Paola Arbour's path to the Chief Information Officer role was unusual. She spent much of her career serving CIOs at companies like EDS, HP, Dell, and ServiceNow. At the last of those companies, she was the President of the ServiceNow business unit, ProV International and Vice President of Professional Services Delivery for ServiceNow.
When Arbour became CIO of $18 billion revenue Tenet Healthcare nearly a year and a half ago, it was her first role in a traditional IT department. Yet, her experience running businesses that served CIOs gave her a different orientation in the role. In fact, she was frustrated that Tenet Healthcare did not expect more from the IT department. She got to changing that from the inside.
She transformed the IT organization from a cost focus to an investment focus. The transformation centered around four imperatives: enhancing the voice of the customer, changing the language of IT, building an innovation culture, and focusing on talent, each of which she speaks about at length in this interview. She also highlights the importance of transparency, communication, and collaboration among teams to successfully lead an organizational change of great scale.
(To listen to an unabridged podcast version of this interview, please click this link. This is the 49th interview in the CIO’s First 100 Days series. To read future articles in either series, please follow me on Twitter @PeterAHigh.)
Peter High: Paola Arbour, you have been in your role as the Chief Information Officer of Tenet Healthcare Corporation [Tenet] for about a year now. Describe the organization you found a year ago and some of the changes you made in the early days of your tenure.
Paola Arbour: We are currently conducting agile training. We would not have done that a year ago. We did not have a team that was interested in that, nor would it have been a thought for us to consider moving to an agility mindset.
A year ago, I found what I thought was a typical IT organization. It was more focused on keeping the lights on than having a seat at the table. It was more of a cost center and less of an investment opportunity. I do not want it to sound as if the entire system went from bad to good. Rather, it was an inflection point. We had a new CEO [Ronald Rittenmeyer] who was making dramatic changes on the leadership team. He moved the IT and Information Systems branch into an Extract, Load, Transform [ELT] leadership position. He ensured that the CIO did have a seat at the table and that technology was not an afterthought or a vertical but an enabler for all of our business strategies. That became incredibly pronounced. He enabled and invested in the team that was part of that movement. There was a distinct correlation between these actions and the success of our customers, who are the people that take care of our patients every single day.
Tenet is acute care, we are ambulatory, and we manage revenue cycles. The role that physicians and clinicians play is to serve patients. From a technology standpoint, we determine how to help them be successful in delivering care. This was the starting point of a simple thought process that we embarked on. It has been “Mr. Toad's Wild Ride” in a year, but it was fundamentally about focusing on four key imperatives that we took to the board and wrapped an entire transformation program around.
- The first point was the voice of the customer. We were missing stakeholder management. We immediately launched a huge program around the voice of the customer, and then I hit the road to about 50 of our acute care hospitals. We have over 60 in total, and I tried to do that in about three or four months to ensure that we were listening to the customer. This was the big program.
- The second imperative that we put in place was not only a cultural change for the team but a language change. I did not want to talk about cost, cost reduction, or budgets. To me, budgets were synonymous with entitlement. One would get a budget and spend it, and then get another budget and spend it. I wanted to reshape our thinking into efficiency and investment. What do we do with the funds that we have? Instead of simply spending them, how do we minimize spending through efficiency and productivity? How do we further invest in our work to drive the voice of the customer and deliverables against our customers’ expectations?
- The third objective was to build an innovation culture, which was something we had completely lacked. Because we were too busy keeping the lights on and managing a budget, there was no time to think outside of the box or reward or recognize people for thought leadership. We ground up the phenomenon around innovation. We built a sandbox and began partnering with external partners much more heavily. We connected people who had never had the opportunity to talk before, which received positive feedback.
- As a continuation of those three trajectories, our fourth imperative was focusing on our talent. One year later, 75 percent of our leadership team is new. It is a completely different operating model. We have moved into a flat and highly functional organizational structure. In that period, we integrated our other businesses.
Tenet is composed of three main lines of business: The United Surgical Partners International (USPI), which is ambulatory care, Conifer Health Solutions, which is our revenue cycle subsidy, and Acute Care Legacy Tenet. We brought those three pieces together through IT. We have a CIO for USPI, a CIO for Conifer, and CIOs for our regional markets where our acute care hospitals are located. We have IT that operates close to the customer within the market, supports all of the technology deliverables into the market, and acts as an advocate for the market in corporate information systems [IS]. That is how we started and are operating today, one year later. It has been exciting.
High: I want to follow up with you on the voice of the customer. As you went on your listening tour visits to the different centers around the country, what did you find? Did you notice that your customers were particularly tech-savvy? Did they have their own ideas of what change should include? Were they showing symptoms for which you had to find a cure? Tell me a bit more about those conversations and how they focused the attention of the team.
Arbour: I found a population of customers who felt under-served and disconnected. We held forums with our physicians and nurses, and we would do what the clinical providers call “rounding.” We did not expect customers to come to us, so instead, we went to the hospital floors and engaged in real-time with nurses and physicians while they were working. We asked, “What is technology doing that is impeding your ability to deliver care, and what is technology doing that you like or find useful?” The list for the latter question was a bit thin, though it has grown. It was more helpful to hear about their perceived impediments because they had not been asked before. Net-net, there was a security problem. We had made access difficult for customers, as healthcare has not kept up with the dramatic changes to technology. Providers within healthcare must know more about technology to do their jobs, yet healthcare technology has not supported them to be able to do so. Robotics is an example of such a divide.
It was extremely useful to listen to those roadblocks where our processes and our technology from an IT standpoint needed a significant face-lift to keep up with what providers use to complete their work. Security [was key]. Healthcare is highly risk-averse for all the right reasons, but the world has changed and moved. Historically, IT felt rebuffed as they were constantly said “no” to innovation because of security concerns. We have had to put our thought leadership and connectivity within the industry through different aspects of technology to enable them and remove the barriers of security while still keeping in check our responsibility to protect our patient data.
If one looks outside the doors of her company, there are partners and companies that do all the right practices. We need to be technologists and put those pieces together to make them work for our providers. That was the biggest piece of customer feedback we heard outside of the comment that, "Nobody has ever asked me my opinion before." I look at the security aspect as access, meaning accessibility in enabling customers to do their jobs. Secondarily is speed, which is predominant in IT overall and entails the rate at which we deliver to their requirements and requests.
We focused on speed and the technology evolution around security. Then, from the standpoint of the voice of the customer, we ran truly legitimate forums. We invited customers, rounded with them, took notes, and collected almost 5,000 discrete pieces of feedback. The fact that we called them our customers was abundantly well received.
Afterward, we put a communication process in place which started with single points of contact with real people, not service desks. We are putting portal capability in today, but we did not start there. We gave customers true one-on-one interactions with clinical and technology people to enable them to provide feedback and submit requests for what they need. Admittedly, we were two years behind in responding to their needs and their requirements in some cases. Those are the comments that we heard a lot. Customers were not shy, which was great.
High: You generated a tremendous amount of demand as you began with a listening tour. You talked about the 75 percent of leadership that was replaced, suggesting a considerable amount of people-change is necessary to create a new culture and bring in new skills. Presumably, speed was hindered for a time during that change as people adopted new positions. How did you set expectations as you drew demand from them regarding what to tackle first, what might have to wait, and what necessarily had to wait until the right people were in place to be able to deliver a specific response?
Arbour: It was setting the right expectations. It was giving the internal team within our IS organization an opportunity and empowering them to be honest with the customers and to have a continued dialogue. While this process was ongoing, I was simultaneously in the process of hiring our permanent client delivery leaders which we had not had before. That was not an overnight sensation. It has been a pretty laborious process finding somebody who is clinical, technical, customer-facing and understands a backdrop of financials. It took time, as they are tough people to find.
In the first wave of responses, people were simply happy that we listened. I hate to admit this, but expectations were low. Customers had heard a lot of proposals from the company before about future actions that never occurred because priorities and people changed. The diligence that we put in place was about ongoing dialogue and communication.
The biggest step forward was when we did a quick set of analytics around the feedback. 80 percent of that feedback was clinical in nature. We quickly parsed out that which we could do on our own and that which would require significant changes in the system. We constantly fed that which we could do swiftly and put an imperfect process in place to catalyze workflow changes. This included more education, analytical reporting, and other practices that would enable changes a bit more.
Regarding the big stuff, we then embarked on resolving the electronic health record. That electronic health record culminated in a brand new system in partnership with Cerner Corporation [Cerner]. This was a pretty significant step forward in our new electronic health record for all of our hospitals as well as some of our ambulatory facilities. We made the deal, we announced it to our clinicians, and we earned some credibility when our customers realized that we were serious.
Starting with the listening tour, we developed a continuous feedback loop mechanism that allowed us to see what was working and what was not. Being open, honest, and transparent and then earning credibility by delivering on our promises has gained us trust with our customers. The Cerner deal helped significantly.
High: You talked about changing the culture from more of a traditional, order-taking IT department to one driving new ideas and educating the rest of the organization on new possibilities. Bringing in new leadership that is oriented differently must be important, though I am sure that the vast majority of people throughout the organization predate your time with the company as well. How have you inculcated the rest of your organization to be oriented towards a different way of thinking about how value is created through IT?
Arbour: I do not have a perfect answer for that. There are days that I think I am doing it right, and there are days that I wish I had sought other plans of action. Some of it has been trial and error. I went into this process based on experiences in my previous career. We determined the four areas that were important and put aside what did not matter. I made sure that that resonated with the team. I created a 100 percent aura of transparency. My message to the company was clear: we are in this together. I have a responsibility to the company as a CIO, but I am right there with you. I am talking to customers with you, hugging you, praising you, and telling you when we can perform better.
The feedback loop between ourselves and our customers was imperative to address. One can earn trust that way, though it was hard and people were scared. It was nerve-wracking to see people who had been with the company for a long time be replaced with 50 new people from outside. I knew that change was overwhelming. Additionally, we brought in a lot of external consultants. We were attempting a significant paradigm shift in a short period of time. I wanted people to understand what I was signing up for and how this decision required them to sign up as well. In return, I wanted to ensure that I was giving back to the team, not only through open dialogue and communication but through the enablement of progress, learning, and improvement by all employees. Everybody wanted to be better. The rallying cry of the team was "Oh, thank God, we have got it."
We want to serve customers. We mobilized into a servant-leadership format to support each other on this mission. We moved into our agile innovation platform that centers around collaboration to solve problems, as nobody can solve a problem individually. Teams solve problems. I do not only speak for Tenet but for many companies in healthcare that are super silo-oriented. We were extremely siloed—by business, function, and floors—so integration was important to us. Being able to collapse those silos and create a horizontal workflow with joint ownership of problem-solving was difficult. It required great trial and error, but people were excited to be part of a team that was winning and deemed important. People began to feel confident in their work and valued as employees because they started to see the fruits of their labor.
High: While many CIOs accrue responsibilities as they grow within the IT function, this is your first experience as a CIO. You worked for several leading technology firms including Electronic Data Systems (EDS), Hewlett Packard Enterprise (HPE), Dell Technologies, and ServiceNow. You were a consultant for a year under your own shingle. You helped set up a services business through ServiceNow called ProV International. You possess non-traditional sets of experiences, having spent extensive time on the other side of the table in companies that work with your current role as CIO as well as having an entrepreneurial background yourself. You have a revenue orientation that many CIOs do not have. I wonder if you could reflect on how this background has colored the way you see the role of CIO.
Arbour: My entire career has been spent serving CIOs, which I loved and was good at. I never thought I would depart from my past and sit on the other side of the table, but it is a lot of fun. My past makes me a humble and knowledgeable CIO. I do not take anything that we do for granted. I have end-to-end knowledge of where processes begin, where they end, and how they loop around because I have my past experience. This knowledge catapulted us into true stakeholder management thinking about ourselves as a business and not a cost center. I make sure that I have the aptitude to help people understand how integral we are to the company, and my past is extremely relevant in allowing us to do this today. Another important point is that I am a technologist, not clinician, by trade. Coming into Tenet Healthcare, which is a massive company serving providers and clinicians, I was worried that I could not offer what they needed. Having a technology and a customer service background has helped a lot.
I am thoroughly passionate about everything that I do, and I run at hyper-speed. The innovation and entrepreneurial parts of my background working in a Silicon Valley company taught me considerably about how to move fast, embrace, adopt, fail quickly, rally teams around thought leadership, have an active mind around development, and partner well.
I will emphasize the partner well aspect. We could have done a better job at partnerships in the past. They are extremely important to all companies. In healthcare companies, competitors will move as quickly as your constituents and stakeholders require if you are unable to provide what they need. Your ability to size them up, bring them in, manage them, measure them, and maintain pace is critically important to success. The security space in healthcare has changed considerably, for example. If we do not move quickly to embrace that change, it will be perilous. The speed and agility that comes from my entrepreneurial background enable me to stay energized.
High: What trends that are rising in importance from your perspective or beginning to make their way on to your road map for a couple of years out?
Arbour: I will hone in on two critical trends. The first is artificial intelligence, which is central to healthcare. Robotics play an enormous role in the efficiency inside of a hospital. We are developing our ability to drive artificial intelligence, especially within security. While some people may feel it is elementary, it is critical to a physician and the workflows within a hospital. The ability for us to onboard a physician, nurse, or resident quickly and get them working is a crucial path item.
Our capacity to do that through human beings is not sustainable. Using robotics embedded into programming and using artificial intelligence to deliver a self-service capability to physicians is what we have to do. Simultaneously, we must protect the data that we have and ensure that the right physicians access the right information for the right purposes. Our CEO has a technology background, and he constantly pushes the envelope with us in this regard.
Secondly, data and analytics are critical because of the service lines that we operate, especially in our acute care facilities. We are doing a considerable amount of work exploring data and analytics to see how it can be manipulated to inform us. We are information-rich, and this completely changes the experience of a patient. Going to a hospital is complicated for patients, but leveraging data uncomplicates the background operations to make it easier for them.
We are investing in those two areas that help our providers deliver better patient care and ultimately give the patient a better experience. When they go to a hospital, we do not want them to be unnecessarily labored with paperwork or questions they do not have answers for, which create time gaps in receiving the appropriate care. The reason we are investing in technology comes from our predominant mission of serving the patient.
High: You are part of a growing cohort of female CIOs at Fortune 500 organizations. It is not representative of the overall population of women in the US, for example, but certainly, progress has been made. What are your perspectives on the state of the union of women in IT? To what extent do you pay forward some of the factors that have led to your advancement and your growth as a leader?
Arbour: Conversations such as these are important. Being visible and vocal establishes role models who show that this is possible for women. I used to hold female-only forums where up and coming leaders within organizations would help other women in technology feel valued and prepare to navigate their careers going forward. I would share how funny it was that I do not think about myself as a woman in IT when I think about work. Occasionally, however, I walk into a conference room and the ratio I see startles me. I have become accustomed to this trend because I have always been in technology. Interestingly, there are many females in healthcare, which I love. I feel proud to see Chief Strategy Officers, Chief Operating Officers, and Chief Executive Officers who are women in the hospitals.
Where these forums are lacking is in advocacy. It is critical to have coaching and mentorship. Companies that value those capabilities and those roles which support the career mobility of women are vital. Strong advocacy, coaching, mentoring, and programs allow women to be a part of this sphere. Providing these assets is a part of our company goals and objectives. 50 percent or more of my leadership team are women. Everyone has an objective to enter the industry. Once one woman has entered leadership roles through the support of coaching and mentorship, it is important that she becomes a coach or mentor for someone else. I truly believe in mentorship.
Peter High is President of Metis Strategy , a business and IT advisory firm. His latest book is Implementing World Class IT Strategy . He is also the author of World Class IT: Why Businesses Succeed When IT Triumphs . Peter moderates the Technovation podcast series. He speaks at conferences around the world. Follow him on Twitter @PeterAHigh.
