Cybersecurity Requirements May Break the Back of Nonprofit Health Care in the United States

 

Cybersecurity is a huge concern for health care entities as one of the most targeted industries by cyber criminals according to an article by the EC-Council University (https://www.eccu.edu/blog/cybersecurity/top-industries-most-vulnerable-to-cyber-attacks). The health care industry is so targeted in fact, that Congress is now considering a bill, with the backing of HHS, to mandate that health care organizations strengthen their cybersecurity defenses (https://www.finance.senate.gov/imo/media/doc/health_infrastructure_security_and_accountability_act_leg_text.pdf). This is all well and good for those for-profit entities such as United Healthcare, Humana, or CHI who have fairly deep pockets. The big question is where does this leave nonprofit entities struggling to provide safety net services on sliding fee schedules depending on decreasing reimbursements and grant funding to survive?

Microsoft and Google, working with the White House, have come up with a so-called plan to help, consisting of free and discounted cybersecurity resources to assist in enhancing health care cybersecurity. I call this a so-called solution because it only addresses one discrete area of need, rural hospitals. What this completely misses are the over 1,400 Federally Qualified Health Care (FQHC) centers operating at more 15,000 sites serving more than 26.6 million patients per year or the over 5,200 rural health clinics (RHC) serving more than 37.7 million patients per year, both providing integrated outpatient care to those who otherwise would not have access to health care or couldn’t afford it. These organizations survive on shoestring budgets where the goal is to dedicate every penny possible to patient service. With cybersecurity threats increasing in complexity and number almost daily, it is nearly impossible for these organizations to keep up. Yet instead of providing help where it is actually needed, our technology industry and government make superficial efforts to look like they are helping with the problem while Congress seeks to pass more stringent regulations without any assistance in meeting those regulations.

If you have been watching the news lately, you have seen a number of rural and nonprofit health care organizations closing facilities at a breakneck pace because the margins are so low that they cannot survive. When we layer in the hundreds of thousands of dollars or more that each health care organization is going to have spend to keep up with cybersecurity threats, that means we can expect to see even more health care facilities closing in the areas where they are needed most. We aren’t talking about metro areas like Los Angeles or Chicago, we are talking rural, less densely populated areas such as rural areas of Nevada, Utah, Colorado, Arizona, California, and much of the southern United States. On average, these residents tend to be older and potentially require more medical attention than the average person. In an article published in the Journal of the Missouri State Medical Association (https://pmc.ncbi.nlm.nih.gov/articles/PMC6140198/), it was stated that while 20% of Americans live in rural areas, only one-tenth of physicians practice there.

My call to action is this: While we all agree that increased cybersecurity in health care is necessary and we are all tired of reading about the breaches, we need to come up with some real solutions to assist this industry, especially the safety net and rural providers who are hit hardest by the extra costs that these initiatives bring. We need to stop complaining and put together real action plans because our health care industry is already straining and struggling and the added burden of increased costs around cybersecurity is enough to break it where it is needed most. 

In my next post, I will attempt to provide some suggestions as to how we might be able to attempt to solve this problem.

Think Globally, Act Locally

 Anyone who grew up in the 1970s through the 1990s probably recognizes the slogan “Think globally, act locally” from bumper stickers, t-shirts, and activist advertisements of the era, but I think this slogan actually has a lot of value for us to consider as leaders. In this context, I use “globally” to mean the entire organization and “locally” to mean your department, team, or unit that you manage. As leaders, we should always be thinking about the overall organization and how what we do impacts it, either positively or negatively. We should strive to align our actions with the common goals and objectives of the business, always pressing to further those as much as possible. This thinking recognizes the limitations of our reach as individual leaders, and brings to mind the sphere of influence concept:

There are things that we can control which are our own actions, the actions of subordinates, and the actions that the units we lead take. Then there are those things that we can influence (but not control) which are our peers and possibly our leaders through discussion and debate in meetings, emails, etc. Then there are those things that are completely outside of our control such as organization strategy, board and executive leader decisions, market pressures, and regulations. Basically, what this whole model shows us is that while we strive to help the organization move the needle on its objectives, we should put most of our concentration on those actions that we can directly control and the rest on what we think we can influence and align those actions with the goals of the greater organization, which is mostly outside of our influence.

At the end of the day, our responsibility as leaders is to do what we can to contribute to the success of the organizations for which we work. In order to do that effectively, we have to think about our organization (thinking globally) and align the actions of the units or departments that we lead with the goals of our organization (acting locally). If we always act and make decisions with the goals and objectives of the overall organization in mind and not just what is good for our teams and departments, we will find ourselves contributing and influencing more and more how our organization performs against those goals. You see our actions have influence beyond just the outcome of those actions. How we get to those actions can influence how others outside of our control think about and decide their actions and can have the effect of creating more unity around organizational goals.

Are Are Today’s IT Worker’s Missing Out on Understanding the Demands of the Job?

 

When I first started my career, back in the days of the dinosaurs 😊, positions in IT required a university degree. Coming from that background myself, having earned both an undergraduate and a master's degree, I initially supported this approach. As I moved into leadership and evaluated the fast-changing landscape of IT, I started questioning whether traditional degrees were necessary for success in the rapidly changing IT field. My experience with university education, both from a personal perspective and those that I have worked with over the years, is that most university educations taught outdated and obsolete technology and don’t really prepare employees for the technical aspects of their jobs. This led me to re-evaluate hiring practices, and I began prioritizing specific skill sets and certifications over formal education. It seemed like a win-win: employees gained valuable, job-ready skills quickly, and organizations benefited from their immediate contributions.

However, after several years of hiring employees without degrees, I began to notice a concerning pattern. Many of these employees, often younger and without formal university training, did not seem to understand the full demands of a salaried IT job. Unlike their counterparts with degrees, they appeared to expect a strict 40-hour workweek and consistently sought comp time or flex time for any hours worked beyond that.

When I reflect on my own experience, I realize that my time in university wasn’t just about learning technical skills. It also prepared me for the realities of a professional career. In college, it was regularly emphasized that certain fields, like accounting and IT, required flexibility. There were times when more than 40 hours a week would be expected, whether due to month-end closings or critical system maintenance. These discussions helped me understand that salaried positions often come with an expectation of extra time and effort, and the compensation reflected this.

In contrast, employees without university backgrounds often don’t seem to arrive with this understanding. While they are more technically proficient, they might not anticipate the broader responsibilities that come with a salaried role. This has emerged not just at one company, but across different employers and cities.

To be clear, my observations are anecdotal and may not fully capture the root cause of this issue. It’s possible that what I’m seeing is more of a generational shift, with younger workers in general expecting a stricter work-life balance. Or, perhaps, the trend reflects a difference in how skills-based training programs prepare individuals for the professional world compared to a traditional university experience.

As IT leaders, it’s worth considering whether this is an issue of education or simply evolving workplace expectations. While I don’t have a clear solution yet, I believe this is a topic that deserves attention. How can we better set expectations for new hires who come through non-traditional education pathways? Should we do more to explain the demands of salaried IT roles during onboarding? Or is this part of a larger shift toward rethinking work-life balance in tech?

I’m curious if others have noticed similar patterns. And if so, what steps have you taken to address this challenge?

How Do You Do Innovation?

 

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As an IT executive, I constantly get asked questions about innovation, whether it be from board members, members of our executive team, leaders from other organizations, etc. In fact, back when I was looking for my next role 18-24 months ago, this came up a lot in interviews. What I thought was interesting was the perception that some have, especially outside of the IT space, about how innovation occurs. It seems that there is the misperception that most “innovative” IT departments have teams of individuals just working on innovative solutions or to borrow a term from defense contracting -skunkworks. Many are surprised and usually enlightened when I discuss my approach to innovation. To me, innovation isn’t something that you come into the office and work on as just another task in your day where you require yourself to try to be innovative. I see that as counter productive and a waste of time. Innovation to me is solving a problem in a new or novel way. Now, you will notice that I didn’t mention technology there. Innovation doesn’t necessarily require technology. In fact, numerous times I have worked with department leaders to create an innovative solution to a problem that didn’t require me to add any additional technology to the equation, just a different perspective on how to think through the problem and redesign the workflow. Too often, we think of innovation as some mad scientist creation that happens in the bowels of our IT departments waiting to be sprung on the organization. While some innovation might come about that way, the innovation that I think most of us are driving toward is innovation that solves a problem and not innovation that is looking for a problem to be solved.

So, when I am asked how I encourage innovation across my team, I typically walk through my approach to innovation as a leader with them which usually consists of the following:

I start with developing a mindset toward innovation in my team through coaching and expectation setting.

·         First off, whenever I conduct team meetings, large or small, I always have someone present a problem that they are working on. This is typically voluntary, and my teams have learned to trust each other and me enough to know that this is a safe learning experience and one that they may derive great benefit from.

o   We walk through the problem statement, any steps that have been documented as part of the current process, and then what my team member has done or at least their thought process around how they are going to approach the problem.

o   I usually go first by asking some questions, which is typically where I encourage the innovative process because it lets my team know how I would approach or try to bring innovation to the problem.

o   Now, I know that my answer isn’t always or probably not even usually the right answer, so this is where I invite the rest of the team to chime in and ask their questions and begin to provide their suggestions.

o   What the presenter walks away from the meeting with is usually a pretty decently fleshed out plan for how they might solve this problem, and it is typically much more innovative than if only one or a couple of us had come with it.

·         So, this is the second thing to keep in mind about innovation: it quite often requires more than one brain and one set of eyes to really work. While encouraging innovation I also encourage collaboration, and I think the two go hand in hand. And this collaboration doesn’t just stop with the IT team but should also include the person/department that raised the problem in the first place and any potential stakeholders.

·         The third thing to keep in mind about innovation is there are no heroes in innovation. Everyone that participates in the process is part of whatever innovative solution that has come up. No one should be keeping score or trying to get credit for something innovative. Once that happens, innovation is now stifled by individual glorification. Let’s look at an example of how this might play out in both a positive and negative way:

 

Take my earlier statement about how often times when I get involved in helping solve a problem, that solution is often not a technical solution. So, let’s assume for a minute that I have a purchasing department that is swamped and another department that they serve that is frustrated because purchasing is way behind on their orders. Let’s also assume that many of those orders are pretty small amounts, say less than $50, and are typically ordered from one or two vendors. Through me asking questions to try to facilitate brainstorming a solution, the two departments agree that for purchases under $100, the department can place the orders themselves as the control provided by the purchasing department in this case probably costs more than the items being purchased. The purchasing manager can review a report at the end of the month for those items purchased by the department to make sure that they pass a reasonableness test and everyone is happy. In this case, I didn’t create a solution, I facilitated a discussion that led to an innovative solution. Now, if I were looking to get credit for a solution, I might have suggested creating a digitized process that has a digital requisition that gets routed for approval and where everyone could see the status. This solution uses technology and may speed up the process somewhat, but it doesn’t really solve the true problem, the bottleneck in purchasing, especially during busy periods.

I guess in conclusion, what I am really trying to say is that innovation is much less a process or a function than it is an approach to problem solving. True innovation takes a problem and comes up with a way to solve that problem and hopefully makes some process much faster or easier. Innovation is all around us, you just need to learn to recognize it. So, keep this in mind the next time you press a technology leader on innovation and make sure that your perspective is set accordingly. Unless that person is the head of a research and development department, the answer that you should expect or hope to get is some version of innovation is part of the problem-solving process. Understanding that problems don’t always mean something is broken, but just that they are usually something that can be made better in some way. With this expectation and perspective, you will be ready to sit down with your technology staff and discuss the problems that you are facing and work with them to create an innovative solution.

As Executives, Are We Really Listening?

 

As executives, it’s no secret that we’re all busy. I’ve often heard this used as an excuse when a colleague checks out of a conversation, interview, or meeting. While there’s no denying that our schedules are demanding, we also have a responsibility to remain engaged, especially when ideas are being shared that could benefit our organizations.

Let me pose a rhetorical question: If you’re in a meeting and someone is explaining an idea but isn’t being particularly concise, do you stop them to offer feedback, or do you simply disengage and tune them out? If the answer is the latter, I’d argue that you’re not fulfilling your role as an executive. That meeting was scheduled because someone believed the discussion was valuable (this is especially true for interviews, internal or non-sales meetings). By checking out, how can you be sure that you aren’t missing something crucial—an insight that could drive significant change or benefit your organization?

The Missed Opportunities

When we fail to provide feedback or simply "check out" of discussions, we miss valuable opportunities. Not only might we be missing key insights, but we also rob the speaker of a chance to improve. By offering constructive feedback, we help others communicate more effectively, which ultimately benefits the entire organization.

Too often, we allow our own preferences to dictate our engagement. If a presentation doesn’t align with our interests or feels overly detailed, we feel justified in mentally stepping away. But as executives, our role is to serve the needs of our organizations and our customers, not to cater to our personal preferences. I would also argue that our role is to help others in our organization or that we do business with, develop in their roles. This not only helps our organizations in the end but is also the right thing to do as experienced professionals and executives.

I recently witnessed this behavior in another organization. After a meeting, I heard participants express relief that the speaker had finished, citing a lack of conciseness. What struck me was that this wasn’t a large group setting where feedback might feel impersonal—it was a small meeting where immediate feedback could have been offered. I personally found the speaker’s insights valuable, and while they could have been more concise, I focused on the content rather than the delivery.

For me, this was a missed opportunity. Others in the room could have given feedback to help the speaker improve their communication, benefiting both the individual and the organization. By choosing to disengage, they missed out on a chance to help someone grow, which is a core part of leadership.

The Importance of Feedback

We often forget that those presenting to us or interviewing with us are likely nervous or not accustomed to presenting ideas to a group or may not have interviewed for a while. Instead of tuning out and discussing their performance behind their back, wouldn’t it set a better example to offer constructive feedback? Many of us can think back to a time when someone gave us helpful advice in our careers—shouldn’t we strive to be that person for others? There have been a number of times when I have stopped an interview because the candidate was giving longwinded answers and some of my fellow interviewers were beginning to lose interest. When I do this, I typically look at the candidate and let them know that the interview is on a schedule and what I would like them to do is take a moment and think of a way to summarize what they are about to say just like they would if they were going to put it on a PowerPoint slide that had to be seen in the back of a large room. Keep the points to the most important highlights that we need to know to get to know you and make a decision. These interviews almost always end well and more often than not, I have hired this person, and they turned out to be a great hire!

Feedback, when given respectfully and professionally, can transform both the speaker and the organization. I’ve found that when I offer feedback, whether in a meeting, interview, or informal discussion, the person receiving it is almost always grateful. Their goal is to communicate effectively, not to impress us with perfect delivery. The key is to offer feedback in a way that helps, rather than embarrasses.

Actionable Tips for Offering Feedback

Providing feedback isn’t just about pointing out flaws—it’s about guiding someone toward improvement. Here are a few strategies that can help:

• Be specific and timely: If someone is providing too much detail or going off-topic, politely stop them and ask if they can summarize their main points. Doing this during the conversation allows for immediate improvement and helps keep everyone engaged.
• Encourage clarity: Offer suggestions on how the speaker can simplify their message. For example, you might say, "I think this is a great point, but could you clarify it in a few sentences, so everyone stays on track?"
• Frame it constructively: When offering feedback, frame it as an opportunity for growth. For instance, "You have a lot of valuable information here, and I think it would be even more impactful if you focused on these key areas."

By doing this, you not only help the speaker improve but also ensure the entire group remains engaged and benefits from the discussion.

Conclusion

As executives, our job isn’t just to attend meetings or sit through presentations—it’s to actively engage in the discussions around us. When we check out without providing feedback, we miss opportunities to unlock valuable insights and help others improve their communication. By offering thoughtful, constructive input, we foster a culture of learning and improvement, which ultimately benefits both individuals and the organization.

Let’s strive to be leaders who listen actively, provide feedback respectfully, and seize every opportunity to drive progress. By doing so, we not only help others grow but also ensure that our organizations continue to thrive.

Digital Transformation: What Is It Really?

 

                            Image by vectorjuice on Freepik

The IT world is really very good at spinning up buzz words. It almost feels as if some there is hidden part of Madison Avenue that is dedicated to generating geekspeak. One of the latest buzzwords that you probably can’t go a day without hearing it mentioned at least once is digital transformation. If I had a dollar for every time someone asked me what digital transformation is I wouldn’t be writing this blog article right now, I would be sitting on a beach in Mexico sipping a margarita. All kidding aside, let’s dig into what this now ubiquitous phrase actually means.

Definition

Okay, so this is the hard part because digital transformation is one of those phrases that gets used for a lot of different things which makes defining it sometimes almost as hard as nailing Jell-O to a wall. If you really stop to think about it though, digital transformation has been around, at least in theory, since the mid-1970s when the predictions of the paperless office started. Interestingly enough, we still haven’t accomplished the paperless office, but we have coined a new term that aims to accomplish that and more.

So, let me talk about what digital transformation is from my experience. Just for context, I am a CIO in the healthcare industry with experience working with large group practices. When I think about digital transformation, my first thoughts go to those things in the business that aren’t digital such as paper based forms that someone has to fill out, manual processes that require an employee to do something or touch a record (electronic or paper) for which that touch really doesn’t add any control or value, reminder phone calls, collaboration or communication processes that involve sending files to a bunch of different people and then having to somehow process those changes back into a master file, etc. These are the types of processes that are ripe for being transformed in some way to a digital process.

Practical Application

My first order of business when someone asks me how they should apply digital transformation to their organization is to ask them about what kinds of paper they are still passing around and storing. These are often the processes where you are going to save the most time and money moving to a digital process. Think about going to a new doctor for the first time and they hand you that packet of papers to fill out that feels like you are closing on a new house. With the right technology in place, that process can be digitized through the use of electronic forms which are much easier for the patient to fill out, send the information directly to the system that needs it without any manual data entry, and eliminates having to either scan or store the original paper document. The savings with this simple process are enormous and the improvement in the overall patient/customer experience is huge. It used to be that organizations doing these things were forward thinking. Now, if you are not doing this or at least considering it, you are probably way behind your competition.

That was a pretty specific example but consider processes such as how you onboard your new employees. How much paper are you generating through this process that has to be processed in some very expensive way? Or think about your expense reimbursement process. Does someone still have to fill out a form (usually in Excel) and print this out and apply a wet signature to it and interoffice it to the accounting department? If so, that process probably often costs as much or more than the amount of the reimbursement being generated. This, in my opinion, is where digital transformation shines. It is an opportunity to take a look at the most mundane, inefficient processes in your organization and determining whether there is a way of applying technology to those processes to make them faster and cheaper.

Small Wins Matter

While grand projects like intranets or document management systems are also part of digital transformation and usually tend to get most of the coverage we hear about, starting with smaller, impactful projects can offer immediate returns. These quick wins can build momentum and justify those larger initiatives later.

In summary, digital transformation is about identifying inefficient processes in your organization and applying technology to make them faster, cheaper, and more efficient. Start small, think big, and watch your organization thrive.

Healthcare: Everyone Is Talking About Provider Burnout, But What About Staff Burnout?

 

 

image: Freepik.com

Introduction

If you've spent any time in healthcare over the past two decades, especially since the pandemic, you've undoubtedly heard about provider burnout. This issue has garnered significant attention, with countless studies, committees, and initiatives aimed at addressing it. Providers drive the revenue that powers the healthcare engine, making their well-being a strategic priority for many organizations.

However, focusing solely on provider burnout might be too narrow a perspective. While there's no denying the value that providers bring to healthcare, it's essential to recognize that burnout extends far beyond this group. By concentrating only on providers, we may be overlooking and even exacerbating the challenges faced by the departments that support them. These challenges are leading to high turnover rates and declining morale among vital support staff, such as IT, Security, and Billing teams.

The Overlooked Issue of Staff Burnout

In many healthcare organizations, support staff are burning out at alarming rates, yet this issue often goes unnoticed. The IT department, Security teams (both cyber and physical), and Billing departments are just a few examples of areas where burnout is taking a toll. These departments are the backbone of healthcare operations, and without them, quality patient care would be impossible.

Unfortunately, when key leaders delay replacing these positions or cut administrative costs, they often only see the dollars saved, not the damage done to morale. This short-sighted approach can lead to overworked and undervalued staff, further contributing to burnout and turnover.

Challenges in Implementing Solutions

One significant barrier to addressing burnout across the board is the resistance to change. In my experience as a CIO managing in an Epic EHR environment, I’ve encountered this resistance firsthand. For example, my teams have developed training specifically designed to help providers struggling with the system become more productive. Despite the potential benefits, participation in these training sessions is often low, and those who do attend are sometimes reluctant to change their workflows, even if it could save them time.

Another initiative we've explored is the introduction of AI scribes to assist with documentation. These AI-generated notes are typically more consistent, accurate, and cost-effective than those produced by human scribes. However, they require some changes in how providers document their work, which has met with resistance from those who find it too difficult to adapt.

The Need for Effective Change Management

To address burnout effectively, we must create a culture that embraces change rather than resists it. Healthcare is an industry that is constantly evolving, and shielding staff from change is not a sustainable strategy. Instead, organizations should focus on developing robust change management processes that support staff in adapting to new ways of working.

By helping our workforce navigate change, we can better equip them to handle the demands of their roles, ultimately reducing burnout and improving retention. This shift in mindset is crucial for the long-term success of our healthcare organizations.

Conclusion

When you hear about provider burnout, remember that it's just one piece of a much larger puzzle. Support staff burnout is a critical issue that deserves attention, and addressing it requires a holistic approach that includes change management and a commitment to supporting all members of the healthcare team.

We may not have all the answers yet, but acknowledging the problem is the first step toward finding solutions. As the ancient proverb in the Bible at Luke 4:23 suggests, "Physician, heal thyself." In other words, we must first address the issues within our organizations before we can hope to resolve the broader challenges facing the industry.