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LIVE from the CHIME Fall Forum: Breaking the IT Governance Barrier

October 17, 2012
by Mark Hagland
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CIOs from two very different organizations offer their colleagues hard-won lessons from the trenches

As consultant and author Guy Scalzi noted on Wednesday, the title of the session “Managing the Tidal Wave of IT Demand: The Keys to Successful IT Governance?” contained a metaphor that should strike CHIME12 Fall Forum attendees as broadly apt. To underscore his point, Scalzi, a principal in the Pittsburgh-based consulting firm Aspen Advisors, began his moderation of the session by showing a photo of a tsunami as one of his first slides. The breakout session was one of several offered on Oct. 17 at the Fall Forum, hosted in Palm Springs by the Ann Arbor-based College of Healthcare Information Management Executives (CHIME).


Jamie Nelson (l.) and Debe Gash respond to
questions from Guy Scalzi during a CHIME Fall
Forum session on IT governance

Following Scalzi’s introduction, Debe Gash, vice president and CIO of the 11-hospital Saint Luke’s Health System based in Kansas City, Mo., and Jamie Nelson, vice president and CIO of the 200-bed Hospital for Special Surgery in Manhattan, made presentations on their organizations’ IT governance journeys. Inevitably, as both CIOs openly conceded, healthcare IT governance is a complex, very often messy, affair. Indeed, Nelson spoke quite frankly about the dysfunctional IT governance landscape she encountered when she joined the prestigious specialized surgical hospital, which performs about 30,000 orthopedic surgeries a year, just six months ago. But she and her colleagues are beginning to turn things around, focusing strongly on setting priorities and organizing the hospital’s prioritization processes under a strong organizational CEO.

Fortunately, Nelson told the audience, the Hospital for Special Surgery’s CEO is firmly committed to investing in IT as an “enabler” of performance improvement for the organization, which is a key foundational support. Figuring out exactly how to do so will be the next hurdle, she said, noting that while the hospital’s 2012 capital budget included $14 million in IT spending, “We’ve asked for $35 million in 2013, and will probably get about $20 million of that. So,” she noted, “a lot of prioritization will have to happen” in the coming months. She cited unraveling and rebuilding the organization’s tangle of committee  structures as one of the key necessary steps in the next few months, adding that “The governance structure I walked into was very disjointed. Many of the committees had not met in quite a long time, and there was absolutely no connection between what the committees were doing and actual prioritization.”

Turbocharging IT governance

Meanwhile, Saint Luke’s Health System is considerably farther along on its IT governance journey, and Debe Gash was able to provide the session’s audience with a portrait of an integrated health system that has achieved considerable discipline and focus in its IT governance processes. “The governance structure that we’ve established has helped to really weed out the things that are not that important, and has helped the IT organization to focus on our really strategic objectives, Gash noted. At Saint Luke’s, a strategic planning council, composed of top-level system executives, presides firmly over the health system’s physician leadership and committees, the (centralized) IT department, and over prioritization groups (both financial and clinical).

What’s more, “We’ve really given to the prioritization committees the ranking of projects,” Gash noted. “We evaluate each project with all the others and come up with a ranking structure. And I have yet to have the strategic planning council challenge any of those prioritization decisions.”

Among the key points Gash made were that first, every IT project has to support the entire organization, not just an individual department (that in fact is an explicit principle created by the strategic planning committee); every IT project is evaluated using a variety of “quality, clinical, customer, financial and other criteria”; and IT projects within Saint Luke’s are not allowed to be individually concepted or approved.

Though there were no philosophical disagreements in the discussion, Jamie Nelson did offer the following caution: “Don’t let the perfect get in the way of the good—don’t over-process,” she said. “If you make somebody go through a huge, complex process, they won’t want to go through the process. You have to be nimble.”

And, above all, Gash and Nelson agreed, there must be supreme transparency in the IT governance process, in order to build and maintain the confidence of all the stakeholders in a patient care organization regarding that organization’s governance strategies. Not doing so, they agreed, will only lead to dysfunction and project failure down the road.