The subject of this installment of “C-suite Conversations” is none other than Mikki Clancy, Chief Digital Officer at Premier Health. Mikki first joined Premier Health, the largest comprehensive health care system in Southwest Ohio, in 1994 as an IT auditor and she rose to CIO in just eight years. Premier Health has three hospitals, numerous affiliate organizations and 13,800 employees in over 100 locations.

Key Takeaways

• More CDIOs will come from operations or strategy backgrounds rather than traditional IT paths. Health systems should prepare to consider candidates with operational expertise who understand technology, rather than requiring extensive technical experience first and operational knowledge second.
• A big part of a strategy to retain top IT talent is making sure that they know when their workday starts and ends. Contrary to what many people think, remote employees tend to work more than they should, which can lead to burnout.
• To start gaining experience in operations and prove you can work outside of IT, work with the CEO to get placed on interesting projects, take on new duties and learn things you won’t learn as CIO.

Q & A with Mikki

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

JK: After many years with Premier you were promoted to CIO, then COO of your health system’s flagship hospital, and now CDIO. Can you please talk about these transitions?

MC: I was promoted to CIO very early in my career, as a young 30-something. Some of that was circumstance and some of that was the fact that I had run the Y2K project for Premier. When I left that function, I had the choice of continuing as a director of audit, becoming an information security officer, or moving over to applications. I chose applications because I wanted to do more.

About 18 months later, our CIO had to leave for medical reasons and Premier said to me, “We’d like to take a risk and a chance on you. We think you have what it takes to be a CIO.” I’d never really been through all the processes, but I’m pretty good on my feet and I researched a lot and built teams that helped me be successful.

After about 12 years, I thought maybe I could help our operations folks to use the technology better and was looking into a VP of Operations type role. But instead, they made me COO of Miami Valley Hospital, our largest hospital. I learned all the things that I didn’t know about how people use our technology, how they work around our technology, how they adopt it. It taught me a great deal about operational change management to drive KPIs, outcomes, expense savings and revenue generation from a point of view I never had as a CIO.

JK: Many individuals don’t have a CEO willing to take a chance and put them into a COO role. How would you recommend they get some of those experiences?

MC: That doesn’t happen very often. I knew about seven years earlier that I needed to start getting experiences to prove I was more than a technician. I worked with my CEO at the time to get placed on certain projects to gain experience and prove that I could manage operations and work with physicians. So I took on additional duties and started learning about things I wasn’t doing as the CIO.

JK: What were some of these projects?

MC: The very first one was as project manager for our strategic planning cycle, working with the chief strategy officer directly. I worked inside the hospitals on how we piece the strategy together. It forced dialogue about the strategic operations of Premier, and gave me exposure and the opportunity to develop relationships.

I also was given several tactical projects for which I was asked to orchestrate both the technology and the operations. I did work with our PACS environment and on the facility master plan, looking not just at what we needed infrastructurally, but also strategically. Where should facilities be placed in our region to drive access? Those opportunities really flipped the lens for me.

A lot of people thought it was nuts to make me a COO rather than start with a VP level operations role. But my managers did a fabulous job of paving the way by saying to the team, “We would like to think about our operations differently. We think technology is going to be an underlying strategic lever for a very, very long time. Having someone with Mikki’s background will help drive operational improvement.”

JK: Tell me about your current role as CDIO and what that covers.

My CDIO role is a blend of operations and technology. I hold the transformation office, which leads all of the performance improvement and all of our transformation work, digital and otherwise. Then I have the traditional IT division, and I have product leadership, which is a combination of technology and operations teams, whether it’s in our continuum of care or in our integrated delivery system, whether it’s the lab or home health, the hospital setting proper, revenue cycle, or back office.

In this digital technology CDIO role, I’m flipping the lens to what the patient needs. What does the caregiver need? Are we meeting them where they are? A lot of technologists are just saying, “Gotta put in AI to be more efficient.” But I actually believe it’s about meeting the caregiver and the patient where they are, which for us is not always going to be just a technology solution. Some of those are going to be personal solutions because healthcare is still very individual.

The CDIO is accountable for driving operational metrics change through the enablement of technology. So, it isn’t just about running the technology; it’s about operational change management. It’s about outcomes-driven activity that improves some portion of our environment, whether it’s new patient volume or creating a new work environment for our registrars so that they can work remotely.

You still need a CTO with the expertise to drive the architecture of the ecosphere, which is different than driving the operational outcomes.

JK: Looking out over the next three to five years, how do you see the CDIO role changing. What might some new responsibilities be?

MC: The CDIO role is going to become more blended with the strategic arm of the organization. Digital innovation can become a revenue stream as some larger organizations have already shown. I also think the CDIO is going to become a thought leader at the table more than a tactician.

They will have a lot more responsibility for data governance, data management, and analytics because that will drive the artificial intelligence capabilities of the organization. But they will always have accountability for technology rationalization. I think that will always be a part of this role.

JK: What about emerging new job qualifications for the CDIO role?

MC: I think operations is a qualification that hasn’t traditionally been in the requirements of this job. But I do believe that CDIOs will be more likely to come from either a strategy background or an operations background, with technology experience. It will become more blended. And to be effective, CDIOs will rely more on their relationships with the operations and strategy teams.

JK: One of the big concerns I hear over and over again is the lack of up-and-coming IT leadership interested to fill future healthcare CIO or CDIO positions. What are your thoughts about this void and the growing number of people who say, “I don’t want to move up. I want to stay where I am”?

MC: That is a challenge right now. We’re spending a lot of time on succession. I think that more risks need to be taken in the technology organization. Traditionally, you want to see 10 to 15 years of experience before you move someone up into these C level roles. I think health care systems will have to start considering candidates with five to 10 years of experience, and I think many are going to come from an operational background where they’ve become educated enough on technology to be able to ask the right questions.

Reliance on the CTO role is going to become greater as we go forward because of the strategic value that the CDIO role holds. And unless you’re a really profitable organization, to have three or four chiefs is not sustainable. Chief data officer, information officer, technology, security – that becomes quite costly, I think we will see more combined roles.

There’s a lot of churn in the market right now in these roles. I get contacted all the time by recruiters asking me to interview for open positions. When I talk to people in my own organization about their career aspirations, I am not hearing from many that they want to become a CIO or CDIO. Successful succession planning has to include selling the value of being in these roles.

JK: I agree. Hopefully there are enough rising professionals interested in becoming a healthcare CIO or CDIO. What career advice do you have for them?

MC: The advice I usually give is to continue to learn and enjoy learning, because in this kind of role, you are going to do so many different things hour-to-hour, day-to-day, month-to-month, and year-to-year. If you don’t figure out how to learn constantly and quickly, it will become overwhelming.

I also coach people that they control their “yes” and their “no” just like they control their calendar. If you let everything be a “yes” or everything be a “no” or do whatever your calendar says you are supposed to be doing, you’ll get overwhelmed.

If you look at my calendar on any given day, I have invitations to four or five meetings at the same time. I have to make a choice. I can’t be in all of them at once and they can’t wait for me to sequentially map it out. So, you must learn to delegate a lot and spend a lot of time building your team.

JK: Recruiting and retaining top talent has long been a challenge in IT, even before the pandemic. And now with hybrid and remote work in the mix, what is one of your most effective recruiting or retention strategies?

MC: We are 100 percent remote unless you choose not to be, or you work in a job that has to touch the machine. Close to 80 percent of my division is fully remote and it is changing how we do engagement. It is much more intentional than it was when we were all in the workplace, because you can no longer just casually walk by and talk to people and see how they’re doing and see what barriers are in their way.

The biggest thing that I have to work on for retention of my team is making sure that they know when they’re successful, and when their workday starts and ends. When they’re remote, they tend to work way more than they should. It’s not the opposite as some might think. I find that I have to get them to not be working all the time. That’s a major part of the retention strategy so they don’t burn out.

JK: Are you seeing results from these efforts?

For recruitment, being fully remote for those who choose it has helped tremendously, as has our focus on innovation. Over the last 18 months, we’ve gone from a 40 percent vacancy rate on my team down to seven percent.

We are also finding that onboarding and pre-onboarding strategies are critical in IT but also across the whole organization. For a while, we had high churn in the first 90 days of employment, and in the first two years of employment. But an intentional strategy of pre-boarding and onboarding in the recruitment process has helped us get people used to our large organization and who their teams are.

JK: Can you talk more about how succession planning is handled in your organization and the approach you’ve taken?

MC: We have been doing a lot of work to identify what the successful traits are for various positions. We spend a lot of time with our current teams, figuring out what they want to do for their next career progression. Then the employee is accountable for creating their development plan, but it’s the manager’s responsibility to help make the development plan work.

JK: On the subject of generative AI, what is your company’s strategy and what type of work are you leading to plan, evaluate, educate, or implement new AI capabilities?

MC: I can’t go to any meeting where someone isn’t asking about AI in the first five minutes. We are taking an approach that is different than what we’ve done with most other technologies. We have put in governance for AI, and the governance is not about saying “No” – it’s about how we do this safely with high quality and put in the right risk mitigations. We’ve had to spend a lot of time with our workforce. We’ve been out on a roadshow to management forums and to other communication mechanisms to help people understand that this is not about replacing our workforce with AI. This is about helping them work at a higher level.

We have been pretty cautious about what we’ve implemented, most of which has not been generative AI but machine learning or predictive modeling AI. We’re working on building large language models to be able to get to the generative AI. We are also leveraging what our core vendors are doing with AI and adopting that rather than trying to build it all ourselves. I don’t really have an AI work team. I do have an AI product manager who started recently.

We have a list of criteria: Is it going to bring clinical value? Is it going to bring business value? Are there any risks in legal, ethical, security, etc.? Is it aligned to organizational priorities? And, is the vendor viable? We’re not a development shop, we’re an integration shop.

JK: One thing that seems to keep everyone up at night right now is cybersecurity. How are you handling the increasing threats?

MC: We have had to double- and triple-down on access controls in our environment, on geo-fencing, on network segmentation, monitoring and endpoint protection. All those are investments and people and technologies and resources that distract us from our mission of delivering high-quality care to our community and inspiring better health. It’s become a good 20 or 25 percent of our focus.

Every new technology has to go through a security review to manage the third-party risk alone, because it’s not just what’s happening in your environment, you’re now accountable for what’s happening in somebody else’s environment.

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

MC: I would have still been a leader of business somewhere. I like leading people. I like making a difference. I like demonstrating that you can lead with love and with kindness. I think I still would have done that, whether it was in technology or business.

JK: Somehow, I don’t put Marine Corps leadership training and love in the same sentence. How did you transition from Marine Corps leadership to love leadership?

MC: Actually, I think I led with love as a Marine Corps leader. I think the principles of leading with love is about caring for your people. And in the Marine Corps, we learn to take care of our people first. The leader eats last. The Marine Corps has been doing that for 245 years. It’s about making sure your teams have what they need to be successful. It’s making sure their voices are heard. It’s making sure that you’re considering their opinions when you can.

JK: Final question. Outside of work and spending time with friends and family, what’s something you love to do in your spare time?