Living a Conscientious Life

Amazing...This is a picture of Vic Sundquist, 95 years old, in the log cutting contest at the Dolores, Colorado Escalante Days celebration last weekend. A better man and person, you'll never meet. 

He and our dad worked together in the logging camps and mountain forests above Dolores, affiliated with the now-underwater logging town of McPhee. In their time, logging was the gold rush... the dot com era of their generation... where young risk-taking men could make their fortune. All of those young men would later take that same courage and toughness into WWII. Poor Germans and Japanese didn't stand a chance.

As kids, we had the blessing of being able to sit around and listen to their stories. Those stories shaped our perception of what it meant to be men, husbands, and fathers... And especially what it meant to live a life with a mischievous sense of humor, a sense of adventure, and live life in such a way that you have memories and stories to tell... like having the gumption to join a log cutting contest when you're 95 years old and cut through that log in 22 seconds. "Live your life the right way, not half-assed. For hell's sake, get up early and make your bed the right way. Tuck in your shirt and wear your hat the right way. Mend the fence the right way. Set the water the right way. Stack the hay the right way. Feed, water and take care of your horse the right way, first, then yourself. Drive your car and truck and take care of them, the right way. Open the door for women. Love and protect everyone's children, not just your own, at all costs. Grab for and fight over who pays the check at the restaurant. Wave gently to oncomers when driving on backcountry roads. Hunt and fish because you love Mother Nature, not because you love a trophy to yourself. Climb a mountain so that you can see, not so everyone can see you. It's ok to stretch a tall tale once in awhile, but never, ever lie or cheat. Help someone who needs it, but be very reluctant to accept help yourself. Stay strong and independent." These are not their words, but their actions. I guarantee that Vic Sundquist oiled, tightened, and sharpened the blade on that chainsaw, himself, the right way.

This is conscientious living.

Much later in life, after Vic's wife and our dad passed away, our mom and Vic struck up a mini-romance, mostly just a deep friendship, that never ended. Mom would often say, "He is such a good and interesting man." And that he is. And that they were.

To Do List for a Healthcare CIO

I was searching through some files today, looking for something else, when I came upon this. It's my "CIO Watch List" from November of 2012, while I was CIO for the Cayman Islands Health Services Authority.  One of the fun things about being a CIO in any industry, healthcare or not, is being able to learn from and interact with virtually everything that goes on in an organization. Information systems, software, and data are the backbone of all modern companies. The CIO knows a little bit about virtually everything in the company, and a lot about a few things.

Here's the list. I won't even try to describe the entries, but rather leave it up to the reader to have a crossword puzzle opportunity to decipher them.

0-6 Month Priorities

Infrastructure & Technology

1. Telephone Modernization
1. Updates to messages and tree
2. Physical and environmental audit of closets
3. Automated Call Attendant -  Contact Center Software
4. Call Accounting Reports - TIMS
5. LCR Update
6. Conference Bridge
7. Unified Message (Voicemail)
8. SIP
2. Mobile technology options for clinicians - iPads
3. CCTV – Project 
4. Disaster Avoidance Modernization
1. Sign Points of Failure – ASA Firewall and Core Switch
2. SQL Server (Upgrade)
3. Full DR test
4. Citrix DR with BIC
5. Desktop Modernization: PC metrics - PC-to-Staff ratio
6. Network Modernization:
1. Fibre to Clinics (BT and WB)
2. Active Directory Reengineering & auditing
3. Reengineer the IP schema
4. VPN/Firewall enhancements
5. Network Authorization Control
7. Printer Modernization:  Metrics, maintenance contract
8. IT Policies Update
9. CUC Downtime enhancements (Printer Bank ,Hubs, Ref. Office, Phones)
10. Equipment Depreciation Plan (Switches, PCs, UPS etc...) 
11. Network assessment 

Clinical Systems

1. Pharmacy System Modernization
2. Cerner Re-Tender
3. BMJ/Chronic Condition Management Project
4. Mobile Clinical Strategy
5. APACHE scoring in CCU (Hold)
6. Semantic text search
7. Dynamic Documentation - Nursing
8. Software for Dr. Clem

Financial and Administrative Systems

1. CarePay Project
2. Reprocessing
3. Lock Box for Self Pay EPOs
4. 835 Interface
5. HSA Web Site Modernization
6. Maintenance Management System - FMIS
7. Centralized Admissions
8. Cerner scheduling and registration in clinics
9. E-Billing/E-Payment
10. HSA Intranet Upgrade
11. Charge Master management: Craneware utilization
12. Configuration control, pricing methodology defined with CINICO
13. PAIN Management Project
14. OR Requests (Intranet)
15. HR Intranet Forms

6-12 month priorities

Infrastructure & Operations

1. Patch Management: Windows, Java, Adobe, Office, IE 9
2. Storage Management Metrics and long term growth strategy
3. Autologon to PCs in certain areas; Cerner auto logoff in OT
4. PCLA tested and working to new Service
5. Windows 7 Upgrade
6. Enterprise intrusion and vulnerability scanning
7. Dedicated Private Line vs. MPLS
8. Upgrade Citrix remote access network connection from Logic 2M
9. Hosted email strategies: Brac Informatics, Microsoft Outlook

Clinical Systems

1. Cerner optimization or implementation of new system
2. Medication Order Entry
3. Bedside bar coding
4. Nursing supplies and medication dispensing & management system (PICIS)
5. Easier, faster logon for clinicians
6. Document scanning & multimedia image storage in Cerner
7. Finish deployment of Web cams in outlying clinics and specialists
8. Telemedicine strategy
9. PACS web link in Cerner
10. IMO for Procedure implementation

Financial & Administrative Systems

1. ICD10 migration
2. End of Shift & Bank Deposit Reports
3. Gold Standard Reports
4. GL interface from ProFit

Longer Term Priorities

Clinical Systems

1. FetalLink/Partograph
2. Mobile results 
3. Personal Health Record
4. Cerner Fax Server Assessment
5. E-Prescribing
6. Cerner LightsOn Utilization
7. Convert Surgery spreadsheet to a database
8. GE PACS ADT Integration with Cerner
9. Dental Medical Record and Billing system

Financial & Administrative Systems

1. Automated envelope processing
2. Migration to ICD10
3. 1500 Interface developed
4. Procurement and Materials Management System

Healthcare Data Governance in Collaboratives and Partnerships

The number of mergers, acquisitions, and collaborative partnerships in healthcare continues to skyrocket. That's not going to change for the next few years, unless the FTC decides to be more restrictive. In all of these activities, older generation executives (I can say that because I'm older) have underestimated the importance and difficulties-- technically and culturally-- of integrating and governing data in these new organizations, and the difficulties are exponentially more complicated in partnerships and collaboratives that have no formal overarching corporate governance structure. In 2014, one-hundred percent of Pioneer ACOs reported that they underestimated the challenges of data integration and how the lack of data integration has had a major and negative impact on the performance of the ACOs.

After 33 years of professional observations and being buried up to my neck in this topic, especially the last two years as the topic finally matures in healthcare, I'm convinced that the role model organizations in data governance, practice it seamlessly. That is, it's difficult to point a finger directly at a thing called "Data Governance" in these organizations, because it's completely engrained, everywhere. It reminds me of the US transition in the early 1980s when organizations finally realized that product quality was not something that you could put in an oversight-driven Quality Department, operating as a separate function. Quality must be culturally embedded in every teammates' DNA. Data governance is the same, especially data quality.

This week, one of my teammates sent me an email, paraphrased and anonymized below:

"We are headed to John Doe Health Center Network next week to talk to them about how we can help them with analytics/quality improvement. This organization provides managed care services to 8 community health centers in their county and our main champion is fighting for a shared analytics platform. Since they do not own any of the health centers, they are struggling with how to establish data governance with this type of environment (rather than a single entity). 

Do you have any recommendations or talking points that we should make clear with this group as to how they may find success with this model?"

Here is my response:

"It's the soft side of trust and leadership that makes these things possible. The [anonymous] project that I've been working on in [another country] has firmly crystallized in my mind that the success of these data sharing initiatives comes from 90% diplomacy, 10% technology; and genuinely finding a way for the contributors of data to the platform to receive more value from their contribution of the data than if their data were not shared. That's data synergy.

The facilitator/leader of the data sharing initiative has to wriggle their way through all the participants' motives-- that leader has to craft a strategy and broker the personal relationships that provides compelling and attractive data value back to each of the participants. The participation in the data sharing initiative must scratch every organization's need for increasing the mastery of their mission; increasing the organization's autonomy to execute their mission without having to coordinate and ask for more permission from members of the initiative; and the data has to feed the organization's desire to be a part of a purpose that is larger than themselves.

In this sort of setting, you can start by chartering a steering and governance committee that is comprised from volunteer representatives in each organization. Simple things get complicated quickly, but can be solved. For example, who has voting rights on the committee (Biggest data contributor has the most voting rights or is this going to be a Senate model?) and who is going to chair the committee that is trusted and respected by all members?  Who is going to contribute money to development and operations of the shared data platform and how are you going to calculate those relative contributions?  What are the subcommittees and working groups and who is going to lead those? Long term, in these settings, you need to plot a trajectory towards creating a separate legal entity and small company that can manage the asset, manage the funding, leverage the asset to the value of the organizations, and handle liability, data commercialization, etc. issues that will eventually emerge.

"Fighting" for a shared analytics platform won't be successful. The leader has to sell the vision of data sharing… the data synergy that comes with it… and "what's in it for us?" so that organizations are fighting to get in, not fighting to stay out. The mantra I use in these situations is: Stop convincing and start connecting."

Data governance in healthcare today feels like the quality movement of the US in the early 1980s. Data governance cannot act or feel like a separate, technology-driven entity. Successful data governance is culturally embedded and in those cases where sharing data is important to loosely affiliated organizations, the leader of the effort to bring that data together and leverage it for the benefit of the participants must be a data-savvy version of Henry Kissinger.

Leadership in the Participation Age

First things, first, I want to acknowledge fellow-Coloradoan Chuck Blakeman for inspiring me to write this blog. His philosophies about business leadership resonate with me, and much of the content of this blog, below, are a direct reflection of his insights. For years, I've thought that my philosophies about corporate culture and beliefs were too unusual to practice openly, but Chuck motivated me to come out of the closet.

This blog is an amalgam of thoughts and feelings related to corporate leadership and culture, and it starts with my basic belief that 95% of all humans are great people who, if given the right environment... the right soil... they will flourish on their own, with very little needs-- give them a caring, compassionate, supportive environment, then get out of their way and let them grow. As Mr. Blakeman explains, we have transitioned from the Industrial Age to the Participation Age-- from employees to stakeholders and those stakeholders are running the corporation, not the other way around. The average Fortune 500 company grows 110% over 10 years. Jim Collins "Good to Great" companies grow at 316%. Participation Age companies grow at 1,025%.

The underlying business premise here is this, as recently described by Paul Girouard, former President of Google Enterprise Apps: "All things being equal, the fastest company in any market will win", and all companies operate at the Speed of Trust. Decision speed matters and is largely determined by the degree of trust that exists between members of the company.

Below is a verse from the 17th century priest and poet, John Donne, that beautifully describes the philosophy of human "connectedness"-- that we are not disconnected individuals, but rather all part of the same ecosystem. What happens, good or bad, to one of us, somehow ripples through all of us. We are all participants in the same inseparable network of humanity, just trying to get along and get through our lives with as much fulfillment and happiness as possible. You will recognize this poem as the inspiration behind Ernest Hemingway's, "For Whom The Bell Tolls."

No man is an island,
Entire of itself.
Each is a piece of the continent,
A part of the main.
If a clod be washed away by the sea,
Europe is the less.
As well as if a promontory were.
As well as if a manor of thine own
Or of thine friend's were.
Each man's death diminishes me,
For I am involved in mankind.
Therefore, send not to know
For whom the bell tolls,
It tolls for thee.

Participation Age organizations understand this sense of human connectedness. Operationally, below are some of the characteristics of these organizations, as summarized by Mr. Blakeman:

1. Email is an interrupt, task driven, first generation technology tool for collaboration. In Participation Age companies, email has been replaced entirely or significantly by third and fourth generation collaboration and project management tools.
2. Meetings have been dramatically reduced or eliminated; communication occurs through collaboration tools.
3. There are no managers, managing people. Managers have been replaced by leaders and mentors.
4. There are no personnel evaluations.
5. They believe that the art of leadership is how many decisions you don't have to make. Every decision you make as a leader is a lost opportunity for mentoring, learning and leadership development.
6. They believe that managers focus inappropriately on processes. Leaders focus on results.
7. Managers delegate tasks. Leaders delegate authority.
8. In the Industrial Age, we traded time for money. In the Participation Age, we trade money for time. Give people control over their own time. Focus on results.
9. ​Trust in adult behavior.
10. ​Everyone's work rhythm varies according to when, how, and where it works best for them. Acknowledge and allow for that whenever possible.
11. Question EVERY decision with at least three Why's?
12. Allow and encourage stakeholders/teammates to bring their whole messy, creative person to work. Make no false distinctions between personal and professional lives.

I suspect there are many of you, like I was, who are afraid to be "outed" for believing such crazy philosophies. If enough of us come out, we become the majority and crazy becomes the norm. That's how significant change in human culture always happens. What was once crazy is now the norm.

Make it happen and have fun doing it.