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HIT Leader 3.0 Cornerstone: Setting Vision and Strategy in
Dynamic Times
Russ Branzell, CHCIO, FCHIME CEO/President
American College of Healthcare Executives
Top Issues Confronting Hospitals: 2013
Issue 2013 2012 2011
Financial challenges 2.4 2.5 2.5
Patient safety and quality2 4.9 4.4 4.6
Healthcare reform implementation1 4.3 4.7 4.7
Governmental mandates 4.9 5.0 4.6
Care for the uninsured 5.6 5.6 5.2
Patient satisfaction 5.9 5.6 5.6
Physician-hospital relations 6.0 5.8 5.3
Technology 7.9 7.6 7.2
Population Health Mgt 7.6 7.9
Personnel shortages 8.0 8.0 7.4
Creating ACO 8.6 8.6 8.4
How to Be a CEO for the Information Age Michael Earl and David Feeny
Sloan Management Review, Winter 2000, Volume 41 Number 2
“The implications for existing and aspiring CEOs are equally clear.
Information technology is now a survival issue…more and more frequently IT issues are now wrapped inside wider
questions of business strategy.”
The Black Hole of IT Value
“While [the system] has helped [us] boost patient safety and medication administration processes, [we have] put quality of care and improving safety ahead of ROI and time savings.”
- VP of Quality and Care Management
“I estimate that about half of our IT investment generates value . . . I just can’t figure out which half.”
- Healthcare CEO
“Some healthcare CEOs refer to IT as that black hole you pour money into… never seeing results.”
- Healthcare CEO
The Healthcare CIO: From Crawling to Walking Upright, to Carrying the Organization
Knowledge
Purveyor
Technology
Interpreter
Process Visionary
Process
Consultant
Financial Analyst
Change Agent
Educator
Lobbyist
Service Broker
Project Advisor
Venture Capitalist
Customer Service
Innovator
Economist
Risk Manager
Political
Visionary
Application
Purveyor
Vendor Manager
Project Manager
Asset Manager
Problem Manager
Skill Manager
Process Navigator
An Advisor role
A Driver role
Tech Manager
A Supportive role
CIO 1.0 CIO 2.0 CIO 1.5
An Enabler role
IT Operations
+ +
Building Blocks of HIT 2.0
• Healthcare Information Exchange
• Certified Electronic Health Record
• Patient Portals
• Data Warehouse
• Business Intelligence
• Complete Data Integration
• Data Analytics
• World-class IT Team
• Unified Communications
• ACO System
• Population Health System
• Document Management
Business Value in Healthcare
Healthcare Value ˭ Dollars
Spent
Patient Outcomes &
Revenue Enhancement
Adapted from Value Measurement for Healthcare, Harvard Business School Executive Education
˭ IT/Informatics
Value
Future IT Trends • Security
• Cloud
• Telemedicine
• Predictive Modeling
• Patient Empowerment
• Big Data
• Consumerism
• Consolidation
• mHealth
• BYOD/T
versus
Evolution: gradual development of
something, especially
from a single to a more
complex form.
Revolution: fundamental change
in a way of thinking
about or visualizing
something.
EVOLUTION REVOLUTION vs
.
Care Improvement Process
Status Quo – Fee for Service
Wellness Care
Quality Care
Managed Care
Value Care
“The job of the leader isn’t
just to make decisions, it’s
to make sense.”
The Big MOO, The Group of 33, Edited by Seth Godin. Quote by John Seely Brown
What we are talking about
• Values: the identity of the organization
• Mission: the reason for being
• Vision: a mental picture of what you want to accomplish or achieve.
• Strategy: how to get there
How do they work together? Values Mission Vision Strategy
• Determines distinctiveness
• Prescribes participation
• Expresses essentials • Affects action • Inspires investment • Leverages leadership • Supplies success
• Dictates direction • Formulates function • Focuses future • Directs decisions • Causes congruence • Enhances
effectiveness • Ensures endurance • Facilitates feedback
• Endows energy • Creates cause • Fosters failure
(positive) • Legitimizes
leadership • Sustains structure • Commands
commitment
• Accomplishes mission and vision
• Improves insight • Maximizes
momentum • Retains resources • Accentuates
achievements
Adapted from “Advanced Strategic Planning” by Malphurs
Determines Mission and Vision
“ The people in the high-
performance IT organization
don’t feel different from other
corporate citizens…They
operate according to the same
corporate values as everyone
else and are measured by the
same tough performance
standards.”
“Getting IT Right” by Charlie S. Feld and Donna B. Stoddard
Harvard Business Review, February 2004
“Making IT work demands the same things that other parts of the business
do - inspired leadership, superb execution, motivated people, and the thoughtful attention and high
expectations of senior management.”
“Getting IT Right” by Charlie S. Feld and Donna B. Stoddard Harvard Business Review, February 2004
Be a Strategic IT Leader • Understand the business
• Build bridges with clinicians
• Anchor your thinking in process improvement and measurement
• Use simple and straight forward communication
• Establish trust by achieving results
• Look for direction and new approaches
• Contribute ideas and options
Engage Your Senior Team
• Explain and educate on the value of IT; encourage CEO’s visible commitment
• Build relationships with key IT vendors and suppliers
• Partner with the CMO, CMIO and CNO to build a strong clinical informatics function
• Work with the CFO to build effective financial processes and systems
Create a Framework for Strategic Alignment
• Establish an IT executive strategic planning group (IT governance)
• Guide the executive team to set priorities, standards and guidelines
• Contribute to decision-making methods and criteria
• Include regulatory, security and infrastructure requirements
Approaches to Strategy
Strategy creation follows a three-stage process:
1. Analyze the context in which you're operating
2. Identify strategic options
3. Evaluate and select the best options
Approaches to Strategy Stage 1: Analyze Your Context and Environment
• Analyze Your Organization
– Resources, liabilities, capabilities, strengths, and weaknesses. (SWOT Analysis).
– Core Competencies. Unique strengths--differentiators—gaps
• Analyze Your Environment
– Opportunities you should pursue?
– Future scenarios that are likely in healthcare
– How will these impact the work that you do?
• Analyze Your Customers and Stakeholders
• Analyze Your Competitors
Approaches to Strategy Stage 2: Identify Strategic Options
• To create a clear advantage and meet your objectives.
1. Brainstorm Options
2. Examine Opportunities and Threats
3. Solve Problems and Fill Gaps
Approaches to Strategy Stage 3: Evaluate and Select Strategic
Options
• Evaluate each option in the light of the contextual factors you identified in Stage 1. What do these tell you about each option?
• Techniques like Risk Analysis and Impact Analysis to spot the possible positive and negative consequences of each option.
• Financial techniques like Cost-Benefit Analysis, Break-Even Analysis, use of Net Present Values (NPVs) and Internal Rates of Return (IRRs), and Decision Trees are helpful.
• Grid Analysis is particularly helpful for bringing together financial and non-financial decision criteria
Develop the IT Strategic Plan • Start with executive sponsorship
• Match technology options to your organization’s strategies, initiatives and timelines
• Identify key initiatives and due dates
• Develop the high level financial requirements – capital and operating
• Include strategic commitment for infrastructure and life cycle investments
• Include staffing requirements
Cultivate Sponsorship
• Seed formal Executive Sponsor for all IT enabled strategies
• Use IT as an accelerator of strategy
• Build clinician driven structures to design and validate applications and to prioritize demand for optimization and continuous enhancement of systems
Create a Multi-Year Roadmap
• Identify the key IT initiatives
• Identify project schedules and duration
• Include interdependencies
• Use as a basis for developing the business case and Total Cost of Ownership models for projects
The Big Shift in IT Leadership Strategy -- 7 Action Steps for CIOs
• Architect the digital blueprint
• Become an information steward
• Get the basics right
• Eliminate cyber threats
• Collaborate around the clock
• Strengthen relationships across the C-suite
• Look above the operational parapet Linda Ban, "Moving from the Back Office to the Front Lines"
Aligned Top Five or So
• Thoroughly Understand System Plan
• Determine Enterprise Architecture Requirements
• Build IT Plan to Enable System Plan Success
• Ensure Direct Correlations Between Plans
• External Reviews with Partners & Advisors
• Bounce Concepts & Plan with Steering Cmte
Strategic Advantage Comes via Differentiated Capabilities, not Position
If we don’t develop differentiated capabilities, the competition will eventually catch up and pass us
Start Finish Position
Capability
2 mile / hr.
8 mile / hr.
Differentiated Capability
18 mile / hr.
Radical • Initiate New Business
• New Executive Orientation
• Embed in Governance and PMO Processes
• Engage Rank and File
• Allow Margin for Innovation
• Review & Adjust Quarterly
• Plans Should Reflect Simplicity and Beauty
• Signatures
• Execution > Pontification
Care Improvement Process
Status Quo – Fee for Service
Wellness Care
Quality Care
Managed Care
Value Care
1. Don’t accept the status quo
2. Semper Gumby: “Always Flexible”
3. Plagiarism is skill, not a crime
4. Don’t evolve, REVOLVE!!!!
5. Make somebody mad today!!!!
Rules of the Revolutionary CIO