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A Real Legacy

September 25, 2008
by Anthony Guerra, Editor-in-Chief
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Superior managers understand that making their mark is all about grooming their replacement

What is the definition of a successful tenure when it comes to healthcare IT executives? Often in IT, impact is determined by the laundry list of applications that can be attributed to a CIO or CTO. But is this the best way to measure an individual's impact?

While reviewing such accomplishments is one way to determine effectiveness, a recent interview with Hackensack University Medical Center CIO Lex Ferrauiola and CTO Ben Bordonaro made me think about a more telling measure — staff development and mentoring.

Jim Collins' well-known book on organizational effectiveness, “Good to Great,” makes this case very clearly — great executives are those that leave the company better than they found it by, for one, developing staff.

From a very extensive interview with Ferrauiola and Bordonaro (which can be found in its entirety at, I pull the following excerpt to illustrate my point.

LF: I think one of the most important things is really succession planning. Ben and I talk about this a lot. Ben is brilliant. My hope is that Ben goes into my job; I think he will. I've been very fortunate that I've had a number of really good people in this role. Part of it is to give them the freedom to have the high profile in the organization so that they can develop. And sometimes they move on.

One of Ben's predecessors, a great CTO, went on to be the CIO at Moffit down in Florida. The CMIO we had here went on to MedStar. I'm hoping, selfishly, that Ben will stay in this role while I'm here, and when I'm ready to go that he can move into it. You have to select people and really want to nurture them. I think that's our responsibility as leaders and managers and executives to really nurture people, whether it's in the place that you're in or from the next step of what their career's going to be. It's not just to have people in the roles to do the job.

I remember being very impressed with this sentiment during the interview, as I sat in the room with both Ferrauiola and Bordonaro.

Ferrauiloa has it right, but not everyone is so secure in their position. Holding the reins too tightly comes from weakness and insecurity. Those that manage this way have it all wrong, mistakenly believing that empowering staff ultimately diminishes their own value. They fear they'll be exposed as unnecessary or redundant. They're afraid of being outshone. They want the place to “fall apart” when they go on vacation or are out sick, so they can ride back in to save the day.

Do you manage like this? Do you (God forbid) work for someone who does, or does someone like this work for you? Managing from weakness has a number of consequences.

First off, it necessarily means the manager is inefficient, performing even the most basic tasks themselves, rather than “sharing the recipe” with others. Getting bogged down in the details means the big picture falls out of focus.

Secondly, it means those reporting to the manager are stagnating — employees worth their salt will soon leave for other opportunities. This means no homegrown executive talent, and the further entrenchment of a manager who can't provide strategic direction.

Lastly, managing from weakness results in organizational malaise. With no one looking at the organization's long-term strategic direction, no new ideas are suggested or adopted. Having a checklist mentality usually means falling behind as others innovate.

The best managers continually look to develop their people by assigning them new and challenging responsibilities — and by assigning, I mean truly stepping back. Nothing will get employees to shine like genuinely empowering them by trusting their judgment.

So I ask you, what kind of legacy will you leave? The first six months after you're gone will be telling. If it's chaos, I would argue that rather than being a sign of how valuable you were, it will show you were selfish and insecure. If, on the other hand, the transition is so seamless that no one notices you're gone, everyone will realize how much you gave.

Anthony Guerra, Editor-in-Chief
Healthcare Informatics 2008 October;25(10):6