Middle and upper management are, generally speaking, mediocre to poor. There is very little software implementation skill within management -- I would guess that much of management (especially middle management) is comprised of people that have a clinical background or people that were hired 20 years ago when BJC was a small shop. Therefore, most have no real enterprise-level software implementation experience. There appears to be some awareness within the organization that something is amiss, because senior management appears to be attempting to change things. Unfortunately, the changes appear to largely consist of the hiring of directors, VPs and administrators rather than software experts. The belief that "black belts," professional bureaucrats and PMPs will fix an organizational lack of technical expertise is unsound, at best.
BJC management will frequently tout its economic conservatism as a sound strategy, especially in economic downturns. However, the strategy needs to be coupled with sound investment of the funds it actually does spend. It would be worthwhile to look to a proven IT consultancy for advice on ways to invest funds in infrastructure improvements and ways to eliminate waste.
Overall, the motto of BJC IT appears to be "Sufficient is Good Enough." In general the company avoids spending more than is necessary to complete the task at hand. This may have been sufficient 15 years ago, but probably will lead to greater costs and difficulties as the health care sector is subject to increasing oversight and regulation.