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June 11, 2009
by Neal Ganguly
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Without real collaboration and participation, a great opportunity may be lost

I am ending a term as president of our State’s chapter of HIMSS, and presided over my final meeting yesterday. It was our annual spring forum, and the topic was Hospital, Facility and Physician Alignment. Two years ago, the room would have been filled with IT folks complaining about how the clinician’s don’t get it, and bemoaning the fact that we don’t have enough money. Yesterday, there was a diverse audience of clinicians and administrators in addition to the IT contingent. In fact, the event was co-sponsored by the NJ Chapters of the American College of Healthcare Executives, the Healthcare Financial Management Association, and the Organization of Nurse Executives as well as the Medical Society of New Jersey (with journalistic representation by our own Anthony Guerra). Listening to the presentations, and more importantly, the lunchtime and hallway conversation, it was clear that the ARRA Bill has exposed an alignment of interests that was previously buried.

Sure, we all believed in providing high quality care, and being efficient, but each came at it from different directions. The Clinicians approached the environment using the high-touch, independent expert philosophy around which they were trained – marginalizing administrators and IT people and necessary evils that just ‘got in the way of good care’ and did not understand the nuances of patient care. The Administrators approached the environment as a business where clinicians were viewed as a necessary evil. Prima donnas, that did not care to understand the complexities of managing a business enterprise. The IT people, of course, recognized that neither side ‘got it’, and that they would have to clean up everyone’s mess and make it all work. Of course, the truth is somewhere in the middle – a place where the various constituencies learn enough about their ‘business partners’ to collaborate and build a better environment. I believe that is what I was witnessing at this event and what we are all seeing at events around the country. An energetic and engaged interaction between the players in healthcare focused around improving the environment and sharing information. This collaborative momentum must be sustained. We all must work to understand more about the big picture of healthcare in order for us to effectively contribute In our areas of expertise. The Stimulus Bill has given us a rallying point. It’s up to all of us to make it count.



Neal, Thanks for your post. You raised the point that social aspect of problem wickedness demands tools and methods which create shared understanding and shared commitment. In my experience, dialogue mapping is one such critical tool.


see this attached file for definitions and resources: REMOVED


The 'wicked problem' angle is very interesting. I totally agree on the point of social factors being the greater challenge in attaining our end goals. I will check out the links you and Jeff posted to dive into this a little deeper.


Jeff, you're absolutely right. I publicly apologize for the oversight. I overly distilled a much broader set of notes and, in the process, failed to fairly and adequately cite your work.  I am sorry.

I am thrilled to have your comment.  Thank you.

Readers are strongly encouraged to hear and watch Jeff directly illustrate an important technique, here:

Jeff's book is here.  Interested readers should definitely head to CogNexus Institute.

I've personally seen the power of dialogue mapping.  


I couldn't agree more with your points about wicked problems and dialogue mapping. However, I would be very grateful if you could mention my papers or website ( when you discuss dialogue mapping. The document that you do mention in your comment, "2004 Wicked problem.pdf", uses ideas and graphics taken from my website (i.e. and from my writings (e.g. but cites only the 1973 seminal paper by Rittel and Weber. This is good as far as it goes, since much of my work is based on Rittel's, but several of the points in the PDF (especially on the final slide) are from my papers, not from Rittel and Weber's.

Nonetheless, I'm very happy to see these important ideas being discussed in the health informatics field.

Jeff Conklin