Change Management: Influencing the Uneasy Alliance Between Man and Machine

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No one faces a constantly changing landscape more than the CIO at a large health care institution. Until recently, Michael T. Balassone was CIO at West Virginia University Hospitals, a 522-bed teaching hospital and medical complex in Morgantown. He currently serves as senior information officer, University Medical Associates, Medical University of South Carolina, Charleston. His message, presented on May 16, 2008, at the annual meeting of the Society for Imaging Informatics in Medicine in Seattle was that the pace of change requires CIOs to create new paradigms to deal with the shifting status quo. On one side, Balassone says, are the technological changes that are producing more capable (but complex) scanners, computer systems, and data-storage/manipulation systems all the time. While the lags between technological generations were broad in the early years, new versions of hardware and software are much more tightly spaced now, he says. Technology Evolution Over a period of about 15 years, Balassone notes, microprocessors went from “the equivalent of about 29,000 transistor replacements up to about 55 million transistor replacements—a fairly large gain over a fairly long period of time.” Then, gains in the capacity of chips accelerated. Between 2005 and 2007, chip sets went from single units to dual and quad processors that doubled and quadrupled processing power. “We are now up to about 580 million transistor replacements,” Balassone says. The evolution of CT scanners has been similar, with slice counts moving from 64 to 256 between 2005 and 2007. “That’s a lot of change for an organization to deal with in a very short period of time,” Balassone observes. In the past 10 years, the other sorts of applications that a CIO might have to deal with have gone from wireless communication, videoconferencing, and handwriting and speech-recognition devices to a whole range of voice over Internet protocol technologies, radio frequency trackers, biometric devices, tablet PCs, and speech-synthesis systems, Balassone says. “Not all these technologies make it to maturity, and not all these technologies become commonplace in every institution, but they are there, and we have to understand what that means as a CIO. To do that, I have to understand where my organization is in acceptance of change. Are we going to be an organization on the cutting edge of technologies, or are we going to take the safer approach of more mature technologies? That’s a decision each institution has to make for itself,” Balassone says. Another factor is competing through technology. If your competitor has a 64-slice CT, do you need one? “You have to understand asset management. When does the asset wear out—when it is obsolete?” Balassone asks. “You also have useful competitive life; the question is, is that the same as the useful functional life?” It might not always be the same, he suggests, but whatever the motive for replacement, cost is always an issue. “As a CIO, I not only endorse the acquisition of technology to support better patient care; on the flip side, I have to answer questions of network support and storage. How am I going to back it up? We have to be an integral part of those decisions organizationally, and they go on every day in my institution,” Balassone explains. The Generational Challenges The technological changes pale in comparison with what CIOs have to deal with on the people side, especially where there are several generations of employees in the health care entity, all working with different mindsets, Balassone says. He defines four generations still in the hospital work force: The veterans, born between 1922 and 1943; the baby boomers of 1943 through 1960; the members of generation x, born from 1960 through 1980; and the generation next members born between 1980 and 2000. “All of them have significant strengths and weaknesses,” Balassone says. Veterans are reliable, boomers are driven, x members are unintimidated by authority, and next members have technological savvy and are good at multitasking. Keeping all four groups on the same page is a challenge, Balassone suggests. Since information flows through what people do with technology, the CIO has to be aware of the human aspect, he adds. Looking at the West Virginia hospital’s nursing staff, Balassone notes, more than half are members of generation next, but about 20% are boomers due to retire in the next 15 years. This indicates that an increase in the nursing shortage will occur, he says. Doing a similar analysis of a whole department or institution will “give you some interesting results—which groups are devoted to the job, which to the dollar? You will get very different results and have to manage those different groups.” He says that it is the CIO’s responsibility to make the CEO and the hospital board understand what the definition of life cycle really means. It is the same with people and with asset management, he says. There is always the interaction between the staff life cycle and the equipment life cycle. “Having the right technology can make a big, big difference in how well you can recruit and retain,” he says. New graduates may expect the latest technology. The balancing act between equipment change and personnel change is something that the CIO needs to keep in focus, Balassone emphasizes. Change is always ongoing, he concludes. “You have to be ready, you have to know your organization’s capacity for change.”