5/24/04
Exciting News! Anxious Times! And HIM Leaders Are Needed!
Leslie Ann Fox, MA, RHIA, Patty Thierry Sheridan, MBA, RHIA, CCS
Thank you to Advance Magazine for permission to use this article

Leslie: What a year we are having! Health information management (HIM) is again in the spotlight as the transition to electronic health records (EHRs) continues gaining momentum. On April 26, 2004 President George W. Bush backed up the commitment he made during this year's State of the Union Address, to provide leadership for EHRs by announcing "The President's Health Information Technology Plan for transforming health care" (See www.whitehouse.gov/infocus/technology ). He stated the goal of ensuring that most Americans have EHRs within the next 10 years.

Patty: He also called for the completion and adoption of standards, proposed another $100 million dollars for demonstration projects in 2005, and indicated he wants the federal government to create incentives and opportunities for health care providers reimbursed by government sponsored health care plans or working in government health care facilities to use EHRs. On May 6, 2004, he appointed David Brailer, MD, to serve as national health information technology coordinator, a new sub-Cabinet level position.

Leslie: These exciting events are the result of tremendous efforts being made by numerous organizations that have been working collaboratively to create a sense of urgency and need. (See "EHR Reaches Its Tipping Point," October 2003, Hands-on Help column at www.ADVANCEforHIM.com .) The work of these organizations is an excellent example of how to bring about change. Creating urgency is the first stage in a sound change management process according to John Kotter, author of two books on change management, Leading Change and The Heart of Change .

Patty: This is certainly good news for HIM professionals because opportunities for our profession will expand exponentially in light of these new developments. The first opportunity HIM professionals must take is to provide leadership in their organizations' EHR activities. Whether as a Chair, Co-Chair, or member of an EHR Steering Committee, or as a Project Team Leader or member within the HIM department, providing leadership in our areas of expertise should be a top priority for HIM professionals.

Leslie: We must realize however, changes of the magnitude of a transformation like EHR can really throw people off-balance. When the dust settles, HIM professionals must have redefined their jobs and the role of the HIM department in their health care organizations. To successfully reinvent ourselves, we must lead by being fully present every step of the way, demonstrating expertise, creativity and the value that HIM professionals bring to the transition process involving envisioning, selecting, designing, implementing and using EHRs, as well as the value we will continue to bring to the ongoing delivery of customer-focused HIM services.

Patty: I agree. Defining such key HIM roles and functions as "keeper of the legal medical record," as experts in data integrity, privacy, compliance with external standards and requirements, and the use of personal health information must be an ongoing discussion throughout the transition. The messages must be delivered consistently, over and over.

Leslie: What we describe is no easy task. Providing leadership in organizations is particularly complex and challenging during times of major transformation. The EHR isn't just another IT project. It is a disruptive change. It changes the way all clinicians and users of patient records do their work. Disruptive change dramatically increases anxiety in an organization, making quality leadership all the more important and all the more difficult.

Patty: Anxiety can derail even the most desired changes. In the American Health Information Management Association (AHIMA)-sponsored seminar, "Renaissance for the 21st Century: Leading the Change to e-HIM," the Care Communications' faculty and coaches explore anxiety in the workplace, its origins and manifestations, and its impact on the functioning of those involved in, or affected by serious change.

Leslie: Recognizing anxious behavior in others and managing one's own anxiety is fundamental to good leadership. There is a growing recognition of the "emotional" aspects of leadership and workplace behavior, which suggests that understanding human behavior and increasing self-awareness of emotional functioning is an important effort to make when developing one's leadership capacity.

Patty: Perhaps we should define what we mean by "emotional" here.

Leslie: "Emotional" refers to an automatic response to a perceived threat. Emotions are instinctual. They are outside of our awareness and come from a primitive part of our brain, the amygdala, rather from the cortex or "thinking" part. We touch something hot and reactively pull away. We don't have to think about it and make a choice. What would happen if you were walking down a street and suddenly saw a tiger walking toward you?

Patty: Well, for starters my heart would race, I would begin to perspire and my hands would get cold. At the same time my vision would narrow as my eyes sought out a safe refuge, immediately followed by my feet virtually flying through the air as I scrambled to a safe place.

Leslie: That's the stress response. It kicks in automatically. We don't have to consciously think about the need to run, we just take off.

Patty: We are using the term anxiety to refer to the automatic behaviors that people exhibit in an organization undergoing a major change or transformation. It is difficult for people not to initially perceive change as a threat. For clinicians, the EHR will mean learning new ways of documenting and retrieving patient information. The change is more than just learning how to use a keyboard, a tablet or a voice recognition system. For some clinicians who have always handwritten their notes, they may find it difficult to think about the patient care information they are recording without the tactile cues to which they are accustomed. It is not an impossible change, but it is likely irritating in many cases, and it is probably more time-consuming for clinicians until they are completely reoriented to new workflow and tools.

Leslie: Employees in the HIM department will have similar challenges. Remember when we interviewed the transcription supervisor who had just implemented voice-recognition technology?

Patty: Yes, I do. She said that the newer people were able to learn the new procedures more quickly and with much less angst than the long-term employees in that area.

Leslie: Effective leaders need to become more aware of how they exhibit anxiety. They also must recognize anxious reactions in others, and to learn to manage or modify anxiety in self and in the system. I see this as a critical leadership skill, perhaps the most difficult of all to cultivate. Yet, when mastered, an individual becomes very attractive to others in the system, and people more readily listen to and respect that person.

Patty: How can HIM professionals become more aware of the anxiety in the system and how can they learn to manage their own reactivity?

Leslie: Think about anxiety as having different symptoms in different people. For some people, anxiety triggers the exacerbation of a chronic physical symptom, such as recurrent headaches, backaches, hypertension, psoriasis or other minor or major acute ailments. Others have mental symptoms; they start to act depressed, defensive, combative or irritable. They have difficulty concentrating, become easily distracted and may have accidents. In the workplace, people often will start to make more careless errors or start piling up incidents of tardiness or absences when anxiety increases. Cliques may begin to emerge and gossip seems to be everywhere.

Patty: Well, it may not be that hard to recognize anxiety, but I'm sure our readers are wondering, how in the world can they learn to manage it?

Leslie: Realize you can only manage anxiety in yourself, not others. Being aware of when your behavior is anxiety-driven rather than thoughtful is the all-important first step. You can only accomplish that through self-observation and reflection.

Patty: What do you mean by self-observation and reflection?

Leslie: Primarily stepping back and thinking about how one handled a stressful situation. Here are some sample questions for self- reflection. Think back on the past day or two and ask yourself, "Were there times when I wish I had responded to my boss, to a colleague or to a customer more directly than I did?" "Did I walk away from a situation when I wished I had taken a position?" Or, "Did I ignore or avoid someone because dealing directly with that person is just too painful?" Those are anxiety-driven distancing behaviors. "Did I snap at someone, because I became too annoyed to address the individual in a calm and thoughtful manner?" That's anxiety-driven conflict. "Did I do something for an employee or colleague that he should have done for himself, but I didn't have the patience to teach it to him, or the confidence to let him learn for himself?" That's anxiety-driven over-functioning.

Patty: I see, once we are aware of our anxiety, we can begin to work at modifying our behavior.

Leslie: Right. We can learn to be more self-reflective and to think more often before we react. It is a learning process that takes time and commitment. But it is one that has big benefits, not only in our leadership roles in the workplace, but in all aspects of our lives.

Patty: It is important to note that anxiety is contagious. Leaders who manage their own anxiety well become a calm presence. Being calm is also contagious, which helps others in the system to calm down and become more thoughtful. Functioning improves and change projects such as those related to EHRs and e-HIM, have a better chance of being accomplished successfully.

Leslie: Finally, I can't resist ending this discussion with one of my favorite quotes about leadership. In 1977 the economist John Kenneth Galbraith wrote, "All of the great leaders have had one characteristic in common; it was the willingness to confront unequivocally the major anxiety of their people in their time. This and not much else is the essence of leadership."

Leslie Ann Fox is president and chief executive officer and Patty Thierry Sheridan is vice president and chief information officer of Care Communications Inc., a Chicago-based HIM services company. They invite their readers to send their thoughts and opinions to lfox@care-communications.com ,or pthierry@care-communications.com .