One very large hurdle in any really big EMR project is to get board approval. While every significant hospital capital expense requires board approval, the projects with all these zeros on the bottom line require more than merely approval—they require genuine commitment.  Bringing the board along on the journey is just as important as with every other stakeholder group, but board members require their own special process. And despite all the groundwork, every CIO has to get past the final meeting and vote.

Here are my steps to success:

1. Look the Part.

OK, so I know this sounds rather shallow, but clothes make the man (or woman). This probably includes a good hair day and nails that are neat and pretty.  Also part of my arsenal is my favorite Ellen Tracy suit with the shoes that I spent my kids’ college fund on.  I know that nobody else will notice the effort, but it gives me confidence. Besides, who wants to invest millions on a project led by a pediatrician in a cheap wrinkled suit with dirty nails and greasy hair?  Oh—and wear a double application of deodorant which leads me to…

2. Be Nervous. 

I remember learning in med school about how to use beta-blockers in the treatment of nervous public speakers.  The idea was that the beta-blocker would take care of the outward manifestations of anxiety—the sweaty palms and pits, the racing heartbeat.  I actually disagree with this blunting of the physiology.  Feeling nervous is good.  It gives you the little bit of oomph and enthusiasm, makes you want to do your best.  A little nerve is good as you will be on your toes, which leads me to…

3. Forget the Techno-Jargon.

I am a clinician—a pediatrician, of all things—and really, really not that technical.  At a recent deep-dive meeting with one of our hardware vendors, I understood less than half of the dialogue. But even I can lapse right into techno-speak, especially when nervous.  Focus on the simple, using lay terminology and keeping everyone on the same page, which leads me to….

4. Read the Room. 

I was constantly scanning the room to determine who was engaged and who was not. I would try to respond when there was some sort of quizzical facial expression. I would attempt to address questions before they spun off into a swirling tangent of distraction. I wanted to make sure I could flex the presentation, however needed, without jumping around too much, which leads me to…

5. Crunch the Numbers.

Regardless of the organization’s mission, board members are for the most part numbers guys and gals.  I needed to justify why this EMR was multiple times the cost of our previous EMR. I knew the costs backwards and forwards: the license costs, the capital costs, the implementation costs, the training costs; and I could split it out based on total or incremental, with or without MU dollars.  I showed each of the numbers two or three different ways but every time trying to tell a story of the investment required.  The key here is knowing the touch points for each board member so I could respond to the various concerns, which leads me to…

6. Know your Audience.

I was very fortunate to be attending our board meetings as a member of the executive team for two years before having to present our project. I knew who liked to play devil’s advocate, who was going to ask for the hard costs, who wanted to the back-story, who was going to ask about the nurses, who would ask about the physicians and on and on. With all the differing personalities in the room, you need to make sure you know how some people feel ahead of time, which leads me to…

7. Pre-Prepare.

Identify the individuals on the board who understand technology and what it means to implement a complex transformational project. My CEO was a great coach in this arena. One of my board members had experience in a large international manufacturing organization with a CRM system. He was not a healthcare industry guy but he completely understood my story.  He was the one who I ran all my presentations across and made several changes to the deck based on feedback, which leads me to…

8. Be a Control Freak.

I almost always prepare my own slides anyway, but I did ALL of these myself just to feel confident on the content. The audience can tell when a presenter is comfortable with the material and when they are not.  For me that meant adjusting every bullet and every font on every slide.  Of course, that does not mean that it did not take a village to prepare, which leads me to…

9. Bring Backup. 

I was very fortunate that that my two incredible directors and one of our amazing physicians were part of the prep team and in the room.  They could lend some color commentary and perspective. They are very experienced individuals and therefore their passion for this project was very credible to the board, which leads me to…

10. Go with the Value.

In the end, no matter what you are selling…the audience has to want to buy.  We proposed a fantastic future for our organization—where technology meets patient care and organization strategic objectives.  When the conversation turned from the cost of the program to the cost of not doing the program, I knew we would get the thumbs-up!

Now, then—all we have to do now is to go forth and execute.