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EBSCO : eBook Collection (EBSCOhost) - printed on 5/7/2019 3:23 PM via UNIV OF WEST FLORIDA AN: 285303 ; Cellucci, Leigh W., Wiggins, Carla.; Essential Techniques for Healthcare Managers Account: uwfl.main.ehost

CASE STUDY

LEADERSHIP

CHAPTER 12

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ROSA’S IT VISION

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Rosa Guiterez was the director of information technology (IT at St. Nicholas Hospital, a community-

owned hospital with 130 acute beds in a medium-sized Kansas town. Rosa had a degree in

health information systems management and had started at St. Nick’s four years before as a

systems analyst. She had a natural aptitude for working with computers. In addition, she

seemed to have the unusual ability to work easily with computer “techies,” clinicians, and hos-

pital managers. She steadily progressed up the ladder from analyst to team coordinator to IT

systems manager. When the IT director position had opened up the year before, she had ap-

plied and had gotten the job.

St. Nick was like many U.S. hospitals in that its IT systems had been purchased and were

being used without an overarching approach or plan. Departments purchased and used IT systems

specific to their specialty areas with no consideration of their interoperability or their fit with the

hospital’s hardware platform. The result was that St. Nick’s had small, stand-alone, proprietary IT

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systems that functioned quite well for their dedicated departments, but few actually inter-

faced with each other. This “best of breed” approach to IT is common in hospitals. In this

situation, IT departments must create interfaces and coordinate the stand-alone systems

into the hospital network as well as possible.

While she acknowledged that best of breed was a legitimate approach to healthcare

IT, Rosa had a different vision for St. Nick’s systems. It would start with one electronic med-

ical record system (EMR to be used throughout the facility. The EMR would then be inte-

grated into the hospital’s admissions and financial systems. Eventually, all hospital

departments and functions would share a common database with all systems being inter-

operable and all departments and functions sharing and using the same information. This

approach is often called an enterprise resource planning (ERP) system, and it integrates all

computer functions of an organization into a unified system.

Rosa understands that many of the staff at St. Nick’s see computers as a necessary

evil—something they have to learn to use to get their work done, not tools that can help

them achieve their goals. In addition, she knows that her starting point, the EMR, will set

the tone for all future technology changes. Most clinicians still view the paper medical

record as the gold standard, and it is going to be a challenge to help them see the advan-

tages of the electronic version. Rosa’s plan is to find one or two “champions” in each de-

partment who will not only train their colleagues, but also demonstrate the advantages of

EMR and spread their enthusiasm for it. She plans to create an IT steering committee and

an IT task force, both of which will be composed of St. Nick’s employees from a broad spec-

trum of areas and disciplines, to help plan and support the implementation of the EMR and

St. Nick’s migration from the best of breed to the ERP approach. She knows that if the EMR

implementation goes well, the entire organization will begin to respect her judgment about

IT and trust her abilities to implement a unified IT system for St. Nick’s.

Best of breed

An arrangement of IT

systems that consists

of many small, stand-

alone, proprietary sys-

tems that function well

for their dedicated de-

partments, but few of

which actually inter-

face with each other.

Enterprise resource

planning (ERP) system

An overarching IT sys-

tem in which all users

share a common data-

base and operating

system, with all sys-

tems being interopera-

ble and all departments

and functions sharing

and using the same

information.

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LEARNIN OBJECTIVES

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Aft r studying this chapt r, you will b abl to

� discuss leadership from an historical perspective,

� explain how leadership can be seen as a competency, and

� outline the exceptional leadership model, which is based on self-concept and

built on the four cornerstones of

� self-awareness,

� compelling vision,

� a way with people, and

� a masterful style of execution.

Leadership

The characteristic of

guiding, directing, and

assuming principal re-

sponsibility.

Characteristic

Leadership Model

A model that defines

leadership as a collec-

tion of characteristics

that all leaders share.

12.1 HISTORICAL OVERVIEW OF LEADERSHIP The Greek poet Euripides, who lived during the fifth century BC, said, “Ten good soldiers wisely led/Will beat a hundred without a head.” Leadership is critical to almost any en- deavor. But that raises the question: What is leadership? Is it something innate? Can it be taught? Can it be learned? Or is it simply something we know when we see?

Historically, leadership was often seen as something one was born into. Western kings ruled by divine right, and their progeny ruled after them. The idea that leaders are born, not made, survived well into the twentieth century with the assumption that busi- ness ownership would be passed from father to son. However, this view eventually gave way to the Characteristic Leadership Model—the idea that leaders possess specific char- acteristics, such as the following 17 qualities: ability to make decisions, energy, humor, sense of justice, determination, example, physical fitness, pride in command, loyalty, sense of duty, calmness in crisis, confidence, ability to accept responsibility, a human element, initiative, resolute courage, and enthusiasm (Adair 2005, 12). Clearly, not all leaders pos- sess and demonstrate all 17 of these qualities. And many people who are not leaders share

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some or all of these qualities. So perhaps they are necessary but not sufficient to define leadership.

The next approach to leadership was the Functions Leadership Model. This ap- proach holds that it is not so much the qualities that one possesses as the actions that one takes that define a leader. Peter Drucker, often called the father of management thought, proposed the following four components of a leader s job:

1. Purpose: the capacity to get the right things done, a clear sense of mission, and the application of talent and intelligence to the right things.

2. Performance: the consistent ability to produce quantitative and qualitative results over a long period of time in a variety of positions.

3. Motivation: A person motivates herself and others by having positive feelings about the job and possessing a sense of pride about the products and services of the corporation. The job is the avenue to self-development.

4. Practice: the job as a learning process. The key to effectiveness is practice, and as with any practice, ability to perform the job does not come automatically but can be acquired through constant learning. Effectiveness is a habit; that is, a complex of practices.

(Flaherty 1999, 281–4)

12.2 COMPETENCY APPROACH TO LEADERSHIP Recent theory defines leadership as “a set of competencies, a set of professional and personal skills, knowledge, values, and traits that guide a leader s performance, behavior, interactions, and decisions” (Dye and Garman 2006, xiii). While one might argue that a leader is a leader is a leader, the high-stakes environment of healthcare presents a set of unique challenges. A number of leadership models specific to healthcare have evolved over the past decade. For example, the National Center for Healthcare Leadership s (NCHL) Leadership Competency Model, developed in 2004, consists of three domains and 26 behavioral and technical com- petencies. “The three domains—transformation, execution, people—capture the complex- ity and dynamic quality of the health leader s role” (National Center for Healthcare Leadership 2004).

Another example of a leadership model specific to healthcare is the Healthcare Causal Flow Leadership Model. This model is “a series of seven variables including three independent healthcare leadership variables, three patient moderator variables, and one dependent health outcome variable, linked in a causal flow” (Pelote and Route 2007). One of the healthcare leadership variables in this model is Leader Competence and Style, which encompasses 21 competencies grouped into the four categories of (1) Self

Functions Leadership

Model

A model that defines

leadership by the tasks

and functions in which

all leaders engage.

Competencies

Specific areas in which

leaders must have the

skills and abilities to

function adequately

and appropriately.

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Management, (2) Power and Influence, (3) Logic and Reasoning, and (4) Helping and Caring.

While these two models certainly provide excellent descriptions of healthcare leader- ship, it is difficult to see how an understanding of them is going to help Rosa achieve her goal of an ERP IT system for St. Nick s. On the other hand, the Healthcare Leadership Alliance s (HLA) fifth competency of leadership, which lists “three areas that are central to effective leadership in health administration, particularly at higher levels: a compelling vision, ener- gizing goals, and organizational” (Garman, Butler, and Brinkmeyer 2006, 360), seems a lit- tle too simple for Rosa s situation.

12.3 EXCEPTIONAL LEADERSHIP MODEL Carroll and Edmondson (2002) suggest that “the mention of ‘the leader should not be taken to mean only the CEO or other executives. Leadership must be distributed broadly throughout the organization.” In keeping with this, Dye and Garman s (2006) model for healthcare leadership is applicable to Rosa s achievement of the ERP. The Dye-Garman model consists of a foundation of a healthy self-concept, four cornerstones, and 16 related competencies and is depicted in Figure 12.1.

FI URE 12.1 Dye and arman’s Leadership Model

The Foundation Self-Concept

The Cornerstones

Well-Cultivated Self-Awareness

Compelling Vision

Real Way with People

Masterful Style of Execution

The Competencies

Living by personal conviction

Being visionary Listening like you mean it

Generating informal power

Possessing emotional intelligence

Communicating vision

Giving feedback Building consensus

Earning loyalty and trust

Mentoring others

Making decisions

Developing teams

Driving results

Energizing staff Stimulating creativity

Cultivating adaptability

SOURCE: Reprinted with permission from Dye and Garman (2006 .

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FOUNDATION: SELF-CONCEPT

Self-concept is the foundation. This is your understanding of and comfort level with your- self. Most leadership materials focus on behaviors and competencies, but without a healthy and realistic sense of self, the competencies “will feel unnatural at best, and at worst will never be mastered.…Leaders with appositive self-concept do not have to tear down others to bring up themselves. They rarely yell, scream, or curse, and they do not feel the need to play political games for their own gain. Their value systems engender a positive regard for others because they first have a high, but appropriate, regard for themselves” (Dye and Garman 2006, xxvii).

CORNERSTONE 1: WELL-CULTIVATED SELF-AWARENESS

The first cornerstone is well-cultivated self-awareness. Part of this is knowledge of one s own values and beliefs and comfort with living them. The other part is emotional intel- ligence. Emotional intelligence, sometimes called EQ, is “recognizing your own strengths and weaknesses, seeing the linkage between feelings and behaviors, managing impulsive feelings and distressing emotions, being attentive to emotional cues, showing sensitivity and respect for others, being an open communicator, and being able to handle conflict, dif- ficult people, and tense situations effectively” (Dye and Garman 2006, 18).

CORNERSTONE 2: COMPELLIN VISION

The second cornerstone for healthcare leadership is compelling vision. Being visionary means creating clear and effective plans for the future based on a full understanding of the trends, opportunities, risks, and rewards. Rosa has a vision of what St. Nick s IT system should be and of the advantages the ERP approach will bring. Her problem is that few others will be able to really visualize an ERP and its benefits. Few people other than her IT specialists will have any grasp of the details, the expense, and the amount of planning and strategy that are needed to get there. IT has its own language laden with acronyms, nick- names, and technical terms. Healthcare then builds upon this with its own jargon, abbre- viations, and complex processes. Clear and convincing communication in this situation is a must. Rosa s ability to work with computer specialists, managers, and clinicians will help her meet this challenge.

Rosa must help her colleagues understand the need and the rationale for the mi- gration from best of breed to ERP. She needs to create a compelling story of where St. Nick s IT system is, where it should go, why it should go there, and how it is going to get there. She needs to tailor her communication to her audience; the hospital board of gov- ernors will have different questions and different concerns than the medical staff, the nurses, or the billing office. To build trust, confidence, and loyalty to her vision she must be pre- pared to connect her vision authentically to each of her stakeholders values and goals.

Emotional intelligence

(EQ)

The ability to recognize

one’s own strengths

and weaknesses, see

the linkage between

feelings and behaviors,

manage impulsive feel-

ings and distressing

emotions, be attentive

to emotional cues,

show sensitivity and

respect for others, be

an open communicator,

and be able to handle

conflict, difficult peo-

ple, and tense situa-

tions effectively.

Visionary

Having foresight, imag-

ination, and the ability

to form mental images

of the future in a spe-

cific way.

http:office.To

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Train the trainer

The process of training

one person or a small

group of people, who

then each train addi-

tional people, who

then train more people,

and so on.

Informal power

The capacity to influ-

ence others without re-

sorting to formal

authority.

CORNERSTONE 3: A REAL WAY WITH PEOPLE

The third cornerstone is having a real way with people. It sounds simple, but the most difficult factor in this cornerstone might be listening like you mean it. When you are the person with the information, the vision, and the passion, it is hard to sit and listen to other people s laundry lists of concerns and reasons your plan won t work. Listening is more than waiting for your turn to speak. Really effective listeners not only understand the other person s message, they also un- derstand what is behind it. Many concerns or voices of dissent may be based on fear, lack of con- fidence, or discomfort with change. Perhaps more importantly, resistance often stems from a true concern that this is not what is best for the organization. Rosa has to realize that not everyone is as comfortable with, or as fluent in, technology as she and her staff are and that many people at St. Nick s might have legitimate concerns about this change in the hospital s approach to IT.

Rosa may already have a good feel for developing teams, mentoring, and energiz- ing others. She plans to find “champions” in each department and train them in the new systems as they are brought on board. This is a tried-and-true “train the trainer” approach that is particularly well suited to healthcare IT changes (McGinnis et al. 2004). The cre- ation of a steering committee and a task force composed of people from many areas and disciplines is an example of the entrepreneurial approach to IT governance that is recom- mended for healthcare organizations (Wiggins et al. 2006).

CORNERSTONE 4: A MASTERFUL STYLE OF EXECUTION

The fourth cornerstone is a masterful style of execution. Informal power can be defined as the capacity to influence others without resorting to formal authority (Dye and Garman 2006, 132). Rosa s knowledge of computers and her way with people is a good start toward building informal power. The creation of committees and taskforces and her train-the- trainer approach will go a long way to building consensus and an open, participative team approach to decision making.

Healthcare organizations, particularly small rural facilities, tend to be traditional and cautious. Tight reimbursement and the large number of uninsured people in many rural areas result in hospitals having to watch every penny and to be excellent stewards of all their resources. IT systems are incredibly expensive, and the time and energy needed to implement, manage, and maintain them well is a huge expenditure for any organization, but perhaps more so for small, rural St. Nick s. Rosa s ability to drive results and stimulate creativity and adaptability will depend as much on her untested abilities as on the history and culture of St. Nick s and the hospital s ability to absorb IT expenses and tolerate change.

12.4 FINAL COMMENTS Rosa s story is typical for many up-and-coming healthcare leaders. A young manager has observed the trends in her area of specialty and has a vision of where the organization

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DISCUSSION QUESTIONS

EXERCISE 12.1

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should go. She has many of the leadership basics needed to implement this change, but she is untried in many ways. Using the Dye and Garman model, we can speculate on Rosa s strengths and weaknesses and the possible outcomes of her endeavors.

Leadership is a fine-tuned balance of skills, behavior, and art (Battistella et al. 2007). While no leadership model is perfect for every manager in every situation, they can serve as guides for healthcare managers. Healthcare is in great need of leaders. If not you, who?

� Think about the Dye and Garman leadership model and pick three factors that you see

as areas of strength for you. How did you develop these areas of strength?

� Thinking again about the Dye and Garman model, what are three areas that you see as

your weaknesses? Create a three-point plan to strengthen each of these weaknesses.

� Pretend you are Rosa’s boss. What areas would you suggest she learn more about? What

specific skills would you help her to build?

T E EFFICIENCY FACTOR

Hans Bellingham is the IT manager in a large family practice clinic in New York City. Most of the

patients who come to the clinic are from low-income families, and Medicaid is the primary third-

party payer for healthcare services. Consequently, reimbursement for services is low, and the

staff must focus on cost containment to remain in business. Activities at the clinic are focused

on increasing efficiencies so the clinic may remain financially viable. One recent effort has been

to increase the number of patients a physician sees during the work day from 20 to 25.

To achieve this increase, Hans has implemented a strategic plan that includes the following:

1. decrease the no-show rate (the office assistant calls patients to remind them of appoint-

ment times ;

2. rearrange the supply cabinet in the exam rooms to reduce physician effort to retrieve

supplies and thus, individual visit length;

3. improve the workflow by reducing bottlenecks (move the copy machine from the hallway

into a closet so the path in the hallway is open for easier movement ; and

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EXERCISE 12.2

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4. increase the number of exam rooms by reassigning the break room to serve as both a

break room and conference room.

Hans was pleased that the staff had supported his ideas to increase efficiency, but

to everyone’s surprise, the increase in the number of patients per physician per day was

not realized. Hans did not think that there was anything wrong with the plan. Other clinic

managers that Hans knew had implemented similar plans with positive results. Hans thinks

that perhaps some aspect of the plan is not working properly, but no one on the staff has

been able to help identify what is not working.

This morning, Hans received a phone call from the clinic’s billing officer. He had com-

pleted his accounting report for the quarter and was calling to express his concern. He told

Hans that Medicaid was planning to reduce reimbursement again, and that the numbers

“were not looking good.”

� Review Hans’s strategic plan, and determine what might not be working to help increase

the number of patient visits per work day.

� Using your knowledge of Drucker’s four leadership concepts, what would you recom-

mend Hans do?

EMOTIONAL INTELLIGENCE AND JOB PROMOTION

The committee for the HR director search had been working hard these past three months. Of

the 21 applicants, five candidates had been interviewed by phone and two candidates had been

brought to the Hot Springs, Arkansas, hospital campus for face-to-face interviews. The two fi-

nalists’ references had been called, and the purpose of today’s meeting was to decide which

candidate should receive the job offer. The committee members reviewed the two finalists:

Evan Scott, an assistant HR director at a hospital in Oregon, was interested in the po-

sition because she had experience in the field and wanted to move back to her home state

of Arkansas. Evan still had family in the Hot Springs area and wanted to raise her children

there. Evan demonstrated great poise throughout the interview, listening to each commit-

tee member and answering their questions well. The committee members liked Evan’s cre-

dentials and the way she had conducted himself. She exhibited self-assurance and

confidence. The chair of the search committee reported that her references had been called,

and all had said that Evan would be a good fit for the HR director position. A common state-

ment made by the references was, “Evan is smart and just knows how to read people.”

Catherine Curlington, an assistant HR director at a hospital in Texas, was interested

in the position because she had experience in the field and was seeking an opportunity to

http:ThecommitteefortheHRdirectorsearchhadbeenworkinghardthesepastthreemonths.Of

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serve as an HR director. Catherine answered all the interview questions well. She was smart,

and her record showed that she had done a lot to help increase retention of the healthcare

personnel at her hospital in Texas. The committee members respected Catherine’s creden-

tials and past performance, but were concerned about the way she had conducted herself

during the interview. She had had an altercation with the waitress at the restaurant where

they had had dinner, and the behavior seemed odd. The chair of the search committee re-

ported that her references had been called, and all of them said that Catherine was great at

achieving the CEO’s goal of increased retention. A common statement made by the refer-

ences was, “Catherine is smart and focused on what she wants.”

� With reference to the tenets of emotional intelligence, whom do you think will receive

the position?

� Why do you think Evan will or will not receive the position?

� Why do you think Catherine will or will not receive the position?

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Bestofbreed:
facewitheachother 1:
facewitheachother 2:
information:
amasterfulstyleofexecution:
Leadership:
sponsibility:
Characteristic:
thatallleadersshare:
FunctionsLeadership:
allleadersengage:
Competencies:
andappropriately:
1 5 4:
competencies and is depicted in Figure 121:
The Foundation:
SelfConcept:
Compelling Vision:
The Competencies:
Livingby personal conviction:
Beingvisionary:
Listeninglike youmeanit:
Generating informalpower:
Possessing emotional intelligence:
Communicating vision:
Givingfeedback:
Building consensus:
Earningloyalty andtrust:
Mentoring others:
Making decisions:
Developing teams:
Drivingresults:
Energizingstaff:
Stimulating creativity:
Cultivating adaptability:
SOURCEReprintedwithpermissionfromDyeandGarman2006:
Emotionalintelligence:
tionseffectively 1:
tionseffectively 2:
cificway:
Trainthetrainer:
andsoon:
Informalpower:
authority: