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Welcome to this Week in Health It. My name is Bill Russell Healthcare, CIO, coach and creator of this Week in Health. It a set of podcast videos and collaboration events dedicated to developing the next generation of health leaders. . This episode and every episode since we started the CVID 19 series has been sponsored by Sirius Healthcare.

Now we're, we've exited that series, but Sirius has stepped up to be a weekly sponsor of the show through the end of the year. Special thanks to Sirius for supporting the show's efforts to develop the next generation of health leaders. I got a call out of the blue from, uh, friend of the show, mark Weissman.

He does the C-M-O-C-M-I-O podcast and he's just been moved into a new role, inherited a new staff, and uh, he said, bill, I'd like to pick your brain. And what do you do in the first 90 days? How do you, uh, establish vision? How do you establish just all the things that I do in my coaching practice? And he had the idea to record the show, and we're going to air it on both channels.

So on the CMIO podcast, you can hear this or you can hear it on this weekend, health It, and it's just a discussion mark's mostly Mark, asking me questions and, and me just responding of how I approached the first 90 days. As ACIO for the health system that I inherited, and, uh, just a little back and forth.

I, I really enjoyed doing it. I hope you enjoyed it as well. So, welcome to a joint podcast today, you've got, uh, bill Russell with this week in Health it, and Mark Weissman the, uh, moderator for CMIO podcast. And we're doing something a little d.

Very complimentary anyway.

I'm now in a new position, the CNO and myself, CNIO, and myself from Peninsula Regional. We now have 60 plus some odd epic analysts reporting to us. And so the topic today is taking over a new team. What that's, and we're not the only ones in healthcare IT who are doing this.

So we thought the topic would be applicable to a lot of people, and I get to pick Bill's brain for a little bit here on some of the things that he would do if he was taking over a new team. And what are the first 90 days like? So Bill, that's where I think we should go with this. How about you? Well, mark, I'm looking forward to doing this.

This should be fun. I, and by the way, happy birthday, so everyone who's out there who has, uh, Mark's email address, go ahead and send him a birthday greeting. Um. So, and, and, and you're, you're how old now? Am I allowed to ask how old you are? I'm 50 for crying out loud. Oh, so it's a big one. It's 50. Yeah. That is one.

And they're making a deal of it here. I'm not gonna show you my office here, but they decorated it with all kinds of, uh, old age related things. , so Well, 50 is a big deal. A lot of different kinds of things happen when you go to your first clinic checkup and those kind of things. Yeah. The first 90 days, I don't know why we picked 90 days.

I think it was the government, right? So the, when, when the president comes in, the first 90 days is such a big. Event they say, you can almost see which way the, the administration's is, uh, gonna go based on the first 90 days. So they spend so much time planning out what they're gonna do in those first 90 days of a, of an admin administration.

And I, I think it is really important for new leaders. And by the way, just another weird fact for you, I was talking to ACIO the other day who was in contact with, with a recruiting firm, and they said they have 16 open. Healthcare, CI positions across the country. That's a lot by the way. Yeah. Yeah. So we're, you're not gonna be the only one going through this first 90 days thing, so this is probably a pretty good topic.

So let's just touch on the first 90 day bit for a minute. There's a honeymoon period. I'm thinking that you get to screw up a little bit and they give you a little of leeway and then they start to you. Or if you go in and start making changes hard and fast, what are the first 90 day feel like it? A lot of it depends on what you're inheriting.

The, I had Daniel CI. New York Presbyterian on the show. And he said, and I asked him this specific question first, 90 days, and it, and his, his response, he said, healthcare, it is 80% people, 15% process, and only 5% technology. Uh, we could argue about the percentages, but that's roughly, that's generally what it is.

It really is a leadership and a people job, and you have to really take the temperature of the, of the room, what's going on within your team, what's going on within. Your peers, how do your peers feel about it? And clinical informatics, are we delivering, are we giving them the tools they need to be successful or is it a critical thing when the, the last CIO job I took over, the data center had gone down eight times in six weeks.

In that case, they're looking at you saying, put out the fire. So it's, you know, you really do have to take the temperature. But then there's some basic things that everybody should really take a look at. I agree that particularly the culture where I'm at it, healthcare IT in general is risk averse in my opinion.

And we're no different. We're 120 year old hospital system. We don't turn on a dime yet. The CEO and COO approach there and myself to make some things different because.

I'm sensitive to that, but, uh, I think the first 90 days will be interesting for us and for any new leader because you gotta feel out what's the, what, what do your constituents want, and what do your employees want because they may not be the same thing. And then how to start reconciling that. Do you, do you recommend doing a roadshow, going out, shaking hands, and getting to know the operational leaders first?

Or would you go more towards your own employees and your internal team, finding out the strengths and weaknesses? Where would you go? ? Yeah. The answer to that is yes. So I, I co in, in fairness, I coach CIOs and a lot of 'em are, are, are new to the role and it, it really depends. So one of the, one of the people who's been very vocal about the fact that I'm his coach is, is Lee Milligan.

And when Lee came in, he'd been at the organization for 15 years. There's no one in the organization that didn't know who he was. Or what he was about. So it wasn't a matter of him doing a road show, uh, but it was a matter of him having a different lens. You know, he was just given a new lens to which to look at the organization.

But again, there's a handful of things that every CIO or every leadership team, so in your case you have C-I-O-C-N-I-O-C-M-I-O really operating as a joint team going about it, and Baptist Health in Kentucky has a similar model of. CMIO, uh, and CIO and ciso, uh, chief Information Security Officer, who all act as peers and function together.

But either way, the first 90 days you have to look at a handful of things and, and those are finance, uh, around finance, people, operations, strategy and communication. And it doesn't matter if you're new to the organization or if you've been there forever, uh, you really have to take a look at those. A little bit at a time we can, and then, you know, just unpack them.

Alright, so let's go with, how about finance first, because I think failure to show financial stewardship can lead to a very short tenure, very short career. So. I believe there's a need to show return on investment. That yes, we can utilize these teams, achieve the clinical goals that they're expecting, but also help, you know, rest cycle reports to us now as well, and that's new.

Our rest cycle team's very strong. I don't need to rock the boat very much there, but reducing denial is something that the c.

Through health it that there is a component to rev cycle management that's very much health IT related. So focusing on that and improving that, I think has immediate value and show, hey, we're serious in in what we're doing in helping the organization, at least on the financial end. Where would you go? So, uh, it, I'm gonna talk about RevCycle under strategy, right?

Okay. So you, because you've, so you just laid out an objective, uh, around it, which means it's a project. And does the project take technology? Is it process related? Is it structure related? What is it? But finance is really about fuel you want, and I, so here's. Categorically true about every health IT organizations across the country.

And you hate to speak in these black and white terms, but it's absolutely true. Everyone outside of health IT who works for a healthcare organization thinks it gets too much money, period. Just everywhere I've gone, everyone I've talked to, it's the health it that we spend so much money over there, uh, and not sure we're getting our value for it.

So couple things I say to people, it is fuel. And you can crash a plane in in two ways. One is you can take on too much fuel over and over again and starve the other planes on the runway, in which case the other planes figure out a way to make sure you don't take off. So you want only the amount, the amount of money you need to deliver on the expectations and the objectives of the organization.

No more and no less, but you have to have enough because I've seen a lot of CIOs. Get let go after a period of time where their, their organization was underfunded for a number of years, so they weren't able to keep up on refresh cycles and, and they ended up with a lot of end of life equipment. They ended up with a lot of challenges, but they didn't know how to make the case for a, a strategic investment or even a tactical investment in, in making sure that their equipment stayed, uh, current.

Make sure their EHR stayed current, made sure that they were on the latest builds, make sure that they were doing all those things. And then the one thing you did touch on, which is really true, is in those first 90 days, I want to know, I wanna know everything about budgeting. What's the process? What's the cycle?

And how do we report out? And then I wanna know within our organization, what are the controls on spending? I wanna know everyone who has the ability to spend money. Because, you know, that's, you can easily get in trouble in that space if somebody spends money and, and essentially they report to you. But if they spend it in the wrong way, uh, that could reflect on you.

So you have to understand those, and, and most organizations have those in place, but sometimes there's gaps. Sure. What do you think about culture though? Where's culture change fit into this? Is that a strategy or is that its own bucket? Yeah, no people, culture, everybody wants to build a, an innovative culture, a culture of trust.

And what I found is. One of the, one of the foundations is everyone knows what's expected of them, and, and they know, and the organization gives them something in return for what's expected of them as long as they deliver on that. So in order to build that, you know, culture of trust and accountability, which by the way I think is harder across three people and across one, because what, what you're gonna wanna do is you're gonna want to create clarity.

Clarity for people in terms of their roles. One of the, uh, things that shocked me after two years of being in my position, I went out and did a survey and people, the number one thing we heard was people were unclear about what was expected of them and what their next role was in their career. That creates a, a murky area.

And so people struggle. If they don't know what's expected of them, they, it's hard for them to deliver on it. And if they don't know what's next, they don't know what to hope for. They don't know what the organization's giving them in return for their work. So that's one of the, that's one of the key areas.

I understand the job descriptions, the roles, and, uh, map those out for people and then get that integrated into the review process and then some other basic blocking and tackling. There's, uh, you have to listen and you have to create that rhythm of communication and the rhythm of listening. How often are you hearing from your staff?

Are you giving them multiple venues to talk to you some more personal than others? Some where they can. Somewhere more town hall ask, where you're really giving a state of the state of the, you know, situation. And others are, I, I've heard like breakfast with the CIO kind of thing, where people can just, smaller group, ask the kind of questions they want.

You have to give 'em all those kinds of, uh, ways to interact. But changing culture is, it's hard. It's not something you do overnight, it's something that is, has to be intentional. Identify that we, we wanted to create a meritocracy in, in our, uh, health system where I was the CIO. And so we wanted the best people to elevate to the top.

It was interesting 'cause as we learned, as we went, one of the people I promoted to VP didn't have a college degree that's set a whole bunch of people off. But what we were trying to create was a meritocracy, and we did do that. People realized that if you do a really good job. Regardless of your, your education status or whatever else people think gets in the next role.

What we communicated very clearly was what you deliver, what you are doing today matters. And if you deliver well on the things you're doing today, we're gonna give you more things to prove yourself and you're gonna be able to get there. You've gotta decide intentionally, what are you trying to create, and then reinforce that over and over again with communication.

And then with, with action. Sorry, I'm doing a lot of talking actually. You're good, you're good. So I was gonna ask you, we keep finding that there's a lot of pressure on the financial side for it, as you mentioned. So that tends to create very flat organizations. There's not a lot of vertical leaps that you can make in healthcare IT in our organization.

So I want people to look forward. I.

Slots that you can jump towards. Are you comfortable with training people that they're gonna be outstanding, but they may not be with you? I'm okay with that. I want them to be outstanding players and be happy in life, but I also, I'd love to retain them. Of course. What do you think? Yeah, no, absolutely. Uh, yeah, that was my promise to people is if you come back into work tomorrow, I will make, we will figure out a way as an organization to make you more valuable.

If you ever leave here. And so that's the commitment I can, can make. I can't commit to them that they'll always have a job. 'cause markets come and they go and technologies change and those kind of things. But we're gonna invest in them. And so we created a thing called it university and all the leaders, all the VPs and above had to teach a class.

We brought, uh, vendors together to teach classes. We did a lot of creative things in that area. To make sure we were passing along, like I taught a class on lead, um, John Maxwell's 21 Laws of Leadership. I know that dates me and I know I'm old, but there was a lot of good stuff to talk to about that. And our head of finance did a thing on creating budgets and then he came around and did a thing on healthcare finance and how, how healthcare systems make money and uh, different buckets of money and the person in charge of applications.

Went through a pro training class on governance and how to think about governance, think about all those things. All those things made people more valuable wherever they went. It didn't matter what the next role was.

What about, I wanna talk about communication for a second if we could, because I know that's a key pillar in the first 90 days. I think that we're communicating a lot to the end users. That's where I need to be communicating because I know our situation. There's, there were unhappy positions and that's what started to stimulate some of the, the change to happen here.

So there's a lot of communication needs to happen out to nursing and position leadership. Yeah. In terms of doing that, what do you think of, what's the best way that you've seen? Not the board that I'm worried about. It's other physicians that can make or break a career here. Yeah, it's a, it's the physicians with the pitchforks.

I've, yeah. I've been there. And when I took over the, yeah, our satisfaction rate with our EHR implementation was extremely low, which is a perfect time to take over. By the way. It's, it's hard if you're there after year two and year three, you're not doing your job. But the, so what we started with was a survey I wanted to get as much, we had a physician, uh.

Big physician get together coming up, and I wanted to fly around to every location and talk to everybody. We're talking 16 locations across, uh, you know, multiple states and whatnot. I didn't have enough time. We put together a survey. We went through the uh, CMO and he got it out to all the physicians, and we collected as much information as we possibly could, which formed the foundation for my presentation to the physicians.

And I was able to say, Hey, we hear this is, these are the questions we ask. This is what you're telling us. And the, the now famous quote, I think I've said on the podcast a couple time times, uh, from one of the physicians, we left a lot of like just blank spaces that they could write stuff in. That was the most telling things, not just check boxes.

Each financial. Package was, or each financial close was its own entity, and then they had to roll up and the system office would take the better part of 30 days to close each month. So the day they closed, they started the next month's close. And it was just an awful situation. But I, all I had to do was talk to one person.

I could have figured that out. That's not the point of it. The point of it was. To let people know that we are gonna create a culture that we wanna listen. We want your input. If we're doing bad, we want you to tell us we're doing bad because we wanna, we really wanna give you the things you need to be successful.

And that's a double-edged sword. It's great 'cause you create that ongoing dialogue, but then you have to deliver right on, on all those things. So I think it's important to know what you're gonna be about. And then create mechanisms to reinforce that. So the survey was one thing, by the way. I didn't do another survey for three years, and the reason I didn't do another survey for three years is 'cause we didn't really need to.

'cause out of that first survey we create, uh, I was able to identify who the champions were gonna be and who the physicians were. That really made a, that really had the influence within the organization. And I brought them together. We created a multi-year strategy, got that funded. And uh, then I ended up working real closely with them and they were the champions out in the field.

As we moved that forward. We're gonna do the class survey. We've done it once before. We're gonna do it again, at least that way. We have the benchmarks to go off of. The culture that I'm looking to create is more, I dunno if you've ever read the. Instead of, no, but that concept in it, it tends to be we're overwhelmed.

So the answer is no, and then it shuts down all the creative thought that happens after that, as opposed to Yes. And we do need to think about, we're gonna have to put these other projects on hold or whatever else we need to do to fund it. I wanna get to that kind of a culture in it. And we don't have that now.

I'm looking forward to it. I've seen it done in other businesses where they've moved to that. Yes. And culture. So you're always keeping the ideas going and sometimes it's Yes. And we can't get to it for three years. That's okay. It's yes. And so I love.

I'm hoping to, to instill into the, the people who are interacting with the end users. The, I want the analysts to be closer. I want them to be connected to the clinicians because I think that's also missing in healthcare. It sometimes we're a little, we're a little too far. We're in the cubicles. Too much.

Get out of the cubicle, get to the front line. Yes, there's covid going on. Put your mask on and go out there. And follow a nurse around. Follow a doctor around, see what they're experiencing, see what the bill that you did. Is it really working the way you thought it would, or they're using it the way you thought they would use it.

And so I think we do need to bring, that's a culture change for it. Also, to bring them closer to the clinical world where they most of came from and they wanna be back there. It's just they've been turned into ticket cleaning monsters. And we need to get away from that. We're ticket takers and ticket closers to, we are clinical it.

We're at your elbow building the tools that.

That's where I think we go. Couldn't agree more, but I, I will say this, it's your job to create the systems that allow people to do the things that you're asking them to do. And so my example for that is the first 30 days or so, I met with a lot of people from internal it, and I was looking for those no answers.

Those were keys. So when I'd say things like. Hey, is there any way we can bring on more? We, we had a large clinically integrated, uh, network and I'm like, can we bring these on faster? I'm hearing from the business that we're not bringing these on fast enough, and they would say, no, there's no absolutely no way to do it.

We only have, you know, this much bandwidth. It takes this long to bring people on, and those kind of things. And I'd say, okay, no, and I'd circle those things because they always gave me the things I needed to work on. When they said, no, you can't do it. Was an indication. And what that was an indication of was that our, our integration and data sharing practices were so antiquated, by the way, they weren't wrong.

We couldn't, I saw this spreadsheet, we had 110 clinicians waiting to get connected and it, it, it was gonna take us better part of three years to con connect up those clinicians. And that's without adding any to it. And based on just sheer numbers and facts, they were absolutely right. So we sat back and said, all right, this, you said, no, we can't do it this way, so let's explore a different way.

And so we created a different way to do it, which we could onboard almost 10, 10 or so a month. And so now we're starting to crank. We could crank through those pretty quickly. And we've also figured out a way to accelerate the backlog. So we were able to get through most of those. Once we got the new platform and the new stuff set up, we were able to get through that backlog almost within about six months.

And, but those, no, there's no answers upfront. Those are gold for you? No, we can't do it because, because we don't have enough servers, we don't have enough storage. I don't have enough time in my day. The, those, those, the physicians don't want us around during this time. They only want us around during that time.

Those nos are great 'cause they give you the the clues you're gonna need later to solve the problem. That's good. That's good, good stuff to hear. We, I hear plenty of nos. So there's no , no shortage of work that we'll be able to accumulate by that method. So, let's see. We've covered finance, we've covered people.

We, uh, talked on communications. You know what, lemme go back to that one thing. 'cause here's the other thing, and, and this is me giving. Health it, a little bit of medicine here and is to say, our problem is we consider it a good day if nothing went down. And we sort of, we got our work done and nothing went down.

And the reality is every day that nothing went down and you got all your work done, you fell one day behind. Because at the end of the day, the whole world is changing, but you're standing still. If that's your goal, then you're standing still. And so when we talk about on on this week in health it, when we talk about cloud and we talk about platforms and we talk about integration strategies and APIs, people are like, oh, that's crazy.

That's Epic's job. We don't have to really worry about that. And I'm like, yeah, that's exactly how you can think, but you're just falling behind every day. You don't look into those strategies and whatnot when it comes time to move a lot faster. You're not gonna have put the infrastructure in place so you can move faster.

So when you say no, a year from now or two years from now, it's because you didn't do your job. Two.

So that gets to strategy. That's very forward thinking. We're looking at strategy in terms of, the organization has its three year plan. We don't have a three year it strategic plan. I suspect we should have one. Would you agree with that? Uh, softball, by the way, here's really, it's interesting back in the day, I would say that is absolutely the case.

But if you're a really forward-leaning health system, the system strategy and the IT plans have gotten so integrated that you don't need an IT plan in and of itself. 'cause one of the challenges we used to have is we had an IT or we had a health system plan and we had an IT plan and we had to integrate 'em.

So we had to make those alignments and, and do all that stuff. Really forward thinking health systems. Right now, when their chief strategy officer. Or COO or whoever's leading the initiative gets going. They understand that almost every initiative they're doing has an IT component, and that almost sets your IT strategy for the year, if not three years.

I agree with you that the system strategy has to drive the IT strategy, but I think many of us are coming from the point of, Hey, we, we don't have a cloud strategy. We don't have a work from home strategy. We don't have a digital front door strategy.

And perhaps those systems that are cutting edge and they're already, they've already got those table stakes in, they're probably more advanced and they don't have to worry about those things. I think there's a plenty of us out there who still have a lot of table stakes to build on. Hey, hey Mark. A majority, actually I was, I just had a conversation over the weekend with the CIO and we were talking about, we were talking about a platform strategy, and he was saying, he goes, I've never thought about this before.

Why do I have to think about a platform strategy? I'm like, you don't. You don't, you're in a market where you have 60 si, 65 to 70% market share, and there's no Walmarts coming in or CVSs coming in. There's, you have that market share and you have it tied up for the next five years. You don't, you don't have to think about it, but that's, a majority of health systems don't have those kinds of integrated strategies at this point.

So you, you are absolutely right. When I went in, I set a five year IT strategy and it. I'm huge in making, in communicating. Right. So communicating in a way that they understand. So it was, the mantra was a data-driven strategy Back in 2 20 11, this was new talking data-driven strategy. And our, our mantra was, free the data, share the data, apply the data.

And I gave it to those things so people could remember it. And they still remember to this day, they, they crack me up 'cause they'll see me and they go, Hey, free the data. Share the data, apply the data. I'm like, yeah. So that was our analytics and. App store strategy, that's where we were going. And the other side was we had two pillars.

One was data-driven strategy, and the second was move to the cloud. And everyone knew the reason we were moving to the cloud was not to get to the cloud. 'cause it was the big thing. We were moving to the cloud for one thing, agility. We knew there was gonna come a time where we needed to move really fast.

And the cloud offers you agility and people are like, are you doing it to save money? No. Are you doing it for new capabilities? No. We're doing it for agility. We wanna be able to move fast. And we know that this fixed data center with the diesel generator outside that we had to fire every week or every month to test and do all this other stuff, did not give us the business agility we needed to move into the future.

And to be honest with you, I wasn't sure how the system was gonna respond. We said, here are the two pillars and here's what it's gonna cost. And it was a lot of money. And they looked at us and said, absolutely. And they funded it a hundred percent. I think everyone who's moving into health it and taking over a team is gonna be told part of the same thing, which is we want more agility out of it and we want the, and we wanna reduce head count and we want the do more with less, and we want engagement to be higher.

What else do they throw in there?

We do need as leaders to figure out how are we going to get there and that strategic. Is when presented properly. I think to the other leaders in the organization, they'll nod their heads and say, yes, we want you to be more agile. We see how you're gonna get there. Take us there. That's a good vision. We wanna be with you when you go there.

So that's part of what I think we need to do as IT leaders is to, as you said, break it down into simple terms. But they're probably not gonna understand the Amazon Webservices versus.

They wanna understand what do they get when they go to the cloud? What is so magical about it? And that's where I think we have our responsibility to share that a manageable way. Understandable way. Yeah. I, I remember my data center operator coming to me and saying, we need, uh, $12 million for our data center.

We need new crack units, we need new C use, I forget what they were, forget what the acronym was. But essentially it was power distribution, PDUs, power distribution units. Stuff like that. And I'm like, alright, I'm not asking for that stuff. And he just looked at me like, we need it. The data center needs it.

I'm like, yeah. I'm not asking for it. I'm not going into a healthcare CEO with a bunch of doctors sitting around the room saying, Hey, we need some crack units and pdu. He's gonna think that we're like throwing a, a party and we're gonna get high or something. . We, I'm like, I'm just not doing it. I, and that, and then I asked him the question, which I think, you know, made him shudder, which was, do we really need any data centers?

And he just looked at me like I was insane. And I'm like. No, it's a valid question. We need to ask that question. Do we need any data centers? And he said, I, I don't even understand. Like the concept didn't even dawn on him. I'm like, look, let's draw a circle around this building within 10 miles. How many data centers do you think there are within 10 miles of this building?

He goes, that we can use. I'm like, yeah, that we can use because I don't think there's that many. I'm like, I guarantee you there's at least 10. Nah, there's no way. And, and, and we never actually did, I never actually found the numbers, but we did find, like in southern California at at least, there's at least a dozen, and you wouldn't think Southern California, that there would be a lot of data centers.

Since it's earthquake zone, there's a ton of data centers we could use. And so the question remained. Why am I going and asking for 12 to $14 million for PDU crack units and stuff like that when I could just go down the street. And by the way, I'm not even talking cloud at this point. I'm just talking, get out of the data center business, move my stuff into somebody else's building and let them run the generator test, let them run the pdu, let them do the crack units, but if they don't live up to their thing, we'll move our stuff to a different data center.

Absolutely. How we doing on time? We got time for one more topic. Yeah. And if I'm frustrating you at all, if I'm too high level, feel free to dig in. I, you know. Perfect. This is perfect. I do wanna talk about managing up because every new leader who gets into their role is gonna wanna know, all right, what's my first 90 days with my new boss?

What should I be?

When we stepped into this role, theres, and I, we sat down with the CEO and COO, and they laid out very clearly, this is what we wanna see. Made it very easy for us. They're very explicit with that. I'm not sure everyone who steps into a new role gets that clarity. Sometimes they're just like, go, go fix it.

Be kind of general like that. So sometimes you get that thrown at you. What questions? How do.

At what's important to them for what they wanna see from you? Yeah. I'll tell you one of the interesting things with the, the CIO job I took in Southern California was, uh, a lot of the big name CIOs didn't want the job because it did not report into the CEO. It reported into the, I think the COO at that time, which changed.

It was eventually the president, but I never reported into the CEO uh, directly. I knew that relationship was key and critical. And so what I asked of her was that we would get together on a monthly basis and that we would make sure that that calendar invite never came off for whatever reason. And what's interesting is what started out as a, I really need clarity from you.

I need to ask you a couple questions. And also I needed to figure out how to navigate going past my boss to, to his boss, and meeting with her directly. And so I just made that part of the, Hey, this is just what we're gonna do. It started off as a, Hey, help me to understand some things. And she did that really the whole time I was there.

But the other thing it ended up being was, uh, I started sharing articles with her every time I went to see her. I had an article with me that explained cloud computing, that explained APIs, that explained platforms that explained, because you know what she knew. She knew as the, even back then, she knew as the leader of a healthcare organization that she was gonna have to be able to speak technology.

She had to understand it, how it was gonna be applied, and how it was gonna, uh, and, and we're seeing a lot of CEOs start to make that leap, and that's part of my job. I saw that as part of my job was educating her. If you're in a role right now where you don't know what your expectations are or if you're delivering on those expectations.

I, it doesn't matter what job you're in right now, I would give the same advice if you were my kid. I'd give the same advice, which is go get clarity. You cannot succeed without clarity. You just can't do it. Uh, you can't even do that in your marriage, for heaven's sake. Go talk to your wife. What does she expect?

Serious? How do you, at least in baseball, when you go to the plate, what's expected of Get on base, put the ball in play. Don't strike out. There's a clear set of rules in. Athletics that sort of define this is what you're supposed to do. But we get into the, the business world and we'll operate for the better part of a year or so, not really knowing what our expectations are or we we're, we think the expectation is make sure the data center doesn't go down, but the expectation really is to make the EHR more usable and to engage the community in, in health, and to help our ACO partners.

We're like, oh gosh, I didn't know that was something that was expected of me. The CIOI thought that was a, a clinical thing. Just ask get, get somebody who's gonna tell you what's the, and by the way, the expectations don't just come from your leader. There's the expectations of the physician community and the clinician community, the nurses as well.

That was critical because I knew every time the CEO went out on a visit to a hospital. She was gonna hear, oh, this EHR is hard to use and we don't have access to the reporting that we need. We can't. So if I'm not listening to each one of my hospitals and what their specific needs are, and I'm not coaching my team to be out there and listening, and they're not in the huddles identifying those challenges, and I haven't empowered them with the tools and the ability to make decisions that they can actually address those problems.

Every time that CEO goes out there, she's gonna hear the same stuff over and over again, and she's gonna go, you're not doing your job. And she would be right. It's the, it sometimes the unwritten expectations that are out there that it's just a matter of having a high degree of emotional intelligence to understand not only what they're telling you.

Yes, you may be in charge of keeping the data center on and the lights on and the phones working, but people are expecting more from it. They're expecting us to be the strategic partner for that operational leader and to deliver with them, Hey, here's some new ideas and thoughts and different tools that you could take advantage of that they're not looking at because they may not even know such things exist.

They want us to be that partner, doesn't mean we're telling 'em how to do their business. We're, you know, we'll help for you. And I think that's a component that's not in any job description. It's not gonna be someone you, but everyone wants you to be a strategic partner. And we're also dream killers when we say no on a consistent basis, we're dream killers because not only do they think oh, they can't do things, but they're, they're also, when they come up, , when we established a platform within the health system and we had analytics and app capabilities, doctors were coming to me all the time saying, I've got this idea.

I think we could do this, and we could do this with the perioperative admissions process, and we could do this over here. We could do this over here. I, to be honest with you, I couldn't keep up the, the physicians were so creative. They were just constantly coming up with, Hey, I could fill this gap with the EHR and I could fill this gap in, in our PACS communication process with our patients.

And I'm like, to a certain extent, I, I created my own monster in that, Hey, we wanna listen and hey, we want to enable you and those kind of things. But it's again, that's, we want that problem. Like we have too many things coming at us rather than we have nothing coming at us. We've killed the dreams of so many people.

'cause they're like, look, it can barely keep the systems on. I, I'm not gonna ask them if we can, uh, integrate via fire, uh, through an app so that I can create a better, uh, patient experience for our, our peds patients with with cancer. Which is, which is . Think about the different engagement levels though that you just described with your providers pinging you saying, I wanna do more, we want more capability, as opposed to the disengaged providers, which are simply, they're torpedoing, you don't know it.

But when the CEO goes on rounds and get ashed, you would much rather have say, I.

The, the no people . So Mark, you know this, know this better than I than anybody, and I'm painting this picture and I don't wanna paint a perfect picture here. 'cause I had my share of physicians who wanted to string me up. You're focusing on the future too much and we need better stuff. Our EHR was not a hundred percent.

Our EHR probably got AB grade every year from the physicians and from some of 'em it got an F every year. This is the worst thing I've ever had to deal with. I wish I was with another health system. How do you deal with them? How do you deal with the people that are gonna give you an f regard? You could give 'em the best EHR, your class rating could be through the roof.

And then there's just that physician that's sitting over here going, yeah, I don't like you people. You don't know what you're doing. Uh, we had this physician constantly gave us an f We actually put a, a, a physician champion at his elbow for two days and he's, he's like helping him to customize it. He customized the whole thing.

Because he had never customized it. He had never built it out. Even though we offered him training, he didn't go to the training even. What do you do in those cases? Yeah, so most of the time they're right that if they're struggling, something is intuitive. We didn't build something the way that they wanted it to be, and sometimes they're just being, yeah, they like their paper charts and that's gonna be a hard person to satisfy, but I found that I can engage with them.

I can sit down and usually put them in charge of making that part better, and they get to lead the analysts and they get to develop it. It's hard to complain about something that you develop yourself, so that's a little bit of co-optation. But sure, letting them own some of that and that experience if they're willing to engage, if they're so far disengaged,

sog. They disengage from their, their practice, their family, their whatever else is going on. So we put our psychology degrees on and, and we get tried to get in there and this is where being that home for dinner program that I had helped create in my previous organization, we got really personal with some of the providers who are very unhappy and they're expressing their frustration.

That's the, the tool that's easy to point to. It's in front of you every day. It's where you throw your frustrations at. There's a lot that you can get at that's underneath and it sometimes takes another clinician, whether it's another nurse with a nurse, doctor, with a doctor or whatever it is, that people will open up to people who they feel, recognize and understand the pain they're going through.

So that's how we tackle that is one-on-one very up close and very personal. I'm gonna ask for the last word here because we're coming up on our time and the one thing I, I tell all my coaching clients, and I would say to you, this is an exciting time when you typically get promoted because you were successful in your last role, but in your last role, you might have had a team of.

10 people, 15 people, five people. It depends on, on the organization and where you're coming from. Now you have 200. That becomes an extension. What, what the expectation is, and the opportunity is that what you were able to do as a single person in a team of 10 people, that you'll now be able to do across 200.

And so it's how do you lead through them as opposed to the individual contributor? How do you lead through them? So you have people. How do I make this, how do I make Peninsula one of the best EHR implementations in the country, one of the best it shops in the country. Uh, a place where we innovate, where we work together to really, you know, all those things that are in your head.

You have to figure out how to empower your team so that you, they, they know that they can make a difference on a daily basis. 'cause if you have 200 people making a difference, that's 200 times what you could have done by yourself. That's good stuff. Bill, I wanna thank you for doing the show with me. I think it's gonna have value for a lot of people out there who will be taking over roles either to, you know, in tomorrow or soon in the future.

And this will give us some good foundation, whether that's A-C-M-I-O-A-C-I-O-A-C-N-I-O. This applies to all. So, uh, great show and thank you. Uh, big fan show. I listen. Absolutely. I'm gonna go hit golf balls right now and put your show on so I can listen to your last episode, . That's, that's what I do. I put the headset on.

I listen to some of these podcasts and I go hit balls. That man. See you, bill. Thanks. That's all for this week. Don't forget to sign up for clip notes. Send an email to CliffNotes at this week in health it.com. Special thanks to our sponsors, our channel sponsors VMware, Starbridge Advisors, Galen Healthcare Health lyrics, serious Healthcare Pro talent advisors, and HealthNEXT for choosing to invest in developing the next generation of health leaders.

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