CIO: No longer just 'the IT guy'

The healthcare CIO is emerging as a skilled strategist at the executive table, with more demands on the role than ever.
By Bernie Monegain
06:07 AM
Executives and doctors at conference table

In chess, the positional play is characterized by long-term maneuvering -- strategic moves. It's exactly what is being required of healthcare CIOs today. Over the past decade, the role has changed from technology manager to valued strategic player, one who helps drive transformational change and who is welcome at the executive table.

Expectations are high and getting higher for today's healthcare CIO, who continues to be deluged with "do-it-now" projects at a time when, more than ever before, she or he is expected to bring top executive skills, the long view and strategy to the table.

It's not enough to excel in the role. Executives at the top of many healthcare systems are looking for their "IT guy" to be a transformational leader.

At the same time, surveys show that CIOs are feeling underutilized – hamstrung when it comes to their strategic skills.

"What we see is what everyone knows," said Pamela Dixon, founder and managing partner of SSi-Search, a national executive search firm. "CIOs are now managing enormous budgets. They're leading deployments, which could be in excess of a billion dollars, and they're managing large teams with hundreds of reports."

As Russell Branzell, CEO of CHIME, sees it, "there has been a transformation that's occurred from the original tech manager – data processing manager – to the drivers of transformational change with the appropriate use of IT as the leverage point for that."

To offer a sense of the scale of some CIO jobs, consider that Bill Spooner, vice president and CIO at Sharp HealthCare had 450 people reporting to him, including three vice presidents and dozens of clinicians.

"I think the main changes have been from technologist to strategist and business leader," said Judy Kirby, president and CEO of national healthcare recruiting firm Kirby Partners. "We look back and it was all about the technology, which was seen more as a utility. It was sort of like your lights. It was either on, or it was off. That's not the case anymore. It's more complicated."

Today, Kirby said, healthcare IT touches every aspect of healthcare, while not so long ago it was far more focused on automating the financial piece. Today's CIO has to be well versed in both clinical and business needs.

[See also: CIOs gauge decade of health IT headway.]

Understanding the needs of the clinical side has been a career-long challenge for Spooner, who recently retired.

"What has probably tested me the most is being a non-clinical person when your whole mission is providing technology support for clinical practice," he said. "I almost never go through (the hospital) without recognizing how much I have to learn. It's just so important to be able to partner with the clinical side of the business to be able to really do the best work for them."

SSi-Search recently conducted a survey of 200 CIOs, interviewed 20 leading CIOs and, with CHIME, assembled a panel of CIOs to get feedback on the SSi-Search survey. The results are in a white paper titled "Why the CIO is Healthcare's Million Dollar Man." The "million dollar" alludes to the cost of projects CIOs manage – millions to billions of dollars. There's a lot at stake if things go wrong.

It appears that despite the expectation from top executives that the CIO will participate in strategy discussion and contribute to the vision, it's been hard for some organizations to shed the "IT guy" perception.

"If you look at the long-term frustration of CIOs, many of them have been frustrated that their strategic abilities haven't been leveraged as much as they feel it should have," said Dixon. "They feel that they've earned a seat at the executive table in terms of strategy setting, but they feel they aren't there. That's the greatest frustration that CIOs voiced during the course of the survey and the white paper."

"They have to be able to be part of the executive table," Kirby said, "and they have to be able to still get back in the weeds when need be."

James Turnbull, CIO at the University of Utah Health Care in Salt Lake City, is among the frustrated.

"Where it's frustrating for me," he told Healthcare IT News in a February 2013 interview after he was named the CHIME/HIMSS John E. Gall Jr. CIO of the Year, is "I've got a tremendous amount of operational experience. I've got a lot of strategic planning experience from some of the roles I've had over the years, but being CIO you're still considered the IT guy. I feel like a V-8 engine running like a little V-6. I have not been able to crack through this barrier of being seen as the IT guy despite a wealth of experience and knowledge in these other fields. It's more of a personal frustration. I have a feeling of frustration of not being able to use all of my capabilities."

"I feel like a V-8 engine running like a little V-6."
James Turnbull

Turnbull came to UUHC about six years ago. Before that, he served as senior vice president and CIO at the Children's Hospital in Denver from 2000 to 2007, and senior vice president and CIO at Sarasota Memorial Hospital in Florida from 1993 to 2000. His career spans 37 years, and it includes work as chief operating officer of a five-hospital system in Canada.

He has a bachelor's degree in organizational psychology, an MBA and a doctoral degree in health administration.

The findings of the SSi-Search survey indicate that Turnbull is not alone in feeling frustrated.

"The most interesting thing that came up was that their greatest frustration was that their strategic abilities, which they consider their second greatest ability -- almost on par with their operational -- is underutilized, and that's a tremendous frustration for CIOs," Dixon said. "We've heard that for many years, but with the landscape in healthcare technology having changed so dramatically over the last five years -- and technology itself is a strategic initiative for -- you know, it's a tool, and it's a key to transforming healthcare. So, it's understandable that the CIO feels underutilized strategically."

[See also: James Turnbull, CIO of the Year.]

Workload expands

Over the past several years, the work of the healthcare CIO has multiplied, spurred in large part by the HITECH Act and the Affordable Care Act.

How much has the workload expanded? So much so that the über-productive John Halamka, MD, CIO at Beth Israel Deaconess Medical Center in Boston, took notice.

"In 2014, my work role has evolved to convener, communicator, mediator, navigator and load balancer instead of technician, architect, programmer, informatician and clinical expert," Halamka wrote in his January 15 blog. "Not that the evolution is bad. In the modern era, we all have about 5 careers in our lives. What's amazing to me is how many careers I can have without changing my position as CIO!"

In a Nov. 19, 2013 commentary published by InformationWeek, Halamka wrote: "The pace of change is accelerating to the point that scope, time, and resources can no longer be balanced with demand, expectation and sustainability."

The situation reminded Kirby of a Far Side cartoon by Gary Larson: Two deer are standing in the woods. One has a birthmark on his chest in the form of a red and white target. The other deer says: "Bummer of a birthmark, Hal!"

"I feel like today's CIO has that target on their chest because they do a lot, and they're doing a lot more with less in some cases," Kirby said. "And when things go right and when things go well, they don't get a whole lot of recognition. But the least little thing goes wrong and they've got that bummer of a birthmark, where they've got that target on their chest."

In her view, some organizations recognize the value of CIOs, while others take potshots – "and they’re having to protect their staff from potshots," she said.
It's hard for CIOs to respond to all the demands.

"You have somebody out there who says, 'It's only going to take 10 minutes. I want it done now,' but it's not on the governance list; it's not on the prioritization. And, you've got somebody that's called, how do you deal with them? It's not going to take 10 minutes, and, if you don't get it done that person's unhappy. It's a very difficult position – everybody wanting everything and wanting it now."

The pressure and stress mounts.

"It is a lot of money at stake," Kirby observed, "and it's up to these individuals to lead large teams, lead complex projects at the executive level. These projects aren't IT projects. They're organizational projects that they want to be successful."

Pay rises, but does not keep pace
According to the SSi-Search survey and white paper, "the typical healthcare CIO today is a highly educated male, who has served in the role for 10 years and earns $286,000 a year."

Branzell believes CIOs are being paid fairly, but the compensation probably has not kept pace with other C-suite jobs.

"Part of it is that the role of being a true C-suite transformational leader is relatively new," he said, "so, it may take a little time to catch up with the other C-suite leaders from a comp perspective as well as seeing those benefits in there. You know, with great benefit comes reward."

He said most CIOs he knows from the top 50 to 100 organizations are "all being well taken of."

Maybe so, but Dixon pointed out that the compensation has not kept pace with the increasing workload. CIOs surveyed reported receiving raises of 10 percent or less over the past five years.

"According to our white paper, the majority report that their responsibilities have increased both in complexity and skill about 25 to 50 percent," Dixon said. "It's dramatic."

"It's hard to compare healthcare CIOs to CIOs in other industries because our world is so unbelievably complex to begin with, and then we're going through a tumultuous period right now, and I don't think any other industry can claim that to the same degree that healthcare can in that regard," Dixon added.

"Executives hiring CIOs are probably going to have to think seriously about increasing compensation. We're seeing that."

Because there are several CIOs retiring and no one on the bench to hire – Branzell has noticed efforts by organizations to keep their CIOs happy.

"We're starting to see now the concept of golden handcuffs and packages and contracts that are kind of back-loaded to keep people around," he said.

[See also: CIO salaries lag as work multiplies.]

Turnover, churn, half-life
At one time there was a high turnover in healthcare CIOs, a high turnover throughout the C-suite, said Branzell.

"I think at one time, the term was three to five years was kind of the life of the CIO in an organization," he said.

Some called it the "half-life," a term borrowed from science, referring to how long it would take for half of the unstable, radioactive atoms in a sample to decay.

"I think at one time, the term was three to five years was kind of the life of the CIO in an organization, which really I think was true of most of the 'C-suite' jobs," Branzell said.

Recruiters have told Branzell recently there is no one on the bench, no one sitting on the sideline looking for jobs. "There are just no CIOs in need of work, so you can kind of consider that kind of a zero unemployment rate," Branzell said. "Then on top of that if you're really looking for the top 10 percent to 15 percent CIOs. The only way to get them is to steal them."

Some have retired. Others, like John Glaser, former CIO at Partners HealthCare in Boston, have gone to work at vendor organizations. Glaser serves as CEO of health services at Siemens Healthcare. William Bria, MD, formerly CMIO at Shriners Hospital for Children's, joined consulting firm HCI Group.

However, Branzell envisions a better situation ahead. He sees many up-and-comers in the industry. We've put now over a thousand students into our boot camp, of which probably 70 to 75 percent of those are next generation leaders that are not in CIO jobs yet."

"That's one of the things I'm very optimistic about," he said.

"In every class you see three, five, maybe as many as 10 that you go: 'OK, that's someone I see in a CIO job – in one year, five years, maybe 10 years,' and it almost always comes to fruition. You can just look at them and go 'that's a great leader who just needs a chance.'"

Branzell advocates for the training of the next generation of other IS executives. It's something under discussion at CHIME.

There are many possibilities: chief security officers, chief technology officers, chief application officers, chief innovation officers, chief data officers, and the list goes on.

"We refer to that as the C-suite of CIO," Branzell said. "Those are new and emerging executive roles that really complement the whole IS concept, and we're seeing those really as great executive grooming opportunities."

"It's a huge need," Branzell said. "You take security officers, for example, significantly negatively employed, meaning there's three job openings for every one person in that career. People are trying to hire them; they can't find them. They steal them from other industries, but it takes them five to 10 years to learn healthcare."

"There's a whole new generation of next level executives that provides an opportunity to move up into the CIO ranks as well," Branzell said. "There are lots of different jobs that kind of provide you experience before you move into that senior position of CIO."

Mergers and acquisitions are also having an effect on CIOs today.

"So if you're a CIO of a stand-alone hospital today," Dixon said, "that's likely going to change tomorrow."

"Leaders who can operate well in these dynamic elements we call synaptic leaders, because we have our clients asking for this skill set," she said. "They need someone who can perform well in a large environment – a highly matrixed environment. We see this a lot also with organizations that are going through mergers and acquisitions and with communication channels that are fluid and dynamic."

Are those people hard to find? "Extremely," Dixon said. "We always like to see someone who's demonstrated innovative results. That's a really good indicator that they are capable in this new environment, and they have that kind of synaptic ability."

"I think CIOs are wonderfully positioned to take the strategic path in their careers," said Dixon. "They have in their hands the most important lever for innovation, and that lever is going to be technology."
Three must-have skills CIOs need today
By Pamela Dixon, managing partner, SSi-Search and Steve Nilsen, general manager, SSi-Search

One thing became clear in 2013, all leaders across the health system have been challenged to keep pace with change, and the best of them have been driving change. In a year of active mergers and acquisitions, most of our clients voiced a need for leadership that can facilitate change across complex organizations.

At the same time, we noted that all organizations are keenly aware of the M&A climate and that awareness is part of what is fueling a demand for a new type of leadership.

We were struck by how key healthcare leadership roles have changed, from the chief information officer to the chief medical officer. We have seen new leadership dyads emerge, such as the chief information officer and the chief medical information officer, and we have seen new roles emerge, such as chief accountable care officer and chief data officer. We have also seen some of the greatest turnover in the industry, including the highest CEO turnover in a decade. Each leader in the healthcare system has had to learn how to help his or her organization deal with change.

This drives our list: the ability to lead change more effectively, dynamically and more quickly. In fact, we have boiled our annual top-10 list down to a top-3 list. Rather than listing 10 items, we believe that what permeates each healthcare leader's list of objectives for 2014 will be the ability to lead change. The concept lead us to create a new term for what we believe will be needed most, "synaptic leadership." The brain relies on synapses to exchange information. This exchange of information is at the heart of leading change. That is, leaders who know how to engage themselves in the flow of information to lead and foster change: synaptic leadership.

Here are the top three skills all healthcare leaders will need in 2014:

1. Interconnectivity – Going beyond organizational intelligence, we need leaders who understand how to engage themselves at the synapse or the flow of information. Time is at such a premium, and the amount of information so vast that leaders can no longer act in a linear fashion. Nimble leaders who engage with their organizations in a non-linear and inclusive fashion will be most successful. Healthcare is too important, and healthcare organizations increasingly complex, that the time for synaptic leadership is here.

2. Innovation – All healthcare leaders will be challenged to think in new ways, to adjust to change and to lead change while carving out new models of care. The term innovation began to surface in our client's list of leadership needs in 2013, and we believe that those leaders will become vitally important in 2014. While the concept has been around for a long time, and with a growing number of chief innovation officers in place to prove it, innovation is recognized as a critical element of success. Last year we conducted a series of interviews with healthcare innovation leaders – many carrying the title of 'chief innovation officer' – to better understand the role. It made it clear to us that innovation as an element of healthcare's overall strategy is beginning to solidify. The phrase "innovate or die" has a new ring of truth to it.  

3. Communication – This is not a new skill, but it has new meaning when it is coupled with interconnectivity and the race for information. Finding new and better ways to communicate greater amounts of data and information will become increasingly important. Great leaders have always needed to rely on strong communication skills. Moving to a data driven culture will create new demands on a healthcare leader's communication skills. Whereas the past emphasized the form and style of communication, the accelerated availability of data has rendered the decision of what is useful and what to communicate as important as how to communicate it.

In summary, the successful combination of these three skills would be "synaptic leadership." Synaptic leadership is a term that describes the ability to manage and consolidate information that is being sent and received simultaneously across complex organizations and needed by multiple individuals for a wide variety of purposes. We introduced the term in 2013, borrowing from neurobiology, and we believe it summarizes the concept that is driving a new breed of leadership.

Leading change at the vortex of information, creating agile, systematic response mechanisms, communicating vast amounts of information and building organizations with the ability to act on that information – that will be the holy grail of leadership in 2014.