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Better Care Through HCIT 101: Part Six - Narcissism, Oxygen and HCIT Vision

June 7, 2009
by Joe Bormel
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Better Care Through HCIT 101: Part Six - Narcissism, Oxygen and HCIT Vision

What can General Motors' bankruptcy teach healthcare IT professionals

This past week saw the bankruptcy of General Motors. There is no shortage of explanations and factors to account for GM's failure. The high cost of U.S. healthcare, U.S. labor costs in general, product offerings, value, quality, and insurmountable global competition are all cited as significant components. Whether you look back 20 years or 20 weeks, there were signs of management failure. Oddly, the most important management practices, both good and bad, had to do with vision. Vision is also a critical component of HCIT success, so it might be useful to explore this a bit deeper.

In a nutshell, narcissistic visionaries are very important and essential, just like having 21 percent oxygen content in the air is essential. But, just like oxygen, too much or too little narcissism leads to demise. That's at least part of the systematic failure of GM.

Narcissistic Leaders: The Incredible Pros, the Inevitable Cons

A quick digression to define terms here. I'm potentially blurring vision with narcissism and I want to correct that. In his stunning, McKinsey Award winning article, "Narcissistic Leaders: The Incredible Pros, the Inevitable Cons" (Harvard Business Review, January 2000, and freely available

here), Michael Maccoby describes the pros and cons of visionaries, charismatic visionaries including Bill Gates, Andy Grove, Steve Jobs, Jeff Bezos, and Jack Welch:


- Great Vision

- Scores of Followers


- Sensitive to Criticism

- Poor Listeners

- Lack of Empathy

- Distaste for Mentoring

- An Intense Desire to Compete

In short, narcissistic leaders have great vision, often combined with a rage for the gap between that vision and current reality. A friend of mine, who happens to be a serially successful CEO, in addition to having training and experience as a psychiatrist, corrected me once before when I said that first sentence. She said, "

Joe, it's not rage, it's blind rage. Big difference." If you've raised children or coached challenging subordinates, you might have seen blind rage once or twice.

We all know that vision is critical in HCIT. Without "Vision" and it's translation through responsibilities and ultimately to results, we're left with confusion, anxiety, frustration, and false starts. An adequately developed vision, that includes clinical, financial, operational, and societal benefits is essential. A strategy without that will be DOA.

Narcissistic Process and Corporate Decay

Here's the warning for HCIT. It comes from an interesting and perhaps forgotten book published in 1990 call "Narcissistic Process and Corporate Decay – The Theory of the Organizational Ideal," by Howard S. Schwartz. In 1990, he published, in a succinct chapter, a review of GM's decay, then very much in progress. There were eleven recurring causes of organizational decay rooted in narcissism out-of-control:

1. Commitment to Bad Decisions

Tendency to justify past actions … running counter to rationality

2. Advancement of Participants Who Detach Themselves from Reality and Discouragement of Reality-Oriented Participants Who are Committed to Their Work

Core organization processes become dramatization of organization ideal; evaluation for promotion and continued inclusion made on basis of contribution to the drama.

3. The Creation of the Organizational Jungle

The more successful the organization is at imaging itself as ideal, the more deeply committed participants experience anxiety. The discrepancy between reality and the image causes pain, feeling of threat, and heightening of self-doubts.

4. Isolation of Management and Rupture of Communications

The more successful the totalitarian manager, the more isolated they feel (and become) from their subordinates. For totalitarian management, communication to subordinates is not communications at all --- it is deception.

5. Development of Hostile Orientation Toward the Environment (development of arrogance)

The environment outside of the ideal organization is seen to exist in order to support the organization, not the other way around. From this standpoint, the demands of the environment must be presented as hostile actions by bad external forces --- hostile actions to which a legitimate response is equally hostile action.

6. The transposition of Work and Ritual




This "Conversation Starter" (Mark Ritson, Why Saturn Was Destined to Fail) addresses the "real reasons" behind Saturn's demise, and it's impact on GM.  And, if Ritson missed anything, his blog commenters filled in the gaps!

Ritson's perspective concludes that GM's business model for Saturn was fatally flawed from it's outset in January of 1985.  (These aren't 20/20 Hindsight issues.  As noted above, in Schwartz's 1990 "Narcissistic Process and Corporate Decay – The Theory of the Organizational Ideal," and his succinct chapter, a review of GM's decay, described exactly what ultimately happened.

Fighter Brand:
"In Saturn we have GM's answer — the American answer — to the Japanese challenge."
Roger Smith [a BS speaking point, or a serious strategy?]

Saturn was working:
"By 1996, orders actually exceeded Saturn's production capacity, and the brand's fighting prowess was further confirmed when dealer research revealed that 50% of these orders were from individuals who would otherwise have bought a Japanese import."

Saturn wasn't working:
"By 2000, Saturn was losing $3,000 on every car it sold. "  --- Ritson (not everyone agrees)

Saturn was used as window dressing for GM (rather than an important experiment):
"If only Roger Smith had not believed that Saturn was the 'key to GM's long-term competitiveness, survival, and success as a domestic producer,' the company would have moved faster and earlier to fix its core business."

- Seriousness -
In trying to make sense the GM/Saturn leadership message, I conclude that it is simply about taking leadership seriously. That means
(1) getting the model right at the outset, and
(2) staying focused on get results quickly enough.
Arrogance doesn't assure positive results; seriousness might.

Thanks for your comment Anthony. I agree, ... AND ... in a world where succession planning and execution is rare (I can only think of Jeff I at GE), it would appear that being founder-led is the huge advantage. (I left out a Neil in my earlier comment. No offense!) And, of course, being privately held. Does that cover it?

In Jim Collins' "Good to Great," he makes the point that great companies (as he defined them according to long-lasting positive financial returns) have leaders who consider succession planning and the long-term health of the organization as intertwined. Companies like GM often suffer from CEOs that live more for themselves and to server their egos rather than the organization.

Great leaders know that the measure of their success is not the degree of profitability on the day they depart, but the condition they leave the company in, and the stewardship they turn the keys over to. If they have developed and mentored the next generation of leaders, all will be well. If they have never thought of such things, each change in the top slot will cause a change in strategy and culture, as the company lurches left and right in fits and starts, fruitlessly spewing valuable resources along the way.

Tim, Thanks for your comment.

For me, the biggest pain I see and feel is the apparent arrogance of GM (not the apparent ignorance or stupidity):

  see #5 above: Development of Hostile Orientation Toward the Environment (development of arrogance)

In my experience, it's rare to see arrogance combined with good decision making. Arrogance seems to have an embedded anger that causes a reciprocal anger in the recipients of that anger.

Part of my style is to send a courtesy email to people who I blog about. I reached out and received a reply from Dr. Schwartz last night. He pointed out a number of interesting dimensions I didn't bring up. Key among them was the idea that companies led by folks like Neal and Judy are very distinct from companies where the founders are long since gone. The latter are much more likely to demonstrate negative aspects of narcissism as played out with General Motors. Good point.

For more freely available articles by Dr Schwartz, go here:

This includes a full elaboration of the GM chapter I referred to in my post:


One of the joys of blogging is the comments and behind-the-scenes communications that are created.

I love the comments posted here. Aside from basic feedback, there are usually insights that are new to me.

The other feedback comes as private email. Where appropriate, I try to share it with my readers. Here's one such private communication:

If you haven't read it, Bob Jackall's book Moral Mazes is terrific.


Excellent post and it struck a nerve with me regarding GM. Let's face it (and to your point) GM did not have a vision for the future and some might argue had NO strategy to re-tool to compete with other brands that had a real grasp of where the market was heading years ago. To design automobiles for consumers in 2009 that get less that 20 MPG is just beyond me when fuel costs have skyrocketed over the past few years. What's even more amazing to me are the dozens of people I have spoken to that know absolutely nothing about the auto industry - but understood years ago where the market was going.
Great American ingenuity — sent overseas (once again) where we competed with our own inventions and ideas - and lost. It really starts with a vision - and it's clear to me that GM lacked vision and the leadership to change. Now the company and countless others including shareholders, employees (and their families), suppliers, and dealerships ect.) are left holding a very empty bag.
What a shame...