Change Management: A Critical Skill for Today’s CMIOs

The American Board of Medical Specialties (ABMS) approved the Chief Medical Information Officer (CMIO) subspecialty in 2011 when it recognized a growing divide between the capabilities providers needed to meet today’s clinical and administrative requirements, and what the IT community was providing.

“Doctors want systems that help them deliver quality care,” says Rocky Reston, MD, Cognitive Medical Systems’ CMIO. “But too often they are asked to articulate their requirements to technical people that don’t speak their language. There is a need for providers who can translate clinical ‘speak’ into technical requirements.”

In order to be eligible for taking the examination, a provider must be ABMS certified in a medical specialty, possess a valid medical license, and have demonstrable experience in informatics. Additional skills in change management and quality improvement are also important, although perhaps under-appreciated. Being a champion for, and enabler of, workflow-appropriate clinical processes are critical for a CMIO’s advocacy role. “They don’t teach this in medical school,” says Reston. That’s why he wrote Clinical Informatics Board Review: Pass the Exam the First Time.

Whether you’re a relatively seasoned CMIO, new to the role, or thinking about getting in, chances are you could stand to learn more about getting your co-workers, and the IT community, through technology transitions less painfully.

Getting to a Desired Future State

If change management is a transition into a desired future state, we must first evaluate the current culture. This involves asking some basic questions, such as what is the physical environment, and some not so basic, like what idiosyncrasies surround the organization? Who are the local heroes and villains? Even if your organization’s culture appears obvious, this activity will likely yield surprising insights. You can use these to determine which management theories might work best to guide your organization through the transition.

• Precede-Proceed: Although not an organizational change management theory but rather a theory for improving public health outcomes, this approach focuses on results over activity and the agency of individual participants.

• Social Influence: You can think of this one like a domino effect. If change were to happen from one person to the next, whom might you select as change agents and how would they tip the rest of the dominoes—through likability, conformance, or obedience?

• Complex Adaptive Systems: Organizations are made up of complex, partially connected micro-systems. Adaptation is critical to their survival, and disequilibrium will either cause them to die to reintegrate. This theory directs change managers on how to use disequilibrium to the advantage of the organization.

“You can force people to use software with a stick, but to get them to use systems in a manner that fundamentally improves the quality of care, you really have to entice them with a carrot,” says Reston.

An organization’s CMIO is a central figure in this effort. From ensuring that providers get sufficient training on the new systems, to ensuring the organization remains open to feedback and constructive criticism, to periodically reevaluating what additional adjustments are needed to ensure provider buy-in, the CMIO is the great communicator facilitating constructive change in both process and culture.