In this edition of “C-suite Conversations,” Judy interviews Doug Dean, Chief Human Resources Officer (CHRO) at Children’s of Alabama. With over 26 years at the organization, Doug brings a wealth of experience, humility, and forward-thinking wisdom to his role. From tackling burnout and embracing AI in HR, to fostering cross-generational understanding, he offers a candid perspective on what it really takes to lead with heart in today’s healthcare environment.

Children’s of Alabama is one of the nation’s largest pediatric medical centers, offering inpatient and outpatient care at its main Birmingham campus and locations across central Alabama, including Huntsville and Montgomery. As the state’s only health system dedicated exclusively to children, it also serves as the primary teaching hospital for UAB’s pediatric programs.

Q & A with Doug Dean

Judy Kirby: Doug, I’m so impressed that you’ve been with Children’s of Alabama for 26 years! What has kept you there all this time?

Judy: You’ve seen the evolution of the role over 26 years that we now call the Chief Human Resource Officer. What do you predict will be the focus of the CHRO role for the next three to five years?

Doug: I love that question. It is almost universal that if you ask not only CHROs like myself, but CEOs and COOs what keeps them up at night, they almost all now point to concerns about staffing the organization, developing leaders, and the challenging supply of talent. So, talent acquisition, recruiting, and retention are in the CEO vernacular these days, which means that the primary impact by CHROs and their teams is at the top of the leadership agenda.

Judy: A lot of the CHROs feel that they don’t have a seat at the executive roundtable. Why is that?

Doug: I don’t think there’s, as perhaps some colleagues may believe, an inherent disdain for HR leaders or underestimating the importance of the human resources function in an organization. If you’re not at the executive roundtable, it is often a self-inflicted wound if we’re honest. Frankly, some don’t polish their skills and learn to be a compelling presenter and use data to make their case compellingly. So I think we still earn our seat on the big issues.

I try to hire people who are smarter than me and then turn them loose to research who’s ahead in the world, especially in the healthcare industry. Are there good ideas we can borrow or adapt? In HR the trend can be to seep into being transactional and focus on pushing mundane work out the door. You really need to wall off – quite literally, physically –  the strategic planning work and protect it from the transactional grind.

Judy: How do you see AI influencing HR in the future?

Doug: I was at a seminar recently given by a well-known international HR consulting firm, and they presented some findings from a survey of a large group of HR leaders. Not surprisingly, only about 25 percent of those surveyed are doing what they consider meaningful AI implementations. We too are playing a little bit of catch-up, but I’ve started. I do think we need to step on the accelerator with AI in the HR profession. The cost of waiting or being risk averse as a “late adopter” might be higher and more painful.

It’s a simple step, but I encourage my HR team to play with simple AI applications, get their feet wet and go to conferences where people are talking about what’s already happening in HR with AI.

For example, almost all of us in HR love to use video as a communications method. It’s just more compelling in many instances. There is AI technology that produces very high-quality videos for your messaging with incredible speed and for dirt cheap.

I think we’ll also see more use of AI in the screening of candidates, and candidates more comfortable interacting with a bot. It’s already happening. Then, the only candidates that come across my and your desks will be the finalists, which reduces costs and the time required.

Judy: Everyone in healthcare hears about physician and clinician burnout. I saw an article at the end of 2024 about HR leader burnout too. What are your thoughts?

Doug: I think that there’s a constellation of issues, and many of them don’t have anything to do with what we experience at work. For some, maybe it is just life as they envisioned it in terms of the architecture of life, whether that’s relationships, friendships, or even the stress and joy of raising children. There are unprecedented pressures and demands on people outside of work, and yet we bring our entire self to the office. I think companies are only recently coming to terms with that – that we don’t want you to compartmentalize.

But I think that there are ways to forestall and overcome burnout by deliberately taking on new challenges at work that excite you. That might mean redirecting your career and it might mean a temporary drop in salary. What’s the saying? “If you do something you love, then you’ll never work a day in your life.” It’s kind of sappy, but I do think there’s a kernel of truth to it. So, I encourage my colleagues who have very long tenure like myself, to start to be a little selfish in their non-work life. “What things really give you joy when you’re away from work?” If you can optimize those and make sure you practice great self-care, that you’re eating well, you’re exercising, you have good experiences outside of work, I think it can dramatically forestall the ill effects of burnout through a more holistic approach to life.

Judy: There are multiple generations in the workforce. From your point of view, what are the differences between those generations in terms of what they want from the work experience?

Doug: What we’re experiencing is the outflow of baby boomers who have run our organization for a long time. They’re so loyal and hardworking. And there is an inflow of millennial and Gen Z workers. Our total population at Children’s of Alabama is just under 6,000, of which about 65 percent are in the millennial and Gen Z category. To me they seem so young, but you know what? They’re incredibly well-educated, well-trained, very high-tech, and very compassionate about what we do and what they bring to the table.

You’ve got to pay attention to the demographics. The minute our leadership starts building the work experience around people in my demographic – I’m between boomer and Gen X – we are making a strategic error because the reality is we’re only going to continue replacing experienced workers with younger people. So, we need to get really good at understanding these workforce demographics, their work preferences, and how they like to be led, the kind of feedback they want. It’s become a very big deal.

Judy: What differences are you seeing among the younger demographics?

Doug: Sometimes when we’re talking about generations, it still feels like we’re stereotyping with a broad brush. Dominant profiles of demographics like Gen Z, millennials, etc. are useful in many ways, but we should always be open to the possibility that an individual’s life experience and their upbringing and who they are might put them outside the mold. You might meet a Gen Z in their late 20s who is an old soul, and talking to them might sound like you and I having a conversation, Judy.

The differences I see mostly with the younger generations are that they really value when you check in with them so they can ask, “How am I doing?” Sometimes they literally mean, “Am I secure in my job? Am I performing well?” So, leaders and future leaders need to develop the habits of sincere and authentic ways of talking about development, growth, and performance, and paint a picture for the younger generations. “Hey, you’re really on track to be in position for advancement soon.” Frankly, they’re more like free agents, which I do not equate with disloyalty. I think younger workers have seen that if you stay at a company for 20 years, you can still get RIF’d or laid off. So, what’s the point in excessive loyalty, they may think? And I don’t feel that is a cynical point of view – maybe they’re the smart ones.

Judy: Relocation continues to be an issue for a lot of executives or high-level leaders. What have you implemented to get the talent you want to move to Birmingham, Alabama?

Doug: You need to have the good fortune of city planners and leaders who are working on the quality of life. For example, my HR colleagues and I had nothing to do with the food and wine scene here in Birmingham, which has become unbelievable! When my friends from cities like Atlanta, Chicago, New York, and Boston come here, they rave about our fine restaurants. If it’s a family moving here, there is access to very high-quality schools. The natural resources include freshwater lakes, and in 3 ½ hours you can drive to the world’s most beautiful beaches in Destin, Florida and Gulf Shores, Alabama.

Some may come here kicking and screaming because of outdated preconceived notions, but once they’re here and they get plugged into what we mean by southern hospitality and the friendliness of a place like Birmingham, Alabama, they want to stay. We see it time and again.

Judy: What testing, interviewing techniques, or other strategies do you employ to make sure you hire the right person in every position?

Doug: This is going to sound like a paid endorsement but we’re about 10 years into the very successful use of an instrument called Judgment Index. It’s not a personality or IQ test, neither of which is very predictive of performance, especially in a leadership role. But we believe strongly in the Judgment Index, which is considered to be among the most reliably validated and tested assessments of its kind. It is much more predictive of performance in a work setting, especially in a leadership role.

Judy: Over the course of your career as the HR leader, how have you partnered with departments to improve their culture?

Doug: What’s interesting about your question is that you’re invoking the notion of not just the organizational culture, but a culture within a particular department. I think we’ve done that but I would describe it as informal. I’d be a little nervous about a department veering away from the organizational values much at all. If they are able to take our organizational culture and values and put their own unique stamp on it, as long as those two are compatible, that can be a beautiful thing. It’s mostly my OD leaders having a lot of conversations with a director and asking, “What does your team need? What will attract talent?” For some, that might mean offering four 10-hour days and letting people have long weekends during the summer. For others, it might mean the ability to cross-train so people feel like they’re growing and developing. So, it can be a wide array of things.

Judy: What is your organization doing when it comes to remote and hybrid work, and what has been successful for you?

Doug: At the start of the pandemic, we had to send upwards of 1,800 staff members home. It was for safety reasons; we had no choice. What’s that phrase, “Necessity is the mother of invention?” If we didn’t do something, their income would be impacted. So, we quickly got very good at people working productively from home. Of course, patient care is not remote, but the corporate service areas.

Culturally, we think great things happen with teams when they’re physically in contact and come to a central office. That’s not to say this subject hasn’t been controversial. People got used to being at home and working remotely, and it was popular. But except for IT workers and a handful of other areas, we’re mostly back at the office, and that’s unpopular with some. Maybe they have work-life balance challenges. But I think there is a socialization and a mental health that can come with going in and being with people and not getting too isolated in your own home space for long hours. I do expect that the world will compel us to offer some hybrid work-from-home options, but we’re unlikely to have leaders leading their teams remotely.

Judy: Is IT still fully remote?

Doug: It is case specific. For those in IT doing a lot of heads down systems work, it doesn’t require a great deal of face-to-face communication, many of those are fully remote. Others want to come in a few days a week, so they are taking creative approaches that are driven by the nature of the work as opposed to enacting broad, deep rules. We’re trying to be nimble and flexible, and when we can, we adapt the rules to what will make the most sense for a particular employee.

Judy: There has been a lot of quiet quitting and early retirements in healthcare. What are you seeing as CHRO at Children’s of Alabama, and how are you addressing these challenges?

Doug: For more than 15 years, we were successful at keeping voluntary turnover under 12 percent system-wide, which is remarkable. Then in the wake of the pandemic, we joined the throngs of hospitals where it spiked to over 20%. The worst year was probably 2021. That was a shock to the system that forced us to ask a lot of difficult questions around what our workforce planning assumptions should be. 

One strategy when good people leave the system is that maybe they’ll be interested to come back and work with us again in the future. So let’s get really good at re-recruiting them because we’ve already made this enormous investment in them. And, when we make an offer and fill a single position, we should still be very interested in the two or three runner-ups. They were talented enough to be a finalist so could they be a quality hire for another position?

Judy: Were you successfully mentored at key points in your career?

Doug: I was very fortunate along the way that in several cases, my bosses were friendly and didn’t always have to act like my superior issuing directives, and we became mutually respectful. My experience has been that people are usually delighted to share their lessons learned, and what they see in you, where you can grow and improve your chances to have impact as a leader.

My advice is to be a sponge when you’re around leaders you really admire and become a student of their leadership. If your company will help fund it, I highly recommend a quality executive coach as a safe space where you can go talk about a weakness or a specific mismanaged situation, and get coaching on that. Maybe they’ll do a 360 with your peers and subordinates, but be prepared for that to sting a little and point out some areas that you really need to improve. I think it’s just being humble and never feeling like you’re a finished product, and finding the joy in continuous development.

Judy: I hear from HR executives that often, one of their strongest relationships is with the CIO because IT touches everything. From your experience, what does a really strong partnership with the CIO look like?

Doug: I admit that we don’t speak the language of IT, but the CIOs I’ve worked with understand and are happy to translate. I think it’s critically important that you hire a very capable, strong HRIS leader so that you have a translator walking along with you. We’re trying to turn data into useful management information to operate our workforce and do all the powerful things that you can with technology. So, build a relationship and get to the point where your gap in technical knowledge compared to a CIO’s does not become an impediment.

Judy: What do you like to do in your free time?

And anything outdoors, whether it’s on the water, in the woods, on a golf course, or just sitting on my back deck with my sweet little yellow lab. I love the fresh air, and I think getting  into the great outdoors is good mental health advice for all of us.

Heather Nelson brings a unique blend of operational skills, strategic vision, and deep dedication to healthcare to her job as SVP and CIO of Boston Children’s Hospital. In this edition of “C-suite Conversations” Heather shares with Judy how she launched her IT leadership career, the mentors who shaped her path, and how she’s building empowered, forward-thinking teams.

Boston Children’s Hospital is one of the largest pediatric medical centers in the United States, offering a complete range of healthcare services for children from birth through 21 years of age. Boston Children’s is home to the world’s largest pediatric research enterprise and is the primary pediatric teaching hospital for Harvard Medical School.

Q & A with Heather Nelson

Judy Kirby: Heather, your entire career has been in healthcare technology. How did you choose technology and healthcare, and why have you stayed?

After a year, I got a job as a system administrator in case management. The job was implementing a case management system for our case managers in the hospital and our health plan, Priority Health. I taught myself what I needed to know because I was not a computer programmer by any stretch. Later this led to a job as senior analyst in IT when Butterworth and Blodgett were merging to become Spectrum Health in the late ’90s. We had selected Cerner as our EHR and my job was to focus on the legacy systems. That’s how I got into healthcare IT.

I stayed in healthcare IT because I had a tremendous manager who saw something in me that I didn’t see in myself right away: that I was a people leader, a strategic thinker, and that I knew how to bring people to the table to have a conversation. She promoted me from an analyst to a team lead while we were implementing Cerner, rolling off legacy systems. This allowed me the opportunity to understand hospital operations from a perspective larger than just the project I was focused on. I’m just so fortunate, Judy, because I’ve had such tremendous mentors and folks who looked out for me as I grew up in my career. As I always say, “In IT, we’re the people who take care of the people who take care of patients.” That’s why I stay.

Judy: You’ve continually been promoted and grown into increasingly responsible positions during your career. What skills and abilities have helped you do that successfully?

Heather: I love operations and understanding the problems we’re trying to solve. I love the relationship aspect of what I do. I think what’s helped me succeed is building and fostering those relationships, especially coming into a new organization. So I credit my listening skills, my ability to build relationships, and the fact that I’m a straight shooter. I’m an executor, which means I like to get things done. Sometimes that’s a weakness that I have to balance, because I’m not a very patient person.

I look for opportunities to stretch my abilities. The CIO role is so different today than it has ever been, and it’ll continue to evolve. You have to be seen as a strategic partner and have a seat at the table, not be seen as an order taker. I don’t want anyone on my team to be an order taker. I want them all to feel empowered as strategic partners, to have the conversations, and to bring options forward.

Judy: How do you position your team not to be order takers? How do you train them and help them show up as strategic partners?

Heather: A lot of my team members were used to someone calling them or sending them an email, and using a first in, first out approach. We had to restructure how we take in work and how we prioritize work. I told them, “As we move to new enterprise systems, we have to be very thoughtful, and we have to think through an enterprise lens. We have to understand the risk and the impacts of making a change or a request.”

We talk a lot about this in our monthly departmental town halls, and at quarterly leadership meetings. We talk about how important it is that they all feel empowered to ask questions, to ask for a seat at the table, and to bring options. I’ve been here three and a half years, and we don’t have it nailed down perfectly yet. We’re still learning, both as a leadership team and as a department, but I practice what I preach. My job is to advocate for my teams and their job is to let me know when they need help, when they need a different voice at the table. That’s really how I enable and empower my teams.

Judy: How did you decide who to seek out as mentors, and how have they bolstered your career? And as a corollary, how are you helping your team pick mentors?

Heather: For me, it was observing senior leaders in the organization, watching how they interacted and communicated. Then, I would ask my manager, “Can I go meet with so and so? Would you mind if I reached out to them?” I was fortunate that I never had an upline who felt threatened by that. I sought out female executive leaders because IT was a very male-dominated environment when I was getting started.

When I’m asked to be a mentor, one of the first things we talk about is, “How are you building your network? Do you understand what that means? Do you have someone besides me who you trust and who you look to for guidance?”

I still have a lot of mentors I can reach out to and throw something at them that I’m struggling with. You’re one of them, Judy.

I encourage folks to look for leadership mentors and peer mentors. I think having peers you can lean on and trust is just as important as having someone who can move you up in your career. You need to strike that balance.

Judy: I hear from a lot of CIOs who are concerned about the division of technology within the organization. Some are responsible for data while others aren’t. Some have AI, some have cyber, some have analytics. What areas fall under your leadership?

Heather: I see digital as part of what healthcare IT is responsible for. Every organization is structured differently, but here at Boston Children’s Hospital, there is a separate digital health team. Obviously, we work very closely together. And there are times when the lines are blurred a little, but we just work through that. Everyone brings value to the table. Everyone has a job to do.

I have data and analytics, I have cybersecurity, research informatics, medical informatics, and all of the systems and over 22,000 devices across the enterprise, so it is a very big scope. I’m partnering with our chief innovation officer on AI. The two of us have stood up AI governance in partnership with our senior executive leaders, who have provided tremendous support for this. I don’t want his job and he doesn’t want mine, so we have found a way to partner, because there’s so much potential for AI in healthcare.

We’ve been using AI for a long time at Boston Children’s, especially in the research space. Now, how do we take innovation happening in one small group and make it work for everyone? A lot of good things are happening and AI is crossing multiple teams, which is okay because we’ve created those guardrails and some structure.

Judy: How do you see the CIO/CDIO role evolving over the next three to five years? What are some of the new responsibilities and new job qualifications?

Heather: Having strong financial acumen is so critical for a CIO or a CDIO. We manage multi-million dollar operating budgets and capital budgets. You have to make sure that you help the organization build ROI from the investments it makes. Healthcare organizations are doing a lot of building, a lot of facility work. More and more we’re moving out into the communities. Then we also have connected care, hospitals at home, virtual visits and virtual care. What technologies do we need to bring to bear there? How are we pivoting from only bricks and mortars to supporting these new workflows?

And it is different for our care teams, who are accustomed to having the patients and the patients’ families physically in front of them. But it’s hard to get to Boston Children’s because driving in Boston is not easy. If we can care for our patients at home with wearables, or with a virtual visit, and they don’t have to worry about the stress of driving or finding parking, how awesome is that? So as CIOs and CDIOs, we have to make sure that we’re at the table early, that we understand what problems we’re trying to solve, and bring some recommendations, whether that’s from a business lens or financial lens, and support the processes.

We’re change leaders and change management is hard. No one wants to change but I need to ensure that utilization and adoption is where it needs to be. Therefore, we need to wear business hats, strategy hats, operational hats, and financial hats as much as we have to wear technology hats.

Judy: A lot of CIOs aren’t at the table early, or they’re late to the party, so to speak. How do you make sure you’re present early in the conversation?

Heather: One way is using situations where we were late to the table as examples. So often we’re given dates – “We have to open the facility to our first patients in January.” “Well, I appreciate that you’ve set this date but we need lead time to be able to deploy and to test it, so realistically, it’s going to be February. We have to help them understand the complexities of the technologies, and that we can’t just flip a switch and make everything work. Next time, please bring me and my team to the table earlier.”

Governance is a big part of this. We have an IT executive steering committee that is chaired by some of my operational partners.

Judy: Another big concern I hear about on a regular basis is the lack of up-and-coming IT leadership talent to fill future healthcare CIO positions. Are you seeing this?

Heather: I don’t see it, and maybe it’s because of the market that I’m in. I’m in the Boston market and previously the Chicago market. Every market is so very different when it comes to talent, whether it’s recruiting or retaining. I’ve spent the last three and a half years building a team. The leadership team I have today is completely different from the one I had when I started.

Whenever I’m hiring leaders, I’m thinking about who can potentially sit in this seat if I leave for a new opportunity or if I win the lottery. We spend time as a leadership team talking about succession planning at Boston Children’s. Not every organization does it but I think you have to be intentional about it for it to be successful.

Judy: So you’ve been recruiting and retaining the best senior level talent. What are some of the keys to your success there?

Heather: I think it’s the name, Boston Children’s. People want to work here, and many of them have worked here for a very long time. I mean, I have tenure on my team of 20, 30, 40, even 50 years. I think a hybrid work environment is a big draw as well. We have team members from Florida, from Idaho, from almost all the states that we can hire from, which has enabled us to get some really great talent.

Having big projects like an Epic implementation, and our next big, a new ERP implementation draws talent as well. Sometimes they start as a consultant, and then they want to stay and work at Boston Children’s full time because they are so excited about the mission, and seeing the fruits of their labor.

Judy: Some organizations are calling their people back. Some are struggling with the remote versus the hybrid and how to grow those who haven’t built the relationships. What have you learned along the way? What’s made you successful doing that?

Heather: We are not calling people back. Boston Children’s senior leaders, in partnership with our Chief Human Resource Officer, have created the policies and the environments where some people will be 100% remote. Their roles are conducive to that, but for the most part, I have a hybrid environment in IT. I’m in the office most days. There are 20 to 30 people who are in the office every day. During the EHR implementation we had folks who needed to be on site four days a month. Not four days a week, four days a month. Some people didn’t even want to come in four days a month, so they chose to leave and I was okay with that.

Judy: What unique things have you done to engage your team in activities remotely?

Heather: This past fall, we did a costume contest, and we had it online. We even did a pet costume contest. We had different virtual conference rooms set up so people could walk through and see each other. Sometimes at our town halls, we’ll do a water cooler session, give people a topic, and send people off into groups to engage. I do a “coffee with the CIO” for all my new hires every month, just to get to know one another, because many of them will remain remote and will never come into the office.

Judy: I read an article recently saying that people who work in the office, at least part-time, if not all full-time, are more likely to be promoted than those who are totally remote.

Heather: I haven’t seen that in this organization. I think that the work that you do, whether it’s remote or in person, speaks for itself. And I think those who are remote are very intentional, and want to grow and want to take on new things. I think they actively seek it out and make themselves known to their leaders. I don’t have metrics on that, but anecdotally I have a nice blend of that in my department.

Judy: As CIO, are you involved in any strategic initiatives around sustainability?

Heather: Yes. One of the pillars in our enterprise objectives and strategic plan is around sustainability. In the Boston market and being in Massachusetts, sustainability, being green, the environment are top of mind. We’ve done a lot of building over the last few years, and there are many requirements and regulations around sustainability that our senior VP of facilities understands. She is amazing. I try to help as much as I can by limiting the size of our technology footprint and keeping things in the cloud. Maybe we don’t need a printer in every room, just one printer at the nurses station, for example.

There is a realization that how we’ve operated in the past is just not sustainable. It’s not good use of our finances and it’s not good for the environment. So we are very, very conscientious about how we deploy any new facility and what goes into that facility. Because it is an enterprise priority for the organization, all of us are aligned with that and my teams think about it a lot, especially in our data centers.

Judy: If you hadn’t become an IT leader, or a doctor or PA, what other career do you think you were cut out for?

Heather: I would love to be a COO, or a CAO, or even a CEO of a health system. I’m just so drawn to operations. I love learning the ins and outs of the hospital and I think being a CIO has afforded me that because IT crosses every single vertical of the organization. Maybe there’s still a COO or a CAO or some type of operational role in my career path. I wouldn’t shy away from it.

Judy: What’s something you love to do in your free time?

Heather: I am a workout fiend. I love the Peloton and the Peloton app. I have a 667-day streak going of doing something Peloton. Whether it’s running, biking, whatever, lifting weights, it is a stress reliever for me. It’s something that I make time for every day. It’s a non-negotiable for me.

Few understand the intersection of healthcare and technology better than Terri Couts, EVP and Chief Digital Officer at Guthrie. With a career that began in teaching and pediatric nursing, Terri has navigated the complex world of healthcare IT, leading transformative initiatives that enhance patient care, efficiency, and operational effectiveness. In this interview for ‘C-suite Conversations’ Terri covers a range of topics from sustainability to AI’s role in healthcare.

Guthrie is a non-profit, integrated healthcare system offering a comprehensive range of healthcare services across 12 counties in north central Pennsylvania and upstate New York. The organization manages over 1.5 million patient visits annually, providing care to predominantly rural communities.​

Q & A With Terri

Judy Kirby: Terri, you started your healthcare career as a pediatric nurse. How did you end up on the path to becoming a technology leader?

So I interviewed for an analyst role with ASAP, which is Epic’s emergency department information system. I didn’t truly understand what the job was even after the interview, but they offered it to me, and I needed a change, so I took it.

I really loved solving problems through technology. If there was a way to make what they did better it really interested me, so I dove in and got every certification that I could. After some time I was managing the inpatient team at Akron Children’s. Meaningful use had kicked up so I decided to go into consulting. I learned a ton about all kinds of different healthcare systems, big and small, and how we could make EPIC enhance that work.

In 2014 I joined NYC Health and Hospitals, leading their Epic implementation. When our CIO Bert Robles left there and landed here at Guthrie, he recruited me. At that point, I was ready to be off the road. I had a daughter entering high school and she was a little bit in need of some parenting at home, so we made the leap and moved to Pennsylvania.

Judy: Did you have a strong mentor who helped you?

Terri: I’ve had a couple of mentors, starting with a physician at the Cleveland Clinic. He was a renowned pediatric surgeon, and while some surgeons can be socially inept, this one was the opposite. He really wanted you to be engaged in the care he was providing. He wanted you as part of the team. I’ve had some mentors in IT also. Because I was a nurse leading IT, there was constant questioning of my ability. But I know how technology ties to the patient, and I think that’s what my mentors have focused on—the art of storytelling, the art of understanding the why, listening, and relationship management.

Judy: What do you bring from your background as a pediatric nurse that helps you be a strong IT leader?

Terri: I think being able to meet people where they are. As a pediatric nurse, I had to assess the child’s capabilities, you know, their understanding and communication and all those things. I’m a great observer and listener, and I’m able to get to know the audience that I’m talking to. Another attribute that a pediatric nurse has that is valuable as a CIO is patience and a certain level of empathy and compassion. I want to make sure that I’m meeting people where they are, not to always say “yes”, but to make sure that they understand my position, that I understand their position, and we can meet somewhere in the middle.

Judy: Has your lack of hands-on technical expertise been a positive or a negative?

Terri: Honestly I think it’s been mostly positive. The reason I say that is because I can ask all kinds of questions and it requires people to think differently because my questions come from a clinical framework and not from a technical framework. Sometimes I will even ask questions that already I know the answers to just to help the technologists think a little differently. I listen a lot. I want to learn enough to understand the why behind things and make sure that I can pick the right vendors and partners. I don’t need to be highly technical to lead relationships and to drive innovation and serve our patients, but I make sure I have a strong team underneath me.

Judy: One of the biggest concerns I hear over and over again is about the lack of up-and-coming IT talent to fill the CIO positions. There are a lot of CIO positions open right now. What do you see as the reasons for this, and how are you helping your leaders position themselves for career growth?

Terri: You know caregivers are not the only people who burn out in healthcare. With the challenges around cyber threats and infrastructure and audits and rising technology costs, it is a high-stress job. It takes away from time with your family and being able to care for yourself. I have a hard job but I actually like the challenge. I thrive in this kind of environment. But five years down the road I might not want to, so I can understand it.

IT is so diverse, we have to have an EPIC expert, an infrastructure expert, we have a desktop expert. There’s not one person who knows it all and I think that makes it challenging to groom individuals into leadership positions by allowing them to get outside their particular area. I try to connect people with other groups on my team, and have them participate in some of the boot camps and the training that will give them experience but also the peer connections.

I coach people that it’s okay to be uncomfortable. If I were comfortable every day in my position, then something is probably wrong. Four or five years ago, I had somebody who had started out as a lab technologist. She came into the EPIC space and she was managing that really well because she was meticulous in her detail. We didn’t have a project management office at the time so I said to her, “I want you to lead my new project management office.” At first she was like, “What are you talking about?” But she thrived in the role even though she was so uncomfortable at first because it wasn’t what she knew.

Judy: There are a lot of conversations about the CIO position. What should their responsibilities encompass and what should it be titled? You’re a Chief Digital Officer. Others are still CIO, but there are CHIOs, the Chief Data Officers, the CMIOs, the Chief Analytics Officers, Chief AI Officer. They all have different parts of IT. What do you think it should be called and what parts do you have or don’t have, and why?

Terri: I think it depends on the organization. I started out as the CIO and we changed it under Dr. Sabenegh’s guidance, our CEO, to add digital because of his beliefs around how technology enables care and how we strive to be more transformative in our care model using technology. I have all the traditional CIO responsibilities and AI now falls into that. We don’t have the type of organization that would need a chief AI officer, but at a place like the Cleveland Clinic that has a lot of funding to invest in building large language models that they could even sell at some point, it makes sense to have that oversight. But there is the worry that having a lot of chiefs can lead to fragmentation. When you have silos, particularly in larger organizations, things start to break down, like security and change control processes, and redundant technology tends to grow out of that. If you have an academic center and a large research center, having a chief data officer makes sense. But we have a small research center. We are building out our own data lake house and keeping it under my purview makes a lot of sense to ensure we have all the security.

Judy: One of the other concerns I hear is recruiting and retaining top talent. It’s long been a challenge for IT, especially during and after the pandemic. What’s one of your most effective recruiting or retention strategies? And what positions are the most difficult to fill right now?

Terri: We’re a hard organization to recruit to for pretty much every role due to the rural location. If you recruit a physician, you have got to make sure their spouse is also happy in this environment. It’s an hour to Starbucks, so for many, it’s a different kind of lifestyle.

But the pandemic really opened it up for us. It allowed my team to work remotely in an organization where that had previously been frowned upon. They have work-life balance and flexibility now and that has been a large retention factor for us. They don’t have to do all that driving and pay for gas. It also opened up the doors to recruit in other states. I have a manager who lives in Utah, and I have a cybersecurity expert who lives in North Carolina. They work our hours and they make it work for their families, but they don’t have to move.

Cybersecurity is probably our hardest area to recruit in right now primarily because those are entry-level positions doing a lot of groundwork that isn’t very exciting. Infrastructure has been a challenge too, because those individuals need to be on site. As the talent ages out, it’s been a little bit harder to recruit for that.

Judy: With continuing financial pressures in healthcare, how do you meet the rising demands of costs of technology? Are you able to track a true ROI for the investments you are making?

Terri: Outside of the traditional EPIC stuff and standing-up servers and those kind of things, pretty much everything technology-driven that we bring in requires a pro forma. That’s a process we started about four years ago. So for example, with the Guthrie Pulse Center, which is highly technology-enabled, we took a five-year outlook. We put down the hard cost, and we put down the savings. The first year and a half was all investment, but now we’re actually seeing savings. But we plan for all of that. But some things you just have to do even when there is no ROI, like replacing aging PCs. You have to spend the money, otherwise, you’re going to have a cyber event.

I think the pro forma process also helps with other things like adoption of the technology because you already know the problem you’re trying to solve and you’re targeting it together with the business owner. It’s not just about deploying the cool thing.

We try to take a platform approach. We have three major platforms, Microsoft, Oracle, and EPIC. Whatever the ask is, we try to make it work through one of those platforms before we look for something new. But for most things we can prove out at least a small ROI. There’s also a lot of soft ROI that comes down the line that may not have a direct correlation. For example, remote patient monitoring tech in the home probably reduces visits to the ER, but that is not necessarily a correlation being tracked.

Judy: How is generative AI impacting Guthrie’s strategy? What type of work are you doing along those lines?

Terri: We don’t have the shop to do any kind of large language model training ourselves, but we’re working with partners on their AI products. We evaluate AI in three key areas: improving patient care, increasing provider efficiency, and enhancing operations. Every AI tool goes through a governance process to ensure that it’s necessary and ethical.

Generative AI is especially tricky since it relies on sensitive patient and organizational data. We’re using it carefully for operational improvements like predicting falls and pressure ulcers (Artisite), capturing provider-patient conversations (Ambient Listening), and strengthening security.

AI won’t replace human interaction; it’s about creating a more personalized, proactive, and connected experience. AI is both exciting and daunting, but if it becomes more affordable, we could see some game-changing advancements.

Judy: As the CDO, are you involved in any strategic initiatives around sustainability?

Terri: Absolutely. We recently held leadership discussions on transformation—not just for a single project, but for the broader goal of sustaining our ability to serve patients, remain financially responsible, and address workforce shortages. Technology is required to make these things work, and I wouldn’t want to be in an organization where I wasn’t part of that conversation.

We’re trying to balance innovation with cost efficiency. For example, we’re exploring ways to offer our call center services to smaller hospitals or rural healthcare centers that lack the resources to build one of their own. They get access to high-quality support without the overhead, and we earn a little bit of profit. Our goal is to control costs while transforming to meet our community’s needs.

Judy: So, as you look ahead to the rest of 2025, what are your biggest challenges?

Terri: It’s the amount of work. I see a lot of change happening and everything is supported by technology. So, keeping my team engaged while not burning them out will be a big challenge.

What’s happening at the federal level impacts us because there doesn’t appear to be a game plan right now, and there’s a lot of change management happening in our organization when it comes to care model redesign. Because we’re being asked to move fast, and change is coming so fast, we need to be able to support our users through these changes. That is something I want to keep my eye on. That and the patient experience in general.

Judy: If you hadn’t become a nurse who then became an IT leader, what other career do you think you were cut out for?

Terri: When I was growing up, I always wanted to be a pediatric physician, but I got my first degree in education. I was a teacher for about four years before I went back to school and got my nursing degree. I guess medicine has always been where I wanted to be. I never thought that I would be sitting in this chair, although I do love what I do most days.

Judy: Outside of work, what’s something you love to do in your free time?

For this edition of C-suite Conversations, I sat down with Keith Perry, SVP & CIO at Carilion Clinic, to discuss his journey into technology leadership and the evolving role of CIOs in the healthcare industry. From an unexpected career pivot to leading digital transformation efforts at a major healthcare organization, Keith shares his insights on leadership, governance, AI integration, remote workforce management, and the future of healthcare IT.

Carilion Clinic is a non-profit health care organization serving nearly one million people in Virginia through hospitals, outpatient specialty centers and advanced primary care practices.

Q & A with Keith

Judy Kirby: Keith, thank you for speaking with me for our ‘C-suite Conversations’ series. When did you realize that technology leadership was of interest to you, and why?

I had always been interested in technology, so I started my undergrad work in computer programming and business administration. And later on, I got my graduate degrees. The leadership aspect has kind of grown organically over the course of my career. I did not start out thinking that I would end up in technology leadership. I was just interested in technology in general, and midway through my career I stepped into a leadership role. And I guess the rest, as they would say, is history.

Judy: You were with a consulting firm for about six years. How did that influence your approach to your career as well as your leadership style?

Keith: Most of our clients were C-suite executives, so it was a really good opportunity to have exposure to the C-suite and to learn how important relationships are to being successful. Consulting firms are really built around relationships. And I think it also helped me set a work ethos of doing what it takes to deliver for your client. I still carry that with me today, that discipline, that rigor around that process for how we deliver work for our patients and our customers.

Judy: I talk with CIOs who are concerned about the division of technology responsibilities within their organizations. Some have data, some have AI, some have cybersecurity, some have analytics, population health. Some don’t. They’re concerned about the division of it and the siloing effect. How you do work at Carilion?

Keith: I’ve talked about this with my colleagues from across the country, and there doesn’t appear to be a one-size-fits-all model. Even in organizations that are similar in size and structure to us, you see very different organizational structures in technology. Personally, I have overall accountability for information technology, information security, and also clinical engineering, because the medical equipment, for all intents and purposes, looks like all other computer equipment that sit on our network today. Here at Carilion, we’re a physician led organization, and we subscribe to the dyad model. So, there’s a physician leader and an operational leader who are paired to deliver medical services to our patients. I have a very similar partnership here. I partner very closely with the CMIO, we report to the same executive leader, and we form a dyad partnership to deliver technology services to the organization.

The CMIO has health analytics, clinical informatics, and digital health, and I’ve got everything else, but we work together. You see very different footprints across different organizations. Those that are larger that need to compartmentalize have created separate roles for AI, or reporting and analytics. In the end, for me, it’s less about the title that I have and more about what we’re doing to take care of our patients and our internal customers.

Judy: You’ve been in the CIO role for some time now. How do you see the CIO or the CDIO job evolving over the next three to five years? What are some of the new responsibilities and job qualifications that are going to emerge?

Keith: I think we’re continuing to see the CIO become more and more strategic, helping the organization set its strategy and being involved in the business side of things. Technology plays a crucial role in driving the delivery of services within healthcare organizations, as well as across all other industries. I think that is placing an increasing burden on technology teams to deliver and on CIOs to understand all sides of the business, including the care side of it. Establishing relationships and having close partnerships with the other senior leaders in the organization is critical. I spend most of my time doing that, working with the clinical and operational leaders. I spend very little of my time actually running the business of IT. That’s primarily delegated to my senior leadership team in technology.

Judy: How have you worked with your team to make them more savvy on the business side, especially now that we have so many hybrid or remote employees? Has that been a negative for getting to where you need them to be?

Keith: I wouldn’t say that it’s been a negative. I would say that it has posed some interesting challenges. Helping to educate my leaders and encouraging them to become more involved in the business and operational aspects of the work that we do has been critical. One of the first things I did when I got here at Carilion was establish the business relationship management model and embedding our IT folks into the clinical and operational sides of the business. So, my Business Relationship team is embedded throughout the organization. They’re out with our clinical and operational leaders. They’re attending their regular meetings. I don’t think we can be effective in helping them do what they need to do if we don’t understand their work.

There’s a unique opportunity here to connect people in IT with the meaningful impacts we have on people’s lives, their health outcomes, and our communities. The challenge that comes from having remote workers is that it’s not as easy to get those teams engaged and out in some of our facilities. But we have regular team meetings, we bring folks in from remote locations so that they are here onsite to develop that connection to the mission and the work that we do. However, it’s important that my leadership team is all local. We feel that it’s critical to have that face-to-face time with the clinical and operational leaders.

Judy: How has your team learned to lead remote employees? Prior to COVID, most people were in the office. How has your team responded? What lessons have you learned?

Keith: I would say we’re ahead of the curve on leading a remote workforce, or a hybrid one. We had already started moving down the remote work path about a year and a half before COVID. We were doing that because we were finding challenges from a recruiting perspective, and we were looking for ways to offer more flexibility to our existing teams as a retention strategy. We sat down and talked about what that would look like. How do we stay connected with the teams? How do we ensure that we’re still seeing the same quality product, the same level of production, etc? We developed a remote worker agreement that has a lot to do with how we stay connected. For example, we require everybody to have their cameras on during meetings. We also encourage “drop by” meetings, just like you are in the office and drop by someone’s office if you need to chat or work through a problem. We just do it virtually with them.

Judy: You once told me a story about how your contract negotiation skills came in handy when you were building your house. It was an amazing story. How have negotiating skills been useful in your career?

Keith: I have to say that I think it’s one of my best skills, negotiating contracts and honing in on the parts of contracts that are important. We have hundreds of contracts that are constantly in a state of being renewed or renegotiated. I’ve worked really hard to educate my leadership team who have overall accountability for those contracts and our compliance with those contracts. Every vendor is different in terms of how they leverage licensing models, and the shift to software as a service brings new things we have to be concerned about.

You use those skills not just in contract negotiation with vendors, but a lot of what we do day in and day out is negotiating systems, negotiating problem resolution, negotiating timelines, etc. It’s all about how flexible you can be, and how persuasive you can be.

Judy: What do you see as your organization’s biggest strategic challenge this year?

Keith: I think it’s going to be a challenging year for us. Our organization is transitioning after Nancy Howell Agee retired as president and CEO. Steve Arner, our former COO, has stepped into the role and will likely bring new leadership ideas as well as a new direction for the organization.

We have a half-billion dollar tower expansion that is coming online next month. We’re doing a wholesale replacement of our ERP platform. And just like every other organization, we’re dealing with a significant influx of demands for AI technologies and the work it takes to navigate these requests and distinguish those tools that are useful versus noise is taking a lot of resources. We’ve got our hands full for sure!

Judy: You mentioned AI before. How is AI impacting your organization? What type of work are you leading to evaluate new AI capabilities? Is it changing your IT org chart or your operating model?

Keith: It’s like trying to herd cats. I can’t ever recall a time in my career where there has been this level of interest, and hype, in a set of technology tools. Companies that are months old, rather than years old, are offering some of these solutions. Like other organizations, both within healthcare and beyond, we are working to understand these tools and try and help our leaders strip out the noise.

We’re trying to understand how these technologies can help us provide better patient outcomes and deliver more efficient and cost-effective care. But working through the onslaught has been challenging.

Early on, our CMIO and I realized that we had to have some discipline as we work through this. We put together an AI steering committee made up of our senior leaders. Now we put all requests for AI technologies through a process, looking at the use case, and how it is aligning with our strategy, because every vendor that we have is stepping forward saying, “You need this latest, greatest AI that we’ve incorporated into our platform.” It’s just a lot. And you’ve got to have discipline as you work through it for many reasons, including the cost.

I have some real security concerns about some of these technologies and some of the vendors because many of them are black-box solutions. They don’t want to expose the special sauce behind their solutions because it’s their intellectual property. But we need to understand what they are doing with our patients’ data.

But I will say that some of these tools show a lot of promise and can help us from a security perspective. We’re really interested in Agentic AI in the form of what Gartner calls guardian agents, where you’re deploying AI to watch and monitor AI to be sure that it’s not going outside the guardrails and doing what it’s not supposed to be doing.

Our organization is taking the approach of buy versus build, at least initially. It is better for us to look at some of the solutions that our existing vendors are bringing forward first. Number one, we’ve got a trusted relationship with those vendors already. And if that’s our quickest route to get some wins and get some solutions in place faster that bring value, we feel like that may be the best approach for us.

Judy: What is your best use of AI right now, the most successful one you’re using?

Keith: We have two or three really successful projects. We have deployed ambient co-pilot technology in the Nuance Microsoft space for physicians. That technology essentially records the conversation between patient and physician. It summarizes and creates the documentation for the provider in Epic which takes a lot of the administrative burden off the provider. We have seen increased satisfaction in terms of being able to get that documentation closed more quickly, which certainly helps from a revenue cycle perspective. More importantly, it’s helping with provider wellbeing and is reducing “pajama time” for our providers.

We’ve also deployed a couple of predictive models in our quality area to help identify things like sepsis and early sepsis intervention. We are looking at AI and predictive modeling to predict early deterioration of a patient. Those are examples that have been successful and that we’re continuing to expand.

Judy: A lot of organizations are touting sustainability. Healthcare doesn’t seem to address it as much as other verticals. As a CIO, are you involved in strategic initiatives around sustainability? And if so, what are they and what’s your role?

Keith: We actually have a leader in the organization who is focused on sustainability. She’s done a lot of tremendous work. One of our acute care facilities has a solar array farm that is producing a portion of the energy required to run that facility.

From an IT perspective, we have implemented ‘pull printing’ in the organization. One of the things that we noticed as we walk by any printer is that there is always a stack of unclaimed printouts on it. We determined that people print things they ultimately don’t need or the printouts are auto-generated by a system.

With pull printing, all of our multifunction devices are now equipped with card readers. Folks walk up to a printer when they’re ready and tap their badge to print documents that  are holding in their queue. In some instances, those documents never get printed and after a certain period of time, they just drop out of the queue. We’re seeing an overall reduction in paper and toner use. We’re also looking at our data center footprint and power efficiency in those data centers.

Judy: So, Keith, if you hadn’t become an IT leader, what other career do you think you were cut out for?

Keith: You know, I have always been fascinated with airplanes and the aeronautical industry. I think I would have been a good airline pilot. And given the fact that technology is running those aircraft today, it probably would have been a good fit.

Judy: What’s something you love to do in your free time?

Keith: I love to travel. Especially as I’ve gotten older, I have an even bigger fascination for new cultures and new places. We have a really big trip coming up next year to Japan that I’m really looking forward to. I’m also a hobbyist when it comes to photography, especially drone photography and videography. So, I’ve taken my fascination with airplanes and miniaturized it into drones and combined it with my technology skills and love of photography. You’re able to capture some really unique images from a drone that you can’t get from regular photography.

Judy: What’s your favorite place that you’ve visited?

In this edition of C-suite Conversations, Chuck Podesta, CIO of Renown Health, reflects on his 30-year CIO career in healthcare. He discusses the future of the CIO role, the power of adaptability, and the need for more mentorship in the profession. From governance and cost efficiency to personal growth, Chuck offers candid advice for IT leaders navigating today’s complex landscape.

Renown Health is Northern Nevada’s largest not-for-profit healthcare network, serving over one million patients each year. Renown operates hospitals, clinics, and specialty centers, offering advanced care in trauma, cancer, cardiology, and more. Based in Reno, Nevada, Renown employs 7,300 people.

Key Takeaways

• After 30 years as a healthcare CIO across eight organizations, under 18 different bosses, Chuck stresses the importance of adaptability and relationship building to stay relevant and valuable, especially during leadership transitions.
• Becoming a CIO requires shifting your focus from day-to-day tasks to long-term strategy. Before their first CIO role, IT professionals who thrive on the gratification of operations should think carefully about whether they would truly enjoy strategic thinking.
• Strong governance in IT is crucial. Without clear decision-making processes, organizations will chase shiny objects and overspend on technology without achieving real value.

Q & A with Chuck

Judy Kirby: Chuck, you and I have known each other for more years than we care to admit, and we’ve witnessed a lot of change in healthcare technology. What got you into healthcare technology in the first place?

Eventually, I landed a data entry job at UMass Medical Center, where I met the guy who was running the computer center all by himself. He needed help, so he hired me and trained me in computer operations—doing backups in the middle of the night, working with old equipment. I moved up from there, becoming a supervisor as we hired more people, got more equipment and started automating more things. What I liked about it was I got to do a lot of different things. We ran wiring through ceilings, set up printers and did a lot of hands-on work, but it was great training. That was my start in tech back in 1981.

Judy: So I have to ask, what was your first salary? Do you remember?

CP: I think it was somewhere around $10,000. So, it wasn’t great, but I got overtime. I wore a beeper, and back in the day, a beeper was a status symbol because only doctors carried beepers.

Judy: In what ways has the CIO role changed the most in recent years?

CP: Most of my decision-making is not dictatorial as it was at the beginning of my career. Now it’s more of a collaboration. At Renown we take an SBAR approach: Situation, Background, Assessment, Recommendation. Everything comes through our president’s council, which is made up of all the CEO’s direct reports. We meet every Wednesday.

There really aren’t IT SBARs anymore other than data center and network stuff. But if we’re going to move to Workday, the Chief People Officer would bring that, or operations. IT has a role, but they’re organizational implementations now, not IT implementations. I know a lot of CIOs who struggle with this because they want to own it. That’s a dying breed of CIO right now. The CIO who is out there collaborating with the organization, giving up some of the ownership is the future.

Judy: In what other ways do you see the CIO or CDIO role evolving over the next three to five years?

CP: I think we need to be more of a people connector across the organization. We really need to open up the IT world and share. There are things like citizen coding coming along. If you’re not open to that in IT, again, you’re going to have to move on.

I think my job is going to be more about understanding the problems that we’re trying to solve. What kind of team do I need to put together, and connecting all those people so they can now collaborate without me being in the room all the time. They’re coming up with the solutions and that’s where the power is. Maybe it’s like being the conductor of an orchestra.

If I were a new CIO coming into an organization, I would spend all my time the first 60 or 90 days building relationships, first across my peer group, then down through the organization, at VP level, director level, and certainly my team.

Judy: In your opinion, should there be or can there be one leader over all technology and where should that leader report?

CP: I think in big organizations like Cleveland Clinic, Mayo, and Stanford, they’re huge and you have to have gatekeepers. You have to have that chief analytics officer, chief AI officer, chief digital officer. But most health care organizations are more like Renown in size and complexity than Cleveland Clinic. I don’t think many one to two billion dollar organizations are big enough to be creating the role of chief data officer, chief analytics officer. They need more of a collaboration model and a strong governance model.

This raises a related question: Do you need a CMIO anymore? CMIOs were brought in when electronic health records took off because of Obamacare. We needed CMIOs to do the translation between IT and the doctors and get them to buy into EHR. Well, everybody has it now. At Renown, we have a lot of people who really understand the EHR. Many doctors are like CMIOs within their own area.

It really comes down to education. For example, I’m going to my president’s council in a couple of weeks to talk about our AI policy. But I’m really using it as an opportunity to educate them on AI. That way, when these things start to come forward, they can help me choose which ones are going to work for our organization, as opposed to the shiny bright object. We don’t need a chief AI officer at Renown. If I’m doing my job educating them, working with the right vendors and bringing the right tools in, then we don’t need that type of person and I would say other organizations the size of Renown don’t need one either.

Judy: The average tenure for healthcare CIOs is still about four years. You have had eight jobs in 30 years, roughly about four years per job. Can you talk about the short tenure in this profession?

CP: Well, some of it is due to moving up in your career. When you get your first CIO job at a small hospital and you’re 35 years old, you’re going to move to that next one and the next one, because you’re building your career. There’s more money and bigger organizations.

A lot of CIOs struggle when there is a new boss. There are some new bosses who come in, and they have a CIO that they worked with previously who they want to bring on board. There’s nothing you can do about that. Other CIOs don’t last very long because they could not adapt to the new CEO’s style.

It comes down to relationship building. If I’m a CIO, and I’ve been in an organization for two years, and I have not built relationships across the organization, I’m doing things in silos, and a new CEO comes in, I’m in big trouble. But if I have built those relationships across the organization, where I’m a valued partner, when a new CEO comes in, and he or she asks the CFO about IT and our relationship, then you have someone else advocating for you. That’s powerful.

I have given CIOs this advice when a new boss is coming into the organization. For your inevitable one-on-one with the new CEO, put together a presentation about how you lead your organization and how your organization benefits the rest of the business. What you want to do is leave the new CEO with the impression that he or she doesn’t have to worry about your org right now. Because you can imagine that there are a lot of issues the new CEO needs to worry about. You don’t want to be one of them.

But you still have to be transparent. If you have problems, you’re going have to tell him or her, “I’ve got this one area in IT that I’m still focused on. You’re going to hear noise about it but here are the things we’re doing to resolve it.” That’s okay, because when that CEO goes out there and hears from others about this problem in IT, she or he won’t be surprised by it.

Judy: That is great advice. One of the big concerns I hear about over and over is the lack of up-and-coming talent in IT leadership to fill CIO positions. What are your thoughts about this void?

CP: There aren’t enough mentors out there right now. Unfortunately, a lot of CIOs I know that have been at it for 20 or 25 years are looking to retire. I get it. I think about it a lot myself these days because it’s not an easy job. I ask them, “Can you hang in there a little bit longer and do some mentoring? Because you have wisdom that you can pass down to this younger group so that they don’t make the same mistakes that we made.” I try to get out there and mentor as many people as I can.

When you go to CHIME and HIMMS events—and I have great respect for those organizations because they do add value—but a lot of their presentations are around what’s coming, like GenAI. And vendors are saying, “Pilot this, pilot that, it’s going to move your career forward.” Some young CIOs decide, “Let’s do this. I’m going to put it on my resume, and it will lead to my next big job.” But unfortunately, they’re chasing the shiny bright object.

When I got to Renown, we were spending seven percent of total Opex of the organization, which by any benchmark is way too high. And we were known as the department of “No.” We had morale issues, customer service issues, and we were in the bottom five in employee engagement. Fast forward 18 months, and we moved to the top in engagement and customer service, and brought our spend down from seven to four percent, saving millions of dollars for the organization. So, I ask rising IT leaders, “If you and I were going head to head competing for a new CIO position, and I tell my seven percent to four percent story, and you tell your shiny bright object story, who do you think is getting the job?”

And people say healthcare IT doesn’t have enough money compared to banks and other industries. But there’s plenty of money in healthcare IT. Plenty. We’re just spending it on the wrong things and wasting a lot of money. I like to call it, stick to the knitting.

Judy: Where exactly do you see the waste and how can CIOs add value to their organization by cutting costs?

CP: If you have no governance, the organization is going to go around you and figure out a way to buy that application or buy that product without you. And, so you end up with $30 million in software maintenance. Another example is moving things to the cloud. What people don’t realize is that the cloud doesn’t save you money. It may allow you to fire things up faster but there’s a cost to that in the cloud.

When I go into a new organization, the first thing I do, besides developing the relationships I talked about, is to find out what the governance looks like. How does that work? Is there an SBAR type of approach? How does somebody go from an idea stage to approval to the implementation stage? Is there a process that you can put your finger on? I can tell you that in most organizations it’s all disjointed and a big mess.

At first, strong governance sounds like you’re just slowing things down, but you’re actually speeding things up. Here at Renown, if it’s an SBAR that comes to the President’s Council, we meet almost every Wednesday, so it’s not going to be a big delay. If it’s approved it goes into an enterprise PMO process, and we have a gate process that we go through that everyone understands. It’s hard work though to implement it, but you’ve got to do it to be successful.

I’m worried about the IT leaders coming forward as others retire and move on. And with this AI craze, we really need to focus on platform enabled AI. What does that mean? Epic is working on 100 AI projects right now, and I’m going to look at 10 of those. It’s integrating with DAX Copilot, for example, or Ambience. They’re integrated with AI and Epic supports it—that’s platform enabled AI. It has gone through a process already. Epic is doing all the work for you. They’re doing the Cleveland Clinic work. They do the Stanford work with the startups. They’re making all the mistakes, but they’re planned mistakes. You don’t need to be first to be innovative. You just can’t be last.

Judy: Looking back at your own journey, what career advice do you have for technology professionals interested in becoming a CIO, besides stay away from bright shiny objects?

CP: First, find a good mentor. One thing that people need to understand is that when you are at the director or VP level, you are 80 percent operational, keeping the trains running on time, and 20 percent strategic. When you become CIO, you flip that overnight. You become 80 percent strategic and 20 percent operational because the people below you are doing the operational stuff. What do you need to do to make that switch? And I’m telling you, a lot of people can’t make the switch because they like the day-to-day operational stuff. They feel good going home at night because they accomplished 10 things. You don’t get that instant gratification at strategy level. It takes a year, sometimes years for things to happen. So, if you’re an instant gratification type person, you’re not going to fare well. That is why when I’m mentoring rising IT professionals, I encourage them to get introspective as to what their abilities are today. It’s okay if you don’t want to make the leap. I’ve had unbelievable operational people report to me. They make a good living and they’re happy doing that, and that’s okay.

I have known others who have gone into the CIO role and weren’t happy, and it affected their personal lives. Some got divorced, they couldn’t sleep at night, they were miserable, they got the Sunday scaries. On Sunday afternoon, are you really nervous about Monday? If you are not sleeping well on Sunday nights, that’s a problem. You should be energized! That’s a little test you can give yourself to know whether you’re in the right job.

Judy: What is some advice you have for CEOs when they’re hiring their technology leaders?

CP: Candidates all come with references, and of course, those are all going to be good. So, you have to find people to talk to from the organization that they’re coming from, or where they worked previously. Leverage your network and try to have a confidential conversation about the CIO candidate, about their relationship building. Because what CEOs are looking for is a good fit. Yes, the candidate has to be competent, but will they be a good fit with the rest of the team?

The good CEOs I know will have the C-suite candidates interview with the entire C-suite to find out, “Can our CFO work with this individual? Can the chief people officer work him or her?” I think that’s the most important part.

Judy: What do you love to do in your spare time?

CP: I’ve learned as I get older that life begins at the edge of your comfort zone. So, in 2013, at age 55, I started running marathons. I had no idea I could actually run one, never mind train for one. It was the hardest thing I’ve ever done, and it changed my life. I actually became happier and I have picked up other challenges. Pick something that you would normally say no to and just go and do it and it’ll change your life.

The poet George Eliot—actually a woman named Mary Anne Evans who took a man’s name because you couldn’t get published as a woman in the 1840s in England—wrote something that has stuck with me to this day: “It is never too late to be what  you might have been.” I’m kind of like a cowboy now. I remember growing up watching Westerns with my father. We both loved them, but we were in New England which wasn’t a place where you dressed up as a cowboy or rode horses. I easily could have said no to the photo shoot, no to riding horses. 

I’m trying to impart to people that it is never too late. Just because you turn 50 or 55 or 60 doesn’t mean you stop doing things. You only get one life. Find something you love to do and give back. Mentoring is my give back and I’m doing a lot more charity work as well. But I’m also doing new things, saying “Yes” more than “No”. And, you know, I wish I had learned this when I was 30. That George Eliot saying means a lot at any age.

David Lehr’s career story highlights the value of curiosity, hard work, and a willingness to take on new challenges. After pivoting away from his education as a physicist, David worked his way up to become a healthcare CIO, and he is currently the Chief Strategy Officer at Meritus Health and Chief Operating Officer of the Meritus School of Osteopathic Medicine. In this edition of “C-suite conversations”, David shares the many lessons he has learned along the way, his approach to talent development, and his thoughts on the future of healthcare and technology.

Meritus Health is Western Maryland’s largest healthcare provider with over 4,000 employees, 500 medical staff members and 250 volunteers. Meritus Medical Center, the flagship facility, has more than 327 beds. Meritus Medical Center is a teaching hospital serving as a clinical training site for the Meritus Family Medicine Residency Program and more than 1,000 nursing and allied health students annually. Meritus Health also includes the Meritus School of Osteopathic Medicine.

Key Takeaways

• If you want to be seen as a strategic leader and earn larger roles, don’t stay in your lane. Engage with the broader goals of the organization, volunteer your ideas and offer to take on responsibilities that overlap with other departments.
• To be viewed as a trusted leader, CIOs must focus on building strong relationships, especially with physicians, and treat them as customers.
• Give your team members assignments that stretch their skills and push them outside their comfort zones. Provide guidance and support but let them solve problems on their own.

Q & A with David

Judy Kirby: When did you realize that technology leadership was of interest to you, and why?

That’s kind of been my philosophy on career and life. There’s something interesting about just about everything. Just keep moving until you find something interesting, but once you find that thing, work your butt off and be awesome at it, and eventually new opportunities will come up. Then work your butt off on the next thing, which will result in yet another better opportunity.

That’s how I ended up where I am now. But I never sat down when I was 18 or 25 years old and thought, “I really want to be a technology leader.”

JK: Tell me about your first CIO role.

DL: Eight years ago, I started my own consulting firm and I was working with a client in Annapolis, Maryland. After a while they told me they were very happy with my work and invited me to become their full-time CIO. I wasn’t sure I wanted to accept the offer. But I thought it through and realized that my consulting business would be better and more lucrative if I had CIO experience on my resume. So I decided to try it for a year or two, and as they say, the rest is history.

We were able to achieve some really great things while I was CIO and eventually I was offered opportunities in other areas. The leaders of the company came to me and said, “You’re really good at managing big projects in IT. Managing a construction project can’t be that different. Why don’t you try that? You turned around IT so why don’t you try taking on the lab? Or pharmacies?” And, before I knew it, I had operational responsibilities for the health system and continued to grow my role from there.

Eventually, the president of that hospital left to join Meritus as CEO. He and I had worked really well together. In fact, he was my mentor. He asked me to join him at Meritus, and here I am.

JK: Your current title is Chief Strategy Officer, Meritus Health & Chief Operating Officer, Meritus School of Osteopathic Medicine. What are your responsibilities?

DL: We have organized the company into hospital related, and non-hospital. The non-hospital stuff rolls up to me – ambulatory practices, the home health agency, and IT. So, the CIO reports to me, as does facilities, construction, marketing, all of our non-hospital businesses, ancillary services, and the medical school.

JK: Can you talk a little bit about how having IT leadership in your background helps you with your operations and strategy responsibilities?

DL: I’ll give you an example that I think illustrates the value of having IT and operations rolled into one. Here at Meritus, we started thinking about how to make the experience of accessing care more seamless. What could we do to eliminate the friction and make it fast and easy to get a telehealth appointment. We came up with MeritusNow, and our promise to the community was that it would take less than five minutes to get scheduled for a telehealth appointment, and 20 minutes to an hour till you are done with that appointment.

Okay, so what does IT need to do? Also, operations and physician services need to work together, but physician services starts saying, “My docs don’t like this, and my docs won’t like that.” And IT says, “I can’t configure it. It doesn’t integrate like it ought to.”

JK: Are you meeting your goals of five minutes to schedule and under 60 minutes to be seen?

DL: We are. I think the median time to get through scheduling is just below two minutes, and the average time until the actual telehealth appointment is about 35 or 40 minutes.

JK: For IT executives who want to move into other areas, like operations, what advice do you have for them?

DL: Good question. I talked to someone about this recently. He is interested in taking on some operational responsibility and was also considering other opportunities. So, I said, “What if you go back to your boss and say, ‘I’ve got this other opportunity, but I’d be willing to stay here if you agree to cross-train me and let me take on some operational responsibility. Let me be the manager for a project on both the operations side and the IT side.’” That’s one way to go about it.

But I still hear CIOs say, “I am not a true member of the C-suite,” or “I don’t really have a seat at the table.” Well, you know, that’s a two-way street. It’s rare for an organization to think, “That CIO with all the great ideas and awesome input on everything, and a full understanding of our business – let’s keep him out of the inner circle!” Most organizations I know would embrace that individual and they are desperately looking for that level of talent. So, my advice to those CIOs is, “Don’t stay in your lane.”

JK: As a former CIO, and now that you have a CIO reporting to you, how do you see that role evolving over the next three to five years? What might some new responsibilities and job qualifications be?

DL: That’s a really good question. I encourage CIOs I work with directly to focus on building strong relationships, especially with the physicians. You don’t have to spend a lot of time in any healthcare setting to see that there’s frustration with the way that technology guides people through their workflows.

If you can help your users understand the best ways to get through the day, how to use AI features, and give them the support they need to get their work done, you’re going to be much more successful.

I encourage IT leaders to focus a lot more on the people side and treat them like they are your customers. If they’re not satisfied, that’s a problem. I think the people side is something that hasn’t been focused on quite enough in this profession.

JK: There are lots of conversations about the CIO position and what it should be titled. Should it now be called the Chief Digital Officer? And then there are all the other titles: CHIO, Chief Data Officer, CMIO, Chief Analytics Officer, Chief AI Officer. What are your thoughts on siloed roles versus an all-encompassing technology officer?

DL: I think that at the end of the day, whatever the title, it really comes down to the work and making sure that you’re contributing to the community, contributing to the organization, and getting the work done. If a new job title helps you explain a change in the way that the IT organization is structured, then that can be a good thing. I think that’s why people have started to test out different titles like CDIO, to indicate to the team that we’re going to start doing things a little differently.

JK: Succession planning is the responsibility of all senior executives. Can you talk a little bit about the status of your organization’s succession plan and the approach you’ve taken?

DL: That is an area, admittedly, where I have work to do. I’ve been talking about an idea I have for creating a chief of staff position that would basically help me with all the things we have going on. We’ve got mergers and acquisitions going on. We always have new projects, new construction, expansion. It’s a lot of balls to juggle and it’s hard to keep it all straight. So having somebody help manage that body of work would be extremely helpful. But more importantly, they would learn all the ins and outs of getting that work accomplished and eventually be part of the succession plan. This is something we need to think about for my role and a couple of others across our organization.

JK: A big concern I hear about is the lack of up-and-coming IT leadership talent. Do you share that concern?

DL: I don’t believe that there is a lack of talent. I see so much talent in so many people that I’ve been lucky enough to work with. I think the bigger problem comes when you have five superstars and just one vacancy to promote one of them into. How do you do that without disengaging the four who get passed over this time?

I can’t imagine working in a place where you can’t find talent. I do know that the workforce, in general, is constricted, but the caliber of people, especially if we are developing those people, has not disappointed me at any point in my career. Maybe I’ve been super lucky. Or maybe the leaders who are saying there isn’t enough rising talent are not developing their people appropriately.

JK: How do you develop your people?

DL: By giving them opportunities. When I was running an analytics shop, I used to sit down with everybody on their very first day and say, “Here’s how it’s going to work. For six months, you’re going to need a lot of help. You’re going to lean on me, on your colleagues, you’re going have questions. Don’t be embarrassed about that. That’s the expectation. In the second six months, you’ll be expected to be more independent. For every question you ask, you should answer a question or two as well. And then after the first year, I’m going to hire someone new, and that person is going to lean on you, and you have to be ready for that responsibility.”

Without fail, people have been able to follow that progression because you’re pushing them to their limits. You’re getting them outside of their comfort zone every step of the way. When you say, “I’m not going to tell you how I would do it, but here’s the goal,” people will exceed your expectations.

JK: With continued financial pressure on healthcare, how do you meet the rising demands and costs of technology, and how can you track true ROI?

DL: I’m a little bipolar on this particular question because, on the one hand, nothing is becoming cheaper and no costs are going away. Now, suddenly, you have these AI companies coming in and saying, “Here’s how much it’s going to cost you to add additional technology on top of what you have.”

On the other hand. You keep hearing, “Our margins are too thin, we don’t have enough money in healthcare.” I have to remind those people that one out of every six dollars spent in the United States is spent on healthcare. That’s a lot of money! I bet we can figure out how to find some money to cover what we need to do.

JK: Speaking of generative AI, What type of work are you leading in this area, and is gen AI bringing changes to your IT org chart?

DL: It hasn’t changed our IT org chart yet and I don’t know that it will change the way IT is delivered, but it’s obviously changing the way that people work. There are different rates at which people are adopting and embracing the change. I talked to one physician who said if she had to choose between the AI and her husband, her husband would be out of luck. But not everybody is as enthusiastic.

A patient is going to come in not feeling very well, and they’re going to need to leave with a remedy of some sort, whether that’s a medication, some sort of an intervention, like physical therapy, a surgical intervention, and some sort of a plan. Nothing really changes about that per se. But then there’s all that stuff in the middle, like the paperwork, the decision-making, which can be improved by GenAI.

We don’t have any more answers than anyone else. When I talk to people in private, they all say basically the same thing. We’re all in the same boat, and we’re all figuring it out at the same rate. When I listen to experts and podcasts, people have a lot fancier answers, but to be honest, we’re just about where every other organization is.

JK: Many organizations are touting sustainability. As the Chief Strategy Officer, are you involved in initiatives around sustainability?

DL: Since all of our facilities, plant management, and construction rolls up to me, I’m very involved in sustainability. This year, we did a project that reduces our carbon footprint by 30 percent. On our main medical campus, we installed a microgrid that adds resiliency to our power plant. If the grid goes down, most hospitals in the country will kick on their emergency generators, and those generators will produce around 30 percent of the power that they normally consume. So, OR lights will stay on, your ventilators and life safety stuff, will keep going. but otherwise 70 percent of your stuff has to be diverted to other processes. With the implementation of this microgrid, we are able to keep going at 100 percent at all times. And that’s through our own power generation, through a combination of solar energy, combined heat and power.

The solar obviously helps reduce our carbon footprint. Our combined heat and power, that is through on-site generation of electricity using more conventional methods. But we take the heat off that results from the power generation and pump it into the buildings, and that provides our heat. It also provides air conditioning, believe it or not, through a contraption called an absorption chiller. All those things reduces our carbon footprint by 30 percent compared to pre-project, and we also don’t lose any outlets during a grid failure.

JK: Dave, if you hadn’t become an IT leader and then a chief strategy officer, what other career do you think you were cut out for?

The subject of this installment of “C-suite Conversations” is none other than Mikki Clancy, Chief Digital Officer at Premier Health. Mikki first joined Premier Health, the largest comprehensive health care system in Southwest Ohio, in 1994 as an IT auditor and she rose to CIO in just eight years. Premier Health has three hospitals, numerous affiliate organizations and 13,800 employees in over 100 locations.

Key Takeaways

• More CDIOs will come from operations or strategy backgrounds rather than traditional IT paths. Health systems should prepare to consider candidates with operational expertise who understand technology, rather than requiring extensive technical experience first and operational knowledge second.
• A big part of a strategy to retain top IT talent is making sure that they know when their workday starts and ends. Contrary to what many people think, remote employees tend to work more than they should, which can lead to burnout.
• To start gaining experience in operations and prove you can work outside of IT, work with the CEO to get placed on interesting projects, take on new duties and learn things you won’t learn as CIO.

Q & A with Mikki

Judy Kirby: When did you realize that a technology leadership career was of interest to you, and why?

JK: After many years with Premier you were promoted to CIO, then COO of your health system’s flagship hospital, and now CDIO. Can you please talk about these transitions?

MC: I was promoted to CIO very early in my career, as a young 30-something. Some of that was circumstance and some of that was the fact that I had run the Y2K project for Premier. When I left that function, I had the choice of continuing as a director of audit, becoming an information security officer, or moving over to applications. I chose applications because I wanted to do more.

About 18 months later, our CIO had to leave for medical reasons and Premier said to me, “We’d like to take a risk and a chance on you. We think you have what it takes to be a CIO.” I’d never really been through all the processes, but I’m pretty good on my feet and I researched a lot and built teams that helped me be successful.

After about 12 years, I thought maybe I could help our operations folks to use the technology better and was looking into a VP of Operations type role. But instead, they made me COO of Miami Valley Hospital, our largest hospital. I learned all the things that I didn’t know about how people use our technology, how they work around our technology, how they adopt it. It taught me a great deal about operational change management to drive KPIs, outcomes, expense savings and revenue generation from a point of view I never had as a CIO.

JK: Many individuals don’t have a CEO willing to take a chance and put them into a COO role. How would you recommend they get some of those experiences?

MC: That doesn’t happen very often. I knew about seven years earlier that I needed to start getting experiences to prove I was more than a technician. I worked with my CEO at the time to get placed on certain projects to gain experience and prove that I could manage operations and work with physicians. So I took on additional duties and started learning about things I wasn’t doing as the CIO.

JK: What were some of these projects?

MC: The very first one was as project manager for our strategic planning cycle, working with the chief strategy officer directly. I worked inside the hospitals on how we piece the strategy together. It forced dialogue about the strategic operations of Premier, and gave me exposure and the opportunity to develop relationships.

I also was given several tactical projects for which I was asked to orchestrate both the technology and the operations. I did work with our PACS environment and on the facility master plan, looking not just at what we needed infrastructurally, but also strategically. Where should facilities be placed in our region to drive access? Those opportunities really flipped the lens for me.

A lot of people thought it was nuts to make me a COO rather than start with a VP level operations role. But my managers did a fabulous job of paving the way by saying to the team, “We would like to think about our operations differently. We think technology is going to be an underlying strategic lever for a very, very long time. Having someone with Mikki’s background will help drive operational improvement.”

JK: Tell me about your current role as CDIO and what that covers.

My CDIO role is a blend of operations and technology. I hold the transformation office, which leads all of the performance improvement and all of our transformation work, digital and otherwise. Then I have the traditional IT division, and I have product leadership, which is a combination of technology and operations teams, whether it’s in our continuum of care or in our integrated delivery system, whether it’s the lab or home health, the hospital setting proper, revenue cycle, or back office.

In this digital technology CDIO role, I’m flipping the lens to what the patient needs. What does the caregiver need? Are we meeting them where they are? A lot of technologists are just saying, “Gotta put in AI to be more efficient.” But I actually believe it’s about meeting the caregiver and the patient where they are, which for us is not always going to be just a technology solution. Some of those are going to be personal solutions because healthcare is still very individual.

The CDIO is accountable for driving operational metrics change through the enablement of technology. So, it isn’t just about running the technology; it’s about operational change management. It’s about outcomes-driven activity that improves some portion of our environment, whether it’s new patient volume or creating a new work environment for our registrars so that they can work remotely.

You still need a CTO with the expertise to drive the architecture of the ecosphere, which is different than driving the operational outcomes.

JK: Looking out over the next three to five years, how do you see the CDIO role changing. What might some new responsibilities be?

MC: The CDIO role is going to become more blended with the strategic arm of the organization. Digital innovation can become a revenue stream as some larger organizations have already shown. I also think the CDIO is going to become a thought leader at the table more than a tactician.

They will have a lot more responsibility for data governance, data management, and analytics because that will drive the artificial intelligence capabilities of the organization. But they will always have accountability for technology rationalization. I think that will always be a part of this role.

JK: What about emerging new job qualifications for the CDIO role?

MC: I think operations is a qualification that hasn’t traditionally been in the requirements of this job. But I do believe that CDIOs will be more likely to come from either a strategy background or an operations background, with technology experience. It will become more blended. And to be effective, CDIOs will rely more on their relationships with the operations and strategy teams.

JK: One of the big concerns I hear over and over again is the lack of up-and-coming IT leadership interested to fill future healthcare CIO or CDIO positions. What are your thoughts about this void and the growing number of people who say, “I don’t want to move up. I want to stay where I am”?

MC: That is a challenge right now. We’re spending a lot of time on succession. I think that more risks need to be taken in the technology organization. Traditionally, you want to see 10 to 15 years of experience before you move someone up into these C level roles. I think health care systems will have to start considering candidates with five to 10 years of experience, and I think many are going to come from an operational background where they’ve become educated enough on technology to be able to ask the right questions.

Reliance on the CTO role is going to become greater as we go forward because of the strategic value that the CDIO role holds. And unless you’re a really profitable organization, to have three or four chiefs is not sustainable. Chief data officer, information officer, technology, security – that becomes quite costly, I think we will see more combined roles.

There’s a lot of churn in the market right now in these roles. I get contacted all the time by recruiters asking me to interview for open positions. When I talk to people in my own organization about their career aspirations, I am not hearing from many that they want to become a CIO or CDIO. Successful succession planning has to include selling the value of being in these roles.

JK: I agree. Hopefully there are enough rising professionals interested in becoming a healthcare CIO or CDIO. What career advice do you have for them?

MC: The advice I usually give is to continue to learn and enjoy learning, because in this kind of role, you are going to do so many different things hour-to-hour, day-to-day, month-to-month, and year-to-year. If you don’t figure out how to learn constantly and quickly, it will become overwhelming.

I also coach people that they control their “yes” and their “no” just like they control their calendar. If you let everything be a “yes” or everything be a “no” or do whatever your calendar says you are supposed to be doing, you’ll get overwhelmed.

If you look at my calendar on any given day, I have invitations to four or five meetings at the same time. I have to make a choice. I can’t be in all of them at once and they can’t wait for me to sequentially map it out. So, you must learn to delegate a lot and spend a lot of time building your team.

JK: Recruiting and retaining top talent has long been a challenge in IT, even before the pandemic. And now with hybrid and remote work in the mix, what is one of your most effective recruiting or retention strategies?

MC: We are 100 percent remote unless you choose not to be, or you work in a job that has to touch the machine. Close to 80 percent of my division is fully remote and it is changing how we do engagement. It is much more intentional than it was when we were all in the workplace, because you can no longer just casually walk by and talk to people and see how they’re doing and see what barriers are in their way.

The biggest thing that I have to work on for retention of my team is making sure that they know when they’re successful, and when their workday starts and ends. When they’re remote, they tend to work way more than they should. It’s not the opposite as some might think. I find that I have to get them to not be working all the time. That’s a major part of the retention strategy so they don’t burn out.

JK: Are you seeing results from these efforts?

For recruitment, being fully remote for those who choose it has helped tremendously, as has our focus on innovation. Over the last 18 months, we’ve gone from a 40 percent vacancy rate on my team down to seven percent.

We are also finding that onboarding and pre-onboarding strategies are critical in IT but also across the whole organization. For a while, we had high churn in the first 90 days of employment, and in the first two years of employment. But an intentional strategy of pre-boarding and onboarding in the recruitment process has helped us get people used to our large organization and who their teams are.

JK: Can you talk more about how succession planning is handled in your organization and the approach you’ve taken?

MC: We have been doing a lot of work to identify what the successful traits are for various positions. We spend a lot of time with our current teams, figuring out what they want to do for their next career progression. Then the employee is accountable for creating their development plan, but it’s the manager’s responsibility to help make the development plan work.

JK: On the subject of generative AI, what is your company’s strategy and what type of work are you leading to plan, evaluate, educate, or implement new AI capabilities?

MC: I can’t go to any meeting where someone isn’t asking about AI in the first five minutes. We are taking an approach that is different than what we’ve done with most other technologies. We have put in governance for AI, and the governance is not about saying “No” – it’s about how we do this safely with high quality and put in the right risk mitigations. We’ve had to spend a lot of time with our workforce. We’ve been out on a roadshow to management forums and to other communication mechanisms to help people understand that this is not about replacing our workforce with AI. This is about helping them work at a higher level.

We have been pretty cautious about what we’ve implemented, most of which has not been generative AI but machine learning or predictive modeling AI. We’re working on building large language models to be able to get to the generative AI. We are also leveraging what our core vendors are doing with AI and adopting that rather than trying to build it all ourselves. I don’t really have an AI work team. I do have an AI product manager who started recently.

We have a list of criteria: Is it going to bring clinical value? Is it going to bring business value? Are there any risks in legal, ethical, security, etc.? Is it aligned to organizational priorities? And, is the vendor viable? We’re not a development shop, we’re an integration shop.

JK: One thing that seems to keep everyone up at night right now is cybersecurity. How are you handling the increasing threats?

MC: We have had to double- and triple-down on access controls in our environment, on geo-fencing, on network segmentation, monitoring and endpoint protection. All those are investments and people and technologies and resources that distract us from our mission of delivering high-quality care to our community and inspiring better health. It’s become a good 20 or 25 percent of our focus.

Every new technology has to go through a security review to manage the third-party risk alone, because it’s not just what’s happening in your environment, you’re now accountable for what’s happening in somebody else’s environment.

JK: So, if you hadn’t become an IT leader, what other career do you think you were cut out for?

MC: I would have still been a leader of business somewhere. I like leading people. I like making a difference. I like demonstrating that you can lead with love and with kindness. I think I still would have done that, whether it was in technology or business.

JK: Somehow, I don’t put Marine Corps leadership training and love in the same sentence. How did you transition from Marine Corps leadership to love leadership?

MC: Actually, I think I led with love as a Marine Corps leader. I think the principles of leading with love is about caring for your people. And in the Marine Corps, we learn to take care of our people first. The leader eats last. The Marine Corps has been doing that for 245 years. It’s about making sure your teams have what they need to be successful. It’s making sure their voices are heard. It’s making sure that you’re considering their opinions when you can.

JK: Final question. Outside of work and spending time with friends and family, what’s something you love to do in your spare time?

For this edition of “C-suite Conversations” I had the honor of interviewing my long-time friend and industry colleague, Dr. John Glaser. John’s career in healthcare IT has been illustrative and impressive, to say the least. He is currently an Executive-in-Residence at Harvard Medical School. Previously, he served as CIO of Brigham and Women’s Hospital for over seven years, and CIO of Partners HealthCare for 15 years. He was also SVP of Population Health at Cerner and CEO of Siemens Health Services. John was the founding chair of the College of Healthcare Information Management Executives (CHIME), he is a past president of the Healthcare Information and Management Systems Society (HIMSS), and he has served on numerous boards. Read his full bio here.

Key Takeaways

• Establish clear accountability structures when creating multiple C-level technology positions – having numerous chief officers (CISO, CMIO, CDO) can create confusion about decision-making authority, especially during vendor issues or major initiatives.
• Prioritize core leadership skills over technical expertise when selecting technology leaders – this includes strategic thinking, communication abilities, and team-building capabilities.
• Focus on senior executive capabilities first and technical knowledge second when hiring technology leaders – seek candidates who can effectively move organizations forward, motivate teams, and maintain emotional stability while understanding the technology landscape.

Q & A with John

Judy Kirby: John, you are an icon in the healthcare technology profession. First, I want to thank you for all the contributions you have made to the industry over the years. You and I have known each other longer than either of us care to admit at this point. And we’ve witnessed a lot of changes – changes you have influenced. But first, how did you get into healthcare technology?

So, I went back to Durham and took the first job I was offered as a programmer analyst at Research Triangle Institute, which was doing a study of national medical care expenditures and quality. So, I randomly stumbled into healthcare by following my heart, and 50 years later I am still together with both the healthcare industry and the woman, Denise.

I thought healthcare was pretty darn cool but I didn’t really want to be a programmer for the rest of my life. My stepmother suggested I go and get a Ph.D. in medical informatics. So, Denise and I got married and went off to the University of Minnesota, where I spent four years getting overly educated in medical informatics, which led to becoming head of the healthcare IT consulting practice at Arthur D. Little.

JK: Years ago, you and I presented at CHIME on the evolution of the CIO. But today we see so many new titles. What are the major differences between the titles of chief data officer, chief digital information officer, and CIO? How do you feel about spreading technology across many different people?

JG: I became CIO at the Brigham and Women’s Hospital in 1988. At the time, the CIO job title was becoming common in other industries but not so much in healthcare. It was relatively new for the boards of healthcare systems and for CEOs. But IT has evolved a lot from a cost center to being viewed much more as a strategic asset. There’s no question on the part of leadership that there is strategic value in IT.

Now there are all these chief officer roles – chief information security officer, chief medical information officer, chief nursing officer. Now there’s a Chief AI officer. On the one hand, if you really want to attract talent, sometimes you have to put this fancy title on it. I get that. But I do think it runs the huge risk, and I actually wrote an article a couple of years ago about having too many chiefs.

With so many chiefs, the accountability becomes a little murky. If we have a Chief Medical Information Officer, CIO, and a Chief Analytics Officer, and there is a major issue with a vendor, who deals with that? Who’s fundamentally accountable for certain relationships? So, I think it’s okay to have chiefs, but you better be sure you keep the accountability structure clear about who gets to make what decisions.

JK: I would agree with you. Something I have seen recently is the top IT person is now titled Chief Technology Officer. It’s gone from the CTO reporting to the CIO to the CTO being the top IT role.

JG: Chief Information Officer is a little fuzzy. What are you in charge of, information? How does that work? Information is everywhere. The traditional role of CTO was the tech wizard. They made sure that the architecture was solid, that the interoperability was as good as it could be, and that things were secure. So, if one views it as a technical role, and that the top person should be a technical person, that could be a mistake because it’s broader than that. They’re functioning as a change leader, strategist and business expert.

Call them whatever you want, but you have to be careful with how it is perceived externally and internally. You run the risk of confusing the rest of the organization, and you run the risk that, as you’re trying to attract talent, they will read certain things into the title that you don’t intend. Make it clear what the role does, and be sure the actual title doesn’t demean, diminish, or narrow the perception of the job.

JK: Whatever the title, how do you see the top IT officer role evolving over the next three to five years? What might some new responsibilities or job qualifications be?

JG: In a way, Judy, the qualifications and the skills are the same ones that you and I were talking about 20 years ago. You want someone who has good strategic instincts. You want someone who communicates well with the clinical leaders. You want someone who builds great teams and motivates them to do amazing things. You want somebody who’s got an astute read of the technology and is not overwhelmed by fatuous sayings. All of that is the same. You have to know new things that you didn’t have to know about before, like AI and value-based care, but the human skills needed are generally the same.

I do think that the bar continues to get raised. So, if you got an A grade as a CIO 10 years ago, today you’re going to get a B. The bar is raised in terms of the skill and the prowess. It’s just harder, it is more demanding, it requires that you communicate more effectively than you did before. It requires that you have a better performing team than you did before. Things that need to get done are more significant, more strategically critical, and frankly, you’re more resource constrained. You have to operate with less budget than you had before. So, in many ways the role is the same as before but it is much more demanding.

JK: I agree. The average turnover of healthcare CIOs has been somewhere between three and four years for a long time. Why such high turnover?

JG: I think it is not all that different from CEO or CFO turnover. I suspect a couple of things happen. One is that as a CIO, you can make a wrong call for which the results are more dramatic. You know, one bad implementation and “Adios.” One security breach and it can all be all over in a hurry. A CIO’s bad call is much more dramatic and obvious than when a CEO misses a call on strategy.

But nonetheless, people burn out. They think, “I’ve done what I wanted to do here, and as a careerist, I want to try something different.” They get kind of tired and stale at a level, particularly people who are ambitious and who want to climb ladders.

JK: One of the big concerns I hear repeatedly, and we see it in our search business, is the lack of up-and-coming IT leaders to fill future healthcare CIO positions. What are your thoughts around this void, and how do we fix it?

JG: We see that issue in multiple parts of our economy. For example, there’s a shortage of primary care providers. How do you persuade people to become primary care providers? Well there’s a lot of reasons why that’s hard, or they want to go off and make more money as a specialist, etc.

I don’t know what we do here. You have to tap into the people who want to be in IT and healthcare because it’s interesting. It’s got some significant challenges, and many people want to do good in the world. They want their lives to have meaning and help people who are sick or dying or going through tough times health-wise. This is largely a nonprofit industry so you are competing with the golden riches of stock options, which may or may not happen, but they’re still enticing.

Healthcare has some things going for it, but still, you have to reach a 22-year-old who’s in college or someone who’s 25 and maybe doing banking and IT stuff. Once you get them in, you can see who wants to climb the management ladder, who is good at it, and who thrives on it. You ask a good question. I don’t know what the answer is.

JK: Looking back at your own journey, what career advice do you have for rising healthcare technology professionals interested in becoming a CIO one day?

JG: You have to decide that you really like leadership and management and that you enjoy motivating people. It’s very paternal because the victories are in what they do, not what you do. It’s like watching your kids do great things. I like running things, and I like the paternal feeling, and I like helping people go left versus right.

The other advice is to seek out role models. I remember going to medical informatics conferences when I was in graduate school and seeing a panel up there with all the legends of the field: Clem McDonald, Octo Barnett, the first pioneers of medical informatics, and thinking, “Wow, they’re really smart, and some of them are really funny, and they’re really competent. I want to be like them.” It’s fine to let them know it, to go up to them and say, I admire and respect you. Would you talk to me from time to time?” People warm up to that.

JK: Great advice! Anything else?

If you hit a ceiling, try another organization. I also think it’s fair to take reasonable risks. Don’t bet the farm and don’t bet your life savings, but it’s okay to try things that you’re not sure you can do and that you might screw up. In the grand scheme of things, if you get fired, no big deal. People survive that, and it is nothing compared to other calamities like having a sick kid.

JK: Where do you see generative AI having the most impact in healthcare over the next three to five years?

JG: I don’t know. I had an interesting conversation with some Scottsdale Institute CEOs from large health systems a couple of weeks ago about where they are with GenAI. They’re all experimenting with it at various levels – ambient listening, where the computer creates notes, some revenue cycle coding. But I wouldn’t characterize these as transformative.

I think what’s needed now is a set of ideas on the table which really could change the game, and we’ll have to see whether those play. So, I’ll give you an example. I sit on the board of National Committee for Quality Assurance (NCQA). I’m the incoming chairman of the board, and as you know, they do Healthcare Effectiveness Data and Information Set (HEDIS) measures, the methodology by which to measure various aspects of care. Well, how does that methodology work? They convene a room full of blue-ribbon clinicians, and they feed them lots of articles, and they arm wrestle, and several weeks later out comes an answer. An example answer might be the best way to measure the quality of prenatal care. It’s a process that works but it’s slow and it’s expensive to do this way. How about we have GenAI scan the literature and offer up a draft, then the committee debate the draft? Wow, that’s different. You might do that in minutes versus weeks.

As another example, of AI (although AI that is deep learning) a health plan can go through a range of diseases, and we believe that for every 100 subscribers, roughly one third will get vaccinated. We don’t have to do anything, they just will. And another third, they’re not going to get it for whatever reason no matter what we do. It’s the middle third, the persuadable ones who, if we play it the right way, will tilt. The question is, who are they? So, using algorithms to identify and target that one third would be much more precise and personalized. We see this already in retail. It’s unbelievable. My kid, the middle kid, is the VP of Consumer Analytics for a large department store chain and they are really all over this stuff.

I think we’ll also use AI to personalize care perhaps to identify treatments that are more effective than others.

I think one of the other things to remember is – how long has the internet been around? I mean commercially. Google was founded in 1998, that’s 26 years. On one hand, we have seen an amazing range of uses in a very short period of time. On the other hand, the web is still evolving in our lives.

So, you can look for ideas that are three to five years out but I think the question is also how will AI affect society for decades. There is this rolling horizon of new things coming that will never stop. Even 20 years from now, we’ll always discover new ways to leverage the technology.

JK: What advice would you give to CEOs about hiring their next technology leader?

JG: I think it’s the same advice I would give them if they’re hiring their next CFO, or their next chief medical officer, or their next chief human resources officer. You need a senior executive who functions and acts like a senior executive. They’re smart, they’re articulate, they communicate. They have an emotional even keel, and they know how to pull together teams. You want someone who’s skilled at moving an organization and motivating people, but you also want them to possess a knowledge base. With the CFO, you want that person to understand the ways you can borrow money. With the chief medical officer, you want someone conversant with, for example, GLP-1s, and the issues confronting the medical staff. You want the same in your CIO – someone who understands the technology and can sit with you and have a conversation. When you ask a candidate what they think about GenAI, you better get a pretty articulate answer, that you can relate to and understand.

JK: Right. If you hadn’t become an IT leader, what other career do you think you were cut out for?

I like the fact that technology can enable you to do things which are really impressive. I remember CPOE (Computer Provider Order Entry) back in the day and how it significantly reduced medication errors at the Brigham. That was really cool! That’s why we’re here. So, for someone like me who likes leading people, likes the world to have meaning, likes writing, likes teaching, and likes the power of ideas, what other roles are there? I wouldn’t be a professional basketball player. I’m not sure I’d want to be a lawyer, or a doctor. I would be something in the general management realm, although maybe not as much IT. We’ll just have to see, although my career is largely winding down at this point.

JK: So outside of work and spending time with friends and family, what’s something you love to do when you have time?

St. Luke’s University Health Network is a fully integrated, regional, non-profit network of more than 20,000 employees providing services at 15 campuses and 300+ outpatient sites in Pennsylvania and New Jersey.

Chad’s passion for IT at an early age led him to a short career progression from tech support to a 21-year career as a CIO.

Key Takeaways

• When evaluating AI and other initiatives, use evaluation tools that compare level of lift to expected value – this helped his organization narrow 150 initiatives down to about 15 priority projects.
• Consolidate technology governance under one leader to avoid duplication – as Chad notes, allowing “federated technology decision-making” leads to duplicate purchases and complexity.
• Build internship programs with multiple universities (13 in Chad’s case) and place interns in departments with anticipated future job openings – over 50% of their interns go on to take full-time positions at the organization.

Q & A with Chad

Judy Kirby: How did your career in healthcare technology leadership begin

JK: Your career rise from tech support to CIO was relatively short. Can you talk about that progression and how you advanced in such a short amount of time?

CB: I think I just loved it so much that it wasn’t work for me. I was young and ambitious, I didn’t mind working late, and always wanted to take on more projects. I was constantly asking what else I could do, and what projects people had that I could help with. I guess people thought I did a good job with them, which kept accelerating my career.

After working as a technologist in several different domains – engineer, programmer, etc. – I moved into project management and got into healthcare. I was helping open up a large ambulatory center and was project manager for a $110 million project. I was still fairly young and I was enjoying it. After being promoted to manager, I worked on a bunch of projects with some of our C-suite in different departments – PACS projects and stuff like that. These gave me the chance to work with our VPs and COOs, and when the CIO position job opened up, I applied and got it. Now it’s been 20 or 21 years as a CIO.

JK: Wow, that is very impressive! Did you have a mentor who helped you move your career forward?

CB: I have had multiple mentors, especially if you count my parents. My dad was a construction business owner, and he was always a mentor to me. But the reason I got started in healthcare was because of my mom. She was a nurse, and she would always talk about all the technology they were using, and thought I could really help out and have a career in healthcare. But when I reached director level, I realized that I needed to branch out beyond my parents. I met mentors both inside and outside the organization working at levels above me, always in technology, who I trust and respect.

I have really learned a tremendous amount from all of them. When I stumble upon an issue or a situation, I might bounce it off one or two of them for their perspective or advice. That’s how I have always done it. I’m always doing something new at St. Luke’s, and I think one of the key things about leadership is being able to learn new things, especially by seeking advice from others who have been successful in similar situations.

JK: So you’ve had CIO experiences in a couple of organizations over 20 years now. How do you see the role of the healthcare CIO evolving over the next three to five years?

CB: It is going to be interesting because of the acceleration of technology. We’re seeing AI hit the ground pretty hard and there’s a lot of opportunity, but there’s also a lot of noise. It is important to be a strong communicator, and knowing how to handle the hype cycle.

When it comes to innovation, probably 60 to 70 percent of it is noise, and the rest is real tangible work that will produce solid outcomes for your business if you put a lot of effort into it. And that is what I think CIOs need to do is latch onto those things that are going to have real ROI, and to get rid of the things that are just noise, clogging up your IT resources.

JK: As CIO, how do you help people separate the signal from the noise?

CB: We have tools we use to look at the level of lift required compared to the expected value. We have used this tool in multiple areas but we’re doing this right now for the AI portfolio, in particular. It’s an ongoing process to bring an idea in, evaluate it, do a quick analysis on it, figure out where it fits, and then decide what to do. We have had as many as 150 different initiatives on the list, and we’ve already executed on about 36, but we’ve refined it down to about 15.

JK: How do you deal with a situation where someone is really passionate about an initiative, but the ROI just isn’t there? How do you handle that?

CB: You have the leaders be part of the process. It has to become a group effort. A lot of these types of projects come up through the specialties like oncology, cardiology, and radiology. It’s a discussion with the organization, including the leadership, to clearly say “Here is what we’re going to focus in on. This is what we’re going to commit to, and this is the number of initiatives we’re going to commit to this year,” and getting the organization to buy into that. Then it’s just a discussion on which ones are going to be selected.

JK: You have had a lot of success with innovation. What have been some of your biggest wins in that area, Chad?

CB: We created an innovation fund in 2015 and it has been one of the biggest wins that we’ve had. It has had a definite financial return that is easy to measure. We have about $50 million in that fund, and we’ve produced solid market returns in the low double digits. It’s very easy to report. You have some winners and you have some losers. You have some really big winners, and you have some small losers, hopefully, and some companies in between.

We also benefit from what we call “strategic project value.” We might have 10 companies in the fund, and we might execute two or three really big transformational projects inside of that, which generate returns in the form of high ROI, but also when we sell the company.

JK: Can you share what some of those projects have been?

CB: The projects that have the highest ROI in healthcare tend to be in the revenue cycle areas. Anything around case management, denial management, clinical query systems, and what we are getting paid on inpatient cases.

A big transformational area for clinical would be the integration with our scheduling platform. We originally built this with a third-party vendor back in 2016 or 2017, and when we integrated it with scheduling, it was a game changer for our physicians. It was an enterprise-wide communication system for who is on call and where people are. In a big organization like ours, it is very complicated to know all that information. We moved it over to Epic about four months ago and every day we have around 18,000 users on that system. It’s huge and it’s highly utilized, and now that it is integrated with the clinical schedule, it provides a lot of value.

JK: There is a lot of talk about the CIO position and what it should be titled. Should it be called the chief digital officer? CDIO? CHIO? What are your thoughts?

CB: I have been wondering the same thing, Judy. In my organization, my title is CIO and other domains like informatics, the technology organization, security, innovation, all report up to me. When organizations start hiring a lot more C levels reporting to different people in the organization, I think the governance around that creates complexity and duplication. I’m not sure it really matters what the top person’s title is, but in my opinion, you should have all your technology initiatives in a cohesive integrated strategy underneath one leader.

JK: That makes a huge difference. At some healthcare organizations we have seen the IT department go out and buy something, and then another department goes out and buys the same thing.

CB: That’s what happens. Do you think Apple or Tesla allows that to happen? No. But in healthcare, for some reason, we’re allowing all this duplication and federated technology decision-making. It’s not good.

JK: Why is that?

CB: I think the problem is that some of these organizations don’t operate as a single entity because they’re in different markets, and they might not be able to share resources to the same extent that we can. I definitely think geography plays a role in that. And culture too, especially after a merger. Which organization prevails on clinical decisions and order sets and workflows? That can be complex when you have two large organizations coming together.

JK: With continued financial pressures on healthcare, and technology vendors raising their prices, how do you meet demand within your organization?

CB: We try to find technology projects with ROI high enough to pay for the other technology projects. It’s like the healthcare business. Some of your business units aren’t going to make money but others will, and those subsidize the ones that don’t make money. The same thing goes with technology. We’re looking for projects that can generate enough ROI to offset the costs for other projects we need to do in our portfolio.

JK: Succession planning is the responsibility of all senior leaders. Can you talk a little bit about the status of your succession plan and the approach you’ve taken?

CB: We have formal succession planning in our organization. We identify potential successors and we work with them on their development plans. I have several folks that are potential successors for me and I meet with them frequently. I just gave one of them one of the first CIO books that I ever read, “The New CIO Leader – Setting the Agenda and Delivering Results” by Marianne Broadbent and Ellen S. Kitzis.

JK: You mentioned AI earlier. How is generative AI impacting your organization or your company’s strategy? And what type of work are you leading to plan, evaluate, or implement generative AI?

CB: We’ve done a lot of work in the area of predictive analytics or predictive AI, which is the precursor to generative AI. GenAI has only been market-ready for a year or so. We have a few projects that we’ve been piloting with a low number of users – 300 or less. One of them is ambient documentation, another one is the revenue cycle using Microsoft Copilot. So we have some of those projects lined up over the coming months. In the clinical area, we’re okay having Epic do chart summarization and other things, but we definitely are ensuring that we have a clinician in between and analyzing the interface of that system before it gets scaled. So, we are cautiously optimistic but we’re pacing ourselves, and focusing more in the back office instead of the front office on GenAI projects.

JK: Recruiting and retaining top talent has been a challenge in IT even before the pandemic. What is one of your most effective recruiting or retention strategies?

CB: The hardest roles to hire now are in data science and AI, and high-end developers. I think we’ve been fairly good and consistent. Our turnover has been steady at about 4 percent in IT, which is relatively low. I think that it’s due to our culture, to be honest. We’re a very flexible and team-oriented culture. We onboard people quickly into our teams and the teams are good at making feel like they are part of the family.

A lot of our talent has come from the consulting world. We’ll have a consultant working with us and they’re like, “Hey, I really love your team and your organization. I want to come work for you full time.” We’ve had a lot of that over the years.

In addition, we have a large internship program, working with 13 different colleges and universities. This past year we had 22 or 23 IT interns, including eight in cybersecurity. Some students will intern with us for three or four years, starting when they are freshmen.

We like it when they come from the local area because they’ll be more likely to stay. Their families are here and they want to stay in the area. We select them based on the specialties where we want to grow. It’s been very successful.

JK: Of the interns, what percentage of them end up staying?

CB: We’re north of 50 percent of our interns who get a full time job and stay with us.

JK: Oh, that’s amazing.

CB: We don’t always have a position open for every one of them, but we try to. That’s why we position them in areas in which we know we will have open jobs in the future.

JK: If you hadn’t become an IT leader, what other career do you think you were cut out for?

CB: I don’t really know. I have the CIO job, but I’m also responsible for other operating areas: cardiology, radiology, and supply chain. So, it would definitely in leadership. I enjoy working with people and developing people. If I hadn’t become a healthcare CIO, I’d probably have my own company, or two or three or four. Who knows?

JK: Outside of work and spending time with friends and family, what’s something that you love to do when you have the time?

CB: My son is going off to college, so the last kid will be out of the house and I will have more free time. My top priority is probably hunting. I love that the most. But hunting season is only a couple of months a year. My second priority is golf. I used to play a lot before my kids were born. So now I’m getting back into golf and playing a little more. And then my third thing is fishing.

JK: What’s your golf handicap?

CB: It’s an 18 right now, which is not good. But I used to carry a single digit handicap. So my goal is to play some more golf and get it back down.

Since leaving the Navy, Rick Roche has spent his entire career in healthcare human resources. Currently, Rick serves as Chief People Officer at Grady Health System in Atlanta.

Grady Health System in Atlanta, Georgia, is a premier public healthcare provider, renowned for its world-class trauma, stroke, and burn care. Anchored by Grady Memorial Hospital, one of the largest hospitals in the U.S., Grady delivers exceptional emergency, outpatient, and specialty services. Partnered with Emory and Morehouse Schools of Medicine, Grady is a leader in medical education and research, dedicated to transforming lives and providing top-tier care to Atlanta’s diverse community.

Key takeaways

• The best healthcare CHROs do things very differently and they distinguish how they view the HR function. They act as impartial consultants and trusted advisors to other C-suite executives.
• Having a new senior leader come in from outside the organization can be disruptive, so Grady’s succession plan focuses on developing its most talented people and preparing them to fill future C-suite vacancies.
• Gen Z has a totally different perspective, but their perspective is correct. You have to accept that there are different ways of doing things and meet them halfway.

Q & A with Rick

Judy Kirby: Rick, you have had a long and impressive career in healthcare HR. You have led HR for Children’s Hospital Medical Center in Cincinnati, University Health Care System in Augusta, Georgia, Memorial University Medical Center in Savannah, The Health Care District of Palm Beach County, and the University of Miami Health System. You have been here at Grady as Chief People Officer since 2020. How did your career in this industry get started?

So, I borrowed a sport coat and went on the interview at Shriners Hospitals for Children in Cincinnati, which was a burn facility. Before I started the interview, I asked for a tour because I had never been around burnt children, and I knew couldn’t work there if it made me uncomfortable. I also just wanted to have a look around this very opulent looking hospital. I’d never seen anything like it.

On the tour I was able to goof around with the children quite a bit and when I went back down to HR they said, “When can you start?” I said, “Oh, you must not have got the note from Dr. Donnelly. This was really meant as a practice interview for me. I just started as an undergrad. But they said, “We know, but here we care about people who care about our patients.”

I was taking 24 hours of classes at the time but they told me I could come and go as I pleased throughout the day. They didn’t call it flexible scheduling back then. So, I worked about 30 hours a week in HR and 24 hours on the weekends in housekeeping there at Shriners.

After I graduated I got promoted to Director of HR at Shriners in Boston and I’ve been in HR in some form ever since. So, it was Irish luck that got me into it and kept me here.

JK: What an interesting story! So, you’ve seen a lot of changes in the industry over the course of your career. How do you think the CHRO role will evolve over the next three to five years, and how do you see the responsibilities changing?

RR: As a discipline I think that we’re probably not quick enough presenting change to our organizations. In HR, historically, the people are really good at service and really good at HR, but we haven’t been great at advising on what the future looks like, particularly as it applies to people. I think that’s going to be more prominent in the future. HR has to be able to provide a point of view on where the business is heading and how it can be best managed from the people side.

The COVID pandemic is a great example. For the most part, in HR, we managed a very difficult situation really well and gave good advice to our fellow leaders. But we should have been talking about remote work and hybrid working three to five years prior to the pandemic. I think that that’s going to be our role as HR leaders, really helping our organizations adapt. We have to see the future better and adapt to changing environments more quickly.

JK: I saw an article recently about how a lot of organizations are firing their Gen Z staff because they can’t adapt well to the culture. What is the experience with Gen Z at Grady?

RR: I think you have to have leadership courage, and above all, you have to hire the right people. Gen Z has a totally different perspective. And that is not a criticism at all. Their perspective is correct, it’s just different. But we have to meet them halfway, and really educate people about our culture, and acclimate them to it. You can’t force it. You can’t force someone who’s been working remotely 100 percent into working on-site 100 percent. You have to accept that there are different ways of doing things, which brings me back to my previous point: HR needs to be ahead on this rather than reactive. We need to be working on what’s going to be happening in a year, in two years, and three years from now.

JK: Looking back on your own journey, what career advice do you have for rising HR professionals interested in becoming a CHRO one day?

RR: The CHROs I have admired did things very differently, and they distinguished how they view HR. The opportunity they gave me at Shriners is an example. Allowing flexible scheduling was very unique at the time, and they didn’t even use the term culture yet. But that HR leader distinguished how she applied HR philosophy to the organization.

The best HR professionals I have been around do things differently. They don’t look at just compensation or benefits, or recruitment. They don’t look at the functions of HR independently. They have a broad philosophy. In healthcare, we’re guilty of doing everything the same way. All the hospitals in the country have almost the same benefits and almost the same compensation structure. We don’t distinguish ourselves as an industry or as a hospital, or as an entity. But the best CHROs think about it differently and distinguish their HR functions from their competitors.

JK: Have you been able to do that at Grady?

RR: I believe so, yes.

JK: Can you give an example?

RR: One example is that we eliminated HR policies. We went from 600 policies written by attorneys telling our employees how we don’t trust them and how many ways we could fire them, to 12 pages of guidelines that tell our employees how much we care about them and how much we trust them. We didn’t do that just to distinguish ourselves. It was a strategy specifically designed to change the work experience at Grady.

JK: What has been the outcome of that HR policy change?

RR: Three years ago our turnover was 40 percent. Healthcare norms right now are at 21 or 22 percent, I believe. Last year our turnover rate came in at 12 percent, and we’re a large, inner-city hospital in a challenging neighborhood. It is challenging to get here and we’re a safety net hospital, so we deal with a lot of mental health patients. It’s a challenging work experience. And having just 12 percent turnover during a time of growth – we’ve grown by 3,000 employees in the last 3 or 4 years – that’s certainly an indicator that the changes we have implemented are working.

JK: Are there any other examples of how you have done things differently?

RR: Yes, but I want to preface this by saying that I do not take any kind of pride or enjoyment in firing people. But in my first three years here we let about 1,200 people go. We did this during a pandemic and a staffing shortage. To provide some perspective, in the three years before I arrived, Grady let something like 60 to 70 people go.

We have a very simple premise: In order to work here, you have to demonstrate the ability to be an exceptional colleague and deliver exceptional service. And if you don’t possess both of those skills, we won’t hire you, and you can’t work here. Parting ways with those 1,200 employees over three years was a direct reflection of that philosophy. Our idea was that people who are not good colleagues or do not provide good service to our patients and their families, are not enhancing the work experience. If we replace them with people who are good at those two things, the patient experience and employee experience are going to be enhanced, evidently and obviously, and I think that has happened.

JK: How was it first perceived, though, by the organization?

RR: Not well. People may have thought I was crazy, and I don’t blame them. In healthcare, they weren’t accustomed to that. They saw it as radical and I think some still do. But at the time Grady was not viewed as a great place to work. To change that required drastic steps.

JK: Do you have any other career advice to share for HR leaders in healthcare?

RR: I have always thought it is important to conduct myself as a third-party consultant. Even when you’re deeply ingrained in the organization, I think that others leaders should see HR as an impartial, objective consultant to help them with their operation. HR has to be a trusted advisor to the other C-suite executives. If you can’t do that, it will be difficult to succeed as a CHRO.

JK: Succession planning is a responsibility of all senior executives. Can you talk a little about the status of your succession plan and the organizational approach you’ve taken?

RR: There is nothing more disruptive than having a senior leader come from outside the organization with a different approach to the work experience and how they deal with people. So, we have built a succession plan for our V-level roles.

The objective is very simple: give people an opportunity to develop into the next level to replace a C-suite person and give us the ability to promote our vice president-level people from within. With that in mind, we do a gap analysis. So, if there are five skills necessary to be a chief people officer, I do a gap analysis with my senior leaders and then help them fill in the gaps so that when I do leave, they are prepared to take my position.

No one is guaranteed they will get the job, but they’re in a good position for that. This succession planning approach lends itself to continuity and sustainability in an organization over time. People tend to stay longer at the director or vice president level if there’s an opportunity to grow into a C-suite position from within or be developed for that level role, even if it means eventually going elsewhere. It’s a good retention tool for talented people, and that’s become a significant part of my job.

JK: When interviewing candidates for a job in today’s healthcare enterprise, especially senior leadership roles, how do you test for these attributes – being a good colleague and delivering excellent service? Are there any questions you ask or scenarios you ask them to describe?

RR: Before we hire someone, we have to believe that they’re going to be an exceptional colleague, that they will walk in every day thinking of the success of the people they work with and the people that work for them. The skill set and experience are easier to find but it’s those two things that are most important for us. And we use some formal testing to assess that.

One interview question is that we ask candidates to describe the most interesting thing they’ve done for a colleague, or the thing that they’ve done for the employees that work for them that they’re most proud of. Their answer gives you insight into someone’s perspective. We hear amazing stories but we also get answers that are not impressive. It helps you ascertain whether a person has been in an environment that highly values being a great colleague or providing great service. We want people who have come from that, or at least to the extent we can assess it, to have it in them innately.

JK: You mentioned culture and change. How are you changing the culture at Grady to one that prioritizes being a great peer and providing great service?

RR: You have to literally build it into the infrastructure of your HR organization. We’ve built our philosophy into everything we do, from recruitment through retirement. So, we hire with those two things in mind. When we welcome people into our organization, those two things are reinforced constantly. Also, our performance appraisal is one page, and we assess only an individual’s ability to be an exceptional colleague and be exceptional at service. When I got here, the performance appraisal was 18 pages.

JK: Let’s talk a little bit about technology, starting with generative AI. How do you think GenAI will affect your organization over the next three to five years?

RR: If I had the answer to that, I might become a high-paid consultant. What I do know is that it is imperative for healthcare leaders – HR in particular – to become educated on AI and all of its implications, particularly with people. I’m not an AI expert, though I try to read as much as I can about it because AI is going to force us to change much quicker than we have historically. Healthcare tends to change more slowly.

JK: Do you think physicians will get on board with it?

RR: They’ll have no choice. A recent study showed that AI predicted or diagnosed a particular type of cancer 17 or 18 percent more accurately than physicians, and there are multiple studies like that. Physicians need to embrace that AI is just an additional tool to ply their craft and not take it personally.

JK: From your experience, what does a really strong partnership between the CHRO and the CIO look like in a healthcare organization?

RR: People and innovation are joined at the hip and they have to move in sync with each other. In HR we have to know what our technology capabilities are, what the talent market looks like, particularly in the younger demographics – the things they’re interested in, things they’re trained on, skills that we need in healthcare. HR has to be connected with the CIO. I’m happy to say I have a great rapport with our CIO here at Grady, and he’s an exceptional colleague and a leader in his field as well.

JK: Did you have a mentor during your career who really helped you?

RR: Actually, I had a boxing coach who was a bit of a mentor to me, and he told me one time that, “You learn something from everybody in the gym.” And he said, “Don’t admire the people, but admire their characteristics,” and that always resonated with me. I’ve met a lot of people along the way, leaders and non-leaders, and I think you can take a lesson or a characteristic from each one and try to apply that as best you can.

JK: What do you like to do in your free time?

RR: I am a pretty regimented person. I’m up usually up before 4:00 AM every day and I get a good workout in one way or another. And I have a dog named Marvin Hagler, named after the great middleweight champion, and I see my grandsons on the weekend. It’s a pretty simple life.

JK: What kind of dog is Marvin?

RR: He’s an Irish terrier.

JK: Sticking with that Irish theme?

RR: Yes. A bit stereotypical there.