Shortly after graduating from college, David P. Gawaluck was working as a ticket agent for Northwest Airlines when the carrier changed to a new information system.
There's nothing like personally going through a system conversion to show a future chief information officer how it feels on the front lines. Besides his own experience, Gawaluck says, the impact on other users stayed with him -- for example, what it means to "a user with 15 years of experience who suddenly has to change systems." The workplace was rife with "havoc, anxiety and stress."
When he emerged from the graduate program in health administration at the University of Minnesota some years later, his undergraduate years as an economics major and his experience at the airline helped drive home a key -- if unconventionally learned -- lesson about the central role of the rank and file in successful deployment of information technology.
At one time or another Gawaluck has sat down and gotten real with board members, senior management, physicians, nurses, medical records staff and insurers -- everyone who has a stake in patient information. And as a result, he can communicate across the board.
About five years into his healthcare career, Gawaluck's sense of what information systems can accomplish helped him pull an important contract out of the fire for the University of Cincinnati Medical Center, where he was working as a financial analyst. It was the late 1980s, and medical insurers were threatening that they wouldn't renew their contracts, claiming the medical center was a high-cost provider.
The good old days. Those were the days of room-size mainframe computers, dot-matrix printers and Lotus spreadsheet programs. Nevertheless, "It was amazing what you could do with a mainframe download and Lotus," he says. Analyzing case-mix results gleaned from the hospital's classification of Medicare DRGs, "we showed Blue Cross/Blue Shield that once you removed the outliers, we were actually cost-competitive in terms of run-of-the-mill procedures," he says.
Rather than present 100 pages of DRG numbers, however, Gawaluck and his team created a simple visual. "It was that dang color graph that did it," he says.
"Most information systems executives don't know what questions to expect from users, what data they'll need upfront," he says. "But when you have all the information at hand, decisions get made more easily."
Gawaluck didn't start out to manage information systems and technology -- it was more of an on-the-job development. As a financial analyst, he saw how hard it can be to get data from a hospital's unconnected departmental information systems. The experience in Cincinnati with the Blues drove home the need for timely, easily understood information.
When Columbia/HCA Healthcare Corp. bought his next employer -- Tulane University Hospital -- in 1995, Gawaluck was assigned the task of coordinating information systems for five New Orleans healthcare facilities.
"Having worked at academic medical centers, I had experience in negotiating between multiple parties (the hospital, medical school, faculty practice plan and the university) to implement information systems," he says. "The Columbia role was very similar in negotiating between the hospitals in the market and overall schedules with the corporate IT group." By 1997, he had acquired the skills to be a CIO, which he took to Florida.
At Lakeland Regional Medical Center, Gawaluck manages both the information technology area and the medical records department. Each group has 65 employees, for a total department of 130 people. "I'm clearly not a technical expert," Gawaluck says. "I depend on my staff for that expertise. I'm the guy who gets to tell the success stories, but it's my staff who make the miracles happen. My challenge is to get the right minds into those positions."
And his strength is to peer into the right minds for guidance. "Two things drive my approach," he says. "First, people make the systems happen, more so than the technology. Investing in staff and training is important," he says.
Secondly, says Gawaluck, professionals have to remember that "information technology is a tool. It's an important tool, but in the end, computers don't cure a patient." Getting the right information to the right person at the right time in a way they understand can help a doctor or nurse get a patient out the door a little earlier and perhaps improve their lives, he says.
That credo and the personal experience behind it were tested starting virtually the first day of Gawaluck's tenure at Lakeland. When he arrived in 1997, Y2K was the technology agenda.
When the millennium cloud finally passed, Gawaluck found himself on the opposite end of the same situation he confronted back in his ticket-agent days. Faced with an array of aging systems in what seemed to be a fading product line, "We made the decision to bite the bullet and change vendors" rather than create system fixes. The systems up for conversion included patient management and accounting, clinical information systems and pharmacy.
Gawaluck budgeted money to train everyone who would touch any of the new systems -- 1,200 staffers in all.
Lakeland set training requirements by job role. Nurses were required to take eight hours of training, pharmacy staff 16 hours and business office staff 40 hours. To relieve the strain on the departments involved, the conversion budget included funds to pay for substitute workers in the various departments. So not only were the regular employees free to concentrate on being trained, but department managers also didn't have to pay for substitutes out of their own budgets.