Manage Decisions

Mr. Steward took over as CEO in 2001 and has been looking at ways to make healthcare delivery more efficient and effective. True to the company commitment to value care, Mr. Steward launched an IT initiative to streamline data collection procedures and consolidate all disparate systems into an integrated health informatics system. Mr. Steward sought expertise from the CIO and other IT specialists before finalizing the strategy.  When the employees were informed of the new IT initiative, there was initial resistance to the idea from the administrative offices where the IT automation was to happen.  In addition to the individual stakeholder’s resistance; the technical, project management and organizational “people” skills that were inadequately addressed throughout the project implementation will be highlighted in relation to their impact on the “innovators to the laggards”.

As for this IT Implementation, although the system was not an outright failure it did not meet user and organizational expectations; perhaps due to system limitations and lack of customization and interoperability which may of course been due to the budget constraints of this not-for-profit healthcare organization.

If one looks at the necessary system components to ensure a successful health informatics implementation, the traditional focus in healthcare organizations has been first on hardware, then on software and the final and least prioritized component has been the peopleware. First, the staff was never familiarized with the software and there was no initial buy in from them. Lack of familiarity and visibility caused resistance to change.

During the project implementation, a strategic decision made to move beyond technology acquisition to the next level of technology assimilation; unfortunately there was more of a financial incentive driving the assimilation goals in the area of capturing charges, compliance with regulatory governing bodies and revenue enhancement than on the area of provider delivery of quality of care and efficiency by ensuring stakeholder and end user communication, involvement and satisfaction.

Organizational politics among leadership led to some forcible acquisition of a less robust system.

With no perceived unified model or leadership confidence by the departments and subunits, which had in the past been forced to manage their own information challenges due to an unresponsive overworked IT department, they set out from beginning to end of the project to “control” their data and became the greatest obstacles to success.

Leadership was reactive rather than proactive leading to lack of empowerment over the “big picture” that the department heads perceived. The perception of the stakeholders, (department heads, line supervisors and end users), was that the decision was made personally by someone in high level administration (without a medical or an information technology background), and then delegated the “change agent” and project manager role to the CIO, Chief Information Officer, (who also had no medical background). The CIO was given the mandate of pushing the organization toward results as opposed to pulling it toward a shared vision.

The controlled nature of the project supervision and the lack of strong leadership developed into a definite disconnect between this designated change leader and the stakeholders, including the physicians who blamed the CIO for their lack of involvement by not including their medical informatics liaison to the degree desired by the medical staff.

Executives must be willing to move to a shared-leadership model that involves all employees in developing and enabling a common vision. They must be comfortable receiving constructive feedback from employees about what’s working and not working within and commit the time required for teams of employees to work on improving internal communications.

Without Senior Leadership’s willingness to acknowledge the importance of communicating a clear vision to the entire stakeholder and end user group, a shared vision that was not only in line with Corporate view for the individual Healthcare Organization, but also that met the needs of all stakeholders’ within the individual organization and the patients served challenges heightened.

The end users blamed the technology instead of the lack of planning, communication or involvement that was more the cause than the “off-the-shelf” hospital information system and clinical data repository. There was waning of support from the department heads that had been charged with supporting the change leader. There were no “in common” focus groups. Lack of empowerment led to backstabbing, gossip and disregard for organizational values. These were early signs of lack of readiness on the part of the organization for a system that must capture data from multiple sources to be used in critical decision making at the point of care.  No multifunctional team was assembled to work with leadership, the CIO, the IT Department and each other to establish their own and a common hospital wide vision and goal. The organizational structure was rigid and very inflexible.

Staffing reductions coupled with use of outside experts to bring culture change caused distrust and had in some cases caused low self esteem among workers.

Add to the existing lack of trust culture was the lack of time spent on the planning, communicate and involve phase; holding all “conflict issues” until after the go live and false assumptions turned early innovators to laggards due to despair and disappointment. The lack of involvement of the stakeholders, “early adopters” and end users in the decision for implementation of systems and methodology caused delayed in their acceptance of the innovation and diffusion was further delayed. Involve and communicate methodology had not been followed as recommended, lack of training for physicians led to lack of self confidence and faith in the new system. In the end a complete change in leadership was introduced and the CEO fell victim to his own gross incompetence and lack of oversight and control.

Dennis Steward is a perfect example of ineffective leadership.  First he lacked the emotional intelligence to be self-aware and self-regulated. He was not comfortable with ambiguity, never relied on real-assessments, wasn’t open to communicate freely, trusted few individuals and delegated most responsibilities assuming commitment and seamless execution. He was unable to motivate people, establish harmonious relationships, influence positive behaviors and show empathy towards employees. He never made efforts to seek their feedback. Inability to establish create a shared vision, coherence, poor decision making and management strategies led to lack of trust, dissonance and failure. I could only see few streaks of coaching style but that too is fraught with weaknesses and loyalty issues. At times, he behaved arrogantly and was adopted an authoritarian style.

The real key to success is user involvement, involving them every step of the way to gain trust and buy in on the redesign of their work practices and ensuring that their priorities have been met as part of a larger team effort to prioritize patient care and public safety. Equally as important is the adherence to the organizational aspects of change management and to pay close attention to the support and structure given to the empowered “change agent” ensuring that the person designated to this role stays as the perceived champion of the project and does not become the detriment unknowingly through poor decision making and management strategies.

Ensuring a positive working environment that respects people and encourages the high level of team work and collaboration is the result of focus on these important attributes to be included in the process and the project.

The company’s culture is grounded in loyalty, respect and dignity, honesty, integrity and fairness in conducting business.