6/21/04
It's All About Leadership
Leslie Ann Fox, MA, RHIA, Patty Thierry Sheridan, MBA, RHIA, CCS
Thank you to Advance Magazine for permission to use this article

Leslie: Leading today's e-HIM™ activities in health care organizations requires effective leadership skills. While I may be stating the obvious, I cannot emphasize enough that leadership is one of the most serious issues facing the health information management (HIM) profession today.

Patty: We have received excellent training as managers but not as leaders. And let's face it; medical record tasks require excellent detailed and meticulous management. Ten to 15 years ago we could get away with being managers most of the time. However, today with HIM, and health care in general, in the midst of supersonic change, it's our leadership skills that are needed to successfully transform HIM to e-HIM.

Leslie: John Kotter, a change management expert who wrote the book The Heart of Change , makes the clearest distinction about the differences between management and leadership. Kotter identifies management as tasks such as plan, budget, organize, staff, control and problem solve vs. leadership, which establishes direction, aligns people, motivates and inspires. I see his distinction as largely tactical activities vs. strategic actions, laced with a heavy dose of "strategic" communications.

Patty: During "Renaissance for the 21st Century, Leading the way to e-HIM," (The Renaissance Program) presented by AHIMA last month, the attendees identified leadership as having vision, presence, competency and creativity. They also emphasized the importance of being able to collaborate and to have influence in strategic decisions.

Leslie: Isn't it fascinating that nothing related to management is in the attendee's definition of leadership? They really confirm that there is a big difference between managing and leading. Kotter observed that in successful transformations, such as e-HIM, 70 percent to 90 percent of a leader's time is spent on leadership activities and 10 percent to 30 percent on management tasks.

Patty: In working with our clients, I too have found that Kotter's observation about percentage of time spent on leading vs. managing plays out in successful change initiatives. Less time spent managing and more time spent leading appear to be a critical success factor in successful outcomes. Of course managing and leading are both important and need to happen.

Leslie: Our readers in HIM leadership positions might want to assess what percentage of their e-HIM transition time is spent on management vs. leadership. If the number is less than 70 percent, I would recommend that they commit to a goal to increase the percentage of time spent on leadership and develop the associated strategies that would be required to achieve this shift in time.

Patty: That's a great idea Leslie. Our readers shouldn't be too hard on themselves if they do find that most of their time and energy goes into managing rather than leadership. As we noted earlier, most people were not trained in leadership, therefore it's common to find busy people with more focus on urgent tasks like problem solving or meeting difficult deadlines, than on strategy, collaboration and communications. Even the management literature is more focused on managing. However, when it comes to change, you have to draw a line in the sand, because you really can't "manage it." You have to take the time to lead it. That is why leadership skills are so important to the survival of the HIM profession. Fred Nichols, an organizational performance improvement consultant said:

"How do you manage change? Pretty much the same way you'd manage anything else of a turbulent, messy, chaotic nature, that is, you don't really manage it, you grapple with it. It's more a matter of leadership ability than management skill."

Leslie: HIM leaders have a great challenge before them. The electronic record eliminates boundaries as we know them. And when that has happened historically, it has required great leadership. Can you imagine living in the days when the perception of the world went from flat to round? Talk about boundaries changing! What a disruptive change!

Patty: Fortunately, we don't live in such dramatic times but for the HIM profession, the electronic record is like the world going from flat to round. The electronic record challenges everything we learned and experienced to date related to coding, dictation and transcription, data management, record management, the legal paper record, etc. Every belief of how one handles medical records is up for grabs, has to be examined and new rules and processes need to emerge.

Leslie: Well put Patty. HIM professionals have a daunting mission: to redefine our profession, to expand our body of knowledge and to communicate a new vision of the role of health information in the delivery of health care. The HIM profession is indeed entering its defining moment. The role of HIM in organizations will be best preserved by HIM leaders who are able to articulate key e-HIM positions and bravely lead their staff to the new world of e-HIM.

Patty: The concept of an HIM department is already changing. Decentralization of HIM activities is occurring, walls are coming down, virtual coding workforces are proliferating and transcriptionists are moving into more knowledge-based roles with coders destined to follow the same kind of shift in the near future.

Leslie: And don't forget ICD-10. It's just a mere three years away.

Patty: That's right! Let's hope so. That's a lot of change over the next five years for the HIM profession. Leslie, you mentioned a few minutes ago the need for HIM leaders to articulate key e-HIM positions. Let's review what they are with our readers. These are key messages that the American Health Information Management Association (AHIMA) has been communicating around the country at state HIM educational meetings and at the Renaissance Programs.

Leslie: There are five key messages. They are:

1. The electronic health record vision

2. Legal aspects of the electronic health record

3. HIM role in collaborating with information technology leaders

4. Transformation of the HIM department as we know it to e-HIM and the transformation of HIM staff into knowledge workers to meet the new HIM needs of the organization

5. Demonstrating competency in the e-HIM best practices focus areas. Six practice guidelines can be found at www.ahima.org/infocenter/ehim . Additional practice guidance is in progress on four other practice issues including computer assisted coding and will be available by the fall.

HIM professionals need to be well versed in the above topics at a moments notice. This list helps HIM leaders know where to focus. Once that is known, it's important to determine for their organization, what to say about these topics to senior management, stakeholders and HIM staff, how to say it and when to say it. And if they aren't being heard, what strategies they can use to be heard.

Patty: Participants always have good dialogue on these topics during the Renaissance Program because, while they are on our radar screen, we don't necessarily have formal strategies around the conversations related to these topics. It's like creating a communications plan for the topics you mentioned.

Leslie: Exactly. We know for example, that organizations often have multiple visions of an electronic health record (EHR), which leads to confusion, fragmentation, waste and delay in the change process. (See "Creating a Unified Vision of the EHR," www.advanceweb.com/him .) This means HIM leaders must step up to help their organizations evolve a unified vision that incorporates multiple and sometimes competing visions.

Patty: I think the transformation of staff to knowledge workers will be a challenge for many leaders. First off, it's not crystal clear yet on what new roles might look like. It's getting clearer on the transcription side now that speech technology is more wide spread, but coding roles and other existing clerical roles are harder to visualize.

Leslie: The term knowledge worker was sort of vague to me until more recently. I understand it now to be a worker whose primary work product consists of information.

Patty: That's right, they are workers who are experts in specific fields like HIM and who add value because of what they know rather than how long they have worked on the job they do. Examples of valued HIM knowledge are: characteristics of the legal record, uses of the health (medical) record, health data flow, characteristics of data integrity, and coding classification and reimbursement systems (beyond how to code as in what the code means, when it is applied correctly or incorrectly, and aspects of various reimbursement systems and compliance requirements). Also, teaching patients how to organize and maintain their health information in personal health records is a perfect role for HIM professionals.

Leslie: Those examples are helpful, as health care organizations require expertise in each of the areas you mentioned.

Patty: Yes, but we can't take it for granted that the organization will look to HIM leaders because other professions claim expertise in these areas. It's up to HIM leaders in their respective organizations to position HIM in a way that creates value and ensures the survivability of HIM professionals as sought after knowledge workers. n

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 .