[MUSIC] Welcome I'd like to introduce Mr. Kumar Chatani, who is the Chief Information Officer here at Mount Sinai Health System. Welcome and thank you for joining us today. >> Thank you, Bruce, I'm glad to be here. >> Excellent, tell me how do you get to be the chief information officer of a large healthcare system? >> Very carefully. [LAUGH] Well, I think you have to have breadth of experience in different industries. You have to have experience in management consulting. You have to have experience in health care. You have to have experience in technology. And all that comes together through some alchemy and then they appoint you the CIO. >> So it's not a job for the faint of heart or the slim of resume. >> Well, you have to have tough skin and you have to be really nimble to be able to respond to anything. Every day when I come to work, I don't know what is going to hit me. I mean, the predictable is only 50% of my job. 50% is unpredictable. And I have to be able to deal with all that. It could be an employee who is in distress, it could be a leader who is asking for something which is not doable, it could be a vendor that is acting up, it could be a situation that hits you from of the press from outside. It could be a disaster like Sandy, anything can happen so you have to be ready, and in order to be ready you have to be prepare and the remaining 50% that is predictable is the preparation. And you gotta prepare. You gotta prepare your team, you gotta prepare you're system, you gotta prepare your business partners to be ready at all times. And you have to make this long term investments in disaster recovery and security and training your people in how to become high reliability organized. And when you do all that, when a disaster hits you, you are able to cope with it. And then, the last thing is, you have to be able to step away from it all. And look at things from a different perspective. Because people are on the treadmill and they are looking at what they have to see. But as a leader you got to step back and see what others are not seeing. And for you to be able to do that, you have to have a really strong leadership team. That is able to function without you. See and that's where the ego comes in where you will say I can build a strong team that can function without me. And when you do that and the team is operational and the team they don't need you in a crisis hit. That's when you step in and you help them out. So I think it's a really broad role. And to prepare leaders to be chief information officers. You have to prepare them for different aspects of that role. >> So I once heard a saying that the most important thing that you can have, the most important trait you can have for this kind of job is to have good judgement. And the only place to learn to have good judgement is by having bad judgement. How much of your journey to this position do you think was learned on the backs of whether be it your own mistakes or watching other people's mistakes? >> I have hundreds of scars on my back. And you learn through that. I must have done maybe 5 to 10,000 projects over my career. And many of them have gone south. But it's not the product that goes south. It's what you do with them when they go south and how do you get help from people. When you do that, you learn. And you learn along with your team. You learn along with your coaches, your disaster coaches or your bosses, sometimes you get fired, and that's okay too, because it happens. So, you gotta learn from all that, and, when you do that, you are building up your muscle, really, and your muscle memory becomes stronger, and then you can react to these kind of things intuitively, you don't have to think about them, you just know what to do. And when you go into a complex situation like we have here at Mount Sinai health system where we have a six billion dollar company you can't start at a six billion dollar company. You've gotta work in smaller organizations and work your way up so you're dealing with more and more complex situations. And that gives you the tools, sometimes it's dumb luck. Sometimes you hope for the best that nothing bad happens. But you have to be prepared. >> So obviously you have a lot of leadership responsibilities. And you have to lead within the organization, and within your team as well. Tell me, let's step back a little bit. I want to make sure I understand. Tell me a little bit about the responsibilities that you have and your team has. What are you on the hook for? >> So when you look at the CIOs role you have to cover everything that goes through the wire, everything. That means all the way from the infrastructure where you have a data center. You have your hardware. You have the network software. You have applications. You have analytically tools, you have data warehouse. You have to have end to end responsibility for all information that is needed by the organization. And you have to be forward looking. What you're supporting today is not going to be needed five years from now, it's going to change. So you have to realize that If you're not looking ahead at the new things that are coming your way, you will become an ex CIO real fast. So, think about, for example, what is happening in telemedicine, what is happening in digital medicine, what is happening in big data, what is happening in population health. I mean, these fields didn't exist five years ago. And if you're not keeping up with those things, then you can not move the organization forward. By the time your leaders and your people are asking you for something, and you haven't thought about it, it's too late. Because it takes long time to make these things work and then you fall behind. So you always got to be looking ahead. You're gotta push the organization and say, where is the puck going and where can I push them? How can I push them? And people will resist because they are so busy on it. They are running on the treadmill, right? You have a day job. But if you come and tell them there is a better way to do your day job, they don't have time because they're so busy. So you have to figure out how you disrupt their thinking, give them the new tools and let them absorb the tool. That's where chain management comes in, you have to be able to lead the organization into the future. And sometimes your leaders don't know where technology is going because you are the technology specialist, so you have to raise awareness. And you got to find the funding, and you got to make it work, and you hope it works because if you do all that and if it doesn't work, and that's a problem for the organization. So you got to take strategic bets on the right kind of investments and right areas, and emerging technologies are always five to ten years ahead of where the organization is. Now some companies like Google are on the cutting edge. But most health care organization are still on the trailing edge so you gotta to keep moving the organization forward. >> So it sounds like you're describing the information technology business structure of a healthcare organization as a strategic business partner. But historically IT has always been sort of a service provider. When did IT move from being a service provider to being a strategic business asset for organizations? >> It happened in the health care industry. It happened in the late 90's. When you went from having an MIS shop, which was management informations system shop, to information technology, you will wish to call the CIO as the director of MIS. And that started evolving to realize that IT is a strategic asset for the organization because healthcare Is becoming an information intensive business. So if you have an insurance business, what are you selling? Risk? Guarantee or true information? You don't have a product that you can touch, you're not manufacturing anything except that it's a promise delivered through technology. So if you are in the insurance business and if you don't have good IT systems, you will not be able to compete. So as once I have becomes an insurance company and we take on more and more risk and we will have over 750,000 members in our insurance business in 2017. So how do you support that? As to information technology. Now for that to happen you have to make investments in technology and when you do that people realize the value of IT and they pull you out of the back office and put you in the front to deal with these things. >> Now I know that as an IT leader in the organization you talked about change management and I have heard you in the past refer to four gate. When you're talking about this process of bringing a change into reality. Can you elaborate a little bit on that? >> Yeah, what happens is you have hundreds of competing requests coming in. At any given time I have about 200 requests, and I can execute on only maybe 50. How do you decide, right? And everybody wants something out of IT. How do you deliver? How do you prioritize? How do you align your projects and investments with the strategy of the organization? So, first and foremost, you have to look for a sponsor. If a project doesn't have a sponsor it probably won't happen because Ignore it. >> So gate one is the sponsorship? >> Gate one is the sponsorship. Then you go to say, does the sponsor have money? If you have a sponsor who has empty pockets the project probably won't happen. So that's gate two. Gate three is to say, well if the sponsor has the interest and the money but his people are not ready. The project won't go anywhere. So that's user readiness, that's gate number three. Are the users ready to absorb the change? Even if you have all the three lining up, if you don't have IT resources, you cannot execute. So that's the fourth gate. You have to have all four gates cleared for you to be able to say now I can work on this project. >> So in terms of leading change, the concept of business readiness is obviously one that's keeping success of a lot of the product. How much of that falls to the CIO and the IT team and how much of it Is the responsibility of the sponsors and the people who are looking to put the change in place? >> Now, the argument of state that you have to arrive at is where you can not distinguish between an IT sponsor and a business sponsor, and if you have a good partnership with the business leaders. You can not tell who is who. So having done IT for a long time people like me have done thousands of projects. Whereas the business leader may have done three IT projects. So it is for us in the IT organization to help the business leader understand the mechanics of change, the process, the steps you have to take. And then also understand what their users are saying because IT is everywhere, it's pervasive. We know every person in the organization, we know everything that is going on constantly because we are connected. So we have a way to find out which users are ready, which users will have difficulty, which users will have to be moved out of the project. So we have to give their feedback to the business sponsor and help them understand where the obstacles will be and how to overcome them. because we have a methodology, we have the experience and we have the connections. And all those things have to come together in such a way that, you don't make anyone feel inadequate when you are giving them that advice. But you have to work with them. And partner with them in such a way that they understand that's a precondition. And if the user is not ready, then you are not ready. For example, I was working at a company where we wanted to deploy an electronic medical record. We had the sponsorship. We had the money. The IT was ready. But the nurses said we won't be ready for two more years. So guess what happened? The whole project stopped for two years until the nurses were ready. because if your nurses are not ready, they don't know how to use a mouse pad. Then you have difficulty, right? So you have to bring your partners along sometimes you got to stop. And everybody when I was working in the organization, in the previous organization. And we had to stop because if you didn't stop you would have a disaster on your hand. >> One of the interesting things to consider when looking at the role of IT and healthcare delivery is the tremendous amount of heterogeneity. So, for example, if you go to a bank, any bank you go to is going to have an ATM machine. And it's going to accept whatever card you put. And it's going to pull from whatever account you have. And it's going to know if you pulled from an account across the street or across the world. Whereas in health care, we don't even have that level of homogeneity within a single hospital system a lot of the time. How do you bring performance? How do you lead? Through such heterogeneity. >> So IT is a sophisticated cottage industry. In a cottage industry the medieval townspeople built their own things. So we still have that. It'll probably take us another 20 to 50 years to be at the same level of sophistication as the banks and all the investment organizations, because we have so many standards or not, lack thereof in some cases. And we have so many stakeholders that haven't been brought together because of the way the payment system works. So, we don't have that standardization. And until that happens, you will have a loose configuration of systems that will somehow talk to each other are not in some cases. And as we develop the standards as the government helps us enforce meaningful use standards or we have health information technology standards. Then we will start converging, but it's a long ways off, we have made a lot of progress, at least internally within Mount Sinai for example. We have seven hospitals that we want to come on to a commonly integrated platform for electronic medical record, for our financial systems, for our billing systems, for our HR systems. So as we converge we will have seamlessness. And that reduces the friction cost in the organization. Earlier packs that you pay when you have disintegration or fragmentation of systems. And as you get integrated, as you get seamless, that tax is lowered because people are able to move back and forth within systems easily. So it'll take some time, the government is encouraging us to some incentive for meaningful use, we are being compelled to do it because we want to get more efficient. We are getting encouragement from large programs like the Medicaid waiver disruptive delivery system reform incentive program. The state is encouraging us to partner with 260 entities in the state. So we have to build common platforms, common standards. Will take a lot of time, but, again, remember where we started from, right? 20 years we were a cottage industry and now we are bigger and more sophisticated. >> In addition to the heterogeneity and the problems associated with bringing multiple hospitals onto a common system and having common processes. There's all this stuff that's outside of your control, the things that are outside the boundaries of your healthcare system but are part of the healthcare system. So we live in an environment where maybe as many of 40% of the hospitals out there are below EMRAM stage four which means that if somebody is ordering a medication in a hospital, they're writing that order down on paper rather than putting it in a computer. How much do the limitations of the external healthcare system play into the limitations of what you can do here at Mount Sinai? >> Well you are only as good as the weakest link in the system. And if those entities become the weak link in the system you gotta find a way to bypass them. Not necessarily in terms of providing care or in terms of the information they provide you. So you're to figure out how you connect them to some new cloud technologies to some kind of exchange where they are able to scan their paper record. And put it in the cloud and you can look at it. Or maybe the almighty fax is still powerful and prevalent in the systems. And you have to figure out how you can help them. You can give them online tools, at the end of the day, if you don't coordinate the information, you cannot coordinate the care and if you don't coordinate the care, you will have inefficiency and poor quality. So as a provider you want quality, and as a financial leader you want efficiency. So how do you do that? Well, you have to figure out how the information can be transported as efficiently as you can as possible, with minimal transmission losses. So if somebody's polluting your data, you gotta figure out how to clean the data when it gets to you. Or if you have the classic problem that you have with the enterprise master person index. You have systems with eight or ten medical records for the same patient. As a patient goes from one provider to another everybody creates his or her own medical record. Now tying that together is difficult, right? So how do you coordinate the care for a patient with eight medical records right? Now the state is helping us. They're trying to use the driver's license or some ID like that as a unique identifier but until that happens you've got to cope with it so we are building our own electronic master person index. Every business has rain makers, right? If you go to a law firm, you have the top lawyers, the partners who are the rain makers. They will treat IT differently, because they are the rain makers. If you go to the financial services industry, you have the top bankers. They have the same mind set. If you go to the hedge funds. They have the hedge fund manager. So every industry has its rainmakers, and there is a class-based system. So the IT organization as a service provider has to recognize how to support those business leaders in a different way, right? So you have to learn that in every industry. So for healthcare in our case, it's generally the clinicians who are at the top of the food chain, right? Besides the CFO of course. So you have to support the clinicians differently. You have to understand what works for the physicians. How do you effect change as an IT leader with a group of people that are extremely smart? They are independent, they've been trained to solve problems. And you're going to help them solve a problem that they didn't even know existed, right? So you may need their support for HIPAA, for security, for compliance. They may not know that's a problem until you tell them, right? So how do you do that? You gotta learn the skills in that industry. You have the same problem in law firms. You have the same problem in finance industry. You just gotta. As an IT service provider, you gotta learn how to do that. I've worked in about ten different industries and it's the same everywhere. You gotta figure out which is that special group and how do you target it. And your change management efforts have to be targeted to that specific group. For example, if you're dealing with nurses. Now your nurses have to be dealt with in a different way than the clinicians. And your front office staff, the administrators who are the registered clerks, have to be treated differently, handled differently because their way of absorbing information is different. So you have realize What does the target need to move in the direction you want to move the target? Because that is your goal, to effect change in the organization. And you have to study your target and then move them the way they want to be moved. Not the way you think they should move because at the end of the day the target is moving, not you. You're just moving the target. >> So it sounds like a large part of your responsibility is not just the core IT, the as you say, the wires and the applications but also the change management. Talk about the role of change management. >> So I spend a third of my time internally within IT, I spend a third of my time with my business partners, understanding what the business partners need, how I can more effect change in the organization. And a third of my time outside, thinking what is happening in the industry, what are my colleagues doing, what are my peers doing, where is the next competitive threat coming from? What do I need to learn to be able to keep up? So I have split my time in all three ways. But when I spent time with my internal team, I get them ready for change. By asking the right questions by pushing them in different areas. So I have to get my team ready. And then when I talk to my business partners. I have to understand what they need. Sometimes they don't know what they need, I have to help them understand what they need. Then steady the target, see what it will take to affect the change. What does it mean to take a group of 35,000 people who come together at Mount Sinai health system and have all of them do a certain thing next day, because the laws have changed. How do you do that? Well you gotta put the tools in place. The training tools that are available to all 35,000 people. You have to put compliance standards in place. You've got to have some enforcement strategy. You gotta encourage people. You gotta show them what are they going to miss out on if they don't follow the standards or the institution will lose. HIPAA security for example right when you double click on the attachment that comes to you via email you're going to bring the whole organization down. So how do you train people? So you have to study the subject, understand what the target is going to be missing out. And then you also have to get in that pain chain, what is causing them pain? And you're already sure how you can help relieve that pain. Just like doctors do except we are doing it in the business sense. And when you solve that problem for them and they understand that they will have less pain by doing what you are trying to do. Then they'll move in the direction you want them to move. And very rarely, you can move people through fiat or by through a stick, you already show them what it is in it for them. And most people will learn that way. Some won't, but those have other problems. But in most cases you'll find people have to know why you're doing it. And you have to take the time to explain to them why you're doing this. And help them understand how there's a burning platform app site. Our bring in an outside adviser that says, look this is what is happening with our competitors. You better move. So you got to show them what they lose, and what they gain for them to know. >> I would imagine being in the world of IT there are a number of, sort of core responsibilities or potential problems that would keep you awake at night. What are the hard parts? What are the things that you worry the most about? >> I think it's the unknown. So you don't know what the next disaster is going to be. You gotta stay up for that. And you gotta think about how are you going to use your resources that are limited to do the maximum, provide the maximum benefit for the organization. So if you have only $50 million in capital, and the demand is $200 million, how do you use the $50 million as a good steward in such a way that you are solving today's problem, and helping us move a little bit in the future too? So that's a challenge. And you gotta think about how you balance the capital needs and supply and demand. And you go to think about people. How are you building the next generation of leaders? How are you building, how are you keeping your people in your team? Because every day they walk out, and they come back. And they walk out, and they come back. What if they don't come back, right? And we have 10% attrition in IT. That means, I lose 80 people a year, that's a lot of loss. Now what if I were to prevent ten of them from leaving through some leadership development or giving them some different kind of motivation. Whether it's compensation or whether it's exciting projects. So you gotta think about how you handle your people. You think about how you handle your capital. And you gotta think about what problems are coming down the road. So you gotta be thinking about that. And then of course you always have to think about some urgent email that comes to you that are meaningless, but you gotta resolve. So that keeps you up at night. >> You mentioned that the need to keep your people engaged and coming back the next day, and how if you could decrease a number people who would leave your organization by ten every year, what that would mean. Talk about, a little bit, about their responsibilities of a leader in organization as a leader of people. >> I think we get so busy with the day to day, work that we have to do, we forget that it's all about people. I have 800 people working in IT, but I don't work for a living. Those 800 people do, and that's how I'm successful, because those 800 people do a great job. Now how do you motivate them? How do you give them, how do you align their career aspirations with the availability of resources in the organization and opportunities in the organizations? So, if somebody wants to become a program manager, and you don't have the opportunity for them, they'll move on. They'll go to see your competition. How do you provide opportunities for them? Or how you move them within Mount Sinai Health System. We have 35,000 people to say, maybe there's no opportunity in IT, would you like to work in HR, or finance or clinical areas? So you can still be a program manager, and we don't lose you at the system. That's your responsibility. So you gotta constantly be thinking about what is the skill gap? What is the skill surplus? And you gotta figure out a way to close the opportunity deficit and the skill gap, okay. The skill gap you can close by bringing in new people or training your people. The opportunity deficit that you have is you have to help your people find other opportunities, hopefully within the organization. But you got to grow them. If your staff does not believe that you have their interest when you want to work with them, if they feel that you don't have that interest in heart, in mind, then they won't be engaged as well as you want them to be engaged. And you know, in healthcare, we don't pay the same as Goldman Sachs or Google, right? What motivates people in healthcare is connecting to the mission. So how many people understand the mission of the organization? How often do you say what are your values? What are the organization's values? And how do you, as a person, practice those values and behave accordingly. So people know that there's congruence between the values of the organization and the leader that they're following. When that happens, your employees will be more engaged. And when you do that, you reduce the attrition, and you build more energy in the system. And one of the roles that the leader has is to constantly be pumping new energy in the system, because if you don't do it, by default, entropy sets in, right? You got to keep pumping energy in the system, and it's hard work. You know, we get so busy with doing the mechanical parts of our job, the results portion, we forget the relationships and the rewards. And we have to have both of those working simultaneously with the results. >> One of the other things that potentially distinguishes IT from other areas of the health care system in terms of engaging your employees, getting them to lead within the organization, is toys. You have all the cool things. You have the devices. You have the new watches. You have the smart devices. You get to play with, your team gets to play with things first, before anybody else does, and to be involved. What is the role of IT in the organization, in sort of the development of the new, the fun, and the cutting edge? >> Well you have to balance it. I think 95% of our efforts should still be on keeping the core organization operational and growing. But there has to be at least 5% cool factor, 5% fun factor. So if everybody's getting Apple Watches and if your IT people don't know how to use Apple Watches, and how to synchronize the Apple watch with an iPad, then you're going to be having problems when they go visit their customers. And the customer says, well, my iPhone is not synchronizing with my Apple watch, then what happens? So, you gotta find a way to provide them those tools out of necessity, and also as a way to a little bit of entertainment. I'm not saying we have to have a foosball table in every cubicle, but you have to have some kind of fun things that they can play with, some cool toys that they can play with. Now, a lot of people stick around because healthcare is exploding in terms of IT opportunity. There's a lot of investments going on in IT world and healthcare. So people want to be in healthcare, because that's where the money is being spent. The banks,the entertainment industry, they did their cool things 20 years ago. Now there's not so as much fun, there's as much discovery happening in that space compared to health care. It's all relative, but healthcare is a budding area. So a lot of people want to be there. And you ought to give them the opportunity, or otherwise they'll move move on to the next place, because they want their careers to grow. You know, they want to find a way to improve themselves. And if you don't give them that opportunity, and you keep them as a drone, doing the same thing over and over again, they'll move on. >> We're coming to the end of this discussion here, and I wanted to make sure I gave you an opportunity. When we're talking to tomorrow's healthcare leaders, and they're looking to figure out how IT plays a role in what they're going to do, how they're going to succeed, what would your advice be to them? >> First of all, this is going to sound a little perjorative. I don't mean it that way. But just because I read a book on psychology, I don't become a psychiatrist. A psychiatrist has to practice. They have a specialized field. Same thing with IT. Just because somebody knows how to turn on the computer, does not make them an IT expert. People who practice IT Have been doing it for decades, right. And there is a science behind it, there is a discipline behind it. So, my advice to healthcare leaders of the future would be to learn as much as you can about IT but still respect the IT practitioner, because they have a lot of depth in their field. Just as the practitioners may have expertise in clinical areas, nursing areas or some other areas, you gotta respect the active practitioner. And just like a CPA, how a CPA thinks so broadly in terms of risk management, IT leaders also think in terms of risk management. And they're also thinking about innovation, they're thinking about the future. So, the emerging health care leader has to partner with the IT leader to understand what is happening in the industry, what innovation is coming down the pipe. So, for example, tele medicine, or digital medicine, right? Now if a leader comes in and they don't want to partner with IT leaders to understand how digital medicine works, how tele medicine works, and they want to stay behind. Well competition is going to provide Uber like services or tele medicine services, and we will lose. So my advice to all the emerging leaders in health care would be to partner with your IT partner. Think about it, take that advice and grow with them. And there is a lot of depth in IT that is not visible, which is a good thing. But behind every application that we support, there are hundreds of things that happen, 24 by 7, that you never know that happened, and you gotta respect that. >> In that effort, I'm going to ask you for a recommendation about a book. When I was growing up the book was The Soul of the New Machine by Tracy Kidder. And it gave insight into the development process behind creating a new computer at the time. If you were to give advice to the students about a book, that not about leadership but that would give them insight into this IT world, what would you recommend? >> Instead of a book, I would say stay current in magazines like Computer World, Health Information Technology. They keep giving you the latest things that are happening. You don't have to read the whole magazine, but if you spend five minutes a week on that magazine over time you'll see a lot of emerging trends. That's what I would say, go look for the latest periodicals that are coming out. Many of them are online and you can, Information World, Computer World, HIT News. It takes five minutes a week and you can keep up with the trends. >> You're exposing me for my old fashionedness, I ask for a book and you tell me to get a podcast instead. >> Yes. >> [LAUGH] All right, fair enough, anyway I want to say thank you for your time, and for your advice. >> Thank you Bruce, good luck. [MUSIC]
