Russell Branzell - CIO/HIT Leader 3.0 The Future of IT Leadership

1. CHIME LEAD – New York
September
2015

2. CIO/HIT Leader 3.0
The Future of IT Leadership

4. We’ve come a long way!

5. Healthcare 2015: The Perfect Storm

6. HIT Challenges of Today – The Perfect Storm

7. What’s Important to the C-Suite?

8. American College of Healthcare Executives
Top Issues Confronting Hospitals: 2014
Issue 2014 2013 2012
Financial challenges 2.5 2.4 2.5
Healthcare reform implementation 4.6 4.3 4.7
Governmental mandates 4.6 4.9 5.0
Patient safety and quality 4.7 4.9 4.4
Care for the uninsured/underinsured 5.5 5.6 5.6
Patient satisfaction 5.9 5.9 5.6
Physician-hospital relations 5.9 6.0 5.8
Population health management 6.8 7.6 7.9
Technology 7.3 7.9 7.6
Personnel shortages 7.4 8.0 8.0

9. 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.”

10. 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

11. The Healthcare CIO/HIT Leader:
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 2.0CIO 1.5
An Enabler role
IT Operations
+ ++

12. CIO/HIT 3.0:
The Transformational
Leader

13. CIO/HIT 3.0
• Operational Management (2.0)
• Senior Management Leadership (Strategic)
• Change Leadership
• Innovation
• Talent Management
• Information Governance/Knowledge
Management
• Relationship Management

14. Setting Vision – Clear Target

15. Vision Exercise
Envisioning the Future:
Seeing with the Mind’s Eye
Tomorrow’s Healthcare
Environment

16. Blank Canvas
Tomorrow’s Healthcare
Environment

17. 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

18. “Enduring companies have clear
plans for how they will advance
into an uncertain future.”
Jim Collins
Building your company’s vision
Harvard Business Review
September – October 1996
Introduction

19. What makes for a successful
vision statement?
1. Communicates the resultant outcome or future
position of the organization
2. Inspirational and invokes followership
3. Simple and Concise
Our reason to be…
Part I: Vision, Goals, and Objectives

20. Vision Statements
• “We create happiness by providing the finest in
entertainment for people of all ages, everywhere”
• “Strategic innovation in health care, for today
and tomorrow.”
• “Globally Responsive, Regionally Engaged”
• “To inspire and nurture the human spirit – one
person, one cup and one neighborhood at a time”
• “Shaping the future of healthcare through IT
Leadership”

21. Vision Statements
• “Leading the Way”
• “Striving to be the world’s leader in patient
experience, clinical outcomes, research and
education”
• “To be earth’s most customer centric
company”
• “To bring inspiration and innovation to
every athlete in the world”
• “Exceptional Leaders Transforming
Healthcare”

22. CHIME “2020” Vision*
“Exceptional Leaders
Transforming Healthcare”
CHIME Current Vision
“Shaping the future of healthcare
through IT leadership”
Part I: Vision, Goals, and Objectives
* To be proposed for review, approval by CHIME Board

23. NHIN Architecture
A Nationwide
Health
Information
Network must
be …
• Private
• Secure
• Seamless
• Flexible,
Open,
Transparent
• Responsive
• Reliable
• Affordable
• Simple
• Scalable
The NHIN Prototype – Landscape

24. Vision Picture

25. 1
Strategy in Dynamic Times
– On Target

26. 1) Integration
2) Value (Cost & Quality)
3) Transparency
U.S. Healthcare - Three Process Trends
What is your strategic focus???

27. Healthcare Value = HIT Value
Healthcare
Value
˭ Dollars Spent
Patient Outcomes
&
Revenue
Enhancement
Adapted from Value Measurement for Healthcare, Harvard Business School Executive Education
˭
IT/Informatics
Value

28. Care Improvement Process
Status Quo – Fee for Service
Wellness Care
Quality Care
Managed Care
Value Care

29. Care Improvement Process
Status Quo – Fee for Service
Wellness Care
Quality Care
Managed Care
Value Care

30. “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

31. 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

32. 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

33. 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

34. 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

35. 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

36. 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

37. • Understand and be prepared to manage 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
Being an Institutional Leader:
The CIO as a Member of the Executive Team

38. • Create a foundation team of operating and
project leaders
• Challenge and mentor the next generation
of leaders
• Recognize that your role is changing
Building Your Team: Creating Capacity for
Strategic Leadership

39. Engaging your CEO:
Establishing IT Governance, Process and
Decision-Making
• Formalize IT Governance Structure
• Demonstrate visible commitment to the value of IT
• Build relationships with key IT vendors and suppliers
• Dialogue with peer CEOs
• Advance the industry through sharing your experiences

40. • Seek formal “Sponsorship” for all IT enabled
strategies
• Use IT as an accelerator of strategy
• Build clinician-driven structures to prioritize
demand for continuous enhancement of systems
Partnering for Success:
Cultivating Sponsorship

41. Sustaining High Performance:
Measuring, Monitoring and
Communicating for Success
• Stay focused on achieving outcomes
• Measure your success in well defined clinical,
operating and patient satisfaction metrics
(vs. milestones)
• Use dashboard reporting to bring clarity and
transparency

42. 1
Strategy of Change

43. From “Good to Great” by Jim Collins
“…technology by itself is never a
primary root cause of either
greatness or decline.”

44. How Different Will Health IT Be,
When?
2030 2015
Technology
Trigger
Peak of
Inflated
Expectations
Trough of
Disillusionment Slope of Enlightenment
Plateau of
Productivity
time
expectations
Positive
Hype
Negative
Hype

45. What is the Hype Cycle Telling Us About IT’s
Role in Healthcare?
Innovation
Trigger
Peak of
Inflated
Expectations
Trough of
Disillusionment
Slope of Enlightenment
Plateau of
Productivity
time
expectations
Plateau will be reached in:
less than 2 years 2 to 5 years 5 to 10 years more than 10 years
obsolete
before plateau
As of July 2015
Precision Medicine
Patient Decision Aids
Smart Machine Healthcare Sages
3D Bioprinting Systems
for Organ Transplant
Nanomedicine
Patient Engagement and
Persuasion Analytics
Real-Time Healthcare Costing
3DP-Aided Hip/Knee Implants
Genomics Medicine
Population Health Management Platforms
Healthcare-Assistive Robots
Quantified Self
Personal Health Management Tools
Care Coordination and Management Applications
Provider Population Health Analytics
Computer-Assisted Clinical
Documentation Improvement (Hospital)
CPOE/E-Prescribing (Non-U.S.)
Big Data Generation 3 EHR Systems
(Non-U.S.)
PCMH Certification
Personal Health Record
Accountable Care Organization
LCST App Platforms
Computer-Assisted Coding (Hospital)
EHR-Based Perioperative Charting and Anesthesia Documentation
Advanced Clinical Research Information Systems
Integrated Clinical/Business Enterprise Data Warehouse
Interactive Patient Care Systems
Generation 3 Enterprise Patient
Financial Systems (U.S.)
Patient Portals
E-Visits
Real-Time Healthcare
Temperature/Humidity
Monitoring
Remote ICU
Wireless Healthcare
Asset Management
Patient Throughput and
Capacity Management
Source: Gartner, “Hype Cycle for Healthcare Provider Applications, Analytics and Systems, 2015”

47. Using a business case cycle that produces VALUE.
3. Baseline
Existing
Performance
4. Describe the
Capabilities
of the Solution
5. Negotiate the Targeted Improvements
7. Develop
the TCO
6. Convert
the Targeted
Improvements
to Financial
Results
8. Calculate the
Hard-Dollar ROI
2. Select
the Metrics
1. Organize Stakeholders and
Focus on Benefits

49. Value Realization Requires a Structured
Approach
Current
State –
Start the
journey
Execute
Roadmap
Manage Change
Capture Value
Realization
Opportunities
Future State – Define
the ideal
Change Readiness
Assessment
Envision the Ideal State
Innovate & Optimize
Costs with Disruptive
Technologies (Cloud,
Social Media, Big Data,
Mobility)
Identify Metrics and
Develop the Business
Case
Implement PMO &
Governance ModelMeasure Benefits
1
6
4
7
2
Develop Implementation
Roadmap
5
3
Q4 12 Q1 13 Q2 13 Q3 13 Q4 13 Q1 14 Q2 14 Q3 14 Q4 14 Q1 15 Q2 15 Q3 15 Q4 15
Program Management and Governance
1.0 Enterprise Services Transformation – Change Management1.1 Org Design
& Process/Role
Change Mgmt
1.2 Communic.
Planning
1.3 Business Case
Development
1.4 Readiness
Assessment
2.0 Rationalize/Standardize/Define
2.2 Knowledge Mgmt Processes &
Tools
2.5 Reporting Processes & Tools
2.1 On-Boarding
& PD/Accred.
Processes
6.0 Service Support &
Enhancement
3.0 Enabling Capabilities – Service Detailed Design/Build
4.0 Monitoring & Assurance – Service Detailed Design/Build
5.0 Business Area Service Deployment
Quarterly Formal
Communications Releases
Quarterly Formal
Communications Releases
Quarterly Formal
Communications Releases
Quarterly Formal
Communications Releases
Quarterly Formal Business
Case Updates
Quarterly Formal Business
Case Updates
Quarterly Formal Business
Case Updates
Quarterly Formal Business
Case Updates
2.6 Assurance Processes & Tools
2.3 Sourcing
Processes &
Tools
2.9 Demand Fcstg, Resource
Planning, and Scheduling Processes
& Tools
2.7 Financial Mgmt Processes &
Tools
2.10
Requirements
Gathering Tool
2.11 Test Planning & Execution Tool
2.4 Functional Capabilities Demand/
Supply Assessment
3.2 Knowledge Mgmt Processes &
Tools
3.3 Sourcing
Processes &
Tools
3.5 Transition to Desired Functional
Capabilities Capacity
4.1 PRT
Enhancements
4.4 Assurance Processes & Tools
3.6 Demand Fcstg, Resource
Planning, and Scheduling Selection
3.8 Requirements
Gathering Tool 3.9 Test Planning & Execution Tool
4.2 PRT Replacement Selection
3.7 Demand Fcstg, Resource
Planning, and Scheduling Design &
Build
4.3 PRT Replacement Design/Build
Wave 1 (All)
5.1 On-Boarding
5.2 Personnel
Development &
Accreditation
5.3 Sourcing
Wave 2 (All)
5.4 Know. Mgmt
5.5 Funct. Capab.
5.6 Assurance
5.7 Governance
5.8 Rqmnts
Gathering Tool
Wave 3 (All)
5.9 Financial
Mgmt
5.10 Test Plan &
Execution Tool
Wave 4 (By Business Areal)
5.11 PRT Replacement
5.12 Demand Fcstg, Resource
Planning, Scheduling Tool / Demand
Mgmt
2.8 Governance
Processes
6.1 Wave 1
Support Begins
6.2 Wave 2
Support Begins
6.3 Wave 3
Support Begins
6.4 Wave 4
Support Begins
6.5 Enterprise Services
Continuous Improvement
4.5 Financial Mgmt Processes & Tools
3.4 Governance
Processes
Quick Wins
Month 3 6 9 12 15 18 21 24 27 30 33 36 39
Re-
Calibrate
Iterative Definition to
allow for Quick Wins
Delivery
Iterative Design to
allow for Quick Wins
Delivery
3.1 On-Boarding & Personnel Development/
Accreditation Processes
Transformation

50. William Bridges
“The three phases of transition”
Time 
Acceptance
The phases are not separate stages with clear boundaries….

51. The eight-stage process of
creating major change

52. 1
Strategy of Engagement

53. Employee Engagement Groups
28% 55% 17%
Engage
d
Not Engaged Actively Disengaged
These employees are loyal and
psychologically committed to the
organization. They are more
productive and more likely to stay
with their company for at least a
year.
These employees may be
productive, but they are not
psychologically connected to their
company. They are more likely to
miss workdays and more likely to
leave.
These employees are physically
present but psychologically
absent. They are unhappy with
their work situation and insist on
sharing this unhappiness with
their colleagues.

55. -79.5
-45.6
-29.9
-18.1
-8.7
0.0
8.7
18.1
29.1
44.1
78.7
-100
-80
-60
-40
-20
0
20
40
60
80
100
Engagement Percentile
Average%Gain/LossinProfitability
Engagement Drives Profitability
Copyright © 2007 Gallup, Inc. All rights reserved.

56. 58
“Every behavior is motivated
by need. Change – any
change – may be perceived as
disruptive and potentially
dangerous as the status quo
becomes unstable.”
Maureen Mackenzie
Mackenzie, Maureen (Associate Professor of Management, Dowling College, NY) (2008). Senior
Leadership's Role in the Change Process. www.dowling.edu/faculty/Mackenzie/docs/change.pdf

57. Physician Engagement
Motivators
• Patients (improve health and wellness)
• Save Time
• Improve Revenue (reduce expense and
increase profitability)
59
Dr. Todd Whitsitt, Colorado Health Medical Group - Chair

58. 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
Leader

59. Thank You