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Five Reasons For Hope

Over the past decade as a CIO, I’ve had successes and failures. I’ve learned about leadership in a crisis , how to resolve disputes, and how to serve my customers/employees/superiors . As I watch the first few days of the Obama administration, I have a great deal of respect for the initial activity, as seen through the lens of my own leadership experience. Here are five reasons I have great optimism for the new administration:

1. Smart People – Obama is surrounding himself with smart people, regardless of party affiliation or ideology. In my experience, A-level leaders surround themselves with A-level staff, since they are not intimidated by people who are smarter or more experienced. However, B-level leaders surround themselves with C-level staff who do not question the ideas and actions of their leader, resulting in sycophants rather than a strong leadership team. Of course, as we learned from Jimmy Carter’s presidency (he’s been a great post-president), the smartest people are not always the most successful people, but I have great faith in the new team!

2. Listening – As I’ve described in my blog about leading change , the most important part of Kotter’s principles is to build a guiding coalition. By engaging the stakeholders and listening to their priorities for change, Obama has created powerful grass roots momentum.

3. Doing the right thing – A wise person once said “When one bases his life on principle, 99 percent of his decisions are already made.” Should we drill for oil in the Arctic? Should government decide what therapeutic options doctors and their female patients can talk about? Should government decide science policy based on religious beliefs? The answers to these questions should be clear if we objectively ask ourselves what seems like the right thing to do based on the best objective evidence. The Obama administration is doing that.

4. Let the ideas flow – The web “democratizes data”. Ideas need to flow freely and as country we need to come to consensus about our priorities based on open and transparent communications. The Obama team, with the able assistance of Blue State Digital and other technology partners, has created Change.gov and Whitehouse.gov to reduce information silos.

5. Embrace technology – Obama is the first president to have a computer on his desk. Obama will keep his Blackberry. The communication systems in the Whitehouse will be upgraded to Web 2.0 technologies. Working with better technology will result in better,faster decisions and more enlightened management.

Will the Obama administration be perfect? No. Will the change management ahead be easy? No. Will we get to the right decisions faster and regain the respect of the world. Absolutely.

Have hope.

John Halamka is the CIO at Beth Israel Deconess Medical Center and the author of the popular Life as a Healthcare CIO blog, where he writes about technology, the business of healthcare and the issues he faces as the leader of the IT department of a major hospital system. He is a frequent contributor to THCB.

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17 replies »

  1. Obama is surrounding himself around smart people. You mean smart people who do not pay their taxes like Tom Daschle? Obama does not have a clue on what to do in fixing the economy.

  2. “Not with our current legal system we won’t. Other countries ration care at the end and the beginning of life. The 23 week old is considered a spontaneous abortion and never makes it as a statistic. Makes us look bad and them good.”
    Z, let me tell you about what Canada does with premature babies. First, 23 weekers are the exception not the norm of premature babies. Canada has neonatal intensive care (NICU) units which most large hospitals will have, If they don’t then the babies are flown to a NICU. When my wife worked in Toronto as a NICU nurse 23 weekers were not viable. Today they can be, but still with long term health and developmnent issues. In Canada they try to counsel the parents about the health issues, but they DON’T deny care. Visit a Canadian NICU and see what type of life sustaining technology they have as compared to a U.S. hospital.
    Now for end of life in Canada. Canada does not deny care if that’s what relatives or the elderly want. When my mother was in a old age facility I (power of attorney)was given the option of what type of care I wanted when the time was coming. Anywhere from keep her alive at all costs, to keep her comfortable and pain free but no heroic measures.
    Premature babies and the elderly are not disposable items in single-pay countries.
    “They just pay everyone in their health systems a LOT less.”
    Yes tcoyote, and pay less for everything else as well, but I don’t see starving healthcare workers in those countries or shortages of staff any worse than here.

  3. “”When will we learn there are cost for caring for 23 week old premature babies and conducting Cornary Artery Bypass Surgery on 75 year old Medicare patients.”
    When we have universal budgets and those types of care are viewed as budget busters not profit generators. However we can study why we get premature babies and tax those habits that cause coronary disease.”
    Not with our current legal system we won’t. Other countries ration care at the end and the beginning of life. The 23 week old is considered a spontaneous abortion and never makes it as a statistic. Makes us look bad and them good.
    We ration care here too but never at the beginning and end of life. We ration preventive care here by high copays and deductibles for drugs and preventative services so that disease is allowed to progress.

  4. Peter, it’s really simple how those other countries do it. They just pay everyone in their health systems a LOT less. Most of the clinicians and managers are members of the middle class. It’s just that simple.

  5. “our national health expenditure will rise from 16.2 to 27.5 percent of GDP. When will we face the true causes of our dilemma?”
    The true cause is our prices are too high. How is that single-pay countries are able to, “grant universal access to all health care services.” at about 8% GDP?
    “When will we learn there are cost for caring for 23 week old premature babies and conducting Cornary Artery Bypass Surgery on 75 year old Medicare patients.”
    When we have universal budgets and those types of care are viewed as budget busters not profit generators. However we can study why we get premature babies and tax those habits that cause coronary disease.

  6. John –
    Your points are great and I do believe there is reason for hope. However (isn’t there always a however?), I am very concerned that the “smartest people” are still be heavily influenced by mis-directed momentum. There are answers (and as I too am a CIO I think many of them involve technology) – I don’t see where the government is really reaching for the right answers, rather they are defaulting to the easy answers (e.g., let’s throw $20 billion at HIT).
    So in the spirit of hope – I hope rationale thinking will surface and the great inentioned, smart people will take the time to find real solutions – not just bail outs.
    Thanks again for your 5 points – together as a country we can solve these major problems.

  7. Dear John,
    I concur with your assessment of the incoming Obama Administration. The reality however is that Congress continues to function in a bipartisan business as usual politic as the country faces a dramatic crisis built on decades of unrealistic expectations. The magnitude of the problem is staggering. Consider this: based on CBO projections if GDP remains “Flat” through 2015….our national health expenditure will rise from 16.2 to 27.5 percent of GDP. When will we face the true causes of our dilemma? We can not grant universal access to all health care services. When will we learn there are cost for caring for 23 week old premature babies and conducting Cornary Artery Bypass Surgery on 75 year old Medicare patients. HIT and EHR are great tools but they will not stop the expanding comsumption of GDP by health care until we as a great nation decide there are limits to the services we provide. We will never control our national health expenditure until we engage in preventative medicine and limit services. I believe the crisis we face will continue to deteriorate but the good news is that…..in true crisis America solves its problems. Lets all support the Obama Administration in seeking real solutions for the health care and related economic crises we face. Tom Clarke, CEO, Kissito Post Acute

  8. I’m also read the new that obama using the blackberry. It really technologist. Go impression on the beginning of his administration. Hope he will do as what he promise.

  9. John,
    Smartness is just one key ingradient to success and in fact how do you define success – Ken Lay? These bank Leaders? They all were smart and were able to please people and that led to their rise. Mind you, they were not necessarily intelligent. Lots of time I agree with Icahn – he says most of the CEOs do not belong where they are. In our society, to succeed, you need to be only a bit better so that you do not excite apprehension and rest is your social skills.
    So what makes a leader: Here are some pointers from my public speech: Truth, Compassion, Courage, Patience, magnanimity, spiritual strenth, discipline, knowledge, etc.
    It is the fearless intellect moderated by core values that creates the great leader. When I see these days and in recent past, the headcount reduction – it simply makes me feel that there is not leadership but a financial accounting which a highschooler can do. I would like to see when they find a way to increase work rather than hire or fire people just based on the voume of work.
    rgds
    ravi
    http://www.biproinc.com

  10. President Obama has received criticism for his insistence on using personal technology because of security reasons. I am glad he keeps his Blackberry in hand and a computer on his Oval Office desk. Security concerns should not be cause for the President to abandon that which enabled his campaign – the same technologies that enable us, too. Security concerns are “opportunities for innovation” in data security and technology use. Think: Creativity, Entrepreneurism, Jobs.

  11. Your “Five Reasons” certainly are high on my list of things we didn’t get from the Bush years and at least the screaming in my head has stopped, if not only for a while. I have some hope, with caution, because I understand voters don’t have much patience and this country wants quick fixes for policy that has been going bad for decades, but covered up with debt. I’m with Z Woznica and will see if Obama can deliver or at least put us in the direction of more realistic hope. But don’t kid yourselves, if this economy does not turn around the Democrats will be short on friends come the next election. My greatest fear is that all this deficit spending will only come with bills due which will give us the next great economic crisis.

  12. Agree on the quality of the people. Can you please tell us where the 200 thousand new jobs estimate you gave NPR for $20 billion in healthcare IT spending came from?

  13. Please don’t be offended if I don’t share your enthusiasm for hope. I grew up with the saying that hope is the mother of fools. I am adopting a wait and see attitude instead. I am waiting for bold moves. I am also not impressed with the intelligence of his advisors. They are all intelligent. That’s why they end up with salaries in the millions for steering tax dollars to their firms. It’s their principles that matter and we shall see if they do the right thing. Whether we will have a more enlightened management because of technology and get to the right decisions faster, I wouldn’t be too sure. I will wait and see. I have a problem with regaining the respect of the world. Do you mean the world fears us and does not respect us? The rest of the world could just as easily laugh at us if we become a third world nation. I hope that doesn’t happen.

  14. Thank you for a post that evokes the spirit of hope in a nation (world) that has seen better days.
    We’re in a new dimension of uncertainty and the velocity of change can be intimidating as we step forward.
    Your post provides sincere personal reflections and ideas that we may find useful as we live each day looking for more promising opportunities.

  15. Hope is never a bad idea, and I second (or third) your call to it. That said, I couldn’t agree more with your statement: “Will the Obama administration be perfect? No. Will the change management ahead be easy? No. Will we get to the right decisions faster and regain the respect of the world. Absolutely.
    Have hope.”
    Thanks for a great read.
    -Scott

  16. Thanks John Halamka
    At this point I would echo your call for hope with a phrase I began using in 1985-
    “Optimism is a moral imperative”
    (most especially in the face of abundant objective evidence for pessimism)
    Rick Lippin
    Southampton,Pa

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