Introduction
Joan S. Ash
Joe Simpson, M.D., was known as a charismatic leader. A dynamic, persuasive speaker, in his role as chief medical information officer at United Hospital he could convince the hospital’s administrative team to move in whichever direction he wanted. He enjoyed articulating his vision of a paperless hospital and was successful in getting the budget needed for implementing computerized physician order entry. The only problem was that he neglected to share his vision with either the information tech- nology (IT) group or the physicians and other clinical staff whose jobs would change as a result of the new system. While he appeared on the surface to be a strong leader, he lacked a number of key characteristics needed by a truly great leader.
What, then, is a good leader? It is generally believed that good leaders get good results, but it is important to consider the time period used for measuring results.
Dr. Simpson might have been considered a good leader at the moment he secured funding for his project, but in the long run, his efforts were bound to lead to a failed system implementation and organizational turmoil. Another important consideration is that leadership and management are not the same thing. Leaders create and com- municate a vision, while managers implement strategies that lead to achieving that vision. Great leaders need not be great managers, but they must surround themselves with great managers. Dr. Simpson had a vision, but he neglected to include infor- mation technology managers in that vision. Another critical consideration about leadership is that it does not always follow that the formally appointed leader is the true leader of a group. Informal leadership can be just as important. It is quite likely that there is at least one clinician at United Hospital who has an interest in medical informatics and is an opinion leader, a well-respected clinician who has influence by virtue of her clinical skills and who could also convince her peers that Dr. Simpson’s vision is a good one. Instead of neglecting her, Dr. Simpson should be partnering with her.
Leadership is important in all organizations, but perhaps even more so in the realm of health informatics. This is because of its complexity, its interdisciplinary nature, its dependence on continuously changing technology and the involvement of users. In this tumultuous environment, a leader must be truly remarkable: a superb communicator, knowledgeable about both the technology and the clinical domains, able to innovate and adapt, and able to convince many different types of smart people from different backgrounds to work toward a vision. And excellent leaders are terribly important in informatics because, once burned by bad leadership and failed projects, stakeholders, including users of informatics applications, are reluctant to give the next project a chance.
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According to researchers, leadership is a blend of traits and skills, is directed toward a vision or task, and involves the ability to motivate people to accomplish that vision or task. So-called trait theories of leadership have given way to situational and con- tingency theories that take into account attributes of the leader, the followers, and the context. There is no magic blend of skills and traits that is applicable to all organiza- tions at all times. One useful framework for describing the general capabilities that a leader needs is that outlined by Goleman,1 called emotional intelligence, which is defined as the ability to manage oneself as well as one’s relationships with others. He breaks the capabilities into four categories: self-awareness, self-management, social awareness, and social skills.
• Self-awareness. This includes awareness of one’s own emotions and the impact they have on one’s work. It also includes the ability to assess oneself. Not only that, but successful leaders need to be able to learn from both successes and failures, espe- cially if their leadership played a central role. A leader needs a good deal of posi- tive self-esteem to be able to recognize that the failure was his fault, however. If Dr. Simpson pushes for implementation without ensuring that the organization is ready, and if the system fails, he needs to be self-aware enough to learn from the experience.
• Self-management. This includes self-control of one’s emotions, trustworthiness, con- scientiousness and drive, adaptability, and initiative. Adaptability and flexibility are especially important in informatics because it is likely that different leadership styles may be appropriate at different times. If Dr. Simpson had been a leader with a par- ticipative style and had developed a high level of trust with the IT group and the clinical staff, he might have been able to successfully launch his system using a more authoritarian approach. We are aware of situations like this, and the stakeholders often go along with this type of leader because they trust him (though they still grumble at first).
• Social awareness. Empathy is an important characteristic in any leader who needs to be able to understand other people’s perspectives. There also needs to be an orga- nizational awareness—the ability to sense the political climate. A good leader does not avoid power and politics but uses them to facilitate action and movement toward his vision of the organization. Leaders in informatics also need a user orientation—
the ability to recognize and meet the needs of different stakeholder groups. Dr.
Simpson does not seem to rate high on the social awareness scale.
• Social skills. A leader needs to inspire movement toward the vision. He understands the big picture of the new healthcare and informatics environment and establishes a future vision that energizes and inspires. A leader must also make sure that goals are set that provide a strategy for reaching the vision. This might be done by others, but the leader must make sure it gets done. A leader must also make sure that others understand the vision, and so communication skills are of great importance. Other social skills in play include the ability to develop others, to stimulate and manage change, to resolve conflicts, to cultivate social networks, and to build and nurture teams. Dr. Simpson’s social skills are clearly not too bad since the hierarchy above him gave him funding for his pet project. However, he seems to be lacking when it comes to communicating his vision to the people responsible for implementing it.
Dr. Simpson is not unusual. It is not easy to be a leader in the informatics environ- ment. The following cases illustrate the difficulty that even experienced, talented leaders face when times change, technology changes, and organizational structures change. When reading the following cases, think about the four characteristics of
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emotional intelligence and how the ideal leader might handle the situations described.
Chapter 18 involves a dilemma about planning and the difficulty of developing a needed strategic plan when so much change is occurring in both the technological and organizational environments. Chapter 19 outlines a situation in which implementation of a pharmacy system proved unpopular and the dilemma is how to improve it within the terms of the organization’s contract with the vendor. In Chapter 20 the decision maker is confronted with tension between what the leaders above him at the corpo- rate level want and what he thinks is best at the local level. He tries to understand the shortcomings of the radiology imaging technology and its potential impact on the organization’s bottom line, and at the same time he wants to keep those above him and within his local organization happy. Finally, Chapter 23 presents a wonderful opportu- nity to apply the emotional intelligence framework to a situation in which emotions within the organization wreak havoc.
Reference
1. Goleman D. Emotional Intelligence. New York: Bantam Books, 1997.
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