The bar was set pretty high. During her 17-year tenure as EVP, Carla Smith helped guide HIMSS through periods of tremendous growth, launching several successful programs around public policy, workforce development, the advancement of women in Health IT, and innovation. As the industry evolved, so did her strategies.
And so, when it was time to start the next phase of her career, she wanted to find a way to leverage the experience she has gained, while zeroing in on the areas that are close to her heart. It’s precisely what she has achieved with CarlaSmith.Health, the consulting practice she introduced late last year.
In this interview, Smith opens up about what she enjoyed most about her time with HIMSS, what she believes are the most critical components of successful leadership, and what it takes for startup companies to get off – and stay off – the ground. She also talks about the ultimate goal of achieving gender and racial equality in leadership roles, and the “new reality” she has created.
- Reflecting on her HIMSS tenure
- 12 years of expansion – “It’s the type of growth numerous companies haven’t survived.”
- Stability in leadership
- Changing habits – “People feel a lot of ownership.”
- Active listening skills – “You need to check judgement at the door.”
- Interest in startups: “I could see a change occurring.”
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I promise you, it’s going to change. It’s going to change dramatically and it’s going to change almost without warning. If that works for you, it might be a good fit.
I want to be part of an environment where I will at least be given the respect of voicing truth to power. It doesn’t mean that you always get your way, but you have to be in an environment where truth can be spoken.
When someone says, ‘We’re not going to do things the way we’ve done it,’ or ‘we’re not going to do that anymore,’ that can be very upsetting. A leader needs to be able to simultaneously share the vision of what can happen when we let go of those things, and what is the path that’s going to take to get us there.
Be very clear as the leader that you believe in the existing people and you believe in the new person, and you are committed to finding a healthy new normal for the group. Be clear that you will work with individuals to create a healthy new environment, and demonstrate it with your actions.
I remain an optimist. I think it’s fantastic for the health sector to have so much innovation in it. Simultaneously, it’s also incredibly challenging because so much innovation can end up as confusing noise. You don’t know where to turn, you don’t know who to listen to, and you don’t know who to believe.
Gamble: Hi Carla, thank you for joining us. I think this will be really fun. I want to talk about your career, including your time with HIMSS, as well as how the industry has changed, and what you’re doing now.
Smith: Thanks Kate, I’m delighted to have the conversation.
Gamble: Great. Let’s start by talking about your time with HIMSS. One thing that’s really interesting to me is how you were able to navigate the tremendous growth it experienced. It’s concerning if an organization is growing too fast or getting too big. How did you approach that from a leadership standpoint?
Smith: I’ve thought a lot about that, because the growth we experienced for about a 12-year period is the type of growth that numerous companies have not been able to survive. What was it that went right for us? I have a few thoughts on that. One is that for many years, it was a three-person leadership team. Norris Orms [former VP and COO] and I reported to Steve Lieber for a number of years. My skills, Steve’s skills and Norris’s skills were complementary — we didn’t overlap. Sometimes you end up with a management team that’s very heavily weighted toward financial skills, but they’re skimpy on human and interpersonal skills. We were very well-balanced, so that was an asset.
Another is that we were unafraid of change. Somehow it got into the vernacular of HIMSS at the time that if you’re uncomfortable with change, we were not the group for you. No harm, no foul if you weren’t, but we wanted to be very clear up front, because we’re chameleons. I promise you, it’s going to change. It’s going to change dramatically and it’s going to change almost without warning. If that works for you, it might be a good fit. To me, it’s like giving candy to a baby. I love that kind of environment. Thirdly we created an environment where the norm was to challenge. We created a norm where people could speak truth to power.
Gamble: I’m sure that can get challenging.
Smith: It can get very challenging. It’s really hard to inculcate and live that. I believe a core part of my leadership is having people around me who believe I’ll listen to them when they speak truth to power. I want to be part of an environment where I will at least be given the respect of voicing truth to power. It doesn’t mean that you always get your way, but you have to be in an environment where truth can be spoken.
Gamble: I imagine that involves putting aside a certain amount of ego as a leader and being willing to have tough conversations.
Smith: Yes. The fourth component is the ability to leave things behind; to stop doing what isn’t working. That’s really hard too. People like to keep doing the same thing over and over again because they get good at it, but it doesn’t mean the outcome is what you need. You have to make those leadership decisions where figuratively you can’t buy enough buckets to hold people’s tears as you leave something behind, but sometimes as a leader, you have to do it in order to grow.
Gamble: That’s something that I think a lot of leaders in this industry struggle with, and it’s understandable. IT and other departments are being asked to do so much and resources are stretched so thin, and that can make it even more difficult to say, ‘Okay, now we’re going to throw another change into the mix.’ Is that something that can really be a challenge?
Smith: It’s a huge challenge. There are practices or areas of focus that have become habitual that no one even questions or looks at anymore — those are exactly what leaders need to be looking at. Sometimes it’s a shock to the system because it has become part of the wallpaper of the organization. You don’t even see it anymore. And so when someone says, ‘We’re not going to do things the way we’ve done it,’ or ‘we’re not going to do that anymore,’ that can be very upsetting for the staff. A leader needs to be able to simultaneously share the vision of what can happen when we let go of those things, and what is the path that’s going to take to get us there.
Because you can’t just tell people that this thing that has become habituated it isn’t going to be done anymore, because people feel a lot of ownership. You have to give them hope that they will have a future in this new reality, and that you will support them in becoming competent in this new arena. In order for people to follow, they have to believe in you as the leader.
Gamble: That brings up an interesting point about trust. It’s something that can’t happen right away, but what can leaders do to build trust with their team?
Smith: One thing is tell the truth. You want to give the amount of information that’s needed at that time, which is a value judgment made from experience plus smarts. Give enough information so that your team will follow you, but not so much information that you open up a possibility for competitors to understand everything about what you’re planning to do, or that frighten your team. Give them the information that’s needed at the time.
Another one is to listen and demonstrate active listening skills. For example, if you and I were talking and I was explaining something new or different to you, I would ask, ‘What kind of questions do you have for me? Can you repeat what you think you heard me say?’ Then I would listen to what you’re saying and respond by saying, ‘Okay, if I’m understanding you correctly, you’re asking me this.’ And you would say, ‘yes’ or ‘no, not exactly.’ We’d get to a place where you believe that I understand what you’re saying to me or what you’re asking me. That’s going to increase my trustworthiness and my integrity in your eyes, because I took the time to hear what you were trying to say. It doesn’t mean I agree with you, but I respect that you have a point of view and you have questions.
Gamble: That seems like a relatively simple way to get through some of the communication hurdles.
Smith: It’s one that takes a lot of practice. To the best you can, you need to check judgement at the door so that you can hear what somebody is trying to say and resist becoming defensive. Another is to try to find words other than ‘why’ and ‘should,’ because those are often interpreted as judgmental and can get in the way of communication. There are some very tangible skills to learn in order to become an active listener.
Gamble: And I would guess they’re honed over time. When you talked about your time at HIMSS, you mentioned the three-person leadership team. When somebody new is thrown into the mix and that rhythm is disturbed, how can leaders deal with that in the best way possible?
Smith: It is challenging; I know because I’ve lived it. To the extent possible, a leader needs to involve his or her direct reports in any change to the team. This will increase the probabilities of success, because then the direct reports can join in helping the new person succeed. If the existing direct reports can have some type of say in how the responsibilities will be shifted and reallocated, that can really help with buy-in.
Another one is to be very clear as the leader that you believe in the existing people and you believe in the new person, and you are committed to finding a healthy new normal for the group. Be clear that you will work with individuals to create a healthy new environment, and demonstrate it with your actions. Take time for team-building. Take time for the arguments and the disagreements and stay focused on the North Star — we will come out the other end, and we’re going to be a stronger team for it.
Gamble: You were involved in a lot of different areas during your time with HIMSS, one of which was startups. What made you interested in that particular area?
Smith: I pay attention, Kate, and I could see a change occurring. There were little companies bubbling up that I had not experienced before, and I saw that as an opportunity to pay attention. Inside startups could be really interesting new ideas that were worthy of observation and discussion, and because of the bully pulpit I had and because of the leadership team I was part of, which emphasized and supported new ideas and testing and piloting things, I could do it. So I did.
Gamble: Looking at the impact they’ve already had, what do you think we will continue to see as far as startups? There’s obviously some risk involved but there are also some really bright ideas that could be game-changers.
Smith: It’s interesting; I have an even richer perspective now that I have transitioned into a new phase of my career. I’ve got private equity client I’m engaged with, as well as some early-stage companies, and I’m working with a couple of different funds. There are several things I see going on. One is that it’s very, very clear to me that it’s not enough to have a great idea. You need to have an effective management team structure in place. You need to have a story to tell that is compelling enough to get you paying clients, and you need some type of evidence that your product or service actually works. That can take the form of a use case or a case study depending upon the type of startup. If it’s something that’s eventually going to have to go through FDA approval, you need much more than that — you need scientifically defensible evidence. Oftentimes with early stage companies, all of those items are aspirational goals versus what they’re working on right now.
Gamble: As we start to see more startups pop up, are you concerned as to whether these companies are sustainable or are being approached in the most effective way?
Smith: I do question their sustainability, but I remain an optimist. I think it’s fantastic for the health sector to have so much innovation in it. Simultaneously, it’s also incredibly challenging because so much innovation can end up as confusing noise. You don’t know where to turn, you don’t know who to listen to, and you don’t know who to believe. So it’s a yin and a yang.
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