The Magic of Positive Politics

Being a CIO in the health-care industry can be a trial. For Sutter Health's John Hummel, practicing the art of political theater helps soften the tribulations.

For John Hummel, managing the way all 41,000 employees across the Sutter Health network perceive his IT department is one of the most important aspects of his job. Hummel, senior vice president and CIO at Sutter, a 28-hospital health-care system in Northern California, believes he can't accomplish anything without paying careful heed to the way his IT department is seen, heard and understood. And there's quite a lot that Hummel hopes to accomplish—including an electronic medical records system, an electronic medical orders system for administering prescriptions (known as computerized physician order entry, or CPOE), a virtual ICU initiative, an ERP implementation and a network upgrade.

To make sure that the administrative, clinical and executive staff think about IT in the way Hummel wants them to, he engages in what he calls political theater. And it's a leadership skill he's mastered. On a Monday morning in February, for example, Hummel sits in a regularly scheduled meeting with his executive IT staff to ensure that they're all delivering a consistent message about the status of several key projects, including the ERP implementation and the electronic medical records system. Later that day, Hummel and two members of his staff will be going into a meeting of the Executive Information Technology Committee (EITC), Sutter's IT governance body, and he wants everyone to be prepared. One thing that he wants to happen in the meeting is to get the EITC (which consists of the CEO, COO, chief medical officers and executive vice presidents) to agree on the group of individuals who will make decisions about the electronic medical records project. So Hummel rehearses his staff as if he were directing a play, cuing them on when and how to ask various questions.

"When we get to the agenda item on the charter, governance and budget for EHR [electronic health records], say, 'We would like to have EITC approve the EHR committee structure. We are here to gain approval for the current structure,'" he instructs his staff.

John Hummel, CIO at Sutter Health, believes the best way to advance his IT agenda is to understand his stakeholders, customize his messages and maintain a sense of humor. Such staged communications are necessary at Sutter and, indeed, at every organization—especially for CIOs. That's because IT is so complicated, involves so much change and creates such anxiety in employees. Therefore, CIOs have to carefully craft their message. "The idea is to make everything seem so well-planned and well-done that people get this overwhelming sense of confidence in you and don't mind being led down the primrose path," says Hummel. And because CIOs have a limited amount of time with an audience—whether that audience is the board, the executive team or the CEO—they have to spend time up-front to research and rehearse their message so that when they do get that minute in the elevator with the CEO, their delivery is flawless and convincing, says Hummel.

At Sutter, Hummel's practiced and deliberate communications and attentive hand-holding are particularly instrumental in helping him overcome doctors' traditional resistance to technology. He has used his powers of persuasion to push through expensive and high-risk initiatives—such as a $150 million picture archival computer system (PACS) that will help doctors to more quickly and accurately diagnose patients' conditions (the project also includes a $30 million ERP installation); a $25 million remote virtual physician system for intensive care units (known as eICU) that has decreased the mortality rates among those monitored by the system by up to 30 percent; a $30 million bar-coding system that has prevented approximately 28,000 medication errors across more than 4.6 million attempted drug administrations in 12 hospitals from the time it was implemented in May 2003 through December 2004; a $154 million investment in an electronic health record system that will also enable computerized physician order entry (CPOE), which gives patients and medical professionals secure access to digital medical records housed in one system across both inpatient and ambulatory settings.

In total, Sutter will spend $1.5 billion on IT over 10 years.

"The stuff John was doing a few years ago is now seen as just de rigueur," says Scott Wallace, president and CEO of the National Alliance for Health Information Technology, a professional organization and lobbying group in which Hummel participates. "The things he's done have really been impressive." Because of his reputation, Hummel is rapidly becoming a big name in health care. "He is as sophisticated and savvy as any Fortune 500 CIO," Wallace adds. Perhaps even more so.

The Director of Communications

"I have to make sure people understand why we're doing what we're doing in IT," says Hummel. If we're not all reading from the Book of John, IT can't give out a consistent message about what we're doing."

Consistency is of tantamount importance at an organization as large and geographically diverse as Sutter, where it can take Hummel as long as nine months to assign the proper business or clinical owner to an IT project and then sell all key stakeholders on the value of that project. (Hummel, who has been with Sutter since 1998, says it's a tremendously consensus-driven organization.) Consistency is also instrumental in reminding Sutter's top executives why they approved technology investments. "In the IT world, because these projects take months and months and months and years to roll out, you have to remind people of the reasons they invested in them in the first place," Hummel says. If you don't, says Hummel, the top brass may decide to pull the plug on a project if it's costing too much money, or worse, yank the welcome mat from under your feet. Effective politicians do the same thing: They constantly reinforce messages, persistently repeat hopes and steadfastly reiterate dreams.

Hummel uses the tactic of repetition when discussing a Lawson software ERP implementation that's been going on for seven years. The reason it's taking so long: Sutter spent the first few years building the system, and the organization's resources limit rollouts to 12 business units each year. (Sutter currently has rolled out the system to 65 business units, with another 25 to go.) At the February EITC meeting, the ERP implementation is the agenda item that Hummel is most concerned about because several user groups need to be retrained before Sutter can fully realize the cost savings from the system. The message he wants his staff to reiterate to the EITC is that ERP will save up to $38 million based on ROI analysis.

Like a politician, Hummel carefully considers his audience before addressing them and tailors his message accordingly. For example, when selling doctors on the benefits of bar-coding medications, he emphasized patient safety. To reinforce his message, Hummel shared with them studies from medical journals indicating that more than 51 percent of adverse drug reactions occur at the point of medication administration versus the point of ordering. When discussing the same initiative with the CFO, Hummel included an emphasis on ROI. He showed the CFO how much medical errors cost, how often they take place, as well as the costs Sutter incurs when it has to credit patients' bills for medication when it is not administered.

"He understands the audience he is presenting to and how to operate in that context," says Todd Peterson, Sutter's vice president and CIO of systems support operations, one of Hummel's top lieutenants.

John Hummel knows that if he's not visible to employees throughout the organization, they won't know what he's doing or recognize IT's value. In addition, Hummel uses his background in clinical care to relate to doctors. He spent part of his career in the mid-1970s working as a biomedical engineer for lithotripsy and laparoscopic devices, teaching doctors how to use an articulated ultrasound arm—then new equipment for breaking up kidney stone—among other things. His experience working directly with medical personnel gave him a valuable insight: He now knows better than to bring his laptop to a meeting with doctors. "Physicians are very intuitive and rely on eye contact to read how people are feeling. They see laptops as a barrier," he says.

Dr. Gordon Hunt, a senior vice president and Sutter's chief medical officer, says that the many hours Hummel has spent in operating rooms gives him credibility with the medical staff. "John was close enough to the problems doctors see in delivering care to understand how real those problems are," he says.

Making the Rounds

Hummel puts 35,000 miles on his Ford Escape each year driving to and from Sutter's various hospitals and facilities in Northern California. During his travels, he attends board meetings, pitches doctors, nurses and pharmacists on IT initiatives, and checks in with local IT staff. The informal check-ins keep him in touch with employees' perceptions about Sutter's business and technology initiatives, and help to inform his own opinions when he addresses Sutter's leadership in meetings. "I liken what I do to passing a bill in Congress," Hummel says. "By the time the senators and congressmen make their formal arguments on the floor, they've already visited all the people, done all the arm-twisting and made all the concessions they need to get that bill passed."

While preparing for February's EITC meeting, Hummel discussed one of the agenda items—a potential partnership with another health-care system—with other Sutter executives. The other hospital group (which Hummel won't identify) had approached Sutter in 2004 with a proposal to partner with Sutter to extend Sutter's electronic intensive care unit (eICU), a remote monitoring system, to its hospitals. In those conversations, Hummel learned that executives had mixed feelings about Sutter sharing its eICU. There were those who, like him, saw the partnership as a strategic opportunity. Proponents believed that by extending its technical and clinical capabilities into hospitals that might not otherwise have the resources to afford them, Sutter could enhance its reputation. Opponents saw the idea as a burden for a company that was already juggling 800 IT projects, building new hospitals and negotiating with labor unions. Hummel understood this perspective as well, having encountered similar concerns in his own thinly stretched IT organization.

The Power of the Informal

Before scheduled meetings, Hummel makes the time to speak with people privately because he says people rarely oppose popular ideas publicly for fear of being branded as a naysayer. By meeting informally with executives, Hummel's aim is to see if they have specific concerns, and to address those concerns up front. Hummel strives to meet informally in environments where people feel comfortable enough to speak frankly—whether in someone's office, a hallway or the bathroom. The sooner Hummel can head off people's concerns, the sooner he can get them into his corner, and the more likely he's able to prevent them from engaging in passive forms of resistance—such as agreeing with him in public meetings but then failing to act when he needs them to move forward.

Hummel's goal in the EITC meeting was to gauge how serious Sutter's top executives were about the partnership. Hummel wanted them to make a clear, unwavering decision in favor of or against the partnership because in the past, executives had committed to moving forward with initiatives without adequate consideration, only to conclude later that their decision wasn't such a good one. Unfortunately, such changes of heart came after IT had devoted time and effort to such initiatives. Even though Hummel believed the partnership was a good move, he was prepared to live with a decision against it.

Hummel had to carefully lead the committee into a discussion about extending Sutter's eICU. He didn't want to be too forceful because he worried that if the project was viewed strictly from an IT perspective, businesspeople wouldn't see it as a priority and thus wouldn't take the actions necessary to move the project forward. Instead, Hummel wanted the CEO and the EITC to make the call. If the partnership was viewed as the will of the CEO, the organization would intrinsically see it as strategic, and it would be easier for Hummel to get the necessary funding.

When the topic of the partnership came up, Hummel and his staff, while in support of it, balanced their opinions with their own reservations and the general concerns about the initiative that Hummel gathered from other executives. They then asked the EITC to weigh in.

At the end of the meeting, Van Johnson, Sutter's president and CEO, decided that extending the eICU, while risky, was a good strategic move for Sutter. The partnership got the green light; Hummel's magic worked again.

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