Viewpoint

The Money Bone's Connected to the Service Bone

By Wayne Thompson
Vice President Information Services and Technology, University of New Jersey School of Dentistry and Medicine

Most of us in any kind of a leadership position within academic medicine have seen the phenomenon. We have humorous stories about the disconnects, and sometimes not so humorous stories about the consequences. I'm talking of course about the tendency to go through the year discussing how to optimize IT investments and generally improve services, and then to go through a budget cycle or departmental administrator conversations in which we discuss how to minimize expenditures, decrease investments, and generally do more with less. At some institutions it is more of a stark contrast than in others, but it usually takes place to some extent. What follows are some suggestions for why this persists at AMCs.

The first and perhaps most obvious reason is the old cost center vs. investment center discussion. Although IT as investment center is widely accepted in most industries, I would argue that AMCs have a much stronger traditional view of their enterprise, and IT is still the new kid on the block. Depending on where your organization stands on the evolutionary curve, you may have more "necessary evil" sentiment and less "strategic investment" sentiment floating in the ether. Just like at home, we want to minimize the electric bill, but maximize the retirement investments. We understand what each does and the impacts of the actions we are contemplating.

The second is the dreaded ROI argument. People and organizations are generally more willing to invest in areas where a clear (and preferably hard) return can be articulated. IT investments often lend themselves to softer arguments or indirect contributions. They are also often tied to savings which happen (or at least are supposed to happen) elsewhere. If the "investment" argument is fuzzy, then the tendency may be to revert to the cost center approach. At AMCs with their often balkanized structure, interlaced entities, and multiple missions, following the trail between investment and return is often a task worthy of Sherlock Holmes.

Next is the Left-hand-Right-hand phenomenon. This is not necessarily the more traditional "ignorance" argument where one does not know what the other is doing. In my view it is treated more like a healthy check and balance on runaway costs for a service organization. One faction can focus on ensuring that services are robust, while the other can keep the costs in line.

Although often said, it is true that IT professionals have not always done the best job of communicating the vital function and value that they provide to the lay audience in general, and to senior leadership in particular. On the other hand, senior leadership is not always receptive to a crash course on a critical but highly technical area. Again, it is hard to treat an item like an investment if it is not well understood.

Leadership at the AMC and the departmental level should be well aware of the portfolio of IT spending and the value proposition for each "fund" in the portfolio. Investments in "keeping the trains running" often have the same potential for enabling the enterprise (or averting disaster) as those aimed at exciting new capabilities. Many of us can't say that we have such a level of transparency and understanding, and getting there is usually not a simple challenge.

With this mindset, the service discussions should always include the business managers and CFOs who manage the budget/investments, and budget/investment discussions should always include the service consumer. A deceptively simple concept that is often easier said than done, but as IT leadership, we are the connecting tissue between the money bone and the service bone...