Russ Branzell responds:

Let me first address this question with the real answer to what is really most attractive in hiring talent into our organization or any organization: “FIT”!  We follow a simple, yet critical principle: “Hire for fit and train for skill.” If you hire someone that fits the cultural and value-based environment, we have cleared the first and most significant hurdle to individual success.    Skill doesn’t matter if they don’t fit, because they won’t be here/there long.

So making a really big assumption that we have hired and screened the correct candidates into our organization, the question of depth and quality of skill is a question that arises often, especially with individuals without a healthcare or healthcare IT background.

There are numerous positions within the typical IT organization whether hospital, health system or medical group, each with unique requirements.   Some healthcare experience is absolutely required, some preferred and some of no real competitive advantage. 

Positions such as telecommunications, helpdesk, network, etc… really are only dependent on technical knowledge and any needed healthcare experience can be picked up thru the oriented and OJT process.  With that said, as these individuals progress into leadership or management positions the ability to have a deeper understanding of the healthcare environment and apply project management skills becomes more critical.  It could be said that they won’t make it the next level of their related technical position without those abilities.   The lack of clinical and project understanding can negatively impact the clinical services being delivered or supported. 

Positions such as clinical applications, clinical informatics, PACS, and EMR specialists the ability to bring clinical expertise or understanding is invaluable to work with synchronicity with direct care providers.  Many of these individuals come from the specific areas that they support.  In those cases, we train the technical or project management skills as part of the transition process.    Eventually, most of the these individuals have strong skills in all three areas, so those with that come to the table with these skills have a significant competitive advantage. 

Most organizations do not have significant need for generic project management skills unless they are running a centralized PMO or internal PMO within IT.  With that being said, some project management skilled staff have so impressed our leadership, we seek a place for them and then train the need skill grap.   Good project management skills are critical to IS success, but rarely used separately from the other positions, but rather developed within the existing staff positions. 

So, if you consider fit the entry level constraint along with basic qualifications for the job, the rest is a combination of the other skills and the needs of the organization.  In many cases the need  for healthcare experience is not critical, but in some the only way to get the job. 

The healthcare industry need talented and quality staff to feed the overwhelming amount of work that needs to be accomplished in the next few years.  Good people can always find a place in healthcare. 

Chuck Christian adds:

I will echo Russ’s comments; you need to determine how the individual will fit into the culture of the organization/department and the team they will be joining.  Being a clinician myself, my answer may be a little bias; but I’ve always sought to find the individuals that have excellent process knowledge and “people skills.”  I’m of the opinion that you can teach the necessary application/technical skills to an outstanding clinician, but it is far more difficult to teach the clinical aspect of healthcare to someone who has very competent technical skills.  The down side of this approach is that you are removing very skilled members of the patient care team out of a direct patient care setting.  The up side is that the person who is working to implement a clinical system has full understanding of the clinical workflows and has “walked a mile” in the staff’s shoes. The other great thing about this approach is that the folks that will be working shoulder to shoulder to implement the required process/workflow change are known entities within the organization (yes, I recommend hiring from within, if possible) and well respected (that is, if you recruit well).  Of course, you also have to create a work environment that attracts and retains these very skilled and talented clinicians.

Melinda Costin responds:

It is a marvelous goal to want to work with and for the best in the industry. That environment will provide you with constant challenges and continually learning. Some points to consider when choosing an organization. The outstanding organization knows themselves and their environment and strives to continually improve that environment for their patients and their employees. It recognizes a commitment to safe, timely, effective, efficient, and equitable patient care and sets higher quality and financial management goals on a regular basis. The goals are well known to all within that organization and leadership is often compensated based on the ability of the organization to meet those goals.

Next is quality and the organization should have established training and structures to support the staff in creating and executing quality projects, and then publically recognizing their successes. The leaders of a top notch organization communicate regularly both up and down the organization and create governance bodies that provide for coordinated and prioritized efforts. Employee and leadership development are foremost for this organization as they continue to invest in driving excellence.

Finally, another consideration is the management. A great manager may be different depending on the person they are managing. What might be a "great manager" for one, may not be the same perfect match for someone else. In general, the ideal manager in healthcare is one who is able to provide that unique balance of understanding the business of healthcare while tracking the advancements of technology and knowing when and how to apply them.

Who makes a great manager in these organizations? A manager who understands and recognizes the organization structure and knows how to move effectively in it while supporting the goals of the organization and his team. Most importantly, someone who moves comfortably in the world of the customers and clearly understands their operational needs. A great manager researches, coordinates and communicates solutions in meaningful ways and knows how to involve all the associated parties. An effective manager leads his team, coordinates with his/her peers, and manages up his employees to the executive level. A manager who trusts the individuals he manages and provides them the freedom to make decisions and creates a learning environment is invaluable. With healthcare reform, leaders today should know and educate their teams about finance as well. Budgets, capital and cost management and even revenue cycle basics are important. The ability to put together a Total Cost of Ownership (TCO), and anticipated Return on Investment (ROI), for major initiatives is needed as you move up in most organizations. Finally, an effective manager is a member and participate in healthcare organizations such as HIMSS, AMIA, TEPR, as well as communicating with similar provider organizations so that he/she continues to learn about the industry and can share that knowledge with those they manage.

George Hickman adds:

Working for an "outstanding" organization begins with making some choices about mission. Assuming your interest is in the healthcare provider space, mission choices can be made regarding:

• Academic or community-based
• Acute, post-acute, physician practice or integrated delivery network
• Not for profit or for profit
• Rural, metro or critical access

There are many industry-accepted ways to define "outstanding." These may include those listed by Melinda and may be the metrics used by those analyst companies that benchmark and publish on "top" organizations. Other attributes should be your own; e.g. make certain that you have thought about what "outstanding" means to you and discriminate accordingly. This is a very important step in finding yourself working for that organization that you believe is "outstanding."

"Great" managers come in all flavors. Great managers have competencies that suit their roles, have concern developing their people, understand their respective organization's cultural nuances, know how to make decisions and deliver outcomes, and generally garner trust. Great managers may have varying leadership styles - so Melinda is spot on - how you "fit" with your manager is a matter of style, not necessarily greatness. And great managers may or may not be in the public light - sometimes great is less seen though the influence is felt.

Karen Ondo responds:

Somewhere along the line you develop a set of principles that help guide you through life and the decisions you will make. Some call this work ethic, but it’s much more than that. So for starters, I thought I would list some of the guidelines that have helped me either into making better decisions (success) or avoiding mistakes (failure).

If you can’t say anything good about someone do not say anything at all. It just isn’t worth it, besides focus on the positive. The damage you could do in 30 seconds could mean a lifetime in recovery. I found that there were only a few people I really disliked and when that was the case I avoided them whenever possible. That said; attack your naysayers head on. When they can’t be avoided sit next to them at meetings, learn what’s important to them, a little about their private life. More than likely you will find some common ground, but its work and something that will take you out of your comfort zone.

Speak softly but carry a big stick. I never had a job I didn’t like and always felt a little lucky to get paid for something I liked doing. But, in return, I always give 120% and because of this I can’t imagine doing a job (for long) that I did not like. Being a woman, I was also cognizant of the ‘glass ceiling’ but can say that I never thought I ran into it, but like it or not it still is a man’s world so I learned to speak softly but carry a big stick.

Work hard and play hard. I would never ask someone to do something I would not do myself and those around me knew it. One of my most interesting emails came from a staff member deep into the night who responded to an email I had just sent… “Are you up for the day or have you not gone to bed yet?” A good night’s sleep, good nutrition and time off go a long way to keeping you in balance and capable of handling what life throws at you.

Learn to play golf.  You don’t have to be good, just good enough to play in charity tournaments. A lot of business is conducted on the golf course and I didn’t realize this until I was a VP. I would go to meetings, sign up for tennis, only to have it cancelled due to lack of participation, everyone was on the golf course. It’s the conversations, before, during and after. I once had a sticky contract term written to me on a coconut and left on my tee box. Not long ago I participated on a panel geared more for professional women and when asked ‘if there was one thing you could do differently what would it be’, the panel was unanimous in answering, ‘learn how to play golf’! 

Management is as much an art as it is a science. Just because someone asks you a question does not mean you have to answer it, politicians are really good at this. This is especially true in confrontations or management/staff situations. The art is in choosing the question(s) to answer, the science is the answer.

There is more than one way to skin a cat, translated, there is more than one way to get from A to B. This took me a while, because when I delegated something, I still want the person to do it ‘my way’. When you delegate a task to staff, your role is to explain the desired outcome, talk about how long it should take and then let them do it ‘their way’.

Surround yourself with good people and a communication network that is meaningful. It is impossible for you to know everything and you need to find ways to feel comfortable about making decisions with less than 100%. If the answer was easy they wouldn’t need you. Expect the unexpected, but don’t get hung up on the ‘what if’s’. When possible take the emotion out of the equation of decision making. When you detect emotion in yourself or others, call a time out, take 5', 30', a day or whatever necessary. You want to avoid ‘reacting to the emotion of the delivery’ as opposed to the ‘content of the discussion’.

Have an ‘ace in the hole’. This was someone I could trust, someone that could maintain confidences and someone who had the skill set (senior analyst) that you could delegate the most sensitive things to when you could not do them yourself. Being a good analyst was especially helpful when projects were going sour and you needed to intervene before bad things really happened.

A little bit of luck goes a long way. You need to learn to take it when you get it, because when you want it, you probably won’t get it.

Maintain confidences. As hard as it might seem, you must maintain confidences until the information is in the public domain. In that regard, staff will tell you I had two phrases I used to use (1) you need to trust me on this one, you are better off not knowing, and (2) I will tell you when I retire. 

Develop a trigger mechanism.  You need an internal alarm mechanism, a trigger that goes off when things are not quite right. And respect that trigger and recognize that it means ‘step back’, slow down and that you need more information.   My internal trigger has helped me or those I was working for to avoid mistakes and served me well in what I believed to be my first serious defeat, an answer to the second question posed. Example:  I was seeking my first real promotion (post college graduation), from staff to management, and someone else was chosen. If fact, this someone was a person I helped daily. My emotions ran high, I was angry, mad, upset, and bitter for starters. I remember thinking ‘if they do not appreciate me, then I am working for the wrong company’. Unknowingly, I used time to my advantage, overnight, while I did not sleep much I thought about my next day at work.  I was devastated and did not like the thought of being embarrassed, but it was my choice how I handled it. How could they not see and recognize my good work? I reconciled myself to keeping my negative reactions in check and simply decided to find another job quietly. I actually had interviewed at a few companies when my employer came to me and said… "We know you wanted this job but we had other things in mind. We knew ‘X’ was also leaving but before we offered you this much bigger job we thought we would watch your reaction." Within six weeks I found myself in my first executive job, on the hospital board and making CON presentations to the State. I firmly believe that good work will be recognized, however, that recognition does not always come when you think it should.

Being a part of HIMSS was a great stepping stone in regards to national recognition. I would recommend the HIMSS Board of Directors to anyone. My tenure was near the end of my career, so I was not looking to gain or boost my career with such an appointment. Even so, coming onto the Board with many years of experience I found myself learning new things and the exposure to Capitol Hill was humbling. When my term ended, I found myself thinking about how in awe I was of our nation’s capital and its activities and at the same time, I now understood why it was so hard to accomplish anything.

Bottom line.  I would attribute most of my success as staying true to my principals.   I do think my clinical background helped quite a bit. I used to say it’s easier to teach a clinical person the technology than to teach clinicals to a ‘techie’. When things go well there is always enough credit to go around, so I never looked for it. I figured that if those I was responsible for did a good job enough of the credit would come my way. It didn’t always, but it was never my concern.

Herb Smaltz adds:

I share a number of Karen’s key points and for the sake of brevity will try to complement, rather than repeat.  Certainly getting involved in HIMSS and then CHIME have been incredibly enriching both at an educational level and on a personal level.  Some of my closest friendships have been forged by countless conferences and committee activities.   Having close friends and colleagues at other institutions that can call on each other to collectively think through strategic options or tactical problem solving has been invaluable to my own success.  Often the problems that one faces may seem very unique to one’s own organization, but often they have already been solved or adequately mitigated by one of your friends or colleagues.   On a related note, one of my earliest mentors in hospital administration was Terry Cunningham a Fellow and Regent in the American College of Healthcare Executives (ACHE). He encouraged me to think of myself as a hospital administrator first and IT executive second and to become involved in the leading professional society for hospital administration, the ACHE. I’m very glad to have taken Terry’s advice and to have also been involved in the ACHE for virtually my entire career, eventually attaining Fellow status.  This professional rooting in both mainstream hospital administration and in IT, I believe, made me more of a business minded CIO than a technically oriented CIO – something that continues to be a distinguishing characteristic in the contemporary CIO position description.

Another success factor, I believe, is developing a trusting relationship with your boss.  I’ve found the best way to do this is by developing an analytic orientation to decision making.  I learned early in my career that my bosses very much valued solid due diligence in any major management decision such as a major investment or major process changes.   I learned to think through and analyze at least two, ideally three, viable alternatives, the pros and cons of each and the costs and benefits of each along with my recommendation and the rationale for choosing that alternative.  The trust that this approach builds with your boss is incredible and it’s so simple and easy to do.  I know – you are all likely thinking – ‘duh’.  Interestingly, I’ve found this approach seems to be not so common among IT managers that I’ve encountered in the industry.  What I’ve found in some IT managers that have worked for me (with a number of notable exceptions of course) is that they tend to have a strong bias towards a particular alternative and simply cannot hide that in their due diligence.  I can’t tell you how many times I’ve had someone come to me with a decision in which one of the alternatives clearly is well thought out, well supported, and the other alternatives clearly haven’t been developed to the same level of detail.  Nothing destroys trust more than feeling like someone is cutting corners in their due diligence for a major decision.   To develop trust, the folks that you work for need to feel confident that you have a sound analytic approach to bringing them management decision alternatives.

Another success factor I believe is that no matter what position I had in an organization, I always tried to contribute beyond my particular position description.  By that I mean I didn’t let myself be “pigeon-holed” into a particular job title and the imaginary contribution boundaries that we sometimes impose on ourselves (or that others impose upon us).  Early in my career, as a young IT manager in a 300 bed hospital, during the total quality management movement of the early 1990s, I volunteered to become a TQM process action team facilitator where I was assigned to a number of process action teams that worked on reengineering specific processes throughout the hospital.  Not only was this incredibly enriching to me as an IT manager, my peers in the organization that may have, up until then, viewed me as the “IT guy”, saw me in a much different light – as a fellow hospital administrator that just happens to have a specialty in IT but is contributing to help solve oftentimes, non-IT process problems.  On a related vein, at key points in my career, I competed for positions for which I wasn’t yet fully qualified and, like Karen, was pleasantly surprised when I was selected/elected to the position.  At the time, I truly believed that I was not qualified to serve on the HIMSS Board of Directors when I was nominated but, like Karen, it was one of the most enriching experiences of my career.

Finally, writing and giving presentations throughout my career was instrumental in attaining some recognition, though that was never the main purpose. I found that the research that one has to do to prepare to give a presentation or when writing an article or a book chapter always led to increasing my own learning or knowledge base.  As the saying goes, you learn the most about a topic when you are teaching it.  So even though, like most managers in healthcare, I rarely had the time, I tried to push myself to write and give presentations whenever it was possible.  And each time I’ve learned something I didn’t know before.

On the topic of failure – I have.   Anyone that spends any amount of time as a healthcare manager will fail at some point in their career. I believe that you can learn a great deal about a manager’s potential for increased leadership by how they handle failure.  When failure happens, I’ve always found it useful to first look at the process (not at individuals) that led to the failure.  To decompose the process and determine if the failure was within your own management control or not is important.   If it was within your management control, try to understand what actions led to failure.  Was it a set of assumptions that turned out to be wrong?  Was it a series of actions that did not occur as planned?   Learning what the cause was of the failure and putting checks and balances into your management processes that seek to not repeat the causes of the failure is the only practical approach to failure.  Most important, I never lingered on a failure.  When you accomplish “post mortem” analyses on failures, learn the process causes of the failure and take steps to not repeat them in the future that is the only sane approach to dealing with failure that I’ve found.

David Finn responds:

The demands will not be reduced in the foreseeable future so the ability to keep people happy, challenged and empowered will only grow.   This requires creativity from employers and employees alike.   Here’s some thoughts to consider:

• Vendor training and sponsored user’s groups
  This can range from a vendor’s formal training to ‘educational’ sessions or just trends in a vendor’s area of focus.  Most have such offers so ask and don’t pay for it.  Additionally, my staff always wanted to know what nearby providers were doing.  Vendors helped pull together ‘user groups’ and we’d rotate locations.  The vendor “hosted” the event but weren’t always invited to attend. Consider a cross-institutional group (managers and up); prep an agenda, start with an educational session and then ask the presenter to leave and spend the rest of the time with providers engaged in open dialogue.

• Local programs or agencies
  A local FQHC about to roll out a new EMR had clinical staff with experience on the system but needed a project manager.  We went to a provider which had recently implemented the same product.  They had an analyst working on PMI certification who needed to manage a project - - a match made in heaven! 

• Travel to conference where staff  have places to stay
  A network engineer wanted to attend a training program in a city where he was also meeting family.  Since he already had travel and lodging, he asked if I’d pay for the course.  Win-win!

• Presentations/case studies with vendors
  Poster/speaking/webinar opportunities are great experiences for staff.  These aren’t endorsements, just share your experience (success stories are easier to sell but even failures can help others avoid the pitfalls).

• Matching expertise to need
  If you’ve got a lot of organizational employees who need personal technical help and a lot of technical employees looking for extra money, set up a paid technical support match.  This takes a bit of work because the separation has to be clean and expectations clear. The work couldn’t be done on hospital time or with hospital resources but we could match expertise to need.  The employees got someone they might already know and the IT staff got to pick up a little extra money.  We established rates, made clear that this was not an official function and there were no guarantees of work produced.

• Local community colleges, high schools offer teaching/training opportunities
  Local high schools or colleges are often looking for people for career day events. You can grow a relationship and even pick up new recruits.

• Build a career path within IT and grow your own
  After hearing a few of my teams complain about candidates, we challenged leadership to build an IT Career Path.  It started simple, but as the requirements and experience grew it accommodated ‘jumps’ and horizontal moves.  It empowered the staff to create their own future and get the people they needed to work with them at the same time.

• Job swapping/shadowing within the organization
  We started a job shadow program between departments.  We couldn’t always fix everything but we did achieve new levels of understanding and cooperation.

• And don’t forget HIMSS!
  HIMSS is like life - - the more you put in, the more you get out; so get involved.

Carla Smith adds:

David has provided excellent advice on using comprehensive training programs to retain staff.  I would like to address two an additional components of retaining good people – mission and autonomy.

I often think about a story – when some Members of Congress visited NASA in the 1960s to ensure that taxpayer dollars were being spent appropriately for the space program, one Member approached a worker emptying wastebaskets.  The Member asked the NASA employee, “And, what do you do here?”  The employee responded with “I’m putting a man on the moon.” 

Now, that’s mission. 

Healthcare has a similar urgency of mission – to return people to health, and keep people healthy, as expeditiously and safely as possible.  As managers and leaders, we inculcate mission across and throughout our team.  If we believe in our mission, and consistently return to the mission as our source for inspiration, others will too.  Many people are highly-motivated by a sense of mission.  We want to believe that we matter – that our work matters.  That in some small (or large) way, our efforts, combined with others, will result in a better world.  Steve Jobs said, “I want to punch a hole in the universe.”   That’s mission.

Take the time to think about your organization’s mission, and your role in it.  Consciously and consistently, weave mission into your communications with team members.  In a positive, affirming way, become known as the standards-bearer for the mission.  You’re not there to be punitive as the “mission police”; your role is to draw people’s attention to the purpose of their work. Help connect the dots – tell them how their work enables the achievement of an important mission.

And, within reason, give them space.  Autonomy is highly-motivating to many.  Note that autonomy is earned; it is not automatically granted.  Autonomy is built upon trust and a demonstrated ability to make effective decisions and execute projects well.  A manager must learn how to, first, find trust-worthy staff.  Then, the manager must equip a staff member to make effective decisions. 

Such a skill-set is not innate.  It is learned through both training and experience.  Managers themselves must be in an environment in which they have a baseline of trust and autonomy.  And, staff must be equipped, through training such as David outlines above, and through one-on-one mentoring, to understand the boundaries of decision-making. 

In any economic environment, good people are hard to find.  What I have experienced is that good people are drawn to healthy organizations – organizations that have a compelling mission, are known for treating employees with respect, and where the majority of the team works hard and smart.  Good luck!

Chris Belmont responds:

Here are a few things that I feel will help any professional move to the next level:

First Innovation. Particularly in Health IT the need for innovative ideas, concepts and general thinking is extremely important. We are challenged with keeping up with other industries and our customers are demanding convenience, self service and interaction anytime, anywhere.

Next comes strategic thinking. Most mid-levels think very tactical and in the moment. Looking beyond is critical to the next level. Think about what things would look like one or two years from now. Stay up with challenges in your organization and the industry. Strategic thinking is not about what needs to happen but what will differentiate you or your organization from others. For example adding more staff to the help desk to handle more calls is not strategic. Preventing calls from happening is strategic.

Next comes understanding finances. Financial management is very critical as budgets are challenged each year, contracts are negotiated, and reimbursements change and projects are executed. Cash flow analysis, capital vs. operating, contract negotiations, IRR and return on investment knowledge are very critical to success at the next level. Don't over think this component. No need to be a CPA. There are probably strong financial leaders to learn from within your organization but it takes exposure and practice. Look for a chance to gain experience or launch your own project or analysis.

As far as obstacles, you often have to break them down yourself. Make it known that you have interest in gaining knowledge and experience in these areas. Be proactive with ideas and plans. Create a presentation or business case for an innovative idea without being asked. Even if it doesn't "take", you will at least have planted a seed that you are thinking differently. Assist with budgeting at a detailed level. Ask if you can sit in on a contract negotiation. Shadow other leaders in strategic planning sessions. I often invite emerging leaders to attend as observers. Basically you need to sell yourself.

John Daniels adds:

I sure could have used Chris' advice 25 years ago. He makes some really good points. What I hear Chris saying is similar to what one senior executive advised me early in my career. In short, he told me not to worry about what it's going to take to land that ideal pinnacle position; instead, concentrate on being THE expert in what you're doing today. Chris gave us some great tips on how to be that expert today. Your reputation will precede you, and if you ensure today that your reputation tomorrow labels you THE expert --the go-getter, the effective problem-solver, the innovator, the cool-headed leader, the collaborator, the critical thinker, the crucial communicator, etc -- that's what will help move your career to the next level. I think the expression "actions speak louder than words" applies here. Get involved, and take on projects no one else wants to touch. Like Chris said, if it doesn't "take", you've shown others you're willing to take risks and innovate.

I also like what Chris said about handling obstacles and roadblocks. My biggest obstacle is myself. I am my own worst enemy when it comes to advancing my career. That's why I read books, take self assessments, ask others for feedback, and seek advice from mentors on how to mitigate my weaknesses. It's sometimes tough to do, but you can't fix what you don't understand. So, my actionable advice here is to do what it takes to identify and understand your weaknesses. Take command of those weaknesses by facing them head on, break them down per Chris' advice, and try the things I mentioned to help either turn them into new strengths or make them go away for good.

Pete Shelkin Responds:

Let me begin by congratulating you on your new job! This is an exciting time to be a senior leader in healthcare IT, and as you are already learning it can be a time of great challenge as well.

The first thing I'll say in the way of advice is to remind you that as the senior IT executive, your job is not to do it all. Your job is to work with the other leaders to assure that you have an IT plan that supports the business plan. This plan becomes your to-do list for the next few years, complete with measures for success, and your team must execute it under your leadership. Your question shows me that you already understand this, and that you are intuitively heading in the right direction.

So here is my second piece of advice: Make sure that your organization has a committed and engaged IT governance council that includes senior leadership. Ideally, your governance team should be integrated into the overall governance structure of your organization, and report either to the board or to a board committee. You will need this level of oversight and support to assure that tough decisions are made, and that once made, resources are committed.

Note the emphasis on commitment and engagement in the above paragraph. It is essential that members of your governance council are engaged to the degree necessary to decide what belongs in the plan, and committed to the degree necessary to make sure the plan is funded. The members of this group are people who need you to provide IT services in order for them to meet their goals, and they are also the people competing with you for funding. It is imperative that they have input and ownership in the plan.

The third thing that you need to keep in mind is that even though you need a committed and engaged governance team taking ownership for the plan, it's still your plan. You need to make sure that all elements for consideration in the plan, such as Meaningful Use, Inpatient EHR, etc. are well defined in terms of costs, benefits, level of effort, risks, trade-offs, etc. Your peers, your boss, and even the board consider you to be the expert and expect you to educate them so that they can make the best decisions possible.

To successfully lead your organization in this planning effort you need to spend time gaining a deep understanding of both the business and the people running the business. The best time to do this is now, while you are still new. People expect that you will spend time asking questions. Ask them - a lot of them. Find people's pain points. Find the quick wins. Find the things that work well in one department but cause problems downstream. While you're at it, find their pet peeves, the pet projects that don't really add value, and the political landmines (it's a lot less painful to find these through conversation than by stepping on them).

Once you finish doing your homework you should have the information you need to build a list of candidate items for your strategic plan. Next, you and your project champions must build the case for each item. For each item on your list you need to identify not only costs and resource requirements, but also the metrics that will show improvement. For items that make improvements to existing areas it should be easy to find baseline metrics. However, for items that bring entirely new functionality, such as a new inpatient EHR in your case, it will be difficult to establish a baseline from which to measure. Your organization's culture will determine how you handle these cases. You may be able to use anecdotal evidence to establish your baseline or you may be required to bring in some outside expertise to help establish proxies for baselines. Consult with your boss and your governance council in these cases to determine how to craft measures for success. One very important note on this process: Make it an iterative one where you start with high level cases and then add more detail during each iteration. There is no point wasting 100 hours of valuable time building a detailed case for an initiative that will not survive the first pass.

The final step is to have the governance council evaluate the initiatives and select those that will make it onto the strategic IT plan, all the while working within the context of the resource constraints that you face. This will take several iterations and may take several months, but in the end you will have a strategic plan that balances the needs of the organization against the bandwidth of your staff, and includes clear measures for success. Good luck!

Rick Schooler Adds:

As a new member of your organization's executive team, you have been presented a great opportunity to make a lasting impression. Given the situation, your colleagues will be closely observing your leadership style and decision making abilities - forming critical opinions and perspectives from the outset. Although new positions often afford a "honeymoon" period, you are faced with the need for immediate attention and focus to several strategic, high-risk initiatives.

Your ability to build consensus and maintain alignment with organization priorities while setting realistic expectations will be of paramount importance. This, of course, comprises the core of sound IT Governance and must be accompanied by agreed-upon resource and budget allocations. Effectively engaging others in understanding the present reality and prioritizing what are likely competing initiatives will make a significant and positive impact. Most importantly, your initial actions must be fully understood, supported and jointly owned (as appropriate) by your colleagues.