M.D. Anderson Cancer Center Hires IT Pros Who Can Keep Up With Doctors’ Ever-Changing Needs

The University of Texas M.D. Anderson Cancer Center employs more than 700 professionals in its IT department. They support roughly 16,000 employees, more than 20,000 desktops and the more than 79,000 cancer patients the center will treat this year. Unlike many healthcare organizations, where the IT department supports only the clinical side of the business, the IT department at M.D. Anderson supports all the cancer center’s business processes and functions, from treating patients to research to granting academic degrees.

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The IT department also does much of its own application development, especially for clinical software and systems. It developed its own electronic medical record (EMR) system, for example, that combines patient data from the treatment and research sides of the organization. The IT department implemented a service-oriented architecture (SOA), which, during any given month, handles 125 million service calls for the EMR system alone.

Such a large, complex organization with such a critical mission demands customer-focused, team-oriented IT professionals who can keep up with the organization’s ever-changing needs, says Dr. Lynn Vogel, M.D. Anderson’s vice president and CIO. M.D. Anderson is one of the premier cancer treatment and research facilities in the U.S.

“Working in a place like M.D. Anderson is like working in quicksand; things are constantly shifting under your feet, and you have to be fairly fast to keep up with that,” he says.

To determine whether candidates for positions in his IT department possess the mettle to survive and thrive at M.D. Anderson, Vogel focuses on their technical expertise and accomplishments during job interviews. In this Hiring Manager interview, he discusses what it takes for IT staff to succeed in his organization, how he makes hiring decisions and the hiring mistake he just can’t seem to shake.

John Mann: What are some of the biggest challenges you face in IT, and how do they impact your staffing decisions?

Dr. Lynn Vogel: M.D. Anderson Cancer Center is generally acknowledged to be one of the best cancer treatment and research organizations. When I came on board several years ago, the expectation was that the information technology organization should also be the best. So we started a three-year process of determining if we have the right people doing the right jobs in the right place in the organization. We currently support over 20,000 desktops, and our customers are very demanding: They want bandwidth, reliability, and they want to make sure everything works all the time. It is a 7/24 operation, and our faculty really pushed the envelope with their expectations for everything from Internet access to the ability to transfer gigabyte files to their colleagues around the world. [M.D. Anderson operates an affiliate facility in Spain.]

Consequently, when it comes to staffing, we really have to go for top-notch people who have deep experience. Given what we’re doing technologically with software development, our services architecture and the complexity of our network organization, we don’t compete for people who have just graduated from college. We compete for people who have been in the marketplace for five to six years and have been in a high transaction volume, enterprisewide environment. Those people are fairly hard to find. It is a matter of matching the leadership capabilities of the staff with their technical abilities. I have 13 direct reports, each of whom is absolutely top-notch in their field, whether it is financial systems, clinical systems, security, project management, network services or managing the data center. We push the envelope in each of these areas, which means that we have to hire people who have deep technical expertise and know how to operate in a large, complex organization.

How does the development of new technologies like the EMR application impact your staffing requirements?

We have to hire people who know how to code. We also need business analysts, people who understand the business and IT. In some ways, business analysts are our most critical hiring challenge. They are really the bridges between our customers and the technical challenge of writing the code. Those business analysts tend to come from across a broad spectrum of backgrounds. They are people who have a number of years of healthcare experience: They are nurses, pharmacy people, people who have worked in the labs, radiology, across the gamut. It is the business analysts who have made the difference in making our EMR process work.

Do you often hire IT professionals from outside of health care?

We’re in a situation today where we really don’t compete for staff with the hospital down the street. We do compete with the commercial enterprises in Houston, the airlines and oil and gas companies.

How hard is it to find the right IT professionals for an environment where the safety and lives of patients depend on information technology?

We used to attract very strong IT people from the financial services industry. We would bring them into our hospital, give them a tour and show them the patients. We would tell them that the patients were their customers and that what they did on a day-to-day basis directly impacted the patients. That message typically lasted in their minds about two years because they discovered that when they came to work in health care, they were working the same hours they worked on Wall Street, but instead of getting a big bonus and a 15 percent salary increase at the end of the year, they received a 3 percent increase and very small bonus. So at the end of two years, the panache of working in health care started to wear off.

The flip side is that as a dedicated cancer facility, we attract a number of staff who have had family members treated here, who may themselves have been treated here or who know somebody who has been treated here, so that is a plus for us. The mission of M.D. Anderson is what attracts and keeps people. We try to utilize that as we recruit and hire staff.

What types of positions are you currently looking to fill?

We focus a lot on business analysts. We focus a lot on project managers. We have a whole career ladder built for project managers. We look for people for our more sophisticated projects or people who are certified as project managers. We also look for people with deep technical experience, whether it is managing huge data farms or complex network environments. We try to match experience and expertise with the particular domain people will be working in.

You are the hiring manager for several different areas, including clinical care and operations, research and education, financial and support services, and infrastructure standards. Do you hire differently for these different areas?

On the clinical side, the answer is yes. As I mentioned earlier, we don’t hire people right out of college. We look for people who have several years of experience, both in whatever technology they’re working in and also in health care. That is particularly true on the clinical side of the house. Our director of the data center, for example, has been in health care for about 25 years. The person who heads our clinical applications support group is a nurse.

On the financial side, healthcare experience is not so critical. The person who heads our financial group has been a financial services consultant for a number of years, but not specifically dedicated to health care. On the research side, we hire PhDs who come from chemistry and biology, etc., so that’s sort of a stretch. In some ways it is health care, but we’re looking more for the domain expertise that they bring from their own individual research. So yes, we do hire differently for our different constituencies, and we try to match the expertise and experience that an individual brings with the particular area that they’re working in.

Can you describe your interview process for candidates for IT jobs?

Typically at the senior level in the organization, they tend to be individual interviews. We do give guidelines, such as focus on what the candidate has done, where the candidate has worked previously, try to get a sense of how the chemistry would work and how the candidate would fit with what we do. It is not unusual for a director-level candidate to go through six to eight interviews. At that level, we also have them interviewed by the people who will be reporting to them, so the managers who work for the directors actually have a say in who their boss is going to be. It can get a little awkward if the manager believes that he or she is capable of doing the director’s job, but if that’s the case, the manager is perfectly free to apply for the job and they’ll go through the same process that everybody else goes through.

When you interview candidates from other industries, what do you look for?

I look for two things. One, I look for successful work experience. It really does not help me to know that you have worked for XYZ Company. I want to know what you did at XYZ Company. I want to know what you accomplished.

The second thing is how you work in a team-oriented environment. M.D. Anderson is not a place for people who think they have all the answers or who think they are going to be the critical kingpin to get a project done. I sometimes draw an organizational chart of the IT organization that shows the customers at the top and the CIO at the bottom to get people’s attention. That chart shows that the most important component of what we do is customer service. We look for people who understand customer service because we have very challenging customers. I can’t imagine a more challenging group of customers than physicians who deal with life-and-death decisions, who are on the cutting edge of research, who are under significant pressure to publish and to do research because they work in an academic environment as well as provide clinical care. These are very stressful environments, so you want a team of people who know how to move problems along, focus on customers and communicate with colleagues.

Do you include M.D. Anderson employees from outside IT in your IT recruiting process?

Yes, typically at the director level (which are my direct reports) because they work so closely with the business side of the house and at the manager level. When we seek to hire a new director, for example in financial services, we have a group called Administration & Financial Services that will be part of the recruiting process. We hired a new director for that position a year and a half ago. He went through a very rigorous interview process, not only with the people who would become his peers in IT (other directors) but with vice presidents and the chief financial officer. At the end of that process, we contacted them directly and collected their input on what they thought about the candidate.

Who was the first person you ever hired? What company were you working for and in what capacity?

When I was in high school and college, I ran a house painting business. The first person I hired was a buddy that worked for me in the house painting business. When I got out of graduate school and got into the real world of work, the first people I hired tended to be administrative support staff.

Did you receive training on how to hire early on in your career

No.

What did you base your hiring decisions on then? Do you use the same approach today?

I tended to hire people whom I thought could do the job, and I erred on the side of giving people the opportunity to prove themselves. For example, we would go through the interview process, and if I really needed somebody and the candidate’s skills looked good but I wasn’t sure the candidate was a perfect fit, I would tend to give them the opportunity.

I hope I have become more sophisticated about understanding the experience that I’m looking for, so that I have more confidence in my assessment of whether somebody can actually do the job. At this point, my focus is on really understanding the match between the chemistry, the capabilities, the experience and the task we need done.

Is hiring instinctive, or can you teach people how to make good hires? Do you consider yourself an instinctive hiring manager?

I think you can teach people how to hire. Much depends on the training and interview processes. If there’s an instinctive aspect of hiring, it focuses on the chemistry—will that person be able to work with the team, colleagues and supervisors? The part that’s not instinctive focuses on what the candidate has accomplished.

How do you determine whether a candidate has the needed skills and will be a good fit with your IT group and your organization?

We look at educational accomplishments and credentials. That’s very important to us as an academic medical center. A director in our organization must have a bachelor’s degree in the field in which they are now working. We prefer people with master’s degrees at that level. Virtually all of our directors either have master’s degrees today or are working on them. I have a PhD and that gives me a certain entrée into the organization. I also happen to be an associate professor in bioinformatics and computational biology, which also gives me credibility with my colleagues and customers.

Beyond academic credentials, we also look for certifications. If someone is going to come in as a senior IT project manager, they must have a certification as a project manager. If you’re coming in to work in a clinical area as a business analyst, your position may actually require that you be a nurse. We’re getting to the point now where we’re developing exercises for our technical staff. It is not enough for you to tell me you’re good at your job. I may give you an assignment and tell you to come back and show me that you know how to complete it. We’re increasingly looking for evidence that you not only are who you say you are, but that you have accomplished what you say you have.

What do you consider a successful hire?

In many ways, if we make a successful hire, chances are that person will stay for a while. When I look at people who I think have been successful in the organization, they are—by and large—people who have come in at the right level and progressed through the organization. Every couple of years, these people are looking for promotional opportunities. We have a strong emphasis on continued education, so if you’ve been a successful hire, I want to know that you’ve gone out, looked and taken advantage of our educational opportunities. We have people who come in on time, take an hour for lunch, and leave at 5 p.m., and they are important people in the organization, but a really successful hire is somebody who is hungry to learn, move in the organization and embraces all the aspects of change that we have. Working in a place like M.D. Anderson is like working in quicksand; things are constantly shifting under your feet and you have to be fairly fast to keep up with that. People who are successful do that very well.

What is the biggest hiring mistake you’ve made, and what did you learn from it?

I like to give people the opportunity to demonstrate their capabilities even if there is not a perfect match and I’ve been disappointed after hiring someone who didn’t step up to the opportunity. I’d like to tell you that I made that mistake once, that I learned from it and never made it again. The problem is, I’ve made that mistake a number of times. I think it’s my nature. I’m someone who really likes to give people opportunities, to see people grow and step up, and who tends to give people the benefit of the doubt. In some situations, that has worked, and when it works, it is a fabulous thing to see.

What was the worst interview you ever conducted?

The worst interview I ever conducted was with a staff member whose qualification for the position was a bachelor’s degree in a field related to the position for which we were hiring. This person had been doing similar work but did not have the specific degree we were looking for. That was the dilemma. I was interviewing this lovely person who looked at me across the table and said, “You know, Dr. Vogel, you don’t qualify for this position either.” I said, “You know, you’re right, but then again, I’m not applying for it.” It wasn’t the worst interview, but it was a fascinating twist in the process.

Have you ever had a case where you really liked somebody you interviewed, but your team didn’t like them? If so, did you hire them, and did the person work out?

I don’t think I’ve ever had a situation where I’ve had someone go through a series of interviews where the team didn’t think the person would work, while I thought the person was fabulous. I think the reason is because when a candidate goes through a series of interviews—particularly when they are interviewing with the people they will be managing—if those people come back and say they’re not comfortable with the candidate, you’re setting yourself up for a very difficult situation as CIO if you override that process.

I have had the opposite situation, where the team members liked a candidate who I didn’t think was a good fit. It happened when the team members were not particularly effective in their own interview process. When I hire people who work directly for me, I’m looking for very particular kinds of experiences and chemistry. In a sense, I’m the one taking the risk because I make the final hiring decision.

Do you require unanimity on a hire?

There is usually some dissention because you have six or seven people involved in the interview process and not everybody is going to think the candidate walks on water. For directors, I make the final decision. For managers, the individual director makes the final decision. I’ve even interviewed manager candidates and told the director that I wasn’t sure it would work, but it is their call. I’ll give them the benefit of my experience and questions, but at the end of the day, it is their decision. I think that’s one of the most difficult things that a CIO can do: to let staff make their own decisions because the CIO will pay for some of the consequences if it does not work out.

What should candidates wear to an interview?

That’s an interesting question, because if you’re talking to programmers and they’re dressed in sports shirts and slacks and their boss is wearing a sport coat and tie, you probably ought to wear a tie to the interview. I tend to be more conservative about dress. It was an interesting cultural experience going from New York to Houston. New York tends to be much more formal in terms of dress codes; by and large it was suits and ties and white shirts. Houston is much more laid back. My direct reports and I discussed the issue for months. I have relaxed my standards since being in Texas. It is hot, so the expectation that you should always wear a suit or wear hose does not work when it is 95 degrees and 95 percent humidity. As a general rule for an interview, you create a far stronger impression if you overdress than not.

What should candidates keep in mind during job interviews, whether they’re interviewing for a CIO position or to work for a CIO?

For someone interviewing with a CIO or to be a CIO, you should talk about what you’ve accomplished, how you work in complex organizations, what teams you have been a member of and how that team’s success has been enjoyed by others. You might want to give examples of your leadership on a team and what you have done for your customers. I want to know what teams you’ve been on, what you’ve contributed, and you have to be dead honest.

I think one of the dumbest questions in an interview is, Tell me about your failures. Nobody likes to talk about their failures. There are very few individual successes and very few individual failures. If the interviewer focuses completely on these, it is not a realistic discussion to have.

Do you have any pet peeves during an interview?

People who think they are the most important thing to come down the pike and who can’t imagine in their wildest dreams why you wouldn’t hire them on the spot. I’ve interviewed those people and, frankly, their attitude tells me they don’t understand the complexity of the world in which we work and that’s unfortunate. And, by the way, turn your BlackBerry or phone off before you come into the room.

What advice can you offer candidates about their résumés, thank-you notes and cover letters?

Thank you notes are almost a lost art, but I continue to be impressed with people who write a follow up thank-you note emphasizing their fit with the position. What I find most difficult is when someone shows up for an interview and says that they don’t know much about M.D. Anderson and asks me to tell them about it. That’s something they could have learned had they checked our website and done their homework.

If someone is a quality candidate, would they have a better shot contacting you directly or should they go through human resources?

Our human resources department probably processes 3,000 to 4,000 successful candidates a year. We have an employee base of approximately 17,000, so there are a lot of résumés that flow in either electronically or on paper. It is probably true that sending a note directly to the CIO with a résumé at least gets some attention. If I receive a letter or résumé and it looks like somebody who might be of interest to one of my directors, I will send the résumé to the director and let them handle it. I will also send it to the human resources department.

As a state agency, we do have a fairly formal hiring process, and we have to be sure that we comply with all of the relevant hiring regulations and EEOC requirements, so everybody has to go through human resources at the end of the day. I do get some résumés by e-mail that I do discard because the e-mail is poorly written or the résumé has nothing to do with anything we do. One of the lessons that people need to learn is networking, so when someone is recommended to me from somebody I know, I certainly pay more attention to that than a blind letter. Networking really does work.

What three interview questions do you always ask and why?

I want to know what you’ve accomplished and how you’ve accomplished it. That tells me whether you think you’re the only guy who’s actually done it or whether you were part of a team.

The other question I typically ask is, What do you see yourself doing in three to four years down the road? One of the things that I’m interested in is whether this particular opportunity fits into your career path, and I want to know that you’ve thought about your career. If your response is that you think the job you’re applying for looks like an interesting job, but you don’t have a clue what it is going to do for you, you don’t know where you’re going to be in four to five years or what you want to do in four to five years, that tells me that this person will end up drifting. I want to know that this particular job is something that you think is a fit for you given your career plans because we’re deciding whether it is a fit for us. I think this goes back to the successful hire question—a successful hire being in some ways someone who’s an organizational fit as well as an individual fit. When those two things come together, as someone once said, it is a beautiful result.

John Mann is associate director of The Alexander Group. He works out of the executive search firm’s office in Houston.