For the last 14 years, I have been working in our hospitals. I have always been in the IS Department, but at least I worked in a revenue center. I didn’t work in one of those places that are considered “corporate overhead.” Well, now I’m about six months into a new role that is distinctly corporate overhead.

I lead our three very large core infrastructure teams plus the administrative services group for Partners IS. I have the nicest office I’ve ever had. While it has a beautiful view of Boston Harbor and one can make out some buildings of Massachusetts General Hospital – there is a physical and emotional distance from where the care is taking place. Here are some principles I’m bringing to my leaders and staff – and to myself as I have a more “back of the scenes” role that is still crucial to care delivery.

Our new CIO has organized the department to support our enterprise approach to care provision and the information necessary to manage accountable payments. Traditionally our hospitals and site CIOs have retained significant independent decision making for their profit/loss center. Like many organizations across the country, we find ourselves needing to organize care differently, and consequently our information systems decisions. Our CIO asked me to move from site CIO to Director of IS Operations to promote this enterprise view in the infrastructure groups and to bring some hospital sense of urgency to groups that have been removed from those settings.

Our technical people are excellent and they take care of a massive computing infrastructure that includes a 100,000-node network, 3,400 servers, 50,000 desktops and 45,000 telephones. We have been given adequate capital funding. They are busy and they want to serve. We have a story familiar to most readers – the equipment has continued to grow, but FTEs have not. How can we meet the increasing demands for information systems at the same time we are being asked to cut costs?

Focus on people – especially leaders. Our infrastructure teams grew large and perhaps like the proverbial frog in the pot, didn’t realize that a slow process of decreasing communication created inefficiencies and lack of coordination. On the first day, I asked my leaders to meet together for 90 minutes per week to discuss operations and make decisions together. I actually think we need more than 90 minutes, but I’m easing them into the process. I told them that I prefer not to have one-to-one appointments because I end up arbitrating between leader conflicts. It seems counter-intuitive to work things out in a group, but I believe it’s more efficient. I received immediate objection from one director who said he had hundreds of things that were really complicated and couldn’t be worked out with the other directors. I told him that the CEO of my previous hospital practiced this leadership method with much more diverse disciplines of hospital VPs and that every metric – revenue, margin, patient satisfaction, physician satisfaction and the like – were off the charts for that hospital.

I also told my leaders that the most important thing to me is that they are reconciled. One of the former CEOs I worked for said he spent 70 percent of his time solving arguments and conflicts between senior leaders. I let my folks know they don’t have to be best friends, but that they better resolve conflicts between them or that we’d do it together in that 90-minute weekly meeting. I do meet with the leaders one-to-one, of course, but I prefer to spend that time rounding with them and visiting staff. This gives an opportunity to connect with staff level people, get front line ideas (LEAN principle) and reward and recognize staff as appropriate.
It’s about the patient, stupid! The Partners mission has four components – Care Delivery, Discovery/Research, Teaching and Community Involvement. Clearly all four components have information systems needs, but I wanted to boil it down for our leaders and staff. I told them that there are only two jobs in Partners – either taking care of patients or taking care of the people who take care of patients – and that the patient could be one of their loved ones. In my new role, we are the people taking care of the people who take care of patients. Some remember the story of the government official who came upon a man sweeping the floor while walking through the space center in the late 1960s.

“What is your job here?” he asked the man. Without missing a beat, the man replied, “To put a man on the moon.” Similarly, I want our staff level people to be able to answer that question as, “To make sure our care providers, researchers and teachers have the right information at the right time to best take care of our patients.”

We spent about 70 percent of our IS budget on salary and fringe. Each year, maintenance contracts and utilities increase. We are a not-for-profit, so we don’t have very many tools in our toolbox for retaining our talent. In my estimation, our staff have to be passionate about the patient care to be able to meet the IS demands as budget pressures build. That passion is what will help us gain more efficiency – not a set of rules about hours worked or limits on entitlements such as flexible work hours or on-call pay.

Shift left. Simply put, we have to get more out of the FTEs we have. We have some functions that are staffed 24/7 – Help Desk, Computer Operations and Switchboard Operators. We must seek ways to further automate some of the tasks in these functions, leaving cycles for those employees to take on some of the items done by more senior engineers during the day. In the same way, we need to determine what things can be offered as self-service for our customers to increase their satisfaction and create more staff bandwidth. This, of course, leads into much work on process redesign. My focus has been on people first because I believe we will just have to redo the processes again if we don’t have trained leaders and engaged staff focused on taking care of the people who take care of our patients.

Many find this uncomfortable of course, because it’s change. Some computer operators may not want to learn new skills. Some server engineers may not want to relinquish tasks for fear of losing their purpose. Some customers may be annoyed by self-service offerings.

Our role as leaders is to show the pathway to more interesting work that meets organizational demands and keeps us competitive in our market. Sometimes we use carrots and sometimes we have to use sticks to change behavior. Two out of industry examples of self-service that improve customer satisfaction are online package tracking from overnight express companies and ATMs in banking. Both create flexibility for customers while saving their organizations valuable employee time that can be used for better purposes.

I love my new leadership role and am enthusiastic about leading an overhead group. We know that our market is becoming more competitive and that the public, the government and the employers are demanding better quality care at a lower cost. I enjoy helping our folks engage in this idea that our patients and families have a choice and that we want them to choose our hospitals and clinics again and recommend them to friends. We can work hard, meet the needs of our customers and have a lot of fun doing it. That’s the kind of overhead our company can afford.