In this installment of “C-suite conversations,” Judy talks with Joan Hicks, Chief Information Officer at UAB Medicine, one of the nation’s leading academic medical centers. With a career spanning decades at the forefront of healthcare IT, Joan offers candid insights into her leadership journey. From overseeing acquisitions and shaping AI governance to mentoring the next generation of technology leaders, her perspective is grounded in purpose, rich experience, and a steadfast commitment to patient care.

Located in Birmingham, UAB Medicine is one of the top academic medical centers in the United States and Alabama’s largest single-site employer. Each year, UAB Medicine provides health care services for more than 1.6 million patients.

Q & A With Joan Hicks

Judy Kirby: Joan, thank you very much for participating in our “C-suite Conversations” series. You’ve spent most of your career at UAB (University of Alabama at Birmingham) Medicine. You’re skewing the bell curve of CIO tenure. How have you achieved that type of success and longevity? 

Judy: So, how did you end up choosing technology and health care as your career? 

Joan: My mother was a nurse, and she very much wanted one of her five children to select healthcare, preferably nursing as a career. I was the fourth child, and my three older siblings chose non-healthcare professional fields. Not giving up on her desire for one of her children to select healthcare as a career, she introduced me to medical record technology as an option.  

In the late 1970’s, all clinical documentation was paper-based. I began working while I was in college at the local community hospital, Cullman Medical Center (CMC), and was promoted to the director of the department at age 21. It was a great experience and with all paper-based documentation, there were many opportunities to adopt standalone applications. My first significant IT project was automating the Master Patient Index, which meant entering all the demographic data, medical record numbers, dates of admissions and discharges, admitting physicians, and service codes for all the patients who had been patients in the hospital.  

I was involved in the first IT project with automating payroll, electronic claims submission, and all the quality reviews, and generating reports of the results of the reviews. I used this program to compile information about our incidents for risk management. I assisted in the writing code and testing of the first DRG grouper for the hospital. This was in the early 1980’s which was very advanced for that time.  

Judy: How did you end up at UAB? 

I graduated from UAB and was on faculty in the Health Information Management (HIM) program. While I was teaching, I had the opportunity to be a member of the inaugural graduating class of the Health Informatics program. 

One of the reasons that I left my position at CMC, was not only to teach in the HIM program, but additionally to complete the master’s program in health informatics. This program was one of the first to prepare students to become a CIO in Healthcare.    

Following my seven years of teaching, I consulted and worked at the Children’s of Alabama before returning to UAB Health System in HSIS. I was recruited by Dr. Mike Waldrum, who was the Medical Director for IT. Dr. Waldrum and a group of developers were building a repository for all the transcribed notes from all the clinic visits in the Kirklin Clinic and viewed via a web browser.  

Judy: I talk with some CIOs who are concerned about the division of technology within the organization. Some have data, some have AI, some have cybersecurity, some have analytics, some are called a CIO, some are called a CDIO. What areas fall under your leadership, and which don’t?  

Joan: Within HSIS, we are responsible for all clinical and financial applications, the infrastructure, network, servers, storage, data centers, phone system, clinical communications, desktop support, help desk, information security, PCI compliance, privacy, data analytics, and the Enterprise Data Warehouse which supports clinical and clinical research. We have CMIO/ACMIOs, clinical informatics, project management teams, and we have a small, very skilled AI team.  

In our organization, these information intensive areas and IT are aligning more closely within HSIS. This is being driven by our COO for the health system to whom I report. 

Judy: Interesting. Was he a CIO before? 

Joan: Not a CIO, but he was an IT leader. 

Judy: Some organizations are reluctant to have so much under IT.  

Joan: I think it’s economies of scale. Executive leadership recognizes that distributed IT is more costly. I believe the case is made for centralization by the positive financial impact of bringing all the information intensive areas together. When HSIS is compared to industry benchmarks, two studies were done within the last 18 months, our number of FTEs was well below the average for organizations like our size.  

Judy: How do you see the CIO role evolving over the next three to five years? What do you see as some new responsibilities, and new job qualifications? 

Joan:  The CIO scope is increasing with the mergers, acquisitions, and smaller healthcare organizations seeking assistance for larger organizations specifically in the support of the EHR and information security. 

New responsibilities include implementing and supporting AI-driven technology adoption and assuring ethical use of AI including governance and training. CIOs will need to plan and prepare the staff for the rapidly changing environment and the ‘softer’ side of IT that’s less technical focused but more customer service oriented, and possess critical thinking skills like asking ‘why’. 

Judy: What has made you successful with acquisitions and getting two IT teams integrated? 

Joan: As a university hospital, we need to continue branching out and growing. We need the beds. So, I was absolutely thrilled when I was brought into the discussion about acquiring Ascension St. Vincent’s. When we go out and visit those hospitals and meet with the staff, they are so glad to see us, so welcoming. It is pure joy for me and I feel that, in some ways, I’m ending my career where I started it. It’s good for the state of Alabama, it’s good for our patients, and it’s good for UAB. 

Judy: Are there any lessons you have learned from merging the IT teams? 

Joan: HSIS was the first UAB Health System department when the Kirklin Clinic IT staff and University Hospital IT staff merged. We were still in the development phase of an integrated IT staff when I joined HSIS. HSIS provides IT services for several of our affiliates and those relationships have helped us prepare for the current acquisition. From an IT staff perspective, we have worked well with our new IT partners. I want to make certain the staff within the organizations feel supported and know us. HSIS leaders have visited the Hospitals and Clinics, being on-site during the first phase of the transition 24/7 until all issues were resolved. Being present means when you say ‘we’ it is all of us. 

Judy: Looking back on your own journey, what career advice do you have for rising technology professionals interested in becoming a CIO one day? 

Joan: Serving as a CIO has been one of the most humbling experiences in my life. I am so dependent on the leaders and staff in HSIS. Accept that you can’t be an expert in all areas in healthcare IT and surround yourself with those who have skills you don’t possess. Listen and be patient. 

There are times as a CIO that you must make the final and often very difficult decisions and be willing to do so. Being a servant leader doesn’t equate to being weak but rather displaying strength. 

Judy: How is AI impacting UAB Medicine’s strategy? And can you talk a little about AI governance? 

Joan: AI is having an impact on all organizations. There is tremendous excitement and readiness to adopt. As CIO, I too am enthusiastic about the difference AI can make in the practice of medicine and healthcare. The great opportunity of AI brings the need to build an effective AI governance program rapidly enough to protect the organization without stifling adoption. Balancing the need/desire to move with the market and implementing necessary protocols to retain the security of the patient information can be a challenge. We have partnered with the university to develop a governance program that has been successful in maintaining the balance.  

Another component of our governance is the reviewing of contracts which includes those with utilizing AI solutions and thoroughly vetting the security of the system. 

We have hired an AI expert and biomedical engineer with AI experience to address several opportunities for improvement utilizing AI. One example is the sorting and preparing responses for the patient portal. This project is still underway but significant progress has been made with the sorting and providing responses for those where a simple response is all that is required. 

Judy: So if you hadn’t moved into IT, what other career do you think you were cut out for? 

Joan: Law. I would have been a lawyer. I have always been intrigued by the legal system. I had the opportunity to focus on healthcare law when I was the risk manager at CMC. I worked closely with our external legal counsel. As a small facility at that time, they didn’t have full-time legal counsel, and the attorneys were not well versed in healthcare law. I was fortunate to have the opportunity to be actively involved in the research and preparation for several legal cases. 

Judy: What are some things you like to do with your spare time, when you have it? 

Joan: Currently there is very little spare time with the two very large projects that are underway. When I am not working, I spend as much time as possible with my family. I have three wonderful grandchildren who keep me busy. We enjoy spending time on the lake on the weekends with the kids. There is nothing more relaxing than taking a ride in the boat or having coffee on the deck. 

In this C-Suite Conversations interview, Lisa Abbott, EVP & CHRO at Boston Children’s Hospital, shares her perspective on leading through change in today’s healthcare environment. From supporting employee well-being to navigating hybrid work and embracing AI, Lisa offers practical insights on building a resilient, people-centered culture in one of the nation’s top pediatric medical centers.

Boston Children’s Hospital is one of the largest pediatric medical centers in the United States, offering a complete range of healthcare services for children from birth through 21 years of age. Boston Children’s is home to the world’s largest pediatric research enterprise and is the primary pediatric teaching hospital for Harvard Medical School.

Q & A With Lisa Abbott

Judy Kirby: I appreciate your time today, Lisa. You’ve been a CHRO for very prestigious academic medical organizations. As you’ve moved from organization to organization, what have you done to make each transition successful?

Judy: What is your advice on how to adapt when there is a significant leadership transition, such as a new CEO?

Lisa: You have to recognize that no two leaders are alike, and it’s our job, especially if you’re talking about a new CEO, to remember that we work for that person. We’re all intelligent adults and have our jobs because we’re subject matter experts. But at the end of the day, our job is to support the new leader, so we need to learn what that leader’s style looks like. We must learn what makes them get out of bed in the morning and adapt to their work approach as needed. Do not assume the new relationship will look the same as the previous one.

Judy: So there’s been a book out there for a while by Michael Watkins called The First 90 Days. Are you a fan, and what would you change about his advice?

Lisa: Is it 60 days? 120 days? I think the idea is to measure the organization you’re joining, and push the envelope enough without pushing yourself off a cliff. I’m a person who’s wired to make change, so I have to modulate depending on the organization I’m in. Some organizations want us to move quickly in certain areas. In others, we have to be more thoughtful in our approach. So the pace of change is governed in part by the change tolerance of the organization. That said, most people are averse to change, so you have to overcome that inertia at some point. But in my experience, it’s a lot easier to ask for forgiveness in the first 90 days than to get permission too much longer after that.

Judy: Amid all the uncertainty and looming changes, $340 billion in Medicaid, site neutrality, and so on, how are you dealing with the organizational stress people are feeling?

Lisa: We are in academic medicine, so we are in the crosshairs of every executive order that is coming out, whether it’s Medicaid changes, research funding changes or impact on visas. All of the things happening right now are heightened in academic medical centers. We have lots of students who come from overseas. We have lots of researchers who are paid from grant funding. Many of our patients are Medicaid recipients, so people are on edge. As a result, I think there has never been a more critical time to be really intentional about workplace well-being.

Are we ensuring that our community members understand all the support that is available to them? From Employee Assistance Programs (EAP) to financial planning assistance to paid time off to deal with these emerging issues. There are people asking for access to legal advice right now. What does that mean? So, holistic well-being has taken center stage, which we take very seriously. We’re bringing as much intentionality as possible to that right now, and it’s never been more important.

Judy: Everyone is trying to address physician and clinician burnout, but I recently came across an article about HR leaders becoming burned out too.

Lisa: Right. Anxiety doesn’t stop at the doors of HR. The people who work in HR are human beings, just like the people in the communities that we’re serving. We had an HR town hall meeting yesterday, and we talked about what’s going on in the world. We didn’t try to shy away from it. We talked about the organization’s commitment to upholding our standards and our values, but also emphasized that it’s really important, like they say on airplanes, to put the oxygen mask on yourself before you help your fellow passenger. I believe people need to take time out for self-care, and it is not selfish to do so.

One of the things that we try to focus on, especially in these days of remote work, is to make sure you check on your neighbor, a colleague who isn’t showing up the way they used to. “Is everything okay? You don’t seem like yourself.” Just asking the question and offering to help may be the support your colleague needs.

Judy: What are some of the well-being programs you have implemented for the employee population?

Lisa: We recently hired a Director of Well-Being. Well-being means different things to different people and has many dimensions. We’ve talked about mental and emotional health, but there’s also social well-being, physical well-being, and financial well-being, and we offer solutions in all of those areas. The challenge we’re trying to overcome right now is how to package it and ensure people know what is available.

Judy: During your time as CHRO, you have learned to deal with multiple generations of workers with different needs and priorities. What have you learned? What has worked and what hasn’t?

Lisa: That challenge has increased exponentially over the last decade or two. We see four or five different generations in the workplace. We have emerging workers who are technologically savvy but sometimes interpersonally limited. We have a more seasoned generation of people on the other end of the spectrum who are often lagging adopters of technology. They would like young people to work differently and have the same level of investment in their organizations and careers. When they don’t see that, they perceive it as negativity and laziness.

But the reality is that everybody brings value, and our more senior workers can be amazing mentors, leaders, and teachers. I see them helping the younger generations understand the history, but not living in the history, which is an important differentiation. It’s important to understand how we got here, but in the words of Marshall Goldsmith, “What got you here won’t get you there.”

Young people are the future, so we’d better be paying attention. We need to appreciate their technological prowess and the fact that maybe they have a keener sense of work-life integration. If we can be more purposeful about meeting people where they are as opposed to judging them for where they aren’t, we’ll all see more success in our workplaces.

Judy: COVID sent a lot of people home to work remotely. Some organizations are bringing everybody back on-site, while others are making hybrid and remote work permanent. How are you dealing with that at Boston Children’s, and how does it affect promotions?

Lisa: I’m not sure anybody has the right answer on this. Jamie Dimon has a strong opinion on this and JP Morgan Chase is bringing everybody back to work on site. He talks about the impact on future generations of leaders, and I think he’s right about that. I think that there is real value to incidental contact, that proverbial water cooler chat, or the chance to pass a leader in the hallway and have an impromptu conversation or ask them for career advice.

On the other hand, we have benefited enormously from the ability to attract a much more geographically dispersed population of employees. Plus, some roles are very well suited to being remote, like corporate services roles, some HR roles, IT, and finance. If we, in Boston, were to say everybody has to come back to work, we’d lose a large part of our workforce, not just because people have appreciated the ability to be remote, but because Boston is a really expensive city. It’s expensive to live here. It’s expensive to commute.

You really have to weigh the pros and cons if you’re deciding on anything other than a hybrid model. I imagine Jamie Dimon will see a downward blip on the radar at JPMorgan Chase, because it will take a while before they can start staffing up with people who are proximal to where their banks and offices are. In Manhattan, they have the same problem we have here in Boston. You lose hours of your life just trying to get to work.

Judy: Some positions cannot be done remotely, like surgeons. What have you implemented to get the talent you want to move to Boston, considering the high cost of living?

Lisa: We pay a premium for our geography. That’s just the reality. In cities like Boston, New York, and San Francisco, you pay a geographic premium on top of what the job would be valued at in the Midwest, for example.

The Harvard affiliation is really attractive to people. We are a teaching hospital of Harvard Medical School, and that matters to people. They want to be affiliated with the institution. Many of our clinical colleagues and physicians were trained here in the Harvard system, and I hear a lot of comments about how glad they are to be back. It feels like home.

But we really try to make sure that the job is right for the specific individual, especially at the executive level. As you know, executive turnover is expensive, so when I’m working on an executive search I pay a lot of attention to what the family unit looks like and what their needs are – whether there’s an accompanying partner or children or pets or in-laws.

Judy: Have you implemented effective testing and interviewing techniques to ensure the right person is hired in every position?

Lisa: Everything we do is a data point. We do our best to think about not just the job description and whether the person can do the job, but the leadership competencies that the person needs to bring for the time we are in and, more importantly, for the future. A leader four years ago is a different leader than what we need today, dealing with massive uncertainty and change. It’s not for everybody. We certainly do the aptitude assessment tests, but I’ve had people interview extraordinarily well and pass their Hogan Assessment with flying colors, and then still fail. There is no silver bullet.

Judy: How are you using AI, and how do you think it will affect you and your team over the next few years?

Lisa: I was in IT before I was in HR, so I’m all about freeing up human beings to deal with real problems, not transactions. For example, we’ve used AI to automate the nursing licensure renewal process, which had been exceptionally manual and arduous. No one is complaining that AI took away their grunt work of manually digging for primary source verification.

I’m all for it, and our younger employees expect it. I’d like us to become more proficient with automation and AI. Not everybody feels that way. It can be pretty scary, but there’s only upside for people willing to learn and be upskilled. Yes, your existing job may go away, but we will create a different role for you where you are doing even more valuable work.

Judy: Throughout your career as an HR leader, how have you collaborated with other departments to enhance their culture?

Lisa: We do this in various ways. When you’re on your listening tours, you start to figure out where there are challenges, where people aren’t interacting as we would want them to, and so forth. So, we use observational information, and then sometimes people will raise their hand and say, “Our team needs a shot in the arm. What can you do to help?”

We use our Press Ganey survey data and have partnered with Chartis to gather data on burnout and resiliency in the workforce. We also do what I would loosely call “interventions.” We figure out the problem they’re trying to solve, where the obstruction is coming from, what the leader is like, what the leader wants, and help them create better interpersonal and team dynamics.

I want people to bring their very best selves to work. But more importantly, I want them to bring their very best selves back home because that tells me that they’re engaged, feel valued, and that their work matters. That feeling is tied to how well they get along with their colleagues and their leader. A big part of that work is teaching people how to resolve conflict because the ability to resolve conflict is a key driver of a favorable culture.

Judy: What work have you done to strengthen the IT culture? That’s a group with a high proportion of remote and hybrid workers. We’ve heard horror stories of people taking on two or three jobs while working from home.

Lisa: I believe it. You hit on a key example, the tech roles, but I also think about medical coding and billing. Those are jobs that people from all over the country do and lend themselves to multiple potential employers. So, if hybrid or fully remote work is something that you plan to continue, it’s incumbent upon you the leader to work harder to engage the people who aren’t sitting next to you. Isolationism is not necessarily conducive to teamwork without an extra level of investment. It requires very deliberate behavior, and it is hard work.

Judy: So, you have remote workers all over the country. Has that been the case since COVID?

Lisa: I’ve been at Boston Children’s for two and a half years, so people were remote when I got here. I’m still regularly asked, “Are you taking away remote work?” As if I have the power. But I’ve heard leaders in our organization say, “I want to take away remote work as an option. I want my people back.” To that I say, “You are empowered to make that decision for your work group, but I’m cautioning you, you will lose people, and you have to be prepared for that.”

Judy: What career advice do you have for professionals interested in becoming a CHRO one day?

Lisa: The first thing I tell people is, “learn how to speak the language of the client you’re serving.” I’ve learned that myself. Nobody wants to hear FLSA, wage and hour law, fair labor, OSHA, and all the acronyms. They don’t care about that. They care about P&L, patient populations, and adjusted occupied beds. They care that we understand their strategy as a department within the business we’re in – and that business is healthcare.

Judy: What else?

Lisa: It’s important to learn the varying aspects of HR and understand that we are the compilation of a bunch of different functions. Employee relations is very different from benefits which is very different from compliance. Another thing is that it is really important to have thick skin. We deal with a lot of really complex people problems, things that can sometimes make you feel bad about the human condition. If you’re overly sensitive, this is not a great job for you.

You have to be able to discern the truth in a lot of storytelling. People will come to you with big stories, and when you start to dig a little deeper, you find that there’s an element of truth to that story, but there’s also another side. So you have to have impeccable judgment, a little bit of a poker face, and the ability to take information in and not necessarily react in the moment.

And lastly, you really have to possess the ability to be discreet and to hold information in confidence. This isn’t the old days of the personnel department. CHROs are integral consultants to the CEO and the executive team. Since COVID, the value of human capital and the people that lead the human capital function have become recognized as equally critical to every other resource, so we have an obligation to own that responsibility in a really deliberate way.

Judy: What are some things keeping you up at night right now?

Lisa: Right now, it’s the external environment. Like I said, we sit in the crosshairs of so many of these executive orders, and I worry about the impact on actual people. When we lose grant funding, there are people at the end of those transactions. When Medicaid cuts happen, there are patients at the end of those transactions. I want to do everything we can to ensure we continue to deliver the extraordinary care that we are known for at Boston Children’s and that the people delivering and supporting that care feel safe, feel valued, and still have a paycheck. So that weighs on my mind regularly. I wake up daily wondering how many more shoes will drop and who they will impact. So, we’re doing the best we can in this uncertain time.

Judy: What do you enjoy doing in your free time?

In this edition of “C-Suite Conversations,” Jim Venturella, SVP & CIO and President of Population Health Services at WVU Medicine, shares the leadership insights and strategies that have shaped his successful career. Jim reveals how he has unified a fast-growing, geographically dispersed IT organization into one centralized team while cultivating a culture of collaboration and career development.

WVU Medicine is West Virginia’s largest health system and the state’s largest employer, with more than 3,400 licensed beds, 4,600 providers, 35,000 employees, and $7 billion in total operating revenues. The health system is comprised of 25 hospitals.

Q & A with Jim Venturella

Judy: You started your career in consulting. How has that influenced how you approach technology and health systems?

Judy Kirby: You’ve been with two organizations that have grown substantially through acquisition. Can you talk a little bit about what you’ve learned through those experiences, and any advice you have for CIOs going through mergers and acquisitions?

Jim Venturella: The number one piece of advice is to set expectations early in the process, and ideally, through due diligence. When I joined WVU Medicine, we had six hospitals that had come together through mergers, and they weren’t all aligned. One of my early jobs was to create a common vision and bring things together, which was challenging. My leadership team went through a learning curve. Now, when we go into due diligence, we make sure people are aligned on what changes are going to occur, when they are going to occur, and how fast.  Making it clear that we wouldn’t maintain separate portfolios or teams. Once those expectations are set, when the merger does occur, things go more smoothly.

Judy: How have you brought disparate teams together and gotten them to function as one?

Jim: My early days at WVU Medicine were a challenge. The org chart illustrated that we were one, but it was really five different departments that were not integrated. So, I spent a lot of time on the road, meeting with teams face to face, articulating my vision and where we were going. I’d attend executive leadership meetings at each one of the hospitals. My message was, “We’re not five teams anymore. We are one team, and that’s how we will support the system. If there are issues, I will listen, and we’ll work it out together.  It wasn’t a question of if we are going to change – just how and when we’d consolidate.”

Once the consolidation was complete, it was much easier as new hospitals came into our system. It’s about easing people’s fear of change. It’s going to be different, but they are going to be welcomed onto the team. They will have great opportunities and be part of something bigger and better.

Judy: How did you approach handling duplicate positions, as far as either letting go of people, or reassigning their seats on the bus, so to speak?

Jim: We are committed to bringing everybody into the team. We go through a process of identifying the individual’s skills, what they’ve done in the past, and where they might fit within the team. We then look at where our needs are and do our best to match them up. If there’s not an exact match, we have a conversation with the individual about the training we will give them for their new role. For the most part, people are open. We’ve certainly had some people who decided to move on to something else, but we give everybody the opportunity to be a part of the team.

Judy: You’ve succeeded in keeping your team engaged and not having huge turnover. How have you achieved success there?

Jim: I think it starts with the organization. We have a great culture at the health system – very mission-focused versus feeling like a corporate entity. We focus on developing individuals, allowing them to grow their careers. I am always telling my management team that the first thing they should be focused on is their people. Do you know where they are in their career? Are you doing things to help them move up? Are you focused on recruitment so that you have all the people you need? Who on your team needs extra help, and are you focused on that?

Our talent management process allows everybody to grow their career and move up. This helps to minimize the reasons for them to go somewhere else from a pure career opportunity standpoint.

Judy: WVU Medicine is spread out over a fairly large geographic area, so how are you handling remote and hybrid workers?

Jim: Pre-COVID, I probably had two-thirds of the team in the greater Morgantown area, and almost everybody came into the office daily. As we’ve grown and added more hospitals, new team members are located outside of Morgantown. Since COVID, we have not brought people back. Logically it wouldn’t make sense, because now we’re so dispersed. We’re in four different states, so it’s hard to justify forcing people to come into the office and sit in Teams meetings.

I do think we are losing something by being remote. I think human connection is extremely important for teams. We try to minimize the impact by getting teams together at least four times a year at a minimum.  Hybrid is here to stay, so we are figuring out ways to maximize the new model.

Judy: What do you see are the pros and cons of that, as far as the professional growth of the individuals, and how they interface with the users of your systems?

Jim: For people who’ve been here for a long time, it is less impactful to their professional growth. They know the organization well and have built many relationships. I worry more about the new people we are bringing into the organization.  How do we help them feel connected and part of the team? How will they feel that sense of contributing to our mission?  We must continue to focus on it in ways that are different from how we have in the past.

Judy: I recently saw in an article that organizations are more likely to promote somebody who is hybrid instead of fully remote. Have you seen anything like that?

Jim: A lot of it comes down to the individuals themselves, and how they’re going to manage and how they’re going to interact with their teams. I have one manager who is fully remote, and that was a struggle for me mentally to get through my old-school thinking. I think managing people when you don’t see them is a real challenge, for both sides. I think hybrid is a better option, but that could hinder the growth of talented people on your team.

Judy: Some CIOs are concerned about the division of technology within their organization. Some have data, some have AI, cyber, analytics. At some, it’s more siloed. At WVU Medicine you pretty much have it all.

Jim: I am very fortunate, and it really started when I joined. As I mentioned earlier, there was no central IT group, so I set the expectations coming in that we were going to bring everything together under one group for the whole health system and operate as one IT team. Any shadow groups would be migrated in. And when there is a merger, that IT group joins our team on day one.

For one of the shadow groups, it took some failures before we were able to fully integrate them. There were lots of issues with getting things done, too much overlap between the groups, and escalations were coming in on a regular basis. We eventually gained support to consolidate, and ever since, it’s been a huge success. People wanted control so they could decide priorities. You can still accomplish that with a centralized model. In addition, you can ensure consistency from a standards and toolset standpoint. Also, if one area has some excess capacity, or we have backlogs in another area, we can move things around for the benefit of the entire organization. When you have silos, you can’t do that.

Judy: Does AI report to you as well?

Jim: Yes.

Judy: What are you doing with AI at this point?

Jim: Like everybody else, we are involved in lots of different activities. First, there are the AI functions that come from our vendors, like Epic and Workday. We’re trying to implement their capabilities when we feel they’re good. We’re doing ambient listening and just signed a new enterprise agreement, so we’ll be getting that to every physician who is interested. We have some conversational AI in our call center. We’re building out some custom solutions around the total patient journey, bringing structured and unstructured data together into new models. This provides interesting new capabilities for clinicians and population health groups, giving them a full picture of a patient’s journey throughout the health system. We have a laundry list of other ideas, and we get many new requests on a regular basis. We have been working on more efficient ways to screen them to determine value, so we don’t get distracted by every shiny object out there.

Judy: Did you set up governance to deal with everybody coming to IT saying, “Look at this bright shiny object. I need it now?”

Jim: To handle the added AI complexity, we’re bringing more people from across the organization onto our governance committee, including legal and compliance. We’re still in the formative stage, but the increased focus on governance is critical in this new era of AI.

Judy: I was talking to a CIO recently who said that risk reports to her, because it’s so key to everything that technology does. Does it report to you?

Jim: No, risk reports up through legal at WVU Medicine, and we work closely with them. Cybersecurity is always number one or two on our risk register. AI has become one of the top risks recently, which was the trigger for expanding our governance committee.

Judy: Another thing we hear is concern about the lack of up-and-coming IT leaders to fill future healthcare CIO positions. What are your thoughts around that, and what are you doing in terms of succession planning?

Jim: I do see fewer people with their eyes on the management track. We have three different career tracks, and we’ve identified that once people reach a senior level, a larger share want to be in the technical track or the project management track versus the management track. So, we’ve put a new mentorship program in place this year. We identified high-potential candidates who we think are good candidates to move into a management role. We team them up with leaders to help clarify what the transition looks like. I think helping people understand what life looks like in the management track is going to help us. We’re just four or five months into this program.

We also have a more formal talent management process that I brought over from my consulting days. I spend two full days each year with my senior leadership team, reviewing everybody in the IT organization, where they are on their career path, and who should be up for promotion. We also focus on the leadership team, who’s next in line, and if they are getting the right training and experiences to move up. We’re constantly thinking about growing and developing leaders, and dedicate resources and our time to it.

Judy: Looking back over your journey, what career advice do you have for rising technology professionals interested in becoming a CIO one day?

Jim: One piece of advice is to get comfortable leading without being an expert. As you move up it’s very easy to lead people in an area where you’re an expert. But as you take on larger responsibilities, you must figure out how to balance between managing at a high level, versus when you need to dive down and get into the weeds. You must know which managers are solid and who may need more hands-on support. But as you move to these bigger, broader roles, you have to do that efficiently and not get stuck in the details. It’s certainly a skill that you develop over the years with experience.

Judy: If you hadn’t become an IT leader, what other career do you think you were cut out for?

Jim: I like building things and designing things, so I could have seen myself as a contractor or something in construction. I have a degree in mechanical engineering so naturally I thought I was going to be an engineer. When I got into consulting, my expectation was that I was going to be working in manufacturing. However, my first consulting project was in healthcare and thirty-some years later, I’m still in healthcare.

Judy: Thinking like a mechanical engineer, what would you design to improve healthcare?

Jim: There are concepts from manufacturing around process design that could be applied to how we get patients in the door, through the process, and back home safely. In my population health role, we’re looking at how to ensure high-quality results and great outcomes. In surgery for example, we look at the process from the initial clinic visit to the activities that occur prior to them coming in for a surgery, and then what happens post-procedure. How can we make the entire process as efficient as possible?

Judy: What do you do in your free time, when you have it?

Jim: I like to work with my hands and do things outside. At work there is a lot of time spent in front of a computer screen or in meetings, and while we do a lot of great things, it doesn’t always feel tangible. But doing a little building project or working outside is something that you can step back from and visually appreciate – something tangible you built yourself.  I get a lot of satisfaction from this.

Judy: What have you built?

Jim: Little things like tables or shelves around the house, or a fire pit outside. Nothing major at this time. That’s for retirement.

Donna Roach, CIO at University of Utah Health, brings a valuable blend of healthcare operations expertise and systems analyst skills to her role. Donna leads with a systems mindset and a strong focus on people. In this “C-suite conversation” with Judy Kirby, she shares her perspective on leadership, digital health strategy, hybrid work, and the real-world impact of AI in the industry.

University of Utah Health is the Mountain West’s only academic health care system and provides patient care for the people of Utah, Idaho, Wyoming, Montana, and much of Nevada. The system is staffed by more than 24,000 employees, including 1,600 board-certified physicians at five University hospitals, 12 community clinics, and several specialty centers.

Q & A with Donna Roach

Judy Kirby: Your career has spanned very different organizations, including consulting and academia. What were the skills you possessed or learned that helped you with transitions to different organizations?

In healthcare IT, I started as an application analyst, so I understand how the applications work and how to implement them. I also did a lot of project management work, which came to me naturally.

Another important skill is something I call zooming in and zooming out. When something just doesn’t feel right, it is the ability to zoom in and ask the right questions, listen to the answers, gather information, and then zoom out to offer guidance or advice. Some people might call that micromanagement, but actually, it’s micromanaging when something doesn’t feel right and stepping back again and letting the team do their work when things are back on the right path.

I love leadership development–finding great leaders, understanding the skills they bring to the table, and meshing that into a team. I tend to bring together team players who have very different make-ups, behaviors, and personalities. It’s more work to lead that team compared to one where the people are all on the same bandwagon, but that’s dangerous because you can get into some really bad groupthink and nobody is challenging you.

Lastly, I would say, is relationship building. My top priority is my C-suite executives. They’re the ones that I have the closest relationship with, and to understand what’s important to them and what they need from me. I’ve learned how to be more thoughtful about the questions I ask so that it doesn’t sound like I am challenging them in a negative way, just trying to get better information.

Judy: What do you look for when hiring leaders?

Donna: I want them to know and appreciate that healthcare is unique. Sometimes I’m hiring IT people who have no healthcare experience. They need to understand that they’re going to have to develop and learn, that healthcare is about serving the community, the patients, and our clinicians, and they have to be willing to embrace a servant leadership model. Do they know up front that this is very different from a Fortune 500 or a manufacturing job because there are people at the end of our systems, and they could harm them?

I also look for people with great communication skills, not just written but verbal. Not everyone in IT has high EQ, but as a leader, I need them to bring that to the table because they’re going to be dealing with executives, physicians, and clinicians who aren’t always going to understand the IT speak.

I also like people who have innovation in how they think, aren’t stuck in their ways, and are willing to challenge themselves.

Judy: What has been the biggest challenge during your career?

Donna: The thing that is the hardest to wrap my head around is when people see me and my role and think, “You’re just the computers, right?” Or “You’re just the network.” They look at the CIO role as a director of IT. No, I’m your chief executive when it comes to all things IT and the big C of change management. So it’s a challenge sometimes working with another executive who only wants to bring you in when something’s gone wrong on a system that was implemented five years ago. Why didn’t you bring me in earlier when we could have had a better discussion? It’s like the musical Hamilton. I want to be in the room when it happens. I want to be in the room when we talk about strategy because IT is going to connect to everything.

Judy: You and I have talked about giving back. Can you speak a bit about how you’ve accomplished that and how it has influenced your career?

Donna: Early on, I was very involved with HIMSS, especially at the local chapter level, and I truly appreciate what HIMSS did for me by connecting me with other healthcare professionals. So now I serve on the advisory board, which is my way of giving back to HIMSS because that organization was there for me throughout my career. I’ve also been on the CHIME board, and I’m really active right now on the Federal Policy Committee, lending my voice to comment periods of federal policy. I think that’s giving back, too.

We’ve done some great things here in Utah, and I want the rest of the industry to benefit from the experience, so I try to present at national forums.

Judy: So, one of the questions we’re hearing now is, what’s the difference between a CDIO and a CIO? Is there really any difference?

Donna: I don’t see a difference. I don’t feel the need to have “digital” in my title because I’m doing it anyway. I think it is duplicative. I will say that I’ve had this discussion with my CEO in the context of succession planning. One day, when you are backfilling my job, you may need to add “digital” because otherwise some candidates may not think you’re digital.

When I came to Utah, I worked closely with our chief marketing officer, who has digital over her space. And I think that the collaboration that we created was amazing because she didn’t feel like I was competing with her. The message is “I’m here to collaborate with you, not to take it over.” What’s more important is acceptance among my peers and their confidence that I’m doing the job that will support them and the strategy and vision of the organization.

Judy: One of the big concerns I hear over and over is about the lack of up-and-coming IT leaders to fill future healthcare CIO positions. We’ve seen a lot of retirements recently. What are your thoughts around this void?

Donna: I think it’s real. I think the pandemic did not do our industry any good, especially for female leaders. I think some really strong female leaders look at this job and think, “Why would I take on this level of stress when I could be doing something just as beneficial in another job, in another industry?” It’s similar to the thought process we saw physicians go through, realizing how stressful it was and leaving their medical practices.

It is a high-stress position. Cybersecurity will always keep me up at night. And you have to wear a lot of hats, and I think that can take a toll on your well-being.

Judy: Looking back over your own journey, what career advice do you have for rising technology professionals interested in becoming a CIO one day?

Donna: Create your relationships and contacts with the various groups, like HIMSS, CHIME, and other professional organizations that can put you in contact with other people at your level. If your goal is to be a CIO someday, you will get it through the network you’ve created.

Some people think a CIO role will just eventually happen, but no, you have to have a plan. You have to be purposeful. Think about your background and where there may be some holes, and try to gain some experience in those areas.

Judy: Can you talk a little bit about remote and hybrid working models and what you’ve done there?

Donna: I was hired here in the middle of COVID, so everybody was remote. Then, as the pandemic wound down, there was talk about bringing everybody back into the office. But my IT folks were like, “No, no, we like it.” So I decided that, even though it may make my job a little bit harder, I would support the hybrid model.

I think I get more out of my staff by giving them this flexibility. There are people who want to come into the office every day, and we have that capability. And we do things where we bring everybody in. I have about 450 people in my IT department, and we just had a meeting at one of the big theaters, and we had 300 people in attendance. You have to incorporate those opportunities so you can get people together and have camaraderie and a sense of community.

I’ve heard other CIOs say, “How do you know that they’re working if you can’t see them?” I think, “How did you know they were working when they were all in the office? You’re not watching them all of the time.” It is more about how you are driving your value metrics, whether it be projects completed or project timelines. Those tell me more about how well we’re doing versus me watching people to see if they come in at 8:00 and leave at 5:00.

At the same time, I don’t want someone working 20 hours a day. We even put some rules in place so that if somebody’s in a different time zone, you can’t call a meeting at 5:00 pm for you when for somebody else it’s 7:00 pm. You have got to be thoughtful about that.

Judy: Can you talk a little bit about the status of your succession plan and the approach you’ve taken?

Donna: We’re just kicking off a project to plan for that so that, if I get hit by the proverbial bus, there is someone to step in. I do feel confident that any of my leaders could step in and run the ship for me. I’m very confident in all of their skills because it’s been a team effort. Succession planning must be done across the whole C-suite, and that’s what our CEO is doing right now.

Judy: How is generative AI impacting your organization and your strategy? What type of AI work are you leading, and most importantly, what sort of ROI are you looking for?

Donna: This is probably one of the most exciting things I have seen during my career, but it is early days for us. The university CIO and I issued a guidelines statement, a one-pager. We have a chief AI officer and a Responsible AI initiative on the university side. In healthcare, I hired someone to capture AI use cases and look at the value metrics to make sure we’re working on the right use cases as opposed to the shiniest objects, and to understand what will bring the most benefit back to the organization.

We’ve incorporated different large-language models. We haven’t settled on just one. Part of the secret sauce is that these models are all different, and they have different benefits. Where one may work great for one specific use case, another one is probably more beneficial and has higher viability for others.

One of the most exciting use cases–and I am sure you are hearing this from others you talk to–is ambient listening. I have never been in a situation where physicians come to me and say, “I absolutely love this. If you take it away, I will leave. I will retire.” I love the fact that they have embraced it, and they’ve also helped us refine it and make it better. We started out in the ambulatory space and implemented it in our inpatient space. I want our nurses to be able to tap into it, too.

Even in the Clinical Document Improvement space, there are AI triggers giving the physician feedback as they are documenting. I mean, we’re on the cusp of really changing and improving our clinician workflow. Now, sometimes the workflow is broken, so you have to remap the clinical workflow so that AI can be utilized effectively. It’s an iterative, agile process that’s reducing the administrative burden of documentation, and that’s been fun.

We’re on Epic, and we probably have six or seven applications with the Epic AI tools, but we’re also looking at others. I have a group that is called “Reimagined EHR,” and one of our physicians is improving the clinical workflow within just the EHR and bringing that actionable data back to the clinician.

I have an AI model for the ED that, as people come in, if the model detects a stroke, it immediately calls out the stroke team. And as you know, with a stroke, the faster you can treat that patient, the better. That’s one truly clinical workflow that’s been improved dramatically by AI.

Judy: Have you looked at the cost versus the benefit of ambient listening? Are you able to point to real ROI?

Donna: The way we track the value metrics is by looking at the soft and the hard benefits. Right now, I would say the financial ROI isn’t there. But if we add in the soft metrics, you see real value. For example, we’ve improved things for physicians who can now be more efficient, close out their charts at the end of the day, and not have to work nights and weekends to get that administrative work done. We have essentially removed the administrative burden of documentation.

I think responsible AI will be a factor too–what models we are using and the GPU usage. We don’t have an electrical grid system that can handle all the power required, so it’s also important to understand which is the right model to use and put some guardrails around it.

Judy: If you hadn’t become an IT leader, Donna, what other career do you think you were cut out for?

Donna: Well, two areas. One is a pathologist. I’ve always loved looking under a microscope and the science of pathology. But if I didn’t do something in healthcare, I would have been a farmer, like a fruit orchard or blueberries or something like that. My grandparents were farmers, and in the summertime, I always did 4-H. I’m a farmer at heart.

Judy: What do you like to do in your free time?

Donna: I golf and I play tennis, and I love both. I’ve golfed ever since I was a little kid, but I wish I were better. I am outside with people that I enjoy, and there’s camaraderie. I love tennis because it keeps me really active. I enjoy the competition, and I am getting better at the game. I am very aggressive at the net, which intimidates my opponent.

Judy: How do you have time for all this?

Donna: I make time. If I don’t carve that time out, I don’t do well at work. I like to wake up in the morning and think about what I am excited about today. That excitement, even if it’s just one small thing, like I’m going to play in my golf league that night, that excitement carries me through the day. It gives me a better outlook on my day and affects how I interact with people. When I don’t do that, I carry the weight of the world, and that’s not good. There’s a lot of stress in what we do, so if you focus on something you’re really excited about, it spills over into everything else that you do.

In this edition of “C-suite Conversations,” Judy interviews Doug Dean, Chief Human Resources Officer (CHRO) at Children’s of Alabama. With over 26 years at the organization, Doug brings a wealth of experience, humility, and forward-thinking wisdom to his role. From tackling burnout and embracing AI in HR, to fostering cross-generational understanding, he offers a candid perspective on what it really takes to lead with heart in today’s healthcare environment.

Children’s of Alabama is one of the nation’s largest pediatric medical centers, offering inpatient and outpatient care at its main Birmingham campus and locations across central Alabama, including Huntsville and Montgomery. As the state’s only health system dedicated exclusively to children, it also serves as the primary teaching hospital for UAB’s pediatric programs.

Q & A with Doug Dean

Judy Kirby: Doug, I’m so impressed that you’ve been with Children’s of Alabama for 26 years! What has kept you there all this time?

Judy: You’ve seen the evolution of the role over 26 years that we now call the Chief Human Resource Officer. What do you predict will be the focus of the CHRO role for the next three to five years?

Doug: I love that question. It is almost universal that if you ask not only CHROs like myself, but CEOs and COOs what keeps them up at night, they almost all now point to concerns about staffing the organization, developing leaders, and the challenging supply of talent. So, talent acquisition, recruiting, and retention are in the CEO vernacular these days, which means that the primary impact by CHROs and their teams is at the top of the leadership agenda.

Judy: A lot of the CHROs feel that they don’t have a seat at the executive roundtable. Why is that?

Doug: I don’t think there’s, as perhaps some colleagues may believe, an inherent disdain for HR leaders or underestimating the importance of the human resources function in an organization. If you’re not at the executive roundtable, it is often a self-inflicted wound if we’re honest. Frankly, some don’t polish their skills and learn to be a compelling presenter and use data to make their case compellingly. So I think we still earn our seat on the big issues.

I try to hire people who are smarter than me and then turn them loose to research who’s ahead in the world, especially in the healthcare industry. Are there good ideas we can borrow or adapt? In HR the trend can be to seep into being transactional and focus on pushing mundane work out the door. You really need to wall off – quite literally, physically –  the strategic planning work and protect it from the transactional grind.

Judy: How do you see AI influencing HR in the future?

Doug: I was at a seminar recently given by a well-known international HR consulting firm, and they presented some findings from a survey of a large group of HR leaders. Not surprisingly, only about 25 percent of those surveyed are doing what they consider meaningful AI implementations. We too are playing a little bit of catch-up, but I’ve started. I do think we need to step on the accelerator with AI in the HR profession. The cost of waiting or being risk averse as a “late adopter” might be higher and more painful.

It’s a simple step, but I encourage my HR team to play with simple AI applications, get their feet wet and go to conferences where people are talking about what’s already happening in HR with AI.

For example, almost all of us in HR love to use video as a communications method. It’s just more compelling in many instances. There is AI technology that produces very high-quality videos for your messaging with incredible speed and for dirt cheap.

I think we’ll also see more use of AI in the screening of candidates, and candidates more comfortable interacting with a bot. It’s already happening. Then, the only candidates that come across my and your desks will be the finalists, which reduces costs and the time required.

Judy: Everyone in healthcare hears about physician and clinician burnout. I saw an article at the end of 2024 about HR leader burnout too. What are your thoughts?

Doug: I think that there’s a constellation of issues, and many of them don’t have anything to do with what we experience at work. For some, maybe it is just life as they envisioned it in terms of the architecture of life, whether that’s relationships, friendships, or even the stress and joy of raising children. There are unprecedented pressures and demands on people outside of work, and yet we bring our entire self to the office. I think companies are only recently coming to terms with that – that we don’t want you to compartmentalize.

But I think that there are ways to forestall and overcome burnout by deliberately taking on new challenges at work that excite you. That might mean redirecting your career and it might mean a temporary drop in salary. What’s the saying? “If you do something you love, then you’ll never work a day in your life.” It’s kind of sappy, but I do think there’s a kernel of truth to it. So, I encourage my colleagues who have very long tenure like myself, to start to be a little selfish in their non-work life. “What things really give you joy when you’re away from work?” If you can optimize those and make sure you practice great self-care, that you’re eating well, you’re exercising, you have good experiences outside of work, I think it can dramatically forestall the ill effects of burnout through a more holistic approach to life.

Judy: There are multiple generations in the workforce. From your point of view, what are the differences between those generations in terms of what they want from the work experience?

Doug: What we’re experiencing is the outflow of baby boomers who have run our organization for a long time. They’re so loyal and hardworking. And there is an inflow of millennial and Gen Z workers. Our total population at Children’s of Alabama is just under 6,000, of which about 65 percent are in the millennial and Gen Z category. To me they seem so young, but you know what? They’re incredibly well-educated, well-trained, very high-tech, and very compassionate about what we do and what they bring to the table.

You’ve got to pay attention to the demographics. The minute our leadership starts building the work experience around people in my demographic – I’m between boomer and Gen X – we are making a strategic error because the reality is we’re only going to continue replacing experienced workers with younger people. So, we need to get really good at understanding these workforce demographics, their work preferences, and how they like to be led, the kind of feedback they want. It’s become a very big deal.

Judy: What differences are you seeing among the younger demographics?

Doug: Sometimes when we’re talking about generations, it still feels like we’re stereotyping with a broad brush. Dominant profiles of demographics like Gen Z, millennials, etc. are useful in many ways, but we should always be open to the possibility that an individual’s life experience and their upbringing and who they are might put them outside the mold. You might meet a Gen Z in their late 20s who is an old soul, and talking to them might sound like you and I having a conversation, Judy.

The differences I see mostly with the younger generations are that they really value when you check in with them so they can ask, “How am I doing?” Sometimes they literally mean, “Am I secure in my job? Am I performing well?” So, leaders and future leaders need to develop the habits of sincere and authentic ways of talking about development, growth, and performance, and paint a picture for the younger generations. “Hey, you’re really on track to be in position for advancement soon.” Frankly, they’re more like free agents, which I do not equate with disloyalty. I think younger workers have seen that if you stay at a company for 20 years, you can still get RIF’d or laid off. So, what’s the point in excessive loyalty, they may think? And I don’t feel that is a cynical point of view – maybe they’re the smart ones.

Judy: Relocation continues to be an issue for a lot of executives or high-level leaders. What have you implemented to get the talent you want to move to Birmingham, Alabama?

Doug: You need to have the good fortune of city planners and leaders who are working on the quality of life. For example, my HR colleagues and I had nothing to do with the food and wine scene here in Birmingham, which has become unbelievable! When my friends from cities like Atlanta, Chicago, New York, and Boston come here, they rave about our fine restaurants. If it’s a family moving here, there is access to very high-quality schools. The natural resources include freshwater lakes, and in 3 ½ hours you can drive to the world’s most beautiful beaches in Destin, Florida and Gulf Shores, Alabama.

Some may come here kicking and screaming because of outdated preconceived notions, but once they’re here and they get plugged into what we mean by southern hospitality and the friendliness of a place like Birmingham, Alabama, they want to stay. We see it time and again.

Judy: What testing, interviewing techniques, or other strategies do you employ to make sure you hire the right person in every position?

Doug: This is going to sound like a paid endorsement but we’re about 10 years into the very successful use of an instrument called Judgment Index. It’s not a personality or IQ test, neither of which is very predictive of performance, especially in a leadership role. But we believe strongly in the Judgment Index, which is considered to be among the most reliably validated and tested assessments of its kind. It is much more predictive of performance in a work setting, especially in a leadership role.

Judy: Over the course of your career as the HR leader, how have you partnered with departments to improve their culture?

Doug: What’s interesting about your question is that you’re invoking the notion of not just the organizational culture, but a culture within a particular department. I think we’ve done that but I would describe it as informal. I’d be a little nervous about a department veering away from the organizational values much at all. If they are able to take our organizational culture and values and put their own unique stamp on it, as long as those two are compatible, that can be a beautiful thing. It’s mostly my OD leaders having a lot of conversations with a director and asking, “What does your team need? What will attract talent?” For some, that might mean offering four 10-hour days and letting people have long weekends during the summer. For others, it might mean the ability to cross-train so people feel like they’re growing and developing. So, it can be a wide array of things.

Judy: What is your organization doing when it comes to remote and hybrid work, and what has been successful for you?

Doug: At the start of the pandemic, we had to send upwards of 1,800 staff members home. It was for safety reasons; we had no choice. What’s that phrase, “Necessity is the mother of invention?” If we didn’t do something, their income would be impacted. So, we quickly got very good at people working productively from home. Of course, patient care is not remote, but the corporate service areas.

Culturally, we think great things happen with teams when they’re physically in contact and come to a central office. That’s not to say this subject hasn’t been controversial. People got used to being at home and working remotely, and it was popular. But except for IT workers and a handful of other areas, we’re mostly back at the office, and that’s unpopular with some. Maybe they have work-life balance challenges. But I think there is a socialization and a mental health that can come with going in and being with people and not getting too isolated in your own home space for long hours. I do expect that the world will compel us to offer some hybrid work-from-home options, but we’re unlikely to have leaders leading their teams remotely.

Judy: Is IT still fully remote?

Doug: It is case specific. For those in IT doing a lot of heads down systems work, it doesn’t require a great deal of face-to-face communication, many of those are fully remote. Others want to come in a few days a week, so they are taking creative approaches that are driven by the nature of the work as opposed to enacting broad, deep rules. We’re trying to be nimble and flexible, and when we can, we adapt the rules to what will make the most sense for a particular employee.

Judy: There has been a lot of quiet quitting and early retirements in healthcare. What are you seeing as CHRO at Children’s of Alabama, and how are you addressing these challenges?

Doug: For more than 15 years, we were successful at keeping voluntary turnover under 12 percent system-wide, which is remarkable. Then in the wake of the pandemic, we joined the throngs of hospitals where it spiked to over 20%. The worst year was probably 2021. That was a shock to the system that forced us to ask a lot of difficult questions around what our workforce planning assumptions should be. 

One strategy when good people leave the system is that maybe they’ll be interested to come back and work with us again in the future. So let’s get really good at re-recruiting them because we’ve already made this enormous investment in them. And, when we make an offer and fill a single position, we should still be very interested in the two or three runner-ups. They were talented enough to be a finalist so could they be a quality hire for another position?

Judy: Were you successfully mentored at key points in your career?

Doug: I was very fortunate along the way that in several cases, my bosses were friendly and didn’t always have to act like my superior issuing directives, and we became mutually respectful. My experience has been that people are usually delighted to share their lessons learned, and what they see in you, where you can grow and improve your chances to have impact as a leader.

My advice is to be a sponge when you’re around leaders you really admire and become a student of their leadership. If your company will help fund it, I highly recommend a quality executive coach as a safe space where you can go talk about a weakness or a specific mismanaged situation, and get coaching on that. Maybe they’ll do a 360 with your peers and subordinates, but be prepared for that to sting a little and point out some areas that you really need to improve. I think it’s just being humble and never feeling like you’re a finished product, and finding the joy in continuous development.

Judy: I hear from HR executives that often, one of their strongest relationships is with the CIO because IT touches everything. From your experience, what does a really strong partnership with the CIO look like?

Doug: I admit that we don’t speak the language of IT, but the CIOs I’ve worked with understand and are happy to translate. I think it’s critically important that you hire a very capable, strong HRIS leader so that you have a translator walking along with you. We’re trying to turn data into useful management information to operate our workforce and do all the powerful things that you can with technology. So, build a relationship and get to the point where your gap in technical knowledge compared to a CIO’s does not become an impediment.

Judy: What do you like to do in your free time?

And anything outdoors, whether it’s on the water, in the woods, on a golf course, or just sitting on my back deck with my sweet little yellow lab. I love the fresh air, and I think getting  into the great outdoors is good mental health advice for all of us.

Heather Nelson brings a unique blend of operational skills, strategic vision, and deep dedication to healthcare to her job as SVP and CIO of Boston Children’s Hospital. In this edition of “C-suite Conversations” Heather shares with Judy how she launched her IT leadership career, the mentors who shaped her path, and how she’s building empowered, forward-thinking teams.

Boston Children’s Hospital is one of the largest pediatric medical centers in the United States, offering a complete range of healthcare services for children from birth through 21 years of age. Boston Children’s is home to the world’s largest pediatric research enterprise and is the primary pediatric teaching hospital for Harvard Medical School.

Q & A with Heather Nelson

Judy Kirby: Heather, your entire career has been in healthcare technology. How did you choose technology and healthcare, and why have you stayed?

After a year, I got a job as a system administrator in case management. The job was implementing a case management system for our case managers in the hospital and our health plan, Priority Health. I taught myself what I needed to know because I was not a computer programmer by any stretch. Later this led to a job as senior analyst in IT when Butterworth and Blodgett were merging to become Spectrum Health in the late ’90s. We had selected Cerner as our EHR and my job was to focus on the legacy systems. That’s how I got into healthcare IT.

I stayed in healthcare IT because I had a tremendous manager who saw something in me that I didn’t see in myself right away: that I was a people leader, a strategic thinker, and that I knew how to bring people to the table to have a conversation. She promoted me from an analyst to a team lead while we were implementing Cerner, rolling off legacy systems. This allowed me the opportunity to understand hospital operations from a perspective larger than just the project I was focused on. I’m just so fortunate, Judy, because I’ve had such tremendous mentors and folks who looked out for me as I grew up in my career. As I always say, “In IT, we’re the people who take care of the people who take care of patients.” That’s why I stay.

Judy: You’ve continually been promoted and grown into increasingly responsible positions during your career. What skills and abilities have helped you do that successfully?

Heather: I love operations and understanding the problems we’re trying to solve. I love the relationship aspect of what I do. I think what’s helped me succeed is building and fostering those relationships, especially coming into a new organization. So I credit my listening skills, my ability to build relationships, and the fact that I’m a straight shooter. I’m an executor, which means I like to get things done. Sometimes that’s a weakness that I have to balance, because I’m not a very patient person.

I look for opportunities to stretch my abilities. The CIO role is so different today than it has ever been, and it’ll continue to evolve. You have to be seen as a strategic partner and have a seat at the table, not be seen as an order taker. I don’t want anyone on my team to be an order taker. I want them all to feel empowered as strategic partners, to have the conversations, and to bring options forward.

Judy: How do you position your team not to be order takers? How do you train them and help them show up as strategic partners?

Heather: A lot of my team members were used to someone calling them or sending them an email, and using a first in, first out approach. We had to restructure how we take in work and how we prioritize work. I told them, “As we move to new enterprise systems, we have to be very thoughtful, and we have to think through an enterprise lens. We have to understand the risk and the impacts of making a change or a request.”

We talk a lot about this in our monthly departmental town halls, and at quarterly leadership meetings. We talk about how important it is that they all feel empowered to ask questions, to ask for a seat at the table, and to bring options. I’ve been here three and a half years, and we don’t have it nailed down perfectly yet. We’re still learning, both as a leadership team and as a department, but I practice what I preach. My job is to advocate for my teams and their job is to let me know when they need help, when they need a different voice at the table. That’s really how I enable and empower my teams.

Judy: How did you decide who to seek out as mentors, and how have they bolstered your career? And as a corollary, how are you helping your team pick mentors?

Heather: For me, it was observing senior leaders in the organization, watching how they interacted and communicated. Then, I would ask my manager, “Can I go meet with so and so? Would you mind if I reached out to them?” I was fortunate that I never had an upline who felt threatened by that. I sought out female executive leaders because IT was a very male-dominated environment when I was getting started.

When I’m asked to be a mentor, one of the first things we talk about is, “How are you building your network? Do you understand what that means? Do you have someone besides me who you trust and who you look to for guidance?”

I still have a lot of mentors I can reach out to and throw something at them that I’m struggling with. You’re one of them, Judy.

I encourage folks to look for leadership mentors and peer mentors. I think having peers you can lean on and trust is just as important as having someone who can move you up in your career. You need to strike that balance.

Judy: I hear from a lot of CIOs who are concerned about the division of technology within the organization. Some are responsible for data while others aren’t. Some have AI, some have cyber, some have analytics. What areas fall under your leadership?

Heather: I see digital as part of what healthcare IT is responsible for. Every organization is structured differently, but here at Boston Children’s Hospital, there is a separate digital health team. Obviously, we work very closely together. And there are times when the lines are blurred a little, but we just work through that. Everyone brings value to the table. Everyone has a job to do.

I have data and analytics, I have cybersecurity, research informatics, medical informatics, and all of the systems and over 22,000 devices across the enterprise, so it is a very big scope. I’m partnering with our chief innovation officer on AI. The two of us have stood up AI governance in partnership with our senior executive leaders, who have provided tremendous support for this. I don’t want his job and he doesn’t want mine, so we have found a way to partner, because there’s so much potential for AI in healthcare.

We’ve been using AI for a long time at Boston Children’s, especially in the research space. Now, how do we take innovation happening in one small group and make it work for everyone? A lot of good things are happening and AI is crossing multiple teams, which is okay because we’ve created those guardrails and some structure.

Judy: How do you see the CIO/CDIO role evolving over the next three to five years? What are some of the new responsibilities and new job qualifications?

Heather: Having strong financial acumen is so critical for a CIO or a CDIO. We manage multi-million dollar operating budgets and capital budgets. You have to make sure that you help the organization build ROI from the investments it makes. Healthcare organizations are doing a lot of building, a lot of facility work. More and more we’re moving out into the communities. Then we also have connected care, hospitals at home, virtual visits and virtual care. What technologies do we need to bring to bear there? How are we pivoting from only bricks and mortars to supporting these new workflows?

And it is different for our care teams, who are accustomed to having the patients and the patients’ families physically in front of them. But it’s hard to get to Boston Children’s because driving in Boston is not easy. If we can care for our patients at home with wearables, or with a virtual visit, and they don’t have to worry about the stress of driving or finding parking, how awesome is that? So as CIOs and CDIOs, we have to make sure that we’re at the table early, that we understand what problems we’re trying to solve, and bring some recommendations, whether that’s from a business lens or financial lens, and support the processes.

We’re change leaders and change management is hard. No one wants to change but I need to ensure that utilization and adoption is where it needs to be. Therefore, we need to wear business hats, strategy hats, operational hats, and financial hats as much as we have to wear technology hats.

Judy: A lot of CIOs aren’t at the table early, or they’re late to the party, so to speak. How do you make sure you’re present early in the conversation?

Heather: One way is using situations where we were late to the table as examples. So often we’re given dates – “We have to open the facility to our first patients in January.” “Well, I appreciate that you’ve set this date but we need lead time to be able to deploy and to test it, so realistically, it’s going to be February. We have to help them understand the complexities of the technologies, and that we can’t just flip a switch and make everything work. Next time, please bring me and my team to the table earlier.”

Governance is a big part of this. We have an IT executive steering committee that is chaired by some of my operational partners.

Judy: Another big concern I hear about on a regular basis is the lack of up-and-coming IT leadership talent to fill future healthcare CIO positions. Are you seeing this?

Heather: I don’t see it, and maybe it’s because of the market that I’m in. I’m in the Boston market and previously the Chicago market. Every market is so very different when it comes to talent, whether it’s recruiting or retaining. I’ve spent the last three and a half years building a team. The leadership team I have today is completely different from the one I had when I started.

Whenever I’m hiring leaders, I’m thinking about who can potentially sit in this seat if I leave for a new opportunity or if I win the lottery. We spend time as a leadership team talking about succession planning at Boston Children’s. Not every organization does it but I think you have to be intentional about it for it to be successful.

Judy: So you’ve been recruiting and retaining the best senior level talent. What are some of the keys to your success there?

Heather: I think it’s the name, Boston Children’s. People want to work here, and many of them have worked here for a very long time. I mean, I have tenure on my team of 20, 30, 40, even 50 years. I think a hybrid work environment is a big draw as well. We have team members from Florida, from Idaho, from almost all the states that we can hire from, which has enabled us to get some really great talent.

Having big projects like an Epic implementation, and our next big, a new ERP implementation draws talent as well. Sometimes they start as a consultant, and then they want to stay and work at Boston Children’s full time because they are so excited about the mission, and seeing the fruits of their labor.

Judy: Some organizations are calling their people back. Some are struggling with the remote versus the hybrid and how to grow those who haven’t built the relationships. What have you learned along the way? What’s made you successful doing that?

Heather: We are not calling people back. Boston Children’s senior leaders, in partnership with our Chief Human Resource Officer, have created the policies and the environments where some people will be 100% remote. Their roles are conducive to that, but for the most part, I have a hybrid environment in IT. I’m in the office most days. There are 20 to 30 people who are in the office every day. During the EHR implementation we had folks who needed to be on site four days a month. Not four days a week, four days a month. Some people didn’t even want to come in four days a month, so they chose to leave and I was okay with that.

Judy: What unique things have you done to engage your team in activities remotely?

Heather: This past fall, we did a costume contest, and we had it online. We even did a pet costume contest. We had different virtual conference rooms set up so people could walk through and see each other. Sometimes at our town halls, we’ll do a water cooler session, give people a topic, and send people off into groups to engage. I do a “coffee with the CIO” for all my new hires every month, just to get to know one another, because many of them will remain remote and will never come into the office.

Judy: I read an article recently saying that people who work in the office, at least part-time, if not all full-time, are more likely to be promoted than those who are totally remote.

Heather: I haven’t seen that in this organization. I think that the work that you do, whether it’s remote or in person, speaks for itself. And I think those who are remote are very intentional, and want to grow and want to take on new things. I think they actively seek it out and make themselves known to their leaders. I don’t have metrics on that, but anecdotally I have a nice blend of that in my department.

Judy: As CIO, are you involved in any strategic initiatives around sustainability?

Heather: Yes. One of the pillars in our enterprise objectives and strategic plan is around sustainability. In the Boston market and being in Massachusetts, sustainability, being green, the environment are top of mind. We’ve done a lot of building over the last few years, and there are many requirements and regulations around sustainability that our senior VP of facilities understands. She is amazing. I try to help as much as I can by limiting the size of our technology footprint and keeping things in the cloud. Maybe we don’t need a printer in every room, just one printer at the nurses station, for example.

There is a realization that how we’ve operated in the past is just not sustainable. It’s not good use of our finances and it’s not good for the environment. So we are very, very conscientious about how we deploy any new facility and what goes into that facility. Because it is an enterprise priority for the organization, all of us are aligned with that and my teams think about it a lot, especially in our data centers.

Judy: If you hadn’t become an IT leader, or a doctor or PA, what other career do you think you were cut out for?

Heather: I would love to be a COO, or a CAO, or even a CEO of a health system. I’m just so drawn to operations. I love learning the ins and outs of the hospital and I think being a CIO has afforded me that because IT crosses every single vertical of the organization. Maybe there’s still a COO or a CAO or some type of operational role in my career path. I wouldn’t shy away from it.

Judy: What’s something you love to do in your free time?

Heather: I am a workout fiend. I love the Peloton and the Peloton app. I have a 667-day streak going of doing something Peloton. Whether it’s running, biking, whatever, lifting weights, it is a stress reliever for me. It’s something that I make time for every day. It’s a non-negotiable for me.

Few understand the intersection of healthcare and technology better than Terri Couts, EVP and Chief Digital Officer at Guthrie. With a career that began in teaching and pediatric nursing, Terri has navigated the complex world of healthcare IT, leading transformative initiatives that enhance patient care, efficiency, and operational effectiveness. In this interview for ‘C-suite Conversations’ Terri covers a range of topics from sustainability to AI’s role in healthcare.

Guthrie is a non-profit, integrated healthcare system offering a comprehensive range of healthcare services across 12 counties in north central Pennsylvania and upstate New York. The organization manages over 1.5 million patient visits annually, providing care to predominantly rural communities.​

Q & A With Terri

Judy Kirby: Terri, you started your healthcare career as a pediatric nurse. How did you end up on the path to becoming a technology leader?

So I interviewed for an analyst role with ASAP, which is Epic’s emergency department information system. I didn’t truly understand what the job was even after the interview, but they offered it to me, and I needed a change, so I took it.

I really loved solving problems through technology. If there was a way to make what they did better it really interested me, so I dove in and got every certification that I could. After some time I was managing the inpatient team at Akron Children’s. Meaningful use had kicked up so I decided to go into consulting. I learned a ton about all kinds of different healthcare systems, big and small, and how we could make EPIC enhance that work.

In 2014 I joined NYC Health and Hospitals, leading their Epic implementation. When our CIO Bert Robles left there and landed here at Guthrie, he recruited me. At that point, I was ready to be off the road. I had a daughter entering high school and she was a little bit in need of some parenting at home, so we made the leap and moved to Pennsylvania.

Judy: Did you have a strong mentor who helped you?

Terri: I’ve had a couple of mentors, starting with a physician at the Cleveland Clinic. He was a renowned pediatric surgeon, and while some surgeons can be socially inept, this one was the opposite. He really wanted you to be engaged in the care he was providing. He wanted you as part of the team. I’ve had some mentors in IT also. Because I was a nurse leading IT, there was constant questioning of my ability. But I know how technology ties to the patient, and I think that’s what my mentors have focused on—the art of storytelling, the art of understanding the why, listening, and relationship management.

Judy: What do you bring from your background as a pediatric nurse that helps you be a strong IT leader?

Terri: I think being able to meet people where they are. As a pediatric nurse, I had to assess the child’s capabilities, you know, their understanding and communication and all those things. I’m a great observer and listener, and I’m able to get to know the audience that I’m talking to. Another attribute that a pediatric nurse has that is valuable as a CIO is patience and a certain level of empathy and compassion. I want to make sure that I’m meeting people where they are, not to always say “yes”, but to make sure that they understand my position, that I understand their position, and we can meet somewhere in the middle.

Judy: Has your lack of hands-on technical expertise been a positive or a negative?

Terri: Honestly I think it’s been mostly positive. The reason I say that is because I can ask all kinds of questions and it requires people to think differently because my questions come from a clinical framework and not from a technical framework. Sometimes I will even ask questions that already I know the answers to just to help the technologists think a little differently. I listen a lot. I want to learn enough to understand the why behind things and make sure that I can pick the right vendors and partners. I don’t need to be highly technical to lead relationships and to drive innovation and serve our patients, but I make sure I have a strong team underneath me.

Judy: One of the biggest concerns I hear over and over again is about the lack of up-and-coming IT talent to fill the CIO positions. There are a lot of CIO positions open right now. What do you see as the reasons for this, and how are you helping your leaders position themselves for career growth?

Terri: You know caregivers are not the only people who burn out in healthcare. With the challenges around cyber threats and infrastructure and audits and rising technology costs, it is a high-stress job. It takes away from time with your family and being able to care for yourself. I have a hard job but I actually like the challenge. I thrive in this kind of environment. But five years down the road I might not want to, so I can understand it.

IT is so diverse, we have to have an EPIC expert, an infrastructure expert, we have a desktop expert. There’s not one person who knows it all and I think that makes it challenging to groom individuals into leadership positions by allowing them to get outside their particular area. I try to connect people with other groups on my team, and have them participate in some of the boot camps and the training that will give them experience but also the peer connections.

I coach people that it’s okay to be uncomfortable. If I were comfortable every day in my position, then something is probably wrong. Four or five years ago, I had somebody who had started out as a lab technologist. She came into the EPIC space and she was managing that really well because she was meticulous in her detail. We didn’t have a project management office at the time so I said to her, “I want you to lead my new project management office.” At first she was like, “What are you talking about?” But she thrived in the role even though she was so uncomfortable at first because it wasn’t what she knew.

Judy: There are a lot of conversations about the CIO position. What should their responsibilities encompass and what should it be titled? You’re a Chief Digital Officer. Others are still CIO, but there are CHIOs, the Chief Data Officers, the CMIOs, the Chief Analytics Officers, Chief AI Officer. They all have different parts of IT. What do you think it should be called and what parts do you have or don’t have, and why?

Terri: I think it depends on the organization. I started out as the CIO and we changed it under Dr. Sabenegh’s guidance, our CEO, to add digital because of his beliefs around how technology enables care and how we strive to be more transformative in our care model using technology. I have all the traditional CIO responsibilities and AI now falls into that. We don’t have the type of organization that would need a chief AI officer, but at a place like the Cleveland Clinic that has a lot of funding to invest in building large language models that they could even sell at some point, it makes sense to have that oversight. But there is the worry that having a lot of chiefs can lead to fragmentation. When you have silos, particularly in larger organizations, things start to break down, like security and change control processes, and redundant technology tends to grow out of that. If you have an academic center and a large research center, having a chief data officer makes sense. But we have a small research center. We are building out our own data lake house and keeping it under my purview makes a lot of sense to ensure we have all the security.

Judy: One of the other concerns I hear is recruiting and retaining top talent. It’s long been a challenge for IT, especially during and after the pandemic. What’s one of your most effective recruiting or retention strategies? And what positions are the most difficult to fill right now?

Terri: We’re a hard organization to recruit to for pretty much every role due to the rural location. If you recruit a physician, you have got to make sure their spouse is also happy in this environment. It’s an hour to Starbucks, so for many, it’s a different kind of lifestyle.

But the pandemic really opened it up for us. It allowed my team to work remotely in an organization where that had previously been frowned upon. They have work-life balance and flexibility now and that has been a large retention factor for us. They don’t have to do all that driving and pay for gas. It also opened up the doors to recruit in other states. I have a manager who lives in Utah, and I have a cybersecurity expert who lives in North Carolina. They work our hours and they make it work for their families, but they don’t have to move.

Cybersecurity is probably our hardest area to recruit in right now primarily because those are entry-level positions doing a lot of groundwork that isn’t very exciting. Infrastructure has been a challenge too, because those individuals need to be on site. As the talent ages out, it’s been a little bit harder to recruit for that.

Judy: With continuing financial pressures in healthcare, how do you meet the rising demands of costs of technology? Are you able to track a true ROI for the investments you are making?

Terri: Outside of the traditional EPIC stuff and standing-up servers and those kind of things, pretty much everything technology-driven that we bring in requires a pro forma. That’s a process we started about four years ago. So for example, with the Guthrie Pulse Center, which is highly technology-enabled, we took a five-year outlook. We put down the hard cost, and we put down the savings. The first year and a half was all investment, but now we’re actually seeing savings. But we plan for all of that. But some things you just have to do even when there is no ROI, like replacing aging PCs. You have to spend the money, otherwise, you’re going to have a cyber event.

I think the pro forma process also helps with other things like adoption of the technology because you already know the problem you’re trying to solve and you’re targeting it together with the business owner. It’s not just about deploying the cool thing.

We try to take a platform approach. We have three major platforms, Microsoft, Oracle, and EPIC. Whatever the ask is, we try to make it work through one of those platforms before we look for something new. But for most things we can prove out at least a small ROI. There’s also a lot of soft ROI that comes down the line that may not have a direct correlation. For example, remote patient monitoring tech in the home probably reduces visits to the ER, but that is not necessarily a correlation being tracked.

Judy: How is generative AI impacting Guthrie’s strategy? What type of work are you doing along those lines?

Terri: We don’t have the shop to do any kind of large language model training ourselves, but we’re working with partners on their AI products. We evaluate AI in three key areas: improving patient care, increasing provider efficiency, and enhancing operations. Every AI tool goes through a governance process to ensure that it’s necessary and ethical.

Generative AI is especially tricky since it relies on sensitive patient and organizational data. We’re using it carefully for operational improvements like predicting falls and pressure ulcers (Artisite), capturing provider-patient conversations (Ambient Listening), and strengthening security.

AI won’t replace human interaction; it’s about creating a more personalized, proactive, and connected experience. AI is both exciting and daunting, but if it becomes more affordable, we could see some game-changing advancements.

Judy: As the CDO, are you involved in any strategic initiatives around sustainability?

Terri: Absolutely. We recently held leadership discussions on transformation—not just for a single project, but for the broader goal of sustaining our ability to serve patients, remain financially responsible, and address workforce shortages. Technology is required to make these things work, and I wouldn’t want to be in an organization where I wasn’t part of that conversation.

We’re trying to balance innovation with cost efficiency. For example, we’re exploring ways to offer our call center services to smaller hospitals or rural healthcare centers that lack the resources to build one of their own. They get access to high-quality support without the overhead, and we earn a little bit of profit. Our goal is to control costs while transforming to meet our community’s needs.

Judy: So, as you look ahead to the rest of 2025, what are your biggest challenges?

Terri: It’s the amount of work. I see a lot of change happening and everything is supported by technology. So, keeping my team engaged while not burning them out will be a big challenge.

What’s happening at the federal level impacts us because there doesn’t appear to be a game plan right now, and there’s a lot of change management happening in our organization when it comes to care model redesign. Because we’re being asked to move fast, and change is coming so fast, we need to be able to support our users through these changes. That is something I want to keep my eye on. That and the patient experience in general.

Judy: If you hadn’t become a nurse who then became an IT leader, what other career do you think you were cut out for?

Terri: When I was growing up, I always wanted to be a pediatric physician, but I got my first degree in education. I was a teacher for about four years before I went back to school and got my nursing degree. I guess medicine has always been where I wanted to be. I never thought that I would be sitting in this chair, although I do love what I do most days.

Judy: Outside of work, what’s something you love to do in your free time?

For this edition of C-suite Conversations, I sat down with Keith Perry, SVP & CIO at Carilion Clinic, to discuss his journey into technology leadership and the evolving role of CIOs in the healthcare industry. From an unexpected career pivot to leading digital transformation efforts at a major healthcare organization, Keith shares his insights on leadership, governance, AI integration, remote workforce management, and the future of healthcare IT.

Carilion Clinic is a non-profit health care organization serving nearly one million people in Virginia through hospitals, outpatient specialty centers and advanced primary care practices.

Q & A with Keith

Judy Kirby: Keith, thank you for speaking with me for our ‘C-suite Conversations’ series. When did you realize that technology leadership was of interest to you, and why?

I had always been interested in technology, so I started my undergrad work in computer programming and business administration. And later on, I got my graduate degrees. The leadership aspect has kind of grown organically over the course of my career. I did not start out thinking that I would end up in technology leadership. I was just interested in technology in general, and midway through my career I stepped into a leadership role. And I guess the rest, as they would say, is history.

Judy: You were with a consulting firm for about six years. How did that influence your approach to your career as well as your leadership style?

Keith: Most of our clients were C-suite executives, so it was a really good opportunity to have exposure to the C-suite and to learn how important relationships are to being successful. Consulting firms are really built around relationships. And I think it also helped me set a work ethos of doing what it takes to deliver for your client. I still carry that with me today, that discipline, that rigor around that process for how we deliver work for our patients and our customers.

Judy: I talk with CIOs who are concerned about the division of technology responsibilities within their organizations. Some have data, some have AI, some have cybersecurity, some have analytics, population health. Some don’t. They’re concerned about the division of it and the siloing effect. How you do work at Carilion?

Keith: I’ve talked about this with my colleagues from across the country, and there doesn’t appear to be a one-size-fits-all model. Even in organizations that are similar in size and structure to us, you see very different organizational structures in technology. Personally, I have overall accountability for information technology, information security, and also clinical engineering, because the medical equipment, for all intents and purposes, looks like all other computer equipment that sit on our network today. Here at Carilion, we’re a physician led organization, and we subscribe to the dyad model. So, there’s a physician leader and an operational leader who are paired to deliver medical services to our patients. I have a very similar partnership here. I partner very closely with the CMIO, we report to the same executive leader, and we form a dyad partnership to deliver technology services to the organization.

The CMIO has health analytics, clinical informatics, and digital health, and I’ve got everything else, but we work together. You see very different footprints across different organizations. Those that are larger that need to compartmentalize have created separate roles for AI, or reporting and analytics. In the end, for me, it’s less about the title that I have and more about what we’re doing to take care of our patients and our internal customers.

Judy: You’ve been in the CIO role for some time now. How do you see the CIO or the CDIO job evolving over the next three to five years? What are some of the new responsibilities and job qualifications that are going to emerge?

Keith: I think we’re continuing to see the CIO become more and more strategic, helping the organization set its strategy and being involved in the business side of things. Technology plays a crucial role in driving the delivery of services within healthcare organizations, as well as across all other industries. I think that is placing an increasing burden on technology teams to deliver and on CIOs to understand all sides of the business, including the care side of it. Establishing relationships and having close partnerships with the other senior leaders in the organization is critical. I spend most of my time doing that, working with the clinical and operational leaders. I spend very little of my time actually running the business of IT. That’s primarily delegated to my senior leadership team in technology.

Judy: How have you worked with your team to make them more savvy on the business side, especially now that we have so many hybrid or remote employees? Has that been a negative for getting to where you need them to be?

Keith: I wouldn’t say that it’s been a negative. I would say that it has posed some interesting challenges. Helping to educate my leaders and encouraging them to become more involved in the business and operational aspects of the work that we do has been critical. One of the first things I did when I got here at Carilion was establish the business relationship management model and embedding our IT folks into the clinical and operational sides of the business. So, my Business Relationship team is embedded throughout the organization. They’re out with our clinical and operational leaders. They’re attending their regular meetings. I don’t think we can be effective in helping them do what they need to do if we don’t understand their work.

There’s a unique opportunity here to connect people in IT with the meaningful impacts we have on people’s lives, their health outcomes, and our communities. The challenge that comes from having remote workers is that it’s not as easy to get those teams engaged and out in some of our facilities. But we have regular team meetings, we bring folks in from remote locations so that they are here onsite to develop that connection to the mission and the work that we do. However, it’s important that my leadership team is all local. We feel that it’s critical to have that face-to-face time with the clinical and operational leaders.

Judy: How has your team learned to lead remote employees? Prior to COVID, most people were in the office. How has your team responded? What lessons have you learned?

Keith: I would say we’re ahead of the curve on leading a remote workforce, or a hybrid one. We had already started moving down the remote work path about a year and a half before COVID. We were doing that because we were finding challenges from a recruiting perspective, and we were looking for ways to offer more flexibility to our existing teams as a retention strategy. We sat down and talked about what that would look like. How do we stay connected with the teams? How do we ensure that we’re still seeing the same quality product, the same level of production, etc? We developed a remote worker agreement that has a lot to do with how we stay connected. For example, we require everybody to have their cameras on during meetings. We also encourage “drop by” meetings, just like you are in the office and drop by someone’s office if you need to chat or work through a problem. We just do it virtually with them.

Judy: You once told me a story about how your contract negotiation skills came in handy when you were building your house. It was an amazing story. How have negotiating skills been useful in your career?

Keith: I have to say that I think it’s one of my best skills, negotiating contracts and honing in on the parts of contracts that are important. We have hundreds of contracts that are constantly in a state of being renewed or renegotiated. I’ve worked really hard to educate my leadership team who have overall accountability for those contracts and our compliance with those contracts. Every vendor is different in terms of how they leverage licensing models, and the shift to software as a service brings new things we have to be concerned about.

You use those skills not just in contract negotiation with vendors, but a lot of what we do day in and day out is negotiating systems, negotiating problem resolution, negotiating timelines, etc. It’s all about how flexible you can be, and how persuasive you can be.

Judy: What do you see as your organization’s biggest strategic challenge this year?

Keith: I think it’s going to be a challenging year for us. Our organization is transitioning after Nancy Howell Agee retired as president and CEO. Steve Arner, our former COO, has stepped into the role and will likely bring new leadership ideas as well as a new direction for the organization.

We have a half-billion dollar tower expansion that is coming online next month. We’re doing a wholesale replacement of our ERP platform. And just like every other organization, we’re dealing with a significant influx of demands for AI technologies and the work it takes to navigate these requests and distinguish those tools that are useful versus noise is taking a lot of resources. We’ve got our hands full for sure!

Judy: You mentioned AI before. How is AI impacting your organization? What type of work are you leading to evaluate new AI capabilities? Is it changing your IT org chart or your operating model?

Keith: It’s like trying to herd cats. I can’t ever recall a time in my career where there has been this level of interest, and hype, in a set of technology tools. Companies that are months old, rather than years old, are offering some of these solutions. Like other organizations, both within healthcare and beyond, we are working to understand these tools and try and help our leaders strip out the noise.

We’re trying to understand how these technologies can help us provide better patient outcomes and deliver more efficient and cost-effective care. But working through the onslaught has been challenging.

Early on, our CMIO and I realized that we had to have some discipline as we work through this. We put together an AI steering committee made up of our senior leaders. Now we put all requests for AI technologies through a process, looking at the use case, and how it is aligning with our strategy, because every vendor that we have is stepping forward saying, “You need this latest, greatest AI that we’ve incorporated into our platform.” It’s just a lot. And you’ve got to have discipline as you work through it for many reasons, including the cost.

I have some real security concerns about some of these technologies and some of the vendors because many of them are black-box solutions. They don’t want to expose the special sauce behind their solutions because it’s their intellectual property. But we need to understand what they are doing with our patients’ data.

But I will say that some of these tools show a lot of promise and can help us from a security perspective. We’re really interested in Agentic AI in the form of what Gartner calls guardian agents, where you’re deploying AI to watch and monitor AI to be sure that it’s not going outside the guardrails and doing what it’s not supposed to be doing.

Our organization is taking the approach of buy versus build, at least initially. It is better for us to look at some of the solutions that our existing vendors are bringing forward first. Number one, we’ve got a trusted relationship with those vendors already. And if that’s our quickest route to get some wins and get some solutions in place faster that bring value, we feel like that may be the best approach for us.

Judy: What is your best use of AI right now, the most successful one you’re using?

Keith: We have two or three really successful projects. We have deployed ambient co-pilot technology in the Nuance Microsoft space for physicians. That technology essentially records the conversation between patient and physician. It summarizes and creates the documentation for the provider in Epic which takes a lot of the administrative burden off the provider. We have seen increased satisfaction in terms of being able to get that documentation closed more quickly, which certainly helps from a revenue cycle perspective. More importantly, it’s helping with provider wellbeing and is reducing “pajama time” for our providers.

We’ve also deployed a couple of predictive models in our quality area to help identify things like sepsis and early sepsis intervention. We are looking at AI and predictive modeling to predict early deterioration of a patient. Those are examples that have been successful and that we’re continuing to expand.

Judy: A lot of organizations are touting sustainability. Healthcare doesn’t seem to address it as much as other verticals. As a CIO, are you involved in strategic initiatives around sustainability? And if so, what are they and what’s your role?

Keith: We actually have a leader in the organization who is focused on sustainability. She’s done a lot of tremendous work. One of our acute care facilities has a solar array farm that is producing a portion of the energy required to run that facility.

From an IT perspective, we have implemented ‘pull printing’ in the organization. One of the things that we noticed as we walk by any printer is that there is always a stack of unclaimed printouts on it. We determined that people print things they ultimately don’t need or the printouts are auto-generated by a system.

With pull printing, all of our multifunction devices are now equipped with card readers. Folks walk up to a printer when they’re ready and tap their badge to print documents that  are holding in their queue. In some instances, those documents never get printed and after a certain period of time, they just drop out of the queue. We’re seeing an overall reduction in paper and toner use. We’re also looking at our data center footprint and power efficiency in those data centers.

Judy: So, Keith, if you hadn’t become an IT leader, what other career do you think you were cut out for?

Keith: You know, I have always been fascinated with airplanes and the aeronautical industry. I think I would have been a good airline pilot. And given the fact that technology is running those aircraft today, it probably would have been a good fit.

Judy: What’s something you love to do in your free time?

Keith: I love to travel. Especially as I’ve gotten older, I have an even bigger fascination for new cultures and new places. We have a really big trip coming up next year to Japan that I’m really looking forward to. I’m also a hobbyist when it comes to photography, especially drone photography and videography. So, I’ve taken my fascination with airplanes and miniaturized it into drones and combined it with my technology skills and love of photography. You’re able to capture some really unique images from a drone that you can’t get from regular photography.

Judy: What’s your favorite place that you’ve visited?

In this edition of C-suite Conversations, Chuck Podesta, CIO of Renown Health, reflects on his 30-year CIO career in healthcare. He discusses the future of the CIO role, the power of adaptability, and the need for more mentorship in the profession. From governance and cost efficiency to personal growth, Chuck offers candid advice for IT leaders navigating today’s complex landscape.

Renown Health is Northern Nevada’s largest not-for-profit healthcare network, serving over one million patients each year. Renown operates hospitals, clinics, and specialty centers, offering advanced care in trauma, cancer, cardiology, and more. Based in Reno, Nevada, Renown employs 7,300 people.

Key Takeaways

• After 30 years as a healthcare CIO across eight organizations, under 18 different bosses, Chuck stresses the importance of adaptability and relationship building to stay relevant and valuable, especially during leadership transitions.
• Becoming a CIO requires shifting your focus from day-to-day tasks to long-term strategy. Before their first CIO role, IT professionals who thrive on the gratification of operations should think carefully about whether they would truly enjoy strategic thinking.
• Strong governance in IT is crucial. Without clear decision-making processes, organizations will chase shiny objects and overspend on technology without achieving real value.

Q & A with Chuck

Judy Kirby: Chuck, you and I have known each other for more years than we care to admit, and we’ve witnessed a lot of change in healthcare technology. What got you into healthcare technology in the first place?

Eventually, I landed a data entry job at UMass Medical Center, where I met the guy who was running the computer center all by himself. He needed help, so he hired me and trained me in computer operations—doing backups in the middle of the night, working with old equipment. I moved up from there, becoming a supervisor as we hired more people, got more equipment and started automating more things. What I liked about it was I got to do a lot of different things. We ran wiring through ceilings, set up printers and did a lot of hands-on work, but it was great training. That was my start in tech back in 1981.

Judy: So I have to ask, what was your first salary? Do you remember?

CP: I think it was somewhere around $10,000. So, it wasn’t great, but I got overtime. I wore a beeper, and back in the day, a beeper was a status symbol because only doctors carried beepers.

Judy: In what ways has the CIO role changed the most in recent years?

CP: Most of my decision-making is not dictatorial as it was at the beginning of my career. Now it’s more of a collaboration. At Renown we take an SBAR approach: Situation, Background, Assessment, Recommendation. Everything comes through our president’s council, which is made up of all the CEO’s direct reports. We meet every Wednesday.

There really aren’t IT SBARs anymore other than data center and network stuff. But if we’re going to move to Workday, the Chief People Officer would bring that, or operations. IT has a role, but they’re organizational implementations now, not IT implementations. I know a lot of CIOs who struggle with this because they want to own it. That’s a dying breed of CIO right now. The CIO who is out there collaborating with the organization, giving up some of the ownership is the future.

Judy: In what other ways do you see the CIO or CDIO role evolving over the next three to five years?

CP: I think we need to be more of a people connector across the organization. We really need to open up the IT world and share. There are things like citizen coding coming along. If you’re not open to that in IT, again, you’re going to have to move on.

I think my job is going to be more about understanding the problems that we’re trying to solve. What kind of team do I need to put together, and connecting all those people so they can now collaborate without me being in the room all the time. They’re coming up with the solutions and that’s where the power is. Maybe it’s like being the conductor of an orchestra.

If I were a new CIO coming into an organization, I would spend all my time the first 60 or 90 days building relationships, first across my peer group, then down through the organization, at VP level, director level, and certainly my team.

Judy: In your opinion, should there be or can there be one leader over all technology and where should that leader report?

CP: I think in big organizations like Cleveland Clinic, Mayo, and Stanford, they’re huge and you have to have gatekeepers. You have to have that chief analytics officer, chief AI officer, chief digital officer. But most health care organizations are more like Renown in size and complexity than Cleveland Clinic. I don’t think many one to two billion dollar organizations are big enough to be creating the role of chief data officer, chief analytics officer. They need more of a collaboration model and a strong governance model.

This raises a related question: Do you need a CMIO anymore? CMIOs were brought in when electronic health records took off because of Obamacare. We needed CMIOs to do the translation between IT and the doctors and get them to buy into EHR. Well, everybody has it now. At Renown, we have a lot of people who really understand the EHR. Many doctors are like CMIOs within their own area.

It really comes down to education. For example, I’m going to my president’s council in a couple of weeks to talk about our AI policy. But I’m really using it as an opportunity to educate them on AI. That way, when these things start to come forward, they can help me choose which ones are going to work for our organization, as opposed to the shiny bright object. We don’t need a chief AI officer at Renown. If I’m doing my job educating them, working with the right vendors and bringing the right tools in, then we don’t need that type of person and I would say other organizations the size of Renown don’t need one either.

Judy: The average tenure for healthcare CIOs is still about four years. You have had eight jobs in 30 years, roughly about four years per job. Can you talk about the short tenure in this profession?

CP: Well, some of it is due to moving up in your career. When you get your first CIO job at a small hospital and you’re 35 years old, you’re going to move to that next one and the next one, because you’re building your career. There’s more money and bigger organizations.

A lot of CIOs struggle when there is a new boss. There are some new bosses who come in, and they have a CIO that they worked with previously who they want to bring on board. There’s nothing you can do about that. Other CIOs don’t last very long because they could not adapt to the new CEO’s style.

It comes down to relationship building. If I’m a CIO, and I’ve been in an organization for two years, and I have not built relationships across the organization, I’m doing things in silos, and a new CEO comes in, I’m in big trouble. But if I have built those relationships across the organization, where I’m a valued partner, when a new CEO comes in, and he or she asks the CFO about IT and our relationship, then you have someone else advocating for you. That’s powerful.

I have given CIOs this advice when a new boss is coming into the organization. For your inevitable one-on-one with the new CEO, put together a presentation about how you lead your organization and how your organization benefits the rest of the business. What you want to do is leave the new CEO with the impression that he or she doesn’t have to worry about your org right now. Because you can imagine that there are a lot of issues the new CEO needs to worry about. You don’t want to be one of them.

But you still have to be transparent. If you have problems, you’re going have to tell him or her, “I’ve got this one area in IT that I’m still focused on. You’re going to hear noise about it but here are the things we’re doing to resolve it.” That’s okay, because when that CEO goes out there and hears from others about this problem in IT, she or he won’t be surprised by it.

Judy: That is great advice. One of the big concerns I hear about over and over is the lack of up-and-coming talent in IT leadership to fill CIO positions. What are your thoughts about this void?

CP: There aren’t enough mentors out there right now. Unfortunately, a lot of CIOs I know that have been at it for 20 or 25 years are looking to retire. I get it. I think about it a lot myself these days because it’s not an easy job. I ask them, “Can you hang in there a little bit longer and do some mentoring? Because you have wisdom that you can pass down to this younger group so that they don’t make the same mistakes that we made.” I try to get out there and mentor as many people as I can.

When you go to CHIME and HIMMS events—and I have great respect for those organizations because they do add value—but a lot of their presentations are around what’s coming, like GenAI. And vendors are saying, “Pilot this, pilot that, it’s going to move your career forward.” Some young CIOs decide, “Let’s do this. I’m going to put it on my resume, and it will lead to my next big job.” But unfortunately, they’re chasing the shiny bright object.

When I got to Renown, we were spending seven percent of total Opex of the organization, which by any benchmark is way too high. And we were known as the department of “No.” We had morale issues, customer service issues, and we were in the bottom five in employee engagement. Fast forward 18 months, and we moved to the top in engagement and customer service, and brought our spend down from seven to four percent, saving millions of dollars for the organization. So, I ask rising IT leaders, “If you and I were going head to head competing for a new CIO position, and I tell my seven percent to four percent story, and you tell your shiny bright object story, who do you think is getting the job?”

And people say healthcare IT doesn’t have enough money compared to banks and other industries. But there’s plenty of money in healthcare IT. Plenty. We’re just spending it on the wrong things and wasting a lot of money. I like to call it, stick to the knitting.

Judy: Where exactly do you see the waste and how can CIOs add value to their organization by cutting costs?

CP: If you have no governance, the organization is going to go around you and figure out a way to buy that application or buy that product without you. And, so you end up with $30 million in software maintenance. Another example is moving things to the cloud. What people don’t realize is that the cloud doesn’t save you money. It may allow you to fire things up faster but there’s a cost to that in the cloud.

When I go into a new organization, the first thing I do, besides developing the relationships I talked about, is to find out what the governance looks like. How does that work? Is there an SBAR type of approach? How does somebody go from an idea stage to approval to the implementation stage? Is there a process that you can put your finger on? I can tell you that in most organizations it’s all disjointed and a big mess.

At first, strong governance sounds like you’re just slowing things down, but you’re actually speeding things up. Here at Renown, if it’s an SBAR that comes to the President’s Council, we meet almost every Wednesday, so it’s not going to be a big delay. If it’s approved it goes into an enterprise PMO process, and we have a gate process that we go through that everyone understands. It’s hard work though to implement it, but you’ve got to do it to be successful.

I’m worried about the IT leaders coming forward as others retire and move on. And with this AI craze, we really need to focus on platform enabled AI. What does that mean? Epic is working on 100 AI projects right now, and I’m going to look at 10 of those. It’s integrating with DAX Copilot, for example, or Ambience. They’re integrated with AI and Epic supports it—that’s platform enabled AI. It has gone through a process already. Epic is doing all the work for you. They’re doing the Cleveland Clinic work. They do the Stanford work with the startups. They’re making all the mistakes, but they’re planned mistakes. You don’t need to be first to be innovative. You just can’t be last.

Judy: Looking back at your own journey, what career advice do you have for technology professionals interested in becoming a CIO, besides stay away from bright shiny objects?

CP: First, find a good mentor. One thing that people need to understand is that when you are at the director or VP level, you are 80 percent operational, keeping the trains running on time, and 20 percent strategic. When you become CIO, you flip that overnight. You become 80 percent strategic and 20 percent operational because the people below you are doing the operational stuff. What do you need to do to make that switch? And I’m telling you, a lot of people can’t make the switch because they like the day-to-day operational stuff. They feel good going home at night because they accomplished 10 things. You don’t get that instant gratification at strategy level. It takes a year, sometimes years for things to happen. So, if you’re an instant gratification type person, you’re not going to fare well. That is why when I’m mentoring rising IT professionals, I encourage them to get introspective as to what their abilities are today. It’s okay if you don’t want to make the leap. I’ve had unbelievable operational people report to me. They make a good living and they’re happy doing that, and that’s okay.

I have known others who have gone into the CIO role and weren’t happy, and it affected their personal lives. Some got divorced, they couldn’t sleep at night, they were miserable, they got the Sunday scaries. On Sunday afternoon, are you really nervous about Monday? If you are not sleeping well on Sunday nights, that’s a problem. You should be energized! That’s a little test you can give yourself to know whether you’re in the right job.

Judy: What is some advice you have for CEOs when they’re hiring their technology leaders?

CP: Candidates all come with references, and of course, those are all going to be good. So, you have to find people to talk to from the organization that they’re coming from, or where they worked previously. Leverage your network and try to have a confidential conversation about the CIO candidate, about their relationship building. Because what CEOs are looking for is a good fit. Yes, the candidate has to be competent, but will they be a good fit with the rest of the team?

The good CEOs I know will have the C-suite candidates interview with the entire C-suite to find out, “Can our CFO work with this individual? Can the chief people officer work him or her?” I think that’s the most important part.

Judy: What do you love to do in your spare time?

CP: I’ve learned as I get older that life begins at the edge of your comfort zone. So, in 2013, at age 55, I started running marathons. I had no idea I could actually run one, never mind train for one. It was the hardest thing I’ve ever done, and it changed my life. I actually became happier and I have picked up other challenges. Pick something that you would normally say no to and just go and do it and it’ll change your life.

The poet George Eliot—actually a woman named Mary Anne Evans who took a man’s name because you couldn’t get published as a woman in the 1840s in England—wrote something that has stuck with me to this day: “It is never too late to be what  you might have been.” I’m kind of like a cowboy now. I remember growing up watching Westerns with my father. We both loved them, but we were in New England which wasn’t a place where you dressed up as a cowboy or rode horses. I easily could have said no to the photo shoot, no to riding horses. 

I’m trying to impart to people that it is never too late. Just because you turn 50 or 55 or 60 doesn’t mean you stop doing things. You only get one life. Find something you love to do and give back. Mentoring is my give back and I’m doing a lot more charity work as well. But I’m also doing new things, saying “Yes” more than “No”. And, you know, I wish I had learned this when I was 30. That George Eliot saying means a lot at any age.

David Lehr’s career story highlights the value of curiosity, hard work, and a willingness to take on new challenges. After pivoting away from his education as a physicist, David worked his way up to become a healthcare CIO, and he is currently the Chief Strategy Officer at Meritus Health and Chief Operating Officer of the Meritus School of Osteopathic Medicine. In this edition of “C-suite conversations”, David shares the many lessons he has learned along the way, his approach to talent development, and his thoughts on the future of healthcare and technology.

Meritus Health is Western Maryland’s largest healthcare provider with over 4,000 employees, 500 medical staff members and 250 volunteers. Meritus Medical Center, the flagship facility, has more than 327 beds. Meritus Medical Center is a teaching hospital serving as a clinical training site for the Meritus Family Medicine Residency Program and more than 1,000 nursing and allied health students annually. Meritus Health also includes the Meritus School of Osteopathic Medicine.

Key Takeaways

• If you want to be seen as a strategic leader and earn larger roles, don’t stay in your lane. Engage with the broader goals of the organization, volunteer your ideas and offer to take on responsibilities that overlap with other departments.
• To be viewed as a trusted leader, CIOs must focus on building strong relationships, especially with physicians, and treat them as customers.
• Give your team members assignments that stretch their skills and push them outside their comfort zones. Provide guidance and support but let them solve problems on their own.

Q & A with David

Judy Kirby: When did you realize that technology leadership was of interest to you, and why?

That’s kind of been my philosophy on career and life. There’s something interesting about just about everything. Just keep moving until you find something interesting, but once you find that thing, work your butt off and be awesome at it, and eventually new opportunities will come up. Then work your butt off on the next thing, which will result in yet another better opportunity.

That’s how I ended up where I am now. But I never sat down when I was 18 or 25 years old and thought, “I really want to be a technology leader.”

JK: Tell me about your first CIO role.

DL: Eight years ago, I started my own consulting firm and I was working with a client in Annapolis, Maryland. After a while they told me they were very happy with my work and invited me to become their full-time CIO. I wasn’t sure I wanted to accept the offer. But I thought it through and realized that my consulting business would be better and more lucrative if I had CIO experience on my resume. So I decided to try it for a year or two, and as they say, the rest is history.

We were able to achieve some really great things while I was CIO and eventually I was offered opportunities in other areas. The leaders of the company came to me and said, “You’re really good at managing big projects in IT. Managing a construction project can’t be that different. Why don’t you try that? You turned around IT so why don’t you try taking on the lab? Or pharmacies?” And, before I knew it, I had operational responsibilities for the health system and continued to grow my role from there.

Eventually, the president of that hospital left to join Meritus as CEO. He and I had worked really well together. In fact, he was my mentor. He asked me to join him at Meritus, and here I am.

JK: Your current title is Chief Strategy Officer, Meritus Health & Chief Operating Officer, Meritus School of Osteopathic Medicine. What are your responsibilities?

DL: We have organized the company into hospital related, and non-hospital. The non-hospital stuff rolls up to me – ambulatory practices, the home health agency, and IT. So, the CIO reports to me, as does facilities, construction, marketing, all of our non-hospital businesses, ancillary services, and the medical school.

JK: Can you talk a little bit about how having IT leadership in your background helps you with your operations and strategy responsibilities?

DL: I’ll give you an example that I think illustrates the value of having IT and operations rolled into one. Here at Meritus, we started thinking about how to make the experience of accessing care more seamless. What could we do to eliminate the friction and make it fast and easy to get a telehealth appointment. We came up with MeritusNow, and our promise to the community was that it would take less than five minutes to get scheduled for a telehealth appointment, and 20 minutes to an hour till you are done with that appointment.

Okay, so what does IT need to do? Also, operations and physician services need to work together, but physician services starts saying, “My docs don’t like this, and my docs won’t like that.” And IT says, “I can’t configure it. It doesn’t integrate like it ought to.”

JK: Are you meeting your goals of five minutes to schedule and under 60 minutes to be seen?

DL: We are. I think the median time to get through scheduling is just below two minutes, and the average time until the actual telehealth appointment is about 35 or 40 minutes.

JK: For IT executives who want to move into other areas, like operations, what advice do you have for them?

DL: Good question. I talked to someone about this recently. He is interested in taking on some operational responsibility and was also considering other opportunities. So, I said, “What if you go back to your boss and say, ‘I’ve got this other opportunity, but I’d be willing to stay here if you agree to cross-train me and let me take on some operational responsibility. Let me be the manager for a project on both the operations side and the IT side.’” That’s one way to go about it.

But I still hear CIOs say, “I am not a true member of the C-suite,” or “I don’t really have a seat at the table.” Well, you know, that’s a two-way street. It’s rare for an organization to think, “That CIO with all the great ideas and awesome input on everything, and a full understanding of our business – let’s keep him out of the inner circle!” Most organizations I know would embrace that individual and they are desperately looking for that level of talent. So, my advice to those CIOs is, “Don’t stay in your lane.”

JK: As a former CIO, and now that you have a CIO reporting to you, how do you see that role evolving over the next three to five years? What might some new responsibilities and job qualifications be?

DL: That’s a really good question. I encourage CIOs I work with directly to focus on building strong relationships, especially with the physicians. You don’t have to spend a lot of time in any healthcare setting to see that there’s frustration with the way that technology guides people through their workflows.

If you can help your users understand the best ways to get through the day, how to use AI features, and give them the support they need to get their work done, you’re going to be much more successful.

I encourage IT leaders to focus a lot more on the people side and treat them like they are your customers. If they’re not satisfied, that’s a problem. I think the people side is something that hasn’t been focused on quite enough in this profession.

JK: There are lots of conversations about the CIO position and what it should be titled. Should it now be called the Chief Digital Officer? And then there are all the other titles: CHIO, Chief Data Officer, CMIO, Chief Analytics Officer, Chief AI Officer. What are your thoughts on siloed roles versus an all-encompassing technology officer?

DL: I think that at the end of the day, whatever the title, it really comes down to the work and making sure that you’re contributing to the community, contributing to the organization, and getting the work done. If a new job title helps you explain a change in the way that the IT organization is structured, then that can be a good thing. I think that’s why people have started to test out different titles like CDIO, to indicate to the team that we’re going to start doing things a little differently.

JK: Succession planning is the responsibility of all senior executives. Can you talk a little bit about the status of your organization’s succession plan and the approach you’ve taken?

DL: That is an area, admittedly, where I have work to do. I’ve been talking about an idea I have for creating a chief of staff position that would basically help me with all the things we have going on. We’ve got mergers and acquisitions going on. We always have new projects, new construction, expansion. It’s a lot of balls to juggle and it’s hard to keep it all straight. So having somebody help manage that body of work would be extremely helpful. But more importantly, they would learn all the ins and outs of getting that work accomplished and eventually be part of the succession plan. This is something we need to think about for my role and a couple of others across our organization.

JK: A big concern I hear about is the lack of up-and-coming IT leadership talent. Do you share that concern?

DL: I don’t believe that there is a lack of talent. I see so much talent in so many people that I’ve been lucky enough to work with. I think the bigger problem comes when you have five superstars and just one vacancy to promote one of them into. How do you do that without disengaging the four who get passed over this time?

I can’t imagine working in a place where you can’t find talent. I do know that the workforce, in general, is constricted, but the caliber of people, especially if we are developing those people, has not disappointed me at any point in my career. Maybe I’ve been super lucky. Or maybe the leaders who are saying there isn’t enough rising talent are not developing their people appropriately.

JK: How do you develop your people?

DL: By giving them opportunities. When I was running an analytics shop, I used to sit down with everybody on their very first day and say, “Here’s how it’s going to work. For six months, you’re going to need a lot of help. You’re going to lean on me, on your colleagues, you’re going have questions. Don’t be embarrassed about that. That’s the expectation. In the second six months, you’ll be expected to be more independent. For every question you ask, you should answer a question or two as well. And then after the first year, I’m going to hire someone new, and that person is going to lean on you, and you have to be ready for that responsibility.”

Without fail, people have been able to follow that progression because you’re pushing them to their limits. You’re getting them outside of their comfort zone every step of the way. When you say, “I’m not going to tell you how I would do it, but here’s the goal,” people will exceed your expectations.

JK: With continued financial pressure on healthcare, how do you meet the rising demands and costs of technology, and how can you track true ROI?

DL: I’m a little bipolar on this particular question because, on the one hand, nothing is becoming cheaper and no costs are going away. Now, suddenly, you have these AI companies coming in and saying, “Here’s how much it’s going to cost you to add additional technology on top of what you have.”

On the other hand. You keep hearing, “Our margins are too thin, we don’t have enough money in healthcare.” I have to remind those people that one out of every six dollars spent in the United States is spent on healthcare. That’s a lot of money! I bet we can figure out how to find some money to cover what we need to do.

JK: Speaking of generative AI, What type of work are you leading in this area, and is gen AI bringing changes to your IT org chart?

DL: It hasn’t changed our IT org chart yet and I don’t know that it will change the way IT is delivered, but it’s obviously changing the way that people work. There are different rates at which people are adopting and embracing the change. I talked to one physician who said if she had to choose between the AI and her husband, her husband would be out of luck. But not everybody is as enthusiastic.

A patient is going to come in not feeling very well, and they’re going to need to leave with a remedy of some sort, whether that’s a medication, some sort of an intervention, like physical therapy, a surgical intervention, and some sort of a plan. Nothing really changes about that per se. But then there’s all that stuff in the middle, like the paperwork, the decision-making, which can be improved by GenAI.

We don’t have any more answers than anyone else. When I talk to people in private, they all say basically the same thing. We’re all in the same boat, and we’re all figuring it out at the same rate. When I listen to experts and podcasts, people have a lot fancier answers, but to be honest, we’re just about where every other organization is.

JK: Many organizations are touting sustainability. As the Chief Strategy Officer, are you involved in initiatives around sustainability?

DL: Since all of our facilities, plant management, and construction rolls up to me, I’m very involved in sustainability. This year, we did a project that reduces our carbon footprint by 30 percent. On our main medical campus, we installed a microgrid that adds resiliency to our power plant. If the grid goes down, most hospitals in the country will kick on their emergency generators, and those generators will produce around 30 percent of the power that they normally consume. So, OR lights will stay on, your ventilators and life safety stuff, will keep going. but otherwise 70 percent of your stuff has to be diverted to other processes. With the implementation of this microgrid, we are able to keep going at 100 percent at all times. And that’s through our own power generation, through a combination of solar energy, combined heat and power.

The solar obviously helps reduce our carbon footprint. Our combined heat and power, that is through on-site generation of electricity using more conventional methods. But we take the heat off that results from the power generation and pump it into the buildings, and that provides our heat. It also provides air conditioning, believe it or not, through a contraption called an absorption chiller. All those things reduces our carbon footprint by 30 percent compared to pre-project, and we also don’t lose any outlets during a grid failure.

JK: Dave, if you hadn’t become an IT leader and then a chief strategy officer, what other career do you think you were cut out for?