A physician who became CIO reflects on important lessons learned

Despite the emphasis on technical acumen, success in healthcare IT is all about people. ‘If we don’t get this right, everything else falls apart.’

Originally posted on LinkedIn

On June 12, 2000, I started working at Asante Health System as an emergency department doctor.

My wife and I had just gotten married three months prior. She was two months pregnant. And I was a week out from finishing my emergency medicine residency at UCLA. 

At the time, we didn’t know much about Oregon or Asante, other than the space is beautiful and the people are gold. We were in for an adventure. Over time, we were blessed to have four children born at our flagship hospital – two requiring NICU care – and raise them in the beautiful Rogue Valley.

My career eventually shifted from working in the system to working on the system, most recently serving as senior vice president and CIO.   

Now comes another adventure. After working for Asante for 22 years, I have left to start a new role.

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As you might imagine, this was a hard decision because of deep roots and great connections to my co-workers, colleagues and friends. Many of you have walked with me through the pandemic, southern Oregon wildfires, imminent regulatory changes and the list goes on. I feeling gratitude for the experiences, for the relationships we've built and for the willingness of the team to tackle really hard problems despite the obstacles.

In times of change, there is a natural inclination to reflect. As I thought about this journey, here’s what stared back at me:

People, process and technology

I’m not so sure nowadays if all three are equally important. It’s all about people, people, people. If we don’t get this right, everything else falls apart because the people put in place the process (and process improvements) and select, implement, configure, maintain and train the technology. People are what makes tech work.


If you are in the tech field, you know the pain of infinite desires and finite resources.

People want technology solutions and recognize value in technology. However, the imbalance between what is asked for and what can be delivered can destroy teams and morale. It is the duty of IT leadership to provide clarity on what front-line staff is supposed to actually do on a daily basis. Our staff members deserve clarity of purpose and clarity of work. 

As leaders, we can provide this clarity – even when it creates difficult conversations with other executive staff.

Highly reliable organization

Healthcare organizations need to aspire to become “high reliability organizations.” If the network or any of our core systems are fragile, then this introduces massive business risk.

Health tech is complicated. It has many layers. Still, our first order of business is to assess the current state, using a maturity model framework so that we know where we’re good and where we might need some additional focus. And then we get to work.

We need to craft industry best practice around standard work, which includes redundancy with immediate failover, certificate management, stringent testing protocols and a transparent and blunt change advisory board so that no changes are introduced without thorough vetting. We absolutely have to get this right. Our providers’ experience and ultimately our patient’s health depend upon it.

Cultural issues

There’s a lot of talk about culture. Here are a few of my observations:

Action: People watch what we do rather than just pay attention to what we say. If we tolerate a narcissistic employee because they get the job done, we are failing our team. It’s our duty to manage up or manage out team members who can’t do the work, won’t do the work or are insufferable to work with. There’s no excuse for not taking action because the impact to team morale can be huge.

Translate: As health tech leaders, we should understand the overarching mission, vision and values of the organization and translate them into our IT domain so that they are easily understood and remembered. If the teams understand the “why” behind our work, they will be able to connect many of the dots that we may never see but which will surely arise as they do their work.

Back: Our teams need to know that we have their back and not assign judgement until we fully hear them out and understand their perspective. 

I recall having a supervisor in a prior job who always assumed any complaint against me was valid and immediately began discussing corrective actions. He ultimately left the organization, and his replacement took a different approach: He fairly and impartially heard all sides before landing on a conclusion. And when in doubt, he never threw me under the bus. I would have taken a bullet for that guy. He had my back by simply being fair. And he earned my loyalty.

These are just a small sample of the many lessons learned along this awesome journey. I’m looking forward to learning more and sharing more.

Lee David Milligan, MD, CHCIO, is a healthcare executive and has served as senior vice president and CIO.

Dr Milligan originally posted these insights on LinkedIn.

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