Why Is IT Holding Us Hostage?


Despite advances, healthcare has yet to realize the full promise of digital tools.

Adam Harpool

9 min read

This is a pivotal time for healthcare technology leaders. From assessing chatbots powered by artificial intelligence, to finding the next frontier for virtual care, or using technology to augment the workforce, chief information and chief digital officers have never played a more prominent role in their organizations. They are being elevated from tacticians to business strategists.

Nonetheless, we regularly hear frustration from leadership teams about the unfulfilled promise of digital transformations. One senior executive went as far as to tell us that IT was “holding us hostage” by constantly playing the role of the “department of no.” The other thing we are told is the business side doesn’t understand IT, and vice versa.

As technology strategists, this state of affairs is concerning and leads us to ask: why does this culture still exist and what can be done about it?

Pillars of value creation

Poor value creation from technology does not stem from a single isolated cause, but rather is the result of an unhealthy system that is not properly addressing root causes. We’ve categorized 10 IT comorbidities — listed below — that have been allowed to fester over the last 30 years. Confronting them head-on is the only way health systems will maximize the value from their IT systems. While the CIO should lead this effort, addressing these comorbidities requires full engagement and alignment from the board and C-suite.

We’ve also identified three pillars that are essential for organizations to build if they are going to optimize value through IT. The foundation is creating a digital culture, followed in importance by a shared language — multilingualism — between business and IT departments, and, only with those first two in place, a relentless focus on flawless execution. Each pillar requires the CIO to assume a different leadership persona.

Defining the personas

Digital Culture/Chief Culture Orchestrator: CIOs must start here by working with their C-suite peers to drive changes in the talent and operating models within their organizations, ensuring that digital transformation does not die on the vine due to cultural resistance, misaligned incentives, or a pervasive lack of digital upskilling. Although somewhat novel today, CIO and chief human resources officer collaborations must become the norm in this space.

  • Leadership Example: Jim Swanson, Executive Vice President and CIO at Johnson & Johnson, has fully embraced the need to digitally upskill the workforce. His team has deployed a program that uses AI to identify skill gaps and focus on development needs for the technology organization.
  • IT comorbidities when out of balance: #1 (Talent gaps), #6 (Cultural resistance and talent model challenges)

Multilingualism/Chief Enablement Officer: Exceptional CIOs can leverage their role to ensure that technology is consistently a “department of yes.” These leaders are both technically and politically astute, advocating effectively for a right-sized IT organization, wielding a mastery of peer-to-peer strategy in the C-suite, and aligning enterprise-wide priorities and resources as needed to deliver consistent business model innovation.

  • Leadership Example: Roberta Schwartz, Executive Vice President and Chief Innovation Officer at Houston Methodist, is leveraging technology to solve a core challenge facing many provider organizations today: building a sustainable workforce. Her innovative approach includes using tele-nurses to do patient intake and discharge and tapping into AI to identify staff training needs.
  • IT comorbidities when out of balance: #2 (Senior management with insufficient understanding of technology), #3 (The technology/digital strategy is misaligned with the corporate or business unit strategy)

Execution/Chief Friction Remover: At this level, CIOs must ensure seamless user experiences from digital delivery, both for employees and customers. Tech leaders like Amazon have set the gold standard here: omnichannel, typically error-free, and intuitive user experiences that do not require multiple systems, manual data entry workarounds, or navigating clunky user interfaces.

  • Leadership Example: Anil Bhatt, Senior Vice President and Global CIO at Elevance Health, helped drive agility and speed in his organization’s IT delivery by devolving some control of IT roadmaps and IT investments to business units, with IT providing strategic oversight — a far cry from legacy IT models which attempt to suffocate anything appearing to be “shadow IT.”
  • IT comorbidities when out of balance: #5 (Inadequate project and change management), #7 (Poorly articulated business requirements)

It is unlikely that every IT comorbidity can be completely cured, but with consistent focus and discipline, and CIOs evolving their roles, treatments can be found to mitigate their long-term impact. And when that happens, organizations will see the value of IT rise.

Top 10 IT comorbidities

1. Talent gaps: hiring a generalist to customize a high niche technical solution; lack of access to top candidates due to the war on talent

2. Senior management with insufficient understanding of technology: a CIO who struggles to contextualize highly technical topics to non-technical leadership peers; widespread lack of tech expertise among C-suite and board, leading to IT being seen as a cost center

3. The technology/digital strategy is misaligned with the corporate or business unit strategy: the tech organization invests in priorities that do not directly support the organization's strategic goals. This often occurs when tech investments are allocated based on the “loudest voices at the table” rather than an objective capital allocation process

4. Inappropriately calibrated IT risk appetite and risk tolerance: controls, security, and risk management around IT are not sized to a commensurate level to support the type of change the organization is undertaking — either too conservative, leading to a “department of no” reputation, or too aggressive, risking major cyber breaches

5. Inadequate project and change management: a check-the-box project management philosophy; "watermelon" status updates for major programs

6. Cultural resistance and talent model challenges: legacy attitudes around change are pervasive — “We’ve always done it this way,” highly politicized decision-making leads to a few powerful detractors being able to stall or sabotage modernization efforts, the employee base has not been digitally upskilled and consequently cannot fully embrace digital transformation

7. Poorly articulated business requirements: business units struggle to clearly articulate goals in a way that ultimately can be traced to clear functional and technical requirements; requirements do not reflect what needs to be built; impact on end-user experience is not appropriately vetted in user acceptance testing

8. Unrealistic business case for tech investments: overly aggressive assumptions around the internal rate of return from tech projects; underinvestment in the technology function or specific tech initiatives; the assumption that technology by itself can fix a fundamentally flawed business model

9. Inadequate IT demand/capacity planning: the IT department is not staffed to address demand, often because IT demand and capacity are poorly quantified; misalignment on timing expectations and relative level of effort required for tech transformation

10. Tech debt and legacy infrastructure: an antiquated or deficient tech stack makes it difficult to nimbly evolve the organization

To learn more contact Matthew Weinstock, Senior Editor, Health and Life Sciences.

  • Adam Harpool