LIVE FROM AMDIS: New Titles or More Support for CMIOs? A Clinical Transformation Question

June 27, 2013
An AMDIS Physician-Computer Symposium session entitled “The C Suite and the IT of the Future” triggered a lively discussion, and led to a healthy debate over whether or not creating new titles and positions is the best way to bring about transformational change in healthcare

A Wednesday afternoon session entitled “The C Suite and the IT of the Future,” led by Howard Landa, M.D.,  of Oakland’s Alameda County Medical Center, and executive recruiter Barbara Anderman of Russell Reynolds Associates, in which a variety of new-ish professional titles were cited—among them, chief innovation officer and chief transformation officer—led to a great deal of discussion on June 26 at the 2013 Physician-Computer Symposium, being held once again at the Ojai Valley Inn and Spa in Ojai, Calif., and sponsored by AMDIS (the Association of Medical Directors of Information Systems). What kind of influence does the introduction of a variety of new roles and titles into the hospital and medical group leadership space have on CMIOs, in terms of the ongoing evolution of their roles in the clinical informatics and clinical transformation space?

Shortly after that invigorating panel discussion ended, I had a conversation with Pam Arlotto, owner of the Atlanta-based Maestro Strategies, LLC consulting firm. Pam has been around for a very long time, and is particularly well-positioned to comment on some of the changes taking place in the industry these days. “You know,” she told me, “there are an awful lot of organizations creating these positions with all sorts of new titles”—titles that include words like “performance,” “transformation,” and “innovation”—“but sometimes, they create more trouble than they’re worth, particularly when you put physicians into them, if the physicians involved haven’t yet acquired systems thinking.”

The problem, Arlotto noted, is that the vast majority of U.S. physicians have been trained thoroughly to think primarily in terms of the one-on-one physician-patient encounter, which is completely appropriate in the context of the one-on-one physician-patient encounter. But—unless they’ve had training, preparation, or education to change the equation—when they’re put into leadership positions in hospitals, medical groups, and health systems, and asked to help transform processes and organizations, these physicians tend to find that their “cultural training” as doctors can get in the way of leadership development. “I know, because I come out of a systems engineering background,” she added. “When a bunch of physicians trained as physicians are asked to work collaboratively across silos, they tend to try to maintain those existing organizational and process silos, while also trying to communicate across them. It can be a mess!”

Pam’s core point—with which I concur—is that a lot of careful thinking needs to go into the development of new titles and positions, because healthcare is already organizationally complex enough (and sometimes, confused enough!) that adding more complexity, even in the pursuit of innovation or transformation, won’t necessarily take patient care organizations—or indeed, the entire U.S. healthcare industry, for that matter—where they need to go, anytime fast.

What’s more, let’s acknowledge that the CMIO title itself represents a role that is at least potentially transformational in its orientation. And certainly in many cases, CMIOs are in the think of leading clinical transformation in their organizations already. So does hiring a “chief clinical transformation officer” who comes out of a different place in the organization perhaps potentially confuse things in some organizations?

Better to create the conditions under which CMIOs and other medical informaticists can actually help make change happen collaboratively, rather than in some cases creating change that can ultimately backfire, Pam Arlotto believes; and I agree, though that’s not to say that organizations can’t also hire individuals explicitly dedicated to transformation. But certainly, the bottom line point from the standpoint of today’s CMIOs is that, whatever we do in terms of orchestrating new titles and concepts, let’s also support the CMIOs who are already working towards clinical transformation in their organizations today.

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