Climbing The Curve Of Digital Transformation

Dwight Raum, VP & CTO, Johns Hopkins Medicine
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Dwight Raum, VP & CTO, Johns Hopkins Medicine

Dwight Raum, VP & CTO, Johns Hopkins Medicine

If you were to assess the value and maturity of your IT organization, where would it be? At The Johns Hopkins University and the Johns Hopkins Health System, we developed a framework to assess our IT organization’s value and maturity relative to our mission. We postulated our IT organization would fall in one of four quadrants:

 Technology no longer serves only a supporting role, and now more than ever directly impacts patient care, teaching and research  

1. Barely making it–As tech leaders, we’ve all encountered IT shops with chronic under investment, poor technical leadership and mismanagement. This quadrant is the danger zone, where IT is likely to be outsourced. IT often accepts irresponsible risks leading to catastrophic failures.

2. Uneven delivery–In this quadrant, parts of IT are executing well but are likely stovepiped with internal politics. Undertaking major initiatives is hard, and change is slow. Risk tends to cluster around the stovepipe perimeters, manifesting in extended down times. User experience suffers.

3. Proficient delivery–IT is working well as a team across functions, and regularly undertakes optimization initiatives. IT will often be viewed as competent but expensive, and tends to be risk averse and conventional.

4. Technology as part of the mission–IT is a trusted partner helping mission areas differentiate from peers using technology. This quadrant is also where technology leadership can start to shift from a pure cost center to that of potential revenue generation.

Johns Hopkins is leading with technology now more than ever. The Johns Hopkins Technology Innovation Center (TIC) is inspiring faculty to challenge how care is delivered, and supplying them with the tools and the capacity to innovate. The Johns Hopkins Individualized Health Initiative (Hopkins inHealth) is leading the way in precision medicine, using novel measurements coupled with data science to gain new insights, and delivering new tools to the bedside to guide patient care. Our telemedicine initiatives are using technology to change health care delivery from traditional in-person, face-to-face interactions to connect our medical experts with patients and providers worldwide.

How did we accomplish digital transformation in the worlds of academia and healthcare? At Johns Hopkins, our IT department is unique in that we serve both our university and our medical system. Technology no longer serves only a supporting role, and now more than ever directly impacts patient care, teaching, and research. This shift towards improving value to missions has been deliberate, incremental and transformative. Here’s how we did it.

Our journey to improve the value and impact of technology began in 2013 with a self-assessment where we subjectively placed ourselves in the trailing edge of “proficient delivery”. Comparing ourselves to peers and outsourcers, we realized IT was seen as an expensive enigma. Departments were independently spending considerable resources on redundant services. We were asked to drive lower total technology expense, with only a bit of the spending under direct control. Believing incorrectly we had high-value services, we learned we hadn’t done a good job packaging or clearly articulating their impact. Even worse, traditional cost allocation methods impeded good IT practice and obstructed strategic management. For example, we had numerous email systems on campus, and while the central service worked well, it was considered too expensive based on the chargeback model. Having access to a reliable, secure and usable email system seemed like table stakes in 2013.

Faced with suboptimal funding and governance models, we set out to repackage services with two main goals in mind: simplification and transparency. Simplification led us down a path to value—by aligning services with mission imperatives, value propositions became much more apparent. Furthermore, we measured our performance against industry standards. If we could not establish competitive or superior performance, IT leaders had to dig in and understand why, or risk losing the portfolio. This rigorous self-evaluation is both empowering and unforgiving, setting the bar high for managers and staff to be world class.

Transparency must occur in two dimensions: financial and performance. IT services represent a significant spend, and trust is earned by opening the books and exposing how rate models are established and recovered. It is imperative that IT leaders demonstrate good financial stewardship, including developing realistic financial plans, proposing rational chargeback models, minimizing surprises and vigorously pursuing lower costs. Transparency also extends to the performance of the IT organization, even when this transparency is painful. Having frank and open discussions with business leadership not only demonstrates commitment to mission, but also frequently helps to identify alternatives and encourages non-IT ownership in the eventual solution.

End-user support is an often underappreciated corner of IT operations; however, this area is fraught with peril. For many users, their opinion of IT is solely informed by their experiences with calling the helpdesk and interactions with end-user support. Every negative customer experience undermines the trust in IT to execute, and worse, negativity tends to metastasize. Experience also influences the agility and speed with which IT can implement change; absent the trust of good customer service, mission-critical IT changes become mired with support issues and damage control.

In order to move up the curve and deeper into “proficient delivery”, we focused on improving collaboration between the functional areas of IT. We promoted collaboration in several ways: encouraging resource sharing across teams, promoting several key technology leaders, forming task force to work on emerging technologies and celebrating service to one another. We now have several cross-functional councils that meet regularly with various areas of focus, including monthly forums for managers, incident review and red teaming, architecture, project management and customer experience. The connective tissue between teams yields quicker resolution to incident management, speeds the rate of change and creates growth opportunities between teams.

By transforming our organization with simplification, transparency, service excellence, execution and collaboration, we firmly established our Quadrant 3 position. Moving up to Quadrant 4 required more. The IT organization needed to establish intellectual leadership, only now made possible by the trust established in Quadrant 3. Our journey led us to create the TIC in 2014. Formed from the merger of a software engineering team and a radiology informatics lab in The Johns Hopkins Hospital, the TIC serves as a resource hub, connecting researchers with professional technology leadership well-versed in driving change in a complex health system. By working directly with faculty, the TIC marries research with disciplined design thinking, clinical systems integration and change management. Already, the TIC has assisted with the launch of several startups, all the while leveraging much of the technical infrastructure deployed in the Johns Hopkins Health System.

Building on the success of the technical infrastructure and the culture of innovation inspired by the TIC, we’re moving even closer to mission by supporting Hopkins inHealth with a new precision medicine platform. This discovery and delivery platform provides faculty with quick and secure access to research data using modern data science tools. By lowering barriers, we are shortening cycle time to discovery and translating those insights into practice with TIC-developed point-of-care decisions riding on top of the underlying technical infrastructure.

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