AMDIS HIMSS Symposium Concludes with HIT Luminary Dr. Bobbie Byrne’s Call For Bold CMIO Leadership

Feb. 12, 2019
Bobbie Byrne, M.D., CIO of the Advocate Aurora Health Care system, told AMDIS HIMSS Symposium attendees to step up and use their experiences and expertise to lead their organizations forward

On Monday, February 11, the AMDIS HIMSS Physicians’ Executive Symposium, one of numerous pre-conference symposia prefacing HIMSS19, the annual conference of the Chicago-based Health Information & Management Systems Society, being held at the Orange County Convention Center, and cosponsored by AMDIS (the Association of medical Directors of Information Systems) and HIMSS, concluded with a with a message for CMIOs and medical informaticists to go bold with leadership that will help truly move their organizations forward.

Bobbie Byrne, M.D., the CIO of the 27-hospital Advocate Aurora Health, which last year brought together the Downers Grove (Chicago), Ill.-based Advocate Health Care and the Milwaukee, Wis.-based Aurora Health Care, offered ADMIS HIMSS Symposium attendees—most of them CMIOs and other senior medical informaticists in patient care organizations—a stimulating dose of inspiration, encouragement, strategy, and homespun personal anecdotes, in her closing keynote address, entitled “Being a Physician Leader in a Challenging Environment.” Dr. Byrne, who has been a practicing pediatrician, an EHR (electronic health record) implementation consultant, a CIO, a CMIO, and now the CIO of the tenth-largest health system in the U.S., shared wisdom with her audience that has been hard won through lived experience, and she encouraged the CMIOs gathered at the symposium to use their experiences and understandings as physicians and as informaticists, to act as real change agents in their organizations.

“Let’s start with leadership,” Dr. Byrne said. “What is leadership? Start with your vision. What is your True North? Identify your vision, figure out what needs to be done, and do it,” she urged attendees. “Except that a lot of times, you don’t know what to do,” she added. “And people turn to you and say, ‘You’re the smart one.’ And when you don’t know how to sell [your idea], that’s  a problem, too.”

So, Byrne urged, “Start with your True North. When everything else is changing, your commitment to vision has to be rock-solid. Prior to the [Advocate/Aurora] merger, when I went to Advocate, we had a situation,” she said, and shared a story involving surgical specimens. “We found that about once a year, we lost a surgical specimen, such that it required a patient to have to re-undergo surgery. And last year, it happened to a 28-year-old with lupus pleuritis. Our True North is patient safety and health outcomes; so the result of our addressing that issue was funding for a $30 million integrated barcoded lab system.

Daring to Leave the Routine

One key element for health IT leaders, Byrne told her audience, is the temptation to sit inside one’s office and handle the daily technical and process tasks, while avoiding engaging in the challenging conversations and interactions with clinicians and others, in order to create important changes in one’s organization. “How many of us just like to sit there and jam it out on our computers, handling tickets? Go out and meet with the crabbiest doctor in your organization, the one who says he’s going to run you over with his car in the garage if he sees you—and yes, I did have a doctor like that!” she said. “Sometimes, I think the person who wins is the one who asks the best questions. And we all know the saying, please don’t tell me your solution, tell me your problem; that’s a truism in healthcare IT. It’s important to ask those open-ended questions,” she stressed.  “And sometimes you do need to dig into the details when necessary. God knows, no one wants to be tactical, right, only strategic? But honestly, sometimes, that’s what’s needed.”

Byrne told several anecdotes about situations in her career in which she’s learned from adverse or challenging situations, urging attendees to “Go to the scene of the crime”; “ask open-ended questions”; “dig into the details”; “scan for outliers or patterns”; “get context”; and “know your own biases.”

It’s a VUCA World in Health IT

Dr. Byrne spent a fair amount of her speech talking about VUCA. What is VUCA? As the Wikipedia entry on the subject notes, “VUCA is an acronym—first used in 1987—to describe or to reflect on the volatility, uncertainty, complexity and ambiguity of general conditions and situations; drawing on the leadership theories of Warren Bennis and Burt Nanus. The U.S. Army War College introduced the concept of VUCA to describe the more volatile, uncertain, complex and ambiguous multilateral world perceived as resulting from the end of the Cold War.”

“VUCA is a framework that I think it’s pretty helpful in this context,” Byrne told her audience. “It was actually created by the US Army War College. They realized that in a post-World War II environment, certainty doesn’t work anymore. With regard to health IT, she said, “two areas are particularly applicable: what’s the role of data, what’s the role of expertise?”

With regard to the four VUCA elements—volatility, uncertainty, complexity, and ambiguity, Byrne noted that “Having more data doesn’t necessarily help you” in volatile situations, “and things are hard to predict. For example, in a cybersecurity breach, it’s not like more data will help; expertise is important, and redundancy is important. So, our Internet provider is volatile and unreliable, so we need redundancy. So it’s not if, it’s when. The downside to a volatile situation is that it gives you organizational surprises.” As for situations involving uncertainty, planning is one of the most important elements, because one’s organization probably has the data and the expertise needed, but not the preparation. As for complexity, she noted, “It’s not like a knot; it’s more like a web string, where when you pull one string, something else changes; there are many interconnected parts.” And when it comes to complexity in a situation, she said, “Data can be available, but can also end up being overwhelming.” And as for ambiguity, she said, “We don’t know what we don’t know.” So, she urged, “Fail fast, move forward quickly, set your organization on a forward path.”

Inevitably, the currently evolving landscape in healthcare operations is going to continue to be a “VUCA” situation for healthcare IT leaders, Byrne told her audience. And healthcare IT leaders, working within the context of their specific organizational cultures, also need to think strategically about how to move forward, skillfully using data and technology as needed, but not setting aside strategy for data and IT. She urged attendees to focus on the most important issues and strategies first, and then, to “weave the data into the story, in all these VUCA situations.” What’s more, she said, “In VUCA situations where data is not helpful in determining action, it can still be very helpful in selling/telling the story. Data can be a useful factor in explaining complexity,” she said; but she noted that it has to be used with great skill, particularly when addressing groups like boards of directors, the majority of whose members usually are neither IT professionals nor clinicians. Telling the story is the most important thing.

Indeed, Byrne said, “I think that physicians are amazing storytellers: when you put your mind to it, you have presence in every room you walk into. You’re intelligent, highly skilled messengers. You also have the ability to refine your words for the right audience. You know the spiel you give, and you know how to reiterate your story to the patient if they don’t get it. So take that same expertise you use in the exam room and use it in meeting and presentation settings.”

What’s more, Byrne told her audience, as she reached the conclusion of her presentation, “Whether or not you have an official position, all physicians are leaders; and people are looking at you. And when you look at this VUCA world, where people don’t know what to do—people are looking at you, for expertise and calm. It’s not just the safety and the outcomes, it’s the True North of people looking to you to make their work lives better.” It’s time for CMIOs and other physician informaticists and physician leaders of all kinds, she urged her audience, to make use of their natural leadership positions, and lead—lead from their True North of vision and ideals, to help their organizations move forward in every area of importance to themselves and their colleagues.

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