Tuesday, August 24, 2010

The Role of a Leader

I've written many blog posts about leadership and the challenges of running large complex organizations. Recently, I've thought about how I have personally changed during my 15 years in healthcare leadership positions.

In my early years, the initial challenges were to break through technical barriers by creating prototype applications and demonstrating the possibilities of the emerging web in the mid 1990's.

I then progressed to organization building, devising the strategy, structure and staffing of a growing IT organization.

From there I evolved to thinking about processes - how to ensure reliability, security, and performance of complex infrastructure and applications.

I then moved on to education - writing and speaking about our efforts inside and outside my organizations.

Where am I today as a leader? I believe I'm a convener.

Whether it's my Federal, State, hospital or medical school roles, my most important leadership task is assembling people with various opinions, some of them very vocal, and achieving a set of priorities, next steps, and policies.

In some ways, I'm becoming less technology focused and more business focused. Many of the technologies that were risky/bleeding edge a few years ago - the web, clouds, clusters, enterprise storage, and thin clients, are now mainstream. My day is less about getting the technology working right and more about ensuring we're using the right technology to meet the needs of business owners. Unfortunately, many business owners do not know what they need, although they have high expectations.

The theme of my next leadership year will be governance.

Of course there is meaningful use, EHR implementation, and privacy policy change - but convening stakeholders via a recognized governance model is a prerequisite to getting those done.

It's painful at times to gather everyone together and hear a multitude of diverse opinions, some of which may be factually incorrect and many of which can be critical. All of us are tempted to 'wait to speak' instead of listen. However, the best way I can serve my staff and ultimately all my stakeholders is to condense the messiness of contentious viewpoints and competition for resources into a well communicated list of priorities.

Now that Meaningful Use Stage 1 and the Standards Rules are final, the pace of my Federal responsibilities will be a bit less. This will give me a chance to focus on Massachusetts and hospital/medical school governance. The measure of my success should be the projects we decide NOT to do, since great governance will set priorities and align them with limited budgets and fixed timeframes. A sign of failed governance is saying yes to everything, flogging staff until they resign in fatigue, and creating general dissatisfaction throughout the organization because scope is too large and resources are too small.

Convening and governance will be my role as a leader over the next year. Only when I can master that can I progress to my next leadership stage.


Donald Green MD said...

The role of convener should also include knowing who the true missing stakeholders are. Often an essential viewpoint is omitted when solutions are fashioned. Without such consultation a plan may not be as acceptable when put into action. It is true that the debate ends with an acceptable plan to those present but gets kiboshed when put into action without proper encompassing stakeholder input.

Only 13% of MDs have embraced EMRs and the reasons have only been examined from afar and from the outside looking in. Their inclusion should include proper pre-discussion about the purpose of any work group. It might become a valuable asset in promoting a more digital savvy physician population. Sometimes people do have to be brought into a new arena kicking and screaming but hearing from them and including them may make the process easier.

To date I see little representation from those who have real misgivings about the present state of EMRs and being pushed to use them. Their concerns should be addressed. It may lead to more successful movement into the digital world on the part of physicians if such voices are heard and debated.

The present work although substantial operates more like subcommittees rather than establishing true rules of the road. There is lingering skepticism by many practicing physicians and marching forward with very complex plans may get you too far into the weeds. To then develop exit strategies at that point could be very costly. Paul Krugman won his Nobel Prize examining rushed upfront buy-in leads to major reluctance to turn things around even in the face of outright failure. This stifles progress.

Anonymous said...

I always see that success people frequently fill places for which they are ignorant ...

I other words, at the very moment you are great in a specific role, the all world wants you in a new role where you are ignorant and have to gain experience.

I'm a positive person and I think this is one of the most exciting things in life, strongly related to learning, innovation and wisdom.

It happened to me so many times:
- from university life to the work life (as an entrepreneur)
- from being a "single man band" to be a manager of other people tasks
- from being a child to be a father

and many other examples like these.

I'm sure that if superskilled persons stay stuck in their places without having the chance to merge the experience in new challenges, the world will not innovate and probably other very negative aspects arise (related to human factors).

A place you move in, a place you leave, new ideas coming.

Best wishes. Giancarlo

Wade said...

Professor Ronald Heifetz teaches at Harvard's Kennedy School: "In this view, the function of leadership is to mobilize people -- groups, organizations, societies -- to address their toughest problems," and "Today's complex conditions require acts of leadership that assist people moving beyond the edge of familiar patterns into the unknown terrain of greater complexity, new learning, new behaviors, usually requiring loss, grief, risk, stress, and creativity."

In my own mind, the real opportunity is in finding out what aspects of technology can directly facilitate this process.

Bringing people together, even the right people and all of them at the table, to simply vent past each other seems like technology we had 2000 years ago.

An observation made by Gary Olson, an expert in collaborative systems, was that very few faculty meetings even involved use of a white-board to facilitate reaching amicable an group consensus.

Where and when can collaborative "social" technology be utilized to improve this aspect of "socio-technical system" decisions?

I know that some work has been done, using concept-map tools such as Vensim (tm), to "Get to Yes" by drawing out groups of stakeholders to get clear about simply what the variables are, and what affects what, in positive or negative ways. The objective is not simply that a "decision" get made, but that, along with the decision, the entire group leaves with a greater appreciation of the fact that everyone brings not just opinions but true value from their distinct vantage point, and are not quite the "idiots" one thought before the "meeting".


As the Institute of Medicine put it, "What we need is a billion one-dollar systems, not one billion dollar system." Actually, we need both. Enterprise IT, from what I've seen has neglected small-scale collaboration ware in the focus on high-profile, high-dollar systems.

One parallel focus,the other wing of the bird, has to be on very small "microscale" systems that simply help small teams of people work together and see what they're doing.

Rapid feedback to humans, teams, or any cybernetic entity, in close to real time, regardless how flawed, is at least as valuable as high-precision sanitized data arriving 3-months later from some central QA group. Humans can deal with noise -- we can all drive cars in snowstorms at night with terrible visibility and dirty windshields, because it is live and dynamic and local.

Here's one tiny example of how IT can help. It is possible to make a very nice on-line (or on PDA) flashcard system with people's names and faces, using adaptive feedback control, to make it very easy and rapid for someone to learn the names of everyone else they work with.

Would that help people make better collaborative decisions and build social capital? Of course it would.
Is it done routinely? No.
Is it "IT"?
If it's not IT, then what IS it and who is falling down on the job and not delivering it?

"Little things" like everyone in a group simply knowing the name and face of everyone else in the group have very powerful effects at overcoming barriers to communication and cooperation.

Worth a second look, I'd say.

There's a lot being learned about CSCW - computer supported cooperative work these days. You wouldn't know it to look in most hospitals.

Teamwork, safety culture, high-performance, high-creativity, low-cost solutions all require both trust and legacy IT tools. All the Business Intelligence in the world won't help if the world remains divided and hostile.

Wade said...

Client Involvement in Simulation Model Building:
Hints and insights from a case study in a London hospital


has some useful ideas for building consensus, using IT.

Miguel Vilaplana said...

a) Impressive career and achievements by Dr Halamka. Looking forward to continuing learning from you.
b) Donald is completely right. Forgotten key stakeholders (in this case MD) can cause a lot of problems in the future if not addressed rapidly. EMR will go on yes or yes because of the economic incentives (or the disincentives in the future for not having them), but transitions may be a little bit softer if we start to talk to our peers physicians.
c) Giancarlo, your statement about "I always see that success people frequently fill places for which they are ignorant ..." is called the Peter's principle... and it has more ironic and sarcastic connotations than you posted... YOU ARE AN OPTIMISTIC!, and good for you!!
d) Waden, interesting topics. Only one comment, when you express your idea about "very nice on-line (or on PDA) flashcard system with people's names and faces"... mmm something like that has been tried and rejected in several medical settings.. by their own staff!! (Privacy issues... and basically, not willing to cooperate), so things like these which seems obvious and simple are not seen in the same way. So we go back to the beginning: do not forget key stakeholders (and pissed stakeholders are the worst!) and communicate, communicate!