I'm currently deeply absorbed in a 1991 biography by British historian Anne Somerset of Queen Elizabeth I. The eponymous 636-tome is the opposite of a “quick read”; and yet Somerset's writing and research make this examination of the life and times of “Gloriana” read like a page-turner. And one of the most compelling aspects of the work is Somerset's probing look at the contrasts between the lives, and choices, of Elizabeth (1533-1603) and Mary Queen of Scots (1542-1587), her cousin and royal rival.
Here's what's interesting: at the outsets of their reigns, the general evaluation of the two queens was the opposite of that which later came to be. Mary, who shortly before her 17th birthday became Queen of France, was tall, beautiful, wealthy, and charming, and was initially perceived to be a gifted monarch; whereas Elizabeth, who on the death of her sister Mary Tudor (the infamous “Bloody Mary”), ascended to the English throne, was thought to be a capricious young woman, who had just come to the throne of a nearly destitute country riven by religious conflict and surrounded by enemies on all sides.
Yet when the chips were down (as they so often were in those days), Elizabeth ended up making all the right choices in her life, while Mary Queen of Scots made all the wrong ones in hers. Mary's choices were so disastrous, in fact, that they ultimately led to her death by execution at the hands of her cousin, after nearly 20 years of house confinement in England, after having been forced to abdicate her throne.
What's worth thinking about here is how-rather than whether-the two queens responded to the inevitable crises that afflicted them in their royal lives.
Healthcare CIOs may not be facing foreign invasions, insurrectionist rebellions, or problems with foreign mercantile treaties, but they nevertheless are in a situation right now in which taking risks is not optional. Indeed, in offering $19.1 billion in stimulus funding to hospitals and physicians in order to encourage the universalization of electronic medical records and other forms of automation, federal legislators last year gave healthcare leaders the choice of moving forward in some fashion, or being faced with significant financial penalties just a few years from now. Meanwhile, the passage of sweeping healthcare reform in late March has added new layers of challenges and opportunities to the mix.
The question for every healthcare leader and every patient care organization, then, is this: will you take smart, calculated risks? Or… not-so-smart, potentially ruinous ones? The fundamental challenge is compounded by the fact that, at this point in time, it's not possible to know for certain what the results of any particular strategy will be. That's true with regard to issues around meaningful use; to potential preparations to meet new provider requirements under healthcare reform; and to issues around surviving perilous times, and coming out on the right side of tremendous financial risks during this enormously risky economic period.
OK, so you may not literally lose your head on a chopping-block at an English castle; nor will you have to sort out offers of marriage from a bewildering range of European kings and princes. But if you think the stakes are high going into the next couple of years in healthcare and healthcare IT, you're very right. The question is, what kinds of risks will you take? Let's hope your path will end up happy and prosperous, like Elizabeth's, not disastrous, like her royal cousin's.
Mark Hagland, Editor-in-Chief Healthcare Informatics 2010 May;27(5):8
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