“Sure, that’s no problem but, regarding your other request, I’m afraid we’d have to stick with the process as it’s been laid out,” I said to a potential Webinar sponsor who’d asked about making some changes to the program.
As I’ve run healthsystemCIO.com over the past few years, I’ve come to deeply appreciate the structured approach made famous by one of the more successful EHR vendors in our market, because it is only through continual experience, refinement and repetition of the same activity that one can hope to perfect a product or service. Doing it this way one time and that way another will never yield a streamlined, scalable and efficient offering.
But, as the above quote relates, all aspects of a process need not be inflexible — the key, which one learns through experience, is distinguishing what matters from what doesn’t.
“As one of his staff at the state department later wrote, Marshall did not possess the intellectual brilliance of someone like Acheson, or the gift of eloquence, but he could distinguish what was important from what was unimportant, and that made him invaluable.”
And how can one hope to make such a distinction? Easy — determine the value proposition (what you are actually getting paid for), and have flexibility with those aspects whose adjustment has little, if any, bearing upon your deliverable.
Alluding to a recent column in this space, more than anything else, your career depends on your reputation, not the mirage of job security at one organization. This is important because accepting that premise will allow you to determine when to be flexible. Let’s add to the mix the fact that, as a CIO, your effectiveness is simply determined by whether or not you have been able to increase physician usage of electronic systems during your tenure — that’s it. It’s not about whether your boss liked you or if you put in a nice data center or had the best disaster plan in town. Did you get the docs to do more CPOE and electronic documentation or not?
This realization gives you the necessary framework to handle the many decisions that must be confronted each day, allowing you to select that path that moves your docs ever further down their electronic journey. But what to do if you are being forced to make compromises that are clearly detrimental to that mission?
The answer is the development of a BATNA (best alternative to a negotiated agreement). Simply put, through careful thought and planning, you must put yourself in a position to say. “I’m sorry, but what you are proposing (or ordering) will not work, and I cannot lead this effort.” But you can only stand on such principle if you’ve previously developed a detailed fallback plan. Will you start your own consultancy? Do you have three of four organizations that might be in need of your skills as a new employee? Have you cultivated a rich LinkedIn network of colleagues?
I got to thinking about BATNAs when listening to Barbara Tuchman’s “The Proud Tower: A Portrait of the World Before the War, 1890-1914.” In it, she profiles Thomas Brackett Reed, a Representative from Maine who served as a very powerful Speaker of the House. One of the actions Reed became famous for was fighting to remove the “disappearing” or “silent” quorum, which allowed the minority party to block almost all legislation it disliked, accomplished by its members remaining silent during a voice roll call, and thus not being counted as present. The fight was very vicious, lasting a number of days, yet through it all Reed was the picture of composure — never ruffled or flustered. What was his secret, he was asked?
To paraphrase, Reed said that, quite simply, he was perfectly ready, if he lost the fight, to resign as Speaker, resign his seat as a Representative, and go back into private law practice. If the government was going to function as ludicrously as the current rules permitted, he said, he wanted no part of it. Reed specifically made the point that, once one reconciled themselves to an alternative option, the current fight becomes much easier to brave.
Combining these concepts can be powerful. First, know what matters, thus constructing a framework to evaluate options. Then, adhere ferociously to the concepts that count, forgoing short term gains for the long term value that accrues with consistency. Finally, develop a very real and actionable BATNA. Only then will you have the composure of Reed, a quality that warranted his profile in a book covering the great statesmen and trends in both the United States and Europe during a quarter century.