Sustaining Disciplined Innovation—A Conversation With Mikki Clancy of Premier Health

Mikki Clancy is the chief digital and information officer for Premier Health, based in Dayton, Ohio.

Q: Let’s get this out of the way: artificial intelligence—exciting or overrated?

A: I believe it's exciting, but in a different way than most people think. For me, it's one of several layers of tools that are available to us to help our staff work more efficiently. So that's exciting because the workforce in general is struggling. It allows us to make sure we're letting staff work top of license instead of having them do menial things. But AI has been around a lot longer than people give it credit for, and that's where it's a little bit overrated because it's been there for a while—it’s just getting a lot more press now. Everybody wants their project to have some AI in it, and it helps a little bit with getting funding if people think that it's going to leverage that technology, even though we may not be using the sexiest version of ChatGPT that's advertised out there.

So, I think it's a little bit of both, and I think for a health care leader and a strategist, the important thing is to leverage the exciting points and downplay the overrated points and make sure you still have a good business case for what you're trying to do and not just putting it in for the sake of putting it in.

Q: I first heard the chief digital officer (CDO) title around 2017, and back then the discussion was trying to differentiate the CDO role from the CIO role. Since then, how do you see the division of labor and responsibility between those two titles?

A: Well, we've gone through that evolution, because I am now the chief digital and information officer, so I have an alter ego to balance both the “outside-in” and “inside-out” responsibilities.

I think if you are an organization of substantial size and can separate the two roles, there's still probably a business case to do that, but in these financial times, supporting the salaries of two when you can get it in one made more sense for us. In my combined role, I have to be locked at the hip with the chief marketing and communications officer and the chief enterprise risk officer, because those are the two that really help fill the internal and external viewpoints. And the way that we run as an organization has evolved in the last four years since I initially accepted the CDO role, as I now leverage people and delegate tasks outside of the digital domain in a way that not everybody does, and so that's part of how we scale.

Q: How do you think about balancing bold transformation initiatives with the reality of “keeping the lights on” operationally? What does disciplined innovation look like to you?

A: We have experimented with this a lot over the last four years. If you think of our whole organization is an iceberg, we think of “lights-on functions” as the things below the water line. Innovation functions in most cases are above the waterline, but they need to have the things below the water line to work.

We have dedicated a certain amount of our budget to under-the-water-line activities and those are in my purview to prioritize, so I don't have to go to a steering committee for that (assuming we can work within the agreed upon budget). Anything above the water line for that disciplined innovation goes to our system’s Operational Excellence team on a quarterly basis for prioritization, and those get prioritized based on speed to value. That team includes all the presidents and chiefs across the system, our service line VPs, and a few support department executives (eg, HR, marketing, enterprise risk). Everybody has a chance to say “yay” or “nay” on what we're doing and what we're achieving.

Innovation is always measured, and innovation initiatives are stopped if they are not achieving the measurement. We're always looking at what's going to hit us both long term and short term, and we try to make sure we have a balance on what we're undertaking. It is a very rigorous process. Value is defined by our operational partners—sometimes value is top-line revenue, sometimes it’s bottom-line expense savings, sometimes it’s operational savings that doesn't reduce a person. We do try to make sure we have a blend of hard dollar and soft dollar metrics. We do that quarterly. We also have a “breakthrough” process if some new opportunity comes in front of us. When we first started, about 50 projects were coming in via breakthrough, but last quarter we had eight, so we're capturing them better in the normal prioritization process.

This process has given us the opportunity to achieve value faster than we were previously. When we started, in the first year we achieved almost $26 million in value. In 2023, we achieved $103 million. Last year we achieved $101 million. It's a major contributor to our operating margin turnaround for our organization. It also gave the digital health team a real motivator to know they're contributing to the success of the organization as they couldn’t see that before.

It’s important to have that rigor, to be a responsible determiner of those lights-on functions and really staying in the percentage base we agree upon; and I put the recommendation forward for how much. In 2023, my percentage for lights-on functions was around 35%. It's 77% this year. I can negotiate funds with the CFO and the COO, but most of the time they can see that we are responsibly leveraging the funds that they give us and that we are producing results, so we've been able to get that within a couple percentage points of what I recommend.

Q: Organizations are struggling with managing digital pilots. In your experience, do you find there are some commonalities in determining which pilots are going to scale and which need to be shut down?

A: A lot of it is on a case-by-case basis, but one trend we found is that having operations staff lead the agile team rather than technology staff tends to produce better pilot results and allows us to scale faster. Telehealth is one example where that structure has made those efforts go at warp speed. Our digital front door acceleration and velocity is exponentially faster with the lead who sits on the ops side versus on the tech side, even though it's the same person with the same skill set. With this structure it’s easier to get buy-in and it doesn't feel like a tech person is cramming a solution down your throat.

The other common thread is the faster you pull the plug on something that is not producing the value you expect, the faster you can shift those resources to something else. I would say over 90% of the time something we fail fast on gets re-engineered with the lessons learned of why it failed into something else that emerges in another quarter. We move on—we have enough things in the queue. That makes our scaling rate faster because people know that if it's failing, we're not scaling it, instead of trying to keep fitting a square peg in a round hole.

Q: Thinking of Premier Health’s service region, what are some unique factors of serving Southwest Ohio that maybe get overlooked when we’re evaluating digital health trends on the national level?

A: One major item that appears in our market is how the technical sophistication of our consumers is quite varied, and so while some organizations (at least on paper) appear that they're rolling out a digital solution to 100% of their client base, we have found that we cannot do that. We have been meeting our consumers where they are, so usually, that requires a configuration of three to five solution sets—one of which is still tied to interacting with a person because that personal connection is important. Part of the CDIO’s role is to look from the outside in and consider the persona of your consumers first, which means they may not be ready to fully adopt your digital solutions.

Managing those investments has become a major part of our return to value equation because if we go 100% digital on a solution, we might get X percent value, but if we can only go 50% digital, then we have to adjust the math. But the way that we've approached it is some value is better than no value, and our consumers tend to score us higher on their experience with us because they have some options.

Q: Let's pivot to think about cybersecurity. How do we responsibly balance digital health adoption with the rising threat of cyberattacks?

A: Well, it is a conundrum. I'll just say that we spend a lot of time on a business impact analysis every year and we're looking at how do we keep things up and running within 24 to 48 hours. We probably are more aggressive on implementing some of our back-office automation than we are on the clinical side. We tend to have more embedded automation in our clinical settings, and we’ll trust those solutions coming from an Epic, GE or Philips once we’ve validated their AI or the tech upgrades they're doing. We've built a lot of redundancy in those kinds of platforms. We tend to be a bit more aggressive in the back office so that we can cut our teeth on it and see where the risk points are before we apply it to a front-end process.

But there are still lots of holes that you need to watch out for. When a department can plug in a software as a service solution and start using it without you knowing, that's a huge risk. That's part of why our lights-on funds went from 35% to 77%—we’re putting in some additional cybersecurity tools for discovery that we didn't have before because that risk is too high to let it go unnoticed. Cybersecurity has to be treated as a lights-on function. It's not a discretionary thing.

Also, my chief information security officer (CISO) has direct access to the Audit Compliance Committee of the Board, so if my CISO does not feel like they're getting an appropriate level of risk support from us, he has an avenue to go above me to do that. We did that by design, so there was a little bit of a checks and balance to make sure that we don't shortchange those aspects.

Furthermore, making sure that staff know how to go back to a manual blood pressure cuff or infusion pump instead of an automated machine—those continue to be things we educate on so that we can still deliver care to our patients if we have a disruption. Our chief nursing information officer is accountable for that kind of work and oversees our Learning Center for that reason. She has a dotted line to me, but she reports directly into nursing to ensure that practice accountability is in place and not diluted with just the tech things we have. My chief medical informatics officer is the same way—direct report to the chief clinical officer with a dotted line to me. They work mostly on tech projects, but their accountability is directly to the operations areas so that they can make sure that they're protecting those assets to keep them operational if we have a disruption.

Like others, we still have improvement opportunities to be better at business continuity, and when we have downtime, we practice all of that. We practice communication with our constituents, we practice how to keep running continuity plans while we're bringing the systems back up, etc. We drill for that, but you still won't know if it's sufficient or not until you have a disruption happen. But when we have a disruption, we almost always have at least one or two lessons learned on our redundancy. The important thing is we're learning and adjusting as much as we can.

Q: Any advice you would be willing to share to other women who aspire to climb the ranks as a digital health executive?

A: What I try to tell people that I'm coaching and mentoring is, you need to be like the main character in the movie Rudy, which is about a kid who dreams of playing football at Notre Dame. He encounters one obstacle after another, but he had perseverance to keep at it to eventually get in and play. You must have perseverance. Know your stuff. Do the work. Don’t be intimidated. Remember that you're an equal player in the room and do not let gender get in the way even if somebody else tries to put gender in the way.

I was a United States Marine in the early ‘80s. I had the respect of my fellow Marines because I got up every day and I did the same work they did, and I didn't make it an issue, I just did the work. Certainly, there are unique circumstances and environments for everyone, but my experience is if you do the work and you become an expert in your field, you're going to eventually be recognized as that.

And leadership matters. Like it or not, if you want to be in one of these roles, you must be decisive and confident. I'm probably overly confident at times, but if you know the business and you treat yourself as an equal player in the room that you are in, you will command the respect that you deserve. There'll be times that you might get overlooked, and so raise your hand and bring yourself in. Just make sure you're doing it the right way. I think integrity still matters. Respect still matters. Drive for excellence still matters. Being authentic still matters.

Q: Let’s end with a few rapid-fire questions. First, is there a book or a podcast that you've recently come across that you'd recommend?

A: I would tell you to read anything that Patrick Lencioni writes. That is my favorite author for business. But I’m currently reading Everyone Communicates, Few Connect, by John C Maxwell. That book has been meaningful to create an engaged workforce, which is something a lot of tech leaders struggle with.

Q: What is a daily habit or routine that keeps you going?

A: I have a morning routine that takes about an hour and a half each day. It’s comprised of exercise for half an hour, meditation and prayer, and then spiritual reading. That has been key to my success every day.

Q: What is the best leadership advice you've received?

A: I have two. One is to remember that you are driving a bus, and you need to make sure the people that you lead are on the bus with you and not hanging from the sides of the bus because you're driving too fast and they're not actually on board.

The other is: life is full of balls that we’re constantly juggling. Two of them are glass, the rest are rubber. If you drop the rubber balls, they’ll bounce back up, but those two glass balls will shatter. The glass balls are taking care of yourself and taking care of your family (however you define family). Those two must be your top priority.

This blog post is part of an ongoing Q&A series with digital health leaders at organizations across the US. These in-depth interviews aim to provide real-world perspective and insights in this rapidly evolving space. Don’t miss the first two blogs in the series, found here and here.

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