IM

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IMT Leadership In Healthcare Core Competency
Critical Success Factors For The 21st Century

• HC 2004
• Harrogate March 23, 2004

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Victoria Harrogate
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Presentation Outline

• Characteristics of the 21st century
• Characteristics of leaders
• Psychology of change management
• The head of IMT role
• Being a successful leader of change

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Forces Changing The Healthcare Environment

• Increasing and changing demand
• Aging population
• Longer disease survival

• Increasing political importance of healthcare
• Consumers belief that the state should fix
  healthcare
• Politicization of stakeholder groups

• Provider demographic shift
• Aging population
• Practice pattern changes

• Healthcare consumerism
• Consumers demanding control over their healthcare
  choices
• Consumers demanding better customer service

Changes in Health Care Delivery System
Continuous pressure on costs

• New technology
• Medical
• IT

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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.

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Technology AdoptionNo. 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

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Technology is changing the way we live
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Presentation Outline

• Characteristics of the 21st century
• Characteristics of leaders
• Psychology of change management
• The head of IMT role
• Being a successful leader of change

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• 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

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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 organizations 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.

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Six basic leadership styles (contd)

• 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 its 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.

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Six basic leadership styles (contd)

• 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 leaders demands for
  excellenceand 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.

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• The best leaders dont know just one style of
  leadershiptheyre 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

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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

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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

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Emotional Intelligence (contd)

• 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

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Emotional Intelligence (contd)

• 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

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Emotional Intelligence (contd)

• 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

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Emotional Intelligence (contd)

• 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

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Good leaders pick a good path
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Presentation Outline

• Characteristics of the 21st century
• Characteristics of leaders
• Psychology of change management
• The head of IMT role
• Being a successful leader of change

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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

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Change ? Crisis Opportunity
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Most people in an organization have some
investment in the status quo - there are some
things they like and dont 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 Agents Handbook
• ASQ Quality Press
• 1994

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Four conditions for changing mind-sets

• People will alter their mind-sets only if
• they see the point of the change and agree with
  itat 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 ManagementThe McKinsey
  Quarterly
• Number 2, 2003

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• 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. Skinners theories of conditioning and
  positive reinforcement were taken up by
  psychologists interested in what motivates people
  in organizations.

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• The skills required for change
• During the 1980s, David Kolb, a specialist in
  adult learning, showed that adults cant 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

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• 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 Healthcares
  Adoption of New Technology A guide to increasing
  the likelihood of successful implementation
• November 2003

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Critical Success Factors Relating to Healthcares
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).

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Role models have always been important
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Presentation Outline

• Characteristics of the 21st century
• Characteristics of leaders
• Psychology of change management
• The head of IMT role
• Being a successful leader of change

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The head of IMT 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?

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IMT HeadLeader 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

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IMT HeadLead 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

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IMT HeadBalancing 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

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IMT headOld 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.

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What some IMT leaders are promoting
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Presentation Outline

• Characteristics of the 21st century
• Characteristics of leaders
• Psychology of change management
• The head of IMT role
• Being a successful leader of change

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"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

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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

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1. Be Patient
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• 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.

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2. Maintain Perspective

• Do what you can with what you have where you
  are.
• Theodore Roosevelt

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3. Work with the Power People
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4. Maintain Good Communications
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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 (its not
  like its 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. Lets 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!

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5. Avoid Isolation
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6. Know the "Rules of the Game"
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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

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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

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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.

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Advice when working with physicians (contd)

• 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.

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Advice when working with physicians (contd)

• 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.

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• 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

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A true story

• In a large Academic Health Science Center around
  the mid-1990s, 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.

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• 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.

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• 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.

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7. Maintain High Energy
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8. Be Directly Involved
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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

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10. Maintain a Sense of Trust
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• "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 IMT Planning
  Process
• Journal of Healthcare Information Management.
  Vol. 17, No. 1, pg. 31. 2003

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Welcome your new partners
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• 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 Shouldnt Make
• Harvard Business Review
• November 2002

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11. Maintain Your Sense of Humor
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12. Use Your Silver Bullets Wisely
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Concluding Thoughts

• IMT Leadership In Healthcare Core Competency
  Critical Success Factors For The 21st Century

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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

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Critical Success Factors (contd)

• demonstrate confidence and faith in peoples
  abilities
• delegate, never dump
• encourage independent thinking
• build a team
• listen, listen, listen
• set an example

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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

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Dont 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.

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

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