Leading the Way to the Future State of HIM
Thank you to Advance Magazine for permission to use this article

Patty: We have had so many interesting conversations this year with HIM leaders across the country, listening to their stories of leading change in their organizations. Perhaps we should step back for a moment and reflect on the emerging trends requiring HIM leadership.

Leslie: Good idea Patty. It’s important to step back from time to time to assess the big picture. What are the most challenging issues and how are HIM professionals leading the way to the future state of HIM?

Patty: Our colleagues have reported that their significant challenges this year have been the continued migration to EHRs, which includes defining new HIM roles, defining the legal EHR and responding to the demand for increased public reporting.

Leslie: I have also heard a lot about the stubborn long-standing challenge of improving data quality, both because of public reporting and because of increased auditing of documentation supporting coded data submitted for reimbursement.

Patty: Well the good news is that all of these issues also have the attention of health care executives, raising their awareness of the value of HIM.

Leslie: I think you are right about that Patty. The need for our expertise is top of mind, and we are seeing many of our colleagues step up to the plate to meet those needs.

Patty: I know that you are moderating a panel at the American Health Information Management Association (AHIMA) national convention this year titled “Systems-based Leadership to Advance the Future State of HIM.” Would you like to give our readers a preview of that presentation?

Leslie: Sure Patty. I got the idea for the panel presentation after talking with graduates of the AHIMA’s leadership training program, “Renaissance for the 21st Century: Leading the Change to e-HIM”. Three outstanding HIM leaders will share the stories of how they advanced HIM in their organizations using Systems-Based Leadership and Change Management™, a framework for leading change that they learned at the program.

Patty: The framework for change is unique in that it goes beyond traditional change management and project management processes to really address the “people issues.”

Leslie: The framework we teach integrates four bodies of knowledge to create a comprehensive approach for addressing the strategic and tactical challenges of transformational change, as well as the hidden challenge of the organization’s emotional system and the psychology of transition, which makes leading change more of an art than a science.

Patty: Leslie, let’s talk a little more about the difference between the challenge of the emotional system and the psychology of transition. I know both address “people issues,” but they each have a different focus.

Leslie: When we talk about the emotional system of an organization we are talking about the interconnectedness of human social groups. People who live or work together on a regular basis become an emotional system over time, which means they instinctively function as a single unit, much like a flock of birds or a school of fish. The behavior of every individual within the group triggers reciprocal behavior in the other members of the system, just like a mobile hanging from the ceiling. Move one piece, and they all move.

Patty: We have much in common with other living systems in nature. Just as there is variation across the species in nature, every organization develops its own automatic patterns of behavior in relationships. Emotional behavior refers to behavior that is outside an individual’s awareness. It is instinctual behavior, just as it is in non-human social groups.

Leslie: The threats and pressures that emanate from our fast-paced, highly complex and competitive society generate anxiety that reverberates throughout society, and health care institutions are no exception. The intensity of the behavior in an emotional system ebbs and flows with the ups and downs of the organization as it responds to new regulations, new advances in medicine and technology, and the increasing competition for resources. How well an organization functions in such an anxious climate relates to how well its leaders can manage their own anxiety.

Patty: Systems-Based Leadership is based on Bowen theory, a natural systems theory of human behavior developed by Murray Bowen, a psychiatrist and pioneer in the field of family systems. It is a body of knowledge that informs the thinking of leaders as they observe and think about emotional behavior in their organizations. Systems-Based Leadership helps leaders learn to think of behavior from the perspective of the whole system, rather than the individual. It helps leaders to reduce their own anxiety and not amplify it in their family and non-family systems.

Leslie: The psychology of transition management is quite different from the systems perspective of Systems-Based Leadership. Transition management concepts in the framework are based on the work of William Bridges, an expert in the field of transition management. It addresses how individuals come to terms with change. Again variation across the species comes into play, but on an individual basis not at the level of the system.

Patty: HIM leaders who are advancing HIM to its future state are constantly balancing the challenge of defining new HIM roles and functions to their organizations, while also leading their own employees through a significant transition in how and where they do their work.

Leslie: That’s right Patty. The EHR means that HIM functions can be decentralized. Some HIM professionals will work in other departments of the health care organization in the future. Some will work from home. They will use new tools. They will perform new functions. That’s a lot of change to cope with, and HIM leaders need a process for bringing people along with them.

Patty: If leaders get too far out in front, or fail to acknowledge and address the losses that people will experience as they go through change, they will amplify anxiety and then run the risk of the contagion of anxiety spreading throughout their departments.

Leslie: The leaders speaking on our leadership panel at the AHIMA meeting are Rita Bowen, MA, RHIA, CHPS, SSGB, Erlanger Health System; Jean Clark, RHIA, Roper St. Francis Healthcare; and Susan Postal, MBA, RHIA, Hospital Corporation of America (HCA). They will provide solid examples of how they lead through very anxious times and got results that met their goals.

Patty: I understand that Jean Clark will talk about how after 3 years of trying to get the funding necessary to implement a document imaging system, she incorporated strategies from the framework for leading change to get funding and to overcome the obstacles she encountered during the implementation process.

Leslie: Rita Bowen will talk about how after several false starts, she was able to lead her organization to a clinical documentation improvement program that has staying power. She drew heavily on the change management body of knowledge to achieve her aims.

Susan Postal embraced the principles of Systems-Based Leadership to lead her corporate HIM department through a restructuring process that would put the department on a path to advance the future state of HIM in a health system of more than 179 hospitals and 104 free standing surgery centers in 21 states, England and Switzerland.

Patty: For our readers who are not attending the AHIMA convention in Philadelphia, the paper will be accessible in the future on the AHIMA Web site.

Leslie: Each of their stories is inspiring and the impact these leaders are having on the future of their organizations and our profession will clearly have positive, if not profound, ramifications throughout our industry. They each indicate the leadership training they received from AHIMA was invaluable. For interested readers, the next AHIMA Leadership training program: Renaissance for the 21st Century: Leading the Change to e-HIM is scheduled for Nov. 5-6 in Chicago. We look forward to seeing you there.

References
Friedman, E., A Failure of Nerve: Leadership in the Age of the Quick Fix. New York: Seabury Books, an imprint of Church Publishing Inc. 2007.
Bridges, W., Managing Transitions. Massachusetts: Da Capo Press, a member of Perseus Books Group, 2003.
Fox L., Clark, J., Bowen, R., and Postal, S. “Using Systems-Based Leadership to Advance the Future State of HIM” presented at the AHIMA National Meeting and Exhibit, Philadelphia. Oct. 8, 2007.

Leslie Ann Fox is chief executive officer and Patty Thierry Sheridan is president of Care Communications Inc., a national HIM consulting and staffing company headquartered in Chicago. They invite readers to send their thoughts and opinions on this column to lfox@care-communications.com or pthierry@care-communications.com .