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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

When work, the productive process, becomes display, its meaning becomes lost. This work becomes irrelevant to the world, and becomes a non-adaptive ritual. At the same time, rituals that serve to express the individual’s identification with the organization ideal, especially those connected to rank, come to be infused with significance for the individual (e.g. mtgs.). They become sacred. Thus, reality and appearance trade places.

7. Loss of Creativity

The delegitimization of one’s sense of what is important gives rise to a special case of the ritualization of work --- the loss of creativity. “Conformity” follows from insistence by the organization that all of its norms be accepted as being equally important. “The conforming individual curbs his creativity and thereby moves the organization toward a sterile form of bureaucracy.” <Schein, 1980>

8. Dominance of the Financial Staff

Finance, rather then operations, offers the greater narcissistic possibilities. Operations, the productive process, tends to temper grandiosity. Financial models distort reality.

9. Cynicism and Corruption: or, Self-Deception and the Narcissistic Loss of Reality

People can either be taken in by their own performance or not. The latter case is a means to and ends and such an individual is labeled a cynic, disassociating themselves from discrepant information consciously and through self-deception. If they are taken in by their own performance, they are performer and observer of the same show. There will be things he knows, or has known, that he will not be able to tell himself.

10. Overcentralization

The narcissistic loss of reality among those at the top of the corporation may be a major cause of overcentralization of operational decision making. It results in a tendency to provide simplistic answers to complex questions. Having risen to the top of the corporation, individuals would hold themselves as bearing all of the knowledge and virtues to make make them most capable to make all decisions.

11. The Magical Flight to Utopia
"Saturn" will fix everything.

We've all seen one or more of these causes in multiple large organizations, including vendors, provider organizations, consultancies, and in academia and government. In fact, there are two great chapters, just after the GM chapter (chapter 4), on NASA and how narcissism contributed to the ill-advised launch of the Space Shuttle Challenger, despite explicit data that O-rings blow through at low temperatures and cause catastrophic failure.

Conclusion and Lessons?

Everyone reading this is a visionary and works with visionaries, both in their professional lives and in every aspect of their personal lives as well. That's not a patronizing statement; that's how the human ego works. Getting vision right, that is, translating a great vision into reality is important work. It's part of the critical work of leadership. An important step is to learn the characteristics of vision and from the narcissistic failures. This post provides summaries with teaching points from two of the best business writers I have found on this topic.

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