Seven e-mail patterns for more efficient work
We're ALL on the same team

It's not about the technology

I got a call from a friend last night.    He's the CMIO for a large hospital.  He's smart, works 80 hour weeks, and he's passionate about getting his EHRs to work right, the providers trained right, the order sets configured right, and (most importantly) the patients treated right.

He's been in the role for a number of years - and he's good at his job.  Very good at his job.  He knows the systems (from two EHR vendors - an inpatient system from company A and an ambulatory system from company B) better than many employees of the companies.    He's memorized the criteria for Meaningful Use down to the section and subsection numbers.  It's amazing.  I had a similar role once - about ten years ago - and I vividly recall mentoring him into his new position back then - thinking that his hospital would do so much better than mine - as he'd see the puddles we had already stepped in.  .. 

He's an incredibly gifted physician too - and continues to see patients at least 20 hrs a week - with a full call schedule.  

But tonight he called me because he wants to quit his IT job and go back to being "just a doctor."

Because the politics of the IT world have been too much for him.

"The analysts didn't finish the order sets and blamed the doctors for not reviewing them."

"And the doctors insist that they WANT to review them, but the analysts tell them that they're not ready to be reviewed!"

"We're behind schedule and all they do is blame someone else."

"Why are they lying?  Why do they get mad at me when I point out what's going on?" 

I listened.  And listened.  It sounds dreadfully challenging.  He's implementing TWO EHRs, and getting CPOE up and running in an outlying hospital, and migrating a community of physicians to new workflows, new processes and new habits.  This is no simple task - and he's got the technical details down cold.  

And he's done a great job with all of it ...

Except his relationship with the IT team.    

This is not uncommon.  But there is a solution.  An easy one, in fact.  

"Your should pretend you're a doctor."  I said.

    "I am a doctor!"

"You're a doctor when you are with your patients. But it doesn't sound like you're a doctor when you're with the IT team.  It sounds like you are an angry parent!"

We talked about this for a while.  He wasn't sure where I was going - but he was intrigued.  He knew that somehow I have found it less difficult to navigate the political mine fields of hospitals, academia, industry and government.  Indeed - his minefield is my Fenway Park!  Am I serious that I want him to treat the IT team like they are his patients?


"If your patient tells you that they have been dieting and exercising but they are still gaining weight - what do you say?" 

    "I would say that I believe them 100% - that they are dieting and exercising and that I want to find ways to help them."

"Do you really think they have been dieting and exercising as much as they say?"

    "No.  Of course not."

"So why do you not challenge them?  Why don't you point out how wrong they are - and that they are fibbing?"

    "Because it's not important if I am right.  That won't help them."

"So why is it important that you are right that the analyst streched reality a bit about doing the order sets for Dr PooBah?"

    "Because they didn't do what they are supposed to do.  I need to point that out."


    "OK - I can see what you are saying but it still doesn't make sense.  How will my NOT judging them make them get their work done?"


So this is the key leap of faith for him.  It seems like these are different settings, different goals, and he should use different skills.

But it's not necessary.  The same skills that make a great empathic physician will also make a great empathic results-oriented CMIO.

He's built a (medical) career of great habits that we can leverage.  The habits he'd built are the ones he uses every day to care for his patients in a collaborative, meaningful, non-judgemental way.

The key to his success in the IT world is to say (to himself) just what he says to his patients:

  "Because it's not important if I am right.  That won't help them."

The focus shifts from blaming them for being lazy, lying IT enemies - to "folks who need my support."

Dr CMIO - you already know how to do this!

I could tell he was interested - but still wasn't quite at the point where he could make the leap.  We talked about the dysfunctional team of IT analysts, how they gossip and argue and sidestep work.

"It sounds like they are very unhappy"  I say.

He got quiet.

"Yes - they are - and they make everyone else unhappy."

"So what do you think would happen if they felt like you were an ally?  Like you wanted them to be successful?"

We went on like this for an hour or so.  It's a hard shift - but quite powerful.  He remarked that I was soundling like a buddhist - and I pled guilty - but pointed out that this is not just a buddhist principle to avoid judgment - it's a core component of many of the "success in management" books too - most of which avoid invoking religeon or spirituality.    A few good ones to consider - probably required reading for any CMIO:

Energy Leadership

Five Dysfunctions of a Team

7 Habits of Highly Successful People

I'm giving a talk to a bunch of CMIOs in a few weeks.  Maybe I'll leverage this vignette into a little sermon powerpoint.