The AMDIS Connection | MU Year One: An Education of the Second Order
Positive change hinges on managing data and managing relationships with stakeholders. It is no coincidence that those two key qualities are essentially a job description for a CMIO.
If you had asked me 10 years ago to consider becoming a hospital executive, trading clinical duties for medical informatics, I would have said that was as likely as my beatification.
I should have seen the transition coming, however, because certain milestones brought me here. The first administrative position I reluctantly accepted was associate medical director. My decision was rooted in something a friend told me: “Emergency Medicine physicians are excellent first-order problem solvers, perhaps the best in medicine. What they are not good at is second-order problem solving.”
First-order problem solving is the ability to adapt and improvise to deliver whatever care a patient requires. Second-order problem solving is finding a solution to a problem to prevent it from happening over and over again. Dedicated problem solving requires going to meetings, presenting data and negotiating. I quickly discovered such meetings are where decisions are made, whether or not physicians are present for debate.
Suddenly, I found myself enjoying this engine of change, being part of the team. I knew process improvement was absolutely imperative to a high-functioning department. Continuous process improvement begins with data acquisition and management. Using the data to drive redesign only becomes possible after key individuals involved validate the data, and then are willing to act on them. Positive change hinges on managing data and managing relationships with stakeholders. It is no coincidence that those two key qualities are essentially a job description for a CMIO.
I began the year with the mistaken notion that I knew how the hospital conducted business. I was wrong: My knowledge was superficial. Quickly, the workings of a billion-dollar enterprise invaded my every thought. My purpose became clear. It was necessary to align the interests of the physicians with those of the hospital, and our new EMR was a key tool to accomplish that end. Immediately, I was driving communications with our medical staff and coordinating large groups of hospital employees to interact with equally large groups of our voluntary medical staff. (We have 1 percent employed physicians.)
I was asking physicians to leave busy clinical responsibilities and attend “validation sessions” and “process teams.” Enthusiasm was low, but those who attended were instrumental decision-makers. We formed a physician advisory group (PAG) of 15 physicians representing a spectrum of specialties and attitudes toward the EMR. They meet bimonthly to discuss everything from workflow issues to user interface icons.
Interacting with the medical staff on these different levels is where the true nature of my new job became clear.
The CMIO role was a natural fit because I knew practically the entire medical staff by first name, which helps my ability to negotiate. Just as important is my ability to tolerate harsh criticism directed toward me, but often having nothing to do with me. These traits serve me well when dealing with colleagues frustrated with the direction of medicine, who see the EMR as one more obstacle to patient care.
Similarities have arisen between my former role and new one. It used to be the nurses who put me in my place; now it is my assistant. I used to have physicians become annoyed at my 3:00 a.m. phone calls—now it’s the 3:00 p.m. calls. My wife used to tell me I found the perfect job. Now she tells me the perfect job found me.
If you had asked me 10 years ago to consider becoming a hospital executive, trading clinical duties for medical informatics, I would have said that was as likely as my beatification.
I should have seen the transition coming, however, because certain milestones brought me here. The first administrative position I reluctantly accepted was associate medical director. My decision was rooted in something a friend told me: “Emergency Medicine physicians are excellent first-order problem solvers, perhaps the best in medicine. What they are not good at is second-order problem solving.”
First-order problem solving is the ability to adapt and improvise to deliver whatever care a patient requires. Second-order problem solving is finding a solution to a problem to prevent it from happening over and over again. Dedicated problem solving requires going to meetings, presenting data and negotiating. I quickly discovered such meetings are where decisions are made, whether or not physicians are present for debate.
Suddenly, I found myself enjoying this engine of change, being part of the team. I knew process improvement was absolutely imperative to a high-functioning department. Continuous process improvement begins with data acquisition and management. Using the data to drive redesign only becomes possible after key individuals involved validate the data, and then are willing to act on them. Positive change hinges on managing data and managing relationships with stakeholders. It is no coincidence that those two key qualities are essentially a job description for a CMIO.
I began the year with the mistaken notion that I knew how the hospital conducted business. I was wrong: My knowledge was superficial. Quickly, the workings of a billion-dollar enterprise invaded my every thought. My purpose became clear. It was necessary to align the interests of the physicians with those of the hospital, and our new EMR was a key tool to accomplish that end. Immediately, I was driving communications with our medical staff and coordinating large groups of hospital employees to interact with equally large groups of our voluntary medical staff. (We have 1 percent employed physicians.)
I was asking physicians to leave busy clinical responsibilities and attend “validation sessions” and “process teams.” Enthusiasm was low, but those who attended were instrumental decision-makers. We formed a physician advisory group (PAG) of 15 physicians representing a spectrum of specialties and attitudes toward the EMR. They meet bimonthly to discuss everything from workflow issues to user interface icons.
Interacting with the medical staff on these different levels is where the true nature of my new job became clear.
The CMIO role was a natural fit because I knew practically the entire medical staff by first name, which helps my ability to negotiate. Just as important is my ability to tolerate harsh criticism directed toward me, but often having nothing to do with me. These traits serve me well when dealing with colleagues frustrated with the direction of medicine, who see the EMR as one more obstacle to patient care.
Similarities have arisen between my former role and new one. It used to be the nurses who put me in my place; now it is my assistant. I used to have physicians become annoyed at my 3:00 a.m. phone calls—now it’s the 3:00 p.m. calls. My wife used to tell me I found the perfect job. Now she tells me the perfect job found me.