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Industry Leader Drex DeFord on Leadership for Innovation: “Time to Embrace Your Inner Weirdo”

October 22, 2018
by Mark Hagland, Editor-in-Chief
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At the health IT Summit in Seattle, industry leader Drex DeFord speaks of the need to “feel uncomfortable” in order to lead change

In his featured presentation at the Health IT Summit in Seattle, being held at the Grand Hyatt Hotel in downtown Seattle, and sponsored by Healthcare Informatics, healthcare IT industry leader Drex DeFord shared with attendees on Monday lessons learned from a professional lifetime innovating in IT. Speaking of lifelong learnings of lessons around leadership, DeFord, who has been an IT leader both on the military and civilian sides of healthcare, told his audience that sitting in discomfort, and getting others to sit in discomfort, is not only a good thing; it is in fact essential to creating innovation. In other words, as DeFord put it to his audience, “It’s time to embrace your inner weirdo.”

DeFord, president of the consulting firm Drexio Digital Health, delivered a presentation entitled “Relentless Innovation: Everything I Know About Innovation Was On Display at Burning Man,” sharing insights across decades of experience in the armed services and in the healthcare industry, encouraging his audience of healthcare executives to take risks and upset the accepted order of things in order to push for clinical and operational transformation in healthcare. He spoke from four decades of experience, beginning when he enlisted in the Air Force as “a farm kid from Indiana,” through to his pursuing first an undergraduate degree, and then resigning as a commissioned Air Force officer, pursuing a master’s degree in informatics, becoming a healthcare IT leader in the Air Force, and eventually a CIO in civilian hospitals, including Scripps Health in San Diego (three years), Children’s Hospital Seattle (three-and-a-half years), and Steward Health in Massachusetts (14 months), and then into consulting.

Drex DeFord

At every turn in his career, DeFord made unexpected choices, even choices criticized by others at the time, for their being too unusual. And, dipping deeply into his own personal narrative, DeFord told his audience, making unexpected choices has been true of his thought processes from the very beginning. “I came from a very big extended family,” he told his audience. “I was an only child, but had tons of cousins on both sides of my family. And I was a farm kid from Indiana—and one of the first even to graduate from high school. And I wanted to go to college, but didn’t have any money, so I enlisted in the Air Force; and that was a weirdo thing to do in my farm community. Then I found that I was unusual in the military for not coming from a military background,” he recalled.

DeFord further broke molds by pursuing a civilian undergraduate college after his time as an enlisted member of the Air Force, and coming back as a commissioned officer, whereas most Air Force officers had gone to the Air Force Academy or entered through the ROTC in undergraduate college. Next, he ended up, following service in Desert Shield/Desert Storm, in an Air Force hospital, in the IT department. That, too, was seen as an unusual choice; but it opened up new horizons for him. “We built web pages before web pages were a thing. And we were beta testers for Mosaic. And we deployed the first EHR [electronic health record] in the DoD. That was a weirdo thing, too.” Next, DeFord decided to pursue a master’s degree. And, he said, “That’s much more normal now, but at the time I did it, I got pounded for being a weirdo for getting a master’s degree from a university health informatics program.” But he found the experience—at the University of Alabama-Birmingham, in healthcare informatics—to be precisely what he needed to move to integrate certain types of formal learning into the healthcare IT experience he had already obtained.


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At this point, DeFord paused to note that, “While I’ve been a weirdo across my entire career, one of the things I discovered in the Air Force is that I was allowed to be a weirdo in certain areas, as long as I showed massive compliance to other norms. My uniform was always pressed, my shoes were always shined, I blew away the physical fitness test every time. And I found out that it was OK to be a weirdo if you got stuff done.”

Next, he recounted, as he was graduating from the UAB health informatics program, he got a call from Jackie Morgan, M.D., a flight surgeon, a colonel, and the surgeon general of that Air Force region, who ran the health informatics program for that southern-U.S. region. Col. Morgan had to fight to get DeFord named to that director position, as he was a captain, and the position’s description was tagged to the lieutenant colonel rank; but, he recalled, she felt he was just the right person for the position. And, in that position, he said, “I came up with the idea that we should take money from the hospitals, pool it, and create centralized IT systems. Sounds logical, right? But at the time, we got a lot of grief for it, and that generated a lot of frenzy, and at one point, the Air Force Surgeon General, the top guy, had to get involved, and Jackie Morgan said, you’re going to have to present what you’re doing, ‘cause it’s got everyone in a tizzy.” But DeFord’s presentation to a cadre of senior officers turned out to be so successful that the Air Force Surgeon General determined that that model should be implemented Air Force-wide, and the AFSG asked him to come to Washington, D.C. and help his colleagues implement the plan across the Air Force.

Once again, DeFord made an unexpected decision, asking first to work at an Air Force hospital on the front lines, in order to fully understand the implications of the implementation plan. “What would a weirdo do? I said, ‘No, I want to eat this dog food!’” he shared with his audience. Thus, he spent 23 months at Travis Air Force Base, which had the Air Force’s second-largest medical center, and then after that time, moved to Air Force Command in Washington, D.C. as chief technology for Air Force Health (a global enterprise spanning 78 hospitals).

Following his time in the Air Force, DeFord then spent over a decade in civilian hospital organizations—Scripps Health, Seattle Children’s, Steward Health in Massachusetts; and after a brief time helping to establish a vendor platform, has been happily and successfully consulting for the past three-and-a-half years.

Looking back at the trajectory of his career, DeFord told his audience, “In the end, I decided that the best thing to me was to embrace ‘weirdness.’” Indeed, to put that statement into context, he said this: “The folks in this room who have worked with me have heard me say this many, many times: ultimately, a good part of being an innovator is being comfortable with your uncomfortableness. There are a lot of weird aspects now to our industry. All this stuff that is happening right now with telehealth; all this with disruptive entrants in healthcare. I spent a lot of time working as a consultant, working with the Cedars-Sinai Accelerator, for example. It’s a really uncomfortable industry to work in. Every day, some new thing is going on,” he said.

“So as an innovator in healthcare, in order to innovate, you have to become comfortable with uncomfortableness. What’s more,” he said, “you have to be comfortable not only with your own uncomfortableness, but also, you have to become comfortable making other people uncomfortable. You have to challenge people. I wrote an article on LinkedIn, about antibodies to change,” he said. “It’s almost as though we have people in healthcare whose sub job description is, activating antibodies to change. And for me, I realized that those two things kind of applied to me early on.”

DeFord also spoke about the collaborative innovation he saw firsthand at the Burning Man festival in the desert this summer, in which participants work for the greater good, and come up with innovative ways to solve in-the-moment group effort challenges.

Following his presentation, DeFord spoke one-on-one with Healthcare Informatics Editor-in-Chief Mark Hagland. Below are excerpts from that interview.

Things are moving forward so fast now. What would your message be to CIOs and CMIOs at this moment in healthcare, as they’re being asked more and more to become change leaders, not just technology experts?

A lot of it just boils down to, don’t be afraid of change. You’re probably already very involved, as the CIO in your organization, in seeing the change coming. You see the customer experience in lots of different organizations, and then you go back to your own organization and have to roll your eyes at the unwillingness to change. So, don’t be afraid to change. I think we’re moving into a time where 75-80 percent of the CIO’s job now is the people and process part, no longer the technology part. How do I help people understand where the organization should go, strategically speaking? And help people figure out what the underlying problem is, and help them realize that it involves process change?  Unfortunately, often, you wind up with CIOs who have fallen into the rut of being CTOs who are so overwhelmed by the day-to-day technology issues that they are marginalized and are no longer at the big table.

How do you light a fire under CIOs, to help them become true change leaders in their organizations, in that context?

If you’re not in the right position, you may need to think about whether you need to stay. You may be in an organization where you’re always going to be marginalized, if you started out in a particular role and are viewed that way. And if you move, make sure you’re perceived correctly. We’ve gone from this model of business and clinical people coming up with their business and clinical strategies, and IT’s job is to make it go faster; but we’re moving to a situation where the CIOs are at the table to begin with. That becomes a big part of the job, and that makes other people uncomfortable.

One of the biggest challenges, which industry leaders have been talking about for years now, is the shift in the role of the CIO from being a technology manager to needing to become a true strategic leader in the patient care organization.

Yes. The strategic need now is about the people and process stuff, and about the business and clinical model we should be creating. Where do we compete and not compete? It’s about organizational strategy. The movement from fee-for-service payment to value-based care is a game-changer, and is definitely happening, and will continue. The only question is at what speed, and a lot of that will depend on who’s in office, etc. But we’re going there. We’re talking about it in terms of the CIO role, but we also need the CFO and all the other leaders thinking strategically about how to create better care for patients and families. If you have an army of people who think like that in your organization, you’ll end up being the acquirer, not the acquired.




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The Modern Healthcare CIO, CMO, and CTO

December 10, 2018
by Lori Williams, Industry Voice, vice president of fulfillment, Gigster
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Disruption in the healthcare space comes primarily from the expansion of data’s role in the industry, and the healthcare C-suite’s familiarity with that expansion will help drive company and industry success

For the healthcare C-suite executive, the industry has never been more complex—nor has it ever contained so much potential. Emerging technologies mixed with political uncertainty has created an environment where incredible amounts of healthcare data are revolutionizing how patient care is handled, but patients remain uncertain about the future of their own health. With better data and the means to draw insights from it, healthcare CIOs, CMOs and CTOs are in a position to help address patients’ uncertainties and make hospitals and clinics more accessible and effective than ever before.

Here’s a look at how the role of the modern healthcare CIO, CMO and CTO is changing:

The Modern Healthcare CIO
The modern healthcare CIO’s role has evolved to become more innovative. No longer a title reserved strictly for engineers and IT professionals, today’s healthcare CIOs are focused on information science instead of simply setting up network infrastructure or providing back-end support. The trend towards a more data-centric role began as hospitals rolled out electronic health records, equipping individuals with better access to healthcare provider data. Through enterprise data warehousing, CIOs are becoming masters of data management, governance and predictive analytics, and passing along the many benefits of those knowledge bases to patients.

The Modern Healthcare CMO
The confusing healthcare landscape makes the role of a healthcare CMO more necessary than ever before. Thanks to ongoing regulatory changes, uncertainty surrounding the Affordable Care Act, and shifting consumer expectations for on-demand services, healthcare CMOs are responsible for helping patients navigate their way through a complex and opaque industry. As patients continue to assume the role of consumers, carrying out comparison shopping as they would for any other industry, CMOs must be adept in crafting a healthcare provider’s brand and messaging.

At the same time, CMOs must also ensure that healthcare providers offer a modern online experience, ensuring websites are mobile-optimized and social media accounts are generating engagement. This also means CMOs need to help move marketing efforts into the 21st century, transitioning away from direct mail or billboards towards digital marketing and CRM tools. Because if they don’t, there are plenty of med tech startups that will promptly eat into their market share.

The Modern Healthcare CTO
Unlike healthcare CTOs of the past who remained siloed off from the rest of the organization, today’s modern healthcare CTO is fully engaged with healthcare providers and their technology stacks, utilizing new software and hardware to improve daily workflows. The CTO is enabling the transition to patient-oriented self-service operations, enabling patients to carry out administrative tasks like scheduling appointments or refilling prescriptions over the internet. Because medical data is often stored in a variety of different sources, it’s critical for the CTO to be able to keep these systems interoperable with one another. For hospitals riddled with legacy software, CTOs should expect to continue employing middleware solutions to bridge the gap between old and new.

Members of the healthcare industry C-suite have the power to transform lives, and the CIO, CMO and CTO have roles that directly affect a provider’s ability to carry out positive change. With better data from the CTO’s tech stack, the CIO can use better analytics to help providers determine the best solutions for their patients, marketed to consumers by the CMO through modern platforms in clear, easy-to-understand language.

Lori Williams currently serves as Gigster’s vice president of fulfillment. Prior to joining Gigster, Lori was the general manager for Appririo.

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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.

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