Leadership and Change

Abstract

This chapter discusses changes that leaders must address currently and into the longer-term future. Beginning with the COVID-19 Pandemic, much has changed in organizations, however this is not the only challenge facing healthcare leaders currently and into the future. Technological advances, increasingly relying on teleconferencing, and telehealth is rapidly creating a need for significant change. This chapter highlights the fact that senior leaders MUST build and maintain trust in their teams that support these rapidly changing systems and that this trust must translate to the customer (consumers of health care services). As all members and customers of organizations struggle with issues like the pandemic, an increase in remote (telehealth services), environmental crises (recent Texas weather and Detroit contaminated water), leaders must be empathetic and compassionate to all who are impacted. Focusing on the elements of Post-Traumatic Growth (PTG) allows leaders to address the impact of the recent pandemic and potential future challenges including technology and health IT-related crises as well. A coaching mindset and use of group and team coaching is rapidly becoming another ‘must’ in organizations. This ‘coaching approach’ not only enhances growth and builds trust, the organization benefits from valuable, creative contributions from members of the organization. When leaders change from a ‘control to coaching’ mindset, everyone in the organization is allowed to grow and help design new ways to meet emerging challenges/crises. Leaders also must anticipate and be prepared for Cyber Attacks and increasing unplanned Health IT-related challenges due to climate change (such as the recent Texas weather crisis). This chapter addresses important changes that leaders must choose to better function today and be prepared for rapidly changing new challenges. By embracing the importance of true empathy and compassion, adopting a coaching mindset, focusing on growth, shifting toward more heterarchical versus hierarchical structures/communication, and embracing synchronicity across the organization, leaders will better navigate changing needs and unanticipated crises.

Appendices

Appendix 1: Leadership Changes

Appendix 2: Hierarchical Versus Heterarchical Organization

1.1 Health IT and Leadership Challenges

According to a recent Forbes article, healthcare tops the list of the most cyber-attached industries (Top 5 Industries at Risk of Cyber-Attacks, Forbes 2020). “Chronic underinvestment in cybersecurity has left many so exposed that they are unable even to detect cyber-attacks [or malware attacks] when they occur.” (University of Illinois, 2020).” The New challenges include Malware and ransomware, cloud threats; misleading websites; phishing attacks; encryption blind spots; and employee error. Ensuring the security of healthcare systems will lay the foundation for the level of trust in healthcare.

Leadership in and of the technology and IT area(s) of any organization that uses the technology is difficult and is becoming more difficult. There are so many things about it that appear as magic to the uninterested, underinformed, and unfamiliar; consequently, for some it becomes understandably exhausting to make important and relevant executive decisions. Now to complicate things more, we must include the possibilities of pandemics, climate change, hacking, ransomware, and cyber espionage to the already difficult IT executive decision-making process. Additionally, integrating wearables which track and transmit consumer/patient health-related data to the cloud, both by patients themselves and providers require extended knowledge of complex systems. As mentioned previously the necessary transition to remote care will require an increased focus on consumer/patient collected data that tracks health, chronic care management (versus just treatment) and even citizen science-related data repositories for community-based health/wellness related data. Increasingly new senior housing will be ‘wired’ throughout the day and transmit data to the cloud for easy, ongoing evaluation—both by the patients themselves and by remote care providers. This level of monitoring can help patients with chronic conditions better manage their own health and as mentioned earlier, will shift some of the historical costs related to urgent care and emergency department visits. Finally, new complex systems including: store-and-forward telemedicine; software will facilitate asynchronous communication between consumers/patients and providers so that even photos, X-rays, messages and medical data can be exchanged. This will increasingly be relevant to ‘smart homes’ linked to provider systems for seniors, those with significant disabilities and healthcare enabled housing for historically underserved populations.

The main mission of any IT section is to create and continue the mission-prescribed function which is and will be increasingly complicated by telehealth and robotics in this rapidly changing environment. That function is determined by the organization and, from an IT section perspective, the rest of the organization that depends on its information technology are its customers, including itself. The organization is, to one degree or another, dependent on the IT section to meet its customers’ ever-changing requirements and to make those functions available upon customer (including internal customers) demands. And, the IT section is dependent on its customers’ interaction to define their needs. Without a functional and smooth interdependency such as this, the organization will experience a degradation of mission performance. At the executive decision-making level, some aspects of IT may seem like magic, but there easily understandable foundational requirements of IT systems. Electrical power, software, hardware, data communications, human resources, and security should be considered in support of any organization’s IT and other technological functions including new software and hardware for many systems that will need to adapt to the growing demand of telehealth, remote collaboration. (retrieved on 03/16/2021) from: https://www.intel.com/content/www/us/en/healthcareit/telemedicine.html#:~:text=Intel%20Provides%20a%20Foundation%20for%20Telemedicine%20Technology%20,enable%20manufacturers%20...%20%201%20more%20rows.

Obviously, electrical power must be provided, but its quality must be within normal limits and its availability should be congruent with the organization’s needs. For example, if the hospital’s mission is to provide services during natural disasters and the IT systems during that disaster are required, then acquisition, installation and testing self-contained power generating systems or contracting with a 3^rd party for electrical power must be considered. The recent cold weather spell in Texas is a good example of this situation. “Many hospital staffers have stayed in the medical facilities all week—knowing there was no heat or water at home. At least hospitals have generators for basic electricity” (1).

Benign and functional software running on reliable and sufficiently fast computers, wired or wireless communication media, and/or other data equipment, e.g., bio sensors are necessary to an organization’s IT section. If the software and/or its networking system has been maliciously changed or if the computers are insufficiently powerful enough to provide satisfactory services, then the organization’s mission performance will degrade. In the case of malicious changes to an organization’s software, it should be noted that those changes can occur due to the actions of malicious individuals/organizations or countries conducting criminal activity and/or denial of service activities. This list may include irate employees or hackers. Some more malicious attackers use ransomware which is “malware that requires the victim to pay a ransom to access encrypted file” (2). In contrast to ransomware, the malware attack against SolarWinds, Inc. was a significant and dangerous Cyber Espionage that, had it not been discovered, could have resulted in future debilitating Cyber Attacks, including ransom. Essentially, the sequence of events is summarized by an article published by Malwarebytes Labs where their Threat Intelligence Team said, “This scenario, referred to as a supply-chain attack, is perhaps the most devious and difficult to detect as it relies on software that has already been trusted and that can be widely distributed at once. Among the victims who received the malicious update are FireEye, Microsoft and the US Treasury and Commerce departments, making this one of the biggest cyber incidents we have witnessed in years” (3). A detailed technical explanation of the offending software can be found at CrowdStrike’s website article (4).

Physical security of IT assets is also important and should not be overlooked by organizations’ leaders. Physical security lapses can compromise mission performance as much as ransomware, fire, natural disasters or pandemics. “Information management security systems ensures information, no matter how it is transmitted, shared, or stored, is always protected in an appropriate manner.” So, protecting information from malicious physical access is as important as securing it from cyberattacks and the like. Leaders should consider the following elements of physical IT systems security:

Physical security policy

• Campus, building, floor, room, asset security

• Physical barriers

• Fire, flood, intruders and equipment temperature

• Card readers or combination locks

• Entry/exit logs or video

• Guards (5)

As indicated earlier, the IT section is dependent on its customers’ interaction to define their needs. The effects of COVID-19 during the last year have placed particular emphasis on this aspect of healthcare IT systems. Cerner Corporation reported “…some of the ways health care providers are using data and Cerner tools to strategically schedule their workforce and help avoid a staffing shortage during the pandemic.” Their customers were cited as needing the ability to visualize understaffed shifts, automate schedules during high demand times, track expenses that were not heretofore tracked, track teleworkers, and to track COVID-19 positive patients’ movement through the healthcare system. “Better patient outcomes occur when you have the right caregiver, in the right place, at the right time” (6).

Sufficient qualified technical and supervisory IT staff are needed to continue operation of the organization’s information system during normal and stressed times. Without them the organization will experience degrees of mission degradation. “a prolonged leadership void is too risky. It raises questions about a company's internal talent pool. Is it robust enough? How much attention has been given to developing internal talent, starting at the senior executive level? Are there ready candidates at every key position?” (7). Leaders must ensure that their organizations hire people with up-to-date skillsets unless their organizations are able to teach needed skills, or, through 3rd party teaching organizations, acquire those skillsets for their employees. CompTIA, Inc. suggests that “Digital operations are more important than ever, with many transformative changes accelerating over the past year. Fair treatment for all is an absolute mandate, making diversity, equity, and inclusion a top priority” (10).

The global IT industry is massive and affects most people in one way or another. “In 2020, the global information technology industry took a small step back in terms of overall revenue. As of August 2020, the research consultancy IDC was projecting global revenue of $4.8 trillion for the year, compared to their original estimate of $5.2 trillion. While the tech sector fared better than many other industries during the pandemic, it was not immune to cutbacks in spending patterns and deferment of major investments” (10). Due to good IT decisions made by leaders at many levels, people can now search for, order, and expect fast and reliable delivery of products with a few clicks/presses on their phones or personal computers. Information is available with little effort and time. Marketplaces are leveled now more than ever; small businesses can compete with larger corporations. Education and advice are just a few seconds away. And, with new digital creative tools like desktop 3D printing and milling for example, garage-level innovation and products can form the basis for thriving businesses and artistic expression. “There’s no denying that we live in the age of technology. No matter what industry or aspect of life today we look at, technology influences it in some way or another. It’s changed the way we look at and do everything…” (8). COVID-19 and its variants have caused us to change the way we work and interact with others. However, we do not currently possess the biological technology to eliminate that need for change in all future viral pandemics. Leaders can be thankful that our IT systems and anti-viral research were mature to the extent that they were when COVID-19 pandemic occurred, otherwise it could have been much worse, but leaders should be watchful.

This chapter began with a theme from another disruptive period, the 1960’s. So, an oldie but goodie lyric from a Buffalo Springfield song (1966) comes to mind to complete the chapter’s theme, but the lyric needs to be updated to hold this chapter’s context in mind. The parentheses are the authors’:

There’s something happening here

What it is ain’t exactly clear

There’s a man with a gun (mouse) over there

Telling me I got to beware

I think it’s time we stop

Children, what’s that sound?

Everybody look, what’s going down?