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The Evolving Healthcare CIO: Innovation Over Information

November 15, 2018
by Rajiv Leventhal, Managing Editor
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The pressure is on CIOs and others in the health IT C-suite to become organizational leaders, while delivering in ways different from ever before

The healthcare CIO is the correct initialism for “chief information officer,” but as the landscape continues to shift—with the focus now on digital and strategic optimization, transformation and innovation—some observers are now wondering if “information” is really the most appropriate word for all that encompasses the modern-day CIO.

For the past two decades, Chuck Podesta has been a healthcare CIO, spending the last four years at UC Irvine Health, the integrated health system at the University of California-Irvine in Orange County, California. Podesta recalls the days when the CIO had a more IT-based title and financially-related job in healthcare, since clinical IT wasn’t a strong focus at that time. But with the evolution of EHRs (electronic health records), says Podesta, “The focus became clinical and the job suddenly had a broader scope. It’s not just the day-to-day running of the systems anymore; the CIO is now needed from the standpoint of strategy development because he or she is affecting the entire organization.”

Some would refer to the early-day healthcare CIO as an IT engineer of sorts, someone very technology-focused whose core responsibilities centered around hardware and software implementations, and getting servers up-and-running within the organization. Then came the influx of EHR deployments across hospitals and health systems, and now that there is near-universal possession of EHRs in U.S. hospitals, the tide is once again shifting.

“In the past, the CIO had more of a technical role and the focus was more on the operational side of the house—things such as enterprise resource planning (ERP) and the billing cycle. But the widespread advent of EHRs changed so much of that,” says Dave Levin, M.D., a former chief medical information officer (CMIO) at Cleveland Clinic and current chief medical officer at health technology company Sansoro Health. “When you deployed the EHR, it tightly linked clinical operations to IT. And that’s obvious. But it also put IT in the middle of enabling all kinds of activities and strategies. So, this requires strong enterprise governance and strong IT governance, and it requires that they fit together. A lot of organizations are struggling with that, and that’s reflected in the role the CIO plays,” Levin says.

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Podesta notes that when the CIO title first came about, many directors of IT in healthcare organizations wanted the “chief” designation. But to Podesta, there was a key difference between IT directors and CIOs:  good directors of IT spend 80 percent of their time managing day-to-day operations and 20 percent of their time on strategy, but for “true” CIOs, it’s the opposite, he says. “There was a period where there was a ‘filtering out’ of individuals who tried to become CIOs, but were really IT directors and couldn’t make that leap into the strategy world. That led to a changing of the guard,” he says, adding that much of the new focus turned to developing EHRs and then becoming an equal player in the C-suite on the strategy teams. “You have to be able to work on IT strategy and develop it in conjunction with the business strategy,” Podesta attests.

Today’s CIO—One of the Scariest Jobs in Healthcare?

For the modern CIO, priorities are indeed changing and becoming more complex, and with that comes increased pressure. For instance, in addition to all of the technical aspects of the job, today’s healthcare CIO must also stay out in front of various up-and-coming health IT innovations, while maintaining a much-needed big-picture view of how digital transformation will affect business operations.

And then there is the cybersecurity factor; a 2016 survey of 100 healthcare CIOs from Spok and the College of Healthcare Information Management Executives (CHIME) revealed that 81 percent of CIOs said strengthening data security was their top business goal for the next 18 months. Put all together,

“The CIO role in healthcare is one of the scariest roles there is because of the high risk involved, and the fast pace of technology,” offers David Butler, M.D., founder of healthcare consulting firm Calyx Partners, and a former clinical IT executive at Sacramento-based Sutter Health. “The cost of healthcare IT has gone up tremendously. [The days of] just buying Epic’s EHR and having your job be safe are long [gone],” Butler adds.

Butler notes that an EHR go-live, and the optimization that follows, are typically the most transformational things that occur in a CIO’s life, and the audience for these deployments are what he calls the CIO’s "golden geese”—physicians and nurses. “So there is more pressure on the CIO than ever before,” Butler attests. He adds that in addition to all of the clinical and IT considerations, it’s unfair to expect CIOs to be privy to all of the regulatory requirements that come from CMS (the Centers for Medicare & Medicaid Services) as well. “There is just no way that CIOs can know all these things. I think expectations need to be reset,” Butler says.

New Considerations

As such, experts believe that the “new” healthcare CIO must have a broader understanding of healthcare. “Smart organizations are looking for a more strategic role for the CIO, and think that they should be in the C-suite and in the middle of strategy discussions,” says Levin. "CIOs need to understand both where the organization is going—so that they can think about the technology that can enable that [vision]—while also informing and expanding on the thinking of the folks that are considering strategy—things that might not have been considered without that [CIO] expertise in the room,” he adds.

A core part of a healthcare organization’s vision going forward will certainly involve strategies on transitioning to a value-based care environment. Indeed, the emphasis on accountable care has increased the need for hospitals and health systems to collect and analyze data to drive improvements in quality and efficiency—leading many hospitals to ask more of their CIOs.

To this end, Podesta notes that the industry has been operating in a fee-for-service world for so long now, and in most cases, IT is an enabler of the business strategy, so once the business strategy starts to move toward value-based care, IT needs to come into play from a strategy perspective. “If you don’t have that background or the ability to understand it, you will be left behind,” he attests.

Podesta adds that in some instances, he is seeing CIOs play in both the medical provider and payer world, since lots of healthcare systems also have their own insurance companies. “You will see more and more of that in the future, and as a CIO, you will need to understand what risk means and how to manage risk,” he advises. “It’s a completely different way of caring for patients, and being able to sift through all the technologies out there for your organization, without making huge mistakes and spending the money in the wrong place, will certainly be a challenge,” he adds.

What’s more, all the sources interviewed for this article were quick to point out yet another new business consideration for CIOs: the influx of non-traditional players looking to move into healthcare. Podesta brings up the new Apple Health Records feature that allows patients of hundreds of hospitals and clinics to access medical information from various institutions organized into one view on their iPhone. “Lots of organizations are signed up for [this], and we have actually started to create apps; five years ago, you wouldn’t have been thinking about that. But now you have to model your organization to make sure you have the people to utilize these technologies as they are coming out,” he says, adding that hiring the right people who can work in these environments will be crucial. “The time for the sequel programmers is coming to an end. You need data scientists now.”

And as Butler bluntly puts it, “Apple, Amazon, Google and Microsoft have been watching this $3 trillion [healthcare] prize for a long time, but have not touched it because of HIPAA and other over-regulated [barriers] that prevented them from innovating in this space. But then you had deductibles go from $1,000 to $7,000 before the insurance kicks in, so the patient turned into the customer. And these disruptors said to themselves, ‘We know customers, we don’t know patients. So now we will go for it.’”

The CIO-CMIO Partnership

As CIOs continue to take on more responsibilities, experts believe that another clinical IT role in the C-suite, chief medical information officers, or CMIOs, are also ready to take on an increased role, especially as IT becomes much more critical to support value-based care and other quality initiatives. Indeed, as CMIOs have become more engaged in healthcare organizations, the interaction between these key IT players is expanding and continuing to evolve.

Levin recalls that in the early days of EHR deployments, folks saw the CMIO as the person that should go deal with the “angry physicians.” But now, post-deployment, as the tide turns to thinking about getting the most out of these IT systems, the partnerships between CIOs and CMIOs are stronger and more equal, Levin says.

“You are even seeing CMIOs migrating into the CIO role, which was rare in the past, but becoming more common. You are also seeing CMIOs migrate into other C-suite-type roles such as chief health information officers, chief quality officers, chief transformation officers, and in some cases, chief medical officers. And that makes sense, since there is an increasing emphasis on the intersection of clinical and operational, and the role of IT in supporting all of that,” he says. Podesta agrees with Levin’s premise; quite a few  CMIOs are becoming CIOs, he notes. “A lot of them have gone back and gotten MBAs to understand the business side [of healthcare].”

Podesta is also seeing another trend: that some organizations, such as academic medical centers, are struggling with clinical IT, and are thus recruiting for CIOs who are physicians, to get a level of credibility with doctors to help them with issues around physician adoption and EHRs. “I get lots of calls from recruiters, and when I talk to them about different positions out there, many are looking for clinically-oriented people. I am seeing that more and more,” he says.

To some, the evolution of the CIO-CMIO relationship also paints a bigger picture of just how tightly linked everything has become—particularly the dependency that a healthcare organization has on IT for its success. “It’s never been greater,” says Levin, who believes that the CMIO “is a unique beast, and one of the few healthcare roles in which you sit at a crossroads and have a view of the world that is different from other C-suite leaders.” He adds, "And that view might not be better; it’s complimentary. The typical CMIO has practiced clinically, has been involved in IT, and many have had operational backgrounds as well, or a medical affairs background. They are kind of ‘unicorns’ in a way, and I think they match up nicely with the way the governance and strategic needs of the organization overlap,” he says.

What the Future Looks Like

In a myriad of different ways, it’s been quite the evolution for CIOs, CMIOs and others in the healthcare IT C-suite. With all of the challenges and increased pressure that experts believe have mounted in recent years, comes opportunity for certain individuals to thrive.

Levin says the qualified CIO going forward will need the necessary “soft skills,” leadership ability, and strategic knowhow. It will be less about the technical aspects of the role. “The ultimate challenge everyone is facing is the pursuit of the Triple Aim and doing it efficiently, so a lot of the [job] is about how you can do more with less,” he says.

These roles also have another kind of unique balancing act, in that so many of them try to maintain a clinical practice, which Levin notes “is admiral,” but because they have also taken on these important administrative and leadership roles, he has seen many of his colleagues struggle with the balancing act. “Too often, they think the clinical/administrative ratio is 50:50, but in reality, it’s 75:75 and they are working at 150 percent capacity,” he says.

Adds Podesta, “It’s not just understanding the IT world—the programming and the infrastructure—but you have to understand the business side as well. To be in that C-suite and in those meetings, you need to be able to add value to items that maybe aren’t under your control. But you need to be that thought leader within the C-suite—just like the chief operating officer, chief medical officer and others are.”

Podesta believes that the “information” part of the chief information officer title is simply no longer indicative of all the CIO must do now, and what will be required of the role moving forward. “People view the CIO role as ‘you must work in medical records’ or even that you are in marketing, so yes, I think we probably do need a better title,” he acknowledges. Podesta notes that titles such as chief digital officer are making the way into healthcare organizations, and given the digital landscape, it’s actually more appropriate. “The CIO might move to ‘chief innovation officer,’ and that makes a lot of sense,” he says.


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What Does Your Magnum Opus Look Like? A Few Operatic Thoughts

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I was given the privilege and pleasure recently of presenting, for the second year in a row, a lecture on Richard Wagner’s “Ring” cycle, as the leading opera company in my city, a world-class opera house, has been putting on, in yearly succession, the four operas of the “Ring of the Nibelung” cycle by German composer Richard Wagner (1813-1883). Last year, the second opera in the tetratology, “Die Walküre,” was performed; this year, the third opera, “Siegfried.” After the concluding opera, “Götterdämmerung,” is performed, the entire cycle will be presented in festival format, always a major cultural event. I spoke on “Siegfried.”

I’ve been fortunate to have seen six complete “Ring” cycles in live opera houses in different cities, and I can tell you, it’s a life-changing experience, as this four-opera work (16 hours of music altogether), sits at the absolute summit of western art. Richard Wagner was a hideous human being himself, but spent numerous years working on something that changed the course of classical music and redefined opera.

What’s more, from the summer of 1848, when Wagner wrote a first sketch of the libretti, or texts, of the operas, until their true compositional completion in 1871, more than 23 years were to pass; and it would be another five years before the tetralogy was fully presented, in a purpose-built new opera house in the Bavarian town of Bayreuth. It was a herculean feat to create the entire text of these four long operas, and compose 16 hours of music that would completely redefine the concept of opera. Indeed, when the crowned heads of Europe, the great living composers, and the 19th-century European intelligentsia and glitterati, gathered at the new Festspielhaus in Bayreuth in 1876, many were so overwhelmed by what they saw and heard, that they were rendered speechless. Even now, 142 years later, first time Ring-goers are overwhelmed by the breadth and sweep, the musical and dramatic audacity, and uniqueness of the “Ring” operas, with their story of gods, giants, dwarves, flying Valkyries, Rhinemaidens, one huge dragon, humans, gold mined from a river, magic swords and spears, and of course, a gold ring whose possessor can control the world and its fate.

Even just looking at the third opera, “Siegfried,” Wagner struggled mightily. For one thing, being essentially a grifter and a cad, Wagner borrowed/took money from everyone who would lend/give it, and often had affairs with the wives of the patrons bankrolling his compositional work, leaving his life in constant chaos, as he fled from one city to the next. One such wife, Mathilde Wesendonck, inspired the opera “Tristan und Isolde,” groundbreaking operas that Wagner wrote during a 12-year hiatus in his composition of “Siegfried.” And “Tristan” itself changed the entirety of classical music, its tonality-challenging chromaticism.

Well, no one is expecting anyone to match the unique creativity of Wagner’s “Ring” cycle. But the leaders of U.S. patient care organizations are doing a lot of important things these days, including using formal continuous improvement methodologies to rework core patient care delivery processes in order to transition into value-based healthcare. What’s more, as our Special Report on Leadership outlines, the entire role of the CIO is being rethought now, as the demands for leadership and strategic capabilities are catapulting that role forward; and patient care organizations are beginning to make real headway in advancing equality for women and people of color among the ranks of healthcare IT leaders and managers.

So while no one is expecting anyone to create an operatic tetralogy that will change the face of music, there are plenty of heroic endeavors open to anyone willing to envision the healthcare system of the future. The opportunities are as limitless as the imagination.

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Using Performance Management to Scale

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Performance management is so much more than just a year-end performance review
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Performance management and goal setting have always been part of my DNA. It’s like a compass that tells us we are steering the ship in the right direction or gives us a chance to course correct if we wander off track. It’s hard for any organization to determine how they are doing unless there are clear measurable objectives. CIOs and their leaders need monthly, quarterly and annual goals to measure how you and your team are doing against the plan. I also firmly believe they should be S.M.A.R.T. goals: Specific, Measurable, Achievable, Relevant and Time-based.

Once the goals have been established, you need a written plan. I like three-year rolling plans so you can look into the future and describe your vision of what your organization will look like 36 months out. Then you can work back to the second year, and eventually the first year, to give you the framework for what you need to accomplish in the next 12 months. I suggest you do it with your managers. It makes them accountable to the organization since they are involved in the formation of the plan.

Your plan must be a living document to be used frequently during team meetings throughout the year to see how you are performing as a team and individually. This is not a process you invest in to review at year-end to see how you performed. By then it’s too late. It must be reviewed on a consistent basis to make sure everyone is on track. Performance management is so much more than just a year-end performance review. If there are individuals who are not performing against the plan, you can use the plan as a tool to performance manage them to re-engage as an important member of the team. 

I just returned from the Scale-up Conference in Denver and learned so much about taking goal setting and performance management to a whole new level by adopting the "Rockefeller Habits," as written by Verne Harnish. After reading the book, everything changed for me in the way we will be doing our planning, goal setting and performance management forever. It’s so brilliant and easy to understand. Here they are:

Rockefeller Habit #1: The executive team is healthy and aligned

Rockefeller Habit #2: Everyone is aligned with the #1 thing that needs to be accomplished this quarter to move the organization forward

Rockefeller Habit #3: Communication rhythm is established and information moves through the organization accurately and quickly

Rockefeller Habit #4: Every facet of the organization has a person assigned with accountability for ensuring goals are met

Rockefeller Habit #5: Ongoing employee input is collected to identify obstacles and opportunities

Rockefeller Habit #6: Reporting and analysis of customer feedback data is as frequent and accurate as financial data

Rockefeller Habit #7: Core values and purpose are “alive” in the organization

Rockefeller Habit #8: Employees can articulate the key components of the company’s strategy accurately

Rockefeller Habit #9: All employees can answer quantitatively whether they had a good day or week

Rockefeller Habit #10: The company’s plans and performance are visible to everyone

Accountability is no longer hard to measure since the entire plan is visible to everyone throughout the organization. Each part of your team should have key people accountable for every functional part of your organization. No more guessing is required. I’ve read countless books about leadership, performance management and goal setting, as I’ve been an avid student on the subject for decades.

These ten habits, once adopted and measured regularly, can change any organization that wants to grow and scale, and keep everyone accountable along the way.

Related Insights For: Leadership

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The 21st Century Leadership Challenge: Advancing Diversity and Equity in HIT

November 19, 2018
by Heather Landi, Associate Editor
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Research indicates the average salary of HIT professionals varies by gender and race, with both female HIT professionals and health IT professionals of color paid less than their respective white male peers
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Within the healthcare industry, including healthcare IT, there is an enduring stereotype that IT professionals are mostly male, and also Sci-Fi geeks. But, this doesn’t reflect the current health IT workforce, which is increasingly diverse, both along gender and racial lines.

One informatics leader, Molly Greek, director of enterprise applications at UC Davis Health in Davis, California, recalls a female colleague who went to an IT department and noticed that all the conference rooms were named after Star Wars characters, mostly male characters, and, in the same office, all the visuals on the walls depicted strong, masculine imagery.

"You have to be aware of the images that you’re putting up on the walls, and the way you name the conference rooms; you have to make sure it’s appealing to all groups of people,” notes Greek, who is an industry thought leader on diversity issues in health IT. “You want to make sure you’re not just representing something that is stereotypically something that a male might enjoy, or that a white person might enjoy.”

It’s one small example, but the need for more diversity and inclusion in the healthcare and health IT industries has been gaining more attention as a critical workforce and leadership issue.

Within healthcare, the gender imbalance in organizational leadership has been well documented. According to a 2014 study by The Advisory Board, women make up 80 percent of healthcare workers but only 40 percent of executives.

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For the health IT industry, recent research into compensation trends has found that the average salary of health IT professionals varies by gender and race, with both female health IT professionals and health IT professionals of color paid less than their respective white male peers. On average, across all positions and years in a position, female health IT professionals make 18-percent less than their male peers, and IT professionals of color make 12-percent less than their white peers, according to the 2018 U.S. Compensation Survey by the Healthcare Information and Management Systems
Society (HIMSS).

While male health IT professionals average $123,000 a year, female health IT professionals average $100,000—which comes out to 82 cents for every dollar their male colleague makes, according to the 2018 compensation survey, which is based on the
feedback from 885 U.S. health information and technology professionals.

The 2018 HIMSS U.S. Compensation Survey, which provides a profile of salary and compensation experiences of U.S. health information and technology professionals representing an array of organizations and roles, found that gender pay disparity has persistently existed across a 12-year period (2006-2018).

In 2016, HIMSS released a longitudinal assessment that found female health IT workers in the United States have been consistently paid less over the past 10 years than their male peers, with the pay gap disparity worsening over time. In fact, the gender pay gap within the health IT industry has made almost no progress over the past 12 years, returning to its 2006 level after dipping below 80 percent from 2009 to 2016, according to the HIMSS compensation survey data.

The one positive trend is that the pay gap appears to be closing after years of widening and has returned to its 2006 level, when HIMSS began tracking compensation trends, notes Lorren Pettit, vice president, HIS and research for HIMSS. However, overall, Pettit notes, “The data that we have indicates that gender pay disparity is persistent and consistent. Consistently, we do see this gap.” He adds, “We have a way to go, but I would expect to see the pay gap continue to narrow as the economy churns.”

Lorren Pettit

Gender and racial pay gaps in health IT are a critical issue, but salary inequities are part of a much broader and much more significant issue around equality, diversity and inclusion in the workforce.

A survey by global technology association ISACA, looking more broadly at gender barriers in the technology field, found that wage inequality compared to male colleagues, workplace gender bias and a shortage of female role models were the main barriers that women face working in technology. For that study, “The Future Tech Workforce: Breaking Gender Barriers,” ISACA polled 500 female members of its association, with 6 percent of respondents coming from the healthcare sector.

Women make up 40 percent of the world’s workforce, according to the World Bank, and that number is as high as 59 percent in some countries. According to Payscale, the technology field is male-dominated at all levels—only 28 percent of managers/supervisors in tech are women compared to 48 percent in non-tech industries and women only make up 32 percent of directors in the tech field compared to 49 percent in the non-tech industry. Further, only 21 percent of executives in tech are women compared to 36 percent in non-tech industries.

Making the Case for Diversity Initiatives, and Current Progress

Beyond the ethical, moral and legal considerations that support having a more diverse workforce, research has shown that a business case can be made for increased diversity within organizations. A 2015 McKinsey report on 366 public companies found that those in the top quartile for ethnic and racial diversity in management were 35 percent more likely to have financial returns above their industry mean, and those in the top quartile for gender diversity were 15 percent more likely to have returns above the industry mean.

According to ISACA, research has shown that more women lead to greater innovation and enhanced profitability. In a 2016 Peterson Institute for International Economics working paper, for example, researchers found that having women in leadership positions aligned with a 15-percent increase in profitability, on average. In short, making efforts to increase diversity is a good business decision.

“Companies that take gender parity seriously are the ones that have a competitive advantage over others,” Pettit notes.

Industry thought leaders note that awareness of diversity issues in the workforce has been increasing within the health IT industry, yet, as compensation surveys indicate, there is much more work that needs to be done.

Hillary Ross, senior partner, managing director, IT practice, and Tammy Jackson, senior associate, IT practice, at Oak Brook, Ill.-based executive search firm Witt/Kieffer, note that diversity and inclusiveness are increasingly featured in sessions and panel discussions at health IT conferences sponsored by industry organizations like HIMSS and CHIME (the College of Healthcare Informatics Management Executives). “It is clear that there are initiatives indicating the importance to emphasize greater diversity in health IT. People see a strong and definite need to bring more diversity, reflecting all dimensions including women, minorities, national origin and sexual preferences, into top leadership positions,” Jackson says.

“In the work our firm does in recruiting IT leaders, clients always ask for and expect a diverse slate of candidates,” Ross says. “They want to diversify their leadership teams in general, and therefore are seeking diverse hires for CIOs, CMIOs (chief medical information officers), CISOs, and other IT positions. As we know, there are not as many diverse candidates as organizations would like, so efforts that promote diversity at all levels of health IT and healthcare are so important. It starts with a commitment at the senior level, a plan and goals. The healthcare industry is prioritizing this.”

Hillary Ross

The Institute for Diversity and Health Equity, an affiliate of the American Hospital Association (AHA), has been tracking efforts within the healthcare industry to promote diversity in leadership and governance. A 2015 benchmarking study, the most recent one available, found that hospitals have made little progress in increasing the diversity of their leadership teams and governing boards since the 2013 study. Minorities represent a reported 32 percent of patients in hospitals that responded to the survey, and 37 percent of the U.S. population; however, minorities constitute just 14 percent of hospital board members, the same percentage as 2013, according to that study.

A leadership and governance team that reflects the community it serves helps ensure that the community’s voice and perspective is heard. It also encourages decision-making that is conducive to best care practice, the Institute for Diversity and Health Equity study stated.

Leading health systems and healthcare organizations are taking proactive steps to address diversity and inclusiveness, including hiring chief diversity officers, developing dedicated departments, such as the Cleveland Clinic’s Office of Diversity and Inclusion,
and other organization-wide initiatives.

“Over the past several years our firm has seen increased interest from clients about recruiting chief diversity officers and related positions, and there are more CDOs in healthcare today,” Ross notes. “As hospitals and health systems seek to better represent patients and their communities, they want someone within the organization who is dedicated to promoting diversity and inclusion—who can work with leaders across the organization and help shape the culture.”

A critical key to adding the role is making sure it has support and resources across the organization, notes Jackson, citing Witt/Kieffer’s 2017 survey report on CDOs in healthcare and education. “A CDO should not be expected to ‘fix’ things but rather build consensus and encourage organizations wide collaboration and commitment,” she says.

Tammy Jackson

Each year, DiversityInc ranks the nation’s top hospitals and health systems for employee diversity, as part of its annual Top 50 Companies for Diversity list. Mount Sinai Health System, Methodist Health System and Henry Ford Health System were ranked in the top three in the 2018 list, and Cleveland Clinic was in the top 10, which indicates these organizations scored well in talent pipeline, talent development, leadership commitment and supplier diversity.

This year, DiversityInc named Kaiser Permanente among five companies inducted into its first-ever Top 50 Hall of Fame. Kaiser, which was ranked No. 1 in 2016, is moving forward with a number of initiatives to advance equity in hiring and leadership development, according to DiversityInc. Kaiser Permanente’s diversity efforts have produced better healthcare outcomes for their customers for years, DiversityInc stated.

Accelerating Diversity Efforts in Health I.T.

Within the health IT and informatics fields, industry stakeholders and change makers are leading a number of innovative initiatives to support and promote diversity efforts, within their organizations as well as industry-wide.

Industry organizations such as HIMSS, CHIME, the National Association of Health Services Executives (NAHSE), and the Institute on Diversity and Health Equity, to name a few, are taking steps to educate the healthcare and health IT industries about diversity issues. Through its compensation and pay disparity studies, HIMSS is raising awareness that pay disparities exist, while also providing education on mentorship and career development. HIMSS also sponsors the Most Influential Women in Health IT recognition and hosts Women in Health IT Mentor meetup events.

CHIME leads a number of diversity and mentorship initiatives, and the Institute for Diversity and Health Equity offers strategies, resources, and data, as well as a professional network of experts, to help healthcare leaders accelerate and improve their organization’s equity, diversity, and inclusion objectives.

Then, there are a number of informatics leaders, such as Greek and Janet Corral, who are passionate about diversity issues and are working collaboratively with their colleagues to advance diversity and inclusion.

Greek serves as the co-chair of the Diversity and Inclusion Workgroup within the Group on Information Resources (GIR), as part of the Association of American Medical Colleges (AAMC). Greek, who spoke  about diversity issues in health IT at the Beverly Hills Health IT Summit in November, sponsored by Healthcare Informatics, says there is a misconception that only experts can lead diversity efforts.

Molly Greek

Greek notes that she is not a chief diversity officer but has extensively researched the topic of diversity and inclusion, and through this research, she discovered how much there is to learn. “None of us have to be the expert, we just have to acknowledge that we’re not the expert and that we want to learn more,” she says, And, she adds that many people are interested in the topic of diversity but assume they aren’t informed enough to be involved in an initiative or to lead an effort. “People will say, ‘I’m for diversity but I don’t know what that means. What I am supposed to do?”

Corral, an associate professor of educational informatics at the University of Colorado in Denver and the director of digital education, says that as she has risen through the ranks into a hiring position she has become more aware of the need to address diversity. “I now realize that every single person we hire matters for moving the needle at our organizations and that has changed me from acknowledging the issue to advocacy.” Corral is involved in an upcoming Academic Medical Centers IT Forum at the UC campus in which use cases will be used to spark discussions on diversity issues. “The first big thing we’ve done here is to realize that everybody is on a journey, and we focus on creating an open space for everybody to share.”

Janet Corral

Many industry thought leaders note that having C-suite level and board level leadership support for diversity efforts plays a key role in an organization’s journey to become more diverse and inclusive. Greek notes that at UC Davis Health, advancing diversity is a core mission and approached in a comprehensive manner across the organization.

In partnership with AAMC, the Diversity and Inclusion Workgroup developed an action-oriented list of recommendations for health IT executive leaders and managers—10 Ways to Encourage Diversity in Informatics. One guideline is to lead by encouraging wellness, self-care and family. “We lose a lot of women from the workforce every year. Women have a lot of family responsibilities and if their work doesn’t offer remote work options or flexible work hours, they end up leaving,” Greek says.

Another recommendation to address diversity issues is to focus on employee training, such as offering unconscious bias training, which can include tools like implicit association tests to identify an individual’s unstated biases and then address those biases.

Health IT leades also should include vendors who represent diversity in their preferred list, for example, minority-owned, female-owned, and veteran-owned businesses.

Recruiting, hiring and promotion practices play a large role in diversity and inclusion efforts, and this often starts before the hiring process, with the job description and ensuring that it’s well-worded to recruit a diverse and inclusive number of applicants, Greek and Corral note.

“I recently learned that our position descriptions are not women-friendly,” says Greek, citing research that indicates women will only apply for jobs if they feel they are 95 to 100 percent qualified, while men will apply for jobs if they feel they are at least 75 percent qualified. “When we write a job description where we say, we want somebody who can do everything, there’s a distinction between what we want and what we will accept. With that kind of description, we are discouraging women, because, in general, women won’t apply if they feel that they don’t have all the skills," Greek says.

It is critical for health IT leaders to include diverse and inclusive candidates, not just one diverse candidate, but multiple candidates, in their candidate pool and to ensure diversity on the hiring committee, Corral says.

Ross agrees, noting that candidates who are interviewing and considering a position will also be assessing whether there is diversity in current staff and leadership, on the hiring committee, and whether they will fit within the organizational culture. "Also, in this era of community-centered care, does the organization truly support and reflect its community, or does it just pay lip service?” Ross asks. “In recruiting, it is important to cast a wide net, even across different industries, in order to increase the number of candidates available.”

Health IT leaders also should provide growth opportunities though mentorship or sponsorship. What’s more, men and women alike should work to enhance gender diversity in leadership by taking on sponsorship roles, thought leaders say. Other efforts include sponsoring an inclusion group at healthcare organizations, such as a ‘Women in IT’ group, or making diversity inclusion a formal staff goal, as Greek has done at UC Davis Health.

Addressing pay inequities, which research has shown do exist, also is imperative, thought leaders say. The HIMSS 2018 compensation study indicates the gender pay gap has particularly worsened for female health IT executives since 2011, who now make 22 percent less than their male counterparts. Females in clinical management roles experience the most egregious gender pay disparities, making 59 cents on the dollar compared to men in the same position. What’s more, older females experience greater pay disparities than their younger colleagues in the health IT field.

Racial pay disparities are equally prevalent, the HIMSS survey data shows. A troubling trend identified in the HIMSS survey report is that female health IT professionals of color experience what HIMSS calls “double jeopardy,” with an average salary that is nearly $36,000 less than that of a white male colleague.

Organization leaders need to hold up a mirror and look internally at their salaries, HIMSS’ Pettit says. “Organizations need to do an internal audit. Do pay gaps exist in their organization? And, as part of the audit, they need to look at the composition of their leaders—do they reflect the profile of the U.S., the profile of their customer base?”

Overall, health IT thought leaders agree that the first step to addressing diversity issues is to recognize that the problem exists, that there is room for improvement and then, next, take action to address it.

“It will be critical for health IT leaders to create an open dialogue in the workplace about the obstacles they may face with recruiting and retaining diverse leaders. It will also be important to have executive sponsorship in the form of professional support and networking opportunities for young leaders. Organizations have to make diversity a strategic priority and must understand the importance of training, developing and building a diverse leadership bench of high-potential talent,” Witt/Kieffer’s Ross and Jackson say.


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