Stephen Lieber – President and CEO, HIMSS
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Leadership in Whole Systems
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Stephen Lieber – President and CEO, HIMSS
- 1. Leadership in Whole Systems H Stephen Lieber President and CEO HIMSS
- 2. Control vs Influence Management relates to control of resources and processes in order to achieve an agreed set of goals and purposes. Leadership, in contrast, relies on influence to achieve a desired purpose.
- 3. Keys to Better Results • Collaboration • Facilitation • Iteration • Influence not control
- 4. Whole System….. A system is an interconnected and interdependent series of entities, where decisions and actions in one entity are consequential to other neighbouring entities
- 5. Leadership and Whole Systems.. Whole systems respond to influence, but are not susceptible to control, thereby demonstrating that we must strengthen leadership in preference to management.
- 6. Characteristics of Whole System Leaders… • Put effort into making new connections • An open enquiring mind • Positive about change and uncertainty • Adopt an entrepreneurial attitude • Draw on as many different perspectives as possible • Possess transparent values • A leader in every seat • Establish a compelling vision which is shared by all partners in the whole system • Promote the importance of values – invest as much energy into relationships and behaviours as into delivering tasks • Focus externally rather than inwardly
- 7. Role of the CIO in Whole Systems… • Technology crosses organisation borders • CIOs can help build relationships and bridges • Economies of scale • Reduce duplication • Great use of resources • Facilitative glue
- 8. Some Leadership Enablers for Integrated Care… • Exchange of information • Culture and leadership • Procedures • Attitude of risk sharing (iteration) • Patient choices and engagement (collaboration) • Governance • Clinical practice (collaboration)
- 9. Some of the leadership barriers… • Hard to collaborate: Separate information systems or ones that are not interoperable • No single assessment process • Highly risk averse organisations • Service users exercising absolute choice, not collaborative • Unwillingness to share decision making • Culture – control v. sharing (information and decisions)
- 10. Multiple Model Stakeholders.. Administrators CEO/COO/CFO/CSOs Clinical/Medical Leaders CMIO/CNO/CNIOs Technology Leaders CIOs Forge agreements, policies, and standards that allow and enable progress Drive clinical activities that enable and enhance coordinated care, pop health Build out Information & Technology that facilitate key strategies
- 11. Copyright © HIMSS Analytics Governance Focus National and local policies are aligned. CCMM Governance Focus Policies address non-compliance. Policies in place for collaboration, data security, mobile device use, and interconnectivity between healthcare providers and patients Best clinical practices are derived from care community healthcare data and operationalised across the community Policies drive clinical coordination, semantic interoperability. Change management is documented and standardised Policies for CofC strategy, business continuity, disaster recovery, And security & privacy. Data governance is active Governance is informal and undocumented Data governance across organisations 11
- 12. Copyright © HIMSS Analytics Clinical Focus Comprehensive pop-health. Completely coordinated care across all care settings. Integrated personalised medicine CCMM Clinical Focus Dynamic intelligent patient record tracks closed loop care delivery. Multiple care pathways/protocols. Patient compliance tracking Shared care plans track, update, task coordination with alerts and reminders. ePrescribing. Pandemic tracking and analytics. Community-wide patient record with integrated care plans, bio-surveillance. Patient data entry, personal targets, alerts. Multiple entity clinical data integration. Regional/national PACS. Electronic referrals, consent. Telemedicine capable. Patient record available to multi-disciplinary internal and tethered care teams. EMR exchange. Immunization and disease registries. Limited shared care plans outside the organization. Leverage 3rd party reference resources. Basic alerts. Engaged in EMRAM maturation 12
- 13. Copyright © HIMSS Analytics IT Focus Near real-time care community based health record and patient profile CCMM IT Focus Organisational, pan-organisational, and community-wide CDS and population health tracking All care team members have access to all data. Semantic data drives actionable CDS and analytics. Comprehensive audit trail Patient data aggregated into a single cohesive record. Mobile tech engages patients. Community wide identity management Aggregated clinical and financial data. Medical classification and vocabulary tools are pervasive. Mobile tech supports point of care Patient-centered clinical data presentation. Pervasive electronic automated ID management for patients, providers, and facilities Some external data incorporated into patient record. Data is isolated 13
- 14. Methodology… • Defining the Whole System – The population who’s continuity of care is being profiled • Define up to five “customer selected” care settings, such as… 1. Primary Care 2. Acute Care 3. Home Based Care 4. Urgent Care 5. Long Term Care • Completing Survey – Respond to ~230 compliance statements – 11 distinct categories such as Care Coord., Pt Engagement, Analytics, HIE, Org. Strategy, Security & Privacy, etc… – Pre-defined responses facilitate completion
- 15. Copyright © HIMSS Analytics Information Tech Stakeholder Achievements Info Tech Primary Care Acute Care Post Acute Care Home Based Care Long Term Care Total 38% Total 55% Total 23% Total 22% Total 23% Stage 7 0% Stage 7 0% Stage 7 0% Stage 7 0% Stage 7 0% Stage 6 25% Stage 6 25% Stage 6 8% Stage 6 8% Stage 6 0% Stage 5 58% Stage 5 67% Stage 5 21% Stage 5 17% Stage 5 33% Stage 4 32% Stage 4 55% Stage 4 27% Stage 4 36% Stage 4 27% Stage 3 30% Stage 3 90% Stage 3 50% Stage 3 20% Stage 3 20% Stage 2 36% Stage 2 77% Stage 2 23% Stage 2 32% Stage 2 32% Stage 1 67% Stage 1 75% Stage 1 83% Stage 1 67% Stage 1 58% Stage 0 75% Stage 0 100% Stage 0 75% Stage 0 75% Stage 0 50% Total 33% Stage 7 0% Stage 6 13% Stage 5 39% Stage 4 35% Stage 3 42% Stage 2 40% Stage 1 70% Stage 0 75% Stage Achievement: Stage 1 Overall Achievement: 33% Information Technology Stakeholder Group Achievement Example Results 15
- 16. Copyright © HIMSS Analytics Acute Care Overall Governance Clinical Info Tech Total 40% Total 31% Total 48% Total 55% Stage 7 7% Stage 7 10% Stage 7 Stage 7 0% Stage 6 30% Stage 6 24% Stage 6 56% Stage 6 25% Stage 5 29% Stage 5 16% Stage 5 19% Stage 5 67% Stage 4 51% Stage 4 46% Stage 4 56% Stage 4 55% Stage 3 56% Stage 3 50% Stage 3 55% Stage 3 90% Stage 2 63% Stage 2 63% Stage 2 50% Stage 2 77% Stage 1 80% Stage 1 86% Stage 1 73% Stage 1 75% Stage 0 56% Stage 0 40% Stage 0 50% Stage 0 100% Acute Care Setting Achievements Recommendations Work with Info Tech Stakeholders to document and implement an overarching information and communications technology strategy Develop master patient, provider and facility indexes that are common Develop an overarching care coordination strategy, focusing on higher volume care settings and eventually extending into all care settings Develop care plans that can be shared and leveraged across all care settings as appropriate Build a patient-centered data repository supporting analytics, patient engagement, and coordinated care Aggregate clinical and financial patient data into repository, including some externally sourced data Further expand multi-level clinical decision support systems (CDSS) including into other care settings (e.g.: across acute care facility service lines, in all facilities) Provide actionable clinical decision support and advanced analytics (batch and on-demand), including drug interaction, age and sex appropriate findings, and diagnosis recommendations Example Results 16
- 17. Integrated care requires integrated systems… 17
- 18. Integrated care and integrated systems require whole system leadership…
- 19. Leadership in Whole Systems H Stephen Lieber President and CEO HIMSS slieber@himss.org
Editor's Notes
- Introduction of your choice
- Where a manager’s authority is conveyed through their defined position often within a single organisation a leader’s authority is drawn from the commitment of their followers. By definition without followers, there can be no leaders. However it should not be an effort to create followers or an action that is anyway forced or premeditated. Because followers will allow themselves to be influenced when they can see and admire a cause, vision or purpose which resonates with them. They will only commit to that cause when they also share a common set of values with those exhibited by the leader of that cause.
- A whole system on the other hand is a system of interconnected and interdependent series of entities, where decisions and actions in one entity are consequential to other neighbouring entities. In this country and indeed in many others we have spent years training, developing and promoting Organisational leaders. We have an inspection regime, a regulatory regime and a commissioning regime that recognises organisations rather than whole systems. We hold organisations to account and applaud or penalise in accordance with their performance and compliance against our national targets and key indicators – yet we treat patients across and within whole systems. Would it be possible to commission care from a whole system provider? Inspect a whole system for compliance against whole system standards and use resources for the benefit of the whole system rather than for the benefit of single organisations. Many potential whole systems leaders have been stifled by our preference for competition rather than collaboration. In this sense we may even find competition easier than collaboration and partnership. For many organisations the mantra – “I can only win if you lose” is still a common and convenient perception.
- Great leaders actually give away control rather than accumulate it. Great leaders with vast amounts of power must use that power wisely and sparingly. In fact the more power they have the less they need to use. The values that we spoke about earlier have to appeal and align with the values of the whole system and cannot accord with one organisation at the expense of the rest if the whole system leader is to be successful.
- Far more than simply having a broad and inclusive external perspective whole system leaders look to: Collaborate rather than complete Include rather than exclude Grow networks rather than work exclusively with their peers. They also recognise the importance of value driven behaviour and they ensure that at all times that their actions align with their values. And finally if whole system leaders become disruptive rebels they do it together across the system rather than within single organisations.
- The CIO is in a great place to deliver services across the entire system and this should be the model of choice if the cohort of organisations is looking to operate as a whole system. The CIO whose services are shared with more than 50% of organisations in the whole system will act as the facilitative glue helping organisations to jointly fund, jointly deploy systems and applications that have whole system benefit.
- These are some of the key enablers of integrated care Exchange of Information Share as a priority Culture and Leadership Whole systems with devolved leadership; influencing and facilitation Procedures Multidisciplinary joint assessment processes or another version of iteration Attitude to risk Aligned with agreed procedures. Risk sharing Patient choices Encouraged but only when it adds value Governance Committed to joint governance Clinical Practice Patient Engagement Is evident in all that we do
- The key barriers to provided integrated care across the whole system seem obvious yet sadly many organisations fail to have proper plans or mechanisms in place to tackle these issues. Separate information systems or ones that are not interoperable – Information exchange should be a legal requirement No single assessment process Money doesn’t follow the patient And we let money get in the way of us doing the right thing Highly risk averse organisations Service users exercising absolute choice This creates fragmentation across the system Clinical responsibility is not clear If is not clear there often is none Unwillingness to transfer care Professional elitism Culture – where is the power
- In this model we measure, monitor and evaluate from a Governance, clinical and technology perspective across all organisations identified by the client.
- From informal undocumented governance through the mid range of shared information governance agreements across organisations working towards the top of the model where we look for processes to address non compliance with IG and an alignment between local and national requirements.
- Clinical Limited sharing of care plans and then, Records and registries available across the care setting and thenShared image store and finally Patient compliance checking.
- Isolated data Mobile tech at the point of care Community wide central data store
- You decide who is in the team – who is in your whole system. Typically a health economy would consist of a hospital, a bunch of primary care providers, a mental health Trust, a community provider and a local authority providing social services. We ask each organisation to complete a survey. We look at a number of deicrete categories such as care planning, patient engagement and analytic capability. We are able to report at a number of levels: for example
- This is the Analysis by organisation looking through the technology lens. Organisations in a whole system will often mature together because they recognise the inefficiency of one organisation being significantly ahead or behind the rest. As such money in the whole system is used for the benefit of al.
- This is looking at acute care only through all three lenses – Clinical – governance and technology. So it is possible using the analytical tools to use a number of perspectives to observe maturity across the whole system.
- In order to provide Integrated Care we require amongst other things integrated systems. I am often asked by colleagues working in health care whether they should be using the EMRAM which is the analysis of digital maturity in acute hospitals or CCMM which is the measurement of digital maturity across the whole system. The answer is that you probably need to do both. The EMRAM looks in detail as systems in hospitals that are critical to patient safety and the quality of clinical care. CCMM on the other hand takes a more holistic approach to digital maturity across the entire health community. HIMSS recognises the important of measuring both.
- Integrated care enabled by integrated systems is best provided across a Health economy where whole system leadership is strong.
- Thank you.