Implementing Change

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“The Nurse Informatics Leader” Program Transcript

ROY SIMPSON: Let's talk about leadership in complex organizations, whether it's acute care, it's a vendor, it's a supplier, it's whatever it is. One of the things that we constantly have to be mindful of is that organizations are more and more matrix structured today than they were in the past. And in order to facilitate change, there are certain components to change.

But one of them is communication. You have to be engaged in relationships in the organization in order to be able to make change happen. You have to have a vision. You have to have resources. You have to have an action plan.

You have to have the right set of other types of circumstances in order to get change to happen in your organization. And leadership is about change. And so change is important for the nurse informatician in that the introduction of technology as a leader changes everyone's actions.

And it's important for us to be aware that every time we have an upgrade, every time we have a discussion about a new technology, that we're changing people's work environments and that this has tremendous impact. And we have to be mindful of what other types of activities are going on at the same time because it's not only IT that's changing and technology changes. There are clinical practice changes.

There are other types of domain knowledge changes that are going on for evidence-based practice. And that's a lot of change sometimes in an organization. So as a leader, it's important that you understand change and that you embrace change and you're willing to change with it.

The other aspect that I find the most interesting is is that nursing has a hard time coming together to describe its nomenclature and taxonomy. And it's very difficult when you have over 1,000 different colors of urine to get everyone to come to the same page and say, maybe we only need 10 colors. And I'm not exaggerating. I mean, these are actual cases I've seen.

And that probably is the most difficult, is that political dynamic that I need 1,000 administrations, and I only need 10. Where are we going to meet in the middle, and how can we get there to get this to happen sooner rather than later? But typically, it fails, systems failures basically because people didn't take time to get everybody educated. Communication and education. Those are the two key variables for any systems implementation.

When we look at change agents in an organization, one of the things that I've experienced in executive leadership is people who are specifically hired to be a

change agent, people that are change agents that will manage over time and still be a part of the organization when it changes, and then change agents that are short-term, short-lived, and only there for an explicit amount of time. And one of the things I think as nurse informaticians, especially when we're called in a leadership role, is to be a change agent. And I think you have to know on the front end whether you're asked to be a change agent, and that when you change, you have to leave the organization, versus a change agent who may stay there.

And I've seen both types happen. And I think the most painful is when someone has been hired, and they don't know that they have been hired to be a change agent, and that they're a short-term change agent, and that all the bad goes out with them when they leave the organization. And as I say to my colleagues, that's OK if they paid you for the back end of it, and you knew it all on the back end, and you had down time in order to be able to reposition yourself in the marketplace for another job.

But it's not OK when you're hired, and you don't know that that was what your job was. And I do think that happens in technology because if you take physician order entry, a lot of times, CIOs are hired specifically to get in physician order entry. And there's such bad feelings when everybody is quote, "forced" to be on CPOE that that person has to leave the organization.

And they know it on the front end. If they know they have to have some major obstacle to overcome, that they may be asked to leave, and that that's part of the agreement, if that's on the front end, you're OK. But if you're caught in the middle of it, it's horrible. And it's an experience that people clearly will engage in their life as a nurse informatician, if they don't do a good assessment on their job opportunity when they go for their interviews.

GAIL LATIMER: I think one of the important messages for a nurse informatician is to be successful, you must be a leader and demonstrate leadership skills and know where your strengths are and know where you know you need to grow and select a coach to help you in the areas where you need to grow. And that coach may change over the evolution of your career because you're going to be constantly growing because we're lifelong learners. But make sure that you mentor and coach others that are coming up through the field of nursing informatics. Because that's just as critical to give back to the profession as the learning and the coaching that's been given to you.

Secondly, I think it's very critical that people can get caught up-- do I report to the CIO, or do I report to nursing? Why I wanted to go with your leadership first is it doesn't matter where you report. If you are a good leader, you're a good change agent, you're respected by your peers from a clinical practice perspective, it doesn't matter where you report on an org chart.

And this gets to our power base. You want to be an expert power base, and you're recognized for your expert power. You don't want to be recognized for where you sit on the org chart because that is not the correct leadership position that you should want to have. And titles and places on org charts have never been important to me. What's been important is that I'm making a contribution and that my colleagues see that I am contributing, and I know that I am contributing.

Realize that you're a liaison, and a liaison to that C-suite. If you're in the midst of an implementation, make sure you take 15 minutes or 30 minutes a week to update the executives in the C-suite. And it may not be a face-to-face meeting every week, but maybe you send an email that has the three bullets.

It's got to be short. It's got to be crisp. It's got to be that type of a message. But keep them informed because they're your best advocates in what's happening.

So align with the executives and make sure that they understand the role and how the implementation is going or how the optimization is going. I think those are some real critical components of leadership that are very, very valuable. But the most important thing is give back to the profession.

PATRICIA BUTTON: As the Chief Nursing Officer in my company, as a member of the senior management team, I mean, a great deal of it is the typical things that a leader needs to do. And that is, in a culturally, politically sensitive way of participate in the management of the company. Now, in my particular company-- and this is not unique to my company. It originated as a physician-led company. It was founded by physicians.

It was very, very focused on providing information, clinical decision support for physicians. And the CEO of the company called me and said, you know, one of my nurse colleagues said we really ought to do something for nurses. And we wondered if you'd be interested in doing a market analysis as a consultant, for whether that's something that would be wise for our company to do.

So I did the market analysis, and it was very, very clear that there was really a critical need for nursing and the interdisciplinary team to have clinical decision support the same as physicians. So I reported that. To make kind of a long story short, they then wanted to recruit me to come and work at the company, not function as a consultant.

The tag line of the company at that time was the leader in evidence-based medicine. And I was very excited about this opportunity because to be in on the ground floor, to develop this clinical decision support solution, to support nursing in the interdisciplinary team, was very exciting to me. But I said to the CEO, you know, I can't come and work with you and this company to develop a solution for

nursing and the interdisciplinary team when the company's tagline is a leader in evidence-based medicine.

He said, well, why not? I said, because medicine is what doctors practice. Health care is what the whole team practices.

And I think it's those kinds of situations where one has to clearly but thoughtfully express not so much an opinion as a position, as a leader, to influence. I mean, in this case, it's the tag line of my company, which evolved into the leader in evidence-based health care, and has evolved a few more times since then. But you know, to really influence what be it a company or an organization is doing, to really move toward their goals because it was then and is the intent of my company to be a clinical decision support provider to the whole health care team, but to really identify the opportunities to make that clear and open and something that everyone buys into.