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