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Saturday, April 11, 2009

Advice Re; Healthcare IT

If you are a healthcare CIO or the top IT director/manager and happen to be reading this, or if someone has forwarded this post, and if you feel under some pressure more accomplished (or even to get something accomplished), I have some gentle advice. You're going to get phone calls from angry physicians no matter what you do, so you may as well do the right thing.

It is a fact that, in the history of computing (I.T.), no application or system has ever been delivered to universal acclaim (despite what the marketing people tell you). Medicine has more than its share of curmudgeons and you're going to have to let them become part of the background noise. If you're afraid of losing your job because of the indignation of a few people then you're probably on the wrong career path.

I hope you knew that already, but it can be reassuring to hear it from an "outsider".

Now, if you're still reading, you may be wondering about what the right thing is that you should do. The first thing is to get your priorities squared away. Then you you will have to work very hard to get your priorities into the cognitive space of the rest of your organization's upper management. What are your priorities? What are your 1, 3, 5 year or long term objectives? Are they written down and visible to others? If your answer is no, then your job just became much more difficult. By the way, if you are a CEO, and the only I.T. objectives you know about are the ones you handed out, you may want to re-think your approach to I.T.

What does an objective/priority look like for I.T.?

The big rocks (the ones you put into the container first) are capabilities and alignment. In my career, the most pervasive problem I have seen is that healthcare CIOs invariably focus their attentions outward from their I.T. organization. In nearly 15 years, I have yet to see a single initiative directed at developing or improving capabilities come from the top of the I.T. organization. When such things have happened, they seem always to arise from the introduction of a new application or a new technology. Just once, maybe we could spend some time to actually imagine the kind of I.T. organization we think will be needed five or more years from now. Capabilities, in the healthcare I.T. world come about by accident. The current best case is when there are a few people within the organization doing this kind of thinking on their own.

Of course, when there are uncoordinated pockets of effort, you don't get the other big rock, alignment. By the way, if one of your objectives is something like "reduce or contain costs", you may want to rethink. Cost management is like breathing if you're a manager. To call it a priority or a goal is to divert attention away from the big rocks. Similarly, any objective that includes the word "continue" is a waste of paper. Holding the gains must also be at the level of breathing for managers. You will want to keep measuring to make sure there is no backsliding and take action if there is, but holding onto gains has to be part of the original planning process and should be automatic.

Alignment begins with a picture of your organization now and five years from now. Every manager and supervisor/lead within I.T. must share that picture and understand their own specific role(s) in it. This is something best accomplished as a team. You can't mandate alignment. You will want to decide how you will recognize and/or measure the alignment within I.T. How will you know when you have it? Everyone should understand and be on board. This is the first step.

It is up to the CIO to bridge between the business strategy and the I.T. strategy to make certain that as alignment develops within I.T. it is congruent with (aligned with) the business' strategic plan.

You are fortunate in that your direct reports want all of this as much or more than you do. All they need in the way of motivation is the belief that you are committed to seeing it through. If you don't feel confident that you can produce the I.T. vision, don't attempt it on your own. This is the place for leadership that is confident and sure-footed. Start with a clear and concise vision--it has to be your vision or you won't be able to commit to it, but you can get help to create it.

Healthcare I.T. cannot get where the nation wants it to go as long as are dissociative in our thinking. Things aren't the way we want them to be simply because we say so in a presentation to the CEO or the Board. You know that buying and installing a new system is only the first step of implementation. What we're talking about here is very similar. Forming a committee or naming a Director is only the first small step. If you want to know if you have actually achieved your goals of capability and alignment, I would recommend strongly that you bring in an outside person or group to conduct an audit.

Good luck! You are the leading edge.

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