CIOs grapple with growing workload

How to achieve balance amid pressure to do more with less
By Bernie Monegain
07:52 AM
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Balancing rocks

The ever-expanding workload and mounting expectations of the healthcare CIO have many dimensions. The most obvious are volume and complexity.

In what has been dubbed a "post-EHR era," the demands from CIOs have not abated, but rather become more numerous and more varied.

Now that many EHR systems have deployed, there is the even more difficult work to be done.

"I believe we are in a post-EHR world right now," Glenn Tobin from The Advisory Board Company said. "That doesn't mean EHRs are not important. But that does mean that the original promise for which EHRs were rightly pushed out – we're beyond that. Now we're trying to find the next layer of information systems that's going to tie it all together."

It's the 'tying it all together' that will add to the growing and increasingly intricate work of the CIO.

Deriving insights from all the data being generated, health information exchange, creating and improving accountable care organizations, getting arms around population health, building data warehouses and squeezing time out of existing processes are just a sampling of the projects on the CIO agenda. Lest we forget, there's also interoperability.

A critical piece of CHIME CEO Russell Branzell's job is to meet and talk with CIOs across the country to hear what's on their minds, gauge how things are going. Having been a CIO himself, he is attuned to their concerns.

"It's not getting any better; I think it can't get any worse," he said. "There's only so much that can be done in any given day."

It sounds exhausting.

"You know it is. I think it's starting to become the norm for society as a whole. Everybody just runs at a fever pitch all the time, whether it's in their personal lives or their professional lives. Because the norm is there's really not a slow period anymore in anyone's lives. I think that's very true for the healthcare professionals, and particularly the health IT professionals out there."

In New York, at Memorial Sloan Kettering Cancer Center, CIO Pat Skarulis is working out the knots of state regulations regarding narcotics, adding content to the data warehouse and developing systems to save time, just to name a few projects under way.

MSK has more than 3,000 servers.

"We do our own work, Skarulis said, noting that the build crew uses reporting tools to standardize the construction of the servers.

"If you went back four years ago," she said, "if the programmer wanted a server built, it might take two months, if you were lucky. Every year, we keep improving the process. We now have it down to 11 days. And for virtualized service, we can deliver it in four days."

"It's amazing. We can standardize our own work, and we actually can take steps out of process or automate as many things as possible."

Skarulis also has the MSK data warehouse top of mind these days.

The warehouse contains clinical notes as well other unstructured data, such as the pathology radiology and operative reports. It also holds structured data.

"We're working at beginning to understand what's involved in genomics and other data, the other omics, that are part of that," Skarulis said. "Could be proteomics. We're not there on proteomics. It might be the next phase."

MSK is in the process of moving from having one discovery recovery site that could be used in the event of a disaster – "its warm, the data's there," Skarulis said – to building a second center.

"We will have two centers removed from each other, either of which could fail to the other one," she said.

Charles Christian, CIO at St. Francis Hospital in Columbus, Ga., expects no workload relief anytime soon.

"No, I don't think so," he said, "because healthcare is changing at a blinding pace. The industry has come around to – for a variety of reasons – that IT is a business enabler."

Christian said he is being called to almost every operational meeting in his organization, not always to discuss technology.

"Sometimes, it's just a process discussion," he said. "There's no technological component to it."

However, Christian who, after 24 years, moved from Good Samaritan Hospital in Vincennes, Ind., to Atlanta for a new challenge and to be closer to his Southern roots, understands and appreciates that his colleagues are tapping into his operational experience.

Where some of the increased demand on his time comes from is that clinical and business staffs both are seeing the value of data.

"We're starting to see how useful the data actually is that is a product of all the systems that we put in," he said. "We are now starting to use the technology to create operational excellence, whereas before we were just putting in applications."

There is a demand for creating the enterprise view of the information rather than the very walled off, or segregated view of the data, he explained. "I think that taking that system view of the technology is creating a whole other level of stress on my time."

Christian's Dad, was journeyman, sheet-metal guy and welder, who worked for Goodyear for 43 years. When Christian – and also his brother – graduated from high school, each approached their Dad to help them get a job at the Goodyear plant.

His Dad refused.

"My Dad looked at me, and he said, 'no.' I raised you to use your mind not your back. If you want to screw up your life and work in industry, you do it yourself. And, so I went to college; so did my brother. But, I always wonder, who was the smarter of the two – me or my Dad? When my Dad was not at work, he was not at work. His job and his tools were in that plant. For me, when I'm not at work, I'm still at work. I'm at work or I'm lying in bed at night trying to go to sleep because I'm thinking about the next day, what's going on, trying to solve a problem that seems almost unsolvable. Or I'm on the phone or on email." he said.

"We can leverage every moment of free time with technology."

Ed Marx, CIO at Texas Health Resources has a litany of projects that would not have been on his radar just 10 years ago. Today, they add not just another piece to the workload, but also, because each is a piece of an intricate machine that all has to work together, they demand careful consideration and time.

"Everything is becoming digitized," he said.

As example, he offers smart pumps.

"It was a separate thing that never touched IT," he said. "Now they're digitized; they're part of the electronic health record. So, everything is becoming digitized, whether it's by consumer demand, or just technology growth or evolution."

Also new business models have come on the scene: accountable care organizations, population health, fee-for-performance.

"All of these things require use of technology," Marx pointed out.

He alluded to a post-EHR era.

"The hard part is now, and it's all about optimization, he said. "So, we put in these systems, how do we optimize our investment, how do we make sure every thing is integrated. So, that requires additional effort. So that's part of how workload has increased."

Sue Schade, CIO at the University of Michigan Hospitals and Health Centers at University of Michigan Health System, has seen her workload expand year over year.

"No question that it's increased, and I think that's true throughout healthcare," she said. "It's fairly endless the number of initiatives – parallel initiatives that are happening; the number of meetings that we are in, the volume of email to try to manage," she said. "There's more and more all the time, and you hear people say, it's just endless."

Schade, who was CIO at Brigham and Women's Hospital in Boston before moving to Michigan four years ago, has been named the 2014 CIO of the year by CHIME and HIMSS.

Shade talks with other CIOs, who have also observed the ever-increasing workload.

"One of the themes is the number of meetings," Schade said, "the number of initiatives, priorities." "Organizations aren't great at saying these are the top 10. They're all No. 1."

Just the sheer volume of work is among the concerns she's heard.

"In some respects, the tools just increase that because we are constantly on with email and mobile technology. You know, everyone kind of has to manage themselves. So, I don't know how that's going to change."

What smart, seasoned CIOs know

While the CIO leaders we interviewed acknowledged and elaborated on the growing demands of the job, they are all problem solvers, and each has developed techniques for managing both the workload and the stress.

"You have to leave some white space in your week and perhaps in every day, where you aren't so totally booked that you can't stop and reflect, or you can't have that unscheduled meeting and just stop in at somebody's office or cubicle to talk with them about an idea," Skarulis said. "You have to learn how to work smarter; you have to learn how to acquire information in better ways."

Skarulis said she has also found the delete key for e-mail.

"You can't read everything," she said. "You have to be judicious."

Skarulis also surrounds herself with "buddies" in the industry, colleagues she can call anytime.

"We ask questions of each other. 'What are you doing about this?' You'll get responses back from everybody. Those kind of sources will save you enormous amounts of time."

When someone from the network calls, those are the call you have to answer right away, Skarulis said. "You keep the network alive by being a good network participant."

Branzell, who teaches life-work balance at CHIME's CIO Boot Camp twice a year, says he is seeing people who manage their schedules for their work and personal lives together.

"What we're starting to see is people who just manage their schedules for their whole life," he said. "So, the art of scheduling becomes for everything in your life – personal time, family time, recreation time and work time."

Branzell advocates this type of scheduling and he practices what he preaches.

"As much as our CIO Boot Camp is important for development of soft skills and leadership skills, one of the things that people get the most out of is a reminder that life must come before work. And, if it's the opposite, it will cost you your life," Branzell said.

Ed Marx, who also teaches at the boot camp, applied the concepts of strategic planning he learned from the business world and his professional role to his family life, with an annual strategic planning retreat.

"We go someplace nice, just to get away," he said. "We have mission and vision, and values that we talk about. We talk about our objectives for the year. We measure the past year. We talk about new objectives for the coming year"

"It just helps keep us centered and focused," he said, adding that it also helps with decisions such as, "Do I work 80 hours a week, or do I work much less – and focus on my children or dating my wife?"

Christian relies on an assistant to help him with scheduling, and he also employs technology to help him track projects. He's created a test tracking project management site that he uses with his team to communicate globally.

It's important to have a system that works for you, he said, and it is critical to schedule some downtime. "You can't be on the job all the time."

Texas Health Resources is very much focused on wellbeing and care for the individual, Marx said. So, Marx concentrates on his team and how he can help make it successful and make sure team members have the right tools.

"Obviously, if they're successful, they have the right tools and they're well taken care of as a whole person that certainly helps me," he said. "But more importantly it helps us achieve our organizational mission and vision.

Also, Marx tries to differentiate between those things strategic and those things distracting.

"We're all hit with a lot of great ideas, but some are distracting," he said. "So, I always make sure that whatever I focus on is really aligned with where our organization is headed. And that really eliminates a lot of things that I'd spend my time doing that don't necessarily add value."

Marx pointed out that everyone knows what happens to organizations, IT shops, or industries that don't have a plan. There are statistics that compare companies that have mission and vision to guide them with companies that do not.

"When you compare them, whether its for stock price, whether its overall performance, compared to those that don't have a plan, the ones who have a plan are much more successful," he said. "Why wouldn't you do that for something that is more important in life – and that's yourself and your family."

Schade tries to reinforce the principles of life-work balance for herself and her staff. "I'm not great at it," she admits.

However, she has taken several concrete steps toward greater balance. She reminds herself and encourages her staff to take their vacations.

"When you get back you can pick it up again, and you really need those breaks," she said.

She is working with her staff to apply "lean" concepts to meetings, to eliminate some meetings, or at least reduce the time spent in meetings, perhaps even to replace them with "huddles" to track the day-to-day issues, and use the time more effectively and in a more focused way.

Last year, Schade, a grandmother of three (one, a few days old, 5 months old, and 3 years old), launched "Operation Baby Blanket" and completed her goal of crocheting a blanket for each of her grandchildren.

"This is after not having done anything like that for 30 years," she said. "There would be a point every night when I would stop work, turn off email and I would turn to my work on the blanket because that was a priority for me. Yes, she completed all three blankets.

She detailed the experience in her blog, where she likens Project Baby Blanket to an IT initiative.

CIO guru extraordinaire

After a decade of teaching life-work balance twice a year at CHIME's CIO Boot Camp, Tim Zoph has handed the charge to Branzell, but he's pleased that he's had the opportunity to influence nearly a thousand young leaders over the years.

In his view, you can't be a good leader without it.

Zoph was CIO at Northwestern Memorial Hospital in Chicago for more than 20 years, managing an IT team of 300 people. Today he serves as Senior Vice President, Administration for Northwestern Memorial HealthCare, with management responsibility for the Facility Design and Construction team and Enterprise Project Management Office. He has a smaller team: 35 people, and he also works with a virtual team of architects and construction leaders.

For three years, Zoph had overlapping responsibilities for the two positions – IT as well as facility design and construction. He only recently has been able to focus solely on his new position, one that he appreciates.

"It was important to me to make a contribution, but also to step aside and let others lead," he said. "It gives me another dimension on which to act on a changing healthcare system."

Even 10 years ago, Zoph began to observe and experience the mounting demands being made of CIOs, and the accompanying stress.

The industry then  – and more so now,  "is significantly experiencing what I call really disruptive change," he said. "Technology now is really becoming even more important in order to take hold of that future. That's everything from consumer expectations to delivery model change to new methodologies. With that growing responsibility and demand on leadership, CIOs are continually more stressed with their roles," he said.

What Zoph also observed was reluctance on the part of young CIOs to think about taking on additional responsibility because the work-life balance, even in their current roles, had become challenging.

That observation is what led him to develop a work-life balance module for the CHIME Boot Camp.

As Zoph conceived it, the session "would be a way to give perspective and tools and confidence to young leaders who were worried that taking on more responsibility would further erode what they wanted out of their own lives."

In developing the class, Zoph came to grasp better than he ever had before that having a balanced life was a catalyst to authentic leadership.

"In order to be a person that you would want to work for, have people work for you, it's really important that you demonstrate that you have your life in order, have your priorities straight and that you recognize that it's important that you have to step away from work as your sole purpose in life and make it clear to others that that's important to you."

This is something that Zoph practices in his own life.

It was not innate.

"I had to discover it," he said, "and I wish I had discovered it earlier in life."

"It happens particularly early in the career that you have to throw 100 percent of who you are into your career in order to be the person that you want to be," he said. "Oftentimes you don't really realize it until there are other dimensions in your life that begin to erode away."

Because he found his own life-work balance later in his career, Zoph realized it was important to introduce it to leadership development at an earlier stage to give people tools they needed to make good decisions about balance.

He didn't want up-and-coming leaders to "all of a sudden wake up one morning and say, 'where'd my life go,' or 'I don't want this job anymore,' or 'I don't want to assume leadership,' or 'why is it that people who are working for me are not happy?'"

When CIOs or aspiring CIOs came to Zoph's boot camp, they were asked, "What would you do with an extra day of your life?"

"We wrote it down, and I would catalogue it, and get people to think about it right away," he said.

At the close of boot camp, Zoph wrote the class a letter, which was paralleling all these things that were important to them in their life. Then he summed up the lessons taught at boot camp. The goal was to get them to think about the experience as a way to refresh their skills, but also as a way to refresh what was important to them.

"We brought it full circle from beginning to end and really integrated this whole concept of life balance as a means or pathway to authentic leadership," he said.

The sessions closed with the question, "How are you going to recommit your career around what you've learned this week?"

"We found that people took a lot out of boot camp, there are a lot of leadership lessons," Zoph said. "Often, after this module and time to think about it, there was really a recommitment to step away and really understand what was important to them, and really seek life balance because, as you might expect, there was a lot of concern around the room about whether or not they really had their careers and the rest of life in order."

But, the workload doesn't go away

The load doesn't go away, Zoph acknowledged. "It's just how you approach the stress of it. Actually, it's really healthy to step away, and what happens if you fire on all cylinders you have greater capacity for all aspects of your life, including your work."

As Zoph sees it, productivity is more than a function of time. It's about clarity and focus and approach. "Unless you really get that," he said, "no amount of effort is going to solve that problem of work and stress. You are a better leader and more productive person if in fact you are altogether."

Zoph is a believer in transparency. He keeps just one calendar on which he keeps track of family and health and recreation commitments as well as work appointments, and he makes it available for all to see.

"I put them equally up there with and manage them with things that may be demands of my work, and I don't let the work side corrode what's important to me personally," he said.

"That sends a really strong message because I'm managing my whole life on a week-to week basis and not letting small erosions take it away. People can see it. If I let people know that I'm taking time away to go work out, or whatever it may be. That's just one example."

Zoph's advice: "Put your life on display and be comfortable with it. Let people know where those priorities begin and end. That's OK. People by and large respond to the values that are important to you."

For Zoph, as for others, this type of work is always a work in progress.

For him, his own work on balance has translated into a leadership style that he is proud of.

"I go public with things that are important to me outside of work," he said. "I'm respectful and encouraging of people to have a more complete journey and destination."

In his view balance will become even more critical in the years ahead.

"If you have those tools in place," he said, "it will give you the opportunity to ride out the stress, the change, the transition that are surely ahead."

Branzell does not see the demand on IT teams easing.

"I don't see the workload getting any smaller anytime soon. I think what it's going to force us to do, because I think the funding is going to at best remain flat – at worse shrink – it's going to force not only those leaders, but all organizations to prioritize really what they're going to work on – what's got the most value."

"If that is the outcome of all this, I think it will actually be a healthy exercise. Instead of doing everything OK, we need to prioritize everything really well."