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Collective Action 4/24/13

April 24, 2013 Bill Rieger 2 Comments

The views and opinions expressed are those of the author personally and are not necessarily representative of current or former employers.

Reflections on TEDMED 2013

Unpacking my TEDMED experience will be challenging, much like it would be to unpack HIMSS or CHIME conference, but in some ways more difficult. At HIMSS and CHIME, you walk away tired and overstimulated, but have a sense that we’re all in this together.  Walking away from TEDMED, I am exhausted mentally from all of the stimulating presentations and conversations, but I have a sense of being the bad guy. 

TEDMED is a TED conference dedicated to science and medicine innovation. I attended this conference in conjunction with The Breakaway Group’s annual conference, which was very good and stimulating as well and was a great beginning to the TEDMED experience. 

As we transitioned from The Breakaway Group to TEDMED, I had high expectations of people sharing collaborative ideas and experiences on how we can make healthcare better. I was not disappointed. There were some great ideas expressed at TEDMED. Phenomenal medical and scientific research is being conducted all around the world and it was well presented on the TEDMED stage and in The HIVE. 

The HIVE was similar to the vendor floor at HIMSS, but at a much smaller scale. There were only 50 vendors present, all startups in healthcare. None were allowed to reach out to attendees beforehand and they were not allowed to bring propaganda other than their business cards. Each was given a 50-inch monitor and a small table to show their product. There was no sales pressure at all — attendees were able to approach the vendors and ask exploratory questions without pressure. That was a refreshing experience. 

TEDMED was comprised of 10 sessions each lasting about two hours. In each session were several speakers who had their 20 minutes on the big red carpet. Big data, medical research, community health, indigent care, global health, and even end-of-life issues were discussed and presented from various perspectives. It was thought-provoking to say the least. 

The one sense I left with — and perhaps the biggest discussion at dinner with other attendees and guests of Xerox Health — was how both physicians and hospitals were looked at and talked about as being a big part of the problem and not a part of the solution.  There were physician presenters sharing personal stories of what they have done that is cutting edge, but there was absolutely no representation from any hospital or health system on stage. There was an entrepreneurial spirit there and TEDMED clearly puts the future hope of our healthcare system in the hands of entrepreneurs.

We can all agree that our current healthcare system is unsustainable. Farzad Mostashari spoke at The Breakaway Group event, and while he represents CMS and was talking about the end of fee-for-service, he also said that none of us know exactly what the payment model will look like in five years. He acknowledged that more government was not the answer, but a partnership with payers and providers alike working together to blaze a new trail. He was not asked to speak at TEDMED, probably because he represents the establishment. 

I believe very strongly in the capital system and encourage innovation and starting something new and creative, but that innovation has to be partnered closely with hospitals and with our government. That part was clearly missing at TEDMED. As a result, I believe it took away from its effectiveness.

The mission of TEDMED can be derived from its website. "In its core, TEDMED is a celebration of human achievement and the power of connecting the unconnected in creative ways to change our world in health and medicine." Did they achieve this mission? I would say yes, but did they connect the unconnected with the right people? 

Next year, I hope to go again. I will send TEDMED some suggestions about how it can stick it to the man a little less, and instead maybe partner with the man and talk to the man about news ways of doing things. It sounds like the man is listening.

Bill Rieger is chief information officer at Flagler Hospital of St. Augustine, FL.

Collective Action 4/5/13

April 5, 2013 Bill Rieger 5 Comments

The views and opinions expressed are those of the author personally and are not necessarily representative of current or former employers.

Make It Personal

Everything is a category, until it becomes personal. At one point in my life, my wife was a category. I was thinking about a wife, dreaming about a wife, looking for a wife, but at that point she was a category in my life, a label “Wife.”  

Then I met Susan. WOW! How blessed was I! When she was just a category, I knew I would love her of course, but not nearly as much as I found out I could. She switched from a category to something very personal.  

The same thing happened with my children. Before they were born, even during the pregnancy of each child, they were categories. We shopped for them and tried to love them before they were born, but to some extent they were still a category. Then the moment comes, the moment that happens so few times in life — you hold your child for the first time. This category suddenly became very personal. 

I read a blog post recently by John D. Halamka MD, CIO at Harvard School Of Medicine. In the post, John shared about the loss of his father. There are other posts on his blog where John talked about how his family prepared for this.  It reminded me of when my father passed in 2008.  As I am sure it did for John when he was with his father in the hospital, healthcare became very personal to me.

In the ICU where my father died, I was looking at tags on equipment, making sure they were safety checked.  The computers on wheels were looked at with scrutiny as I tested to ensure they could at least roll around easily. I wanted so badly to check the PCs to make sure they had antivirus software loaded. I watched as the nurse documented and became frustrated at how long it took the screens to update. At that point, processes, policies, procedures, communication, service, and clinical excellence were all very personal to me.  

When I returned to work at my local hospital, my team of technicians were not happy with me for the first few weeks. I was not only dealing with the passing of my father. The new heightened awareness of service gained on that trip was being unleashed on them.  I wanted to bottle the passion this intense personal experience gave me and carry it with me every day, but eventually the rhythm of everyday life interfered and that sensitivity lessoned.

Making things personal made a difference in my perspective. I thought about how to provide this personal experience to members of the team without them having to go through what John and I went through. How do we make flowsheets, order sets, discharge summaries, wireless access points, and Citrix servers personal?  

As we thought about this, the Clinical Experience program was born. Through a great partnership with clinical leadership, every member of the IS team is able to spend eight hours per quarter on a nursing unit observing. They are not there to fix anything or provide support, although I am sure at times they do. They are there to watch, learn, and gain the insights that only a personal experience can provide.  

There are times when team members get frustrated with this program, as they are busy and don’t want to be interrupted in their own work. We reinforce to them the power of personal experience. We ask others to share specific experiences they had while on the floor and how it impacted their work. 

Leaders promote engagement on many levels, but short of being a clinician on the floor, there is no better way to directly engage with our patients and co-workers than to be right there with them as they participate in the care process. We believe that this periodic change in environment will stir up some creative thinking and lead to great innovations for our hospital.

Bill Rieger is chief information officer at Flagler Hospital of St. Augustine, FL.

Collective Action 3/11/13

March 11, 2013 Bill Rieger 3 Comments

The views and opinions expressed are those of the author personally and are not necessarily representative of current or former employers.

What Do You Stand For?

I just couldn’t believe it. There was no way you could convince me when I was 18 that I would live to 21. My lifestyle was so self destructive that I knew I wasn’t going to make it. I was riddled with addictive behaviors. Self-pity absorbed my every thought, and future plans included my funeral and not much more. I literally was standing on what I thought was the truth that I would not see 21.  

It wasn’t until I started to share this with a few people that an orchestration of events happened. I was led into a recovery program that launched me into a new life. I stand on something much different now, a different set of truths that I base my life upon.

Things change and we as people change. Thought processes come and go. Belief systems come and go. You might stand for something one day, receive some different or additional information and your mind changes, now you stand for something else.

There is a saying that bears some thought: if you don’t stand for something, you will fall for anything. There has to be something, however, that we can stand on, something that will not change with new information. I would like to offer a change to that saying because I believe that if you do not stand ON something, you will fall for anything.

The core values for my life are much different today than when I was 18. I was falling over everything, grasping for anything that could give me hope. I didn’t realize I was looking in all the wrong places until I became beat up enough to ask for help. As I found the help I needed, there began to arise in me a foundation for life resulting in a set of core values for my life.  

As I matured,  the core values emerged definable. Today they are Honesty, Integrity, Unity, and Transparency.  

As a leadership team at work, we have incorporated these core values at a departmental level and try to emulate them for our staff. We hold staff accountable to these and ask them to hold us accountable to them as well. They are more than ground rules for behavior, they are a platform that we all can stand on. While there is hierarchy in the department from an org chart perspective, these core values transcend the org chart. In other words, no one should operate and behave outside of the core values.  

Core values are considered before everything we do: decision making, budgeting, staff meetings, difficult conversations, and status reports. Most often they are not considered verbally, it is more instinctual than anything else, regardless, those values are present. Core values alone do not lead to a Utopian environment where everyone is whistling, but they do allow us to move about our day with confidence that we are doing our best and making the best decisions that we can.

Recent events caused me to look at these values as people questioned my decisions. I am confident in my decisions, but I have to admit that I do not always have all of the information. It is impossible to be a decision maker and always have all of the information – that would be way too easy.  

When someone questions a decision, I look at it and see if there is additional information. Perhaps there is a correction either to an assumption I made or to information that was provided. One thing I do not have to do is cover my tracks or try to hide my motives. Core values give me an unshakable foundation to stand on. That’s right, an unshakable foundation. These values do not change based upon any individual circumstance.

Do I adhere to them all the time? No. That is why I have people I trust in my life who have permission to point this out to me and help me humbly apologize and get back on track. They are not designed for a perfect life — they are designed to keep me on a specific path.

Do you have a set of core values that you can verbalize off the top of your head? The truth is that if we don’t know what our core values are, that doesn’t mean we do not have them. We are not even the best person to verbalize our core values. Others around us are better at it because they are more aware of our actions than we are.  

Ask my wife what my core values are. Ask the members of my leadership team, those who work with me day in and day out, what my core values are. Core values are more than just words. They are the way you live, act, play, work, shop, or do anything in life. Core values are behind everything you say and do.

What does this have to do with healthcare? Why do I continue to harp on principles when we have so many other things to be talking about?

I say it again — if we do not stand for something, we will fall for anything. During sweeping change, stability is important. Great focus is needed to guide us through this period of healthcare reform. Define your core values.  If you are not currently living by them, ask some trusting people around you to help. You will be surprised at the response you get.  

If you have them defined, use people around you to help keep you accountable to them and encourage others to do the same  These times are critical and the next generation is depending on us to get this right.

Bill Rieger is chief information officer at Flagler Hospital of St. Augustine, FL.

Collective Action 1/25/13

January 25, 2013 Bill Rieger 1 Comment

The views and opinions expressed are those of the author personally and are not necessarily representative of current or former employers.

Leader the Follow (Part 2) — Identity

Let’s see … where were we? Oh yes, talking about being a follower and the significance of that role. This is a follow up to the last Collective Action post on HIStalk.

Last time I asked for input from readers about what kind of leader you would follow. I received several responses and I will include some of them at the end of this article. Thank you to all who provided feedback — it was insightful and entertaining. 

The key to studying followers is similar to the key to studying leaders. It is not about characteristics of a leader or follower. To me, the key is identity. How you see yourself determines your effectiveness. 

I agree we need to talk about Meaningful Use, business intelligence, ACOs, and what the next great innovation in healthcare will be. But none of those things can happen without  a focus on both leaders and followers and teams they lead.

As I was researching this topic of identity, I came across an interesting term: “metaperceptions.”  This is not how you are perceived, but rather how you perceive others perceive you. The difference is slight, but profound. 

I have a great example of this from a recent presentation I gave. I was speaking to a crowd of about 100 people here at our hospital at a recent event. It was an EMR project-related event that we themed “Finish Strong,” where I and others presented concepts from Dan Green’s book Finish Strong

I consider myself a good communicator. I believe I have a gift that allows me to write and present well. As I was presenting, someone in the audience dozed off. I thought right then that her perception of me was that I was a lousy presenter. Instead of continuing as I should have, I got thrown off. I thought they had lost interest and I started rushing through the rest of the presentation, not giving some of the more impactful parts ample time. 

Afterwards, I spoke to her and asked her how she liked the event and presentation. She said that she loved it, but had a new baby and was very tired. She made some comments about what was said and how it impacted her. I was blown away. My metaperception was wrong, but that didn’t matter, it impacted my effectiveness.

The root of our identity is only partially based on what others think. It is mostly based on how we view and think about ourselves. Here are some interesting statistics regarding how we think about ourselves. 

According to Daniel Amen, MD, a renowned psychiatrist and brain imaging specialist, we have about 60,000 thoughts per day — one every second while we are awake. Ninety-five percent of those thoughts are the same ones we had yesterday (a broken record!) For the average person, 80 percent of those thoughts are negative. 

That is incredible. Every day, the average person working in your department or your hospital or living in your home has 45,000 negative thoughts. Whether you are a leader or a follower, whether or not you care about what others say about you, you can do enough damage to yourself to keep yourself from fulfilling your destiny.

How do we combat this? How do we help those around us combat this? If you don’t think this is true about yourself, then you are probably not average, but you know someone who is. While it may not directly impact you, it impacts you in some way.

Let me offer something to you that is a bit unorthodox, but that has literally changed my life. I got this from the late Zig Ziglar, who says that how you see yourself is everything. A part of his program, called Self Talk, includes a laundry list of positive attributes: honest, intelligent, organized, responsible, committed, teachable etc. He offers several paragraphs with affirmations and instructs everyone he works with to say this list of affirmations in the mirror, morning and night, for at least 30 days. 

When I first heard this, I thought it was ridiculous, much like what you are likely thinking now. When I tried it, I thought it was stupid and embarrassing. I would not tell my wife. I locked the bathroom door and went through it as fast as possible. 

A peculiar thing happened after a couple of weeks. First of all, I finally told my wife, but I also started to become less embarrassed. I started to see that I really was some of these things, and some of them all the time. Other characteristics were just seeds and needed watering. 

At the end of 30 days, although I did not count, I literally sensed the number of daily negative thoughts decreasing, being replaced with thoughts that were empowering. Dare I say, I started to believe that I was just scratching the surface of what I thought I could accomplish in life. There is a lot more to that story, but it is for another post.

Besides how we talk to ourselves, there are additional factors in our life that impact those 60,000 thoughts. In Darren Hardy’s book The Compound Effect, he dedicates a chapter to influences. He says that everyone is affected by three kinds of influences: input (what you feed your mind), associations (the people with whom you spend time), and environment (your surroundings). These external forces are very powerful and dramatically affect how we think and feel about ourselves, our choices, behaviors, and our habits. In this book, he offers suggestions on how you can govern these forces so they can support and not derail your journey towards success.

To help deal with this on a corporate level, we have been walking our team through a couple of things to help positively reinforce who they are and where they are going.

The first was we helped everyone on our team develop a brand statement for themselves and complete a professional bio. This exercise forced them to take a look inside and actually write down what they have accomplished and really who they are as a person and a professional. 

The second thing we did was have everyone complete Clifton’s Strengthsfinder assessment. The result of the assessment was a list of your top five strengths, which most everyone, including myself, has posted on their door or cubicle wall. 

We review these things in team meetings. We try to use them to better align teams. Although we have a long way to go to really perfect this, the attempt alone at trying to deal with this has had a positive effect in the department.

Follower or leader, both are important roles, and while healthcare goes through rapid transformation, we need the best and brightest operating in their gifts with full confidence. If you struggle with this or know someone who does, you can be a resource in their life, and in turn, in this industry. The answer to how to improve healthcare will come from the people within healthcare, and we need these people thinking they can affect change. 

While this topic may not seem relevant, I believe it is at the root of advancement. Whether leader or follower, even this little bit of knowledge about your identity and how you see yourself can help you and help you help others. This is your destiny!   


The first response came from a popular HIT blogger who reached out via Twitter (@SmyrnaGirl) and said, “I would follow a leader who wouldn’t be afraid to impart wisdom and one day let me lead in their place.” 

Not all followers share this sentiment. An anonymous person shared the following. “When my personal convictions are strong and clear, others may agree and choose to follow, but they do so on their own. On the other hand, if my convictions happen to align with those of others before me, then I may seem to be a follower, but in reality I am going my own way. Either way is fine with me. I will never follow or lead just because someone thinks I should, and I have no inherent desire to fill either role.” After a few more comments, he went on to answer the question directly. “For me, I would have to first decide if it was my battle. If so, then I’d follow the plans and directions of the one who seemed most aligned to my own thinking.”  

A practice administrator in Jacksonville, FL had this to say. “This organization thus  far has given me almost free reign on how and where I am taking our primary care network, with the expectation that I do it within cultural norms and corporate guidelines. After 10 months, I am happy to report that this is a comfortable position for me.” 

A quality management informatics analyst sent an e-mail saying, “One of the best leaders I had was a supervisor who openly said that he ‘had my back.’ When business events happened that threatened to undermine my authority or the scope of my work, he would respond by protecting me and promoting my interest in the situation. As a result, I felt a lot of loyalty and trust toward him and tried even more to meet his expectations.”  

The final comment came from a chief operating officer of an HIT vendor. He provided some great comments about leadership and following in general. We had an e-mail dialogue that really gave me some great insight into leadership. He said, “Inspirational leadership is great, but good execution combined with it is rare. Find a CEO or president who is a visionary and the matching CEO or COO who has the power of execution to make it happen. Typically, the inspirational people are not good at actual execution, but they need to let go to have others execute.” It sounds like he would be willing to follow someone who in addition to being able to recognize their strengths,they can recognize their weakness and bring someone in who can help bridge the gap.

Bill Rieger is chief information officer at Flagler Hospital of St. Augustine, FL.

Collective Action 12/26/12

December 26, 2012 Bill Rieger 3 Comments

The views and opinions expressed are those of the author personally and are not necessarily representative of current or former employers.

Leader the Follow (Part 1)

I will never forget how I earned my shellback certificate. Only a few people know what that is. If you have one, you probably remember the experience like I do. It is unforgettable.

I served six years in the US Navy after high school. While in the Navy, most sailors are assigned duty to serve on a ship and go out to sea. A large percentage of deployments end up crossing the equator, and with that crossing comes a very honored tradition and ceremony where a lowly pollywog transforms into an honored shellback.

During this ceremony, the pollywogs (those who have never crossed the equator) are “abused” by the shellbacks (those who have already crossed the equator) through a series of events and scenarios before entering the royal court of King Neptune. There was no real abuse, but there were fire hoses, pushups, haircuts, and lots of crawling around on a very rough deck with your clothes on inside out.

The scenario I remember the most — and where I want to set the stage for this article — was where we crawled through chutes of rotting garbage. This was a great picture of leadership and following. Three people were going through the chute, a leader and two followers. The leader was the only one who could see the exit, but he could not get there unless the followers were “hooked” to him by grabbing onto the bell bottoms of the dungaree jeans we wore on the ship. 

Often there was vomiting. Certainly there was hesitation, doubt, and extreme overload to the smelling senses. It was challenging, but with the help of everyone involved, we made it through and eventually got to rub our faces in the greasy belly of King Neptune and claim our shellback card.

The leader can see the end. They can see where the group is going. But most of the time, the leader cannot get there by themselves. The follower is the key. Instead of focusing on the leader’s responsibility to create an environment where followers can thrive, I want to focus on the follower and try to answer some key questions:

  • What makes a good follower?
  • Who is a follower?
  • Who will a follower follow?

Certainly there are more followers in this world than there are leaders. If not, there would be no advancement in anything, much less technology. You know the saying — too many chiefs and not enough Indians.

If the follower is such a key to success, why is it that there are far fewer books written about followers compared to those written about leaders? Followers are mentioned in the leadership books, but from the perspective of leadership. Maybe many in the workforce are not satisfied with being a follower and do not want to acknowledge their responsibility in being a good follower. Let’s explore these questions and see what we can discover about good followers that really make them leaders.

What Makes A Good Follower?

There is a great YouTube video that speaks to the significance of the follower. In this video, it is the first few followers that are the most important. 

The video helps answer the question of who a good follower is. A good follower is one who is willing to take a risk. The leader may be way off base and be going down a road that leads to failure. A follower assumes risk in whatever endeavor they are on. Much like an entrepreneur, with the increase in risk comes a potential increase in reward.

Lower risk, lower reward. If you have a job with a large hospital system, you are a follower in a relatively low-risk situation. But monetarily speaking, your reward is capped. One of the things I love most about healthcare is that most of us are in this industry because of our compassion for others who may be sick. In this case the emotional reward is great.

A good follower also has vision. Good followers ensure they are able to see what they are marching towards. Two IT people are viewing server log files. One is upset because they feel like they should be much farther in their career than just browsing log files. The other is diligent and disciplined in their review, understanding that if they can find something at this level, they may be able to prevent an unplanned system outage and interruption to critical information flow to clinicians.

Which follower would you rather work with? Obvious, isn’t it. The follower with vision and understanding will ultimately help the company produce quality products and services.

Finally, a good follower is loyal. This is not to say that a good follower may not change jobs. Loyalty runs much deeper than who your employer or boss is. A good follower is loyal to the path they are on in life. They try to align themselves with employers who have a similar vision and who can best help them achieve their personal goals. A leader is not the only one who understands the idea of “co-missioning.”

Covey covered this in his book The 8th Habit. He discusses this idea of aligning your personal mission with the mission of the organization. To me, this is one of the biggest resourcing challenges in healthcare IT, specifically regarding the technical roles. If an individual is passionate about server technology and is fascinated with managing a storage area network, they will be loyal to that versus loyalty to that is specific to healthcare. Technical aptitude is needed in almost every business sector, making it more difficult to keep good technical people in healthcare.

Good followers are loyal to their passion. Good leaders recognize this and work with good followers to best align their work to their passion. This fosters loyalty — and as a result, longevity — in the workplace.

Who Is A Follower?

The short answer to this is “everyone.” I recognize that I am a leader at work. As the CIO, I lead a group of people as we march down the road of improving healthcare delivery through information technology. However, my title is CIO and not CEO, so I need to be a good follower to advance the agenda of the organization.

The CEO is a great leader, but he too is a follower, as he reports to the chairman of the board of directors. The chairman is a follower in a sense as well, because he represents the community we serve. At the end of the day and in every industry, there are the people — community, customers, consumers, and families.

Without losing my focus on followers, I want to make a quick leadership point here. It is critical for a leader to be more that just be a good follower. They need to be a great follower. The eyes of the team are watching. As the leader goes, so goes the team. This is not an opinion, it is a principle.

If leaders are followers — and indeed they are — then they need to set the bar on how to follow. They need to take good risks and show others how to do that. They need to have vision and be able to communicate that vision and help others to see. Finally, they need to be loyal and display loyalty in a way that makes other followers want to follow.

Who Will A Follower Follow?

This leads us to the final question. Who will a follower follow?

I will start by speaking for myself here. I will not follow someone I cannot trust. Trust is such a huge issue for me, probably because I have both broken trust and had my trust broken and have seen the resulting relational devastation first hand. A leader can have a great vision with low risk in an environment that seems to foster loyalty, innovation, and creativity, but unless I trust them, I will not join them.

That is part of why changing jobs is so risky. You never really know what you are going to get until you spend time in that role, and by that time, it is normally too late. I’ll be honest — one of the reasons I have taken to writing is to put myself out there so potential employers and employees can get an idea of who I am and what is important to me. This starts to build trust even before we meet.  Naturally there will still be skepticism, but the relationship can start off with a foundation — albeit a small one — to build trust.

Behind trust, there are many qualities a leader must have for me to follow them in a great way. They must have integrity, must be honest, must have a level of transparency, and must foster unity.

What is more important to me, however, is not who I will follow, but who you would follow. I would like to make this article interactive. I would like to hear from you and find out who you would be willing to follow. What type of person would you follow into battle? Please respond via e-mail, LinkedIn, or Twitter and let me know. I will include this in the next post of Collective Action on HIStalk. Include your name if you like, but I would ask you at a bare minimum to include your role so we can have context around your response.

If a good follower knows how to calculate risk and has vision and loyalty, why are they only considered followers and not leaders? Why is there stigma with being called a follower, a.k.a. a member of the team? I will elaborate on this in the next segment once I get your answers to what kind of leader would you follow.

But I believe what keeps a follower a follower and not a leader ties back to their sense of identity. If you see yourself as just a follower, then whether or not you have the qualities of a leader, you will never lead. If you can see yourself as a leader, then whether or not you have fully developed the qualities of a leader, you still can lead and learn along the way.

Of course there are some who do not have an accurate picture of themselves.  That is when a mentor or someone close can help them point out their strengths and weaknesses.  More to come on this in the next segment, but your sense of identity it is a crucial concept that deserves specific attention because of the significant impact it has on every individual. Even if you remain a follower for the remainder of your career, you can lead strongly by consistently displaying the characteristics associated with being a good follower.

Bill Rieger is chief information officer at Flagler Hospital of St. Augustine, FL.

Collective Action 12/5/12

December 5, 2012 Bill Rieger 1 Comment

The views and opinions expressed are those of the author personally and are not necessarily representative of current or former employers.


I failed, and I mean big time. Like “I was surprised I kept my job” type failure. Fortunately there were circumstances around me that moved the attention off the failure, but it still happened.  

I was 31. It was my first director-level job. I was, in many ways, woefully unprepared. I walked into this IT director position at a 100-bed behavioral health hospital at a time where they were selecting a vendor for their EMR project.

Even before I officially started there, I had to fly out to sit through vendor demos. My second day on the job I was in a meeting with the CFO, CEO, controller, CMO, and a hired consultant and was asked which system I thought we should go with. I didn’t even know where the restrooms were and had hardly logged on to my computer. It was a real “drink from the fire hose” experience.  

We eventually made a decision and started to progress through the project. I leaned on the consultant a lot, as I was learning healthcare terminology and at the same time trying to implement an EMR. It was crazy.  

Ultimately, the project failed. We never got it off the ground. Right about the time it failed, the company was bought by another company and the focus shifted away.

As I reflect on that project, I realize that the biggest piece that was missing was what I now refer to as engagement. We set up meetings and the CMO would not show up. The nursing director was too busy to help document workflows and processes. None of the physicians or nurses ever thought it would really happen — they were all seemingly waiting for it to fail. The CEO was a verbal champion for it, but could not quite get the CMO and nursing leaders to engage appropriately.  

I learned a tremendous amount from that failure. I carry many of those lessons with me today.  

The greatest lesson I learned is the power of engagement. In this example, it was lack of clinical leadership engagement that was the primary reason for failure. That project and experiences since that project have collectively heightened my sensitivity to and awareness of engagement. I now understand that engagement encompasses much more than I originally thought.

I want to provide a few examples of how we at Flagler Hospital are trying to engage with leadership, staff, and physicians.

The first example relates specifically to the IS team. Within my first six months of employment here, I floated the idea of what we now call the Clinical Experience program to the newly formed IS leadership team. The idea is rooted in the fact that we are not here for IT purposes — we are all here to support and improve patient care. How can you sit in a cube and make decisions that impact patient care without understanding what it means to provide patient care?

We implemented a program with the assistance of clinical leadership where every member of the IS team is required to spend eight hours per quarter on a clinical unit or combination of units. This time is documented and included in the employee’s quarterly performance review.

Some people have responded very well to this and have become even more engaged in what they are doing. Some just go through the motions and don’t see the value. They may not see the value, but that does not mean there is no value. The real impact came in one of our team meetings when we reviewed a network incident that took the ED down hard. Everyone there had a clear understanding of what that meant because they had all spent time in the ED, at least briefly, witnessing its dependence on IT services.

The next example of engagement is at the organizational level. We are in the middle of an EMR implementation at our hospital, but of course we have not always been in the middle. There was a beginning! The beginning for us was January 2011, and it was launched with an organization-wide event planned mostly by the marketing team (who else should be planning these things?)

They did a great job of putting a theme together that tied our corporate theme of iCARE (Compassionate, Always listening, Responsive, and Empowered) with the project. This ended up with the project name of iCAREiConnect.

Before the event took place, the marketing department went around with a video camera to each department in the hospital and recorded departmental dance routines to Stereo MC’s song “Connected.” The video they put together kicked off the event.

There were Xbox iConnect stations as well as other game stations around the room. Our vendor, Allscripts, was there performing product demos and handing out marketing items. Overall, it was a very successful event that got the whole organization, including physicians, engaged. If you watch the video, you will see that we are all in. That level of engagement and buy-in has been evident throughout this implementation and is something that we rely on daily to progress forward.

The final example is also project related. We are mostly completed with the build of our Allscripts environment and are looking forward to testing and training phases of the project. As you can imagine, stress levels are high and people are getting worn down. We wanted to ceremoniously mark the completion of build and shift of focus to testing and training, so we decided to have a “Project Reboot” event. The theme of the event would be Finish Strong, based on the book Finish Strong by Dan Green.  

Again, marketing planned and coordinated the event. It included a photo shoot, video shoot, a few speakers, and a formal ceremony. The whole IS department was present, as well as clinical leadership and SMEs, vendor partners, and hospital administration. The CEO spoke, the CMIO spoke, and because Dan Green could not make it to talk about the principles associated with Finish Strong, I took his place and wrapped up the speaker portion of the event.  

The final portion involved two significant ceremonies. The first one was the book. We purchased copies of Finish Strong for everyone present. For four weeks prior to the event, I worked with nursing leadership (engaging nursing leadership) to get each book signed by a patient. When we distributed them at the event, we talked about how a patient signed each book and how we told the patients what we were up to (engaging the community.) People were really touched by this — it suddenly got personal.  

We ended the event by handing out Finish Strong bracelets to everyone and asked them all to wear them at all times until we go live with the new system. We’ve done bracelet checks periodically since the event and most are still wearing them. I sent a book and bracelet to the CEO of Allscripts and asked Glen to wear it, as he is as much a part of this process as we are.

There are so many more examples of engagement. Our CMIO is doing a fantastic job engaging the physicians with the PIT Crew. We are going through every single order set in the hospital and will have consolidated, evidence-based order sets when we go live.

This kind of stuff doesn’t just happen. It must be intentional. It must be authentic. You have to actually believe that without engagement from everyone, you will fail. You can believe it or not, but that does not make it any less true.  

As I wrap this up, I want to encourage you to see where you are engaging others in the organization. Ask other leaders if they feel involved in what you are doing. We have not done this perfectly and are receiving feedback about where we are lacking. We listen to that feedback and try to engage others in different ways. This is not an IT project. It is a clinical transformation that requires the engagement of all areas of the hospital.

Bill Rieger is chief information officer at Flagler Hospital of St. Augustine, FL.

Collective Action 11/7/12

November 7, 2012 Bill Rieger 1 Comment
The views and opinions expressed are those of the author personally and are not necessarily representative of current or former employers.

Legacy .!?

Who wants to think about legacy when there is so much life to live right now? You don’t have to see some of the crazy things that people do to land themselves in an emergency room to see the lack of vision in that naive question. Turn on your local news tonight or any night and see how real-life decisions result in people’s death. Walk through the death of a loved one or friend and the idea of mortality stares back at you like the cartoon picture of bright eyes in a dark room.  

Do I have your attention? Thinking about someone you know or love who recently passed away?

What did they leave you with? I am not talking about stuff. I mean, what did they leave you with that you want to pass on to the next generation?

The first time this idea of legacy hit me was when my mother passed away. I thought about what she left me and what I in turn wanted to pass on to my children. A few years, later I was once again confronted with this idea of legacy when my son was born. It really smacked me in the face when he was two and he mimicked everything I did. What an awakening that was.  

I think about my own legacy all the time now. The house we live in; how we celebrate birthdays and holidays; how we emphasize the importance of church involvement, morals, values; and even “The Talk.” All will be a part of the legacy I leave my children.

The truth is that we get to choose our legacy. We choose our legacy, not by the big decisions that we make, but rather the small decisions we make every day.

We get to be the generation that births the new healthcare delivery system. Others will take it from us and mature it, but we have the responsibility of birthing it. It is comprised of clinical technology and information technology. It is challenged by security, regulation, and being birthed at a time where over 7,000 people a day are entering a period of their life where they will consume a majority of the healthcare provided in this nation.  

Are we too late? Can the last of “The Greatest Generation” and the massive baby boomer generation grasp what we are trying to deliver? Time will tell. A legacy is in the making.

I want to provide two key thoughts as we progress through this birthing process. Both are related to the importance of the decisions we make.

You never know the depth and breadth of any individual decision you make.

In business, we make decisions all the time. With intention, we try to estimate the depth and breadth of those decisions. Let me give you a few pointed examples of what that bolded statement above is trying to speak to.

I have read numerous stories of people who called in sick instead of reporting to work at the World Trade Center on September 11, 2001. If they just toughed it out that day, they might no longer be with us. What a small decision — call in sick, people do it all the time. But what depth and breadth that decision had that day. 

You set off to work five minutes late and pass an accident that, had you left on time, you might have been in. Make that one last sales call of the day, maybe even the 100th call that day, and make a sale. There are literally hundreds of examples if you think about it even for a few minutes.  

If our decisions have the potential for such dramatic depth and breadth, and compounded over time create our legacy, why do most of us make them with such ambivalence?

As opposed to business decisions, we cannot predict which daily decision will result in depth and breadth. This leads us to the next statement, which will demonstrate and provide you with a different way to think about daily decisions. It comes from the book The Compound Effect by Darren Hardy, which by the way I strongly recommend you go purchase today. The quote is really a formula.

Small Smart Choices + Consistency + Time = Radical Change

I cannot begin to express to you the profound impact this has had on my life over the last few years. Profound doesn’t cut it. Life-changing better defines the impact. 

Every decision counts.The book provides several illustrations of how this works, so I don’t want to give it away. However, I will offer one example from my life.  

I recently had a conversation with someone at work who told me that my focus on personal and professional growth and development has had a significant impact on his life. For me, there is no greater goal than to positively impact someone’s life. I asked him what I did or said that made him feel this way.

He could not articulate a specific phrase or behavior. He just said that I had consistently displayed my desire for improvement, and at some point, this consistency caused him to look inside. He realized he wanted this for himself and started to focus on it. There it is — legacy, impact, a passing on of ideas and actions that over time provided radical change.

One final thought about legacy. There is no separation of character from legacy. We do not have to look far in the history books for this one. Penn State Coach Joe Paterno. Whatever his involvement was in what happened in those locker rooms was so significant that all of the work completed in his profession was wiped out. His legacy will be forever remembered more by how it ended than by anything he accomplished during his time as coach.  

I do not want to minimize the victims, but the point is overwhelmingly clear. You may accomplish great things in your career, but they will be overshadowed by character flaws and poor choices consistently made over time. Will we make poor choices from time to time? Yes, we all will. But how you respond to those poor choices and the choices you make right after those poor choices will impact your legacy in a significant way.  

Over time, people forget. But what will be remembered? Read some history books and find out.

This article has flown at various heights. This was intentional. We started out talking about something very personal, then flew to something healthcare related. If your personal legacy does not include your work, then you will have ended up wasting a large majority of your life spending fruitless time at work. MAKE IT ALL COUNT!

The title of this article is Legacy.?! I will end with an explanation of that.  

Yes, he was here.

Is he here now or gone?

He was here and had such a significant positive impact that we will never forget him.  

In healthcare, this generation is the “he” in those statements. Legacy! That is where I want to be and what I want to leave. 

It does not matter what you have done in the past. Today you have an opportunity to make some small smart decisions that, compounded over time, will leave a lasting legacy.

Bill Rieger is chief information officer at Flagler Hospital of St. Augustine, FL.

Collective Action 10/17/12

October 17, 2012 Bill Rieger 4 Comments

The views and opinions expressed are those of the author personally and are not necessarily representative of current or former employers.

Not an App for That

While listening to the radio recently, I heard about a new app called the Super Pac App (as far as I can tell, it is only available for Apple products, go figure.) It got me thinking about how I wish I had this ability in all areas of my life.

The app provides information relating to political ads. It is, of course, an election year, and ads are flying around in both traditional and social media. The app will tell you the following: the validity of the ad, the funding source, who it benefits, and what the ad wants you to believe. Simply stated from their website, "The Super PAC App is a simple way for you, the voter, to bring transparency to the 2012 presidential campaign."

Wouldn’t it be nice if we could apply this app to all areas of our life? What is my wife really trying to say when she casually mentions that there are still coffee grounds in the coffee maker? Why doesn’t she just say that she feels it is my responsibility to empty the coffee maker since I am the one who makes it in the morning? I would like to use this app like Siri: “Super Pac App, what does my boss mean by that statement?" That would be awesome!

Unfortunately, there are no magic apps we can download to help change the effectiveness of our communication forever. There is a reason why communication is very challenging and whole are fields dedicated to the study of it.

In our IS department, we try to tie our core values to everything, especially communications.  Our core values are honesty, transparency, unity, and integrity. Every time I walk away from a conversation (especially a group discussion), I think about the impact of that discussion and whether or not our core values were on display. Sometimes it is an intentional thought. Mostly, it is that gut feeling or instinct a lot of us rely upon. That gut instinct in this case is rooted in our core values.

As I was writing this, the red car syndrome hit me. You know how when you buy a red car, suddenly you see a lot of them on the road? The increase in red cars is not accurate, of course. Because of your focus, you are more aware of them. 

The red car syndrome has delivered a lot of communication-related articles to me, most of them spot on and with several small, important steps an individual or group can take to increase effectiveness. None of them, however, addressed authentic communication, as I like to call it. When you walk away from a conversation or a presentation, you generally know if the presenter or other person was honest and trustworthy.  

If two people in the same day delivered the same news or information to you but you knew one of them was shady and the other was honest and trustworthy, who you would go to for follow up questions or comments? Easy answer, right? That’s the point.  

Now here is a hard statement. If that is true for you, then it is true about you as well.  

Uh-oh, I’ve crossed the line, gotten into your space, stirred you to look inside. Sorry about that, but you need to know that others are looking inside every time you talk to them, regardless of the circumstance.

I am kind of glad this transitioned into a conversation about you and me, because that is where all change begins. I have worked for several organizations by now, as most post-industrial age professionals do. In most of them, I have had issues with management and decisions made. I have made a commitment however — a commitment to making myself better regardless of where I might find myself. 

The good thing about that commitment is that it works everywhere. Let’s bring that back to communication. If I think that people around me are not communicating effectively or are not very trustworthy or honest, I can either complain about the situation or dedicate myself to being trustworthy and honest and using my influence to bring positive change (that’s right, no matter where you are in an organization, you have influence.) When communicating, communicate with others the way you would like to be communicated with. The power of positive influence is strong. Sometimes slow, but always strong.

In my last post, I mentioned the frantic change in healthcare IT today. Research shows that one of the keys to successful change management is communication. If communication is key, then the last thing this industry needs is for people to walk away from conversations second guessing what has just said because they are questioning someone’s character.  

I could easily parrot other published articles here and give you five quick points to help your PowerPoint presentation. That would be fun and provide value. The harder road leads to the core of the matter and recognizes that your character, above everything else, impacts the effectiveness of your communication.

This may not make me many friends, but that is not the reward I am going for. I am striving for something greater. I am determined to effect change in an industry that is in the middle of historic transition and needs great leadership.

The higher up you go in an organization, the more circles you may be exposed to, but sometimes I find the best impact and the biggest influence usually happens around a coffee cup. You don’t need to be high up to have influence and effect positive change. You just need a coffee cup and a few minutes. Sprinkle it with honesty and trust and your message becomes clearer.

It is no different in a group setting. If you are presenting in a group, a lot of people will be "looking in." If that group even senses dishonesty or lack of integrity, the message is blown regardless of how important it is. The core of communication is not what you say — it is how you say it.  What you are saying may be critically important, but what people walk away with is always the “how.”  

Some people are master communicators, but if you do not trust them and you feel there is an angle, how effective are they, really? I would rather be bored to PowerPoint death by an honest, trustworthy person who desperately needs Toastmasters than to be wowed by someone with an angle and a personal agenda.

Keep it real. Keep seeking improvement. Commit to making yourself better regardless of circumstance and you will find yourself experiencing positive change in your communication skills and beyond. Character delivers much more than any app ever will.

Bill Rieger is chief information officer at Flagler Hospital of St. Augustine, FL.

Collective Action 10/1/12

October 1, 2012 Bill Rieger 4 Comments

The views and opinions expressed are those of the author personally and are not necessarily representative of current or former employers.

Collective Action. What does that mean, and why would Mr. H and team allow this to emerge on such a highly regarded and respected industry blog?

I will attempt to answer that question with a definition, a story, and a vision. To put this in context, you will need to know a little bit about me.  

My name is Bill Rieger. I work at Flagler Hospital in St. Augustine, FL, serving as the chief information officer for our community hospital.  Like all of you, I have many life experiences. Some of them were tragic, riding on the edge of self-destruction and death (let’s just say that the 80s were rough, but the last 21 years were much better). Some were hilarious, some were somber, and some were absolutely revolutionary and life altering.  

I have come to believe that all of those experiences were necessary to help me find my destiny.  I am not going to go off here on a deeply philosophical tangent, but I do believe we are all searching for something. Some of us — if not most — are waiting for something big to happen before we take that step we know we could or should take.  My destiny — my calling, if you will — is to encourage you not to wait, but instead to take that leap, that step of faith.

Wikipedia defines collective action as, “Any action aiming to improve the group’s conditions (such as status or power), which is enacted by a representative of the group.” I like the idea of aiming to improve healthcare. I strongly believe that healthcare will best be changed by those who have dedicated their life to this field and are willing to listen to every and all ideas to facilitate growth and improvement.  

The ideas this industry needs will not predominantly come from government, or even hospital executive leadership. I believe the greatest untapped resource for creative ideas will come from the ground floor. Yes, we the people.

The first time I realized this was when I was a golf cart attendant.  Golf is one of my passions. I am fairly decent, usually shooting somewhere in the mid 80s. I was putting carts away one evening as we were preparing to close up for the day. I saw this very Dilbert- looking man working on a rat’s nest of a wiring distribution frame. As I was patiently waiting for him to finish, my type A took over and we struck up a conversation. I asked him if he was a contractor, and he told me that he was not, he was the IT manager there at the resort. I shared my experience with working on wiring frames in the Navy. No sooner had I got that out of my mouth when he asked me to be his assistant. 

In shock, we both started to ask questions. I told him that I was in school trying to get my degree in computer science and that I could not work full time. He told me that was fine. I asked how much it paid. He asked me how much I made. I told him $5.50 per hour plus tips. He told me $12.00 per hour. SOLD! $12.00 per hour — that is crazy money, I thought. I AM RICH! I was living in a trailer. I had a old truck, an old motorcycle, and a snake. This 100+ percent increase in pay would allow me to move up to the big time and fix my floorboards.

I cannot tell you how many times I reflect on that story. There are so many lessons there, but it really epitomizes what I am trying to do with this column. Whether you are putting carts away, moving patients around, writing code, selling products and services to hospitals or ambulatory facilities, presenting to the board, or implementing and optimizing an EMR, you have value. This industry needs the value you have. That Dilbert guy — my now long-time friend Ted — thought I had value when I did not see it. I want to encourage ideas, leadership, creativity, and discipline. But most of all, I want to encourage you to take some action.  

My vision for this is to think big. Think big with regards to what you can accomplish. Think big because we have big problems to solve. Think big in case you succeed!  

I do not believe that all people are inherently good. I do believe, however, that all people are capable of accomplishing more than they think. My goal is to make these articles challenging, humorous, relative, entertaining, impactful, and most of all, encouraging. I welcome all feedback, even and especially a contradictory viewpoint — they are usually enlightening. Please share your steps, even small ones, as you progress with confidence to bring an industry through a new level of maturity.

Why would Mr. H and team want this on their blog? The spirit of HIStalk, according to the “About” section of the website, is informing people about industry news and trends. Mr. H must believe that encouraging HIT professionals to achieve great things in their respective professions is good for the industry and a trend that bears supporting.

10-1-2012 5-33-58 PM

Bill Rieger is chief information officer at Flagler Hospital of St. Augustine, FL.

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