This week's cool technology is truly for the nerdy - it's about bandwidth and fiberoptics now available in our homes, made possible by new products from Corning. Infrastructure in the walls is often ignored because it's not sexy. To me it's necessary and deserving of a cool technology highlight.
The kinds of technologies that are enabling fiber to be run to houses, apartments and dorm rooms is illustrated here. The streaming video is worth watching. Gone are the days of fragile glass fibers that were instantly destroyed when bent or stepped on. These new fiber products empower HDTV, support high fidelity voice over IP and turn our homes into data centers. The future of nearly limitless, low cost bandwidth is arriving.
When I first began software development at the age of 12, I used a dial up acoustic coupler at 110 baud. In college, I was first in my dorm with a CP/M computer that included a 300 baud modem. When I did research at Lawrence Livermore Labs as a Sophomore, I was given a state of the art 9600 baud connection to the Arpanet, the Internet predecessor. In medical school, I had my own 1200 baud dial up, then 14.4K as a post doctoral fellow. In my early days as CIO I had 28.8K then 56K. I was Media One's (predecessor to Comcast) third customer for Broadband in the home at 1 Megabit speeds.
Today, I use Verizon FIOS, which includes a complete fiberoptic infrastructure in my basement. I average 20 Megabit download speeds and 5 megabit upload speeds. My home has 802.11g in every room. My sofa has nearly the same bandwidth as my office as work.
All this connectivity has enabled me to work wherever my laptop is located. Home video teleconferencing is no problem. Skype works well for world wide voice over IP calling. My family is completely connected with me via our home infrastructure regardless of where I am in the world.
Of course, there is a dark side to all this bandwidth - the digital divide. I live in Wellesley - one of the 'W' towns in Massachusetts (including Weston and Wayland ) that havehigh median household incomes. Verizon FIOS is not yet available to all towns, especially less populated rural locations. I hope that the future brings high bandwidth wireless technologies such as free community Wifi and WiMax that enable anyone with a computing device, including the $188 One Laptop per Child device, to experience all the benefits of connectivity to knowledge resources, personal healthcare applications, and social networks that are available today to those living in higher income locations.
Tuesday, December 11, 2007
Standards for Personal Health Records
In my post about Personal Health records , I identified the 4 major types of Personal Health records - provider-hosted, payer-based, employer-sponsored and commercial. As more products are offered, it's key that all the stakeholders involved embrace national healthcare data standards to ensure interoperability of the data placed in personal health records.
To illustrate the point, I am posting my entire lifelong medical record on my blog (this is with my consent, so there are no HIPAA issues) in two ways.
The first is a PDF which was exported from a leading electronic health record system. It's 77 pages long and contains a mixture of clinical data, administrative data, normal and abnormal results, numeric observations, and notes. It's a great deal of data, but is very challenging to understand, since it does not provide an organized view of the key elements a clinician needs to provide me ongoing care. It is not semantically interoperable, which means that it cannot be read by computers to offer me or my doctors the decision support that will improve my care.
The second is a Continuity of Care Document , using the national Health Information Technology Standards Panel (HITSP) interoperability specifications. It uses "Web 2.0" approaches, is XML based, machine and human readable, and uses controlled vocabularies enabling computer-based decision support.
It's critical that Vendors, Payers, Providers and Employers embrace these standards. A standards-based personal health record can be used to prevent medication errors, ensure best practice disease prevention, and serve as the basis for decision support systems which recommend optimal care. Using CCD, data can be turned into wisdom , can be incorporated into EHRs, transmitted between PHRs, and can be easily expanded by the patient throughout life.
Today (December 13), HITSP will deliver the harmonized standards for Personal Health Records, Labs, Emergency Records, and Quality measurement to HHS Secretary Leavitt. These "interoperability specifications" will become part of Federal contacting language and be incorporated into vendor system certification criteria (CCHIT) over the next two years.
To illustrate the point, I am posting my entire lifelong medical record on my blog (this is with my consent, so there are no HIPAA issues) in two ways.
The first is a PDF which was exported from a leading electronic health record system. It's 77 pages long and contains a mixture of clinical data, administrative data, normal and abnormal results, numeric observations, and notes. It's a great deal of data, but is very challenging to understand, since it does not provide an organized view of the key elements a clinician needs to provide me ongoing care. It is not semantically interoperable, which means that it cannot be read by computers to offer me or my doctors the decision support that will improve my care.
The second is a Continuity of Care Document , using the national Health Information Technology Standards Panel (HITSP) interoperability specifications. It uses "Web 2.0" approaches, is XML based, machine and human readable, and uses controlled vocabularies enabling computer-based decision support.
It's critical that Vendors, Payers, Providers and Employers embrace these standards. A standards-based personal health record can be used to prevent medication errors, ensure best practice disease prevention, and serve as the basis for decision support systems which recommend optimal care. Using CCD, data can be turned into wisdom , can be incorporated into EHRs, transmitted between PHRs, and can be easily expanded by the patient throughout life.
Today (December 13), HITSP will deliver the harmonized standards for Personal Health Records, Labs, Emergency Records, and Quality measurement to HHS Secretary Leavitt. These "interoperability specifications" will become part of Federal contacting language and be incorporated into vendor system certification criteria (CCHIT) over the next two years.
Resolving Conflict
I've written about leading change, managing personnel transitions and the next in this series is resolving conflict. Most people do not enjoy conflict and want highly contentious situations to resolve themselves. Sometimes this works and some times it ends in chaos. I am convinced that to be a successful CIO, you must embrace conflict.
Here's the approach I use to resolving conflict.
1. Listen before talking. I find that many conflicts are the result of poor communication. Just understanding the issue deeply can resolve many conflicts. Being proactive by learning more about controversial situations early in the conflict is much easier than getting involved after the situation escalates.
2. Never use email to resolve complex issues. Anytime I receive more than 3 successive email exchanges about an issue, I call a "time out" and schedule a meeting or conference call.
3. Pick up the phone to diffuse emotion. Anytime I receive an emotional email, I do not respond via email. I pick up the phone, even if I know the conversation will be painful. Most people react differently in a person to person conversation than in email.
4. Never send an emotional email or make an emotional statement. If I ever feel a negative emotion while writing an email, I save as draft. Although an emotional email may feel like an effective weapon, it only wins the battle not the war. Emails last forever, can be circulated widely and make conflict resolution much harder in the long run. My experience with emotion, written or spoken, is that no one who responds to any issue with anger looks good while doing it. Those with polished executive presence are always emotionally neutral when dealing with conflict.
5. Talk a walk in the woods, a technique named after a famous story in which international negotiators at loggerheads over a nuclear arms treaty went for a walk in the woods near Geneva and discovered common interests that led to new solutions. The four negotiation steps developed by the Harvard Program for Health Care Negotiation and Conflict Resolution are:
Step one: self interests. Each participant articulates his or her view of key problems, issues, and options. Stakeholders are encouraged to actively listen, question, and interact with one another.
Step two: enlarged interests. The participants reframe their understanding of current problems and possible options with a wider perspective, based on the integrative listening and confidence-building that occurred in step one.
Step three: enlightened interests. The group is ready to engage in innovative thinking and problem-solving, generating ideas and perspectives that had not previously been considered.
Step four: aligned interests. Participants build common ground perspectives, priorities, action items, agreement, or plans for moving forward. Depending on the scope of the intended objectives, at this point they recognize the tangible contributions and opportunities accomplished through the meeting.
My "walks in the woods" usually take place at the Elephant Walk Restaurant on Beacon Street in Boston, so if you ever see someone dressed in all black eating a vegan meal at the Elephant Walk, it's a good guess that I'm resolving conflict!
Here's the approach I use to resolving conflict.
1. Listen before talking. I find that many conflicts are the result of poor communication. Just understanding the issue deeply can resolve many conflicts. Being proactive by learning more about controversial situations early in the conflict is much easier than getting involved after the situation escalates.
2. Never use email to resolve complex issues. Anytime I receive more than 3 successive email exchanges about an issue, I call a "time out" and schedule a meeting or conference call.
3. Pick up the phone to diffuse emotion. Anytime I receive an emotional email, I do not respond via email. I pick up the phone, even if I know the conversation will be painful. Most people react differently in a person to person conversation than in email.
4. Never send an emotional email or make an emotional statement. If I ever feel a negative emotion while writing an email, I save as draft. Although an emotional email may feel like an effective weapon, it only wins the battle not the war. Emails last forever, can be circulated widely and make conflict resolution much harder in the long run. My experience with emotion, written or spoken, is that no one who responds to any issue with anger looks good while doing it. Those with polished executive presence are always emotionally neutral when dealing with conflict.
5. Talk a walk in the woods, a technique named after a famous story in which international negotiators at loggerheads over a nuclear arms treaty went for a walk in the woods near Geneva and discovered common interests that led to new solutions. The four negotiation steps developed by the Harvard Program for Health Care Negotiation and Conflict Resolution are:
Step one: self interests. Each participant articulates his or her view of key problems, issues, and options. Stakeholders are encouraged to actively listen, question, and interact with one another.
Step two: enlarged interests. The participants reframe their understanding of current problems and possible options with a wider perspective, based on the integrative listening and confidence-building that occurred in step one.
Step three: enlightened interests. The group is ready to engage in innovative thinking and problem-solving, generating ideas and perspectives that had not previously been considered.
Step four: aligned interests. Participants build common ground perspectives, priorities, action items, agreement, or plans for moving forward. Depending on the scope of the intended objectives, at this point they recognize the tangible contributions and opportunities accomplished through the meeting.
My "walks in the woods" usually take place at the Elephant Walk Restaurant on Beacon Street in Boston, so if you ever see someone dressed in all black eating a vegan meal at the Elephant Walk, it's a good guess that I'm resolving conflict!
Monday, December 10, 2007
When less is more
In the spirit of my Vegan Thanksgiving post, here are my thoughts about the holidays. I believe that a greater focus on people, experiences, and the world around us truly embodies the spirit of the holidays. When it comes to material goods, less is more.
As Americans, we're taught about the American Dream - a home, two cars in the garage, and an endless lawn for mowing on Saturday afternoons. That's reasonable, but every year the definition of "must have" is expanding. In just my lifetime, the American Dream vision has grown to a McMansion, a television in every room/home theater, appliances suitable for a major restaurant, and trendy designer furnishings. Watching television ads, it's clear that the must have holidays gifts this year include a Nintendo Wii, diamond jewelry, and expensive fragrances.
Malls become chaos, shopping becomes a contact sport, and traffic rules are tossed out the window. By the time the holidays are finished, we're so exhausted by the process that we need a vacation.
This year, I'm trying something different. My family and I are reducing our "stuff" by 30%. We're going through every closet, the garage, the attic, and the basement, analyzing their contents. Sealed boxes from our last move go straight to charity. If we have not touched an item in a couple of years, it goes into one of three piles - eBay, charitable donation or recycling.
We're regaining a knowledge of what we have, and why we have it. The end result will be a simpler lifestyle for all of us. We'll have an inventory that looks like:
For me, my black business wardrobe, my outdoor hiking/climbing gear, my Japanese flute, my Ubuntu laptop and my Toyota Prius hybrid.
For my wife, her New England crafted linen clothing that lasts a decade, her art supplies, and her MacBook.
For my daughter, her personally stylish but non-designer clothing, her iMac and her books.
In common, the early 1900's mission oak furniture that we've gathered for 20 years.
No massive caches of collectibles, no designer products, no need for a rented storage facility for keeping endless amounts of stuff. We'll be able to get the car in the garage, have more spacious rooms, and be able to find anything we need without searching for it.
But most importantly, we'll have the gift of time. With every purchase you make, there are are two costs - the cost of buying it and the time cost of maintaining it. Without having to polish the silver, buy containers to neatly store collections of clutter, and run around the malls to ensure we have the latest designer products, we have time for each other.
We'll have time to talk, to think, to read, and to recuperate from all the increased project workload at the office that the end of the year always brings.
Thus, for the first time, our gifts to each other will not be influenced by advertising, peer pressure, or the next door neighbors. We'll have a net reduction in the material, giving us the time we need to focus on people, experiences and the world around us.
How far can this go? Just as the journey from supersized obesity to healthy vegan was phased and incremental, I expect my efforts at living simpler will be incremental. Here's an article from the UK which describes a vision for the future. I'll report back how it goes!
As Americans, we're taught about the American Dream - a home, two cars in the garage, and an endless lawn for mowing on Saturday afternoons. That's reasonable, but every year the definition of "must have" is expanding. In just my lifetime, the American Dream vision has grown to a McMansion, a television in every room/home theater, appliances suitable for a major restaurant, and trendy designer furnishings. Watching television ads, it's clear that the must have holidays gifts this year include a Nintendo Wii, diamond jewelry, and expensive fragrances.
Malls become chaos, shopping becomes a contact sport, and traffic rules are tossed out the window. By the time the holidays are finished, we're so exhausted by the process that we need a vacation.
This year, I'm trying something different. My family and I are reducing our "stuff" by 30%. We're going through every closet, the garage, the attic, and the basement, analyzing their contents. Sealed boxes from our last move go straight to charity. If we have not touched an item in a couple of years, it goes into one of three piles - eBay, charitable donation or recycling.
We're regaining a knowledge of what we have, and why we have it. The end result will be a simpler lifestyle for all of us. We'll have an inventory that looks like:
For me, my black business wardrobe, my outdoor hiking/climbing gear, my Japanese flute, my Ubuntu laptop and my Toyota Prius hybrid.
For my wife, her New England crafted linen clothing that lasts a decade, her art supplies, and her MacBook.
For my daughter, her personally stylish but non-designer clothing, her iMac and her books.
In common, the early 1900's mission oak furniture that we've gathered for 20 years.
No massive caches of collectibles, no designer products, no need for a rented storage facility for keeping endless amounts of stuff. We'll be able to get the car in the garage, have more spacious rooms, and be able to find anything we need without searching for it.
But most importantly, we'll have the gift of time. With every purchase you make, there are are two costs - the cost of buying it and the time cost of maintaining it. Without having to polish the silver, buy containers to neatly store collections of clutter, and run around the malls to ensure we have the latest designer products, we have time for each other.
We'll have time to talk, to think, to read, and to recuperate from all the increased project workload at the office that the end of the year always brings.
Thus, for the first time, our gifts to each other will not be influenced by advertising, peer pressure, or the next door neighbors. We'll have a net reduction in the material, giving us the time we need to focus on people, experiences and the world around us.
How far can this go? Just as the journey from supersized obesity to healthy vegan was phased and incremental, I expect my efforts at living simpler will be incremental. Here's an article from the UK which describes a vision for the future. I'll report back how it goes!
Sunday, December 9, 2007
Managing Personnel Transitions
As a followup to my Leading Change post, one of the most challenging kinds of change to manage is personnel transitions. There are two major kinds of transitions - those which are done to you and those which are done by you.
Regarding changes done to you, the most important role of the CIO is to foster stability while embracing the change the follows a major transition in leadership. Over the course of tenure as CIO there have been many changes to senior management around me which directly impacted IT. I've experienced the transitions of 3 COOs, 3 CFO's and 3 CEOs. Each time there is a change in senior leadership, the anxiety in the entire organization is palpable. Everyone wants to know what the change will mean to them. Will their project be canceled or their job eliminated? There is generally a frenzy of activity as many folks in the organization jockey for power or try to resurrect projects that were put on hold by the former administration. The largest transition done to me was 10 years ago today when I became the new CIO of CareGroup/Beth Israel Deaconess. Although I was an inexperienced leader at that time, I think my basic beliefs about fostering stability were already in place. One of my staff recently sent me a copy of the broadcast email I sent a few hours after taking the job:
--------
From: John D. Halamka MD
12/10/97 01:01 PM
To: IS Employees
Subject: All is well
Folks:
You may have heard that a change is taking place in Information Systems leadership.
I realize that many of you may be feeling anxiety and are wondering what the future holds.
Over the next several weeks, I will get to know each of you, understand your projects and identify your challenges. My role will be to create an environment that empowers each of you. I will begin each conversation with "How can I help you?"
Working together, we can make Information Systems an even better place. We have a great deal of talent in the organization and I look forward to serving, learning and growing with each one of you.
John
--------
Regarding changes done by you, I've personally led several transtions in IT, ensuring that the organization is always optimally structured to support the strategy of the company. Every time I do any reorganization, I've found that communication is key. Communicating often and transparently, engaging all those affected in the reorganization process really helps. Some organizations do reorganizations behind closed doors and even hire security staff to escort separated employees to their cars. I've never done reorganizations that way. I have treated people with dignity and respect, working hard to ensure their transitions are as painless as possible. There are 3 ways to transition people:
1. Work together on a separation over several weeks giving the affected staff the opportunity to move on to a new position outside the organization. This is by far the best approach, since it often leads to new opportunities for the separated employee and can be a win/win for everyone involved.
2. Work with Human Resources and the affected staff via oral/written warnings, counseling, and progressive discipline. Whenver I work through a termination via this approach, I follow all HR recommendations to the letter.
3. Termination for cause done precipitously. I am lucky that I have never had to do such a transition. It's very challenging to transition an IT professional abruptly because of the lack of time for knowledge transfer.
Although managing personnel transitions is not one of the more pleasurable aspects of being a CIO, it is one of the most essential. Ensuring that no one on the IT team impedes the work of others improves morale, accelerates projects, and minimizes human single points of failure in the organization.
Regarding changes done to you, the most important role of the CIO is to foster stability while embracing the change the follows a major transition in leadership. Over the course of tenure as CIO there have been many changes to senior management around me which directly impacted IT. I've experienced the transitions of 3 COOs, 3 CFO's and 3 CEOs. Each time there is a change in senior leadership, the anxiety in the entire organization is palpable. Everyone wants to know what the change will mean to them. Will their project be canceled or their job eliminated? There is generally a frenzy of activity as many folks in the organization jockey for power or try to resurrect projects that were put on hold by the former administration. The largest transition done to me was 10 years ago today when I became the new CIO of CareGroup/Beth Israel Deaconess. Although I was an inexperienced leader at that time, I think my basic beliefs about fostering stability were already in place. One of my staff recently sent me a copy of the broadcast email I sent a few hours after taking the job:
--------
From: John D. Halamka MD
12/10/97 01:01 PM
To: IS Employees
Subject: All is well
Folks:
You may have heard that a change is taking place in Information Systems leadership.
I realize that many of you may be feeling anxiety and are wondering what the future holds.
Over the next several weeks, I will get to know each of you, understand your projects and identify your challenges. My role will be to create an environment that empowers each of you. I will begin each conversation with "How can I help you?"
Working together, we can make Information Systems an even better place. We have a great deal of talent in the organization and I look forward to serving, learning and growing with each one of you.
John
--------
Regarding changes done by you, I've personally led several transtions in IT, ensuring that the organization is always optimally structured to support the strategy of the company. Every time I do any reorganization, I've found that communication is key. Communicating often and transparently, engaging all those affected in the reorganization process really helps. Some organizations do reorganizations behind closed doors and even hire security staff to escort separated employees to their cars. I've never done reorganizations that way. I have treated people with dignity and respect, working hard to ensure their transitions are as painless as possible. There are 3 ways to transition people:
1. Work together on a separation over several weeks giving the affected staff the opportunity to move on to a new position outside the organization. This is by far the best approach, since it often leads to new opportunities for the separated employee and can be a win/win for everyone involved.
2. Work with Human Resources and the affected staff via oral/written warnings, counseling, and progressive discipline. Whenver I work through a termination via this approach, I follow all HR recommendations to the letter.
3. Termination for cause done precipitously. I am lucky that I have never had to do such a transition. It's very challenging to transition an IT professional abruptly because of the lack of time for knowledge transfer.
Although managing personnel transitions is not one of the more pleasurable aspects of being a CIO, it is one of the most essential. Ensuring that no one on the IT team impedes the work of others improves morale, accelerates projects, and minimizes human single points of failure in the organization.
Thursday, December 6, 2007
Cool Technology of the Week
In several of my previous posts have I described the increasing burden of triaging email
I've described the need to filter out Spam , block Industry related advertising , and prioritize the high volume of email we all receive.
New products are now being introduced to automate personal email management. The Wall Street Journal presented an overview of these recently.
Clear Context is an application that works with Outlook to automatically score email based on relevance - the sender (in your personal contacts or not?), the topic, and the history of your personal email response behavior. This seems to be the first product to implement my Top 10 Rules for Email Triage. As our email burden continues to grow and consume more than 50% of our work time, we will need intelligent agents like Clear Context to automate email management.
Another cool technology with seasonal relevance is ElfYourself . Give it a try and put yourself in the Holiday Spirit!
Wednesday, December 5, 2007
Leading Change
Ten years ago this week, I became CIO of CareGroup. On that day, I learned an important lesson about leading change.
Just hours after getting the job I decided that we'd embrace a service oriented architecture (SOA), standardize all desktop/server/storage infrastructure, and implement centrally managed applications. At 8am the next morning, I was scheduled to meet with my 300 staff members and share with them my vision for the future.
Luckily, experienced leaders counseled me on that first day. I discussed my vision with three Board members - Warren McFarlan (Professor at Harvard Business School), John Keane Sr. (CEO of Keane Inc.) and Sam Fleming (CEO of DRI/McGraw Hill). They told me that announcing a strategic plan without engaging all the stakeholders in the process would lead to mixed support and adoption.
Instead of arriving at the 8am meeting with all the answers, I arrived with questions. I explained to the staff that we wanted to improve customer service, encourage innovation, and ensure our work was aligned with the needs of our stakeholders. I challenged them to tell me what they thought we should do. In the first 30 days of my CIO tenure, I met with every staff member in IS as well as every senior manager in CareGroup to gather their priority lists, synthesize their input, and ensure they had a voice in the future. The result was a new IS operating plan focused on getting the basics done right. We clearly communicated the work to be done, the organizational structure which supported that work and the right people to staff the structure. The next step was to implement the changes.
I've long been a fan of John Kotter and his work on leading change in organizations. His broad recommendations to effect change include:
a. Defrost the status quo
b. Take actions that bring about change
c. Anchor the changes in the corporate culture
The planning meetings described above defrosted the status quo. The actions I took to bring about change included:
Create a Vision for Change - the community came together with a vision of a web-centric organization and I broadly communicated it.
Establish a Sense of Urgency - everyone recognized that IT innovation was essential to coordinate clinical care, improve safety and enhance our competitiveness, especially after the merger of Beth Israel and Deaconess
Elicit Executive and Peer Sponsorship - The CEO declared that medication safety, personal health records, and enhanced communication to all levels of the organization were the strategic goals of the entire organization for that year
Communicate Vision to Implement Change - we established steering committees, project charters, project plans, and communication plans
Empower Employees to Implement Change - we aligned responsibility, accountability and authority throughout the IT organization so that managers had the resources and authority they needed to support our improvement efforts. We created a Special Projects team to coordinate the improvement projects without disrupting day to day operations.
Establish Short-term Goals - we created the first web application in healthcare to share data (with patient consent) among multiple organizations. We created the first web-based provider order entry system, and we created the first personal health record to share all hospital data with patients
Encourage Additional Changes - we created a non-punitive culture in which everyone was encouraged to identify mistakes and opportunities for process improvement
Reinforce Changes Made as Permanent - we built standard processes to deliver service, prioritize new projects, and communicate our multi-year plans to the community
That first year, we implemented strong project management methodologies, eliminated unnecessary work, and focused on getting basic services like email, networks, storage, and electronic result reporting rolled out to everyone in the community. Managing this work required resources, vision, and communication. All the pieces were in place to effect change.
Occasionally, I try to execute a change management project more quickly than usual, bypassing these steps. Whenever I do that I find that adoption of the new technology is delayed, budgets are at risk of overrun, and frustration escalates.
My decade of experience executing change suggests that Kotter was right. Building a guiding coalition, broadly communicating the vision, and celebrating a series of short term successes really works. I've watched projects without vision, resources or communication cause pain and anxiety throughout the organization. The good news is that we now know how to execute change and it is the role of senior management to enforce Kotter's principles in every change project.
Just hours after getting the job I decided that we'd embrace a service oriented architecture (SOA), standardize all desktop/server/storage infrastructure, and implement centrally managed applications. At 8am the next morning, I was scheduled to meet with my 300 staff members and share with them my vision for the future.
Luckily, experienced leaders counseled me on that first day. I discussed my vision with three Board members - Warren McFarlan (Professor at Harvard Business School), John Keane Sr. (CEO of Keane Inc.) and Sam Fleming (CEO of DRI/McGraw Hill). They told me that announcing a strategic plan without engaging all the stakeholders in the process would lead to mixed support and adoption.
Instead of arriving at the 8am meeting with all the answers, I arrived with questions. I explained to the staff that we wanted to improve customer service, encourage innovation, and ensure our work was aligned with the needs of our stakeholders. I challenged them to tell me what they thought we should do. In the first 30 days of my CIO tenure, I met with every staff member in IS as well as every senior manager in CareGroup to gather their priority lists, synthesize their input, and ensure they had a voice in the future. The result was a new IS operating plan focused on getting the basics done right. We clearly communicated the work to be done, the organizational structure which supported that work and the right people to staff the structure. The next step was to implement the changes.
I've long been a fan of John Kotter and his work on leading change in organizations. His broad recommendations to effect change include:
a. Defrost the status quo
b. Take actions that bring about change
c. Anchor the changes in the corporate culture
The planning meetings described above defrosted the status quo. The actions I took to bring about change included:
Create a Vision for Change - the community came together with a vision of a web-centric organization and I broadly communicated it.
Establish a Sense of Urgency - everyone recognized that IT innovation was essential to coordinate clinical care, improve safety and enhance our competitiveness, especially after the merger of Beth Israel and Deaconess
Elicit Executive and Peer Sponsorship - The CEO declared that medication safety, personal health records, and enhanced communication to all levels of the organization were the strategic goals of the entire organization for that year
Communicate Vision to Implement Change - we established steering committees, project charters, project plans, and communication plans
Empower Employees to Implement Change - we aligned responsibility, accountability and authority throughout the IT organization so that managers had the resources and authority they needed to support our improvement efforts. We created a Special Projects team to coordinate the improvement projects without disrupting day to day operations.
Establish Short-term Goals - we created the first web application in healthcare to share data (with patient consent) among multiple organizations. We created the first web-based provider order entry system, and we created the first personal health record to share all hospital data with patients
Encourage Additional Changes - we created a non-punitive culture in which everyone was encouraged to identify mistakes and opportunities for process improvement
Reinforce Changes Made as Permanent - we built standard processes to deliver service, prioritize new projects, and communicate our multi-year plans to the community
That first year, we implemented strong project management methodologies, eliminated unnecessary work, and focused on getting basic services like email, networks, storage, and electronic result reporting rolled out to everyone in the community. Managing this work required resources, vision, and communication. All the pieces were in place to effect change.
Occasionally, I try to execute a change management project more quickly than usual, bypassing these steps. Whenever I do that I find that adoption of the new technology is delayed, budgets are at risk of overrun, and frustration escalates.
My decade of experience executing change suggests that Kotter was right. Building a guiding coalition, broadly communicating the vision, and celebrating a series of short term successes really works. I've watched projects without vision, resources or communication cause pain and anxiety throughout the organization. The good news is that we now know how to execute change and it is the role of senior management to enforce Kotter's principles in every change project.
Subscribe to:
Posts (Atom)
