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Do You Really Think?

March 30, 2009
by Anthony Guerra, Editor-in-Chief
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Creating an environment where the status quo isn't good enough is key to long-term survival

There are three kinds of people in the world (yes, a simplification I know): the first kind works the way they have been taught, the way they always have, not interested or capable of envisioning improvements. A half-step up are the individuals who can see the light, but quickly recoil from it, assuming they have no power to make that vision into reality.

Individuals of the first type might explain a particular aspect of their job by saying: “This is the way we do it” (with no further brain activity). While those of the second type may venture, “I would love to do it a different way, but this is the way we do it.”

And then there is the third type, ‘the Effective Worker’. These people pick up deficiencies in a workflow or process and conceive of better ways to handle them. From there, they make it their mission to effect change in a logical and persistent manner.

Such people might say the following: “This is the way we do it, but it no longer serves the needs of our (insert: readers, customers, patients, doctors, etc.). I have a better idea. I'll write up my idea with a rudimentary cost/benefit analysis, and I'll schedule a meeting with my manager. Let's see if I can communicate the benefits of the new way, along with the risks of the old. I'll pitch it.”

Is there a manager who would not snap up such an employee?

It's interesting that the effective worldview, while perhaps innate in early childhood, is often drummed out of young people from the first stages of formal schooling into the early years of their career. It is only when they reach a certain level (think organizational chart) that they are expected to suddenly break free from such rote thinking. How many of us know of checklist-obsessed tacticians in executive-level strategic positions? These poor souls (ignoring, for the moment, their even less fortunate reports) are like ship captains who would rather see their vessel sink in hurricane-whipped seas than chart a new course, simply because they can't imagine the course can be altered.

I reflect on this process because HCI has done some effective thinking which, we believe, materially improves our product. Immediately after the Stimulus Package was passed, with its $20 billion for healthcare IT, an avalanche of Webinars, articles and conferences started popping up. Of course, we quickly assigned our Policy Department reporter, David Raths, to do a story on what the package meant to CIOs, and how you can get your fair share of the loot.

Having taken that traditional step, we realized there would be about 1,000 of the aforementioned Webinars, articles, etc., before our article got to you. Seeing that, in this case, our workflow was broken, and appreciating that we had not just the power, but the responsibility, to fix it, we permanently converted David from a traditional one-story-a-month journalist (with a two-month lead time between assignment and delivery) to our first ever Online Policy Blogger (, with a possible two-hour lag between assignment and delivery.

In fact, David doesn't have to wait for assignments, as he's been given general marching orders, with the power to make specific coverage decisions. In his first foray into the Blogosphere, David scored our top blog posting, in terms of visits, for that week.

As stated earlier, the most important part of the effective process is not the actual development and implementation of a new idea, but the appreciation that it is possible to do things differently. Has your CEO created such an environment? Have you instilled an effective worldview in your staff? Even before the Stimulus Package, the pace of change in this industry was dizzying. Now, more than ever, only those that think effectively will survive.

Anthony Guerra, Editor-in-Chief
Healthcare Informatics 2009 April;26(4):8