Individuals and systems

The reason why integrated health systems have all implemented proprietary electronic medical record systems is that their processes of care, compensation, costing, procurement, and management are interdependent—in unique and proprietary ways. Rather than force their processes to conform to a standard-format electronic medical records system, it is much more natural and cost-effective for them to develop a system that conforms itself to their own organization’s established processes, not the other way around.

In addition, just as doctors are individual actors within a larger system, so are those hospital systems—they’re subsystems within a larger system. It is simply not in their best interest to force-fit their operating processes into a standard format so other providers in other systems can easily care for their patients. In other words, we cannot expect entities whose scope is that of individuals within a subsystem, or subsystems within a system, voluntarily to invest to solve higher-level systemic problems. We have gotten exactly what we could expect.

Christensen, The Innovator’s Prescription, pp. 137-138

Although my review of Christensen’s The Innovator’s Prescription is still forthcoming (I have about 100 pages left to finish the book), I keep finding gems along the way that raise important issues for leadership.

The quote above is from his treatment of electronic medical records. What I find useful in it is the distinction between individual motivations/drivers and systemic ones, because as a leader, you have to understand both perspectives if you’re going to effectively get lots of individuals to act in ways that accomplish organizational goals.

IT faces this dilemma all the time: implementing a system will have benefits for the organization as a whole, but will require individuals across the organization to change how they work—often in ways they’re not going to prefer to the way they do things now.

For example, moving from an older email system like Novell GroupWise to the latest version of Microsoft Exchange. There will be lots of benefits at the organizational level and lots at the individual level as well; but in the short term, everyone in the trenches will be disrupted: their inbox will look different; scheduling meetings will require different steps; contacts may or may not work like they expect; and so on.

As the CIO in this situation, you have to make some choices about how you handle this. You can be dogmatic—this is a change that needs to be made, so we’re making it, user objections be damned; diplomatic—this is a change that needs to be made, but it will have many benefits for end-users that we’re excited about; inclusive—this is a change that needs to be made, and we’re excited to be partnering with our LOBs to make sure that we meet end-user needs; or reclusive—you may have noticed when you logged into email this morning that we have a new system…

And while some of this will depend on a leader’s individual style, I imagine that different kinds of systematic changes could require different approaches even from the same leader. To keep with the IT example, things like email and shared drives affect almost every single individual at the organization: wouldn’t changes to these systems demand different leadership from a CIO than a change to a system used by a single LOB or to an enterprise system used infrequently by employees?

Anyway, as usual, more questions than answers here, and as always would love to hear from folks about their experience and perspective…


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