8 strategies for managing rapid change from NewYork-Presbyterian CIO Daniel Barchi

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For CIOs and other health system and hospital leaders alike, it is imperative to remember that managing change — whether that be implementing EMRs, clinical pathways or new reimbursement models — is really about managing people, according to Daniel Barchi, CIO of NewYork-Presbyterian Hospital.

Here are eight key principles for managing rapid change, as presented by Mr. Barchi during the Becker's Hospital Review 2nd Annual CIO/HIT + Revenue Cycle Conference in Chicago.

1. Do the work to understand history. After examining a photograph of the Chrysler Building in a conference room at NewYork-Presbyterian one afternoon, something struck Mr. Barchi — and led him on a hunt across the internet, ultimately drawing him to the ALDO Shoes store in the iconic skyscraper's basement. There, he was delighted to find a shoe rack running on a slant toward the Northeast. Through his research, he had discovered the diagonal follows the ChryslerBuilding's trapezoid-like shape, which is determined by a property line that predates the city's 1811grid plan. The property line was based on a trail made by the Lenape tribe of Native Americans.

"I was blown away to think that because of an Indian trail that predated all the modern settlement of Europe, that this ALDO shoe store has a rack that runs to the right," he said. Why care about the Lenape trail, the Chrysler building or the shoe store at all? "We all work in complex environments. We have to know the history of what's going on," Mr. Barchi said. "Let the past inform you." Managing the future is incredibly difficult without knowing anything about the past.

2. Focus on people and processes. Many people believe health IT is about what Mr. Barchi calls the "BSOs," or bright, shiny objects. And while it may be tempting to spend millions on exciting new technologies, applications and equipment, that's not the best way to solve IT problems. Instead, Mr. Barchi believes healthcare is actually "80 percent people, 10 percent process and really only just a sliver of technology." The technology you need probably largely exists already in your hospital or health system, and simply needs to be leveraged to best support your people and processes.

3. Think differently. The development of penicillin is a prime example of thinking differently, according to Mr. Barchi. After a Scottish farm boy — Alexander Fleming — graduated from St. Mary's HospitalMedicalSchool in London, the school's rifle team wanted to keep him, so they asked him to join the research department. Mr. Fleming was placed in the inoculation service, where he experimented with different bacteria. His experiments in the lab later led him to discover a fungus that could kill bacteria — penicillin. It wasn't until a dozen years later, when a team of chemists got involved, that the antibiotic was finally produced and tested on humans. Mr. Fleming would have never been able to discover the fungus that ended up saving innumerable lives if he did not have the freedom to experiment, according to Mr. Barchi. Giving people room to think outside the box is critical to moving ahead. "It's really about leveraging people to do really good work," he said.

4. Simplify. Many health systems have built best of breed health IT systems, according to Mr. Barchi. They buy the absolute best technology for anesthesia, perioperative and ophthalmology systems, for example, and then attempt to tie them all together for the best overall system. This approach runs the risk of resulting in a hodge-podge in which the sum is not greater than its parts.

"I'm a big fan of just making things very simple," Mr. Barchi said. NewYork-Presbyterian owns and manages a tangled web of 2,200 interfaces that he is working to align. Standardizing and simplifying all these systems can lead to better quality, better delivery of care and ultimately, greater physician satisfaction, according to Mr. Barchi.

5. Be bold. "Life shrinks or expands in proportion to one's courage," said Mr. Barchi, quoting essayist Anaïs Nin. If people want to achieve amazing things and make changes effectively, they must create opportunities for themselves to do so. This requires boldness and willingness to move ahead with out-of-the-box ideas, even in the face of uncertainty.

Mr. Barchi compared the need to be a bold change leader in healthcare to his experience as a Naval officer. On an average day at sea, Mr. Barchi said his ship cruised at a slow pace to conserve energy. At low speeds, he was always concerned about accidentally hitting things in the water. However, during one deployment Mr. Barchi's ship was ordered to make a high-speed transit through the Suez Canal into the Red Sea. "When you're going that fast, there are far fewer things that can hit you," he said.

When it comes to designing and implementing change, it is important to keep up momentum and act on bold ideas, not be slow and worried about barriers.

6. Fail and adapt. Failure is an inevitable part of life, though many people believe leaders can't fail and still be regarded as successful. To illuminate this fallacy, Mr. Barchi pointed to President Abraham Lincoln. Mr. Lincoln is regarded as one of the greatest American presidents, yet he failed numerous times in significant ways. Among some of his most known defeats: losing his job in 1832, losing the race for Illinois House Speaker in 1838 and losing his run for Senator in 1854 and 1858.

Leaders today can't navigate through the uncertainty of change without setback or defeat. The true act of leadership is learning enough from failure to make meaningful improvements.

7. Persevere. Perseverance and failure go hand in hand, according to Mr. Barchi. "When you manage rapid change, you must be able to fail and stick to it. Success doesn't come overnight," he said.

The story of the Wright brothers perfectly exemplifies this notion, Mr. Barchi explained. Many people are unaware of the trials and errors that preceded the brothers' first successful flight. For two years before they flew in the first airplane, the two young men toiled with kite designs and studied wind tables in North Carolina. It took many failed iterations of an airplane before coming up with one that worked.

8. Maintain data consistency. The impetus to eliminate silos and improve coordination and collaboration among clinicians also exists on the health IT side of healthcare. For example, Mr. Barchi said it is not uncommon for one health system to have several teams perform different data analyses with little to no communication between one another.

"Everyone wishes they had better data," said Mr. Barchi. "This problem is only exacerbated by having so many different teams working in silos."

To encourage team collaboration to ensure data is consistent, Mr. Barchi began holding weekly Friday lunches for joint analytics planning sessions, knowing food is an effective way to build stronger interpersonal relationships. Each week, the attending analysts would introduce themselves and share stories to help everyone get to know one another. Eventually, the walls between the different groups broke down and the analysts decided to form one joint data analytics team, thereby improving coordination and data consistency.

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