Modern IT strategy requires the CIO to be both technologist and business expert. On this episode of CXOTalk, we bring a book author and IT strategist together with a practicing CIO in healthcare. 

Christopher Houser is the Chief Information Officer at Signature HealthCARE, a $1.1B organization with 116 locations in 10 states and over 17,000 stakeholders committed to services across the continuum of care: skilled nursing, home health, assisted living and in-home care. Christopher supports the company’s digital growth agenda, leading an enterprise technology transformation, including significant modernization of the platforms and infrastructure used by the core business and stakeholders to provide the best customer experience at all times.

Isaac Sacolick is a successful CIO who has led digital transformation, product development, innovation, agile management, and data science programs in multiple organizations. He has transformed underperforming businesses by delivering new digital products, investing in strategic technologies, enabling agile practices, outsourcing commodity services and establishing performance metrics. Isaac has been recognized as a top 100 social CIO, blogger, and industry speaker.

Transcript

Michael Krigsman: I love talking with practitioners. I think it's so important to actually get out into the field and talk with people who are doing stuff.

Before we begin, I want you to right now, please, subscribe on YouTube.

Our first guest is Christopher Houser, who is the chief information officer at Signature HealthCARE. Hey, Chris, how are you? Welcome. This is your first time at CXOTalk, and I'm thrilled you're here.

Christopher Houser: Thank you, Michael. I appreciate it, and thanks for asking me to join you this afternoon.

Michael Krigsman: Chris, please tell us about Signature HealthCARE and tell us about your role there.

Christopher Houser: Yeah. Signature HealthCARE is a leading provider of long-term care, short-term care, managing skilled nursing facilities, assisted living facilities, rehab, home health, and cognitive care. We operate in 10 states, we have 115 locations, and we support 17,000 stakeholders and team members across the organization.

Michael Krigsman: Okay, so it's a large organization, and you're the CIO.

Christopher Houser: Yeah, the CIO, so anything that touches the blue cable. As I've said before, the whole spectrum of IT. If you think of data center, you think of end-user computing, facility computing, anything that touches the CNAs or stakeholders in the field, and you think of data analytics. You think of social media, digital, data warehouse. Anything and everything within IT is under my purview.

Michael Krigsman: Okay. Great. I'm looking forward to exploring more about that during the next 45 minutes. Our second guest has been on CXOTalk before, and it is Isaac Sacolick who everybody knows as StarCIO. Isaac, welcome back to CXOTalk.

Isaac Sacolick: Michael, thank you for having me again. I'm glad to be here. I can't wait to have this conversation with Chris about the CIO strategy.

Michael Krigsman: Isaac, tell us about your book.

Isaac Sacolick: The book has been out for about a year now. It's called Driving Digital: The Leader's Guide to Business Transformation Through Technology. I really wrote the book over my ten years of being a CIO and, ten years prior to that, being a CTO.

Michael Krigsman: Tell us. When we think about the CIO strategy, what are we actually talking about?

Isaac Sacolick: Today, we're talking about not just keeping the lights on and keeping things stable. We're also not just talking about process improvement and cost reduction. We're talking about growth. We're talking about aiming at new markets and improving customer experiences so that our businesses can be competitive over the next five years.

We know that businesses that are falling behind are susceptible to being disrupted, and that's happening across industries. We know that we need to service our customers internal and external with more data and analytics and increasingly more automation and artificial intelligence. The CIO's strategy needs to look at both short-term and long-term opportunities around that and craft a strategy, a program, and an execution plan around that.

Michael Krigsman: Christopher, when Isaac talks about customer experience and things like that, it's kind of shifting away from a pure technology focus. I wonder what is your experience at Signature HealthCARE and how does that play out in the healthcare world?

Christopher Houser: Yeah. I think, if you look at customer experience internally, we've tried to focus that in areas of internal and external. We look at our internal users, whether that's HR, whether that's marketing, whether that's legal, all the way down to the CNAs on the floor taking care of our residents and patients at the facilities. When we look external, we look more toward the patient side or the resident side, coupled with their families.

Looking at all those angles, how do we take IT and apply those changes or updates to those users or enhance the IT. I'd also say that if you look at technology as a whole, consumerism of

Michael Krigsman: I love talking with practitioners. I think it's so important to actually get out into the field and talk with people who are doing stuff.

Before we begin, I want you to right now, please, subscribe on YouTube.

Our first guest is Christopher Houser, who is the chief information officer at Signature HealthCARE. Hey, Chris, how are you? Welcome. This is your first time at CXOTalk, and I'm thrilled you're here.

Christopher Houser: Thank you, Michael. I appreciate it, and thanks for asking me to join you this afternoon.

Michael Krigsman: Chris, please tell us about Signature HealthCARE and tell us about your role there.

Christopher Houser: Yeah. Signature HealthCARE is a leading provider of long-term care, short-term care, managing skilled nursing facilities, assisted living facilities, rehab, home health, and cognitive care. We operate in 10 states, we have 115 locations, and we support 17,000 stakeholders and team members across the organization.

Michael Krigsman: Okay, so it's a large organization, and you're the CIO.

Christopher Houser: Yeah, the CIO, so anything that touches the blue cable. As I've said before, the whole spectrum of IT. If you think of data center, you think of end-user computing, facility computing, anything that touches the CNAs or stakeholders in the field, and you think of data analytics. You think of social media, digital, data warehouse. Anything and everything within IT is under my purview.

Michael Krigsman: Okay. Great. I'm looking forward to exploring more about that during the next 45 minutes. Our second guest has been on CXOTalk before, and it is Isaac Sacolick who everybody knows as StarCIO. Isaac, welcome back to CXOTalk.

Isaac Sacolick: Michael, thank you for having me again. I'm glad to be here. I can't wait to have this conversation with Chris about the CIO strategy.

Michael Krigsman: Isaac, tell us about your book.

Isaac Sacolick: The book has been out for about a year now. It's called Driving Digital: The Leader's Guide to Business Transformation Through Technology. I really wrote the book over my ten years of being a CIO and, ten years prior to that, being a CTO.

Michael Krigsman: Tell us. When we think about the CIO strategy, what are we actually talking about?

Isaac Sacolick: Today, we're talking about not just keeping the lights on and keeping things stable. We're also not just talking about process improvement and cost reduction. We're talking about growth. We're talking about aiming at new markets and improving customer experiences so that our businesses can be competitive over the next five years.

We know that businesses that are falling behind are susceptible to being disrupted, and that's happening across industries. We know that we need to service our customers internal and external with more data and analytics and increasingly more automation and artificial intelligence. The CIO's strategy needs to look at both short-term and long-term opportunities around that and craft a strategy, a program, and an execution plan around that.

Michael Krigsman: Christopher, when Isaac talks about customer experience and things like that, it's kind of shifting away from a pure technology focus. I wonder what is your experience at Signature HealthCARE and how does that play out in the healthcare world?

Christopher Houser: Yeah. I think, if you look at customer experience internally, we've tried to focus that in areas of internal and external. We look at our internal users, whether that's HR, whether that's marketing, whether that's legal, all the way down to the CNAs on the floor taking care of our residents and patients at the facilities. When we look external, we look more toward the patient side or the resident side, coupled with their families.

Looking at all those angles, how do we take IT and apply those changes or updates to those users or enhance the IT. I'd also say that if you look at technology as a whole, consumerism of technology, the experience, and what they expect from that technology is the same as if it's internal or external.

We're trying to reduce turnover within staff right now. Competition is high for CNAs, workforce in the field, so how do we bring technology to their hands to make their jobs easier day-to-day to then take care of our residents and increase that experience as well?

If you look at residents, how do we then take care of them and their facility, whether it's the bedside, whether it's at home, home health or rehab? How do we then take the technology and apply to them as well to increase their experience?

Michael Krigsman: Isaac, it seems like this is really the common thread, not just in healthcare, but across industries. That's the new role of the CIO is growth and experience.

Isaac Sacolick: I don't think you can separate those two. What made our businesses successful to date is really something that's going to have its half-life in months and short numbers of years. There's a higher level of expectations from our customers, whatever industry you're in. We have lower loyalty. We have easier switching costs. We have higher expectations.

Chris, I'm interested in an example. I come to visit one of your facilities. I'm interested and maybe I have a family member there. What's different today than maybe just a couple years ago in improving family or patient experience?

Christopher Houser: Yes, so I think it's, again, the technologies that we have in our hands. It's the mobility, having patient charts, medical records, updates in the palm of the hand of the CNA, the nurse, the practitioner, and having that interaction with the family member, the caretaker real time, being able to exchange that or take action real time. In the past, it was paper charts. It still is prevalent within the industry, paper charts, so we're trying to go from a paperless environment to a mobility strategy within our facilities and across those locations.

Isaac Sacolick: That's a common theme, right? Let's leave paper behind. Let's get more mobile. Let's put real-time information in front of people. Let's make sure it's accurate. Let's think about the experience of somebody who is here for a long-term, and let's think about somebody who is just coming into a facility for the first time and doesn't even know their way around. Right?

Christopher Houser: Right. Absolutely.

Michael Krigsman: Chris, to what extent are you focused on these experience issues, whether it's internal or external, versus maintaining technology?

Christopher Houser: It's a careful balance. When I first started seven, eight months ago, we were focused primarily on IT, keeping the lights on, so end user requests: I need a new computer; I need a new phone; the system is down; it's broke.

Moving away from that, keeping the email system up and running, keeping the network up, that's standard operating procedure, so that's our job, regardless. The shift in reshaping our team internal to be more business-focused when it comes to a business relationship management approach, we have built a project management office. We've put centers of excellence within our groups focused on the network, end-user compute, project management, security, and then as well as data center and your general network support.

Michael Krigsman: I think that's really interesting. To deliver customer experience is not just about having good intentions, which we all have, but it's actually building the processes, the technical infrastructure, and the people, organizational infrastructure, as well.

Christopher Houser: Absolutely. I think one thing I'd left out is we've taken an approach. We've started a monthly tech talk Thursday. I bring my IT leaders, my IT group, and we talk about what are problems in our industry, but then what are problems in our facilities and across the business, and how do we look at that proactively? How can we change things we're doing today to improve not just the customer experience, but operations and business operations? How can we streamline and simplify things we're doing with technology?

Coupled with that, we have IT staff who will be going out to our locations, sitting in the corner of a hallway, and then watch the interactions from our residents, from our staff members, and from family members with the technology we use. That way we get a lift in the use and simplicity of the technology that we're deploying.

Isaac Sacolick: Yeah, and I love hearing those examples. I know, for example, PMOs in CIO organizations come and go. They're in favor; they're out of favor. But, when you're trying to solicit lots of ideas from the organization, particularly in transformations where it really is a bottom-up exercise to hear ideas from people that are actually interacting with customers, you need a place to capture those. You need a place to vet those. You need to find exactly who is going to be impacted by things. I really like the investment in a PMO to be able to manage those.

I like that you're having expressions to teach people and have people, in IT particularly, learn more. People in IT can't be business focused if they don't have the opportunities to learn what patient experience really means or what a doctor really needs to be successful. Putting a program like that in place, and an ongoing one, is really smart.

Then the other part of this is letting IT really go and experience what the end users are doing. So much of what IT has experienced in the past has been filtered through other people and systems and texts, sensors, [and] service desk tickets. To actually go and live the life of an end user is so important for them to think through not just what's being asked of them, but how it's going to impact them and why it's important. That creates really smart implementations when they're ready for it.

Michael Krigsman: Chris, when it comes to the kind of business problems that the organization expects you as the CIO to address, can you tell us about that?

Christopher Houser: I don't know that the business is coming directly to IT. For the standard things, yes. "My system is down." "Can we get this enhancement?" "Can we change this report?" Those things are constant.

I think where we're trying to drive change is being good listeners, sitting in meetings, sitting at the executive table and understanding what we are trying to solve. It's not all directed at IT, but I go back to the turnover, the census, keeping residents in our bed or attracting new referrals from the hospitals or physicians. How do you solve those problems? Most oftentimes, business leaders are looking at those as a business problem, not an IT problem. But, as I sit in those meetings, I come back with ideas, solutions, and then have that dialog to then challenge each other to come up with a solution if IT can be 1%, 2%, or even 10% of that solution that enables and moves the business forward.

Michael Krigsman: Isaac, what about the issue of speed, because I think every CIO is having to deal with that now as well, so overlaying speed on top of these other things that we were just talking about?

Isaac Sacolick: Yeah, so let's use Chris's example. He has a PMO running. He's getting ideas from the organization. He's doing a lot of listening, which is really smart. Netflix didn't figure out what to go market early on because consumers said, "I want the DVDs by mail." They just said, you know, "We want a better experience than what we're doing at Blockbuster, and we don't want to pay late fees anymore."

Lots of CIOs have to not only do this themselves but get out in the field and do a lot of listening and a lot of proposing. Here are ideas. Here are solutions. Here are things that might work. See what has traction. See what people start nodding their heads to.

Then start doing some prototypes because if you put yourself in that marketing role, and that's what I think the CIO is doing a little bit, you can't just listen, talk, and shoot ideas out without having some way to execute it, come back to business users, and say, "What do you think of this? Do you think this is going to work?" Get that feedback, put a beta in front of end users, and say, "Give me some feedback how to make this work better," because, at the end of the day, what we're thinking about today is based on knowledge from the last 6 to 18 months. In 12 months from now, there's going to be a whole new set of priorities and opportunities, competitor pressures, and issues to deal with.

What we're learning today, we need to turn around new ideas into implementations in three, six months. Some of the fastest organizations are taking applications that they're doing today and doing daily changes to it, testing these things, and doing A/B studies like marketers do. I think CIOs need to have that in their toolkit and be able to really think through how to execute faster.

Christopher Houser: Isaac, I think what you said is key, and it's relevant. IT leadership is becoming proficient in all aspects of the business, whether it's marketing, whether it's HR, whether it's legal, whether it's advertising, whether it's the medical side. The CIO's responsibility has become not an expert, but you have to become knowledgeable on how to apply that technology to get those wins and put game changers, from an IT standpoint, into the business so that you get future growth, you get further merger and acquisitions, scalability and flexibility but, at the same time, keeping it easy and simple.

Isaac Sacolick: Yeah, so when I think about them, I'm wondering how you go about doing this. You almost have to have implementation ideas in hand as you're prosing these things, either platforms or partners or things that you can go do and have those head of the curve a little bit so that when an idea takes traction, you have some idea of, yeah, I can implement this in three months, or this is a $10,000 idea or a $1 million idea. How are you learning about these things?

Christopher Houser: Typically, it's just through research. It's peers, other CIOs across the industry, in other industries as well and, in my background, I've been in several different verticals within IT and in leadership, so transportation, retail, insurance, and so bringing that background, some of that background, that experience within healthcare. IT is IT, but how you solve those problems, I think you can bring past experience and expertise. You can apply those and get wins in other verticals as well.

Isaac Sacolick: Yeah, I think that's really smart. I think there are lots of places to draw upon. So much of people have been inside their industry focus, and what is another hospital doing, or what's another care center doing? But, some of the things that you're talking about doing are things you can borrow from retail experiences, from other companies that are doing things that are an interactivity between coming into a center and doing things remotely and through mobile applications, so people who are servicing lots of people--I'm thinking of doctors--how to make them smarter and more efficient when they're used to doing things with pen and paper. How do you get them off pen and paper and using a mobile device to put in a prescription or to read a chart? So much of that has direct correlation to things in other industries. You have to invest the time to go learn what other people are doing.

Christopher Houser: Absolutely.

Michael Krigsman: I want to remind everybody that we're speaking right now with Christopher Houser, who is the chief information officer at Signature HealthCARE and with Isaac Sacolick, who is the author of the book Driving Digital, which is kind of a strategy guide for CIOs.

Right now, there's a tweet chat taking place using the hashtag #CXOTalk. You can participate, and you can ask questions of our guests. We have a question from Twitter, an interesting one, which is, "Christopher, what are the particular challenges of improving resident and patient care in the healthcare industry, and how does IT come into play to support improving that patient experience?"

Christopher Houser: I think the challenge is how quick or how fast IT itself is changing. Technology itself, every 18 months, we're getting a refresh of new systems, new updates. How do you stay relevant in an industry where it's Medicare, Medicaid, you're very lean, you run a very tight operation when it comes to finance?

You have to be creative on solutions sometimes when you come back to present those to senior leadership. You're not always going to be able to go out and build a spaceship that's going to go to NASA. You have to come back and put different solutions, different ideas together to meet those objectives and those goals.

Michael Krigsman: There is a process of gaining buy-in, but how do you reconcile that with that need for speed that Isaac was just talking about and that you were talking about?

Christopher Houser: The speed piece comes back to, I think, the priority and the conversations with the business. Are what they're wanting and what their needs are, is the collective group of leadership across the business all on the same page with that direction, that momentum, and is it a solve that we have to provide? Is it a nice to have or a have to have? Having those conversations with senior leadership, just not IT making those decisions but having business leaders help make those decisions, that's kind of where I'm stepping back within my team. We're looked at more as internal consultants and then bringing those solutions as we see them to the business leaders to have them make the decisions and not just solely on IT.

Isaac Sacolick: Yeah. Just to add to that, I think the speed comes from what Chris is describing and that we often call channeling and MVP, a minimal viable product, something that you can put in front of end users and iterate over and get smarter. I'd contrast that to some of the projects that we've done in the past where end users and stakeholders want a 400-page document delivered and IT is trying to respond to a very long list of requirements. Then people scratch their head and wonder why it's taking months and months of time to do the execution.

The ability to have a discussion about what's really required, what can we iterate on, showing end users results through an agile process and giving them something to look at every couple of weeks and to respond to, I think that's the speed factor. I think pivoting because some new priority or issue has come up, and being able to reprioritize something, I think that's a function of the PMO.

I also think, to something Chris was saying, every industry has its constraints. In medical, its margin is dictated through Medicare and Medicaid. It's being HIPAA compliant. It's recognizing that it's an industry that's had a long history and you can't just change the experience for doctors overnight. You have to nurture that change with them.

It's also recognizing that when a family or a patient is in, they're not at their best moments. How do you make it easy and simple for them to go through what is often a difficult period for themselves? I think all those play into how you design experiences and how you slowly transition users from how they operate today to something that's more automated and smarter. But, I think the speed is about really coming up with ideas that you can execute on and then iterating over them and getting feedback to make them smarter.

Michael Krigsman: Chris, I was very intrigued by something you said a moment ago, which is that speed, that in order to have speed, it demands, it requires close alignment between IT and the underlying business goals. Isaac was just talking about tactical elements of how you get there, but you're saying that in order for any of that to work, IT has got to be on the same page with business goals in the first place.

Christopher Houser: Absolutely. The alignments, if you think of strategy, IT typically follows business strategy or tries to compensate on the strategy of where the business is going. Oftentimes in the past, IT would go off and build solutions, build systems half-baked or what were perceived as half-baked, come back to the business and say, "This is what we thought we heard," and deliver on what wasn't supposed to be or what was not intended to be the outcome. Delivering half-baked solutions and then having to go back and rework the complete solution. Time, money, and resources add up, so having the business a part of that journey or through those conversations, through the selection process, through the requirement process, through the build process, and those iterations are definitely needed and definitely required.

Isaac Sacolick: Chris, let's put that to a practical example. You've been in the organization for a few months. You've done some new rollouts. You're looking at new platforms. How do you make it into a business-aligned project and not just an IT project?

Christopher Houser: I think a great example of that is one we're going through right now, and that's our EMR. We're going through and doing an EMR refresh. In the past life when we built the current EMR, it was in-house built. We had flexibility. Kind of an open source solution. We took business requirements of the business to build this EMR.

Now that it's five, six years later, maintaining, updating, creating, the flexibility there was that we could build whatever we wanted. However, we weren't keeping pace with the industry. We had a lot of shortcomings--good, bad, or indifferent--because we were focused on things that were impacting to us, not necessarily the industry.

As we look for this new solution, instead of IT coming to the table saying, "Hey, this is the solution," we have brought a taskforce or a committee in from all different business units and leadership across the organization to help make this decision, so everything from monthly meetings to reoccurring weekly meetings, and then having the vendors come in through an RFP process. We've had two or three vendors come in to give us that review, and the business was in all those meetings from those respective departments and groups.

Isaac Sacolick: Yeah, so a couple things there worth reflecting on, right? Number one, this idea of taking something that was built in a proprietary way three, five, seven years ago. A lot of businesses find that that no longer makes sense, that there are platforms that are extendible, that are more feature rich, that are more industry standard, that are plugged into ecosystems and things like that are really what they're looking for. Then taking that idea and that need and saying, we're going to partner with the business on a selection process, bring vendors in, and do this collaboratively and together is so important, particularly when looking at key platforms that are running the business.

Michael Krigsman: Really, the thing that you're both kind of homing in on is finding whatever way is possible in order to have closer ties on a more frequent basis with the business, the definition of projects, during the running of those projects, at every step along the way. That seems to be where this is all going.

Christopher Houser: Absolutely. I think you hit it on point with the business has to see value in IT, right? In the past, IT was thought of as an operational organization, meaning go make sure the servers are up in the data center. Make sure the applications are up and running. We don't have downtime. We're meeting five nines.

If that's all I came back to the business in today's environment, I would be surpassed, right? I've got to come back and bring my team, the collective team, and bring solutions for the future. What are we going to do to solve real business problems? I think that, with that, the business wants you to then execute and deliver when you come at those solutions, so you've got to come with trust, and you've got to come with being able to get things done in those moments of time.

Isaac Sacolick: Chris, maybe talk about that in the context of emerging technologies and things that perhaps are some of your ideas that you're bringing to the organization around business intelligence or artificial intelligence where the technology is a little bit emerging and you still want to get that alignment on what ideas to focus on.

Christopher Houser: Yeah, I think, on the AI side, we're looking more at being innovative. What can we do with AI? Everything from predictive analytics, machine learning, or bringing that to understand if a patient or a resident in our facility, if Suzie in Suite X or Y has a continuous fall, can we start to track that through data, through the EMR? Can we then be proactive with that data across the business to prevent that fall or take the action that's needed to do that? In that capacity of AI, we're looking in that area.

We're also looking at AI from an Alexa or from an interaction. Can we bring that into the facility to then enhance the patient experience or a resident experience? Can we use for memory care? Can we use it for dementia? Can we use it for games, entertainment? We haven't rolled it out completely, but we are looking at AI in that capacity as well.

I'd say for the data warehouse, data is key. It's critical for the operation of our business and movement forward. I've got a partner in the business who is in informatics. On the backside, we're looking at refreshing our data warehouse across several different databases and environments.

We have three to four different EMRs because we have different business operations. We have the skilled nursing, we have the rehab, and then we have med partners in our business. Each one of them had their own EMR.

As we're switching to the continuum of care to take a resident or a patient from the hospital, the physician referral, all the way through rehab, all the way through to home health and then discharge, we want to make sure we see that patient, their journey, all the way through and be able to track, update, or report on that as needed. It's bringing that, understanding that the data warehouse today--I don't want to say broken--is siloed, and then how do we bring that data together with reporting tools, whether it's BI or Power Bi, Tableau, Salesforce, et cetera.

Isaac Sacolick: That's awesome. You just hit on almost all the aspects of a transformation journey, thinking through what's the patient journey that they're going through that you have to support, recognizing that you're working with multiple systems, so finding what's the data warehousing approach to bring all of this data together. Looking at that data in terms of what types of problems and questions you can throw at it that will improve your operations and improve safety of your patients. Then even looking at next-generation devices, voice controls, and user experiences, and realizing that that can improve things internally. You've sort of got everything in there in one sentence.

Michael Krigsman: Christopher, as you're thinking through all of these pieces, how much of your efforts are spent towards these innovation activities versus the operational stability and just maintenance?

Christopher Houser: Yeah, today it's 80/20. I came to the organization about seven, eight months ago. We had a lot of work to do from a maintenance standpoint. I say modernization, and I'll say that modernization is always evolving. Modernization, we talk about core systems. The data center, getting out of the data center on-prem solution, moving to Azure. When we talk about a PC refresh, lifecycle management, that's maintenance. When you talk about networks, keeping networks up and running, putting an SD WAN solution in place, that's maintenance.

I would say, today, it's 80/20. We're trying to flip that to a 60/40 over time but, again, since we've just recently put in the project management office, the business relationship management, and then partnering with our partners across the business, whether it's innovation, whether it's data analytics, where we're going, I think that will slowly change. We've just recently set up project management reviews where we bring in business leaders. Our project management takes on and then shares project updates: where's the status; where we're at; what are the constraints; what are the challenges; can we get the projects done? I think, over time, that that will slowly change with what we're putting in place.

Isaac Sacolick: That's also really typical. I'm wondering; are you at a point where you're putting KPIs in place around going from 80/20 to 60/40, or you're still early in your making directional value statements over what you're trying to do?

Christopher Houser: I think metrics will come. We're not there yet to measure that. I can tell you that there's been high success around what we're doing. The business has bought in. The business is appreciative of the direction we're heading with the PM, the PMO office. We think that the IT PMO office will eventually grow to an enterprise PMO because it's not just IT projects, but we need to correlate all the different initiatives and bring those into a strategy, overall, outside of just IT.

Isaac Sacolick: Yeah, and I actually think that's one of the issues PMOs had in the past is that when their visibility was really looking at things from only an IT perspective, so there was the IT part of the project and then there was everything else that was the end-to-end to make that project successful, and the PMO only had visibility and authority in that IT part. As you're doing more growth, experience, and data-oriented projects, you really need to define and manage it from an end-to-end deliverable perspective.

I think, if you're going to do PMOs today, you have to have the buy-in at the executive level that IT is going to manage an enterprise PMO. It's going to start with the business idea. It's going to continue on through an iterative process to deliver. It's going to start measuring the impact of what you're delivering. It's going to decide when it makes sense to invest more or maybe diminish the investment and go after another idea. To have that dialog with the executive group saying, "We're doing this as a service to the business so that we're making the right investments at the right levels and measuring their outcomes."

Michael Krigsman: What are the challenges and the opportunities of having that senior level conversation, and how do you get the top management in the organization to buy into IT as being more than just a technology function?

Christopher Houser: Yeah, so you're always going to have the approach when bringing the project management office together. There's going to be, I'd say, conflict resolution, right? Everybody wants to be first. Everybody wants to have the top priority.

What I'm trying to embrace here is IT cannot be the group who sets the priority of the business projects. How does IT step back, however, be the conduit of the bridge to get these projects done? With the business setting direction, setting priorities, IT then can go execute and deliver on the requirements that are there.

Michael Krigsman: It's a real partnership. That gets back to what you were saying earlier. IT can't take the lead on what the business wants from IT. Yet, IT has to be lockstep with the business in terms of understanding those priorities and also understanding the underlying reasons why.

Isaac Sacolick: Michael, I think part of this is getting a firm understanding of your executive group. Executive groups operate differently. They have different cultures and values. How fast they want to go and what they want and what they're surprised that IT is doing is very different.

In one organization that I was CIO in, I actually had to rebrand IT and call it a digital organization so that people across the organization looked at us differently, had different expectations of us, and allowed us to do things that maybe wasn't expected of IT, as people didn't want to work with IT in that way. I think, very much, we talk about CIO strategy. Part of the strategy is really understanding the temperament of the executive group and finding the right way to position things that you know that the enterprise needs but may never have thought about who is responsible for it, why it's important, and how to orchestrate it across the board.

Christopher Houser: I think you're absolutely right. I think the other piece is also giving IT a voice at the level of the executive team. Often, IT is thought of down in the basement, on the first floor. They're just keeping systems running.

I think, here at Signature, we're starting to change that visual of what IT is from just keeping the lights on to being part of the direction forward. In the past, we were order takers. We're trying to move from that order taker reactive mode, to become part of the business and consultative, provide solutions as we move forward, more proactive than reactive.

Michael Krigsman: What do you have to do inside your IT organization to change this focus in terms of talent management, training, mindset, culture, whatever else it might be?

Christopher Houser: Yeah, so I was very fortunate to join an IT team who had great knowledge of the business here. I'd say the IT technical staff are very well versed in the technologies that we have and that we support. Their eagerness to change, when I was brought in to change the structure of the organization, each and every one of them were flexible, and they wanted to go that path because they knew that it was going to stretch them, as well as they want to learn new things.

We're not at the endpoint yet. However, through this transition and change, I have not had any of the team members raise a hand and say, "I don't want to be a part of this." I think they're all encouraged by it, but the change is difficult because it's something new. It's going to take some time to get to, but I would say that we're executing and delivering on what we've set out to do.

Michael Krigsman: Christopher, as we finish up, we haven't yet touched on security. What about security in healthcare? How do you address that?

Christopher Houser: It's vital. It's required. At the end of the day, patient information, patient data with HIPAA, PHI, even PCI to some extent with credit cards and data going across our network, we have to know where it's at, at all times. We have to know who has access to it at all times, both internal and external.

Therein lies the challenge with security. It's always changing. It's never constant. Threats are always going to be there, so you always have to put a defense plan, electrify the fence, putting up that plan to how you're going to mitigate or prevent against it.

Christopher Houser: Chris, I'm wondering. Is this a conversation that's happening with your executive committee or with your board? Do they want to know what security threats you've been experiencing? Do they want to know what the security plan is, or is this just something that's the blue wire and they expect you to be doing but it's not something they discuss or review with you?

Christopher Houser: No, it's a have to, and I think it's going to continue to elevate Signature. I have a counterpart up here, the vice president of compliance, and she and I both work together through these initiatives, as well as legal. We've got to make sure that we've got our team set up for success.

Here in the next two weeks, we're adding a security manager within our team. That security manager will have a dotted line, kind of the hub and spoke across the organization: compliance, legal, as well as within IT, across infrastructure, across application development, and all systems within. That individual will play a key role on positioning security and how we prevent against and how we best attack it.

Michael Krigsman: As we finish up, I want to ask you both what advice do you have for CIOs who want to accelerate this process of aligning with the business, of being responsive and ensuring that IT is lockstep with the business. Chris, do you want to go first?

Christopher Houser: Sure. I think, first and foremost, it starts with your team and how you structure, how you empower, [and] how you lead your team. The CIO cannot do it all, obviously. How do you put key individuals in key roles who can have those conversations in your absence or on your behalf because you can't attend every meeting, you can't attend every hallway conversation or shoulder tap that's happening? You've got to make sure that your team is set up for success and also aligned on the strategy. It doesn't do any good for IT to have a strategy and then staff members or team members don't know how to convey that or communicate it outward.

I think number two is, as CIOs, you've got to make yourself, sometimes, I think, uncomfortable and take on new projects that are not in your comfort zone. Get involved with peers across the business to lead initiatives in areas that you're not an expert in. Then get stretched that way as well. I think that becoming more aware where the business is and where it's going is key.

Michael Krigsman: Isaac, I will ask you the same question. What advice do you have for CIOs who want to ensure that they're lockstep with the business when projects are defined and so on.

Isaac Sacolick: Yeah, there are still studies that have come out this year that say that CIOs, only 40% to 50% of them, are leading transformation programs in their businesses. I'm appalled by that number. I'm scared for our role in organizations and how it's perceived with our peers.

If you're not thinking about your job completely different than what you were doing three years ago in terms of how you're spending your time, in terms of your focus area and what you're delegating, a tremendous amount of time building relationships one-on-one, one-on-two meetings with the executive workgroup, with their direct reports, cultivating a process of learning from people who are facing customers, if you're not doing those things together, you're going to be really falling behind in your job, in your role, in what's expected of you. I think that really thinking through how you're spending your time is the first step to making a transformation there.

Michael Krigsman: Okay. Well, that has been a very educational 45 minutes and very fast 45 minutes. I want to thank our awesome guests today on Episode #304 of CXOTalk. Christopher Houser is the chief information officer at Signature HealthCARE. Christopher, thank you again for being here, and I hope you'll come back another time.

Christopher Houser: Thanks for having me, Michael. I look forward to it.

Michael Krigsman: Isaac Sacolick is the author of the book Driving Digital, which is a manual for CIOs and for CIO strategy. Isaac, thank you for coming back to CXOTalk.

Isaac Sacolick: Thanks for having me again, Michael. Always a great conversation here on CXOTalk. If there is anybody on the Twitter chat that's asked questions, I'll be checking it afterward to see if I can help out.

Michael Krigsman: Okay. Everybody, go to CXOTalk.com. You can see our upcoming shows. We have great shows coming up.

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