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Who’s Growing CIOs?

November 1, 1998
by Maureen Willenbring Schriner
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There may be plenty of candidates for the job of CIO. But finding the CIO candidate that fits the organization, has the right mix of communications, business and technical skills and the political savvy to be successful is more difficult.

Statistics on CIO turnover rates are not as important as why CIOs leave, according to Betsy Hersher of Hersher Associates, a Chicago healthcare IT recruiting firm. "CIO turnover has a lot to do with senior executive turnover, corporate changes and mergers," Hersher says. A CIO wants challenge, growth and complexity. The salary and size of the organization are secondary to that.

When a job for CIO opens up, the average healthcare organization takes about three to six months to fill that position. While healthcare organizations need to make sure they are offering a competitive salary and creative compensation packages, it’s more important that they find the right person for the corporate culture, Hersher says.

As the role of CIO evolves, the choices for top IT talent in healthcare are becoming more diverse. People with a variety of backgrounds and experiences are moving into the ranks of senior IT management. Among these choices, who would most likely be a senior IT manager?

  1. a nurse with an MBA degree?
  2. a finance vice president with little technical experience?
  3. someone with no college degree who has IT experience in manufacturing and banking?
  4. a medical records director?
  5. a history major with a master’s degree in health informatics?

The answer is all of the above. The surprising aspect of the people in these careers is that technical know-how is not at the top of the list for skills they consider essential for their work. The common thread of all these senior IT managers is at sometime during their career, they have all been IT consultants to healthcare organizations and they have all had a mentor who was willing to teach them what it takes to advance their IT management careers.

"Healthcare organizations are looking for CIOs with some technical background, who have communication and leadership skills and a real understanding of the business," says Hersher.

And there are plenty of people in the marketplace who have the right kind of experience to be a healthcare CIO, and plenty of places to train, mentor or recruit CIOs.

The challenge of recruiting the right candidate for CIO begins not by looking for the right person, but by clearly defining the responsibilities and expectations for the role of chief information officer. "I thought this problem would go away, but it’s not going away," Hersher says. "Organizations still really don’t understand what a CIO does. They can’t quite get a grasp on why the CIO is on the executive team." If the CIO position has a good job description, finding the person to fill that post is much easier, Hersher adds.

There is a great diversity of people with differing experience, education levels and IT philosophy. It all depends on what the healthcare organization is looking for.

Cultivating your own CIO
It is possible for healthcare organizations to grow their own CIO candidates, to foster the training and experience among current employees so they can become CIOs. But that task of mentoring to create CIO material gets moved down the priority list in organizations dealing with mergers, new IT demands, budget cuts and a shortage of IT employees across the board.

Thelma Kay Weiss, head of the healthcare IT recruiting firm TKW HIS Search and Recruitment, says internal candidates should be a first option for a healthcare organization searching for a new CIO. "I always make sure that they have looked internally because usually that’s the least painful way to go," Weiss says.

At the same time, healthcare organizations should not pick an insider just for expediency’s sake, Weiss adds. "Make a really good decision that will work not just for right this minute but for the long term." IT is an expensive investment and the CIO needs to be in a strong enough position to move forward with major IT projects, she says.

It is rare for programmers or other lower-level IT employees to work their way up the ladder to become a CIO because they need broader experience, particularly in communication skills, Weiss says.

Weiss advises people interested in a career path that leads to a CIO appointment, to go into consulting. "A successful consultant can manage the project and manage the people at client sites." Consulting firms are not only fertile ground for recruiting top IT talent, they are also becoming a stronger alternative to an in-house CIO.

One reason healthcare organizations are turning more frequently to consultants to carry out all or part of the CIO role is the job is too big for one individual to handle, says healthcare IT recruiter Lion Goodman, president of The Goodman Group in San Rafael, Calif. "The industry is changing so rapidly that it’s difficult for anyone to keep up with what is happening."

The high turnover rate among CIOs is likely motivated by unreasonable demands, Goodman says. "Even if a CIO wanted to learn to focus on business issues, he or she doesn’t have the time, or doesn’t have the money, which is why consulting firms are growing in power and stature."

A consulting firm has supplemented the CIO’s role at St. Luke’s Episcopal Health System, a Houston-based medical center. Kay Carr has been CIO at St. Luke’s for three years. She is a certified public accountant and worked her way up the finance side, first as director of financial planning, then controller and vice president of finance at St. Luke’s. Her introduction to IT was as an outspoken critic on the team creating a five-year plan for IT investments.

When the health system decided to fill the open CIO position, the chief financial officer asked Carr if she wanted the job. "It made sense," Carr says, "rather than bringing in someone with a technical background who didn’t know the organization." She brought her business experience, insider knowledge and the relationships she had developed with key stakeholders. Andersen Consulting was brought in to assist her with the technical side.

With that combination of internal expertise and external support, new IT projects have moved into place quickly in the past three years, Carr says, including new systems for payroll, human resources, pharmacology, radiology, medical records and a new network.

"We could never have gotten this done in three years if we had brought in somebody else" from outside the organization as CIO, she says.

While she has the skills to assess and manage these major projects, she’s not afraid to refer to the technology experts. "Sometimes I have to put my pride on the line and say, ’I don’t know what that means.’" Carr says. She also had help from a former CIO who was a consultant from Andersen. And, strong backing from top executives has been critical. "I had a very good rapport with senior management" before becoming CIO, Carr says. That support continued as she made the transition from finance to CIO. "They really recognized that I was spending for business reasons and not IT reasons because I wasn’t a techie with a ’hey, here’s another new toy’ approach. I put IT on a real business basis. That resonated well within the organization."

She is quick to point out that not all IT staff were happy about a CPA from the finance division becoming CIO. "There was some shake-out in the IT organization," she says, particularly among people who felt that IT would be overpowered by finance concerns. "Most of those people are gone now." She has also brought a new philosophy to the IT staff. "We’re not here for IT purposes. We’re here for business purposes."

Techie or non-techie?
St. Luke’s Episcopal Health System is among the growing number of healthcare organizations tapping top IT talent from outside the IT division. There are more people from the clinical, medical records or financial divisions of healthcare who are crosstraining for the IT aspects of their jobs.

Cindy Spurr was a practicing bedside nurse when she decided to broaden her career choices. She went to Boston University for an MBA with a healthcare track. The curriculum included a course on health information systems that introduced Spurr to a new aspect of healthcare. It was also where Spurr made a contact who would later give her a job as director of systems at the department of nursing for Brigham and Women’s Hospital, Boston.

She is now the corporate director for clinical systems management, directly reporting to the CIO for Partners HealthCare System, Boston. Partners includes Brigham and Women’s and Massachusetts General hospitals. In her position, she has recruited more nurses into her division and believes her nursing background makes her a much more effective IT manager.

"I strongly believe leaders in clinical information systems should be clinicians," Spurr says. The nurses who make the best IT candidates are "clinicians who take the time to figure out what is the business of healthcare."

Spurr says she brings credibility to the table and an ability to communicate with doctors and nurses. Within Partners, she has to deal with multiple institutions that have different cultures, which she says has required her to develop political savvy.

"My weakness is the truly technical stuff," she says. "I’m surrounded by folks who have [technical] expertise. I’ve learned a lot through listening and assimilating and asking them to draw me endless pictures."

While CIOs and upper IT managers need to have a good handle on IT, Spurr says the most essential skill is not technical know-how but political savvy, the ability to negotiate and come to a consensus.

Joan Hicks is another person in the upper ranks of healthcare IT who believes technical expertise is not the most important skill for the top IT positions.

Hicks moved into healthcare IT management from the medical records side. She began her healthcare career as a file clerk in medical records at an acute care facility. Fourteen years later, she was medical records director with responsibilities ranging from utilization and review to medical staff services and risk management.

One day, the chief executive officer told her to think about taking over all of the facility’s information systems and becoming the CIO. It was a new challenge that Hicks decided to meet with more formal training. She also decided to change jobs, taking a position teaching medical records skills at the University of Alabama at Birmingham. While she was a faculty member, she also became a student in a new university program, the Master of Science in Health Informatics.

Hicks was among the graduates of the program’s first class and has high praise for the curriculum. "No course in that program was a waste of my time." The case studies in particular were intense, hands-on learning experiences about healthcare IT. "Everything was a team approach, and that’s the real world," she says.

After graduating, she spent two years in healthcare consulting in Atlanta before returning to Alabama to become director of medical information services for Children’s Health System in Birmingham. The position is split between IT and operations. She reports to both the chief technology officer (the system doesn’t have a CIO) and director of finance for the hospital-clinic system. "If it’s wires and networks, I’m involved. If it’s information, that’s my role," Hicks says of her upper IT management position. "My weak area is the technical side. But I still don’t think technical is the most important aspect to getting jobs done."

For someone to be a good CIO, Hicks says, "I see that person as a moderator and leader, not someone sitting there running wire."

In seeking out CIO talent, recruiter Lion Goodman doesn’t think clinical experience yields IT people who have broad enough perspective. Physicians in particular make poor choices for CIOs, according to Goodman. "They don’t think of the business issues at hand because they’re consumed with patient care issues." An MD might be OK as head of IT for a physician group practice, but they must still understand the finance, insurance, claims and other business issues.

Instead of healthcare organizations looking just outside their IT divisions to recruit IT management, Goodman advises, "Look for someone who has experience outside healthcare as well as inside healthcare," in particular people with IT experience from industries such as banking and manufacturing, which use more advanced information system technology. Before entering the healthcare information technology field, David Selman worked in manufacturing IT, in computer operations and programming. He moved on to banking, spending four years working with financial IT systems.

He worked in healthcare IT as a consultant, with a firm that provided a strong mentoring program. He received more mentoring on the job at positions in a Virginia healthcare system and as director of information systems at the University of Michigan Medical Center. In particular, the CIO at the U of Michigan at that time created a strong second role for Selman. He participated in key decisions, did speaking and presentations on behalf of the CIO, and was a partner in carrying out IT plans and events at the medical center. Four years ago, he moved into the top IT spot of CIO for ProMedica Health System in Toledo, Ohio.

Selman is the kind of CIO candidate healthcare organizations drool over, according to the healthcare IT recruiters: an IT background in a variety of industries, consulting work that involved tackling a diversity of IT problems and hands-on knowledge of what it’s like to be in the executive role of CIO.

The interesting twist in Selman’s Cinderella career is that he has no college degree. "It’s not necessarily the educational background that makes the best person" for the CIO job, Selman says. "It’s experience and culture, the ability to structure divisions and deals, and the ability to teach."

Training camp
Selman’s experience demonstrates the value of mentoring and on-the-job training. But there is another option for training people for CIO: a formal education.

David Friday is a graduate of Hicks’ from the University of Alabama’s health informatics program. He is now director of the health services division, reporting to the CIO, at Baptist Health Systems in Birmingham. Before obtaining his master’s in health informatics, he had no experience in healthcare and knew about information systems only from his own personal "playing around with computers." He had a bachelor’s and master’s degree in history and was on track to become a professor when he decided to try something different. "My father is a dentist in town and I knew I wanted to get into healthcare and information systems."

Like Hicks, Friday worked as a consultant in Atlanta for two years after graduating before joining Baptist Health Systems. He has aspirations to become a CIO and has no doubt that his informatics degree gave him a significant edge. Unlike a typical MBA or health administration program, Friday says, with the informatics program, "you get a real good dose of the real world" of healthcare IT management. (See "Postgraduate Training for CIOs," p. 84.)

Adrienne Edens, on the other hand, has an unusual postgraduate degree for an upper-level healthcare IT manager: a master’s degree in psychology. "It certainly helps me to see where an organization is dysfunctional," she jokes. Edens is vice president and information officer for the northern California region of Catholic Healthcare West and is based in Sacramento. She moved into that position after 20 years experience in consulting and in-house healthcare IT positions. Through consulting, she gained perspective on a multitude of healthcare corporations--and experience finding solutions in crises. "Consultants usually get called in when a project has gone south," Edens says.

She believes there are many ways for people to gain the skills needed to be a healthcare CIO, whether it is through formal education, experience on the job, a mentoring program, or networking with other top IT managers. (See "Secret Societies," p. 68.) Healthcare organizations are looking for people who bring a variety of solutions with them. "They want you to come in and say, ’I’ve seen lots of organizations. I have lots of tricks in the bag and lots to offer you,’" Edens says.

The question is whether those CIO tricks can be learned through university courses. "I don’t think a degree gets you anything," Goodman says. IT recruiting pro Betsy Hersher agrees. "There’s nothing like the school of hard knocks."

David Selman acknowledges his ascent to CIO at ProMedica without any college degree may be an unusual case. But it demonstrates an emphasis on recruiting CIOs with hands-on experience. "I have worked with a lot of folks who have a BA, MA or PhD," Selman says. "A lot of them, I find, don’t get it." When it comes to CIO material, Selman says, "you either have it or you don’t."

Targeting talent
Innate talent and personality may be what it takes to make a good CIO. "There is something innate about figuring out how to be politically savvy and deal with multiple cultures," skills CIOs need, says Cindy Spurr at Partners in Boston. "You get to a certain point where people are either going to get it or they’re not. You can only take them so far with training and education."

In her experience recruiting for healthcare CIOs, Thelma Kay Weiss says that innate talent and personality are why some people are so often on recruiters’ lists. "I don’t think it’s a matter of training. I think it’s personality. It’s like when you see a baby smiling at everyone across the room. You know that baby will probably be able to sell anything as a grown up."

Healthcare organizations can benefit by giving people who have that innate talent room to grow. It is part of the succession planning for CIOs. Hersher encourages her healthcare corporate clients to develop strong associate CIO positions. The CIO needs to pick the right person to be a partner and then delegate. A sign that a CIO hasn’t learned, but needs to delegate, is if the CIO is in meetings all the time and is never available, Hersher says. "Get the CIO to let go."

After having benefited from mentoring, David Selman is now in the process of creating an associate CIO position at ProMedica. "A strong mentoring process, I feel, is absolutely the key ingredient to being successful today," he says. That applies to individuals who want to be CIOs and healthcare organizations looking for CIOs.


Four Steps to the Top IT Spot

A combination of steps by individuals and healthcare organizations can lead to good CIO candidates:

  • A mentoring program to identify and train top IT talent within the organization.
  • Opportunities for professionals within the healthcare organization to crosstrain in the IT division.
  • A clear definition of the responsibilities and expectations for the role of CIO and senior IT managers.
  • A chance for talented staff to pursue continuing education, either through a university degree or professional seminars, to develop their IT management skills.

Postgraudate Training for CIOs

A POSTGRADUATE DEGREE IS NOT A requirement to become CIO. Experience on the job counts much more than any extra academic letters on a resume, according to several healthcare IT recruiters.

But formal education is becoming an option for some healthcare professionals to move into senior IT management positions. A new kind of master’s degree is popping up at a handful of universities intended specifically to train professionals for senior-level management positions within healthcare IT, including CIO.

The University of Alabama at Birmingham created a Masters of Science in Health Informatics in 1992 (www.hsa.uab.edu). The curriculum was designed based on a survey of CIOs, conducted by Merida Johns, PhD, who started the master’s program.

The Alabama program differs from master’s programs in business, healthcare administration and even other health informatics programs because of the group activity around case studies--conducted within real-life settings at healthcare organizations--and the requirement for independent learning. "The point of the program is broad-based training in healthcare informatics," says Eta Berner, EdD, professor and program co-director along with J. Michael Hardin, PhD. "It’s not just technical and it’s not just management." Students cover a lot of ground in their two years of study, including:

  • Hands-on experience through intense case studies where students work with healthcare organizations to solve real IT problems;
  • An administrative residency requirement that provides students a mentorship with senior healthcare executives; and
  • A mix of courses that include strategic planning, contract negotiations, network building and clinical systems.

Students have come from a variety of backgrounds. "They are usually looking at a career change," Berner says. Thus far, they have included nurses and other clinicians, professionals with lab science backgrounds and those from within the healthcare IT ranks who are looking to move into management. While the program requires some computer science experience, Berner says that is not a strength for most applicants to the program. "You might think we would get more computer science students, but they are not necessarily the ones interested in the broader role in health informatics that we seek."

The Alabama program is growing in popularity. The first class to graduate, in 1994, had only eight students. This past year, there were 26. Since Alabama began its informatics program, the University of Texas (www.uts.cc.utexas.edu) and University of Missouri (www.hsc.missouri.edu) have adopted similar curricula to create their own health informatics master’s.

While Alabama’s informatics program may seem like a good idea for those who are already CIOs or in senior IT management, they might not have the time to complete a two-year degree program, especially one that is so involved with team projects on case studies.

A more approachable alternative comes through professional organizations, which offer a broad array of short-term courses, seminars and conferences.

Executive seminars by CHIME (www.chime-net.org), the association of healthcare CIOs, come highly recommended by healthcare IT recruiters. HIMSS (www.himss.org), the association for professionals in health information and management systems, also offers professional training. Finally, there are user groups and other professional networks that are intended to broaden the perspective for upper IT managers.


Tips for the Potential CIO

1. Learn or expand the skills you will need to do the CIO job.

There are "hard skills" like business acumen and communication, and "soft skills" such as image, style, decisiveness and credibility.

2. Learn to think and act globally.

Get involved in non-IS issues at your organization, pick a good mentor and choose an organization that fosters growth.

3. Make a career plan.

4. Read, read, read.

Educate yourself in every way you can, through formal courses, professional training and on-the-job assignments and opportunities.

5. Network and market yourself.

Attend regional and national meetings of professional organizations. Seek out speaking and writing opportunities.

Source: Betsy Hersher, Hersher Associates, Chicago


Maureen Willenbring Schriner is a healthcare writer in Minneapolis.



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