Healthcare IT Leadership: Boiling The Frog - InformationWeek

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Healthcare // Leadership
09:05 AM
John Halamka
John Halamka
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Healthcare IT Leadership: Boiling The Frog

Is the job of the CIO becoming an impossible one?

In October of 2013, I had the opportunity write a book about healthcare IT leadership, national IT policy, and work/life balance.

As I assembled its 300 plus pages, I read through all my daily social media posts for the past decade. I re-experienced the challenges, difficult decisions, and conflicts of my career. Along the way, I realized that life as an IT leader is just like boiling the frog.

Although not literally true, some leaders describe the unwillingness to react to significant change by noting that a frog placed in boiling water will jump out, but a frog placed in cold water that is slowly heated will be cooked to death.

Boiling the Frog
Photo: (C) 2010 J. Ronald Lee. (Creative Commons, CC-BY)
Photo: 2010 J. Ronald Lee. (Creative Commons, CC-BY)


IT professionals have experienced constant change so gradually over the past decade that we're not aware of the boiling water we live in every day.

The pace of change is accelerating to the point that scope, time, and resources can no longer be balanced with demand, expectation, and sustainability.

Here are a few examples.

The scale of our work is expanding exponentially. At a recent securities analyst meeting, HP CEO Meg Whitman noted that from the beginning of time until 2003, mankind created 5 exabytes (5000 petabytes) of information. Today, we create that much information every 12 hours.

Technology life cycles are increasingly short. In 2009, my entire enterprise communicated via Blackberry. Today, we have less than 10 Blackberry devices left in my organization.

The burden of regulation is crushing. Since I have been a CIO (1998), over 70,000 new federal regulations have been enacted, consuming over 350,000 pages of the Federal Register. These regulations have replaced innovation and have become the all-consuming majority of our daily work.

Expectations are challenging to manage. Today, I have under an hour of downtime per year and no data loss. I'm asked how I can sleep at night, given the damage to the organization done by that hour of downtime.

Miracles are harder to achieve. So you run a cloud-hosted, mobile friendly, software-as-a-service enterprise, with high security and low cost. Boring. Isn't there an app for that?

If we compared our jobs in 2013 to our jobs in 1998, we'd leap out of the boiling water. However, the journey from 1998 to 2013 has been so gradual that we're just enjoying the warmth of being slowly cooked every day.

What are our choices?

1. Give up -- The job of an IT leader may soon be impossible given the mismatch of supply and demand, agility imperatives, and technology expectations. Farming sounds good.

2. Change the rules -- Work with all our stakeholders to reduce burdensome regulations, reduce the scope of services, and more aggressively manage demand by limiting functionality/choice. All of that sounds good and may work over the long term, but it's as politically impossible as asking Congress to work together in the interests of the greater good.

3. Outsource the problem -- If IT leaders become managers of outsourced services, they can always put the pressure and blame elsewhere. Although this sounds good, my experience is that the cloud is just "your mess, outsourced, with less reliability." Users ultimately blame the local IT leader for any outsourcing issues.

4. Acknowledge that burn out happens -- Expect higher turnover rates/shorter life cycles for IT leaders. As a volunteer leader of many Washington activities, I've watched many colleagues begin their tenure with energy and conviction, only to crawl away after two years of government service. With fresh energy through leader replacement every few years, maybe the pace will be sustainable.

5. Spread the burden via delegation -- In my view, the role of a leader is to hire delegates to do the work the leader is accountable for. The work of the leader should be to serve the delegates and support their success. Since I believe the role of CIO is no longer viable in many industries, a reasonable choice is to break up the position into an "Office of the CIO" containing a Chief Information Technology Strategy Officer, a Chief Technology Officer, a Chief Administrative Officer, a Chief Information Security Officer, and a Chief Innovation Officer. With five people to replace the work of one, the burden of any issue or event is shared. Accountability per person is reduced to manageable chunks, and coverage is available by the team to improve everyone's work/life balance.

My advice to the industry is simple. We're boiling the frog, and we may not notice the psychic and physical damage we're experiencing as IT leaders. It's time to rethink the role of the CIO and create a scalable team to do a job which has become impossible.

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User Rank: Moderator
1/16/2014 | 5:03:40 PM
Re: Overly dramatic?
I don't htink so, did you not watch at CMS how ineffective CIOs function,  i.e. Healthcare.Gov:)  I'm not even a CIO but rather just a consultant and I see the complexities and a few months ago I wrote about it that government and consumers have a real cold hard lesson here with learning that "the short order code ktichen burned down years ago and there was no fire sale" so maybe you might be in that category?  I didn't mean that to be degrading or satircal at all because it is the truth with what the layman knows today and can understand.

When you hear from Dr. Halamka who can run circle around just about anybody out there, time to perk up an ear and see if we are combining the real world and the virtual world of technology together properly. It's something that unless one has written code is hard to understand as the layman cannot have data mechanics logic if they have not been there, it would like me being able to just breeze outside and work on my own car..not hardly:)

It part of the reason that I don't write code anymore as the perceptions of the task, times and time elements are very difficult to explain to a 3 bullet CEO, in other words that's about all they want to read and be the expert:)

Paul Cerrato
Paul Cerrato,
User Rank: Apprentice
11/20/2013 | 2:44:34 PM
Halamka has me worried
John is one of the most talented CIOs I've ever worked with. If he's talking about burnout and being boiled to death,  I can only imagine what others in the field are struggling with who are less talented or have fewer staff responses. 


Paul Cerrato

Contributing Writer

[email protected]
IW Pick
User Rank: Apprentice
11/19/2013 | 9:04:00 PM
Re: Overly dramatic?
I agree with the constant change but not sure splitting the job five ways is the answer. The business struggles as it is to understand IT, imagine attempting to understand the nuances of each CIO spinoff. Let's face it - the business wants "one throat to choke" in the event of a catastrophe and that would be hard to figure out in the delegated model. To Dr. Hamalka's point, the game is different than it was ten years ago, five years ago and it continues to change. The stakes are higher, the budgets are smaller, people resources are more scarce. Frankly as CIOs we have got to figure out a way out of this "water" so we can control the "stove". This may include redefining the CIO role a little differently and structuring internal IT more like it's a small business. Like Dr. Hamalka suggested there is a CIO office that includes a COO (service ops, finance, hr), CTO, Chief Data Officer, and so on. In large organizations, I've seen this work successfully including healthcare. However, the CIO in these cases come directly from the business area (not IT). It's an interesting shift...
User Rank: Author
11/19/2013 | 5:35:08 PM
CIO Debate
The challenge for CIOs is that they are required to have pretty much all the same skillsets of CEOs, but are cast in a position of having to sell, rather than lead, the management team. It's especially tough for federal government CIOs, who in many cases just don't have the authority they need to lead let alone manage their department's/agency's IT vision and operations. I agree with Rob Preston's point, good CIOs earn their pay. 

The other sobering observation in this article: "Since I have been a CIO (1998), over 70,000 new federal regulations have been enacted, consuming over 350,000 pages of the Federal Register. These regulations have replaced innovation and have become the all-consuming majority of our daily work."

William Terdoslavich
William Terdoslavich,
User Rank: Author
11/19/2013 | 1:06:17 PM
Re: Overly dramatic?
Context is missing here. The CIO exists within the context of his corporate culture. If that culture is dysfunctional, then no amount of talent will ease the burdens of this job. Unless there is a mission-focused, problem-solving culture, the CIO goes into his job with both arms tied behind his back, hopping on one leg to keep up with a world on the run. 
User Rank: Author
11/19/2013 | 11:17:06 AM
Re: Overly dramatic?
Lots of people think their jobs are the hardest, most complex, most demanding. But a good case can be made that the CIO role is among the most challenging. CIOs are expected to keep up with myriad technology changes, and the pace of that change is only accelerating. But he/she is also expected to have informed conversations about finance, marketing, sales, regulatory, customer service, HR, product development, etc. And not just superficial conversations. The CIO touches every aspect of the company. And oh, yeah, he/she had better be meeting with and learning from customers and partners as well. Tough gig. CIOs earn their pay.
Alex Kane Rudansky
Alex Kane Rudansky,
User Rank: Author
11/19/2013 | 11:00:17 AM
Re: Overly dramatic?
While I think the tone of Dr. Halamka's column is certainly urgent in nature, the content rings true, especially for large organizations like BIDMC. I can imagine that one hour of downtime per year is incredibly stressful! I wonder how smaller organizations handle these types of challenges.

Re: the "burden of regulation," I think there are two sides to consider: the burden, yes, but also the resulting innovation. Government regulations can be a pain, use valuable resources and stunt innovation. At the same time, we've seen rapid advancements in HIT (EHR adoption, for example) because of those same regulations. It's a question of if those benefits are worth the burden.
David F. Carr
David F. Carr,
User Rank: Author
11/19/2013 | 9:40:40 AM
Overly dramatic?
Is Dr. Hamalka being overly dramatic here? Or do you agree this is one of the toughest jobs around today?
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