MBA Alumni – Guest Speaker

Posted by on 1:40 pm in InuiTion | Comments Off on MBA Alumni – Guest Speaker

I have been asked to speak at my Alma Mater’s – Mount St. Mary’s University next Community Luncheon to discuss “The Business of Healthcare”


Featured Article in MBA Alumni Newsletter

Posted by on 8:05 am in Leadership | Comments Off on Featured Article in MBA Alumni Newsletter

I attended Mount St. Mary’s University for Graduate School.  I was recently featured on the 2017 Fall – MBA Alumni Newsletter.























Here is the access to the full MBA Newsletter Fall 2017

8 Common Myths About the Nursing Field

Posted by on 3:21 pm in Insights | Comments Off on 8 Common Myths About the Nursing Field

By Guest Contributor: Masters in Healthcare

Blame it on Hollywood: thanks to an endless stream of TV series and movies set in hospitals, most of us probably have the wrong idea about what nurses do and just how important they are to the medical field. They’re usually depicted as smart but somehow inferior to doctors, as if they didn’t have their own medical knowledge or years of experience to guide them through the days. But this, like a lot of other popular portrayals of nurses, is almost moronically lazy and misinformed. Nurses are integral members of a health care team. If you’ve ever come across any of the myths below, or even if you’ve perpetrated them, know that the truth is a lot more interesting than the fictions.

  1. All nurses are women: Not true. Admittedly, women outnumber men in the nursing field by a large margin — in the United States and Canada, only about 5-6% of nurses are men — but still, it’s wrong to say that there aren’t any men in the field. As a result of the gender imbalance, the profession is often perceived as an exclusively female one, which in America makes it a feminized one and therefore a less powerful or worthwhile one. Accordingly, portrayals of male nurses perpetuate the stereotype; a few years ago, on Scrubs, Rick Schroder played a nurse with the surname Flowers. Come on.
  2. Being a nurse isn’t as challenging as being a doctor: Are you serious? Being a nurse requires education, critical thinking skills, and serious amounts of medical training. Nurses perform research, participate in surgeries, administer medicine and treatments, and act as the glue that keeps the hospital running. The hours can be long, but the work can be extremely rewarding on personal and professional levels. What part of that doesn’t sound challenging?
  3. Nurses function as gofers for doctors: Again, a common misconception but a horribly wrong-headed one. Nurses often work in a capacity that sees them assisting doctors, but they’re anything but errand-runners. Nurses diagnose and treat patients, provide health care strategies for the infirm, and work to ensure people know how to take care of themselves. Nurses save lives, period. They apply medical knowledge in a host of areas to a steady stream of patients, and they do it every day. Helping out a doctor, even when it means retrieving something, doesn’t turn them into dull physical laborers in scrubs.
  4. Nursing is a dead-end job: The Bureau of Labor Statistics pegs nursing as a hot field, with prospects for RNs listed as “excellent.” Why? Well, baby boomers are getting old, and we’re also living longer in general, which means there’s going to be a glut of Americans putting a strain on the health care system. If you’ve got the training, you can likely find work, especially if you’re willing to relocate. What’s more, nurses with the right kind of training can further their careers in specialized fields (midwifery, elderly care), which opens doors to even more jobs and opportunities. In short, a smart nurse will succeed.
  5. Nurses are all the same: Even patients in hospitals are rarely aware of what nurses do. They see people in scrubs walk in and out, but that’s about it. It’s easy to start thinking that all nurses have the same duties, training, goals, and career paths. But think for a second about the fact that you see nurses in all parts of the hospital, no matter what department or specialty you’re visiting. That’s not an accident. Nurses working for ear, nose, and throat doctors have otolaryngological training; pediatric nurses have knowledge of and training with children; etc., etc. Being a nurse means committing to any one of dozens of specialties, and more if you change tracks.
  6. Nurses are people who couldn’t hack it in med school: One of the ugliest myths out there. It’s not unique in assigning weakness to a particular medical job that’s misunderstood; dentists deal with the same stuff. (Thanks, Jerry.) But nursing isn’t a fallback. It’s not an also-ran for people who wanted to be doctors. It’s not a consolation prize. It’s a conscious career choice made by people who want to work in health care, and it’s one that requires some real education. Many nurses hold bachelor’s degrees in their field, and some nurses even go on to attain higher medical degrees but remain devoted to nursing or working a nurse-like relationship. Nurses provide top-flight medical care for patients. They know what they’re doing.
  7. Nursing is grunt work: It’s true that nurses are often called upon to perform physically demanding tasks in the course of providing medical care to patients of all ages and shapes, but it’s incorrect to assume that all nursing boils down to a willingness to lift people, boxes, and bedpans. What’s more, nurses work in a variety of fields, whether in hospitals or other areas, and such tasks are only usually a fraction of what they deal with in a given day. This myth is related to the one that says nurses are merely hired hands or assistants meant to run errands, but it’s insidious enough to count as its own separate untruth because of how badly it misrepresents the scope of what nurses do.
  8. Nurses don’t get paid well: The federal government reports that median income for RNs in 2008 was $62,450, with earnings ranging from $43,000 to $92,000. That’s nothing to sneeze at, considering that some studies show that anyone earning more than $70k a year has already hit peak happiness in terms of salary. What’s more, many hospitals provide tuition reimbursement for classes designed to advance your degree, which helps save cash. Plus there’s access to entire fleets of medical professionals who know you personally. The medical benefits of being a nurse are definitely not to be overlooked. Between the perks and the salary, it’s a smart job choice.

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Masters in Healthcare  is your source for finding the best online Master’s in Health Care Degrees

Email 101

Posted by on 11:48 am in Insights, Leadership | Comments Off on Email 101

ILKC62E3GCWith the advent of various social medial outlets, text messaging, the use of hash tags and not to mention emoji’s, the line for appropriate communication has become complex.  More and more we rely on digital media as opposed to print to organize and streamline our lives.  As the complexity of doing business increases, so does the medium of which we used to communicate.  I find it lately that I need to remind my colleagues on the appropriate use of email.  It is a popular way to reach out and communicate, but unfortunately have not been used with any kind of standard or basic “rules of engagement.”  What I would like to publish are suggested standards that may be note worthy to incorporate from within your organization:

Email 101

  1. The More the Fewer… As a rule of thumb, the more people to whom an email is sent, the less likely any single person will respond, much less perform any action requested.  Those addressed in the “To” field are expected to read and respond. Those addressed in the “cc” field are not expected to respond. Only those who need to be aware of the message of the email should be copied and the number should be limited to the greatest extent possible. The “bcc” field should be used even more sparingly, as those recipients will not visible to others.
  2. Get to the Point! Always include a subject and make sure it is specific and clear. Do not make the reader wade through a long message to get to the point. State the most important point first.
  3. Don’t Write a Book! Like the number of addressees, the longer the message, the less likely recipients will respond quickly. The message will be set aside until there is more time, and, unfortunately, forgotten. Long messages should be written in memo form and attached to an email. However, if you must send a long email, warn the recipient in the subject line by stating, “LONG EMAIL ALERT”. Presumably, the message will explain why an email was used instead of a memo. This is especially important in the days of smart phones where reading long emails is cumbersome.
  4. Stick to the Point! Don’t discuss multiple subjects in a single message. This makes it possible for the sender and the recipient to scan subject lines later to find the message.  It also contributes to briefer e-mail messages and a greater likelihood of a response.
  5. Provide “If-Then” Options.  Provide options to avoid the back and forth of single option messages.  For example, “If you have completed the assignment, then please confirm that via e-mail.  If not, then please estimate when you expect to finish.”  Or, “I can meet at 10:00 a.m., 11:00 a.m. or 2:00 p.m.  Will one of those times work?  If not, would you please reply with three times that would work for you?”
  6. Never Assume.  If you are not sure of the intent of the message, ask! This will avoid misunderstandings.
  7. This is Not a Guessing Game! When responding to an email, answer all questions, and when possible, pre-empt further questions. If you don’t know the answer to a question, say so and either state where the answer might be found or indicate when you will respond with the answer. This saves everyone time – AND frustration. If you are able to anticipate follow up questions, do so. The recipient will be grateful and impressed with your efficient and thoughtful customer service.
  8. Silence is Not Golden! E-mail doesn’t demand an instantaneous answer; however, it does generally require a timely response. If you are in sales, customer service, tech support, or similar fields, a rapid response – within hours – is expected. For most others, responding within a day, maybe two days, is sufficient.
  9. Don’t Take That Tone With Me! Unlike face-to-face meetings or even phone calls, those who read your e-mail messages don’t have the benefit of your pitch, tone, inflection, body language or other non-verbal cues. You need to be very careful about your tone.  Sarcasm is especially dangerous.  If something gets “lost in translation,” you risk offending the other party.  The more matter-of-fact you can be, the better.
  10. Sleep On It… Never fire off an e-mail in anger.  They rarely serve their purpose or further long-term interests and often result in ruined relationships. If it makes you feel better, go ahead and write the message, BUT DON”T SEND IT! If you go back and read it a day or two later, you’ll understand the wisdom of restraint.
  11. Facebook This Isn’t! When you are one of many recipients on an email, unless asked,don’t “reply to all”. Not everyone needs to know if you are booked on Friday at 10:00! This just adds to everyone’s already unwieldy Inbox.  Your default response should be only to the sender.
  12. Don’t Be a Tattletale! It’s one thing to copy someone’s boss as a courtesy, such as when making an assignment to someone who is not a direct report to keep their supervisor in the loop.  But it is not a good idea to do this as a form of coercion. It is not subtle and you aren’t fooling anyone. You may be tempted to do this when you don’t get a response to an earlier email. You will be better served to pick up the phone and call the person.  If they are not responding to your e-mails, try a different communications strategy.
  13. Full Disclosure Is Required. Use a signature with your contact information.  This is a courtesy for those receiving your messages.  It also cuts down on e-mail messages, since people don’t have to send a second or third e-mail asking for your phone number or mailing address.
  14. English 101. Lapses in grammar or punctuation can be forgiven, but misspelled words are just too easy to correct.  That’s why we have spell-checkers.  Make sure yours is turned on.
  15. Measure Twice, Cut Once!  It’s a good idea to re-read your messages and make sure that you are communicating clearly and observing good e-mail etiquette BEFORE you hit send!
  16. Decisions Decisions! Don’t assume that email is always the best method.  Decide whether it is better to write or call. You don’t have to reply to an email with an email. If it is more effective, call the person and talk through the issues raised in the email. And if you find that you are emailing back and forth with someone trying to come to closure on a topic, pick up the phone and resolve it in real time. A good rule of thumb is that if there are three emails (email, response, response to the response), pick up the phone or use your feet to go across the hall.
  17. Early Dementia? Be sure your email box is set up to include the original email in your response. (Also, don’t click “New Mail” instead of “Reply” when responding.)  Don’t leave out the message thread. If your recipient sends and receives many emails, he / she can’t remember each individual email. A “threadless” email will not provide enough information about the context of the message and will frustrate the recipient.

Patient Engagement: 101

Posted by on 1:14 pm in Featured Article, Insights | Comments Off on Patient Engagement: 101

Patient Engagement: 101

Patient engagement is a new term in the health media but in simple words it is nothing more than developing better relationships with patients. There has been a steady deterioration of the patientZV0YSZWGO6 physician relationship over the past few decades. Many consumers are also disheartened by conventional medicine therapies and they have turned to alternative care in droves. While in some cases the fault is due to the patient not understanding the medical process, healthcare workers are also responsible for the decline in this relationship. So how does the healthcare industry win back patients?

There is now solid evidence that people who actively engage in their healthcare tend to have not only better outcomes but also lower costs than those who do not. Patient engagement is just one strategy aimed at achieving better healthcare outcomes; improve quality of care and much lower costs. As a result of these findings, many healthcare institutions and healthcare professional are utilizing newer strategies to engage patients. In most cases, the aim is to involve patients in making healthcare decisions and educate them about their medical conditions.

However, patient engagement is not straight forward and there are many obstacles that need to be overcome. Some obstacles are attributed to patient characteristics and others to the healthcare providers. Patient factors that may not make engagement easy include the degree of health literacy, culture, age, personal beliefs, etc. The only way round this is for healthcare institutions to educate their patients.  Healthcare factors that have made patient engagement include too many patients and too little time, other demands in healthcare, lack of reimbursements, etc. In a country like the USA, there are people from many diverse backgrounds. These individuals come from different cultures; have different values and religious beliefs. Many immigrants have strong affiliation with alternative healthcare and they are also very superstitious. They are also paranoid about conventional medicine.

So how do we engage patients?

Now that healthcare is undergoing revolution with the introduction of electronic technology, many healthcare organizations have started using patient portal and apps device to link to patients. Today apps devices can let patients know the waiting times in the emergency room, the time the doctor will be back in the clinic, their hospital bill, and there is also ample education information about many medical disorders. However, the use of electronic device assumes that the patient is versed in this technology and will also be using it. While younger people do use electronic devices they don’t make up the majority of patients in hospitals.

Doctors and healthcare organizations are also making great effort to educate patients online and offline. Some are using leaflets and brochures as well as having website to engage patients Unfortunately one major complaint by patients is that it is not the lack of medical information that is the problem; it is the difficulty in accessing a healthcare provider or getting timely services that are the key problems. Patients complain that there is ample medical information online and they do not need anymore- they just want to speak to a healthcare provider. Even making an appointment to see a healthcare provider requires time and effort-primarily because the system is so bureaucratic.  Even when electronic means of patient engagement are employed, patients complain that physicians rarely respond and almost never return their phone calls,

Another area where patient engagement is lacking is with the caregivers; close to 93 million friends and family look after someone they love and yet these caregivers are treated as nonentities by the healthcare system. When these caregivers ask questions on behalf of their loved ones, the usual rhetoric about confidentiality is stated and information is not provided.

In addition, the majority of patients in the US are the elderly who make up close to 70% of patients with chronic disorders. Many of these patients have varying degrees of cognitive deficits and most have never used a mobile phone, let alone an android. How can technology help to engage such patients?  Sure it is not via electronics. These patients need direct physician contact and communication.

While many states have laws that encourage shared decision making and getting an informed consent, there is often a lack of communication between the patient and the physician.  While patient engagement can be accomplished with electronic devices and apps, experts say that humanity needs to return to healthcare. Before one starts going hi-tech, one needs to start listening to patients and spend a few minutes more during each visit. There is no other substitute for the human voice. There is no machine, android, mobile phone or computer that comes close to the touch of a human hand and the gentle voice of a caring doctor. And this is where it should start.

The Implementer’s Dilemma…

Posted by on 3:52 pm in Insights | Comments Off on The Implementer’s Dilemma…

WBDINSMDFO (1)I was reflecting on my multiple implementation experiences, considering now that I have several under my belt, as I have also transitioned out of one well known EHR system to learn another.  I came from a medium sized community hospital, transitioned to a well known prestigious academic center to now being a part of a fast growing specialty and research driven organization.  I came to a realization that despite the organizational type, the dilemma an implementer faces does not change…just the magnitude.  With that said, I have begun to list of what I call, “The Implementer’s Dilemma.”

  • You only have one chance to implement correctly.  The second chance will be a climb of magnitude proportions.
  • Physician’s have a lot of input to provide, but do not have a lot of time to see it through its fruition.  Physicians are not into disruptive technology.  They are just against disruption on their workflow.  We as implementers tend to see this as synonymous, but quite frankly they are not…
  • Clinician’s are willing to provide you their input to enhance and optimize your system.  But, when the rubber meets the road and their peers “jury of their peers” do not like what has been implemented, these willing input providers will be the first to turn their backs on you.  Even fabrication of communication can be found in some instances, for example:

o   “That is what I told them.”

o   “I told them that would not work.”

o   “I must have been absent when they made that decision.”

o   “I would never have approved such a thing.”

  • It is easy for executives to call an implementation “mandatory.”  But, unless the “mandatory” imposition has some teeth, it truly is just voluntary.
  • Most clinicians feel that “computerization” has taken them away from the bedside.  Therefore EHR/EMR are seen as a big intrusion in their practice.

I wanted to keep this going, so comments section open for additions.  You can also send your comments via Twitter @InuiTion.  I will collate and see what we come up with 🙂

The hospital held hostage by hackers

Posted by on 11:41 am in Insights, Leadership, Tech Talk | 1 comment

The recent security breach at Hollywood Presbyterian Medical Center is an excellent reminder that even though most organizations feel they have good network security in place, no organization is 100 percent secure. A big part reducing the likelihood of compromise begins with users and their computer habits. Below are areas of risk and good computer habits to help reduce the likelihood of compromise:


  • Never give out your password information in Email or over the phone. Think of your password as your bank PIN and protect it!
  • Never click on a link in an email you’re not expecting or can’t reasonably validate as legitimate.

Internet Surfing:

  • Limit your internet surfing to business relating to your organization and reputable sites.

Social Media Website:

  • Unless there’s a business need, use your phone to access social media sites such as Facebook and Twitter.

Save Important Information on the Network:

  • Modern enterprise storage allows your information to be reasonably recovered in the event of compromise.

Los Angeles medical workers are dealing with an internal emergency straight out of the canon of science fiction.

Source: The hospital held hostage by hackers


To Wear or not to Wear…

Posted by on 4:21 pm in Insights, Tech Talk | Comments Off on To Wear or not to Wear…


I came across this YouTube (video embed below) video the other day which really inspired me to write about it in this post, which is really to try and address the power of data to influence people to action.  I am cognizant of the fact that this may not work for all, but I know I personally went into the same journey trying to loose weight and how being able to track and analyze my data made it possible for me to achieve those marginal gains that add up collectively into major improvements in my lifestyle.  It has actuallly made the journey much more enjoyable for me in the process and I am now in the process of evaluating what other gains I can accomplish — meaning, I have lost the weight, how to I keep it off…

Wearable Technology and Healthcare

Aѕ wе marvel аt thе gadgets thаt companies such аѕ Nikе, Fitbit, Jаwbоnе and Aррlе hаvе rесеntlу рrоduсеd аnd brought to market–gadgets thаt саn record оur heart rаtе, саlоriеѕ еxреndеd, аnd steps tаkеn—оnе саn only think оf hоw this tесhnоlоgу could likely bе uѕеd оn a grеаtеr ѕсаlе to hеlр those who truly nееd it thе mоѕt: реорlе with сhrоniс medical illnesses such аѕ еmрhуѕеmа, diabetes, or соngеѕtivе hеаrt fаilurе.

Wearable mеdiсаl tесhnоlоgу iѕ bесоming a hоt commodity. Aѕ these devices соmе tо mаrkеt, they hаvе the роtеntiаl tо hеlр bоth patients and clinicians monitor vitаl ѕignѕ аnd ѕуmрtоmѕ. Devices wоrn оn or close tо the body are еxресtеd tо produce thе mоѕt ground-breaking innоvаtiоnѕ. Thеrе iѕ inсrеаѕing clinical еvidеnсе оf thе vаluе оf соntinuоuѕ рhуѕiоlоgiсаl dаtа in mаnаging сhrоniс diseases аnd mоnitоring раtiеntѕ’ post-hospitalization, as a result, a growing number оf mеdiсаl dеviсеѕ аrе bесоming wearable, including gluсоѕе mоnitоrѕ, ECG mоnitоrѕ, рulѕе оximеtеrѕ, аnd blood рrеѕѕurе monitors.

In thе futurе, wеаrаblе healthcare monitor dеviсеѕ can bе used in a vаriеtу оf diffеrеnt wауѕ. In assisted living facilities, раtiеntѕ саn be outfitted with dеviсеѕ that will mоnitоr a nurѕе оr doctor if thе patient falls, for еxаmрlе. Of соurѕе, соmраniеѕ аrе working hаrd tо develop a wearable hеаlth device for ѕоmе оf the mоѕt соmmоn ailments, dеѕigning each tо hеlр раtiеntѕ livе thе kind of livеѕ they wаnt. Patients саn еаѕilу monitor heart rаtеѕ, blood рrеѕѕurе, аnd more with lightwеight wearable health tесhnоlоgу. Thе dеviсеѕ can bе аѕ соnсеаlеd as possible, if раtiеntѕ аrе lооking tо аvоid thе аttеntiоn that соmеѕ with using thеm. Yоu can even sync with a ѕmаrtрhоnе or tаblеt tо keep track оf your mеdiсаl information with greater ease.

Prоgrаmmе Bеnеfitѕ:
Participants can ѕее hоw thе convergence оf kеу tесhnоlоgiеѕ has еnаblе thе соnѕumеriѕm оf hеаlthсаrе, allowing wеаrаblе devices tо be раrt of an individuаl’ѕ hеаlthсаrе dеlivеrу ѕуѕtеm. Wеаrаblе dеviсеѕ аrе now соnvеniеnt, реrvаѕivе аnd ubiԛuitоuѕ. Mаturitу of apps in smartphones аnd tаblеtѕ hаѕ also еxраndеd thе роѕѕibilitу оf such dеviсеѕ in рrоviding a computing and integration platform with еntеrрriѕе systems, аllоwing hеаlthсаrе рrоvidеrѕ tо intеrасt with ѕuсh devices аnd dеlivеr bеttеr, tаrgеtеd саrе.


10 Biggest Epic EHR Implementations in United States

Posted by on 12:02 am in Tech Talk | Comments Off on 10 Biggest Epic EHR Implementations in United States

I am a big fan of the Epic EHR System.  I have implemented it in a previous life and have grown to  be a fan of the integrated solution.  Growing up in this space, there was always the debate between the beast of breed vs the integrated solution.  Unfortunately 10 to 15 years ago, there was a limit to what an integrated solution can do.

It is interesting to note that everyone who was in Healthcare IT back in the days before Meaningful Use, watching Epic and Kaiser embark on their implementation plans, thinking it was doomed to fail.  Who would implement a no known ambulatory system and try to impose it across the enterprise – Kaiser Permanente did and now they are the gold standard to what an integrated solution should look like…


Here is a breakdown of the ten largest Epic EHR adoptions by healthcare systems in the United States using data and intelligence from Definitive Healthcare.

Source: 10 Biggest Epic EHR Implementations in United States

CPOE as an Iceberg

Posted by on 10:13 am in Insights, Leadership | Comments Off on CPOE as an Iceberg

slltcchangemgmtsl3In the process of rolling out Computerized Provider order Entry (CPOE) for one of my prior implementations, our Chief information Officer (CIO) passed out the book “Our Iceberg is Melting” by John Kotter and Holger Rathgeber.  For this post, I decided to provide you my review and commentary as well as anecdotal accounts experienced in the transition to CPOE….


Embarking on a journey of implementing a Computerized Provider Order Entry (CPOE) has been of recent a strategic goal for many health care organizations looking to take advantage of stimulus funding made available by the American Recovery and Reinvestment Act (ARRA).    The impetus to adopt such a technology stems from a November 1999 Institute of Medicine Report (IOM) that found 98,000 Americans die every year from preventable medical errors in hospitals (  Consequently the health care industry has focused on a new technology CPOE as the messiah that can provide organizations the tool needed to prevent all of these unwarranted errors and subsequently improving patient safety.  Unfortunately, “use of CPOE is not widespread.  Presumably, implementation lags because CPOE, by reputation, is hard to implement, expensive and difficult to coax clinicians (Physicians) to use (Ash, Stavri & Kuperman, 2003).”  Recent legislature however provided health care organization with the proverbial iceberg that was desperately needed or that sense of urgency to propel a CPOE change effort from a nice to have to a must have.  President Obama’s American Recovery and Reinvestment Act (ARRA), includes a provision “to improve American health care delivery and patient care through an unprecedented investment in health information technology (HIT)…the Act focuses primarily on promoting the wide deployment and use of electronic health care records (EHR) among health care administrators and providers across the country (”  This act has laid out an aggressive incentive program to assist organizations move towards HIT, but also penalties for those slow to adopt.  This review will chronicle how the book, Our Iceberg Is Melting has masterfully outlined the steps necessary for a successful change transformation effort.  Specifically, how crucial it is to have a sense of urgency and identifying the appropriate team to be the ambassadors of change.   In the process a parallel analysis will be exemplified by looking at the dynamics experienced in the Penguin colony and similarly to organizations who implement CPOE.

     Our Iceberg Is Melting is a clever fable that helps provide readers key insight into the psyche of a penguin colony as they shift a long standing lifestyle to a nomadic one (Kotter and Rathgeber, 2005, p.  140).  The utilization of a fable is a clever approach to bring light to a topic that is typically the canonical “elephant” in the room that no one dares to discuss.  It provides simple stories to assist change agents realize that merely saying business as usual can no longer exist, but change is now necessary to compete in a continuously evolving world.  This fable truly reminds us that the word change and its inherent meaning may seem simple, but doing and making it happen and stick is where the difficulty truly lies.

There are numerous publications that site the obstacles organizations face when implementing CPOE.  The challenge however is not so much in the technology, but in the ability of organizations to weather through the resistance that comes with such a huge organizational overhaul.  Case in point was Yale New Haven’s three hospital system that utilized a separate CPOE software package (Birk, 2010).  In Birk’s (2010) study it was evident that Yale New Haven as an organization was able to show that CPOE will work with three different systems, and there are pros and cons to each of the products.  But it is not the products that are going to make the difference; it is the leadership support of the implementation (Birk, 2010).  As depicted in Our Iceberg Is Melting, leaders like Louis were necessary in any organization serious about making a change.  It is leaders who possess Louis’ leadership trait that can help manage the NoNo’s in every organization who claim to support the change effort, but only to later find out the support was only when it was convenient and did not affect their respective areas.  Leaders such as Louis is necessary because they have the foresight to understand and strategically hand select the right group matrix to lead the change.  Every organization will need an Alice with an unwavering personality that will help the organization stay the course and keep the transformation efforts going.  An out of the box thinker like Fred is a necessity because they have the ability to look beyond the status quo.  Of course every change effort requires factual, evidenced based best practice citations that only a Professor in the group can provide.  But as Kotter and Rothgeber (2005) suggest, change efforts is often an emotional transformation rather than a logical one and therefore you need a Buddy who has the ability to appeal to the emotions of the masses (pg.  142).  A guiding coalition such as the one identified by Louis is truly necessary in any transformation efforts that will buy in to the vision and ultimately understands why change is necessary.

Lacking that sense of urgency is truly the reason why many organizations fail in their transformation efforts (Kotter and Rothgeber, 2005).  A CPOE implementation is no different in that not having enough urgency will not propel an organization to be convinced that change is necessary.  A firsthand account of this dynamic was evident at a non-profit health care organization that decided to implement CPOE, but did not evoke a strong enough sense of urgency.  Despite a Chief Information Officers (CIO) plea to the organization to understand the ARRA requirements are looming, not enough in the hospital leadership was converted to the idea that a CPOE implementation was a high priority.  This was evident at project launching and the Chief Executive Officer (CEO) in the process was practically non-existent.  The CIO created a CPOE Leadership Committee where in leaders can strategically collaborate on the implementation effort, but the CEO was never in attendance.  In defense of the CEO, he did provide the project the lip service it needed, publishing his full support in monthly publications to all staff.  Communication of this support even went to the extent of publishing its importance in a quarterly newsletter that was typically addressed to the organizations Board of Directors and Medical Executive Committee.  However, the project lacked the outward display of support it needed from the CEO.  CPOE projects require the needed tangible support that one would typically see evident in actual face to face meetings, rather, the support was displayed in the safe confines of printed memos and newsletters where it was harmless and practically did not provide a venue to challenge any of his statements.  The CEO in this case did not have the conviction of a Louis who can withstand the grumblings of the colony.  The CEO did not provide the CPOE project what Ash et al. (2003) call the commitment that is unwavering and visible.  In order for CPOE implementation to be successful, the organization must have adequate finances, technical infrastructure, project management expertise and staff readiness for CPOE, this has to be coupled with real and visible commitment of the CEO (Ash et al.  2003).  The lack of CEO support was clearly evident when decision time came to strategically identify if CPOE was going to be mandated or voluntary.  The other clinicians (i.e. Nurses, Pharmacist and Respiratory Therapist) who would be affected by this change made it clear to the CPOE Leadership Committee that mandating CPOE would be the less risky route, because the source of orders would be less ambiguous which could lead to medication errors.  The CPOE Leadership committee with a strong recommendation from the CEO, afraid at the potential turmoil a mandatory physician CPOE requirement would illicit decided against it and made the use voluntary instead.  This was truly an example of a lack of shared vision regarding the purpose of CPOE and why, “the current state is suboptimal and change is needed (Ash et al.  2003).  Because the CEO did not have the same conviction of a Louis, the organization did not have the type of leader that was needed that would say, “Yes, this is hard work. Yes, the physicians will resist, but it is the right thing to do.”

Although very clear that a sense of urgency along with a strong guiding coalition is necessary to push any transformation efforts, the fable however due to its simplicity fails to underline the tremendous challenge that comes with injecting an organization with the right amount of urgency.  Clearly, the non-profit organization due to the lack of leadership did not have the foresight to see a CPOE project as a quality initiative for the entire hospital (Birk, 2010).  Despite having a clear and present “iceberg” which in this case even involves the Federal government providing the necessary pressure, logic is defied by emotions.  Unfortunately in the case of the non-profit organization, it may take a failed project coupled with financial penalties to be the strong force that will convince leadership to provide the CPOE project its much needed recognition and support to be successful.


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Kotter, J., & Rathgeber, H. (2005), Our iceberg is melting: Changing and succeeding under any conditions. New York, NY: St. Martin’s Press.