We’re starting our new series, “C-suite conversations”, with an interview with my good friend, Jonathan Manis, SVP & CIO of CHRISTUS Health.  

Jon has spent over 20 years in healthcare IT roles, including Sterling, Advocate, Provena, Sutter Health, and CHRISTUS, which he joined in 2018. CHRISTUS Health is a Catholic, not-for-profit system comprised of more than 600 centers, including long-term care facilities, community hospitals, walk-in clinics, and health ministries. It has 55,000 employees. 

Please watch this space for more pieces featuring experienced healthcare technology and business leaders sharing secrets from their transformation playbooks, advice for rising healthcare executives, and forecasts for where the role of the CIO is heading.  

Enjoy this Q&A with Jon! 

Key takeaways

• Healthcare must change. We need to become technology companies that provide access to healthcare services when, where, and how it’s most convenient for consumers. 
• Many technological developments have changed business and the role of the CIO, but generative AI will change our world. 
• Labor shortages and burnout issues in healthcare can be solved with better technology utilization. We need to let computers do the work they are designed to do.

Q&A with Jon

Judy Kirby: Thank you for joining me for this series, Jon. When did you realize that a technology leadership career interested you, and why?  

Jonathan Manis: I did not pick this career; this career picked me. I’m a Florida boy and became a ground combat officer in the US Marine Corps. For some unknown reason, the Marines sent me to Norway, north of the Artic Circle where I was freezing to death. One day the Captain came into the officers’ tent and asked, “Does anybody want to go to graduate school?” All of us lieutenants just looked at each other. One of the junior officers finally asked, “Where’s the graduate school?” The captain said, “California,” and I immediately said, “I’ll go!” The captain then asked, “Don’t you want to know what you’ll be studying?” to which I replied “It doesn’t matter. I’d like to go to California.” When I got my orders, it was for computer science and information systems management. I completed my degree at the Naval Postgraduate School at Stanford University, was assigned to the Pentagon for a payback tour, and I have been doing technology leadership ever since.  

JK: You have had an incredible career, including over 20 years as a CIO in healthcare. How do you think the CIO role will evolve over the next three to five years?  

JM: I was once quoted as saying that the CIO role would not exist in three to five years. It would have been more accurate to say that the CIO role as we know it would not exist in three to five years. I think that was true then, and it’s certainly true today.

Most of us don’t really notice the role changing because constant change has become our new normal. The emergence of the IT function out of the basement changed our role. Virtualization and cloud computing, and the rise of nomadic devices and smartphones changed our role. The internet of everything and the evolution of networks changed our role. Consumerism, ease of use, and consumer expectations have changed our role. Digital technologies have changed our role. And I think soon the connectedness of everything will change our role yet again.   

Social networks, Amazon, eBay, Netflix – they’ve all changed our role. The one that feels very different for me is artificial intelligence: generative AI, machine learning, and very soon, artificial general intelligence, which is algorithms and applications having broad general knowledge and the ability to accomplish intellectual tasks autonomously — machines thinking and doing for themselves.

Those kinds of advanced technologies are certainly going to change our role yet again. But I suspect that they may also change our world, more so than just the CIO role. The way we live, the way we work, the way we play. I believe that our lives will be dramatically impacted in ways that we haven’t yet imagined and don’t yet comprehend. That prospect is both extremely exciting and absolutely terrifying.  

JK: How does all this affect the CIO’s job responsibilities. Are there new job qualifications? 

We need to understand those technologies, certainly, but we also need to be able to identify use cases and opportunities to apply them, and we need to be able to communicate a compelling case for investment in them.  

Perhaps most importantly, we need to be able to moderate expectations, something that we haven’t done well in the past. We need to dispel that primal fear that comes with any technology as powerful and potentially threatening as artificial intelligence. It’s scary for many people. It’s scary for me! And look, we can no longer separate technology from operations. Technology is operations today. Healthcare has just been slow to realize it.  

I think every company is first and foremost a technology company, and what separates and distinguishes the industries is simply how they leverage that technology to service consumers. It can be retail or manufacturing or hospitality, finance, or healthcare. CIOs need to understand they are not simply leading a support function. In modern, consumer-centric, market-responsive organizations, technology and operations are inseparable; they have become merged.   

In the meantime, boards and executive leaders are struggling to understand the forces impacting and changing the healthcare landscape, and how to stay relevant in an increasingly nomadic, ever-connected, and competitive marketplace. I think the reason you see the proliferation of so many new job titles like chief digital officer and chief transformation officer is because many CIOs are failing to deliver more visionary operational leadership.  

What I mean by that is a new and far more progressive delivery model, enabled by tools and technologies that provide access to services when, where, and how it is most convenient for the consumer of services, not the provider of services. The Googles and Amazons of the world consider themselves technology companies that provide access to services. We need to be the technology company that provides access to healthcare services.  

JK: As a recruiter, one of the concerns I frequently hear about is the lack of up-and-coming IT leaders to fill future CIO positions. What are your thoughts about this void?  

JM: I think there is an element of truth in what you’re hearing, but I am more optimistic than some on this topic. CEOs and boards are looking for more than technology leadership. They’re looking for business leadership. We teach the use of technology, and we develop technical expertise, but the opportunity we’re missing is leadership development – business and operational leadership specifically. How do we develop our leaders? Where do they train and receive leadership experience? For the kind of organizational leaders our industry needs, we must augment our technical competencies and develop our business and operational leadership competencies.  

JK: I agree with you. Can you talk about the status of your succession plan and the approach you’ve taken?  

JM: In the military, we were taught that the most important responsibility of a leader is to develop those who will be required to step up and carry on the mission in the event of the leader’s transfer, retirement, death, casualty, or capture. Professional development is a personal accountability, but I believe that succession planning is a leadership accountability. Here at CHRISTUS Health, succession planning and mission sustainment are extremely important to the long-term success of our organization.  

It all starts with a personal development plan, in which we include training and certifications as necessary. We have a coaching network, a mentorship program, and we encourage opportunities for exposure, like conferences or speaking engagements. An individual’s professional development plan might also include assignments of increasing responsibility, often with cross-functional, multidisciplinary work groups. In some cases, a development plan might include a recommendation that an individual seek graduate education, move outside the IS function, or even to a different organization to assume a position of higher accountability.  

The performance review process is another integral component of our succession planning process. Each leader at CHRISTUS Health has a plan for professional development and for promotional succession.  

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

JM: My advice would be to challenge everything, to speak up and to stand out. You know, leaders don’t always fit in. Leaders stand out. Sometimes that can be risky and uncomfortable, but things need to change. The healthcare consumer experience needs to be the same as the consumer experience in every other part of our life. We must enable immediate service and become accessible when, where, and how it’s most convenient for our consumers, not for us. Digital doesn’t care where you are when you access services. Healthcare systems do. Healthcare systems are territorial and geographic by design, and don’t want you going anywhere else for services or going out of our service area for care.   

Our industry must change or it will be changed for us, and we’re already seeing some of that. I would tell any new leader to become intolerant of the status quo and to challenge everything. The modern world moves at a different clock speed.  The pace of change is accelerating and that we need to speed up as an industry. COVID brought healthcare and technology into the spotlight. Digital consumerism is all about data, the connectedness of everything, mobility, and personalization. All of those things are enabled by technology and technology dependent. We should own it and take advantage of this unique opportunity. This is our moment.  

I would encourage any up-and-coming technology leader to be a change agent. In our industry we need more than leadership. We need visionary leadership, maybe even revolutionary leadership, I think that’s the incredible opportunity for the next generation of IT leaders willing to step forward and make a real, positive and lasting difference.  

JK: That is bold advice. Clearly, you are anticipating huge changes to come in the industry. 

JM: I think there will always be hospitals, but I think they’re going to be very different. I think our industry has been slow to realize it, but the future of healthcare, in my opinion, is going to be smaller, and it’s going to be outside the four walls of hospitals and clinics.  The exceptions are likely to be emergencies, intensive care, complex surgeries, and end of life. Look at birthing centers, dialysis clinics, urgent care clinics, “hospitals at home,” ambulatory surgery centers, cosmetic surgery centers, cancer treatment clinics…  I’m not a proponent, but it’s certainly not too far-fetched to expect that we might soon see something like an end-of-life center where people will go to pass comfortably in the most appropriate environment.  

I do think that the hospital, as we know it, will change dramatically in the near term. The old saw is to “give customers what they want,” and the number one thing that our customers want is to not be our customers. Nobody wants to be a patient. So, they want us to predict their disease, help prevent their disease, and lastly, they want us to provide care if they have an accident, develop symptoms, or contract a disease. Isn’t that what we all want?   

We have a clinic right here in Texas that offers any healthcare service for $49 or less. Now, you probably don’t want to go there if you have pancreatic cancer. But, if you have a sprained wrist, need stitches, have a sunburn, an earache, a runny nose, a sore throat or whatever, they will see you for $49 or less. You couldn’t touch that price at most large health systems. If we don’t respond with a different care model a lot of business is going to be taken away from traditional provider systems by new entrants offering substantially similar services at a substantially reduced cost.  

In short, the current traditional care model is both challenged and likely unsustainable. I do see big changes ahead for our industry, and we will be left doing the things that nobody wants to do, specifically emergency services, complex surgeries, end-of-life, intensive comorbidities, and intensive care, the things that are high-risk, low-margin. The high-margin, low-risk services we use to offset those other services are being taken away from us. Healthcare is a retail industry. It just doesn’t know it, and that is what’s hurting us. 

JK: Speaking of sustainability, other verticals are working on environmental sustainability initiatives, but I haven’t heard much about it in healthcare. As a CIO, are you involved in strategic initiatives around sustainability?  

JM: Absolutely. Maybe this is because we are a Catholic organization. The Catholic Church is very, very concerned about sustainability, efficiency, and the environment. It’s part of our mission, and we are absolutely committed to sustainability. “Reuse, Recycle, Reimagine, Repurpose” is part of our mantra. We have targets for conserving resources, and we have to prove it, so we actually have a quarterly report on what we’re doing to advance sustainability. In fact, we just built a new corporate office that has been recognized nationally for its sustainability and green footprint. 

From a technology perspective, we work with our vendors to secure the most environmentally friendly products and services.  We look at everything from packaging to disposal, including power consumption and recycling.  We encourage remote consulting and online training, and we have initiated carbon reduction goals.  Finally, our movement to cloud computing and remote hosting provides both value and operational efficiencies and also helps address our environmental concerns by reducing waste and leveraging available compute efficiencies.    

JK: We have a physician shortage and a nursing shortage. How do you see robotics and generative AI filling in the gaps?   

JM: The truth of the matter is that we have technology that would enable us to do with a lot less labor. I’m not sure we have a labor problem as much as we have a technology utilization problem. Make no mistake about it, AI is a very different and very powerful technology, and I think it’s going to change everything, and I believe it will certainly help us address both the labor shortage issue and the concerning clinician burnout issue.   

As a technologist, I believe we should automate everything that can be automated.  We need to let the computers do the work they are designed to do. Leveraging available and emerging tools and technologies – smartphone apps, mobility, connectivity, data, generative artificial intelligence, virtual/ augmented realities, drones, robots, etc. – will help us decrease costs, eliminate friction, address labor shortages, reduce response times, improve convenience, and enhance the consumer experience. We also need to leverage technology and monitoring tools to help our physicians, nurses and other clinicians manage by exception. We reduce clinician burnout by helping to identify only those individuals and patients that truly need to be seen by a clinician. Monitoring, tracking and trending technologies can help us to do just that. 

My graduate thesis at the Naval Postgraduate School at Stanford was on artificial intelligence. Honestly, I never expected to be where we are today in my lifetime. And AI development is accelerating. This is a very interesting time.  When have you ever seen any business sector or industry asking for federal regulation and oversight? This tool, this technology, is just that powerful. And there’s tremendous potential value here, but also tremendous potential for risk and disruption – business risk, financial risk, political risk, societal risk. Institutional trust and job security are likely to be challenged. And it seems to have caught us by surprise. Every CIO I’ve talked to is asking, “Where did that come from?”  

JK: So, what do you do about it as CIO? 

JM: Here at CHRISTUS, we’ve excluded ChatGPT from our network, at least temporarily. I provided our board and our executive leadership with a primer regarding ChatGPT, so that they know what it is and what it’s not. We formed a committee to monitor developments and recommend use cases, and we’ve volunteered to participate in controlled trials with several of our vendors, including Microsoft, Nuance, Epic, and others.  

I think the greatest near-term opportunities for us with AI will be in repetitive tasks and back-office work. I’m thinking of our opportunities to realize value in dictation, scheduling, billing, purchasing, supply chain, service desk, all of which are labor-dependent and maybe a bit less newsworthy than computers diagnosing and treating patients.   

JK: If you had not become an IT leader, what other career do you think you were cut out for?  

JM: The truth is I have always envied the artists, the poets, the painters, the musicians, writers, and storytellers. I’d probably write songs or tell stories. If I could do it all over again, I think I would have learned to play the guitar and maybe become something of a traveling troubadour. You’d probably find me somewhere in the Florida Keys, singing songs and telling lies to a bunch of tipsy, sunburned tourists. At least I like to imagine myself somewhere singing songs and telling stories.  

JK: Outside of work and spending time with family and friends, what’s something you love to do with your free time?  

JM: I grew up on Cocoa Beach, Florida, as you know, and that Florida lifestyle is still in my blood. I love to sail and scuba dive. I prefer to be out on or in the ocean.