Wednesday, December 4, 2013

Commanding Versus Leading

When I first became a CIO, my role involved writing applications and managing architecture at a detailed level.   Over the past 17 years, my role has become much more strategic, ensuring the right investments in the right overall architecture are made with appropriate resources to support them.    I've had to master the political, communication, and interpersonal skills of leading rather than the technical skills of being a strong individual IT contributor.   Although the way, I've learned the difference between Commanding and Leading.

In an academic health center, formal authority is rarely exercised.   The ability to get things done (or not done) depends upon reputation, trust, and personal influence.    The greatest leadership I challenge I face in 2013-2014 is that the plate is overfilled with ICD10, MU2, HIPAA Omnibus Rule, and the Affordable Care Act.   The majority of my leadership efforts involve getting the entire organization to focus on the regulatory must dos, while deferring nice to haves.   I do this because it is the right thing to do for the institution, but equally important is to triage work away from my staff, which are at the breaking point because of too many demands.

Budgets over the next year at most hospitals are not likely to enable the hiring of new resources beyond those needed for ICD10, HIPAA related security updates, and ACA related analytics.   My leadership task is to limit work to the right work, attempting to buffer my staff from the mayhem of competition for scarce IT resources.

With all the tensions and anxieties involved in running governance committees, planning efforts, and communication outreach, what drives me to do it?

I recall reading a quote from General Shinseki about his views on leadership from his retirement message in 2003:

"You must love those you lead before you can be an effective leader. You can certainly command without that sense of commitment, but you cannot lead without it."

I have maintained my role at BIDMC for 17 years because of loyalty, admiration, and affection for my staff.   I've encountered many leaders who do not understand loyalty and are driven by fame, fortune, or the next new thing.    I'm hopeful that my devotion to staff helps with creating a positive culture, reduces turnover, and builds informal authority - a sense that we're all in this together, fighting important battles every day.

Top down command and control works in some organizations and some industries.   Some employees in organizations which thrive on command and control have told me that they work with constant fear of failure/criticism.   My hope is that leadership built on the the strength of employee relationships creates a joy of success motivation without fear.   Whenever bad things happen, and they do, we should ask how our work processes enabled the mistake, celebrating the learning and not blaming the individual.

When I was young, I thought that management meant authority, power, and self-reliance.   Over time, I've learned that management is about relationships, collaboration, and creating a community of people who support each other.   Leading a team of people you admire is much more satisfying than commanding and that's why I'm still a CIO.


Medical Quack said...

Excellent post and one we should all pay attention to for sure. Like you stated the "relationships" are important and over the last few years it's slipped a lot and technology has a lot to do with it, something that nobody seems to want to address. I like new technologies and what it offers too but I also see the dark sides some of it creates for all of us.

I keep stating it is time for some "model accountability" along the line here as decisions that impact all our lives are made on servers running 24/7, and all are not good, although it's not all bad either, but profiteering has overshadowed some of the good stuff for sure.

Right now as I see it with the ACA we dealing with clashing models and spasmodic algorithms that are making all of us nuts if you will as you can't trust everything out there today that you read and there's countless numbers of scientific studies where researchers have lied as well, some by accident and some on purpose.

Data when used correctly does make us smarter but it also opens up the window for a lot of models and subsequent algorithms that hide and re-manufacture risk to where the starting point is missed or skewed, and that's the problem areas. We have the ACA working to dismiss some of the over used and abused segmentation out there while it keeps growing on the business side and just like the Quants of the hedge funds are experiencing too, it's harder to create good models when the field of participants grows, so as I see it we need some kind of balance with segmentation and how to apply it and where with ethics.

I keep watching insurers hire more and more Quants in the pursuit of a profit model which at times clashes with other healthcare models...and they all eventually need to work in harmony but not seeing it now and that brings this right back around to relationships and trust. I call some of this Algo Duping and the Attack of the Killer Algorithms as that lives out there along with the good stuff and seeing the difference is becoming more challenging all the time.

I just see a lot of clashing models out there today and add on a little marketing and the horizon gets a little grayer all the time so I very much agree that it's time to reduce some of the complexities and help make the picture a little clearer so we can take the good stuff and run with it...hope I'm not out to lunch here:)

Elder Granger said...


I agree with your blog on Commanding Versus Leading having served in healthcare leadership positions for 17 years straight out of my 37 years in the Army. I learned from many leaders who had gone before me "You can love them and lead them or you can abuse them and lose them" Leadership is based on understanding People, Processes, Prevention, Productivity, and Price as will as appreciating what has current and future value and revalency.


Elder Granger MD, MG, USA, Retired