4 keys to maintaining IT initiatives and a healthy hospital culture

By Michelle McNickle
01:04 PM

It's no secret CIOs are busy as ever, dealing with everything from to ICD-10 to meaningful use to staff burnout and more. With the flood of new IT and the uncertain future of the industry, it's no wonder many are hesitant about what to do next. 

We asked John Halamka, MD, CIO at Beth Israel Deaconess Medical Center, about maintaining a healthy hospital culture in today's industry. Halamka looked back to a blog post of his, which describes the popular acronym "VUCA." Using that, he outlined four roadblocks to a healthy hospital culture – and offered ideas about how to overcome them.

1. Volatility. Volatility refers to the nature and dynamics of change, along with the nature of speed that change forces and catalysts. Looking to author Bob Johansen, Halamka writes that it's important for leaders to change volatility into vision. He offered the 2008 election as an example. "The Obama campaign suggested that EHRs and HIEs were the right thing to do," he wrote. "We had all the signs that AARA and HITECH would be coming, but large scale EHR rollouts require significant time." He and his organization "had to act," Halamka wrote, and knowing EHRs were the right thing to do, they opted for SaaS systems and created a private cloud. "The concept of the Private Cloud really did not exist in 2008 and we did not know enough to predict it," he wrote. "We just did what we thought was right ... today, people look at our community EHR SaaS model and congratulate us on our foresight to build a cloud." 

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2. Uncertainty. Uncertainty – or the lack of predictability, the prospects for surprise, and the sense of awareness and understanding of issues and events – is essential to have in a well-functioning organization. Once again, Halamka referenced Johansen, who believes in turning uncertainty into understanding. And as a leader, he wrote, it's imperative those in similar positions remain focused on preparing for the future. "My time needs to be divided among federal, state, and local initiatives, so that my governance committees, my staff, and I can make the guesses for the future," he wrote. "None of us know what healthcare reform will bring, or what the reimbursement models will really be. However, we need to act now to be ready for the next two years."

3. Complexity. According to the theory behind the acronym, complexity is synonymous with the "multiplex of forces, the confounding of issues and the chaos and confusion that surround an organization." Maintaining a sense of focus throughout the chaos and noise, Halamka wrote, is key. "ICD-10 is required by 2013, new payment models based on quality and care coordination with incentives to share savings will begin in 2012, and pressure to reduce cost via guidelines/protocols/care plans will increase. Our governance committees will have to make hard choices about what not to do in the VUCA world of the next [three] years. Maybe the future is going to include more ambulatory and ICU care with ward care moved to home care. We'll have to guess again where the puck is going to be."

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4. Ambiguity. Although the acronym seeks to help leaders turning ambiguity into agility, Johansen also believes it's important to turn ambiguity into action. "How many times have you heard, 'I do not have enough data to make a fully informed decision,'" Halamka wrote. "Not acting makes you a target in a VUCA world." Ambiguity – or the haziness of reality, the potential for misreads, and the mixed meanings of conditions – lends itself to confusion regarding rational ways to solve issues, like cost containment. For example, wrote Halamka, "15 percent of the lab and radiology tests done in Eastern Massachusetts are redundant or unnecessary. Ensuring all test results are available electronically among all providers (especially between competing organizations) will cost millions in EHR, HIE, and interface implementation." Therefore, he continued, we'll need to spend money to reduce incomes. "It's the right thing to do, but the medical IT commons will be at odds with individual incentives in a fee for service world," he wrote. "The right answer – change the incentives and pay individuals for care coordination, not ordering more tests." 

Follow Michelle McNickle on Twitter, @Michelle_writes