temp harrogate talk on cio leadership

IM&T Leadership In Healthcare: Core Competency Critical Success Factors For The 21st Century: 

IM&T Leadership In Healthcare: Core Competency Critical Success Factors For The 21st Century HC 2004 Harrogate – March 23, 2004

Victoria Harrogate: 

Victoria Harrogate

Presentation Outline: 

Presentation Outline Characteristics of the 21st century Characteristics of leaders Psychology of change management The head of IM&T role Being a successful leader of change

Forces Changing The Healthcare Environment: 

Forces Changing The Healthcare Environment Provider demographic shift Aging population Practice pattern changes Increasing and changing demand Aging population Longer disease survival Continuous pressure on costs Healthcare consumerism Consumers demanding control over their healthcare choices Consumers demanding better customer service Increasing political importance of healthcare Consumers’ belief that the state should “fix healthcare” Politicization of stakeholder groups New technology Medical IT Changes in Health Care Delivery System

Future Technology Drivers: 

Future Technology Drivers Medical Technology Designer Drugs Nano technology Proteomics In-Vivo Imaging Remote Surgery Genetic Mapping Vaccines Artificial Blood Xenotransplantation Etc. ICT Wireless technologies WAP Voice over IP RCID Remote tele-monitoring Grid computing Interoperability ASP Standards HL-7, SNOMED CT, etc. Etc.

Technology AdoptionNo. of years for 30% of Americans to own technology: 

Technology Adoption No. of years for 30% of Americans to own technology Telephone 40 years Television 17 years PC 13 years Internet 7 years Sand DZ HIMSS presentation 2002

Technology is changing the way we live: 

Technology is changing the way we live

Presentation Outline: 

Presentation Outline Characteristics of the 21st century Characteristics of leaders Psychology of change management The head of IM&T role Being a successful leader of change

Slide9: 

“There are six basic leadership styles. Each derives from different emotional intelligence competencies, works best in particular situations, and affects the organizational climate in different ways.” Goleman D Choosing the Right Leadership Style: No Single Approach Fits All Situations Harvard Business Review, 2000

Six basic leadership styles: 

Six basic leadership styles The coercive style. This “Do what I say” approach can be very effective in a turnaround situation, a natural disaster, or when working with problem employees. But in most situations, coercive leadership inhibits the organization’s flexibility and dampens employees’ motivation. The authoritative style. An authoritative leader takes a “Come with me” approach: the states the overall goal but gives people the freedom to choose their own means of achieving it. This style works especially well when a business is adrift. It is less effective when the leader is working with a team of experts who are more experienced than he is.

Six basic leadership styles (cont’d): 

Six basic leadership styles (cont’d) The affiliative style. The hallmark of the affiliative leader is a “People come first” attitude. This style is particularly useful for building team harmony or increasing morale. But it`s exclusive focus on praise can allow poor performance to go uncorrected. Also, affiliative leaders rarely offer advice, which often leaves employees in a quandary. The democratic style. By giving workers a voice in decisions, democratic leaders build organizational flexibility and responsibility and help generate fresh ideas. But sometimes the price is endless meetings and confused employees who feel leaderless.

Six basic leadership styles (cont’d): 

Six basic leadership styles (cont’d) The pacesetting style. A leader who sets high performance standards and exemplifies them himself has a very positive impact on employees who are self-motivated and highly competent. But other employees tend to feel overwhelmed by such a leader’s demands for excellence—and to resent his tendency to take over a situation. The coaching style. This style focuses more on personal development than on immediate work-related tasks. It works well when employees are already aware of their weaknesses and want to improve, but not when they are resistant to changing their ways.

Slide13: 

“The best leaders don’t know just one style of leadership—they’re skilled at several, and have the flexibility to switch between styles as the circumstances dictate.” Goleman D Leadership That Gets Results Harvard Business Review, 2000

“IQ and technical skills are important but, emotional intelligence is the sine qua non of leadership.”: 

“IQ and technical skills are important but, emotional intelligence is the sine qua non of leadership.” Goleman D What Makes a Leader Harvard Business Review Nov-Dec 1998

Characteristics of Emotional Intelligence: 

Characteristics of Emotional Intelligence Self Awareness The ability to recognize and understand our moods, emotions and drives, as well as their effect on others As shown by: Self confidence Realistic self-assessment Self-deprecating sense of humour

Emotional Intelligence (cont’d): 

Emotional Intelligence (cont’d) Self Regulation The ability to control or redirect disruptive impulses and moods The propensity to suspend judgement - to think before acting As shown by: trustworthiness and integrity comfort with ambiguity openness to change

Emotional Intelligence (cont’d): 

Emotional Intelligence (cont’d) Motivation A passion to work for reasons that go beyond money A propensity to pursue goals with energy and persistence As show by: strong drive to achieve optimism, even in failure organizational commitment

Emotional Intelligence (cont’d): 

Emotional Intelligence (cont’d) Empathy The ability to understand the emotional make-up of people Skill in treating people according to their emotional reactions As shown by: expertise in building and retaining talent cross-cultural sensitivity service to clients and customers

Emotional Intelligence (cont’d): 

Emotional Intelligence (cont’d) Social Skill Proficiency in managing relationships to build networks An ability to find common ground and build rapport As shown by: effectiveness in leading change persuasiveness expertise in building and leading teams

Good leaders pick a good path : 

Good leaders pick a good path

Presentation Outline: 

Presentation Outline Characteristics of the 21st century Characteristics of leaders Psychology of change management The head of IM&T role Being a successful leader of change

“There is nothing more difficult to take in hand, more perilous to conduct, or more uncertain in its success, than to take the lead in the introduction of a new order of things.”: 

“There is nothing more difficult to take in hand, more perilous to conduct, or more uncertain in its success, than to take the lead in the introduction of a new order of things.” Niccolo Machiavelli The Prince

Change  Crisis & Opportunity: 

Change  Crisis & Opportunity

“Most people in an organization have some investment in the status quo - there are some things they like and don’t want to lose.Most people also have some discontent regarding the current order - there are things they would like to alter.”: 

“Most people in an organization have some investment in the status quo - there are some things they like and don’t want to lose. Most people also have some discontent regarding the current order - there are things they would like to alter.” Hutton DW The Change Agent’s Handbook ASQ Quality Press 1994

Four conditions for changing mind-sets: 

Four conditions for changing mind-sets People will alter their mind-sets only if: they see the point of the change and agree with it—at least enough to give it a try. the surrounding structures (e.g. reward and recognition systems) must be in tune with the new behavior. they have the skills to do what it requires. they must see people they respect modeling it actively. Lawson E & Price C The Psychology of Change Management The McKinsey Quarterly Number 2, 2003

Slide26: 

A purpose to believe in In 1957, social psychologist Leon Festinger published his theory of cognitive dissonance. the distressing mental state that arises when people find that their beliefs are inconsistent with their actions Reinforcement systems B. F. Skinner’s theories of conditioning and positive reinforcement were taken up by psychologists interested in what motivates people in organizations.

Slide27: 

The skills required for change During the 1980s, David Kolb, a specialist in adult learning, showed that adults can’t learn merely by listening to instructions; they must also absorb the new information, use it experimentally, and integrate it with their existing knowledge. Role modeling Role modeling by individuals must be confirmed by the groups that surround them if it is to have a permanent or deep influence. Change must be meaningful to key groups at each level of the organization

Slide28: 

“Regardless of the industry, when change through the adoption of new technology takes place, the amount of work required to operate the existing system actually increases. How much the work increases and the length of time depends on four critical success factors.” Leonard KJ Critical Success Factors Relating to Healthcare’s Adoption of New Technology: A guide to increasing the likelihood of successful implementation November 2003

Critical Success Factors Relating to Healthcare’s Adoption of New Technology: 

Critical Success Factors Relating to Healthcare’s Adoption of New Technology amount of resistance to change (i.e., presence of industry experience using the technology) amount of training both before and during the transition (or implementation) amount of buy-in (or contribution during design) from the different stakeholder groups presence of effective reporting on the status of the outcome measures during and post-implementation (i.e., communication on the technology adoption progress).

Role models have always been important: 

Role models have always been important

Presentation Outline: 

Presentation Outline Characteristics of the 21st century Characteristics of leaders Psychology of change management The head of IM&T role Being a successful leader of change

The head of IM&T role: 

The head of IM&T role Is s/he a leader or a manager? Does s/he lead or support? Balance between contrary and consensus Old IM or new IM?

IM&T HeadLeader or Manager?: 

IM&T Head Leader or Manager? One view: Leading is different than planning, organizing and coordinating because leading is focused on influencing people, while the other functions are focused on "resources" in addition to people. Another view: The assertion that "leading is different than managing" -- and the ways that these assertions are made -- can cultivate the view that the activities of planning, organizing and coordinating are somehow less important than leading. McNamara C Overview of Leadership in Organizations

IM&T HeadLead or Support?: 

IM&T Head Lead or Support? Lead Implies “telling people what must be done but not dictating how” Does involve the giving of direction Support Implies service Often accompanied by the term “enable“ which means “make possible or give the means and authority to do something”

IM&T HeadBalancing Between Contrariness And Consensus?: 

IM&T Head Balancing Between Contrariness And Consensus? Leadership is an art. On the one hand, organizational experts say to surround yourself with mavericks and risk takers, to keep an open mind, listen to your team members (especially the dissenters), avoid “yes wo/men" and "groupthink," even to nurture disagreement -- all in the interest of creating change. But then comes the flip side: building consensus and securing buy-in, then moving forward as one cohesive body. Heskett JLeadership: A Matter of Sustaining or Eliminating Groupthink? Harvard Business Week 2 Feb & 23 Feb 2004

IM&T head“Old” IM or “New” IM?: 

IM&T head “Old” IM or “New” IM? Old (traditional) IM Providing the right information to the right people at the right time. New IM Improving the performance of people in organizations, which requires providing the right evidence-based information to the right people, at the right time and location, and in the right way. More importantly, it also includes: the ethical use of personal information, the application of effective change management techniques, and an ongoing focus on outcomes.

What some IM&T leaders are promoting: 

What some IM&T leaders are promoting

Presentation Outline: 

Presentation Outline Characteristics of the 21st century Characteristics of leaders Psychology of change management The head of IM&T role Being a successful leader of change

"Introducing any type of change into an organization, but especially a technological change, is inevitably a very political process.”: 

"Introducing any type of change into an organization, but especially a technological change, is inevitably a very political process.” Nancy Lorenzi and Robert Riley Organizational Aspects of Health Informatics Springer-Verlag, 1995

Twelve Key Strategies to be a Successful Change Agent: 

Twelve Key Strategies to be a Successful Change Agent 1. Be Patient 2. Maintain Your Sense of Perspective 3. Identify and Work with the Power People 4. Maintain Good Communications 5. Avoid Isolation 6. Know the "Rules of the Game" 7. Maintain High Energy 8. Be Directly Involved 9. Manage Your Ego 10. Maintain a Sense of Trust 11. Maintain Your Sense of Humor 12. Use Your Silver Bullets Wisely

1. Be Patient: 

1. Be Patient

Slide42: 

“Have patience, persistence, and a sense of humor. These might be summed up as resilience. They are not just nice to have - they are essential.”

2. Maintain Perspective: 

2. Maintain Perspective

3. Work with the Power People: 

3. Work with the Power People

4. Maintain Good Communications: 

4. Maintain Good Communications

Communication of expectations is the cornerstone of successful IT adoption: 

Communication of expectations is the cornerstone of successful IT adoption Two teams of telephone pole installation technicians are hired to put in telephone poles into a new residential subdivision. The existing crew was the best in the business and need very little guidance. A second crew was brand new, but they receive very little instruction as well – after all, they are only installing telephone poles (it’s not like it’s brain surgery!). After the end of the first day, both teams report to their supervisor. When asked, the first team of experts reported that they had installed 25 poles that day – a new record for that area. When the supervisor asked the second crew team leader, he sheepishly replied that they had only installed two! “Two? How can that be?” was the immediate retort from the boss. “Let’s go out right now to see the work of the first team so that you can see how a real team does professional work!” They all stormed out to the site in the subdivision where the first team had worked. The supervisor looked proudly down the street – “see that is championship work”! To which the second team leader responded immediately – “yeah, sure, but look how much of their poles are sticking out of the ground!”

5. Avoid Isolation: 

5. Avoid Isolation

6. Know the "Rules of the Game": 

6. Know the "Rules of the Game"

“Our interest in the management of change in medicine arose because we had seen so many good initiatives allowed to wither on the vine for lack of a decent strategy to see them into place, so many good ideas wasted because of the way they were presented and so many changes made harder through failure to create a climate of cooperation.”: 

“Our interest in the management of change in medicine arose because we had seen so many good initiatives allowed to wither on the vine for lack of a decent strategy to see them into place, so many good ideas wasted because of the way they were presented and so many changes made harder through failure to create a climate of cooperation.” Gale R, Grant J Managing change in a medical context: Guidelines for action Medical Teacher, Vol. 19, No. 4, p. 239, Dec. 97

Management of change in medicine: 

Management of change in medicine To give detailed advice about the management of change, it is essential to know and understand the context in which the change will take place. The nature of the enterprise, the distribution of power and influence, the degree of external political control and the outlooks of the professionals involved will all interact to limit the styles and types of change that are possible. Advice must be firmly anchored in the context of medicine and must take account of its special nature. Gale & Grant

Advice when working with physicians: 

Advice when working with physicians Consultation Doctors expect to be asked, to be consulted and not to be told what to do. Consultation is a signaling process, it is the first step in change, the first indication that there may be other ways of doing things. Demonstration projects The scientific basis of medicine leads to a reliance on scientific methods in organization too. Doctors place greater validity on the outcomes of proper trials, or demonstration projects, than they do on personal opinions.

Advice when working with physicians (cont’d): 

Advice when working with physicians (cont’d) Evolution Gradual change is preferred to radical change. The progress of medicine as a whole consists of a series of small advances and improvements and a similar style of organizational or educational development is desirable. Ownership The autonomy of doctors means that they will not generally be enthusiastic about change unless they feel they are the owners. For a change leader, wide ownership of the change process presents a possible dilution of the concept or ambiguity in the direction and control of the process. Without a spread of ownership, there will be little enthusiasm and progress.

Advice when working with physicians (cont’d): 

Advice when working with physicians (cont’d) Power to hinder The autonomy of doctors gives them a power of veto over many types of change. Doctors are not as interdependent as many professionals in other organizations and face fewer consequences for lack of cooperation. Commitment, energy & enthusiasm are personal attributes required of the change leader(s). Without commitment from the group leading a change, and the application of time and energy to the process, little will happen.

Slide54: 

“While some healthcare executives have come to accept poor physician relations as the norm, it doesn't have to be that way. By working to balance the heart of medicine with the enterprise of medicine in your organization, you can indeed give your physicians what they want, while operating in the best interests of the patients and the organization as well.” Letourneau B, Curry W In Search of Physician Leadership Health Administration Press; 1998

A true story: 

A true story In a large Academic Health Science Center around the mid-1990’s, the diagnostic imaging department was going through the final stages of the conversion to a completely film-less radiology process – in other words, moving to electronic images of x-rays. During this conversion, the doctors were notified and then sent their patients images by emails. By late morning of the first day of the transition, many doctors complained that they had yet to receive their patients’ x-ray results. Apparently, the doctors did not check their emails.

Slide56: 

In an effort to ensure the success of the conversion, the imaging department then began to send the doctors the radiology results on a computer diskette or compact discs (CD-ROM, depending on the size of the file). Unfortunately, the doctors still continued to complain about the tardiness of the results. Even though they received the diskettes and CDs in a timely manner, they could not match the arrival of these hardware supplies to their own information needs. This is not to say that the physicians were not computer literate; but rather inexperienced at identifying the connection between CDs and patient x-rays.

Slide57: 

So the imaging department hit upon a great idea: they continued to use the CDs but now sent them to the doctors via internal hospital delivery system in the traditional large x-ray envelopes. Recognizing the envelopes, the doctors opened them immediately, placed the CDs in their computers and started reviewing the results.

7. Maintain High Energy: 

7. Maintain High Energy

8. Be Directly Involved: 

8. Be Directly Involved

9. Manage Your Ego: 

9. Manage Your Ego “But of the good leader, when his(her) work is done, her(his) aim fulfilled, the people will say “We did it ourselves”.” Lao-Tsu

10. Maintain a Sense of Trust: 

10. Maintain a Sense of Trust

Slide62: 

"Often, many IT executives find themselves in a “no-win” situation when trying to drive change in a business unit or clinical practice where the departmental leader is not open to change. Realize that innovation requires partnership." Gunasekaran S & Garets DE Business Value of IT: The Strategic IM&T Planning Process Journal of Healthcare Information Management. Vol. 17, No. 1, pg. 31. 2003

Welcome your new partners: 

Welcome your new partners

Slide64: 

“Unless managers take responsibility for the success – and failure – of IT systems, they will end up with systems that, while perhaps technically elegant, will have no impact on the business. Only business executives can be held responsible for making the organizational changes needed to generate business value from a new system.” Ross J & Weill P Six IT Decisions Your IT People Shouldn’t Make Harvard Business Review November 2002

11. Maintain Your Sense of Humor: 

11. Maintain Your Sense of Humor

12. Use Your Silver Bullets Wisely: 

12. Use Your Silver Bullets Wisely

Concluding Thoughts: 

Concluding Thoughts IM&T Leadership In Healthcare: Core Competency Critical Success Factors For The 21st Century

Critical Success Factors: 

Critical Success Factors Lead with high energy and boundless enthusiasm Give people a sense of purpose and direction Plan for success - “prime the pump” Dish out plenty of praise and encouragement Create opportunities for people to get attention

Critical Success Factors (cont’d): 

Critical Success Factors (cont’d) demonstrate confidence and faith in people’s abilities delegate, never dump encourage independent thinking build a team listen, listen, listen set an example

“God give us grace to accept with serenity the things that cannot be changed, courage to change the things which should be changed, and the wisdom to distinguish one from the other.”: 

“God give us grace to accept with serenity the things that cannot be changed, courage to change the things which should be changed, and the wisdom to distinguish one from the other.” The Serenity Prayer Reinhold Niebuhr

Don’t lose the faith: 

Don’t lose the faith In hospitals in 1904 It was not easy for all the doctors to make the change. To some of them the new way seemed more cumbersome than the old, just a lot of unnecessary red tape. It seemed much simpler to jot down a few notes in a ledger lying open on the desk than to fill in all the blanks on a form sheet, much easier to pull out one's own volume and look up what old record was there than to call for an envelope and wait till it was brought from the file. At first some doctors just forgot about the record blanks and used their ledgers when they were very busy, but in time they all saw the worth of the new system (i.e. the medical record as we know it today), and it became a routine followed without question and with tremendous benefit. Those who introduce EHR systems in the 21st century can hope for as much success --- eventually.

Have Confidence and Courage! : 

Have Confidence and Courage! With permission from Drs. Nancy Lorenzi and Robert Riley. Presented April 2002 Working Conference on Health Information Systems, Heidelberg, Germany

Finite: 

Finite Enjoy your time in Harrogate (our home away from home)