Leading Leaders
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Leading Leaders: The Difference Between Good and Great CIOs

The staff meeting ended, everyone was in agreement, and everyone felt good about themselves. Sounds surprising to me. And if this describes your normal staff meetings, you may not have the right environment.

Lessons Learned from the Past

I love the musical Hamilton. Gotta love a depiction of the events that takes away any doubt with the very first song, by having Aaron Burn sing, “I’m the damn fool that shot him.” The story contains enough drama that the event at Weehawken, NJ was merely a bookend for the incredible story of the people who were a part of our country’s first moments.

There are two musical numbers where they depict the contentious cabinet meetings. These scenes, taken straight from historians’ pages, depict battles between strong-willed, battle-tested, brilliant men who each had ideas of how the country should run. The battles were waged primarily between Thomas Jefferson and Alexander Hamilton, to which Jefferson later wrote, “The pain was for Hamilton and myself, but the public experienced no inconvenience.”

Why would President George Washington tolerate such behavior? What is to be gained by allowing his core team to argue like this? The answer is “Better.” Better ideas, better solutions, and better leadership. These are all the result of working through conflict with one another and building on ideas.

In the Book of Proverbs, it says “As iron sharpens iron, so one person sharpens another.”  I love the imagery of this: we refine each other with our interaction.

My friend used to say to me, “Good is the enemy of the best.” I guess Jim Collins would say that good is the enemy of great.

A good staff meeting may end in agreement, but a great staff meeting hones ideas, strategies, and approaches.  A certain decorum of respect and trust has to be established by the primary leader, but after that, we want people to bring their best to the table. In the end, this makes everyone better.

So, what are some of the key characteristics of teams that can go back and forth, retain respect for one another, and, in the end, agree on and implement a plan that is much better than the ideas of a single person?


George Washington established a cabinet based on a constitutional reference. It reads that the President “may require the Opinion, in writing, of the principal Officer in each of the executive Departments, upon any subject relating to the Duties of their respective Offices.”

Every project has operational, technical, financial, and relational aspects to them. By including the team, you expand the perspective. By allowing honest discussion, you improve the solution.

The CIO’s cabinet has to be a voice in the creation of the plan… it cannot simple be a team that carries out the plan of the CIO. We all know that when people have a hand in creating something, they have more buy-in and more ownership. Yet, we struggle to lead that way.  Sometimes it’s just easier to fall back on the command and control model. That is a mistake.

Encourage the dissenting voices and solicit the ideas of the silent. When people speak into an idea, they become a co-creator.

Trust and Respect

Let’s not kid ourselves here – these types of meetings can be frustrating. Washington probably wanted to put these two gentlemen in time-out. However, one of the cornerstones of leading leaders is to know what everyone brings to the table. You must constantly remind everyone of that fact… including yourself.

I had a Wharton School graduate financial person on staff. Whenever there was a question on the numbers, I would turn to him. This reminded everyone of what he brought to the table. He spoke out on topics outside of his expertise, but he spoke with authority on the numbers.

Your team has to respect the work and expertise of the other people on the team or you have another challenge. This is why any new direct report I hired had to be interviewed by my entire staff. In essence, we were inviting them into our inner circle; we all had to agree that this was someone we respected and whose voice we wanted at the table. Everyone had to be trusted to do their job effectively.

Clear Roles

I am a firm believer in a single sentence description of the role of each person on the team. I picked this up from Andy Stanley’s leadership podcast. For example:

My role as CIO was to create an environment within the health system where technology could be used to advance the mission.

The Administrative Assistant’s job is to take away nonessential tasks and decisions, so the CIO can focus on the things that only the CIO can do.

The VP of Infrastructure and Operations needs to ensure that every system works as expected every time it is called upon.

The VP of Customer Experience (yes, we had that role in IT) was responsible for creating exceptional user experiences that surpass the user’s expectations.

I put some of these here to give you a picture of how a conversation might go. From a customer experience standpoint, solutions may deliver an exceptional experience, but might not be built on a reliable platform. The back and forth will help to identify the best solution that exceeds the internal customer experience expectations today and into the future, if it’s built on a solid platform.

If, however, the VP of Infrastructure remains quiet because she thinks the CIO wants a staff meeting without conflict, or because they want the same treatment for the off-the-wall project that they are about to present, the entire health system loses.

Best People You Can Hire

The saying goes, “If you’re the smartest person in the room, find another room.” The same is true for your staff meeting. You should be surrounded by technologists that know technology at a different level than you. You need someone that knows the numbers better, someone that understands the EHR better, and so on. If that is not the case, then you didn’t hire well… and you won’t be successful.

John Moore, founder of Chilmark Research, wrote this in an article this past week:

New breed of CIO. The majority of CIOs that oversaw go-lives of enterprise EHRs over the last decade are not likely to be the ones to drive their HCO’s digital health strategy going forward. A new breed of CIO is on the rise: One with a combination of clinical, business, informatics, and IT skills. They intuitively understand the operational and strategic value of IT in both a clinical and business context.

I posted this on LinkedIn asking if people felt the same. Overwhelmingly, we agree. The question becomes How does the CIO make this transition? The answer is that they have to practice new skills. How do you practice new skills when you have all the existing work to oversee? The answer is right in front of you.

It’s time for your team to step up so you can focus on the next challenge. Lead leaders, treat them as leaders, and let them lead.

Hope this helps. Please follow me on Twitter @ThePatientsCIO, connect with me on LinkedIn, or reach out at [email protected] if you wish to discuss further. Thanks for reading.