Today is my 60th Day with my new employer.

My team asked me recently, “Why do you keep count like this?”

I tell them that it’s to preserve momentum — forward movement. Coming into a new organization, with challenges and things to address, you only have so much time to effect change. You have to accurately assess your environment, decide what needs fixing, and get the pieces in place ASAP.

The first 100 days sets a tone for change. To quote a famous sage:

“Life Moves Pretty Fast. If you don’t stop and look around once in a while, you might miss it.”

–Ferris Bueller

But seriously, folks — we’re getting ready to build a new building in the next block and create a campus. Having done it before, I can tell you that something that monumental doesn’t just happen — you have to prepare for it, and in my area, to avoid expanding one’s FTE unnecessarily, you have to be ready with an organization that matches where you’ll be rather than where you are now.

For me, large and complex IT infrastructure projects like this are heady stuff, and it’s the reason I signed on. But we have a number of challenges:

My Department

  • The IT team is generally a good one, with a lot of heart and devotion to the mission.  However, they have not been given sufficient opportunities to grow their skills.
  • Support-wise, the department is “stuck in 2013” – built on a foundation of providing all services in-house, rather than taking advantage of cloud resources. They’ve taken the first steps by moving to Microsoft 365 in the last year. Over time, more and more systems our clinicians use will move toward cloud-based approaches, transitioning our support model from taking care of servers and systems to providing more business analyst functions to departments.
  • To their credit, they and leadership knew to engage consultants to help with things beyond their scope, but no one on-site acted as Project Manager on any of these projects, or how to determine what success looked like. So, some projects were declared completed, but were never really completed, or done right (according to me, anyway).

Phones and Faxes

OR: “Tell me you’re a medical provider without telling me you’re a medical provider.”

  • Even though it’s 2023, we have too much copper in the building, tied up in circuit-switched, RJ-11-based discrete systems or back-end services. Our current phone system is basically the same “bones” as 2007, but with some new parts: traditional phone circuits terminate here in the building, which start off as analog signals delivered to digital phones and analog fax machines.
  • The desk phones are VOIP (Thank God), so at least there’s modern POE switches and a segmented network, so it’s not all the doom and gloom of antiquated parts.
  • Thanks to HIPAA and our partnerships with other IHS and federal organizations, the FAX remains king. Even now I’m still finding mysterious POTS lines and trying to figure out who’s paying for them.

Network Security

  • During a recent 3-day engagement with an IT consulting firm, one of the principals asked me: “What keeps you up at night?” After peering under rocks with their help, I had a clear answer, and it was: our firewall.
  • It had been selected by the previous regime, who said in essence, “Well, we had their earlier product and it seemed to work okay, so…” In spite of that, we’ve learned there were many things in the conversion that were not completed, or the steps necessary for success were not all performed.

We’re fixing that now.

Systems Replication and Backup

  • Over the past few months, the IT team has embraced Hyper-V Virtualization and replication, which has enabled us to have backup copies of all mission-critical servers.
  • We have offsite backups but will taking on a “trust but verify” approach with that service provider to see that it’s usable. We might be changing how we backup things now that everything is virtualized.

IT Governance and Collaboration

  • To make better strategic IT and purchasing decisions, I’ve asked our Board to create an IT Advisory Committee, made up of seasoned area IT leaders that will meet quarterly. Having a group of colleagues, and a pipeline to the Board of Directors, is essential to our success.
  • I’ll be reaching out to area counterparts at other IHS-affiliated medical centers, to learn from them and determine how we can collaborate more.

As you can see, it’s been a busy 60 days, and won’t really slow down. It’ll take 18 months or so to complete the building, and we’ve been making great progress in how to maximize the benefits, like splitting our two firewalls across both buildings for not only High Availability but Resiliency. The Light Bulb moment of that, courtesy of recent brainstorming with our consultants, has brought about other, similar innovations, and I couldn’t be happier.

Now, on to Day 61 tomorrow…

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