Leading In A Sea Of Change

One of my favorite quotes, which I learned during my four years of Latin in high school, is “In tranquillo esse quisque gubernator potest” by Publilius Syrus. Roughly translated, it means, “Anyone can hold the helm when the sea is calm.”

There has probably been no time in my 33 years in healthcare when this has been truer than it is today. On one hand, information technology is at the solution table for every major issue facing healthcare today. Payment reform, accountable care organizations, patient centered medical homes, clinical cost reductions, clinical outcome improvements, and value-based purchasing all have significant IT components as a part of the underlying infrastructure required to deliver on these important initiatives.

At the same time, declining reimbursements from public and private payers, reductions in medical education and disproportionate share payments, and shrinking grant monies are forcing healthcare organizations to find ways to significantly reduce their cost structures. As a result, we are being asked as organizational leaders to find ways to create efficiencies in our processes to reduce the costs of doing business. “Do more with less” has become the mantra of our time.

Our response to these challenges is a clarion call to significantly transform the way we deliver services within our organizations. We are going to have to make some hard decisions about our sector of the organization that will affect our makeup, what we do, and how we measure and communicate our process. We are going to have to manage our part of the business like a business.

For many of us, there is some low-hanging fruit to be picked simply by restructuring our governance and tightening up our technology decision-making processes. In my own organization, there are far too many groups who make technology decisions in a vacuum, with no accountability structure or upward funnel to a centralized management group. That will be changing over the next few months, with the creation of a governance structure where all significant technology decisions rise up through the appropriate levels, ultimately to an executive management body whose responsibility it is to prioritize all requests from an enterprise perspective and allocate increasingly scarce resources as appropriate. It is important to note that the executive management body is not chaired by IT, but by the CEO of the organization. In this way, the organization understands that these decisions are not being driven by IT, but from the executive team.

In order to move to a leaner, more strategically focused IT organization, it may be time to revisit the services that we provide and the way that we provide them. More and more, we need to move from the traditional IT service management based on functions, to a model that focuses on improving processes within the various business units. While IT has begun to embrace project management professionals (PMPs) as a part of their organization, it is clear that process improvement specialists will be required to supplement existing teams. And if IT wants to play a role in process redesign, our knowledge of business processes will need to increase dramatically.

In this new model, customer intimacy will be a new requirement for traditional technology ‘mechanics’ who understand the technology side but have not historically understood the operational workflows. A new customer-facing role will be created within IT which will serve as a relationship manager and liaison to the business units and business process owners. And in fact, this capability will extend beyond a single role. Nearly everyone within the IT organization will need to significantly improve their customer relationship management skills as they become more closely aligned with the business units themselves.

Finally, I think we would have to take a new look at outsourcing supporting infrastructure capabilities that may be better performed by external service providers. This concept and practice, which has been somewhat cyclical in healthcare, is once again in play, and we can no longer afford to assume our unsuccessful experience in the past with outsourcing will be the same in today’s marketplace.

There are some functions, however, that cannot be outsourced. IT leadership will continue to be crucial to creating a strategic vision and executing that vision. Architectural planning and decision-making capabilities, which are critical to security management, must continue to reside within the IT organization. Technology management, which entails the monitoring and introduction of emerging technologies into the workplace, will continue to be a requirement, assuming the IT organization has moved to a deeper understanding of business processes. And finally, vendor management must continue to be a part of what we do, because we are required to manage both the vendors’ contracts and performance as it pertains to maximizing and optimizing those relationships.

It is a tumultuous and transitional time in the healthcare industry, and every business unit in our organizations will be impacted and changed in some way. We can choose to lead that change or have that change imposed upon us in ways that would not be in the best interest of our organizational success. We must proactively address our own purview if we are going to be able to help our organizations thrive in the New World that healthcare is rapidly sailing to.