I read every comment posted to my blog and do my best to learn from the wisdom of the community. Two comments made about my recent post Honey or Vinegar deserve special highlight.
Tony Parham posted a comment comparing Management and Leadership, quoting the work of John Kotter and Colin Powell.
"MANAGEMENT: Control mechanisms to compare system behavior with the plan and take action when a deviation is detected.
LEADERSHIP: Achieving grand visions. Motivation and inspiration to energize people, not by pushing them in the right direction as control mechanisms do, but by satisfying basic human needs for achievement, a sense of belonging, recognition, self-esteem, a feeling of control over one's life, and the ability to live up to one's ideals. Such feelings touch us deeply and elicit a powerful response."
- John P. Kotter, Professor of organizational behavior at the Harvard Business School
“LEADERSHIP is the art of accomplishing more than the science of MANAGEMENT says is possible."
- Colin Powell
My experience is that as long as a leader unites a team with a clear common goal and enables the team to do their work while supporting their self-esteem and their decisions about scope/time/resources, people thrive. Even recent medical evidence suggests that "Honey" and the positive support of a leader yields healthy, productive, and happy staff. Lack of such a leader can lead to negative health and reduced longevity. It seems intuitive that our moods are linked closely to our job satisfaction and that positive mood improves health, but now we have evidence to prove it.
Katherina Holzhauser, a fellow Stanford graduate from the Czech Republic wrote to me about Servant Leadership as part of her philosophy of favoring "Honey" over "Vinegar".
The important take home lesson about Servant Leadership is the classic organization chart really needs to be rewritten, making staff who interact with customers the most important people in the organization. The role of a leader to serve and support those staff so that they have the resources and processes they need to optimize customer experiences. I completely agree with the statement that the highest priority of a servant leader is to encourage, support and enable subordinates to unfold their full potential and abilities. This leads to an obligation to delegate responsibility and engage in participative decision-making.
The goals of a servant leader - listening, empathy, healing, awareness, persuasion (which I call informal authority), conceptualization (which I call continuous self re-examination), foresight, stewardship, commitment to people (which I call loyalty), and building community - are what guide my day to day interactions in all aspects of my life.
As we take on more work in less time at faster pace than every before, let's all strive to be servant leaders for the benefit of those who do the work and serve on the front lines healthcare and healthcare IT in our quest to alleviate human suffering caused by disease.
Wednesday, 11 January 2012
Tuesday, 10 January 2012
Work Induced Attention Deficit Disorder
When you're in meetings or on phone calls, are you focused in the moment or are you distracted by emails, text messages, or social networking traffic?
When you're reading a 20 page whitepaper, RFP, or article, can you finish it?
When you're writing a presentation or article, can you keep your thoughts flowing or are they interrupted by the urge to check your email or mobile device?
Part of the problem is the expectation that we're all connected 24x7 and should respond in near real time.
Part of the problem is an addiction-like behavior caused by a need to feel connected to other people.
Part of the problem is the pace of change that makes us work two days for every workday - one with scheduled meetings and one with unscheduled electronic messaging.
Do you find that your ability to explore issues in depth has diminished over time because of the need to react to the constant flow of input?
When I write, I close my email client and put away my mobile devices. I often do this between 2a-4a when the tide of incoming messages is low.
I collect my thoughts and write in a single stream, weaving together ideas from my previous compositions when possible. I have been able to keep my 1000+ posts integrated in my mind by writing in the early morning darkness.
However, my reading has suffered. When I was younger, I could sit in my old Morris Chair underneath a Pendelton blanket and finish a book cover to cover. Today, my reading is more web like - I cover a topic and then jump to a different topic until I've rapidly covered the important messages from a book instead of reading it at a relaxed pace cover to cover.
The nature of our work has induced a kind of attention deficit disorder.
To explore this idea further, I looked at my calendar for this week. Across my jobs and volunteer efforts there are few dozen critical projects with due dates in January. Ideally my schedule should block out time to focus in depth on each of these major efforts.
Instead, my calendar demonstrates that I've delegated the "depth" to others in order to achieve a "breadth" of oversight which includes only a few minutes per critical project per day. The rest of the time is spent on urgent problem solving, unplanned work, and reducing the tension of change caused by the modern pace of activity, which is challenging for many people to process.
My blog posts taken collectively often paint themes for the year. In 2012, I'm hoping that I can restore depth, reduce breath, and begin to reform my brain into the linear path of an expert instead of the hyperlinked random walk of a dilettante.
In a world when a 5 minute You Tube video is too long for the average audience and a 140 character message has replaced a thoughtful paragraph, we all need to ask if living each day with continuous partial attention is an improvement.
I for one, am willing to say that the our modern work style is an emperor with no clothes, and we need to recapture our focus in order to solve the complex problems ahead.
When you're reading a 20 page whitepaper, RFP, or article, can you finish it?
When you're writing a presentation or article, can you keep your thoughts flowing or are they interrupted by the urge to check your email or mobile device?
Part of the problem is the expectation that we're all connected 24x7 and should respond in near real time.
Part of the problem is an addiction-like behavior caused by a need to feel connected to other people.
Part of the problem is the pace of change that makes us work two days for every workday - one with scheduled meetings and one with unscheduled electronic messaging.
Do you find that your ability to explore issues in depth has diminished over time because of the need to react to the constant flow of input?
When I write, I close my email client and put away my mobile devices. I often do this between 2a-4a when the tide of incoming messages is low.
I collect my thoughts and write in a single stream, weaving together ideas from my previous compositions when possible. I have been able to keep my 1000+ posts integrated in my mind by writing in the early morning darkness.
However, my reading has suffered. When I was younger, I could sit in my old Morris Chair underneath a Pendelton blanket and finish a book cover to cover. Today, my reading is more web like - I cover a topic and then jump to a different topic until I've rapidly covered the important messages from a book instead of reading it at a relaxed pace cover to cover.
The nature of our work has induced a kind of attention deficit disorder.
To explore this idea further, I looked at my calendar for this week. Across my jobs and volunteer efforts there are few dozen critical projects with due dates in January. Ideally my schedule should block out time to focus in depth on each of these major efforts.
Instead, my calendar demonstrates that I've delegated the "depth" to others in order to achieve a "breadth" of oversight which includes only a few minutes per critical project per day. The rest of the time is spent on urgent problem solving, unplanned work, and reducing the tension of change caused by the modern pace of activity, which is challenging for many people to process.
My blog posts taken collectively often paint themes for the year. In 2012, I'm hoping that I can restore depth, reduce breath, and begin to reform my brain into the linear path of an expert instead of the hyperlinked random walk of a dilettante.
In a world when a 5 minute You Tube video is too long for the average audience and a 140 character message has replaced a thoughtful paragraph, we all need to ask if living each day with continuous partial attention is an improvement.
I for one, am willing to say that the our modern work style is an emperor with no clothes, and we need to recapture our focus in order to solve the complex problems ahead.
Monday, 9 January 2012
Sustainability
As my daughter begins her adult life (she's in Kanazawa, Japan this month doing a winter semester Japanese language intensive), I've thought a great deal about the world she will inherit from me.
I've lived in the creatively vibrant 1960's, the economic doldrums of the 1970's, the go-go 1980's, the .com era of the 1990's, the post 9/11 unrest of the 2000's, and the recovery/reform of the 2010's.
During my lifetime, my rubric for success has changed from one that is judged by salary/position/power to one that is measured by making a difference, living with a small footprint, and ensuring sustainability for the next generation.
I usually write about such topics in my Thursday personal blog post, but I think the concept of sustainability impacts the way we work every day so it's worth a Monday discussion.
Over the past 25 years the US has evolved from a manufacturing economy to a consumer economy that depends upon increasing consumption for success. Unless we grow exponentially - population, sales, and spending - our current economy falters. Since our resources and planet are finite, any strategy based on endless growth will fail.
As I begin the next stage of my life (and we successfully treat my wife's cancer), I believe my best gift to my daughter is sustainability - reducing my consumption of natural resources, reducing my carbon footprint, reducing my contribution to landfills, reducing my belongings/their turnover (what I buy and what I replace), and living closer to the land at a pace supported by nature.
As part of the cancer treatment process, it's important for my wife and me to have long term goals - what will we be doing in 5 years and what can we look forward to?
My wife and I have begun looking at land, discussed low impact/high energy efficiency building strategies, and considered how our community gardening/vegan lifestyle can be extended via additional organic farming activities in Eastern Massachusetts. We've looked at ways to reduce our travel including finding property close to rail lines that will enable us to stop driving in congested traffic and instead take the commuter rail into Boston every day.
Along the way, a few books are guiding our exploration
The Self Sufficient Life and How to Live It by John Seymour
Green from the Ground Up by David Johnston and Scott Gibson
Alternative Construction by Lynne and Cassandra Adams
Back to Basics by Abigail Gehring
Self Sufficiency by Abigail Gehring
I will strive to apply the same principles in my business life as well. Beyond reducing my commute, I will continue to closely manage the power consumption of the data centers I oversee, eliminate the use of paper in clinical workflows, and embrace recycling/reuse/reduction in procurements.
The best thing I can do to support my daughter's generation is to ensure there is healthy planet for her to live in.
You'll see many posts in the future about our sustainability efforts.
I've lived in the creatively vibrant 1960's, the economic doldrums of the 1970's, the go-go 1980's, the .com era of the 1990's, the post 9/11 unrest of the 2000's, and the recovery/reform of the 2010's.
During my lifetime, my rubric for success has changed from one that is judged by salary/position/power to one that is measured by making a difference, living with a small footprint, and ensuring sustainability for the next generation.
I usually write about such topics in my Thursday personal blog post, but I think the concept of sustainability impacts the way we work every day so it's worth a Monday discussion.
Over the past 25 years the US has evolved from a manufacturing economy to a consumer economy that depends upon increasing consumption for success. Unless we grow exponentially - population, sales, and spending - our current economy falters. Since our resources and planet are finite, any strategy based on endless growth will fail.
As I begin the next stage of my life (and we successfully treat my wife's cancer), I believe my best gift to my daughter is sustainability - reducing my consumption of natural resources, reducing my carbon footprint, reducing my contribution to landfills, reducing my belongings/their turnover (what I buy and what I replace), and living closer to the land at a pace supported by nature.
As part of the cancer treatment process, it's important for my wife and me to have long term goals - what will we be doing in 5 years and what can we look forward to?
My wife and I have begun looking at land, discussed low impact/high energy efficiency building strategies, and considered how our community gardening/vegan lifestyle can be extended via additional organic farming activities in Eastern Massachusetts. We've looked at ways to reduce our travel including finding property close to rail lines that will enable us to stop driving in congested traffic and instead take the commuter rail into Boston every day.
Along the way, a few books are guiding our exploration
The Self Sufficient Life and How to Live It by John Seymour
Green from the Ground Up by David Johnston and Scott Gibson
Alternative Construction by Lynne and Cassandra Adams
Back to Basics by Abigail Gehring
Self Sufficiency by Abigail Gehring
I will strive to apply the same principles in my business life as well. Beyond reducing my commute, I will continue to closely manage the power consumption of the data centers I oversee, eliminate the use of paper in clinical workflows, and embrace recycling/reuse/reduction in procurements.
The best thing I can do to support my daughter's generation is to ensure there is healthy planet for her to live in.
You'll see many posts in the future about our sustainability efforts.
Friday, 6 January 2012
Cool Technology of the Week
Hundreds of healthcare IT professionals have offered their support to Kathy as she begins cancer treatment.
Several non-profits have contacted us with educational materials and helpful tools.
One of the most useful is the Cancer Planner from Cancer101.org . Cancer 101 provides the tools and resources that patients and caregivers need to make sense of the overwhelming information and difficult emotions that accompany a cancer diagnosis.
Thanks to CEO Sarah Krug and her staff for sending it.
The Planner contains:
*How to use the Planner and Four Important Things You Need to Know
*Personalize Your Planner
*Notes
*One-year Calendar Planner
*Ten-year Follow-up Calendar Planner
*Address Book
*Medical History & Appointment Tracker
*Symptoms Tracker
*Medical Bills and Insurance Tracker
*Helpful Advice for the Diagnosed and Their Caregivers
*National Cancer Resources
*Questions to Ask Your Doctor by Cancer.Net
*Dictionary of Cancer Terms by the National Cancer Institute
*What Is a Clinical Trial? by the Coalition of Cancer Cooperative Groups
*Become a Lifesaver
Kathy describes this Planner as the perfect addition to her Personal Health Record and the hospital's Electronic Health Record since it enables her to document her thoughts and experiences in a way that complements the objective healthcare data gathered during the care process.
We plan to use the Planner document symptoms of nausea/fatigue so that we can provide feedback to the clinicians providing Kathy with supportive medication.
As I said in last week's Cancer Journey post, the initial diagnostic phase can be anxiety provoking and confusing.
The Planner brings order to the process. That's cool.
Several non-profits have contacted us with educational materials and helpful tools.
One of the most useful is the Cancer Planner from Cancer101.org . Cancer 101 provides the tools and resources that patients and caregivers need to make sense of the overwhelming information and difficult emotions that accompany a cancer diagnosis.
Thanks to CEO Sarah Krug and her staff for sending it.
The Planner contains:
*How to use the Planner and Four Important Things You Need to Know
*Personalize Your Planner
*Notes
*One-year Calendar Planner
*Ten-year Follow-up Calendar Planner
*Address Book
*Medical History & Appointment Tracker
*Symptoms Tracker
*Medical Bills and Insurance Tracker
*Helpful Advice for the Diagnosed and Their Caregivers
*National Cancer Resources
*Questions to Ask Your Doctor by Cancer.Net
*Dictionary of Cancer Terms by the National Cancer Institute
*What Is a Clinical Trial? by the Coalition of Cancer Cooperative Groups
*Become a Lifesaver
Kathy describes this Planner as the perfect addition to her Personal Health Record and the hospital's Electronic Health Record since it enables her to document her thoughts and experiences in a way that complements the objective healthcare data gathered during the care process.
We plan to use the Planner document symptoms of nausea/fatigue so that we can provide feedback to the clinicians providing Kathy with supportive medication.
As I said in last week's Cancer Journey post, the initial diagnostic phase can be anxiety provoking and confusing.
The Planner brings order to the process. That's cool.
Thursday, 5 January 2012
Our Cancer Journey - Week 3
This weekend will be our last pre-chemotherapy time together and we're preparing our home and ourselves for the months ahead.
Last Thursday we met with the care team to assess the physical changes in Kathy's skin and left breast. The mottling of the skin was likely caused by blood settling through tissue planes after the sentinel node biopsy procedure. Over the past few days the discoloration followed the same color changes as a bruise, going from red to brown to green/yellow, then disappearing. The breast swelling was likely caused by the disruption of lymphatics during the removal of lymph nodes. Thus, the cause of all the changes was not new tumor growth but side effects of the biopsy procedure. Her physical exam is now the same as it was 2 weeks ago.
The care team briefed us on the weeks ahead. Together, we discussed the treatment options and finalized a plan - chemotherapy first, followed by mastectomy, followed by radiation oncology.
The appropriate chemotherapeutic regimen for a HER2 negative, ER/PR positive tumor is 4 cycles of cytoxan/adriamycin over the next 8 weeks, followed by Taxol for 12 weeks.
Kathy begins chemotherapy at 10am on August 11. The 3 hour infusion procedure includes anti-emetics (odansetron), steroids (dexamethasone), hydration, a 30 minute infusion of cytoxan, and a slow IV push of adriamycin.
We've been told to expect the worst symptoms to occur 48 hours after treatment and we've been given compazine and lorazepam for nausea. Kathy may also develop constipation and diarrhea, which we'll treat with over the counter medications. We'll have to watch for fever as her white blood cell counts drop to the level that she cannot fight off infections. I've cancelled all my meetings on her chemotherapy days and on the 2nd day after each treatment when her fatigue will be the most significant.
Kathy will lose all her hair about 2 weeks after the first treatment and she's arranged with her hairdresser to shave it off. We've already purchased a few warm winter hats and head wraps.
The chemotherapy medications are effective but can have profound side effects. Cytoxan causes mouth/throat sores. Adriamycin causes heart muscle damage and hand/foot syndrome. Taxol can cause numbness and pain in the hands and feet, a problematic condition for an artist.
Yesterday, she had a pre-chemotherapy echocardiogram to assess her heart function prior to receiving Adriamycin. She also visited Hester Hill, who provided her with guidance about life style, wigs, and sources of support during the treatment process.
The transition from the cancer diagnosis phase to the treatment phase occurs next week. We'll learn a great deal about being cancer patients as we ride the emotional roller coaster of the days ahead.
Last Thursday we met with the care team to assess the physical changes in Kathy's skin and left breast. The mottling of the skin was likely caused by blood settling through tissue planes after the sentinel node biopsy procedure. Over the past few days the discoloration followed the same color changes as a bruise, going from red to brown to green/yellow, then disappearing. The breast swelling was likely caused by the disruption of lymphatics during the removal of lymph nodes. Thus, the cause of all the changes was not new tumor growth but side effects of the biopsy procedure. Her physical exam is now the same as it was 2 weeks ago.
The care team briefed us on the weeks ahead. Together, we discussed the treatment options and finalized a plan - chemotherapy first, followed by mastectomy, followed by radiation oncology.
The appropriate chemotherapeutic regimen for a HER2 negative, ER/PR positive tumor is 4 cycles of cytoxan/adriamycin over the next 8 weeks, followed by Taxol for 12 weeks.
Kathy begins chemotherapy at 10am on August 11. The 3 hour infusion procedure includes anti-emetics (odansetron), steroids (dexamethasone), hydration, a 30 minute infusion of cytoxan, and a slow IV push of adriamycin.
We've been told to expect the worst symptoms to occur 48 hours after treatment and we've been given compazine and lorazepam for nausea. Kathy may also develop constipation and diarrhea, which we'll treat with over the counter medications. We'll have to watch for fever as her white blood cell counts drop to the level that she cannot fight off infections. I've cancelled all my meetings on her chemotherapy days and on the 2nd day after each treatment when her fatigue will be the most significant.
Kathy will lose all her hair about 2 weeks after the first treatment and she's arranged with her hairdresser to shave it off. We've already purchased a few warm winter hats and head wraps.
The chemotherapy medications are effective but can have profound side effects. Cytoxan causes mouth/throat sores. Adriamycin causes heart muscle damage and hand/foot syndrome. Taxol can cause numbness and pain in the hands and feet, a problematic condition for an artist.
Yesterday, she had a pre-chemotherapy echocardiogram to assess her heart function prior to receiving Adriamycin. She also visited Hester Hill, who provided her with guidance about life style, wigs, and sources of support during the treatment process.
The transition from the cancer diagnosis phase to the treatment phase occurs next week. We'll learn a great deal about being cancer patients as we ride the emotional roller coaster of the days ahead.
Wednesday, 4 January 2012
Honey or Vinegar?
There are many ways to approach interactions with superiors, subordinates, and peers.
In my 30 years of working in complex organizations, I've observed different leadership styles with varying degrees of long term success.
I believe it is far better to establish unity, esprit de corps in the foxhole, and boost morale than to create divisiveness, uncertainty, and fear of failure.
My grandmother used to say that "You can catch more flies with honey than with vinegar" meaning that you can be more persuasive with camaraderie than confrontation.
In the short term, formal authority and fear of job loss can be very persuasive. In the long term, such behavior is likely to result in an "Occupy"-like rally of staff seeking a better organizational culture.
My own experience with "honey" includes 5 different characteristics:
Informal authority - Building trust and exploring possibilities together in a non-judgmental way creates lasting mutual respect and grants a degree of authority that is far more powerful than rule by fiat.
Loyalty - I've arranged pay increases and bonuses for staff to recognize special achievements and career growth. The increased payment creates short term joy but the impact on retention is short lived, since the novelty of the change diminishes over time. Far more important is creating a sense of long term loyalty that comes with a family-like atmosphere. All for one and one for all.
Air cover - In a crisis, you're first on the front line fighting the fight, taking the blows, and protecting those behind you. You're not watching the action from a distant hill or criticizing the troops from an armchair.
Good guy can finish first - I'm a strong believer in integrity, honesty, and fair play. I will not hurt my fellow humans to get ahead. My feeling is that those who live by the sword die by the sword.
Strong emotion never works - As a parent and as a CIO, I've raised my voice once or twice in 20 years, then felt terrible for doing it. It diminished me.
I'm sure there are those who equate intimidation with leadership, but for me, uniting people in support of a common cause against a common adversary using trust, loyalty, ethics, hard work, and support wins the day.
Tuesday, 3 January 2012
Thoughts on the Year Ahead
While 2011 was a year of incredible change (Meaningful Use Stage 1, 5010, Pioneer ACOs, State HIE planning, security challenges, compliance/regulatory pressures), I'm hopeful that 2012 will be a year of heads down work. As I've said before, planned work that is appropriately resourced is a joy, no matter how challenging. It's the unplanned work which needs to done within the budget/resources/timeline of existing projects that's the emotional drain. Here are the significant projects I see for 2012:
ICD10
Despite the best efforts of many people to explain the burden of ICD10 and the lack of benefit, it appears that ICD10 will continue forward with a October 1, 2013 implementation date. BIDMC will spend $500,000 on application analysis, education, and project planning, then an unknown amount (could be $5 million or more) on remediation of vendor systems. I predict that 25% of the capacity of IT will be consumed by ICD10 in 2012. If we're lucky and have a perfect go live, no one will notice. Depressing.
Meaningful Use Stage 2 including inpatient clinical documentation
Meaningful Use Stage 2 will likely include replacement of paper-based inpatient progress notes with electronic (not scanned) documentation. We've been thinking about the best way to approach this leveraging templates, macros and social-networking like group documentation. This is an exciting project that will make the clinical record much easier to read, improving clinical care coordination and communication.
ACO Planning
Healthcare reform will require a completely different approach to care, focused on wellness, not just treating disease. Not only will we need new business intelligence and health information exchange capabilities, we'll also need new decision support functionality based on care plans, pathways, and event driven medicine (new data triggers interventions).
Compliance
2011 was a year of increased regulatory enforcement and compliance automation requirements. I believe 2012 will be the same with a focus on conflict of interest tracking, learning management systems for compliance education, and enhanced revenue cycle systems that provide decision support at the point of care to ensure all regulatory requirements are met.
Security
2011 saw an explosion of malware and viruses compounded by an increase of mobile personal devices accessing clinical content. It's likely that we'll need to augment our security team and infrastructure to address the escalating cold war with hackers who have turned identity theft into a business.
Let us hope 2012 is a year of innovation, creativity, and incremental progress. I remain optimistic that the chaos of 2011 built a foundation for achievement in 2012.
ICD10
Despite the best efforts of many people to explain the burden of ICD10 and the lack of benefit, it appears that ICD10 will continue forward with a October 1, 2013 implementation date. BIDMC will spend $500,000 on application analysis, education, and project planning, then an unknown amount (could be $5 million or more) on remediation of vendor systems. I predict that 25% of the capacity of IT will be consumed by ICD10 in 2012. If we're lucky and have a perfect go live, no one will notice. Depressing.
Meaningful Use Stage 2 including inpatient clinical documentation
Meaningful Use Stage 2 will likely include replacement of paper-based inpatient progress notes with electronic (not scanned) documentation. We've been thinking about the best way to approach this leveraging templates, macros and social-networking like group documentation. This is an exciting project that will make the clinical record much easier to read, improving clinical care coordination and communication.
ACO Planning
Healthcare reform will require a completely different approach to care, focused on wellness, not just treating disease. Not only will we need new business intelligence and health information exchange capabilities, we'll also need new decision support functionality based on care plans, pathways, and event driven medicine (new data triggers interventions).
Compliance
2011 was a year of increased regulatory enforcement and compliance automation requirements. I believe 2012 will be the same with a focus on conflict of interest tracking, learning management systems for compliance education, and enhanced revenue cycle systems that provide decision support at the point of care to ensure all regulatory requirements are met.
Security
2011 saw an explosion of malware and viruses compounded by an increase of mobile personal devices accessing clinical content. It's likely that we'll need to augment our security team and infrastructure to address the escalating cold war with hackers who have turned identity theft into a business.
Let us hope 2012 is a year of innovation, creativity, and incremental progress. I remain optimistic that the chaos of 2011 built a foundation for achievement in 2012.
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