutely can.

People

Sarah Richardson: bringing up through the ranks, and I'm like. Wow, you don't have the empathy bone. Like you don't, you actually can't personally connect with people and amazing technologists that I'm like, your train stops here from a promotion perspective under my watch, because you don't know how to connect to people.

And I can't leave you in the basement for the next 20 years. And so there's a space, and some people you do, but if the trajectory is leadership over humans man, you better know how to address humankind. Exactly. Otherwise, yes, I can leave you in the basement, however, you know. But then that also created those duality in the tracks of technical leadership of like the experts that are, people don't talk to them, they solve problems.

Bill Russell: Agree. Interesting. Well, those are gonna be the most quotable quotes from this show, by the way, your train stops here and you, you're the kind of person we can leave in the basement,

Sarah Richardson: which is so anathema of my brand.

But however, you know what? You can be firm and you can be kind. That's right.

Bill Russell: I understand it completely. There have been people that I'm like, you know, what do you want your next role to be? It's like, I think I can run this place. It's like, yeah, but nobody likes you.

So I don't know how to do that. Like, how do we help you to, like, you gotta, you have to have a people sense in you and you have to actually like them and care for them. Sarah, we did the leadership course we have a course that we're going to be releasing part of the part of the 2 29 fellowship program for healthcare leaders.

And that's that whole thing of being able to see the world through that other person's eyes and their lens and walking in their shoes. And what does it look like when you know, when you fire somebody, you should picture that person having to sit. In that home across from their family and explain to them that they got fired that day.

And if that doesn't humble you, as you get ready to have that conversation, then you don't have the empathy bone and you probably shouldn't be in that role.

Laura O'Toole: Yep. And you know, we don't have to, like every single person that we work with, not every single person that we work with, we have to wanna go have a glass of wine with, but you have to.

Bill Russell: yeah.

To

Laura O'Toole: be able to get the job done.

Bill Russell: All right. Well, that's the news. People are busy. They have a lot of things going on. They have to manage people through these challenging times. I wanna thank you two for the conversation, the dialogue, and sharing your wisdom with the community. And we're gonna do this again.

I think we're gonna do this again and we can go in whatever other direction you would like to go in next time because Sound good?

Laura O'Toole: Sounds great.

That's Newsday. Stay informed between episodes with our Daily Insights email. And remember, every healthcare leader needs a community they can lean on and learn from. Subscribe at this week, health.com/subscribe. Thanks for listening. That's all for now.