One-on-One with Seattle Children's Hospital CIO Drex DeFord | Healthcare Informatics Magazine | Health IT | Information Technology Skip to content Skip to navigation

One-on-One with Seattle Children's Hospital CIO Drex DeFord

March 30, 2009
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DeFord talks about the importance of getting governance right

DD: I'm pleased with the structure as it stands today, but I can tell you that, just like the organization structure inside the department, one of the first things I did was a departmental reorganization. I have always said, starting right up front, the governance structure we have today, or the organization structure that we have today, may not be the one we need tomorrow.

We have to be agile and flexible to adapt to whatever might come along. I think the financial crisis is a perfect example of that.

We've got to put ourselves in a position where we can act quickly when times are good and we need to do something very important to give us an advantage or help us move ahead, and we need to be agile so that we can do the things we need to do when times are bad, too.

A big part of what we do at Seattle Children's, we're really tied into the Toyota production methodology, so our change management methods here at Seattle Children's are a process we call continuous performance improvement. So you'll find all of our major business lines have value streams that map all of the projects to particular outcomes, and their current states and future states. There are regular report outs on work that is going on in those value streams, and we have one built in IS and we do a lot of that similar work. Of course, our work is really tied to our customers.

AG: Would you say it's accurate that CIOs have to be proactive about handling the financial crisis by leaning up their budgets before being asked? Would you send that message to your peers?

DD: I think the message I would send to my colleagues on finances and budgets, especially operating budgets, is you really have to do your best and, for me, that has meant having a financial consultant on the staff that's tied at the hip to my CFO's staff. That person must know where and how we're spending virtually every dollar; that I do a good job in building a budget from a zero base, so that it's very clear that every dollar that I'm asking for in my budget, I actually need.

They must make sure that I can explain what happens if I don't get those dollars, what services do we lose, or what capability do we lose, and what capability do we gain when particular lines are funded. That makes it much easier to defend a budget. They need to explain that there isn't any slush in that budget, that the money in there is keeping the doors open, is needed to keep operating; that here is the piece of the budget that might be used for new innovation or other things. They need to help me explain where there might be some cuts available, but everyone has to understand what you lose when you make the cut.

I think you've got to start with a good, solid zero-base budget. Doing that puts the CIO in a much better position than, “I took this year's budget and added 5 percent.” If you do that, the CFO comes back and says, “Cut 10 percent.” Then you've really got to figure it out. But you're dealing from a position where you don't really know from whence you started, so I think starting in a good place puts you in a better position to make any kind of decision.

Healthcare Informatics 2009 April;26(4):66-70

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