The subject of this edition of “C-suite Conversations” is Dr. Michael Waldrum, Chief Executive Officer for ECU Health and Dean of the Brody School of Medicine at East Carolina University.

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

• Dr. Waldrum’s career trajectory includes being a physician, CIO (which he believes is the hardest job in healthcare), COO, and CEO.
• A career path that includes project management, process improvement and quality improvement is excellent preparation for a CEO role in healthcare.
• Because collaboration is a “hard science,” Dr. Waldrum created what he calls the Collaborative Problem Resolution Context to help operations and IT leaders work together to define and implement solutions and share accountability.
• As technologies advance, the human caring component of healthcare will become more important, not less.

Q&A with Michael

Judy Kirby: You’ve had an amazing career in healthcare: physician, CIO, COO and CEO. Please share how you got to this point.

I earned a degree in clinical effectiveness in epidemiology and started looking at big data sets and how information management is used. Back in those days, the early to mid-nineties, we were not very integrated; solutions were very fragmented. I was interested in integrated enterprise solution sets, so I got active in that, working as what is now called chief medical information officer, but that job title didn’t exist then. I was a medical director of information services at The University of Alabama at Birmingham for three years, driving integration, deploying clinical information systems, and building databases to measure the care we were providing in the ICUs.

Then six months before Y2K the incumbent CIO left, and the organization approached me about the role because I was probably dumb enough to say yes six months before Y2K. So, I served as CIO for five years at UAB. In that role, I learned the importance of integrated enterprise solutions, of having a strategic plan for IS that supports the strategic plan of the institution, and then, really importantly, rigorous project management. If we were putting these multimillion-dollar assets into delivery organizations, it had to be done in a way that had industrial strength and that delivered returns to the organization, and so that the projects didn’t fail. I was very active and vocal at that time in HIMSS and in CHIME, talking about the need for the industry to deploy these assets in a way that supports business or clinical processes, and the importance of integration of operations and IS. I developed great relationships with people in the industry and in the organization and we were successful.

I think people saw that we were spending a lot of money, but that we actually delivered as the result of a rigorous project management process. I thought I was going to be a CIO my whole career, frankly. But because of that success running big enterprise projects I got recognized by the organization as somebody who understood both the clinical operations side as well as the IS side, and how to do big change management.

The organization was building a new hospital with all new ORs, ERs, and what was called the Diagnostic and Treatment Facility. It was a $750 million project, and at that time there was a change of leadership in operations at the hospital.

The CEO approached me and asked, “What do you think about moving over and changing your career path to operations?” It was a hard decision, but it was an interesting and scary opportunity. So, I switched over to healthcare operations and moved my office across the street to the hospital.

Then I got immersed in operations and brought over a lot of what I learned as CIO.

JK: What were some of the things you knew as CIO that you applied to your new role in operations?

MW: Understanding the importance of the integration of experts required to solve different problems and the importance of operations and IS to be highly integrated in how they approach those problems. IS may often have a solution, the business owners may have different ideas about those solutions, and then they have acrimony, and we end up wasting resources and time, and we don’t get the outcomes we’re looking for.

So, I created a philosophy. I call it the Collaborative Problem Resolution Context, which is a complex term, and it sounds fluffy, but it’s really hard. Collaboration is not a soft science, it’s a hard science forcing operations and IS leaders to actually work together to define solutions, develop the plans to implement those solutions, and then share accountability.

After I moved over to operations, I’ve had repeated experiences that keep reinforcing the need for enterprise solutions, integration, and collaborative problem resolution. Whether it’s a new hospital, or integrating a large delivery system. or putting in new technology, these learnings just keep coming up, and in a way, I view them as the same problem over and over again.

I do think this idea that we are all technology companies is real. I view technology and systems as tools to manage information, and I believe that information is the currency of healthcare.

I always say I’m a plumber, and I actually know how the plumbing works. I know how that information gets captured and flows through the pipes, but I don’t have a degree in it. I learned it by just doing it.

JK: Can you talk a little bit more about your Collaborative Problem Resolution Context and how you utilize it in your organization?

MW: I believe my job is really to oversee strategies for the organization and then create a healthy environment for people to do the work. In addition, I have to ensure that my leaders know how to create that environment and can set the expectation that people will collaborate, and that IT is not a silo. It is there in service of the organization.

So, that gets into leadership development, constructive conflict, and how people work together to solve problems. And developing leaders to have the competencies to manage that.

JK: What advice would you offer to anyone interested in becoming a CEO at a healthcare provider organization?

MW: There’s a lot of different tracks, but in my case, I think growing up in project management, process improvement and quality improvement was excellent preparation. I advise and mentor young people all the time and I always tell them to be open to new and diverse experiences and learning from those, especially when you’re young. Be willing to go into spaces outside your comfort zone. Don’t worry about where you’re going, just get experience and learn from it. Then right when you’re getting comfortable and understand that space, walk away from it and get to another place where you’re uncomfortable and learn from that new thing.

Do that while you’re in your 20s and 30s, and when you are 40, doors that you don’t even know exist will start opening for you. That has actually happened for me. I never thought I’d be where I am today, doing what I’m doing.

JK: Looking ahead five or 10 years, what is your vision for the future of healthcare, and how do you see technology shaping that future?

MW: Five and 10 years out in this rapidly evolving environment is really hard to predict. I can tell you what my hope is, a career-long hope really. My hope is that we get off paper. I was part of the generation that deployed the first EHRs and took us from paper to electronic.

My hope is that we continuously evolve, and that that evolution leads to the collection of meaningful information about people that helps them live more productive and healthier lives. My hope with AI and other emerging technologies is that they can be utilized to make us more efficient and effective.

I believe that all of the data is already there. I took us from zero to 1.0. I think we’re at 2.0 maybe, or not even at 2.0 in this evolution. But we’re not even using the technologies that have been deployed to their full capability. We have a Ferrari engine running this organization, but we drive it like a lawnmower.

But now we have an architecture that allows us to take the lawnmower and make it a Hyundai, and then next year, hopefully, it’s a Mercedes. How well we use what we already have is important.

My biggest fear is that humans forget that they’re really important in taking care of people. I believe that the human caring component of healthcare will become more important as technologies advance, not less important.

JK: What advice would you give to CIOs looking to build strong relationships with their clinical and operational partners?

MW: Remember that you’re not a silo. You have to be customer-oriented, create forums for collaboration, and listen hard. People often hear from CIOs that the answer is “no.” I always say that the answer should be “yes, but.” When users come to IS, they’re coming because they have a problem. You have to be very open to hearing what the problem is if you’re going to help them improve their situation.

And like I said, collaboration is not soft. It’s really hard. It’s hard to sit in a room with someone, listen to their problem, and then have them listen to you and have constructive conflict to solve a complex, systematic problem. That’s just hard work. The CIO has to be open to that. “Yes, I hear you. I hear that you have a problem, and I’m going to engage with you to solve that problem.”

JK: You have a very successful relationship with your CIO, Donette Herring. She says that in our interview. What is the key to a strong CEO-CIO relationship?

MW: Did she really say that? Oh, good!

I think it is having a long-term strategic vision and plan, being able to articulate that and why the plan is important to the business. And having the rigor to not get distracted. CIO is probably the hardest job in healthcare. I really do think that, and I’ve done a lot of jobs. It’s hard because people use their phones or a computer and think all that automation just happens magically.

A CIO who thinks strategically can articulate the plan to have change happen, and then hold everybody accountable. I think that’s where the relationship with the CEO becomes important. It’s easy to blame IS for a process failure or an information management problem. I can’t tell you how many times I’ve had to explain to finance or HR or any of the functions that, “You know, you want IS to do that, but you’re asking them to solve this problem, and you think you know the solution, but you really don’t. You don’t really know it the way they know it.”

The people on the operations side don’t always want to take the time or make the effort to be definitive. They just want the new report to pop up. Well, how does the information get collected in the first place? Where does it get stored? What’s the definition? There’s not an easy button, so I think that the CEO’s job is to support the people in IS and technology with resource allocation. IS still has to be held accountable, and processes have to be rigorous.

My operators may not like it because I’ll say, “You guys don’t understand what you’re asking Donette and IT to do. You have to get in a room together and solve that problem. If you need me in the room, I’ll help you solve it.” So, it’s really supporting both sides.

JK: If you hadn’t chosen this path, healthcare, what other career path do you think you may have taken? What other profession would have been a good fit for you?

MW: Oh, gosh, that’s a really hard question. I just love healthcare, and I love the people in healthcare and what we do. My father said, “You’re crazy to become a doctor. You should go into computers. That’s where the future is.” I was actually learning how to code in BASIC at the time, so that gives you a time frame of when that was. And I listened to my father. Obviously, I loved him, but I just didn’t feel like that was the right path for me. I don’t know, sometimes I reflect and I wonder if he was right. IT is a really exciting field, and there’s so much opportunity.

For the final exam in my BASIC class I wrote a program that would control the systems for a house – the music and the lights and all of the technologies that run a house. My professor gave me a C+, and his notes said, “The coding is great, but nobody would ever want this.”

It is important to be able to ignore people who say something is a bad idea and trust yourself. The advice I have, on any track, is to have a learning mindset and stay open to experience and learning and following the path and opportunities that appear in front of you. Don’t be afraid to take the steps.

JK: Do you have a passion or a hobby that you dedicate time to outside of work?

MW: I love to read. I love golf, I exercise, and I have a family. Four kids and seven grandkids, so those are really my time. I’m pretty rigorous about time management. I do things with intention, and so I have a process on how I manage my time in my life. That’s kind of a system-based approach, but it includes all those. I play the guitar too but I’m terrible at it.

JK: Who has the better drive, you or Donette?

MW: Oh, it’s been a while. I think we have only played once. I would say Donette, probably. I love golf because it’s like life, right? You can hit a great shot and end up in a bad situation, or you can hit it badly and end up in a great situation, but at the end of the day, you just have to deal with where you land.