Health Care Quality Improvement | Information Technology

By John Glaser	December 06, 2012
I am fortunate to have viewed this industry from different sides and with different perspectives. But as someone once said, just because everything is different doesn't mean anything has changed.

For more than 20 years I was a chief information officer at Partners HealthCare and one of its founders, the Brigham and Women's Hospital. Partners, and its member organizations, is one of the greatest academic health centers in the world and justifiably prides itself on the quality of its patient care, research, education and community service.

For the past two years I have been the CEO of Health Services at Siemens, leading its global health care information technology business. Siemens is one of the greatest companies in world, providing a range of products: trains, power plants and imaging modalities in addition to health care information technology. It, too, is justifiably proud of its products and services.

I have made the transition from a nonprofit organization to a for-profit organization ? from an organization that focuses its care delivery on patients in New England to a company that has a presence in 120 countries; from a health system that has an extraordinary academic core to a company that has an extraordinary engineering core; from an organization that has approximately 60,000 employees to a company that has approximately 360,000 employees.

My former CIO colleagues tease me about joining the "dark side." And they ask me if life on this side is materially different from life on the side of the care provider.

So, with the benefit of two years of dark side experience under my belt, I thought I would share some thoughts about what's different on the vendor side and what remains very much the same.

The More Things Change, the More They Stay the Same

Regardless of which side you sit on, the field and its challenges are still the same. As an industry, we are facing greater challenges in every dimension ? from reimbursement changes and shifts in the health care business model to preparing for ICD-10 compliance, multistage meaningful use achievement and evolving the electronic health record to support the accountable care movement. Indeed, I cannot recall a time in my career when there has been more on our collective plates than we are faced with today. And as the bar on a provider's performance keeps getting raised, so too does the bar on the vendor side.

It is clear that the aspiration to improve all that ails health care and the commitment to get it done is just as strong on the vendor side as it is on the provider side. Yes, a vendor has a profit motive, but people choose to join a health care vendor (versus other options available to them) because it shares the mission of its provider colleagues.

This shared belief in mission among both parties is what drives the industry forward, what leads to terrifically successful vendor-provider partnerships, and what fuels our continued collective dedication to sharing best practices, despite the fierce competitiveness that often exists within this industry.

On both sides of the industry, leadership is needed and the skills needed to be a good leader are the same.

It's time for all of us to step forward and exert as much leadership talent as possible, because our organizations are certainly going to need it. We used to talk in the CIO community about being more strategic and stepping up to the leadership table; that leadership is needed more than ever before. On the vendor side, the leadership standard has been raised, too; rapidly evolving market demands require enhanced product functionality as well as even more efficient and effective implementation services. We must give more substance to the term "solution."

On both sides the skills, experience and talents that make a leader a good leader are the same. Leaders must help their organizations see a path forward in highly uncertain times. Leaders must have the ability to inspire and mobilize others to get things done. They must actively engage in changing the organization. Once committed to the course, they must have the strength to thoughtfully stay the course. These leaders must ask hard questions about the systems and their implementation and whether value is being delivered. And these leaders must be pragmatic; they must be superb practitioners of the art of the possible.

On both sides it takes talented and committed senior leaders to inspire the troops to successfully execute the organization's plans. In fact, over the course of my career, I've come to appreciate just how much influence CEOs, CIOs and other members of the leadership team have on the tone, values and direction of an organization ? whether provider or vendor.

Finally, I've learned that skillfully navigating a matrixed organization and influencing a diverse group of colleagues is certainly a required competency in a large global corporation. But these same leadership attributes also were needed in my former academic health care environment. So, when I'm often asked, "How do you manage the organizational complexity of a huge, global company?" I simply respond, "Years of practice."

Yet, Some Things Are Different

Of course, part of what's different now is being exposed to a much broader, global perspective on health care. While it continues to be really interesting to appreciate the range of providers we have in the United States ? big, little, rural, academic, tightly integrated, loosely affiliated, ACO leaning or not ? and hence their range of needs, it's equally fascinating to see what's unfolding with health systems in Japan, Germany and China, for instance.

I've come to learn over the past two years that across the globe, the practice of health care is very local from market to market, culture to culture. Clearly, the payment systems are diverse. But often, equally diverse are the primary health care challenges faced by the country. For some it is access; for others it is cost; and for yet others, public health challenges are more important than medical care challenges. And you might think that the roles of the physician, nurse and pharmacist are the same across countries; but you would be wrong.

This diversity makes developing a global IT solution very difficult and at times impractical. As a vendor you must not only develop approaches to respond to the diversity of health care in the United States, but also the diversity across the globe; the diversity of the challenge of identifying IT solutions that address care needs is broader on the vendor side. How do you optimize a global product portfolio? What are the keys to success in emerging markets where the main barrier to entry is often a variety of cultural and legal mechanisms that favor local companies over global players? Ideal global markets tend to be those that are mature, sizable, have few technical or other barriers and consist of health care systems similar to those in the United States.

Another difference that exists on the vendor side is the often much crisper and leaner decision-making structure. Health systems generally have a consensus approach to making decisions. In the vendor world you would be wise if you ensured that you had sufficient political support for something significant that you want to do. But at the end of the day, as CEO, I get to decide; there is a strong emphasis on accountability.

Additionally, vendors have a much simpler way of measuring their performance. Order volume, gross margin, profit and customer satisfaction sit at the center of metrics that are used to judge success or failure. Nonprofit providers of care also judge themselves based on metrics: admissions, outpatient volume, margin and quality scores. But health systems have a more complex mission than a vendor. Because of this complexity, health systems often must undertake activities that cause them to lose money or for which the value proposition is expressed in terms of phrases such as "address the care needs of the underserved" or "train tomorrow's care providers." Judging the success or failure of a provider is much harder. That complexity of the mission of a provider makes the identification of priorities much more difficult.

If you join a vendor organization, you will find that your vocabulary changes. Sometimes you use different words to express the same idea. A provider might talk about "increase volume for the oncology service line," while a vendor might talk about "top line growth of orders for a product." Same idea ? different phrases.

While at Partners I don't think I ever used the word "customer"; now I use it routinely, and patient satisfaction has been replaced by customer satisfaction. Also, my daily acronym usage has shifted from common medical abbreviations like ICU, CABG and H&P to incorporate a host of "corporate-speak" acronyms like M&A, SG&A and EBITDA.

On a more serious note, perhaps one of the most potent differences I've felt on the vendor side is simply being one step removed from the reality of the care process. As a CIO, I was able to walk the floors, talk to the unit nurses and come face-to-face with patients who were benefiting from our IT efforts. In the provider setting, the reality of health care surrounded me all the time ? the good and the bad, the joy and the sorrow.

I no longer have those daily experiences, but I understand their importance. These experiences remind me of why I do what I do and the daily life of caregivers. One of the challenges of being a vendor is helping my staff develop an appreciation of the reality of delivering care and managing operational processes that surround care. All vendors would be better at what they do to the degree that their staff "feel" what it is like to take care of someone who is sick, scared and perhaps dying.

We All Play a Part

No matter which side of the industry you sit on, it's going to take all of our effort and hard work to ensure the health care improvement agenda we've embarked upon delivers the intended results. That care is safer and more efficient because the nation's providers are meaningfully using their investments in health care IT. That we are emphasizing outcomes over volume and keeping populations of patients healthy. And perhaps most importantly, that the country is tremendously better off 10 years from now because of the collective work we've done.

Two years ago, I left an organization I treasure, a job I loved and colleagues I care deeply about because I was ready for a change and desired professional growth and learning. I made the transition knowing we were in for a remarkable, tumultuous decade and an incredible amount of change. I arrived at my new place of employment with the same level of passion for this industry and the same depth of commitment to making health care better that I had as a CIO.

Yes, I've gone to the dark side, as they say. But oddly enough, once you arrive there, you find it looks very much like the side you left.

John Glaser, Ph.D., is the CEO of Siemens Health Services in Malvern, Pa. He is also a regular contributor to H&HN Daily.

The opinions expressed by authors do not necessarily reflect the policy of Health Forum Inc. or the American Hospital Association.

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