Former Cleveland Clinic CIO, Edward Marx’s Voices of Innovation is a field guide of case studies that healthcare leaders can use to guide their own innovative projects.
We interviewed Edward recently to help produce our innovation roadmap checklist. The conversation was so full of helpful stories and inspiration that we asked if we could release the audio. It’s different than a tech-focused IT conversation, as Edward views everyone in the organization as involved in patient care.
In the recording (or transcript below), you’ll hear stories from the book, how to create a culture of innovation, and a deep dive on motivation and perseverance during stressful leadership & personal scenarios. Enjoy!
Transcript from the Interview:
It’s Chris Hemphill from the AI Lab at SymphonyRM.
I wanted to share a call that I had with Edward Marx, who has served as Chief Information Officer at Cleveland Clinic & Texas Health Resources and is now offering his services in a new venture. Before we jump into it, let me provide some context.
The original purpose of the call was to take some notes for a blog post about his latest book, Voices of Innovation. Ed’s viewpoints turned out to be so awesome and so inspiring that I asked him if we could post the audio.
If you’re not familiar with Cleveland Clinic, US News & World Reports ranks them the number 2 hospital in the US. They’re number 1 in Urology, and number 1 in Heart Care for the 24th year in a row. They’re constantly making headlines for healthcare innovations, and I know several people who can personally attest to their quality of care.
They’re an $8B health system with more than 52,000 employees, and as CIO, Ed drives the culture and protocols that cement their position as leaders in Healthcare IT and innovation. He participates in grueling endurance challenges such as triathlons, and he served as an Army engineer. He’s got an absolutely dogged fighting spirit.
In the interview, Ed shares what keeps him going strong despite the challenges of leadership and health. He is transparent with personal and professional stories where he has overcome adversity and driven massive change at organizations he’s worked with.
Again, we weren’t originally planning on making this public, so a little background on some of our conversation points.
At the beginning of the call, Ed references a heart attack and a device that helped identify the problem before it was too late. For context, this happened during a long endurance race, which he completed despite showing symptoms.
Towards the end, we were discussing more recent adversity, his recent bout with cancer and how he continued to spread positivity even during one of the most difficult times of his life. You can see his posts on the subject on his blog CIO Unplugged.
Ed is absolutely incredible in his resolve, and in this conversation, you’ll learn how and why he fights for the long haul, how to foster a culture of innovation, and why you should celebrate your failures.
I hope this conversation inspires you as much as it did for me.
The reason I wanted to get together, I’ve been reading through Voices of Innovation, and you said that it was meant to be a field guide for actionable plans & strategies, just like when you were in the military and had a field guide to build air fields and other resources.
Just to kick things off, what would you say is an example of an innovation project you’d like to share?
Yeah, I don’t think I described in the book, but I think you heard me speak about my heart attack situation. There’s a lot of innovation that took place to enable that, some within Cleveland Clinic and some from other companies. The company that produces the EKG that integrates with the iPhone, for example, instantly knew and was able to diagnose.
Since we were all on the same EMR, we could have done this on different platforms depending on interoperability, but all the images and data were easily directed to Cleveland Clinic a couple thousand miles away where the world’s leading experts could look at it. That was innovation done by Epic, and the innovation that we did was the interoperability into the patient health record.
We do a lot of ability to connect devices, such as IOT devices, that connect into a personal health record so that clinicians can instantly see vitals and make same-day or real time decisions on changing medications and impacting outcomes. Those are some things we innovated, other things, such as the EKG device, we provide real time analysis of EKG feeds. For instance, for 30 days after my MI, I would immediately invoke the EKG capability, and within a couple hours, I had an electro-physiologist reading the results and responding back.
That would be an example of innovations done by us, Epic, and the other company that enables remote EKG technology.
Very interesting! When I’m listening to those innovation projects and the results of interoperable experiences with Epic and the EKG system, I’m curious about other people who want to reproduce those results but can’t get the organizational buy-in they need to make it happen. Are there situations or advice that you have for people trying to get organizational buy-in for innovations?
Yeah, healthcare organizations in general tend to be more conservative and for good reason. There’s a life at stake and patient safety/quality we have to be concerned with. Someone’s life is impacted. We’re very careful, and people have become, over the years, risk adverse.
There’s an old saying, “You don’t go wrong with IBM, and it’s the people that take risks that get in trouble.” The way I feel about it is that if you don’t take risks, you’re not going to advance or improve. You have to do what’s called calculated risk, and that’s what you have to do in companies to really impact the culture.
You have to take small wins, wins that don’t impact patient care but build trust and credibility. Over time, you can start changing that culture.
Another way is celebrating failures. It’s okay to fail in a safe environment, and we should celebrate those failures. That helps the culture so that it can embrace innovation and embrace change because failure isn’t punitive. Those are techniques you can employ to help: start slowly, build credibility, celebrate failures.
Start softly, start easily, and build credibility towards bigger things.
Any examples or stories in that regard?
Yeah one example, we wanted to be among the first with Microsoft Surface technology [in the mid-2000s, this was their coffee table sized computer with touch screen technology].
We thought the visual representation would really help with patient communication. The world quickly changed with the advent of the iPad, and everything went to a much smaller form factor causing Surface to become obsolete.
Instead of being mad that we wasted money and spent time developing, we celebrated and kept it as an actual coffee table in our offices. We had a story around it, we take risks and we try things, and the worst thing that happened was a coffee table.
From that launched our ability to help revolutionize and digitize how Alzheimer’s disease is accounted for and tested for. We used the same technologies to bring to the iPad tools to help track progress through the disease.
Another example of where we started slow was by having an app. An app doesn’t hurt anybody, and we started with a small app that people liked, and as people proved that they liked it, we asked for more money for further development on the app.
It was really a matter of taking small baby steps and building trust and capability.
I think that’s a really good approach, and I think the transparency you’ve shown in this conversation and before that is a huge part. People feel like failure is something to be buried, but you’re saying “Hey, we made an attempt at something, and even though it didn’t get the result we were shooting for, we made it work well for us.”
It’s excellent you’re in a culture of innovation, just wondering what are some areas that people should start thinking towards and striving towards fostering that in their own culture?
You’ve gotta be innovative yourself.
Lots of times people want to be innovative, but they’re not innovative themselves, so it’s hard to have that credibility. They might be wearing clothes they wore 15 years ago, or their desks and offices might look like every other office.
If you were to come into my office, it’s completely different than my peers. There’s no computer, just my laptop. There’s no printer, I’m paperless. People know that I’m different.
That’s the first thing, establish that personal credibility on your brand. If you’re trying to push innovation, you should be innovative yourself and not be stuck in routine.
The other thing you can do is start exposing others to innovation. One thing I’ve employed quite a bit in multiple employers is visiting organizations that are innovative. For instance, we’ll visit Google, Apple, and we’ll learn from them what they see as innovative in healthcare.
I’ll also pick one healthcare IT shop that I think is pretty progressive in the industry and we’ll go visit them. The last one was Cedars in LA. We have an exchange program with Thomas Jefferson, and Ascension is doing some cool things as well.
I also always pick one company a year outside of healthcare and meet with them. I’ve met with Kimberly Clark and Pier 1. These different companies that might be a little more advanced, we’re doing something like that with Key Bank. It’s another way of bringing in new aspects of culture and new ways of thinking.
We’ve also done idea–thons or contests where we would fund the most innovative things our employees could think of. “Bring your big bold ideas and we’ll pick one and fund it to see how it works.”
Do something, get a small win that you can celebrate and advertise, then build upon it.
Fantastic, go out there and make a ruckus.
Reading through various chapters, knowing that every health system has different scenarios, just wondering: If there were only one chapter for someone to read, what chapter would that be? What message do you want people to get out of it?
It’s in the conclusion and I already mentioned it, to be innovative, you’ve got to be innovative.
The good news is if you’re not, that’s okay!
There are very simple ways to make change and transform yourself. Do things differently. Switch your phone every year. Try an Android if you always use an iPhone. Try a MacBook if you already use Windows. Dress differently, mix things up.
Be on a board that’s cross-industry. I’ve been part of ATT advisory board, IBM, HP, Microsoft. These are not industry specific. I’d sit across the table from the CIO at General Mills and Ford. I would learn from other people, different things. I was continuously honing myself. It’s important to continuously evolve yourself.
While I believe this truly is a field manual, it’s going to work best if you yourself are innovative and if you’re comfortable trying new things.
That makes sense. If you’re doing the same things repeatedly and expecting change, that’s not going to work.
Yeah, partner with someone, partner with an organization. ATT or Microsoft for example. We wanted to try innovation and be innovative, but we had limited capabilities. We partnered with them and they gave us some engineers to do some of the programming.
An idea that worked really well, we partnered with a company that basically used an iPad, and on the door was all the information you needed to know about the patient.
We couldn’t do it on our own. We didn’t have the hardware expertise, but we brought the IT to the table. We developed this thing and it was popular, and every time they resell it, a couple dollars per unit go to my former employer.
Thomas Jefferson, for example, we may think of something new together and find a way to commoditize that. Leverage other people for help and to promote and execute on innovation.
Great! You don’t have to do all this yourself. I imagine people are overwhelmed by all the things that they can do.
One of the first deals I did – IP telephony had already been out for a while, but healthcare wouldn’t adopt it because they were afraid their phones wouldn’t work, and that people would die. I knew from my own talks in the industry that it was pretty solid and that the traditional system was a failsafe.
Cisco was dying to get their foot into healthcare, I was dying to replace our aging telephony. I approached them, and our CEOs got engaged, and it turned out to be a great pleaser for our caregivers.
Even if you’re not in a super innovative culture, you can do a lot by partnering with someone.
Since I’m doing a writeup on the Create Roadmaps chapter, I was wondering if you see the roadmap as a halo people can gather around, and how you see it driving enthusiasm around change.
Sometimes people think roadmaps are counter-intuitive to innovation because they provide too much structure. There’s nothing wrong with having structured innovation. You should have a plan, but the plan needs to be flexible.
One of our things we’ve set in the ground at Cleveland Clinic is that by 2023, 50% of outpatient visits will be virtual and 25% of inpatient stays will be at home. We don’t currently have all the technology and know-how to do this, but we will figure out with growth how to execute on that within 5 years. We don’t have all the answers, but the roadmap gives us the vision of where we want to be and forces us to think in an innovative way.
If you’re too open with innovation, nothing happens. That’s the black eye that innovation receives. Many spend money accomplishing nothing. Roadmaps give accountability and markers for encouragement, but it needs to be balanced so that it doesn’t become super rigid.
If you don’t have direction, it seems like different projects might happen with many people bringing things to the table, but nothing catches on and gets done. It was pretty clear in the book that governance breeds innovation.
To finish off, you talked about the challenging moments and have been transparent about your life and success & failure.
I know that you’re heavily involved in athletics, and I’ve noticed that you maintain an extremely positive attitude despite the challenges you’ve gone through recently. I was wondering if you have thoughts to help people deal with their challenges, troughs, and valleys.
One is that I know who I am. A lot of people are still trying to figure out who they are. I’m four things: Share, Study, Serve, and Shape. Everything I do is around that core mission.
I know why I was created, and I know why I was called to healthcare IT.
That helps me. When I run into obstacles, I always know this is who I am, this is who I was created to be, and this is my mission in life.
That keeps me going and gives me the motivation I need. I don’t suffer from a lot of insecurities because I know I’ve been called. AS a result, I’m going to be focused on that particular calling.
The runner who wants to do a marathon says, “I’m a runner I was born to run, and it makes me happy.” When you’re starting with a 5k and climbing up and eventually suffer an injury, you don’t get too dismayed about it. You know, “I’ve got this thing, I’m going to run a marathon one day.”
The vision, inspiration, and passion keep you going. That’s what gets you up at 5am to get all your miles in is that you’re not going to let anything get in the way of crossing that finish line.
When I run into obstacles, which I do, it’s “No, it’s okay, we’re saving lives.”
Ultimately, we’re going to keep fighting through. There may be setbacks, but we continue to fight for the best things for our patients and caregivers.
It might be hard for people to relate to, but I know who I am. I know why I was created. I know my calling is Healthcare IT. I know it’s a marathon and not a sprint.
Finally, have a good support system. Have a great team at home and in the workplace. Those are things that are very helpful to me.