CIO CORNER

Healthcare Information Technology Leadership

By bwellman | May 15, 2009

Pressures to change the healthcare delivery system continue to increase from the major healthcare constituencies. The current healthcare delivery system is complex and not structured in a way that helps clinicians systematically improve the delivery of care while simultaneously avoiding mistakes. The future healthcare delivery system has been characterized by some has Health 2.0. Emerging trends will help to shape the future healthcare delivery system some of the following1:

• An increased emphasis will be placed on disease prevention and the creation of healthy communities
• Genomics and proteomics will enable significant advances in the early detection and prevention of disease
• As baby boomers advance in age, the resources of the existing system will be stressed resulting in more innovative ways to care of patients including “in home” care
• Consumer driven healthcare will increased with patients taking more responsibility for their health and demanding to be treated like customers
• Increased transparency of healthcare provider performance and outcomes will improve quality and be an increasingly important factor in consumer driven healthcare
• Specialized centers for chronic disease will be utilized by many patients
• Home based monitoring and therapy that utilizes cost effective devices will expand in conjunction with physical decision support tools that alert primary care physicians to patient problems.
• Healthcare analytics will increase in importance in the detection and treatment of patient conditions and disease

Information technology has been identified as being critical to the transformation of the healthcare delivery system2. Healthcare Information technology leaders must possess the requisite competencies to be a full partner in leading the healthcare organization transformation efforts. Information technology leaders must also posses the judgment and competencies to acquire, implement and operate the “right” portfolio of information technologies that will enable healthcare delivery professionals to create a culture of safety that delivers safe, high quality patient care in an efficient manner. A vision for the future, the ability to execute and a balanced set of competencies will be important to a leader’s success.

Vision

A vision of the 21st century healthcare delivery system and the role of information technology in enabling transformation of the healthcare delivery system is an essential leadership competency. The vision must incorporate fundamental healthcare principles including patient safety, the constraints of available information technologies and the financial realities of healthcare providers under constant pressure to reduce costs. The information technology must be affordable to the organization. Healthcare organizations are well known for their resistance to change, however; vision can be a powerful tool to create change. The Information Technology leader must have the ability to consolidate the vision into an understandable plan that integrates with and supports the organization’s overall plan. The Information Technology leader must also have the ability to communicate the plan to others within the organization, including the Medical Staff, aligning each of the major groups in support of the plan as leadership alignment will be one of the critical success factors to achieving the transformation.

Execution

Information Technology leaders must have the ability to mobilize the organization around the information systems plan and work collaboratively with others to achieve the goals and objectives outlined therein. Information technology projects are notorious for being late and over budget while not delivering on the benefits used to justify the initiative. Information technology leaders will embody the discipline of execution. The leader will have a proven track record of leading the implementation of complex information systems in healthcare delivery organizations. Leaders understand successful implementations must incorporate changes to fundamental clinical processes, made possible by information technology and require computer literate staff willing to embrace change. Information technology leaders must also recognize change can not be successfully accomplished without an effective governance structure in which each member of the senior management team is accountable for effecting the change within their areas of responsibility. These changes will impact many of the core processes upon which the organization operates. Information Technology leaders must be critical systems thinkers with the ability to evaluate both the intended and unintended consequences of the planned changes. Creating a forum in which dialogue about both intended and unintended levels of change is important to successful change.

Innovation

The information technologies available to healthcare providers are created by technology vendors. Most healthcare delivery organizations do not undertake the development of software or hardware technologies rather; they manage the assembly of available technologies to support the organization’s clinical, financial and administrative operations. Information technology leaders need an in-depth understanding of these processes and the available information technologies. Leaders will need to innovate by finding new ways to utilize the portfolio of technologies to improve processes and solve problems. As the “gaps” in the technologies are discovered, Information Technology Leaders need to possess the competencies to work with the technology vendors in the creation of new capabilities in the technologies that close the “gaps” resulting in improvements in the delivery of care.

Balanced Left Brain / Right Brain Competencies

Healthcare information technology leaders must possess a balanced set of left brain and right brain competencies. Left brain competencies are typically characterized as logical, analytical, administrative, controlled and technical while right brain competencies are often described as conceptual, intuitive, synthesizing and artistic. To meet the challenges of the changing healthcare delivery system, information technology leaders will be constantly challenged to operate the information systems that support the current care delivery system while simultaneously designing new care processes and implementing the information technologies that allow these processes to provide safe patient care. An additional complicating factor is it constraints imposed by the package based application systems available in the healthcare industry.

The delivery of safe quality patient care is dependent on the timely and accurate communication of information throughout the organization. The hospital information systems are responsible for storing and transmitting an increasingly greater percentage of this information. These systems must always be available to the care delivery teams where ever they might be with fast response time. Assuring this performance is one of the fundamental responsibilities of the information technology executive. Executing in this area requires well developed left brain competencies and deep experience in the daily operations of information technology in a healthcare provider setting. Establishing the structure and processes that limit the impact of “threats” including but not limited to application software upgrades, human operational errors and natural disasters that seek to disrupt information system availability and performance requires solid experience coupled with well developed left brain competencies.

The innovative use of information technology to support the fundamental goals of the healthcare delivery organization, especially the provision of safe high quality patient care requires well developed right brain competencies. The ability to do the “right thing” and anticipate the needs of clinical professionals before they arise can only be accomplished by those with a well developed conceptual understanding of the overall healthcare delivery system and good intuition.

The balanced set of competencies is important as the Information Technology leader must assume a broad array of responsibilities as depicted in Exhibit I.

Information Technology Leader Responsibilities

 

Exhibit I

 

Responsibility	Description
IT Strategy	Planning and communicating the role of IT in the organization
Application Management	Acquiring, implementing and maintaining application systems
Infrastructure Management	Planning, implementing and refreshing the infrastructure
IT Organization Management	Leading the IT organization
Operations	Ensuring systems and networks are always available and performing (including security and disaster recovery)
People Management	Managing and developing IT Staff
Collaboration	Working together with others across the organization to provide solutions to daily operational problems and executing the IT plan
Financial Management	Budgeting and controlling IT Costs
Clinical Process Transformation	Working with others to transform care delivery processes and do no harm
Prioritization	Determining the right tasks to be performed in the right order and formulating a concensus across the organization
Relationship Management	Building trust and understanding between IT, hospital staff and the Medical Staff

 

Credibility Based Leadership

 

Information technology executives need to lead through credibility based leadership which is built upon a foundation of trust. Trust is built slowly over time as the information technology executive demonstrates an ability to execute, an ability to solve problems and clarifies the vision.  Credibility based leadership is based upon an ongoing process build upon trust and predictability. Individuals follow credibility leaders because over time they have delivered on their promises.  Credibility leadership is comprised of several key attributes that define the leadership style and cause individuals to willingly follow the leader instead of resisting.  Character is a core attribute through which credibility based leaders demonstrate integrity, honesty and respect in their dealings with others. Credibility based leaders must be courageous, willing to stand by their beliefs and take accountability for their mistakes.  People willingly follow because credibility leaders are predictable and execute on their promises.  Information technology leaders must assure the information systems that support daily operations must be available, reliable, secure and fast. This is central to building trust across the organization.  In addition to communicating the vision, the Information technology leader must demonstrate progress is being made toward achieving the vision with minimal disruption to the organization and without compromising patient safety.  As a track record of execution is achieved, the Information Technology Leader will gain trust and credibility.

 

Summary

 

The Information Technology Leader in a healthcare organization is important to the transformation of the organization. The Leader must possess a broad array of competencies to be successful as a member of the senior management team that will transform the patient care delivery processes.  The leader must have a vision for the healthcare delivery system of the future and the ability to deploy information technology in innovative ways toward the realization of this vision.  The leader will build trust across the organization through the implementation of the vision and reliable daily operation of information systems.  Through credibility based leadership based upon trust, the leader will become a full partner in helping the organization through the transformation process necessary to deliver healthcare in the 21^st century.

 

 

 

Footnotes:

 

1        Health Leadership Competency Model, National Center for Healthcare Leadership, www.nchl.org/ns/documents/CompetencyModel-short.pdf.  A comprehensive list of the 26 competencies for health leaders are identified.

2        Institute of Medicine (IOM),  To Err is Human: Building a Safer Health Care System (1999), www.nap.edu/openbook.php?isbn=0309068371

 

 

 

 

 

 

 

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