Why Do Hospital CIOs Have Trouble Keeping Their Jobs?

A recent joke posted by Mr. HIStalk calls attention to the relatively short job tenure of some hospital CIOs (see: HIStalk). It has a kind of "gallows humor" flavor but read on and you will get the idea.

A fired CIO’s replacement finds a note from his predecessor, saying he left three envelopes in the desk drawer to be opened only when things are going really badly. Six months later, the network goes down for most of a day, so the CIO opens up the first envelope and finds a note that says, “Blame the previous CIO.” Great idea! He makes up a convincing story about a historic lack of maintenance and capacity planning, saving his skin. Months later, the executive team complains about excessive IT operational and capital budgets, threatening to freeze expenses. Time to open another envelope. This one says, "Blame your coworkers." He does, arguing that the unchecked technology demands of his executive peers have made him the victim. Months later, doctors are pushing back against mandatory CPOE, saying that it’s typical CIO arrogance that makes him think he understands the challenges physicians face. He opens the third envelope, which says, “Prepare three envelopes.”

This "three envelopes" gag does not explain in detail why hospitals CIOs tend to draw fire at the same time that some of their relatively incompetent C-suite colleagues may stay out of the limelight and retain their positions. Here's my best shot at a list of some of the factors working against hospital CIOs. You may wish to add others or disagree:

• Mistakes by hospital CIOs, particularly when installing an EMR, tends to be obvious and greatly affect the productivity of key personnel such as nurses and physicians. They then tend to complain loudly when their routines are disrupted and they encounter what they perceive as bureaucratic miscalculations. Major decisions by the CFO, by way of contrast, affect such personnel only rarely.
• Many of the electronic record (EMR) products available in the market lack adequate functionality and can be difficult to install and maintain. If such a product is chosen by the CIO and cannot be installed or suffers from periodic and extended "downs" for maintenance, a scapegoat must be sought by other hospital execs who are eager to retain their own jobs. Guess what name tends to pop out of the deck?
• Hospital nurses and physicians would often rather modify new clinical software such as an EMR to support their preexisting work flow and processes rather than adapt to new routines dictated by the new system. The CIO and his/her staff then come under intense pressure to modify any new system. If he or she succumbs to this pressure and customizes the new system extensively, it then becomes a management nightmare. Some EMR vendors such as Epic prohibit such tampering for this reason, thus providing many CIOs a handy excuse to run the system as delivered (see:The Secret to Epic's Success in the Hospital EMR Market).
• CIOs tend to favor the EMRs and other software products of large vendors rather than confront the risk of purchasing products from smaller and sometimes unproved companies. The large companies understand this all too well and may spend more on marketing than upgrading their systems that may lack the necessary functionality to satisfy the end-users of the system in the long run. Older readers may remember the now irrelevant axiom of decades ago: you never get fired for choosing IBM.
• The goal of hospital departmental chairmen (e.g., pathology, radiology, cardiology) is to maximize the functionality and revenue of their own departments. This often results in their selecting best-of-breed LISs, RISs, and CISs. This process may dump into the lap of the CIO "one of every system" to maintain that then require a large and continuously growing central IT personnel budget. The CEO and CFO respond by cutting IT personnel and service begins to further deteriorate.  CIO then begins to stand for "career is over."

Comments

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hey buddy,this is one of the best posts that I�ve ever seen; you may include some more ideas in the same theme. I�m still waiting for some interesting thoughts from your side in your next post.

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I also can't understand why they keep them...

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The system holds patient records and appointments, and at the women's hospital can work with laptop computers on trolleys to allow doctors to order drug prescriptions from a patient's bedside.

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It depend how they perform their duties, loyalty is the main thing they need to maintain when they are at work and as far as their work is concerned but i don't. No company or any hospital is allowed to throw their employees out when they are doing their best for the company's growth.