For this edition of “C-suite Conversations” I had the honor of interviewing my long-time friend and industry colleague, Dr. John Glaser. John’s career in healthcare IT has been illustrative and impressive, to say the least. He is currently an Executive-in-Residence at Harvard Medical School. Previously, he served as CIO of Brigham and Women’s Hospital for over seven years, and CIO of Partners HealthCare for 15 years. He was also SVP of Population Health at Cerner and CEO of Siemens Health Services. John was the founding chair of the College of Healthcare Information Management Executives (CHIME), he is a past president of the Healthcare Information and Management Systems Society (HIMSS), and he has served on numerous boards. Read his full bio here.

Key Takeaways

• Establish clear accountability structures when creating multiple C-level technology positions – having numerous chief officers (CISO, CMIO, CDO) can create confusion about decision-making authority, especially during vendor issues or major initiatives.
• Prioritize core leadership skills over technical expertise when selecting technology leaders – this includes strategic thinking, communication abilities, and team-building capabilities.
• Focus on senior executive capabilities first and technical knowledge second when hiring technology leaders – seek candidates who can effectively move organizations forward, motivate teams, and maintain emotional stability while understanding the technology landscape.

Q & A with John

Judy Kirby: John, you are an icon in the healthcare technology profession. First, I want to thank you for all the contributions you have made to the industry over the years. You and I have known each other longer than either of us care to admit at this point. And we’ve witnessed a lot of changes – changes you have influenced. But first, how did you get into healthcare technology?

So, I went back to Durham and took the first job I was offered as a programmer analyst at Research Triangle Institute, which was doing a study of national medical care expenditures and quality. So, I randomly stumbled into healthcare by following my heart, and 50 years later I am still together with both the healthcare industry and the woman, Denise.

I thought healthcare was pretty darn cool but I didn’t really want to be a programmer for the rest of my life. My stepmother suggested I go and get a Ph.D. in medical informatics. So, Denise and I got married and went off to the University of Minnesota, where I spent four years getting overly educated in medical informatics, which led to becoming head of the healthcare IT consulting practice at Arthur D. Little.

JK: Years ago, you and I presented at CHIME on the evolution of the CIO. But today we see so many new titles. What are the major differences between the titles of chief data officer, chief digital information officer, and CIO? How do you feel about spreading technology across many different people?

JG: I became CIO at the Brigham and Women’s Hospital in 1988. At the time, the CIO job title was becoming common in other industries but not so much in healthcare. It was relatively new for the boards of healthcare systems and for CEOs. But IT has evolved a lot from a cost center to being viewed much more as a strategic asset. There’s no question on the part of leadership that there is strategic value in IT.

Now there are all these chief officer roles – chief information security officer, chief medical information officer, chief nursing officer. Now there’s a Chief AI officer. On the one hand, if you really want to attract talent, sometimes you have to put this fancy title on it. I get that. But I do think it runs the huge risk, and I actually wrote an article a couple of years ago about having too many chiefs.

With so many chiefs, the accountability becomes a little murky. If we have a Chief Medical Information Officer, CIO, and a Chief Analytics Officer, and there is a major issue with a vendor, who deals with that? Who’s fundamentally accountable for certain relationships? So, I think it’s okay to have chiefs, but you better be sure you keep the accountability structure clear about who gets to make what decisions.

JK: I would agree with you. Something I have seen recently is the top IT person is now titled Chief Technology Officer. It’s gone from the CTO reporting to the CIO to the CTO being the top IT role.

JG: Chief Information Officer is a little fuzzy. What are you in charge of, information? How does that work? Information is everywhere. The traditional role of CTO was the tech wizard. They made sure that the architecture was solid, that the interoperability was as good as it could be, and that things were secure. So, if one views it as a technical role, and that the top person should be a technical person, that could be a mistake because it’s broader than that. They’re functioning as a change leader, strategist and business expert.

Call them whatever you want, but you have to be careful with how it is perceived externally and internally. You run the risk of confusing the rest of the organization, and you run the risk that, as you’re trying to attract talent, they will read certain things into the title that you don’t intend. Make it clear what the role does, and be sure the actual title doesn’t demean, diminish, or narrow the perception of the job.

JK: Whatever the title, how do you see the top IT officer role evolving over the next three to five years? What might some new responsibilities or job qualifications be?

JG: In a way, Judy, the qualifications and the skills are the same ones that you and I were talking about 20 years ago. You want someone who has good strategic instincts. You want someone who communicates well with the clinical leaders. You want someone who builds great teams and motivates them to do amazing things. You want somebody who’s got an astute read of the technology and is not overwhelmed by fatuous sayings. All of that is the same. You have to know new things that you didn’t have to know about before, like AI and value-based care, but the human skills needed are generally the same.

I do think that the bar continues to get raised. So, if you got an A grade as a CIO 10 years ago, today you’re going to get a B. The bar is raised in terms of the skill and the prowess. It’s just harder, it is more demanding, it requires that you communicate more effectively than you did before. It requires that you have a better performing team than you did before. Things that need to get done are more significant, more strategically critical, and frankly, you’re more resource constrained. You have to operate with less budget than you had before. So, in many ways the role is the same as before but it is much more demanding.

JK: I agree. The average turnover of healthcare CIOs has been somewhere between three and four years for a long time. Why such high turnover?

JG: I think it is not all that different from CEO or CFO turnover. I suspect a couple of things happen. One is that as a CIO, you can make a wrong call for which the results are more dramatic. You know, one bad implementation and “Adios.” One security breach and it can all be all over in a hurry. A CIO’s bad call is much more dramatic and obvious than when a CEO misses a call on strategy.

But nonetheless, people burn out. They think, “I’ve done what I wanted to do here, and as a careerist, I want to try something different.” They get kind of tired and stale at a level, particularly people who are ambitious and who want to climb ladders.

JK: One of the big concerns I hear repeatedly, and we see it in our search business, is the lack of up-and-coming IT leaders to fill future healthcare CIO positions. What are your thoughts around this void, and how do we fix it?

JG: We see that issue in multiple parts of our economy. For example, there’s a shortage of primary care providers. How do you persuade people to become primary care providers? Well there’s a lot of reasons why that’s hard, or they want to go off and make more money as a specialist, etc.

I don’t know what we do here. You have to tap into the people who want to be in IT and healthcare because it’s interesting. It’s got some significant challenges, and many people want to do good in the world. They want their lives to have meaning and help people who are sick or dying or going through tough times health-wise. This is largely a nonprofit industry so you are competing with the golden riches of stock options, which may or may not happen, but they’re still enticing.

Healthcare has some things going for it, but still, you have to reach a 22-year-old who’s in college or someone who’s 25 and maybe doing banking and IT stuff. Once you get them in, you can see who wants to climb the management ladder, who is good at it, and who thrives on it. You ask a good question. I don’t know what the answer is.

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

JG: You have to decide that you really like leadership and management and that you enjoy motivating people. It’s very paternal because the victories are in what they do, not what you do. It’s like watching your kids do great things. I like running things, and I like the paternal feeling, and I like helping people go left versus right.

The other advice is to seek out role models. I remember going to medical informatics conferences when I was in graduate school and seeing a panel up there with all the legends of the field: Clem McDonald, Octo Barnett, the first pioneers of medical informatics, and thinking, “Wow, they’re really smart, and some of them are really funny, and they’re really competent. I want to be like them.” It’s fine to let them know it, to go up to them and say, I admire and respect you. Would you talk to me from time to time?” People warm up to that.

JK: Great advice! Anything else?

If you hit a ceiling, try another organization. I also think it’s fair to take reasonable risks. Don’t bet the farm and don’t bet your life savings, but it’s okay to try things that you’re not sure you can do and that you might screw up. In the grand scheme of things, if you get fired, no big deal. People survive that, and it is nothing compared to other calamities like having a sick kid.

JK: Where do you see generative AI having the most impact in healthcare over the next three to five years?

JG: I don’t know. I had an interesting conversation with some Scottsdale Institute CEOs from large health systems a couple of weeks ago about where they are with GenAI. They’re all experimenting with it at various levels – ambient listening, where the computer creates notes, some revenue cycle coding. But I wouldn’t characterize these as transformative.

I think what’s needed now is a set of ideas on the table which really could change the game, and we’ll have to see whether those play. So, I’ll give you an example. I sit on the board of National Committee for Quality Assurance (NCQA). I’m the incoming chairman of the board, and as you know, they do Healthcare Effectiveness Data and Information Set (HEDIS) measures, the methodology by which to measure various aspects of care. Well, how does that methodology work? They convene a room full of blue-ribbon clinicians, and they feed them lots of articles, and they arm wrestle, and several weeks later out comes an answer. An example answer might be the best way to measure the quality of prenatal care. It’s a process that works but it’s slow and it’s expensive to do this way. How about we have GenAI scan the literature and offer up a draft, then the committee debate the draft? Wow, that’s different. You might do that in minutes versus weeks.

As another example, of AI (although AI that is deep learning) a health plan can go through a range of diseases, and we believe that for every 100 subscribers, roughly one third will get vaccinated. We don’t have to do anything, they just will. And another third, they’re not going to get it for whatever reason no matter what we do. It’s the middle third, the persuadable ones who, if we play it the right way, will tilt. The question is, who are they? So, using algorithms to identify and target that one third would be much more precise and personalized. We see this already in retail. It’s unbelievable. My kid, the middle kid, is the VP of Consumer Analytics for a large department store chain and they are really all over this stuff.

I think we’ll also use AI to personalize care perhaps to identify treatments that are more effective than others.

I think one of the other things to remember is – how long has the internet been around? I mean commercially. Google was founded in 1998, that’s 26 years. On one hand, we have seen an amazing range of uses in a very short period of time. On the other hand, the web is still evolving in our lives.

So, you can look for ideas that are three to five years out but I think the question is also how will AI affect society for decades. There is this rolling horizon of new things coming that will never stop. Even 20 years from now, we’ll always discover new ways to leverage the technology.

JK: What advice would you give to CEOs about hiring their next technology leader?

JG: I think it’s the same advice I would give them if they’re hiring their next CFO, or their next chief medical officer, or their next chief human resources officer. You need a senior executive who functions and acts like a senior executive. They’re smart, they’re articulate, they communicate. They have an emotional even keel, and they know how to pull together teams. You want someone who’s skilled at moving an organization and motivating people, but you also want them to possess a knowledge base. With the CFO, you want that person to understand the ways you can borrow money. With the chief medical officer, you want someone conversant with, for example, GLP-1s, and the issues confronting the medical staff. You want the same in your CIO – someone who understands the technology and can sit with you and have a conversation. When you ask a candidate what they think about GenAI, you better get a pretty articulate answer, that you can relate to and understand.

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

I like the fact that technology can enable you to do things which are really impressive. I remember CPOE (Computer Provider Order Entry) back in the day and how it significantly reduced medication errors at the Brigham. That was really cool! That’s why we’re here. So, for someone like me who likes leading people, likes the world to have meaning, likes writing, likes teaching, and likes the power of ideas, what other roles are there? I wouldn’t be a professional basketball player. I’m not sure I’d want to be a lawyer, or a doctor. I would be something in the general management realm, although maybe not as much IT. We’ll just have to see, although my career is largely winding down at this point.

JK: So outside of work and spending time with friends and family, what’s something you love to do when you have time?

St. Luke’s University Health Network is a fully integrated, regional, non-profit network of more than 20,000 employees providing services at 15 campuses and 300+ outpatient sites in Pennsylvania and New Jersey.

Chad’s passion for IT at an early age led him to a short career progression from tech support to a 21-year career as a CIO.

Key Takeaways

• When evaluating AI and other initiatives, use evaluation tools that compare level of lift to expected value – this helped his organization narrow 150 initiatives down to about 15 priority projects.
• Consolidate technology governance under one leader to avoid duplication – as Chad notes, allowing “federated technology decision-making” leads to duplicate purchases and complexity.
• Build internship programs with multiple universities (13 in Chad’s case) and place interns in departments with anticipated future job openings – over 50% of their interns go on to take full-time positions at the organization.

Q & A with Chad

Judy Kirby: How did your career in healthcare technology leadership begin

JK: Your career rise from tech support to CIO was relatively short. Can you talk about that progression and how you advanced in such a short amount of time?

CB: I think I just loved it so much that it wasn’t work for me. I was young and ambitious, I didn’t mind working late, and always wanted to take on more projects. I was constantly asking what else I could do, and what projects people had that I could help with. I guess people thought I did a good job with them, which kept accelerating my career.

After working as a technologist in several different domains – engineer, programmer, etc. – I moved into project management and got into healthcare. I was helping open up a large ambulatory center and was project manager for a $110 million project. I was still fairly young and I was enjoying it. After being promoted to manager, I worked on a bunch of projects with some of our C-suite in different departments – PACS projects and stuff like that. These gave me the chance to work with our VPs and COOs, and when the CIO position job opened up, I applied and got it. Now it’s been 20 or 21 years as a CIO.

JK: Wow, that is very impressive! Did you have a mentor who helped you move your career forward?

CB: I have had multiple mentors, especially if you count my parents. My dad was a construction business owner, and he was always a mentor to me. But the reason I got started in healthcare was because of my mom. She was a nurse, and she would always talk about all the technology they were using, and thought I could really help out and have a career in healthcare. But when I reached director level, I realized that I needed to branch out beyond my parents. I met mentors both inside and outside the organization working at levels above me, always in technology, who I trust and respect.

I have really learned a tremendous amount from all of them. When I stumble upon an issue or a situation, I might bounce it off one or two of them for their perspective or advice. That’s how I have always done it. I’m always doing something new at St. Luke’s, and I think one of the key things about leadership is being able to learn new things, especially by seeking advice from others who have been successful in similar situations.

JK: So you’ve had CIO experiences in a couple of organizations over 20 years now. How do you see the role of the healthcare CIO evolving over the next three to five years?

CB: It is going to be interesting because of the acceleration of technology. We’re seeing AI hit the ground pretty hard and there’s a lot of opportunity, but there’s also a lot of noise. It is important to be a strong communicator, and knowing how to handle the hype cycle.

When it comes to innovation, probably 60 to 70 percent of it is noise, and the rest is real tangible work that will produce solid outcomes for your business if you put a lot of effort into it. And that is what I think CIOs need to do is latch onto those things that are going to have real ROI, and to get rid of the things that are just noise, clogging up your IT resources.

JK: As CIO, how do you help people separate the signal from the noise?

CB: We have tools we use to look at the level of lift required compared to the expected value. We have used this tool in multiple areas but we’re doing this right now for the AI portfolio, in particular. It’s an ongoing process to bring an idea in, evaluate it, do a quick analysis on it, figure out where it fits, and then decide what to do. We have had as many as 150 different initiatives on the list, and we’ve already executed on about 36, but we’ve refined it down to about 15.

JK: How do you deal with a situation where someone is really passionate about an initiative, but the ROI just isn’t there? How do you handle that?

CB: You have the leaders be part of the process. It has to become a group effort. A lot of these types of projects come up through the specialties like oncology, cardiology, and radiology. It’s a discussion with the organization, including the leadership, to clearly say “Here is what we’re going to focus in on. This is what we’re going to commit to, and this is the number of initiatives we’re going to commit to this year,” and getting the organization to buy into that. Then it’s just a discussion on which ones are going to be selected.

JK: You have had a lot of success with innovation. What have been some of your biggest wins in that area, Chad?

CB: We created an innovation fund in 2015 and it has been one of the biggest wins that we’ve had. It has had a definite financial return that is easy to measure. We have about $50 million in that fund, and we’ve produced solid market returns in the low double digits. It’s very easy to report. You have some winners and you have some losers. You have some really big winners, and you have some small losers, hopefully, and some companies in between.

We also benefit from what we call “strategic project value.” We might have 10 companies in the fund, and we might execute two or three really big transformational projects inside of that, which generate returns in the form of high ROI, but also when we sell the company.

JK: Can you share what some of those projects have been?

CB: The projects that have the highest ROI in healthcare tend to be in the revenue cycle areas. Anything around case management, denial management, clinical query systems, and what we are getting paid on inpatient cases.

A big transformational area for clinical would be the integration with our scheduling platform. We originally built this with a third-party vendor back in 2016 or 2017, and when we integrated it with scheduling, it was a game changer for our physicians. It was an enterprise-wide communication system for who is on call and where people are. In a big organization like ours, it is very complicated to know all that information. We moved it over to Epic about four months ago and every day we have around 18,000 users on that system. It’s huge and it’s highly utilized, and now that it is integrated with the clinical schedule, it provides a lot of value.

JK: There is a lot of talk about the CIO position and what it should be titled. Should it be called the chief digital officer? CDIO? CHIO? What are your thoughts?

CB: I have been wondering the same thing, Judy. In my organization, my title is CIO and other domains like informatics, the technology organization, security, innovation, all report up to me. When organizations start hiring a lot more C levels reporting to different people in the organization, I think the governance around that creates complexity and duplication. I’m not sure it really matters what the top person’s title is, but in my opinion, you should have all your technology initiatives in a cohesive integrated strategy underneath one leader.

JK: That makes a huge difference. At some healthcare organizations we have seen the IT department go out and buy something, and then another department goes out and buys the same thing.

CB: That’s what happens. Do you think Apple or Tesla allows that to happen? No. But in healthcare, for some reason, we’re allowing all this duplication and federated technology decision-making. It’s not good.

JK: Why is that?

CB: I think the problem is that some of these organizations don’t operate as a single entity because they’re in different markets, and they might not be able to share resources to the same extent that we can. I definitely think geography plays a role in that. And culture too, especially after a merger. Which organization prevails on clinical decisions and order sets and workflows? That can be complex when you have two large organizations coming together.

JK: With continued financial pressures on healthcare, and technology vendors raising their prices, how do you meet demand within your organization?

CB: We try to find technology projects with ROI high enough to pay for the other technology projects. It’s like the healthcare business. Some of your business units aren’t going to make money but others will, and those subsidize the ones that don’t make money. The same thing goes with technology. We’re looking for projects that can generate enough ROI to offset the costs for other projects we need to do in our portfolio.

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

CB: We have formal succession planning in our organization. We identify potential successors and we work with them on their development plans. I have several folks that are potential successors for me and I meet with them frequently. I just gave one of them one of the first CIO books that I ever read, “The New CIO Leader – Setting the Agenda and Delivering Results” by Marianne Broadbent and Ellen S. Kitzis.

JK: You mentioned AI earlier. How is generative AI impacting your organization or your company’s strategy? And what type of work are you leading to plan, evaluate, or implement generative AI?

CB: We’ve done a lot of work in the area of predictive analytics or predictive AI, which is the precursor to generative AI. GenAI has only been market-ready for a year or so. We have a few projects that we’ve been piloting with a low number of users – 300 or less. One of them is ambient documentation, another one is the revenue cycle using Microsoft Copilot. So we have some of those projects lined up over the coming months. In the clinical area, we’re okay having Epic do chart summarization and other things, but we definitely are ensuring that we have a clinician in between and analyzing the interface of that system before it gets scaled. So, we are cautiously optimistic but we’re pacing ourselves, and focusing more in the back office instead of the front office on GenAI projects.

JK: Recruiting and retaining top talent has been a challenge in IT even before the pandemic. What is one of your most effective recruiting or retention strategies?

CB: The hardest roles to hire now are in data science and AI, and high-end developers. I think we’ve been fairly good and consistent. Our turnover has been steady at about 4 percent in IT, which is relatively low. I think that it’s due to our culture, to be honest. We’re a very flexible and team-oriented culture. We onboard people quickly into our teams and the teams are good at making feel like they are part of the family.

A lot of our talent has come from the consulting world. We’ll have a consultant working with us and they’re like, “Hey, I really love your team and your organization. I want to come work for you full time.” We’ve had a lot of that over the years.

In addition, we have a large internship program, working with 13 different colleges and universities. This past year we had 22 or 23 IT interns, including eight in cybersecurity. Some students will intern with us for three or four years, starting when they are freshmen.

We like it when they come from the local area because they’ll be more likely to stay. Their families are here and they want to stay in the area. We select them based on the specialties where we want to grow. It’s been very successful.

JK: Of the interns, what percentage of them end up staying?

CB: We’re north of 50 percent of our interns who get a full time job and stay with us.

JK: Oh, that’s amazing.

CB: We don’t always have a position open for every one of them, but we try to. That’s why we position them in areas in which we know we will have open jobs in the future.

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

CB: I don’t really know. I have the CIO job, but I’m also responsible for other operating areas: cardiology, radiology, and supply chain. So, it would definitely in leadership. I enjoy working with people and developing people. If I hadn’t become a healthcare CIO, I’d probably have my own company, or two or three or four. Who knows?

JK: Outside of work and spending time with friends and family, what’s something that you love to do when you have the time?

CB: My son is going off to college, so the last kid will be out of the house and I will have more free time. My top priority is probably hunting. I love that the most. But hunting season is only a couple of months a year. My second priority is golf. I used to play a lot before my kids were born. So now I’m getting back into golf and playing a little more. And then my third thing is fishing.

JK: What’s your golf handicap?

CB: It’s an 18 right now, which is not good. But I used to carry a single digit handicap. So my goal is to play some more golf and get it back down.

Since leaving the Navy, Rick Roche has spent his entire career in healthcare human resources. Currently, Rick serves as Chief People Officer at Grady Health System in Atlanta.

Grady Health System in Atlanta, Georgia, is a premier public healthcare provider, renowned for its world-class trauma, stroke, and burn care. Anchored by Grady Memorial Hospital, one of the largest hospitals in the U.S., Grady delivers exceptional emergency, outpatient, and specialty services. Partnered with Emory and Morehouse Schools of Medicine, Grady is a leader in medical education and research, dedicated to transforming lives and providing top-tier care to Atlanta’s diverse community.

Key takeaways

• The best healthcare CHROs do things very differently and they distinguish how they view the HR function. They act as impartial consultants and trusted advisors to other C-suite executives.
• Having a new senior leader come in from outside the organization can be disruptive, so Grady’s succession plan focuses on developing its most talented people and preparing them to fill future C-suite vacancies.
• Gen Z has a totally different perspective, but their perspective is correct. You have to accept that there are different ways of doing things and meet them halfway.

Q & A with Rick

Judy Kirby: Rick, you have had a long and impressive career in healthcare HR. You have led HR for Children’s Hospital Medical Center in Cincinnati, University Health Care System in Augusta, Georgia, Memorial University Medical Center in Savannah, The Health Care District of Palm Beach County, and the University of Miami Health System. You have been here at Grady as Chief People Officer since 2020. How did your career in this industry get started?

So, I borrowed a sport coat and went on the interview at Shriners Hospitals for Children in Cincinnati, which was a burn facility. Before I started the interview, I asked for a tour because I had never been around burnt children, and I knew couldn’t work there if it made me uncomfortable. I also just wanted to have a look around this very opulent looking hospital. I’d never seen anything like it.

On the tour I was able to goof around with the children quite a bit and when I went back down to HR they said, “When can you start?” I said, “Oh, you must not have got the note from Dr. Donnelly. This was really meant as a practice interview for me. I just started as an undergrad. But they said, “We know, but here we care about people who care about our patients.”

I was taking 24 hours of classes at the time but they told me I could come and go as I pleased throughout the day. They didn’t call it flexible scheduling back then. So, I worked about 30 hours a week in HR and 24 hours on the weekends in housekeeping there at Shriners.

After I graduated I got promoted to Director of HR at Shriners in Boston and I’ve been in HR in some form ever since. So, it was Irish luck that got me into it and kept me here.

JK: What an interesting story! So, you’ve seen a lot of changes in the industry over the course of your career. How do you think the CHRO role will evolve over the next three to five years, and how do you see the responsibilities changing?

RR: As a discipline I think that we’re probably not quick enough presenting change to our organizations. In HR, historically, the people are really good at service and really good at HR, but we haven’t been great at advising on what the future looks like, particularly as it applies to people. I think that’s going to be more prominent in the future. HR has to be able to provide a point of view on where the business is heading and how it can be best managed from the people side.

The COVID pandemic is a great example. For the most part, in HR, we managed a very difficult situation really well and gave good advice to our fellow leaders. But we should have been talking about remote work and hybrid working three to five years prior to the pandemic. I think that that’s going to be our role as HR leaders, really helping our organizations adapt. We have to see the future better and adapt to changing environments more quickly.

JK: I saw an article recently about how a lot of organizations are firing their Gen Z staff because they can’t adapt well to the culture. What is the experience with Gen Z at Grady?

RR: I think you have to have leadership courage, and above all, you have to hire the right people. Gen Z has a totally different perspective. And that is not a criticism at all. Their perspective is correct, it’s just different. But we have to meet them halfway, and really educate people about our culture, and acclimate them to it. You can’t force it. You can’t force someone who’s been working remotely 100 percent into working on-site 100 percent. You have to accept that there are different ways of doing things, which brings me back to my previous point: HR needs to be ahead on this rather than reactive. We need to be working on what’s going to be happening in a year, in two years, and three years from now.

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

RR: The CHROs I have admired did things very differently, and they distinguished how they view HR. The opportunity they gave me at Shriners is an example. Allowing flexible scheduling was very unique at the time, and they didn’t even use the term culture yet. But that HR leader distinguished how she applied HR philosophy to the organization.

The best HR professionals I have been around do things differently. They don’t look at just compensation or benefits, or recruitment. They don’t look at the functions of HR independently. They have a broad philosophy. In healthcare, we’re guilty of doing everything the same way. All the hospitals in the country have almost the same benefits and almost the same compensation structure. We don’t distinguish ourselves as an industry or as a hospital, or as an entity. But the best CHROs think about it differently and distinguish their HR functions from their competitors.

JK: Have you been able to do that at Grady?

RR: I believe so, yes.

JK: Can you give an example?

RR: One example is that we eliminated HR policies. We went from 600 policies written by attorneys telling our employees how we don’t trust them and how many ways we could fire them, to 12 pages of guidelines that tell our employees how much we care about them and how much we trust them. We didn’t do that just to distinguish ourselves. It was a strategy specifically designed to change the work experience at Grady.

JK: What has been the outcome of that HR policy change?

RR: Three years ago our turnover was 40 percent. Healthcare norms right now are at 21 or 22 percent, I believe. Last year our turnover rate came in at 12 percent, and we’re a large, inner-city hospital in a challenging neighborhood. It is challenging to get here and we’re a safety net hospital, so we deal with a lot of mental health patients. It’s a challenging work experience. And having just 12 percent turnover during a time of growth – we’ve grown by 3,000 employees in the last 3 or 4 years – that’s certainly an indicator that the changes we have implemented are working.

JK: Are there any other examples of how you have done things differently?

RR: Yes, but I want to preface this by saying that I do not take any kind of pride or enjoyment in firing people. But in my first three years here we let about 1,200 people go. We did this during a pandemic and a staffing shortage. To provide some perspective, in the three years before I arrived, Grady let something like 60 to 70 people go.

We have a very simple premise: In order to work here, you have to demonstrate the ability to be an exceptional colleague and deliver exceptional service. And if you don’t possess both of those skills, we won’t hire you, and you can’t work here. Parting ways with those 1,200 employees over three years was a direct reflection of that philosophy. Our idea was that people who are not good colleagues or do not provide good service to our patients and their families, are not enhancing the work experience. If we replace them with people who are good at those two things, the patient experience and employee experience are going to be enhanced, evidently and obviously, and I think that has happened.

JK: How was it first perceived, though, by the organization?

RR: Not well. People may have thought I was crazy, and I don’t blame them. In healthcare, they weren’t accustomed to that. They saw it as radical and I think some still do. But at the time Grady was not viewed as a great place to work. To change that required drastic steps.

JK: Do you have any other career advice to share for HR leaders in healthcare?

RR: I have always thought it is important to conduct myself as a third-party consultant. Even when you’re deeply ingrained in the organization, I think that others leaders should see HR as an impartial, objective consultant to help them with their operation. HR has to be a trusted advisor to the other C-suite executives. If you can’t do that, it will be difficult to succeed as a CHRO.

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

RR: There is nothing more disruptive than having a senior leader come from outside the organization with a different approach to the work experience and how they deal with people. So, we have built a succession plan for our V-level roles.

The objective is very simple: give people an opportunity to develop into the next level to replace a C-suite person and give us the ability to promote our vice president-level people from within. With that in mind, we do a gap analysis. So, if there are five skills necessary to be a chief people officer, I do a gap analysis with my senior leaders and then help them fill in the gaps so that when I do leave, they are prepared to take my position.

No one is guaranteed they will get the job, but they’re in a good position for that. This succession planning approach lends itself to continuity and sustainability in an organization over time. People tend to stay longer at the director or vice president level if there’s an opportunity to grow into a C-suite position from within or be developed for that level role, even if it means eventually going elsewhere. It’s a good retention tool for talented people, and that’s become a significant part of my job.

JK: When interviewing candidates for a job in today’s healthcare enterprise, especially senior leadership roles, how do you test for these attributes – being a good colleague and delivering excellent service? Are there any questions you ask or scenarios you ask them to describe?

RR: Before we hire someone, we have to believe that they’re going to be an exceptional colleague, that they will walk in every day thinking of the success of the people they work with and the people that work for them. The skill set and experience are easier to find but it’s those two things that are most important for us. And we use some formal testing to assess that.

One interview question is that we ask candidates to describe the most interesting thing they’ve done for a colleague, or the thing that they’ve done for the employees that work for them that they’re most proud of. Their answer gives you insight into someone’s perspective. We hear amazing stories but we also get answers that are not impressive. It helps you ascertain whether a person has been in an environment that highly values being a great colleague or providing great service. We want people who have come from that, or at least to the extent we can assess it, to have it in them innately.

JK: You mentioned culture and change. How are you changing the culture at Grady to one that prioritizes being a great peer and providing great service?

RR: You have to literally build it into the infrastructure of your HR organization. We’ve built our philosophy into everything we do, from recruitment through retirement. So, we hire with those two things in mind. When we welcome people into our organization, those two things are reinforced constantly. Also, our performance appraisal is one page, and we assess only an individual’s ability to be an exceptional colleague and be exceptional at service. When I got here, the performance appraisal was 18 pages.

JK: Let’s talk a little bit about technology, starting with generative AI. How do you think GenAI will affect your organization over the next three to five years?

RR: If I had the answer to that, I might become a high-paid consultant. What I do know is that it is imperative for healthcare leaders – HR in particular – to become educated on AI and all of its implications, particularly with people. I’m not an AI expert, though I try to read as much as I can about it because AI is going to force us to change much quicker than we have historically. Healthcare tends to change more slowly.

JK: Do you think physicians will get on board with it?

RR: They’ll have no choice. A recent study showed that AI predicted or diagnosed a particular type of cancer 17 or 18 percent more accurately than physicians, and there are multiple studies like that. Physicians need to embrace that AI is just an additional tool to ply their craft and not take it personally.

JK: From your experience, what does a really strong partnership between the CHRO and the CIO look like in a healthcare organization?

RR: People and innovation are joined at the hip and they have to move in sync with each other. In HR we have to know what our technology capabilities are, what the talent market looks like, particularly in the younger demographics – the things they’re interested in, things they’re trained on, skills that we need in healthcare. HR has to be connected with the CIO. I’m happy to say I have a great rapport with our CIO here at Grady, and he’s an exceptional colleague and a leader in his field as well.

JK: Did you have a mentor during your career who really helped you?

RR: Actually, I had a boxing coach who was a bit of a mentor to me, and he told me one time that, “You learn something from everybody in the gym.” And he said, “Don’t admire the people, but admire their characteristics,” and that always resonated with me. I’ve met a lot of people along the way, leaders and non-leaders, and I think you can take a lesson or a characteristic from each one and try to apply that as best you can.

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

RR: I am a pretty regimented person. I’m up usually up before 4:00 AM every day and I get a good workout in one way or another. And I have a dog named Marvin Hagler, named after the great middleweight champion, and I see my grandsons on the weekend. It’s a pretty simple life.

JK: What kind of dog is Marvin?

RR: He’s an Irish terrier.

JK: Sticking with that Irish theme?

RR: Yes. A bit stereotypical there.

For this edition of “C-suite conversations” I sat down for a long chat with Donette Herring, the CIO of ECU Health. ECU Health is a comprehensive healthcare system in eastern North Carolina, consisting of nine hospitals and over 14,000 employees. It provides emergency, primary, and specialized care across its network of hospitals, outpatient centers, and clinics. Affiliated with East Carolina University, it integrates academic and clinical care for advanced patient outcomes.

Key Takeaways

• Donette’s career was heavily influenced by the leadership style of one of her first bosses, a partner at a large consulting firm who built in her the confidence that she could accomplish anything.
• The CIO title does not reflect Donette’s full scope of responsibilities at ECU Health. She leads the transformation execution office, where the majority of the projects are about operational strategy and performance improvement, not IT.
• Because resources are limited, CIOs need to figure out how to give more responsibility for technology back to business partners so that the IT team can focus on value-added activities that have to remain in IT.
• Having a CEO who once served as its CIO makes her job a little easier. She feels she gets more support as a result.

Q & A with Donette

Judy Kirby: You started your career as a nurse. How did you end up with a successful career in technology leadership?

On the advice of a career counselor at my undergraduate alma mater, I pursue an MBA. I had to write software for a computer science course that was part of the program, and I wrote what I knew as a nurse. That led to a job in the IS department working on a new software implementation.

I worked in the IS department by day, went to school at night, and kept up my clinical skills by working part-time in critical care. When we reached support mode, the vendor whose product we had implemented recruited me. It seemed exciting to go and work for a vendor to do more of what I had done at the hospital. But even then, I wasn’t sure that I saw my career path in IT.

JK: When did that change?

DH: There were two defining moments that made me more confident that technology would be an appropriate career path.

After working for the vendor and finishing my master’s degree I joined a large consulting firm. The partner I worked for has been a strong influence in how I lead. It was how he led that gave me confidence that I could do anything, really. We were constantly in situations where we were proposing new work and engaging with clients, doing work that hadn’t been done before, all in healthcare. He gave all of us the confidence that if you apply yourself, you can essentially figure anything out. And so, it was a result of that experience that I had a greater degree of confidence and began seeing what a potential IT career could be like, especially inside a healthcare provider.

One of the engagements we had was with a vendor evaluating how their product could be used at the patient’s bedside. Up until that time, clinical systems were only ever used from a central nursing station. Going through that process and helping the vendor reposition their product in the industry was extremely thought-provoking and challenging.

So, that was the first defining moment. The other one was, after a seven-year career in consulting, and recently married, I felt I needed to get off the road and have some semblance of a personal life. So, I stepped into the position of Director, System Development for a health system.

After a year and a half, we merged with two other health systems to form Catholic Health Initiatives, now one of the major faith-based health systems in the country. It was divided into five regions, and I was approached about becoming CIO for the eastern region. They saw something in me that I didn’t necessarily see in myself, which caused me to take a step back. Through my consulting days I had had exposure to CIOs and what they did in their jobs, so I thought, “Why not me?” That was the other defining moment, Judy – having someone see the potential in me, willing to invest in my professional growth and development, and to take the risk on me.

JK: In your current CIO position, you report to a CEO, Dr. Michael Waldrum, who is a physician but also was COO and CIO earlier in his career. How does his background affect your role?

DH: The COO and I often debate whether our CEO’s prior experience as both a CIO and the chief operating officer of an academic medical center in a health system makes our jobs easier or not. Dr. Waldrum would argue that it makes our jobs more difficult. We feel that it makes our jobs easier because he’s walked in our shoes and understands what it’s like to serve in the role, even though the technology has changed significantly since when he was CIO.

JK: Can you provide an example?

DH: An example would be our clinical EHR IT transformation program, OneTeamCare, a few years ago. We had been the customer of our EHR vendor for many years and had really fallen behind on taking advantage of all the capabilities and features. So, we designed the EHR clinical IT transformation program, branded it, and Dr. Waldrum did the kickoff and stayed engaged throughout the program implementation. At the kick-off, he communicated the message in a way that really got everyone engaged and set the program up for success. He emphasized system thinking that supported better and more rapid decision making. Seven years later we still refer to his quotes from that time, like “everyone is special, but no one is different.” What he said was that it is basically on operations. IT will make sure that the lights are blinking, the data is flowing, but if this initiative is not successful, it’s all in operations. Not that he let IT off the hook, but that’s the type of support that I have from our CEO, who has lived the experience both as a COO and CIO.

Another example is when we were deciding whether to replace our disparate lab systems with a solution integrated with our EHR. Despite compelling quality and safety reasons to consider a new system, we hesitated due to the comfort of the familiar. After confirming that the EHR-integrated lab system met or exceeded the capabilities of our current systems and could handle the complex operations of an academic medical center, our CEO, who has experienced ‘best of breed’ systems, decided to move forward. Although aware of potential consequences, he knew it was the right decision for the organization. Reflecting on this decision, our CEO and I have acknowledged that our COVID monitoring and response would have been significantly more difficult without the new enterprise lab system, which went live in November 2019.

JK: How do you see the CIO role evolving over the next three to five years? And what might some new responsibilities or job qualifications be?

DH: There is an increasing recognition that CIOs have to have broad organizational knowledge in order to be effective in our roles. We really need to understand the business of healthcare, because essentially, it’s all around how we align our technology with business strategy and operational imperatives.

I think there is broad recognition too that the business and patient care environment are technology dependent. Everything we do now is enabled in some way by technology. So, it’s about applying IT capabilities for business benefit and competitive advantage with a laser focus on business outcomes, being able to clearly articulate business outcomes and have other leaders able to articulate the benefits as well.

JK: What else?

DH: Putting IT responsibility back in the business. In IT there’s usually not enough bandwidth to address all the organization’s technology enablement needs. So CIOs need to figure out how to let go of that, but still have all of the necessary controls in place, especially in cybersecurity. A new CIO skill is striking the balance and allowing the business to assume some of the responsibilities that IT has had in the past so that the capacity you do have can be focused on value-added activities you cannot embed elsewhere.

JK: With the continued financial pressures on healthcare, how do you meet the rising demands and costs of technology? And how often are you able to track a true ROI?

DH: I think some of it goes back to the recognition that digital is really an implicit part of business sustainability and optimization. We can’t look the other way anymore. Financial pressures are such that we need to apply technology to drive as much efficiency as possible. But digital is also important to the growth strategy. There has to be rigor in place when looking at those IT investments, and well-defined business cases, and understanding what the true investment is compared to the benefit, both upfront and ongoing, before pulling the trigger. In situations where this may not be the case, but compelling reasons exist, a proof of concept can be orchestrated, with active engagement from clinical or business operations. This will require more time to iterate on process and technology design, with an uncertain outcome.

In healthcare we sometimes let emotion get in front of our rational decision-making, and we say, “We’re a mission-oriented organization. These are the right things to do.” We are highly focused on making sure that we’re fulfilling our responsibilities to our community, but that doesn’t mean that you don’t need to use rational decision-making. If you make investments where the return may not be as concrete and quantifiable, you should know that going in and continue to monitor and make sure that you’re fulfilling whatever the original intention was.

We’ve put in place much more rigor around business cases, around how we make decisions, how we rationalize the funding that we do have available. We’ve also put in place some new governance committees containing cross-sections of leaders in the organization so we can make those trade-offs.

JK: This is especially important given some of the price increases coming from vendors that I am hearing about.

DH: It is one of our biggest challenges, Judy. Technology companies that we depend on, many of which are publicly traded, are all about maximizing their profits. In most cases, there is not a corresponding increase in value of the product or service – just repackaging. I was on a Gartner call yesterday, and CIOs reported they are seeing price increases of up to four times with some vendors. Interestingly, we aren’t seeing the same high price increases from privately held vendors.

Some of us are highly dependent on certain vendors but we have no choice but to look at alternatives because we can’t afford the price increases.

I’ve had conversation after conversation with some of these vendors, and they talk about the need to meet their margin targets. I try to explain the situation that we’re in in healthcare, especially the nonprofit side, and that we have a fixed income. We can’t pass those rising costs along to our customer like they can. So, I think we’re in a real quandary.

JK: How is generative AI impacting your organization and your strategy?

DH: We took a step back as an organization and educated ourselves, and had conversations at the senior leadership level. We realized that we cannot allow AI to negatively impact the quality and safety of care for our patients. We took a pretty firm position early on, communicated by our CEO, that while we had a strong interest in the potential of AI, we do not want anyone using commercially available AI tools. However, we invited people who were interested in AI to let us know, whether in clinical or non-clinical.

We had a little over 100 people step forward, a mix of clinical and nonclinical people in the organization. We have formed an AI community of practice, and we are equipping them with tools. We have created a secure, controlled environment where these people can use AI and there is collaboration and sharing of how they’re using generative AI in their specific domains. They have to publish their work internally to contribute to our organizational learning about AI.

We also started an AI in Medicine committee that is chaired by our chief medical informatics and digital health officer. Their focus is the clinical application of AI for internally identified use cases. They are also responsible for reviewing all third parties we do business with that claim to have applied AI to their product or solution.

AI hasn’t yet caused any changes to our organizational structures or models other than some of the governance committees. We haven’t identified an AI leader for the organization. Our VP of enterprise data and analytics and our chief medical informatics and digital health officer are co-leaders of the AI work.

We are firm believers that AI is the future, and we are early on with some experimentation, putting structures in place to make sure that we’re not creating any undue risk or exposure for our patients and the organization. We very much subscribe to responsible AI.

JK: Turning back to the future of the CIO, what about the actual title itself: Chief Information Officer? We are seeing more Chief Digital Officer, Data Officer, CMIO. What are your thoughts on the title for the top technology leader in healthcare?

DH: This topic is very timely and relevant. It’s important to approach this in terms of roles rather than titles, as roles and responsibilities evolve over time based on industry trends, breakthrough innovations like generative AI, and organizational characteristics. There’s no one job description or consistent definition for what these roles are and what they do. I question whether or not these new positions are needed in every organization and wonder if the expectations for them couldn’t be part of an expanded role for an existing position in an organization. Having distinct roles may be more appropriate in exceptionally large national health systems where specialization is possible.

Dr. Waldrum and I had this conversation when we needed to recruit a new CMIO here at ECU Health. We decided to expand the role to digital health officer, because essentially, when we’re talking about digital and digital health, it’s all about clinical. Wouldn’t you want a physician or a clinician leading that effort? It’s really the next evolution of a physician informatics leader, because EHR implementations, for the most part, are behind most organizations. Now we’re optimizing the EHR and applying generative AI, machine learning, and predictive models. We’re in a whole different environment today.

So, I think about whether the responsibilities that organizations are looking for in these new leadership positions shouldn’t be assumed by other leaders. Not to mention, who can afford to fund all these new senior positions? Also, they’re going to have some overlapping responsibilities, creating conflicts between them, because they may define strategies targeted at accomplishing the same thing. And ultimately, they all need resources to execute.

I have no idea what the CIO should be called today. I have peers in other organizations who have taken on the title of digital health officer or innovation officer, etc. I think it’s because the CIO has been recognized as someone capable of expanding their responsibilities.

In my case, the CIO title no longer reflects my scope of responsibilities. In the last couple of years, we combined our IT project management office with our enterprise PMO to form the transformation execution office. That rolls up to me, and probably two thirds of the projects that are being led by our TEO are not IT projects. They are supporting execution of operational strategy and leading performance improvement initiatives. I have also picked up responsibility for formalizing our approach to shared services that includes governance, and development of service level agreements and KPIs. Does the CIO title reflect that? Not necessarily.

JK: One of the things I hear all the time in the healthcare industry is that there is a lack of talent coming up and being groomed for the CIO role. Succession planning is a responsibility of all senior executives. Can you talk a little bit about the status of your succession plan and the approach you’ve taken?

DH: My focus has been on developing the team and providing as much opportunity as possible for them to expand their scope of responsibility and to get as much exposure as possible, because that will generate confidence in them as leaders with the potential to step into my position. I don’t want to create organizational risk by relying on one person because they could make an alternative career decision themselves.

An interesting thing, Judy, is that I hear that some may not want the position, even if they’re qualified for it. I hear things like, “I don’t think that I want your job. I see some of the things that you have to do.” So, I wonder if it’s truly a talent gap, or if it’s a matter of people lacking desire or aspiration. One of Dr. Waldrum sayings that I absolutely love is, “The higher you go the windier it gets.” And it’s true. You’re very vulnerable. As a top leader you have to feel very comfortable with that vulnerability, and that vulnerability exists every day but you can’t let it hold you back.

JK: How do you manage that?

DH: I have a little fearlessness in me. You may not know this about me but I am a little fearless and I feel no career risk. I’ve accomplished more in my career than I ever expected to. It has turned out to be an advantage because it allows me to always do what’s right for the organization. There’s no self-interest in any of it. I don’t worry about how a decision may impact me personally. My fearlessness also aligns with my personal core value of integrity. I’m going to make the decision in the best interest of the organization. I think that’s why I’ve been tapped for new opportunities over the years, because there’s confidence that I am going to make the best decisions for the organization.

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

DH: Early on, I thought I wanted to be an attorney. Before I went back for my MBA, I also considered law school, but that was full-time and I needed to be able to work and support myself. So, law school wasn’t an option for me, but I think I would’ve been a good lawyer because I wanted to advocate and represent patients. I still have a lot of strong feelings about that based on my mother’s experience with the healthcare system not too many years ago.

This installment in our “C-suite conversations” series features Sarah Hatchett, who was appointed SVP, Chief Information Officer of Cleveland Clinic last May.

Cleveland Clinic is one of the world’s largest and best healthcare systems, with 80,642 caregivers, 23 hospitals and 276 outpatient facilities around the globe.

In this Q&A, Sarah shares the story of her healthcare technology leadership career, a journey which began somewhat by chance. She discusses her strategic vision for the future of healthcare and the CIO role, including the integration of AI and fostering a culture of collaboration. Her story highlights the challenges and rewards of guiding one of the world’s most highly regarded healthcare institutions into the future.

Key Takeaways

• The interim CIO role is like being on a job interview every day. Following a friend’s advice to “own it from the beginning” helped Sarah make big decisions with confidence and demonstrate that she was ready for the challenge.
• Some may think that once you are the CIO, you’ve arrived. But in many ways, it is just a new beginning.
• Cleveland Clinic’s approach to integrating GenAI into its operations includes piloting AI solutions, moving all data to the cloud, and developing in-house teams with the skills and the processes to execute on their AI ambitions.
• Sarah’s keys to retaining talent and driving team engagement are open communication, celebrating achievements, and fostering a sense of belonging.

Q & A with Sarah

Judy Kirby: How did you get into healthcare technology?

In those early years, I came to have a deep appreciation for healthcare IT. What I loved about it was the intersection of the two – the way that technology enabled and improved healthcare workflows. I really enjoyed the go-lives because you are actually in the clinical spaces with clinicians. It was fascinating to see the tools that you helped build in practice.

Over time, I gained experience and advanced into project and program leadership, but what always resonated was the human connection between the technology and the healthcare that we deliver.

JK: Congratulations on your new role as CIO for Cleveland Clinic! Can you walk us through how you became interim CIO and how that developed into the full-time role?

SH: I am going on seven years here at the clinic. I actually moved to the Cleveland area to have the opportunity to work for Cleveland Clinic. It’s just one of those once-in-a-lifetime opportunities to work for such an amazing brand, such an amazing organization. I first came here to work on EHR-related transformation projects. The Cleveland Clinic’s first Epic agreement dates back to 1999, so we had this amalgamation of lots of different technologies and custom code. With the transition to an Epic enterprise agreement, we needed to rapidly implement new modules and core functionalities throughout the organization.

We developed a playbook that helped us design the way that we were going to use Epic software into the future, which we called that Global Design. And Cleveland Clinic was becoming global. We had a number of acquisitions and construction projects in the UK and elsewhere, and we needed to create a program around that.

Then we created IT’s business office – forming the practical aspects of running IT like a business, procure-to-pay, HR, finance, communications, etc.

More recently, I led enterprise applications before taking on the interim CIO role just over a year ago. I was interim for 10 months and then secured the permanent role in May of 2024.

JK: What were some of the unique challenges that came with being an interim CIO, and trying to earn the full-time position?

SH: Well, there’s the practical aspect of it, which is that you’re on a job interview every single day. You are constantly being evaluated based on your performance, which is extremely tolling mentally and physically.

I got some coaching from my predecessor that I thought was very valuable, which was to “Own it from the beginning.” This advice helped me avoid anxiety about, “Should I be making this decision, or should I wait for the official CIO?” The advice I received gave me a lot of clarity and confidence in the decision-making process, knowing that I’ve been entrusted with this responsibility of leading the team. I wanted people to know that I was ready for the challenge.

JK: Sometimes, getting your team engaged is the hard part. How did you rally them to support you?

SH: One key advantage I had was my deep experience here at Cleveland Clinic, having come up through the ranks for seven years. I know so many of our team members from our shared work. There was trust built and credibility that I could draw from.

One hallmark of my leadership style is having an open door and connecting with people on a personal level. One of the very first things I did as interim was change the tone of our monthly CIO address and made it more of a fireside chat. I spend a lot of time celebrating achievements, recognizing new caregivers, and sharing fun things that are going on around the division.

I receive a lot of positive feedback indicating to me that those things really resonate with the team. They loved feeling connected, not just to me, but to each other. You want people to feel that their voices are heard, and you show that through results, through actions, and through change.

JK: Did you have to do any politicking, so to speak, within the clinic to sort of help your cause?

SH: I believe that if you show up in an authentic and genuine way trying to understand how you can help solve people’s problems, that tends to cut through.

The first order of business during my interim CIO phase was to meet with every single market leader and institute chair to introduce myself and say, “Here’s my cell phone number. We’re here to help you.”

Another thing is that we try to focus on metrics. How are we actually delivering? Let’s look at the data. Let’s look at the facts and figure out where we need to be and what we can do to improve things.

JK: You had a lot of support from the previous CIO, Matt Kull. How did that affect your succession?

SH: It was a real pleasure working for Matt as a leader, personally and professionally. I think the succession planning that we did together in a very intentional way had a lot to do with how the situation panned out, and I’ll be forever grateful for him and the amount of time that he invested in me and growing me as a leader.

JK: Tell me more about the intentionality.

SH: Matt and I entered an implicit agreement that I had intention and that he had intention and that we were going to build on this in a real kind of structured way.

Having that kind of open dialogue really helped clarify where we stood, and it provided line of sight into the specific things that we were going to do to support that type of relationship. That is something I would encourage every leader to do – have a leadership plan. It doesn’t have to be called succession explicitly. Maybe it’s just mentoring, or maybe it’s coaching, or maybe it’s guidance, but entering into it with intentionality is going to make that work together all that more valuable and measurable.

JK: Recruiting and retaining talent has long been a challenge in IT, even before the pandemic. It’s changed a lot since then. What’s one of your most effective recruiting and/or retention strategies?

SH: Career recognition and compensation are certainly and should absolutely factor into your retention strategy, but first and foremost, you have to focus on culture, and make sure your leaders are making people feel inspired and valued.

We do quite a bit of employee engagement surveying and action planning. The metrics that we consistently score high on are “I feel a sense of belonging” and “I feel like I’m part of the team.” That’s retention right there.

JK: Cleveland Clinic is on the cutting edge of so much. How is AI affecting your organization and your strategy? And as CIO, what type of work are you leading to plan, evaluate, and implement with GenAI and ChatGPT?

SH: Late last year we launched our digital strategy, which is largely focused on the use of AI to transform the healthcare delivery process, and there are three key components to the strategy. The first one is Pilots. It’s very early, and this is nascent technology. I don’t think we understand the full value proposition on what these tools can do for healthcare, so, we want to be trialing what those look like. We have a number of pilots in flight right now working with point solutions from different key vendors in the industry.

The next piece is around Platform. We have to move our data into the cloud. We were working off an on-prem data analytics warehouse. Moving the data into the cloud and coming up with a cloud data strategy is going to be absolutely essential to unlocking AI and GenAI capabilities into the future.

And the last piece is what we call our AI Foundation. It’s great that we have pilots and this new toolset, but we have to have a team that can build some of this in-house. This not only reduces our dependencies on vendors but helps us be a truly creative, innovative force for good in the industry. So, the foundation piece is building the skillsets, the team, and the processes to be able to execute on our AI ambitions.

JK: One of the things I hear a lot about from CIOs and CEOs is security. How are you addressing all the security concerns and other interruptions like we saw with CrowdStrike?

SH: This has been very relevant during my time as both interim and now, new CIO, after the CrowdStrike incident, Change Healthcare and a number of other industry-shaking events. The executive team and the board are freshly interested in technology and security. It’s an exciting and, in some ways, frightening time to be in healthcare IT leadership.

For the last decade, we have been committed to growing a cyber program that has truly become world-class. Today, we have an amazing team led by a CISO doing a fantastic job in all of the key areas around cyber.

So now, the question is “What’s the next level?” Even if we’re secure in our perimeter, if we do excellent incident response and have amazing IT and cyber hygiene, that’s not enough. The cybersecurity organization of the future needs to extend out into the business. We need to focus on business resiliency and become an enterprise function proactively managing risk in our organization.

JK: In what is your first CIO role, what have you found to be the biggest challenge, and the biggest reward?

SH: Prior to becoming CIO, I was responsible for segments of IT, such as EHR, business operations, or M&As. One of the biggest challenges when you’re in the CIO role is you have to have an integrated understanding of all domains of the organization.

I have an amazing team that I lean on heavily for a lot of the technical and cybersecurity expertise. That’s where building the team becomes of utmost importance. You need a strong team who understands how to work together and can work with you as their leader to make sure that you don’t have any blind spots. I think we do a really great job at that.

The size and complexity of everything that we’re doing at Cleveland Clinic never ceases to amaze me. I’m always learning new things. That would be the other key to success: being a learner, knowing that you’re always going to have to continue to develop and adapt, whether that’s about new technologies or new lines of business.

Some people may think that once you are the CIO, “you’ve arrived.” But in many ways, it is just a new beginning.

JK: For someone who is offered an opportunity to serve as interim CIO, or interview for the role, what advice would you offer?

SH: One thing that has really helped me is building a support network of peers and seasoned leaders. They can be internal to your organization or external. For example, I was very fortunate to have several other female leaders going through an interim phase here at t Cleveland Clinic at the exact same time as me. These peers have been a valuable source of support.

JK: How do you see the CIO role changing? What will this job look like in five or ten years?

SH: The CIO is never going to be the foremost technical expert who knows everything, and you don’t want to be the only person in the spotlight, because this is truly a team effort. The technology is coming so fast and furious, and it’s so diverse, so complex, so embedded. The effective CIO views herself or himself as an activator and not as a dictator. How do we activate technology so that it delivers the most value to the business?

JK: One of the things that we keep hearing about is sustainability. What is your level of involvement in those initiatives?

SH: Here at Cleveland Clinic, sustainability is owned by our facilities group, who is a close partner to us, whether that’s through power consumption in the data center or all the way down to the individual workstation. Lately, healthcare organizations are feeling cost pressures, and this could be another area where it’s a win-win for IT to get involved. If you can contribute to overall cost savings because you’re reducing power utilization, either in your team or the technology that we use, that’s a huge win for organizations who may be facing really tight margins and trying to save money.

JK: Sarah, had you not joined Epic all those years ago, leading you into a career in technology, do you think you would have stayed in publishing as originally planned?

SH: Yes. I am still interested in publishing, writing, or teaching because, in addition to loving books, I’m a very by-the-book person. I am not suggesting that there is always a right or wrong answer to things, but rather there is wisdom to be captured through learning and experience that eventually becomes best practice. I am passionate about the ability to absorb information and then share it back to others.

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

Soon after Scott Arnold landed his first job working in aerospace, he realized he had a knack for managing technology and technologists.

This passion has led to a successful career, including IT leadership roles in telecommunications and healthcare. Scott joined the team at Tampa General Hospital in 2010. He currently serves as their Executive Vice President and Chief Digital and Innovation Officer.

Tampa General Hospital is a private, not-for-profit hospital with 8,000+ employees and one of the most comprehensive medical facilities in Florida serving a dozen counties with a population in excess of six million.

Key Takeaways

• Build a strong partnership with your CEO by being direct, honest, and authentic. Focus on building trust, solving problems, and removing obstacles to drive the organization forward.
• Make talent retention a leadership priority by setting target attrition rates, investing in leadership training, and fostering open communication. Regularly share information with your team to keep them engaged and encourage their input.
• Stay ahead of emerging technologies like generative AI by understanding their potential applications and establishing appropriate governance. Focus on leveraging these tools to assist and empower team members, rather than replacing them.

Q&A with Scott

Judy Kirby: Scott, when did you realize that a technology leadership position was of interest to you, and why?

JK: What were some lessons learned in aerospace that you brought with you into healthcare?

SA: Aerospace, aviation, and healthcare are actually very close cousins, because they have human factors involved. People can die if you don’t do your job right. I didn’t realize the parallels around safety until I got into healthcare.

Years ago I had conversation with someone from Mercy in St. Louis who wanted me to take a leadership role in their technology division. I told him that I didn’t know anything about healthcare, but he said, “We need people from aviation and aerospace, to bring some knowledge with safety and human factors. Frankly, aviation has a better safety record than healthcare does, so we’d love to have that perspective.”

I said OK and took the job because I’m always willing to learn, and he was right. I was fascinated with healthcare from the start and I’ve been in love with it ever since. Even though I love flying and aviation, healthcare technology is the most favorite thing I’ve ever done professionally and what I have spent most of my career doing.

JK: From where I sit as a recruiter, new CEOs are perhaps the biggest reason for CIO turnover. But you have survived and thrived under a new CEO. What has made the CEO transition so successful for you?

SA: First, we get along great. The CEO, John Couris, and I see the world through the same lens. We’re different people, and we do see things differently sometimes, but our styles and the way that we approach things are somewhat similar. He’s a far better communicator, and he really gets people, so I am learning a lot from him. I think he’s the fourth CEO that has been here since I joined Tampa General 13 years ago, and I’ve learned something from each and every one of them. I think John would tell you he is learning from me too, so when you have great chemistry and authenticity, it just works!

JK: You’re skewing the bell curve on CIO tenure after a change of CEO. What advice would you have for other CIOs for getting on the same page as their CEO?

SA: My advice is to be direct, honest, and authentic. Be someone the CEO can trust. You may not have all the answers because that’s impossible in the healthcare technology. The surface is just way too large. But even if you don’t know the precise answer, you have to instill confidence with the leader that you have put together a team that will know or can get you the right answer.

Do not be an obstacle. That’s a simple formula that has worked for me. Help your CEO solve problems and help them remove obstacles.

JK: Your CEO seems to be very invested in technology.

SA: That is a blessing. Some people might say it’s a blessing and a curse. Sometimes John is hard to keep up with, but I like it that way. He has incredible vision, understands people and inspires team members like no other leader I have seen. He also understands the power of technology and technology’s role in getting the best out of people. That makes my job easier.

JK: How do you partner with the CEO to drive results and ROI from technology investments?

SA: John is skilled in terms of growing the company, and investing in things that either have a benefit that’s accretive, creates an ROI, or is just the right thing to do for the community. We’ve created this mutual trust where we’ll weigh these things together, and then we’ll try something. 90% of the time we’ll successfully move the dial on quality or cost.

JK: Can you talk about your dual role of innovation and CIO, and your involvement in the company’s investment arm?

SA: Innovation means many things. Innovation and research go hand in hand, and we are doing a better job of connecting research, innovation and venture together. That’s new for me. I’m not an expert but I’ve hired some people in our group who manage the venture side and are cultivating innovation in our organization.

I do lean on our team that runs the venture side to know that business, how an opportunity pipeline runs, how to put together the right deals, how to recognize good founders, and what to look for in investable startups. The one thing that has taken the most focus is adjusting our strategy with innovation and investing, not looking for bright, shiny things. What are the problems that we actually need solved, and what are the white spaces that aren’t already covered by enterprise systems that we own, because we want to get the most out of those investments. Then, if there’s anything out there that we haven’t done really well, those startups or emerging tech companies can potentially be a fit for us.

I think I’ve hired well on the innovation side. On the IT side, most of the leaders in my group have tenure over 10 years, so we’ve cultivated an awesome leadership team that loves this community. And we’ve done that while dealing with explosive growth. We’ve grown our health system from $1.3 billion to almost $3.5 billion in the last 5 years. I know I’ve hired well, and I am blessed to be surrounded by some really smart, engaged people.

JK: How did you get involved in the venture capital arm, TGH Innoventures?

SA: Prior to having a venture fund in pursuit of innovation, it sometimes felt like I was gambling with our operating money, which is not how you want to do things. If you make the wrong gamble, that money is gone. It was CEO John Couris’ idea to create a TGH venture fund. We started by setting aside $15 million, which is not a lot for venture, but it was a lot of money to us. But if you’re going to be in the innovation business, you’ve got to put your money where your mouth is and go out on the edge.

In the beginning, John wanted to stay very involved. He took the lead on it and we worked together to get the right person installed to run TGH InnoVentures.. After about a year and a half, he said, “You know what? This really should be yours, Scott, because there’s so much overlap.” Even our venture leaders felt it was a better fit and we can move faster together.. I’m honored that it was bestowed upon me, and we’ve been making a go of it. It helps with great leaders in place.

JK: What are some keys to success leading a venture fund?

SA: It’s understanding what you don’t know, and hiring people that do know that space. Understanding intellectual property, warrant deals, and identifying investible candidates and founders, and then understanding what we should be solving for and what technologies will fit well in our ecosystem. Between the innovation / venture leader and I, we’ve got that covered pretty well, so I feel really good about that.

JK: Is there any company you’ve invested in that you can point to and say, “Here are the positive results for Tampa General?”

SA: One thing that I’ve had to learn is that these investments have a long tail. We’re still fairly new so it is a little too early for me to answer that question. We have not invested in any sort of unicorn, but we’ve invested in some things that have done really well and solved a lot of problems for us. DexCare, HealthSnap, and ModifyHealth are some real neat ones that are really just getting some legs now. It’ll be a lot of fun to watch them and be a part of their success.

JK: Recruiting and retaining top talent has long been a challenge in IT, even before the pandemic. What is one of your most effective recruiting or retention strategies?

SA: We make retention a priority for our leaders. We agree together on a target annual attrition rate. It is the responsibility of every leader to achieve low attrition. But it starts at the top. The senior-most leaders have to make sure they have the right people in place who are able to make jobs a bit more joyful than just work. We invest a lot in our leaders, in their training, we set these goals together, and we are always looking for ways to knock down obstacles for one another.

Also, people can come talk to me anytime. Any one of the 400-plus people in our division can get online with me at 7:15 every morning, and if there’s some issue, they can just ask me directly. I make myself available.

I just got some numbers the other day. Last quarter, we had a 1% attrition rate, which I’ve never had in my entire career. Now, that is just one quarter, but annually our attrition rate has been in the single digits. When I started 13 years ago, it was like 25% or 30%! But let’s not fool ourselves. Having great leaders supports retention and Tampa, Florida is a great place to be, and that really helps!

JK: How do you see the CIO role evolving over the next three to five years, and what might some new responsibilities and job qualifications be?

SA: I think this inflection point we are at with generative AI is going to create new CIO responsibilities, new governance, and new skill sets needed for interrogating data sources. The CIO or chief digital officer role, whatever you want to call yourself, isn’t going away anytime soon. Really smart organizations are going to get as far ahead on emerging technology as they can, to understand what things like generative AI can do to lift administrative work off of nurses, off of revenue cycleteam member, off of any team member that has an administrative burden.

That’s the space for generative AI. The work ahead for CIOs is making sure we don’t misapply it, that we don’t create some sort of cybersecurity or safety issue. It needs to be governed well. Nobody has this figured out yet but it will be our job to figure out what we can do with this assistive technology, not to replace people, but to make them more efficient and effective. Because frankly, most of the people that we support would rather be doing higher order things. There aren’t enough resources available, so we should do everything we can do to put machines to work.

JK: I hear a lot of concern about the lack of up-and-coming IT leaders ready to fill healthcare CIO positions. What are your thoughts around this void, and what are you doing about it?

SA: I feel very strongly about the depth of our bench, the “heirs and spares.” If I won the lottery tomorrow, there would be up to five replacement candidates already in-house that are tuned in to both the culture that we’ve built together, and that have the depth and the training.

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

SA: My advice is to learn about people, how to get the best out of them, and how to hire and retain talent. If you want to be in an elevated role in IT, your success depends on it.

JK: How have you created the culture you have, a culture that keeps people?

SA: I think that’d be a great question to ask some of the team members here, but here is what I think. As a leadership team, we keep each other informed and in the know. For example, when I come back from a CEO council, or a board meeting, I immediately share what was talked about with my senior team. In fact, sharing of information is a standing agenda item in our regular meetings, and they will then share it with their teams in their meetings.

So, we’re in this continuous loop of keeping the whole division in the know about what’s going on, or what we’re thinking. And what I’ve learned is that sometimes I’ll be wrong on something, and I’ll hear an even better idea from one of our team members. It’s a win-win cycle that way. If you’re going to have a successful team, you want to keep them in the know. It’s absolutely foundational.

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

SA: I would be flying in the Air Force.

JK: Do you still fly at all?

SA: I do. I’ve been flying since I was 18. I can’t describe the feeling of the wheels coming off the ground and being at the controls of that flying machine. Aerospace and aviation have always been a passion of mine, but now it’s more of a hobby.

JK: What else do you love to do with your spare time?

JK: How many countries have you been to?

SA: I’ve lost track. Most of Europe. I worked in Australia for three years, so Australasia got covered. The Middle East, Israel, the United Arab Emirates, the Maldives. There are still a lot of places I have not been to, like India, so that should be on my list soon.

JK: What’s been your favorite place so far?

SA: Bora Bora, hands down.

Soon after Charlene Wilson landed her first job working in human resources for a healthcare organization in El Paso, she knew she had found her calling. Charlene’s passion has led to a long and successful career, including HR leadership roles at Loma Linda University Health, ECU Health, and Rochester Regional Health, where she became CHRO in May 2023.

Rochester Regional Health is a physician-led integrated health services organization serving Western New York, the Finger Lakes, St. Lawrence County, and beyond, offering comprehensive care from more than 400 locations, including nine hospitals.

Key Takeaways

• HR leaders need to understand how to connect with the younger generation of workers and future leaders. We are obligated to ensure they are prepared to run this business in the future.
• AI is going to play a major role in the talent acquisition space. Some worry that this could lead to unintended discrimination, but Charlene is reassured by what providers have shown her. A far bigger concern is the talent shortage.
• An emerging challenge that CIOs are going to be faced with is enabling a virtual clinical workforce, such as virtual nursing.

Q&A with Charlene

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

JK: You’ve done this for a while, so maybe you have given thought to how the CHRO role will evolve over the next three to five years. What might some new responsibilities and qualifications be?

CW: Since I started my career, the expectations of the workforce have changed drastically. Leaders can no longer afford to take a command-and-control approach to leadership. They’ve got to learn how to inspire, how to motivate, and build a culture of trust.

Human resources leaders of tomorrow really need to understand how to connect with the younger generation, the up-and-coming leaders, in a very profound way that is different from how my managers connected with me. As we confront the whole retention and commitment issue in both clinical and non-clinical positions, we must be able to relate and lead in a much different manner.

JK: How are you doing that today?

CW: I’m now more of an executive coach to the senior leadership than I was before. 10 years ago I was doing very tactical, traditional HR, building compensation models, building total rewards, talent acquisition, et cetera. But the majority of my time now is spent coaching the C-suite. HR leaders of tomorrow must be very strategic. Every facet of the workforce in healthcare is now leaning on HR for answers that they didn’t necessarily ask for a decade ago. “Charlene, how do I create these tools to help me deal with this younger generation?”

JK: How have you learned to deal effectively with the younger generation of workers?

CW: I learned very early that they are smarter than I am. They have access to information very quickly. They are barraged with data constantly. That wasn’t my career experience. We had to search long and hard for answers, but they know it instantaneously. But what they don’t have is wisdom.

So, I feel that my calling is to share my wisdom so that, coupled with their expertise, coupled with their knowledge, I can rest assured that the young leaders I have touched know how to run this business.

You have to do a lot of introspection and be okay with being vulnerable with this new generation. But at the end of the day, you need to take responsibility for preparing them for tomorrow.

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

CW: As you know, I’ve been here just five months, and we do not have a succession planning framework or model as of yet. I am currently working on developing that as well as an appraisal system to complement the succession plan. There is a three-year commitment for me to get an enterprise succession plan done.

JK: What tools or frameworks do you rely on, especially when it comes to hiring great leaders, and retaining and developing them?

CW: Gallup’s Strength Finders (now called CliftonStrengths) gives you the ability to understand the strengths of an individual, which is good to use not only when you’re hiring, but also for succession planning and career development opportunities for people. Where are their gaps? What do they need to be strengthened in? How do their strengths complement or clash with your current team? There’s another tool by David Lapin, which takes a different approach to understanding what your strengths are. He looks at it through the lens of your values. That is another tool that could be used to help navigate with the individual.

JK: How do you think generative AI will affect you and your team over the next few years?

CW: Oh, I believe that AI is going to play a major role in the talent acquisition space. Based on algorithms, we will be able know whether a person has the potential to do really, really good work in our healthcare system. Some will argue that this could lead to unintended discrimination, but the algorithms in the system I saw recently at Workday’s annual conference in San Francisco have been tested and validated. So, I’m not as concerned about that as I am about the talent shortage. I’m excited about what AI can do in terms of helping us find and manage talent. We will be implementing the Workday AI solution probably in 2025.

JK: What does a really strong partnership between the CHRO and the CIO look like?

CW: I’ve always had a very close relationship with IT, but it’s a little different here. Rochester Regional Health adopted Workday in 2013 as the HR platform, but IT has nothing to do with it at all. HR runs the platform, we monitor it and we manage it, which has been a change for me. Our connection with IT is really about bringing folks into the IT team and working with the CIO to develop career paths. The IT talent market is so volatile and hot due to intense competition for good people.

JK: Over the course of your career as an HR leader, how have you partnered with the CIO to improve the culture of IT?

CW: This new generation of workers is seeking more. They’re seeking more purpose, they’re seeking more flexibility, they’re seeking more opportunity to grow and develop. They’re no longer expecting to come into an organization just for the job. They expect to come in and see a career progression.

My work with our CIO is about building job profiles and complementing them with the career progression from the very beginning. Therefore, when he’s hiring or presenting our company to candidates, they know right from the start that they’re not in a dead-end job.

I’m working with Rochester Institute of Technology to help me develop that career progression and we are going to test it out on some RIT students. We’ve got this well-known, renowned technical school right here in Rochester, and so why not test it with them? I’m working very closely with the CIO on this now because that is what he’s going to need from HR the most over the next couple of years.

JK: What other work have you done to help strengthen the culture in technology, especially with remote and hybrid work?

CW: The real trick is ensuring that people are engaged. Not with just the work, or the work product, but engaged in the IT community here. Gone are the days when we believed that if you’re present, that means you’re engaged. No, it doesn’t.

You could have a leader who is a director living in Kansas. How do you create the atmosphere so that that director can lead and still live in Kansas? I am helping the CIO to utilize different tools to make sure that his people are engaged with one another.

I’m excited about it, about being able to see in my lifetime such a major seismic shift in the workforce, and being able to contribute to it.

JK: The virtual workforce has been a major focus for CIOs I speak with.

CW: Let me tell you about another challenge that CIOs are going to be faced with: the virtual workforce on the clinical side, like virtual nursing. We’re getting ready to launch virtual nursing internationally here. When you call your credit card company, or get software support, you’re often talking to someone that isn’t physically located in the United States. We’re going to start using that same approach to providing our clinical services. I think we will see more of this due to the nursing shortage.

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

CW: My advice to them is to remain relevant, and that means understanding not just what’s going on today, but to also what the workforce is going to need tomorrow. CHRO leaders must accept the fact that they need to serve. If they have issues with being servants, if they have issues with leading not because of the job title, but because being a leader is sacred, I don’t think they’ll be successful. This is all due to heightened expectations of the workforce I have mentioned. We need to position ourselves in such a way that people see us as serving them in a manner that is sacred and purposeful in healthcare.

JK: When you are not working, what do you like to do with your free time?

JK: What do you like to read?

CW: I like to read things that are inspirational. Right now I’m reading Trust and Inspire, the book Stephen Covey wrote after The Speed of Trust. I also like to read John Maxwell’s books because, as I said before, I believe that my career in HR is based on a calling.

JK: What has been your favorite country to visit?

CW: My favorite one was Dubai. The countries where I could actually live would be Germany or Korea.

I have a question for you, Judy. What do you see on the horizon for healthcare talent and recruiting?

JK: One concern of mine is the mergers and acquisitions. The organizations are getting so big, and I’m not sure the leadership is prepared for the scaling, where suddenly you have a CEO or a CFO in a much larger organization. Are they prepared to really lead that large of an organization and bring the cultures together? And do they have the money to really hire the talent they need? For a long time, technologists in healthcare didn’t have the skillset to take to jobs in other verticals, and now they do.

CW: You can’t compete, not financially.

JK: And now we’re having nursing and physician shortages, which are going to continue. As all the aging baby boomers need more healthcare, Charlene, where are they going to get it? How are we going to pay for it?

CW: And that impacts the workforce, Judy. We now have five distinct generations in the workforce because the older generation won’t retire if they can’t afford the health insurance they need. They’re living longer and they are working longer, and that creates this very interesting situation here where you’ve got the younger generation needing to move up, but the older generation deciding to work until they are 70. That’s something we’re dealing with.

JK: How are you dealing with quiet quitting, and individuals who aren’t performing?

CW: I’ve implemented what are called human resources strategy partners. They’re really working with operations on strategy and we’re changing the way in which we collect and analyze feedback. Instead of just once a year or every 18 months, we go in for interviews after the first 90 days, and very regularly after that. The data points us very clearly to where our gaps are. Workday has a robust analytical component for looking at employee survey data. We can slice and dice the data any way you can think of to understand where gaps are and where my strategy partners need to work with the leaders to deal with this culture issue.

This edition of “C-suite Conversations” features Vicki Hildebrand, CIO of Blue Cross Blue Shield of Massachusetts.

After many years in engineering and IT leadership positions in the for-profit sector, and much to her surprise, Vicki was attracted to a federal government opportunity due to the importance of the mission. As CIO of the Department of Transportation, her budget was $3.5 billion. Success in that role eventually led her to the healthcare industry, which she feels is the best place to be if you are passionate about driving transformation.

Key Takeaways

• As a CIO, you must learn to have patience. Change is still hard for many people and many organizations, particularly in the healthcare industry.
• With digital transformation initiatives that no one has ever done before, on time and on budget are not measures that provide a lot of value anymore.
• In IT there is always money being spent on things that are of low value. That is where you can find the budget to fuel innovation.

Q&A with Vicki

Judy Kirby: How did your career in information technology get started?

When I first moved to Silicon Valley, it was really humming and full of people just out of college, so that’s where I started my career. I was an engineer for a long time, and then this IT industry kind of cropped up. I’ll never forget one day getting a message from HR, saying, “You are now in the IT function.”

JK: You have led IT in multiple industries. You spent a long time at HP. Then you were CIO at the U.S. Department of Transportation. From there you became CIO of Blue Cross Blue Shield of Vermont, and now Blue Cross Blue Shield of Massachusetts. Can you talk about those industry transitions?

VH: I was in the for-profit sector for a very long time, and I learned a lot, but after some time and experience, I wanted to do something that was more mission oriented. Then the opportunity to join the Department of Transportation came up. Never in my wildest dreams is that something that I had planned for, but I thought, “Why not interview for it?” After all, the mission of that department is the safety of the American people. And I got the job.

After a few years it became clear that I needed to be closer to home in Vermont. My parents were aging, I was flying to D.C. every Monday, spending four days there, and then flying home every Thursday night, me and Senator Bernie Sanders. Then I got a call from Blue Cross Blue Shield of Vermont, and I thought, “What better place to apply digital transformation capabilities than in healthcare?” Because healthcare, to me, is still behind other industries in the digital space so I was eager to see what I could do to help.

JK: Most organizations struggle with change, and they struggle with digital transformation. What have you learned from your experience that would be helpful to other CIOs?

VH: One of the things I have learned is to have patience. There are enterprises out there that are anxious to pursue digital transformation, while others might eye it suspiciously. “What is this transformation? We take good care of our members today; we’ve got high regulation we have to deal with. Why is it we need to do these things?”

I have been driving this model of equal accountability for our partners and the technology team for speed to value, really driving value to our members. But not everybody embraces that. Change is hard for any company, including one that’s 80-plus years old and successful. Change is hard if there’s no burning platform.

I’m a driver. I’m eager to get things done, but I have learned that it is patience, high EQ, and learning from what’s working and also from what’s not.

JK: What have you accomplished so far with digital transformation at Blue Cross Blue Shield of Massachusetts?

VH: We have a very modern data fabric. I can’t take a lot of credit for it because there was momentum before I started, but I have been a big advocate of it, and I am trying to accelerate it. You know, people are all talking about generative AI, but their data can be awful. You’ve got to start with a solid data foundation. Data is what differentiates us. We have really rich member data, and we’re in a unique position to help them on their health journeys with AI.

Another accomplishment is the CX practice the company is building and we are supporting. Before, customer experience was more about how to resolve survey complaints, now we’re pivoting toward journeys, a “no wrong front door,” and a digital-first approach to things, while ensuring that members still feel a high touch. You don’t want to go so digital that they feel like they’re remote from you.

JK: And what would you say have been the keys to success with those two initiatives?

VH: Changing the accountability. On time and on budget are not measures that provide a lot of value anymore. There is some science and some art to all of these initiatives, and there’s not one person who has ever done any one of these initiatives before. So, why should we know exactly how long it’s going to take and exactly how much money it’s going to cost, and exactly how many resources? We don’t know the answers, and if we take guesses, we will disappoint people 365 days a year.

I’ve created a “two-in-a-box” relationship with our partners. The technology folks are told, and must embrace, that they are equally accountable for the success of our enterprise. We’re trying to create models where the technology leader can finish the sentences of their business partner, and the business partner is learning a ton about technology, and the two of them are operating so quickly and so collaboratively that they’re driving decision-making and progress really fast. We estimate how long things are going to take, and how much money things are going to take. But it’s not a punitive environment, where, if you miss your date, you’re in trouble, because in that situation everybody pads their numbers. So, I’ve tried to change that to, “As fast as possible, drive that minimum value so that we can actually move the enterprise forward, and do it in a collaborative way.”

JK: How do you get your CFO to go along with this practice of not necessarily defining a budget, and a cost scenario that is fluid?

VH: I am a CIO who believes that we have to have an efficiency arm of transformation. It’s one of the first things I did when I walked in the door. I set up an efficiency initiative because there’s always potential savings. There’s always money being spent on things that are of low value. That’s where you find the money to fuel your innovation.

I am not a CIO who keeps going back to the till, asking for more, more, more. I’m a CIO looking for where we are spending money that is not delivering value, and how I can reinvest that in the innovation that we need. So, I have been out there driving efficiency. That means in the workforce and in being brutal with my vendors. If a vendor is not going to work with us on the costs, we’re leaving. Even if they’re strategic, we’re leaving. In this environment where some vendors are asking for 30% upcharges, we can’t do that. It’s not sustainable. I’m always looking to drive efficiencies and I think CFOs appreciate that.

At the Department of Transportation, the biggest splash I made in the government was when a reporter asked me if I was going to take advantage of a new law that added additional funding to IT departments. My response was, “Absolutely not. I have a $3.5 billion budget. Why would I need more money?” And it spread like wildfire across Washington D.C., “CIO, Department of Transportation says she needs no more money.” I even got a little backlash about it. But I had a $3.5 billion budget for a mid-sized department. How could I justify needing more money?

JK: When you came to Blue Cross Blue Shield of Massachusetts and started changing things, you had to bring your team along. How were you able to engage and excite them?

VH: We set up an initiative called MOVE, which stands for Modernize, Optimize, Value, and Empower, and branded it. Then we tried to make sure that we focused on those areas so that people understood what it was we were trying to do and would rally around MOVE.

Transformations don’t have an end game. There’s no end state, no “Voila, I’ve arrived.” It’s all about constantly iterating, changing, and reflecting. What are our impediments? What could we do better?

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

VH: Learn, learn, learn. I had a fabulous boss, who is now the CEO of Xerox. His name is Steve Bandrowczak. I think he now has upwards of 20-plus CIOs that have come out of his organizations. Steve always used to say, “Every day, spend some time learning. Learn your business, learn what’s going on out there in the world, learn new technologies.” To that advice, I would also add, “be a risk-taker.” Just lean into things, go explore, and open doors.

JK: How have you navigated the technology talent shortage, and what advice can you give for hiring in this environment?

VH: We haven’t had a lot of trouble because we’re able to recruit people to the mission of the organization. We’re obviously not going to be the biggest compensators, nor are we the lowest. Healthcare is very complicated, and it doesn’t always serve members as well as it could. There are people out there who really want to help solve that and support our company’s mission. In addition, I’ve been upscaling the organization, and people are reaching out to their colleagues saying, “Be part of our merry band.” I think we’ve got some momentum going here that people are excited about. If you’re passionate about what you’re trying to accomplish, that comes across to people.

JK: You said you are upscaling your organization. Can you talk a little bit about how you’re doing that?

VH: When I arrived here, I inherited a very large PMO. They had years of experience with the waterfall approach, but I knew we needed to adopt the Agile methodology for technology development. I recognized that this would require a significant evolution, starting with our own team. I quickly introduced the mantra “speed to value”, and we took a close look at our processes to identify steps that aren’t necessarily value-add. We were able to eliminate some steps and streamline the approvals process. We also encouraged people and teams to be less risk averse while constantly learning and recognizing what questions to ask. Many of the changes we made are now enabling us to get more hands on keyboards so we are ready when our business partners come to us. Even if it’s not on the fiscal quarter or the year, I want us to be able to work nimbly.

JK: Succession planning is a responsibility for all senior executives. Can you talk a little bit about your approach to succession planning?

VH: I know that at a lot of organizations, technology aptitude is the top of the list, but leadership is top of the list for me. We spend a fair amount of time on training, grooming, and growing people in their leadership skills, and we do have succession plans. It’s part of the discipline that we have. We’re also a little bit more rigorous than other organizations on our performance calibrations. We’re thinking about where this person is going. What do they need to learn? How can we help them improve and develop their skills? I always view it as a real compliment when someone is promoted out from underneath me to do something new, because growing people is such a high priority for us.

JK: The buzzword for the year is generative AI. How is that impacting your organization and the company’s strategy?

VH: We’re certainly incorporating it, but despite the fact that I usually want to be out in front on new technologies, this is one where I don’t want to be the leader. We are doing some proofs of concept with GenAI, but we have to be very careful with people’s personal health information. Security is very high on our list. Right now, we’re seeing generative AI helping us in the back office, inside the firewall. But we’re going to stay very current on the technology, and we’re going to be watching and learning as we go.

JK: Many organizations right now are touting sustainability, but I hear less about it in healthcare. As CIO, are you involved in any strategic initiatives around sustainability?

VH: Yes, sustainability is a priority for us. In fact, we recently won the Social Impact award from sustainableIT.org. We’re always looking for ways to reduce, to automate, and reduce paper, to make sure that we’re using resources efficiently. It goes back to the efficiency I was talking about earlier. We do build sustainability into our initiatives. We ask ourselves, what can we do here that will really help with sustainability goals?

JK: If you hadn’t gone into IT, what other career do you think you were cut out for?

JK: It doesn’t sound like you have a lot of free time, but when you do, how do you like to spend it?

VH: My problem is that there are a lot of things I love to do, but I have a lot of energy. I am on some boards, and I really enjoy that work. I love being outdoors. I love skiing, hiking, kayaking, and biking, and that’s what saves me on weekends, just getting outside and having decompression time. I also love to cook, and I love to read.

JK: What is a good book you would recommend to others?

VH: I am a very big fan of Mark Schwartz. He is at Amazon now, and before that he was in government at U.S. Citizenship and Immigration Services. That’s how I met him originally, and he is based in Boston now. He really understands modern technology. I just reread his book, A Seat at The Table. I’ve read it many times, and pages are starting to fall out, but every time I read it, I learn something new, and I’m very energized.