Situational Leadership

This course, from The Center for Leadership Studies, resonated with me more than any other leadership course or seminar I've ever attended in my career. Perhaps because it's more strategic than tactical, because I've found stuff like '1001 ways to reward employees' to be both boring and borderline insulting. There is no magic formula to managing people; you need to know and understand each individual as best you can (or, as best they'll let you). Not only that, people react differently in different circumstances and situations, so there is no universal 'reward' that will automagically motivate anyone in any situation. Not even money.

The basic idea of situational leadership is that both leaders and followers have styles and readiness levels that need to be matched in order to achieve the best results. Styles for leaders range from the micro-manager (style 1) to laissez-faire (style 4), with styles 2 and 3 lying somewhere in between and taking some form of persuasion. Similarly, followers have readiness levels from needing hand-holding (readiness 1) to highly independent (readiness 4). The trick is to match a leader's style with the follower's readiness. To the surprise of absolutely no one, micro-managers are best paired with those needing lots of direction. Pair that manager with a highly independent follower and you're likely to see fireworks as the follower chafes at frequent requests for status updates and other minutiae. On the opposite end, pair a laissez-faire manager with a typical rookie and you're likely to get nowhere in a big hurry.

Beyond those obvious mismatches, styles/readiness levels 2 and 3 are probably the most challenging to figure out. The leader may be convincing and/or persuasive, but the follower may have internal and/or external constraints that get in the way. The key to results is determining where the follower's limitation lies, which is easier said than done.

Perhaps the struggling follower needs training on a new technology, process or business practice. On the other hand, perhaps the follower is worried about what will happen to them if they help automate the very process that's kept them employed for years. Or, maybe they are being deliberately thwarted by someone else in the organization. A good leader will try to get to the bottom of the cause before addressing the issue. Just as importantly, as part of that, the leader may also need to adjust their style to match the follower's.

This leads to my last point. Styles and readiness levels vary with the individual over time and by skill. Clearly, as a rookie learns a particular skill, they become more independent. As leaders grow more confident in their staff, they tend to delegate more. That rookie in, say, IT, may be a clinician who decided to take a detour and try programming. They very likely need little, if any, help reading a patient's chart but would probably greatly appreciate some pointers about how their code functions and performs.

A National Patient Identifier

While there is much angst in some circles around the idea of a national patient identifier, given privacy implications, the reality is that we need one if we want to have reliable, mobile medical records. It is the only way to ensure that a patient's medical records at any hospital or provider refer to that patient and that patient only.

Absent that, we're forced to rely on some sort of algorithm to match records from multiple systems. For instance, in my work with BMC2, we need to match records of patients in an internal system with those in the National Cardiovascular Data Registry, published by the American College of Cardiology. We use a handful of fields that get us to a roughly 98% match rate, which is very good. But, we're in a very controlled environment, only have two data sources and both sources are maintained by study coordinators whose full-time job is managing registry data. We should have a match rate that high.

Of course, a single identifier isn't foolproof, especially if it is entered by hand or otherwise managed in some manual process. Plenty of data is fat-fingered, transposed, even entered by mistake (Patient A's Id entered in Patient B's record), simply because a human being is part of the process. That will likely never truly go away, and we'll always have records that aren't in a pristine state due to problems with the identifier. But, those can be fixed, as needed, by adding or editing the correct identifier.

However, that's an entirely different issue than an identifier that doesn't exist.