German philosopher Arthur Schopenhauer said that change alone is eternal, perpetual, immortal. Some may disagree with the grandness of that quote, but the fact remains that change is a primary motivator for learning. The American Health Information Management Association (AHIMA) in recently celebrated its 300th graduate from the leadership development program titled “Renaissance for the 21st Century: Leading the Change to e-HIM.” The program was implemented to help the association’s members address the large scale changes occurring in the health care industry, particularly with the transformation of paper medical records into an electronic form.
“It changes the way every health care provider does their work, it changes how every administrative function and process in the organization works – it changes organizational structures in an organization as it unfolds,” said Leslie Fox, CEO, Care Communications Inc. and co-developer of CARE’s Systems-Based Leadership and Change Management Program. “The knowledge and expertise of health information management professionals in a health care provider organization is in tremendous demand right now. The health information management profession has always played a key role in managing the paper records, in protecting privacy and confidentiality, in making sure that medical information was complete and accurately recorded, that medical records were accessible — all the standard, important activities that HIM professionals have done over the years.”
Fox said that during this transformation, health care organizations need more than just HIM managers’ expertise, they also need HIM leadership, which goes beyond management or the planning, implementing and making sure the job gets done. Leadership should address the adaptive challenges brought about by significant change.
“You’re changing the way people live and work. It’s what we call an adaptive challenge — it affects the whole culture of an organization,” Fox explained. “For that reason, the AHIMA felt it was very important that one of the resources they provide to their members would be additional training and support in their role as leaders. This would not be your traditional continuing education program or one- or two-day seminar. It had to be much more comprehensive and substantive than that because leadership isn’t something you learn in a one- or two-day seminar. In fact, I view this leadership training as adding to training and experience people already have garnered over the years. We’re filling in some gaps, some missing pieces that most leadership education doesn’t include, as well as helping people integrate a number of bodies of knowledge.”
CARE offered AHIMA a framework to lead change that takes traditional bodies of knowledge around project and change management and adds a substantive session on the behavioral aspects of change, as well as the emotional and psychological aspects of change, in two ways. First, the program covered transition management, an exercise to discuss how change impacts the individual employee, the individual stakeholder, and how transition management is different from change. Fox said that transition management activities center on work done by psychologist William Bridges, who began to study the subject some 20 years ago.
“Change is an event, a situation, something that happens,” Fox said. “The transition is a psychological process that an individual goes through to come to terms with the change. They have to come to terms with whatever they’re losing because when there’s change, you really start with an ending. Then you have to get through a “neutral zone” or a sort of gray period of time when you’ve got one foot in both worlds. That’s very much where the health care industry is right now with electronic health records. Most hospitals have hybrid records — part paper and part electronic. It’s a very difficult period of time, and then as you get into the new beginning, how do you solidify the changes you’re making and help people come to terms with the fact that they’re living in a new world?”
Second, AHIMA members learned how to apply the Bowen family systems theory to their organizations. Fox said that Bowen family systems theory is used by a large percentage of mental health workers when they look at a family relationship system as a single, functioning unit in order to understand and help an individual in that family to overcome a mental health problem. Fox taught AHIMA program attendees this theory to help leaders could get a broader, more strategic perspective about the emotional issues and process that are often accelerated during change.
“This theory, which was developed back in the 1950s by Dr. Murray Bowen, a psychiatrist, is probably one of the most prominent theories in the family therapy world,” Fox said. “The same automatic patterns of behavior that can be observed in families can be observed in organizations. Bowen describes these patters as “the emotional process.” If one individual in the system changes, it changes the behavior of everybody in the system.
“When there’s a big change, people naturally get anxious, and the more anxious they get, the more anxious the whole system gets,” Fox said. “When you talk to leaders who are about to embark on large-scale change, you ask them what’s their biggest concern, it’s rarely the technical part. It’s rarely whether the software will work; it’s usually the people issues. That’s what the emotional process is. By teaching them systems-based leadership — which is the term we use for applying the Bowen theory in organizations — we provide people with what is generally considered to be the missing piece of the puzzle.”
Fox said that the CARE team tries to meet with graduates once a year to ask for examples of ways they’ve implemented the learning.
“I was talking to one graduate, this woman is quite a prominent leader in our organization, and she was telling me how much she got out of the program. She said, ‘I definitely picked up some important new ideas. For example, in a lot of organizations, the HIM department and the IT department have a certain amount of conflict because there’s some overlap now between health information management and IT, so the roles aren’t as clearly defined. In our organization, I found I had a very poor relationship with our IT director. We couldn’t agree on anything, we were always at loggerheads. From that program, I realized I, too, had a role in that problem.’
“’That’s one of the concepts or principles of Bowen theory, that everyone’s part the system, including me, and so if there’s a problem, you start by looking at your own behavior, and you realize that you can’t change the behavior of anyone else, but if you’re part of a system, if you change your own behavior, everyone else is going to change.’ She said she really sat down and thought about her role in the conflicts they have, and began to change how she worked with him. It’s been two years since she went through the program — she said that now, they’re the best of buddies. She said, ‘We collaborate on everything, we have great communication. I’ve learned so much from him, and he’s learned a lot from me.’ That is exactly the kind of problem solving that people have to do if they’re going to get through this sort of change because there’s so much overlap and changing of roles. If people are just defensive about and try to stay in those roles, they can’t do it,” Fox said.