Aligning Technology, Leadership and Organizational Culture

By Dennis Morrison, Chief Clinical Officer, Netsmart

When an organization recognizes the need to upgrade or change technology, a great deal of effort goes into the selection process. But once that decision is made, executives all too often leave the implementation to the IT department and the vendor’s support team. And that’s when problems start to begin. Because implementing, upgrading or optimizing technology can be problematic – and the issue is usually not the technology itself.

A major change in technology means a major cultural shift. Leading an organization through such a shift calls for strong support and critical intervention from the highest levels of management. To illustrate, let’s take a look at a stalled implementation at a large nonprofit organization that provides child and family services and the steps the CEO took to rectify it.

An Implementation 12 Years in the Making

The organization first started the implementation of its electronic health record (EHR) 12 years earlier and still wasn’t using even a fraction of the functionality. The moment of truth came following an accreditation survey. The organization received accolades from site surveyors in all areas except one: use of technology. With clinical records and other key documentation in several systems and in multiple forms, the surveyor had correctly identified this as a potential long-term risk. As a result, the CEO was forced to reengage in the organization’s technology strategy and address the stalled EHR implementation processes.

Identifying the Problem

Like most CEOs, leader of the organization was not a technologist, but she understood the need for an external perspective on the EHR implementation. A consultant was engaged to help the organization focus on three overall goals:
1. Identify the specific challenges with the EHR
2. Determine if the challenges involved a technology problem, an issue with the organization’s culture or a combination of the two
3. Develop a work plan to move forward
A multidisciplinary work team was assembled and was asked to chart a keywork process. When the result was presented on screen to the whole group, the challenge became obvious. One participant said, “The problem isn’t the EHR. It’s us.”

Recognizing and Supporting the Need to Change

Although the EHR had hardly been discussed, the team was at a critical juncture: Would leadership of the organization support redesigning processes or would the team’s efforts be given lip service with no real change?

Despite resistance from some senior staff, the CEO supported the transformation that would be necessary to make full use of the EHR technology.

The team started with the process for identifying and vetting potential foster parents. Using the EHR to automate this process resulted in substantial hard cost savings. Successful sign-ups increased because information was easier for applicants to understand and follow-up was done more promptly.

As other processes came under scrutiny, a major change in organizational culture took place. Talk about “that’s the way things work here” was replaced with “we can do better.” There was intolerance for duplicative processes. Phrases like “80/20” and “single source of truth” began to frame how problems were approached and became part of the culture.

The long-stalled implementation process has become a process of transformation with full support from the CEO.

Executive Leadership: Four Rules for Implementations

This example encapsulates the unique role executive leader’s play in technology implementations. They do not need to know the minutiae, but they must remain involved strategically and do what only they can do - lead.

In summary, the CEO and leadership team have four responsibilities to ensure new technology and organizational goals are aligned throughout implementation:

1. Understand the issues: Leadership must fully understand what’s working, what isn’t and how new technology can address the issues.
2. Build a team and assign clear goals: Make sure objectives are clear and the team has the right mix of experience to achieve them.
3. Acknowledge the need to change, even if it’s painful: Major implementation projects touch just about everyone in the organization. Be ready to deal with unforeseen issues and opposition to changing long-standing practices.
4. Lead: Step in when the team needs strategic guidance or to lend authority to the work effort and credibility of those involved in it.

By fulfilling these responsibilities, CEOs and executives can set the strategic direction and expectations for the technology implementation as well as the new organizational culture that will emerge. They must empower people who share their vision to handle the details of the implementation but always within the context of the vision. This is how an implementation becomes successful. This is how the new culture of the organization emerges. This is leadership, and it’s a job no one else can do.

Quote: Executives all too often leave the implementation to the IT department and the vendor’s support team, and that’s when problems start to begin