The CIO for the private healthcare provider HCA International and a former CIO of the Hermitage Clinic in Dublin, Mike Gogola gives his prescription for using IT to drive organisational change, and why buy-in is critical to making change permanent.
Can you tell me about what your current role involves?
I’m CIO for HCA International. We have 200 hospitals and 16 divisions. This is the international division, based in London.
What insights have you learned about the role IT can play in an organisation?
We’re using IT to drive organisational change. When I first came on board, I had to get things up to speed, to where they should be.
We only invest in IT capex if it ticks one of three boxes: if it improves patient care, streamlines the patient journey or aligns physicians with our facilities. Sometimes a project will tick two out of the three.
I’ve worked with teams over the years and in order to make the change stick in organisations, you have to get buy-in from stakeholders, the major department managers. So I get a team together and describe how this project is going to benefit the organisation so they know what the outcomes are and what’s expected of them.
Once I do that, then they have ownership of it and once it goes live, they don’t stop using it, whereas if I dictated anything, they would use it for two weeks and give it up. I don’t push anything on people; I make people think it’s their idea.
What has been the biggest challenge in your career?
I put in a PACS [picture archiving and communication system – medical imaging technology] system in 2001 and it was just a time when they started becoming financially feasible for 400 to 500-bed hospitals, because at that time they were normally for large teaching hospitals.
The COO came to me and wanted to do a PACS. We started looking at several PACS vendors and I had the radiology director and different physicians, because this was going to change the way physicians practised. They were used to having their scans on physical film in the lab; now, all they would have was a radiology workstation.
Halfway through the project, the radiology director had a severe heart condition and I learned more about different modalities and interfaces than I would have done, and I was able to get the project up and running.
So you would see it as creating a team to make a project work, rather than one individual like the CIO driving it and determining how it’s all going to play out?
That’s what it boils down to. The role of CIO is to try and keep the vendors honest, because they will try and sell you stuff that might be vapourware. I’m the only one who knows if they’re lying to me or not. I’m not cynical, but I’ll ask them the right questions: what’s the installed base? Can I do a site visit? How long did it really take you to get up and running, and how many people did it really take?
You were involved in the early stages of the Hermitage Clinic in Dublin – what was that experience like?
That was a start-up, and I had never done a start-up before. I don’t think I’d ever do another one: It was more work than I imagined. I was the first employee. No one else had done meditech in Ireland. It was a new data centre; I had to recruit people from all over world because nobody in Ireland knew meditech. We had to do training, wireless, infrastructure. It was quite a project – putting in a patient entertainment system at each bedside, for example.
Sounds gruelling. Did you enjoy it?
I enjoyed it. The building was still in construction and we had metal containers for an office … construction guys were asking me questions that CIOs normally never get asked.
How do you rate your time in Ireland in terms of the experience you gained and were able to put to use elsewhere in your career?
It was a good experience. I did use teams there, too, as people came on board, so it was the same methodology to implement change. But we had a two-year window to get everything up and running, and we did it in 22 months so it was quite an accomplishment. I’m proud of that.
Speaking of Dublin, you’ll be visiting here later this month to give a presentation. What will you be discussing?
I’m going to start off by talking about where IT was when I first came here five and a half years ago, and after we did the first refresh – what the platform allowed us to do with certain applications that are critical to patient care.
Originally when I came on board, we had 80 servers and each of them were maxed out on space, 30 days after a patient was discharged … We went to VMware and a SAN then; now we’re going to a tier 3 SAN.
Right now we have got a master patient index based on Meditech. There are some duplicates, but we have eight other disparate systems that we use to treat other patients with. We want to build an enterprise MPI [master patient index] that will allow us to have one unique record. We’re going to use a program called IBM Initiate, and it’s got an algorithm to tell that, for example, there’s one Mike Gogola.
When we want to pull off a patient’s oncology data, if we can do that, we can do data analytics against it. We can identify which cancer you have … We have a lab machine that can do gene sequencing in four hours. It means we can do data correlation for this type of cancer.
We can improve clinical outcomes, reduce the cost of care, and we can publish the data and also advertise the data – that we’re your best source for cancer treatment. And we can sell anonymised data to insurers. We’re probably about three years from that holy grail. But the changes in technology mean that we couldn’t do this five years ago.
In your role, how much is it a case of you as CIO telling the business what IT is able to deliver, or do you get requests for a particular system, for example?
Really, it’s a combination: I get approached by a lot of the CEOs. I’m like a resource for them to tell them whether something is feasible or not, and to say, ‘let’s try it’.
Is there an overdue realisation that IT people don’t just belong in the server room but they have to be out, interacting with the rest of the business and becoming more visible?
It’s kind of a perception but I’ve been asked the question and I say: I’m a techie, too, but I don’t always talk techie. You have to know the business, plus you have to know the technology. Most of the people in my department have the same dual role – they have to deal with users and systems and applications.
What can IT do to change that perception?
I think over time it will come. If you work in IT, you not only know the business, you have a second skillset in technology.
If that’s the case, to what extent are senior IT roles having to include an element of PR or marketing the job that technology does for a business?
Well, it’s marketing – but then we have a structured planning methodology that defines everybody’s roles, what’s expected, who’s the sponsor and who’s the buyer. We just have regular meetings and go through the process.
We’re more a maintenance organisation. I don’t want to pick out something for nurses and then they’ll never use it.
What have you learned over time about the relative importance of people and technology – do you think IT people are occasionally guilty of underestimating the former and overestimating the latter?
I think it’s probably the other way. I’ve got 6,000 users and they all think they’re the IT director. When they ask me ‘can we do this project or that project,’ I have to say nicely ‘no, we’re not going to do it’. That’s how business has changed today.
How do you as CIO deal with that?
I have to tell them, ‘let’s evaluate it’ or, ‘it’s not going to fit with our infrastructure’. Some things we can pilot, some things are never going to work.
Are there any technologies that really interest you right now?
We’re collecting vital signs on touchscreen devices, there are doctors doing rounds with iPads … It’s become a standard and people just expect that.
And is the ‘bring your own device’ trend something you welcome, or do you see it as a security headache?
I welcome it. People can bring their own device but if it’s going to access patient data, it’s got to have a password that can’t be changed.
Mike Gogola will be addressing an audience of CIOs at a briefing in the Shelbourne Hotel in Dublin on 26 September 2013