In a wide-ranging keynote presentation entitled “A Time to Lead: Reengineering Governance to Execute Business Strategies,” delivered on Dec. 11 as part of the Health IT Summit in Houston, sponsored by the Institute for Health Technology Transformation, or iHT2 (a partner with Healthcare Informatics under our Vendome Group corporate umbrella), Ed Marx, CIO of Texas Health Resources, a 14-hospital integrated health system based in the Dallas-Ft. Worth suburb of Arlington, eschewed the notion of a universal model for organizational governance, and instead stressed a set of broad principles he believes CIOs can apply to any healthcare organization in order to lead at a time of massive change and intensifying pressures in U.S. healthcare.
“What’s the silver bullet for governance? There is no silver bullet for governance,” he told his audience flatly. “People talk about governance models all the time. And when I was in Philadelphia, we built a beautiful model for governance. And it worked there, but not in other places. It’s not about the specific model.” Instead, he stressed, organizations need to work from a core set of principles, in order to fashion models that work for them. He gave an example of cultural differences, noting that, “Ideveloped a specific strategic plan in Cleveland, and had all my VPs sign off on it. That was cool in Cleveland, At THR, I tried to have my executives sign off on it, and they said, ‘What? We don’t do things like that. Just trust our word.’ So you’ve ultimately got to work according to principles” that can be applied to diverse cultures, he emphasized.
His five principles: transparency; boldness; trust; co-chairs; accountability; excellence; alignment; and escalation.
Transparency comes first, he noted, because everything one does as CIO must be above-board, open, and clear to all stakeholders. Meanwhile, he said, “You have to be bold in your principles. It’s better to be blunt and upfront in your ‘no’ than to encourage all sorts of passive-aggressive behavior. Passive-aggressive behaviors kill governance.”
As for trust, he asked rhetorically, “Have you built that trust in your organization?” Is there a level of trust in one another among everyone working in the organization?
Meanwhile, in order to execute and make effective any strategy, Marx said, “No matter where I’ve been, I’ve multiplied the effectiveness of governance tenfold by having co-chairs.” The system of governance is so strong these days at THR, he noted, and the co-chairs of committees and initiatives feel so empowered, that processes are highly streamlined.
As for excellence, Marx noted that “If you do your governance with excellence, it’s going to build trust.”
Another core principle is alignment to strategy, which is absolutely key in order to keep processes and activities on target in any organization, he added.
The final principle he noted was an interesting one, and Marx explained it in some detail. It is the principle of “escalation.” What that means, he said, is that if an individual or group of individuals feel dissatisfied with a process taking place at THR, they can “escalate” their disagreement up to higher levels in the organization, namely up to the CEO. “You have to create escalation paths” to allow for the resolution of serious disagreements over the execution of policy or strategy, he said, but he quickly added that, “I’ve been at THR for seven years, four months, and 11 days, and only once has anyone escalated an issue up to the CEO.”
Cultures are very diverse across U.S. patient care organizations, Marx stressed, but he emphasized that the principles he cited could work anywhere, and do.
Meanwhile, Marx expressed his view that, “In the past, we CIOs have been reluctant to lead; we’ve taken a back seat, and have been order-takers.” Meanwhile, he said, “The post-modern CIO is a dichotomy. We all want a seat at the table. Often, the IT seat is missing,” he said. “We all want to be at the executive table, but we haven’t fulfilled the calling of our leadership in terms of technology leadership. My presupposition,” he said, “is, it’s time to lead. Time to ‘cowboy up,’ as they say in Texas, and lead. You have to be a leader, particularly now that IT is a strategic asset.” And, he said, “As post-modern CIOs, we need to make sure to build resiliency and not get stuck in our ways. Part of the reason IT is so far behind in healthcare is that we’ve gotten stuck in our ways.” But, following the right governance principles, the right strategies, and of course, executing excellently, they now have an unprecedented opportunity to show leadership at a high, system-wide level, in their organizations.
How will CIOs know if their IT governance processes are working well? There will be “peace” and “finality” around them, Marx said. Peace, meaning, a low level of conflict around governance processes. And “finality,” in this way: “It’s never perfect,” he said, “but people know they have the opportunity to present their case, and the judgment is final. No going around and gossiping and engaging in passive-aggressive behavior” to derail decision-making or the execution of strategies. “That sense of finality about things is how you know you have something decent going on.”