So much learned in such a short period of time!

Wow!  What an amazing eight weeks it has been!  We have truly learned an enormous amount of information in this short period of time, from simply looking at various technological tools available to leaders like Camtasia and Edmodo to reviewing how technology affects the workplace overall.   The new work of the “Networked Worker” has created a setting where many of us are at work, even when we are away from our desk, with our families or friends, enjoying our free time.  We are checking e-mail, taking phone calls from clients or students, or simply checking information on the web about a project we may be working on.  Being networked can mean you are always at work, if not managed properly. 

There are a few main takeaways that I have gathered from this course.  First, as workers and leaders become more and more networked, it is vital for leaders to be cognizant of this from a management perspective.   Putting in significant extra hours can lead to burnout, per this journal article from Personnel Today.  When unable to separate your 9-5 job and personal time due to technological assistants, one is more likely to burn out.  Making it more difficult is a leader that pressures staff to put in these extra hours.  Leaders may encourage the use of technology to make life easier, but do not force staff to take e-mails, phone calls, and do work after hours.  Allow staff to have that separate time away from their work so that they remain happy and healthy employees.

Another area that is an important takeaway I discussed in my blog last week.  There are many new and exciting technologies available to leaders in their various professional areas.  In health care, there is always a vendor coming in to sell a new software product that will revolutionize the industry, or a new treatment technology such as a scanner or a surgical robot.  The first step in looking to implement any new technology needs to be education.  How are we performing this task now?  Is it working well?  The next step should be completing a solid cost benefit analysis.  Will be benefits of this new technology outweigh the costs?  In some cases, the benefits will be higher revenue, so these will be easy to see.  In other cases, the benefits will be more efficiency or a longer term decrease in cost, so these will likely be more difficult to measure.  Ultimately making that cost benefit decision is crucial to the implementation of any new technology in most settings.

On a side note, I completely ‘swore off’ of all social media this week.  Although I don’t admit it much, my family is very into stock car racing, specifically sprint car racing.   I was a photographer and freelance writer for NASCAR and Speedway Illustrated, in a previous life.   A terrible tragedy occurred this past weekend involving a young driver and another driver close to our family.  After seeing some of the horrific things posted on Facebook and Twitter, I decided that I needed to take a break from being around people that could treat human beings they’d never met in such a manner.  Two days later, one of my favorite actors and comedians, Robin Williams sadly took his own life.  Again, I hear on the news stories of how his daughter is receiving horrible ‘doctored’ photographs of her father from people on Twitter and Instagram and is forced to shut down her accounts.   I’m reminded of a line from Patch Adams, one of my favorite Robin Williams movies.  He is on a cliff, ironically contemplating suicide, talking to God.   “Maybe you should have had just a few more brainstorming sessions prior to creation. You rested on the seventh day, maybe you should have spent that day on compassion.”

There is greatness to be harvested from the web, but a great deal of negativity and evil as well, just as there is in the population overall.  It’s all about finding that balance, what is good, and what is not. 

What is new? How does it affect me? Gotta stay current!

Staying current in today’s fast moving and ever-changing environment is a challenge, not only as leaders but simply as people.  I considered myself to be fairly knowledgeable regarding a good number of technology products available, and have seen the Google Glass videos  (personally, I like this one better, http://youtu.be/uR9MePvjRuY but warning, bleeped out bad language).  I loved the Corning videos, which I have never seen, and sadly I live 50 minutes from Corning and most of their R&D facilities.  Amazing technology and could have great applications in the health care field, as much of their great work already has. 

What I believe is most important for leaders to focus on is 1) what are the new and emerging technologies and 2) how does it affect my workplace.  For example, we’ll look at Google Glass.  This is a really neat technology that could be helpful for busy people like physicians and other practitioners on the go.  It could pose serious privacy risks as well if the providers are not aware policies and regulations surrounding the use of photo and video equipment in a health care facility.  These rules are no different for cellular telephones, but I think a video chat is less likely in a patient room with an iPhone than with the Google Glass device. 

Kevin Kelly speaks on his blog about how what has been built in the Internet realm is really just a base for what there is to come.  This means for us, as leaders, we truly need to not fear the web but learn and understand it.  So many fear it, fear that it will steal their privacy or steal their identity.  There is so much the web can do for us, professionally and personally (if we’re interested in that), and we need to capitalize from a professional perspective on what the web can do for us.  How can our industry or our profession capitalize on new technologies, such as those types of things that Corning or other developers are creating?  A great example of new technology in the medical world that I find truly phenomenal is 3D printing of medical devices and prosthetics.  Here is a site of one of the firms doing some of this work – Strata-Sys.  There are amazing new technologies, from simple web based systems for providers like connectivity of the electronic health record to being able to ‘print’ an exoskeletion for a little girl from a 3D printer so she’s able to move her arm again.  Health care leaders must embrace the Internet and technology and not fear it.  These changes can bring great positives to our industry.

Ethical Concerns in Healthcare in the Digital Age

For healthcare administrators, there are many areas of concern from a digital perspective.  There are ethical and privacy concern and risks associated with the use of electronic health records and interchange of records promulgated through regional health information organizations.  There are ethical concerns associated with health care provider use of digital means to communicate with patients, such as e-mail and social media.  There are ethical worries related to the use of social media by health care employees in general, such as privacy and security related risks, or improper behavior.  These and other topics create a litany of challenges for health care leaders at all levels.

The electronic health record provides major advantages to health care organizations and their patients.  It provides immediate access to records at multiple sites of the same organization, or even different organizations if allowed by that patient and available in that area.  It allows for ready access to multiple pieces of information combined in one area, such as laboratory, radiology, physician office notes, inpatient hospital records, and any other types of information available for that patient.  As discussed by Kopala and Mitchell in the JONA's Healthcare Law, Ethics, and Regulation Journal, continuity of care will improve, medical errors will likely decrease, and generally the electronic health record is expected to advance health care education and research overall.  However, there are many risks.  Privacy and security of information in an electronic health record (EHR) creates innumerable risks.  Instead of a locked cabinet where files are kept, the information is simply kept in a ‘virtual file cabinet’, and those who make decisions on access must be prudent on choosing which keys are given.  Only those that require business access can be given the key, but even those keys can be abused.  During my time as a privacy and compliance official, I reprimanded and terminated employees for offenses as minor as looking up co-workers birthdays in the EHR, or as major as perusing the emergency room records of a celebrity that they knew had visited the facility.  The ethical ramifications of access to electronic records overall is a concern, but key to this issue is development of a solid policy on access, and maintenance of that policy through auditing.  Kopala and Mitchell also mention data integrity as a potential ethical concern as well.  Data integrity is a major issue in the EHR world, as providers are notorious for ‘cutting and pasting’ when allowed to do so in this setting.  This can wind up with inappropriate information in a record, resulting in poor documentation.  Due to this, many organizations turn off the ‘cut and paste’ function in their EHR, requiring providers to type out their narrative responses.

Another major area of concern for healthcare leaders is in the realm of allowing providers to communicate with patients via digital media.  Some organizations allow this with signed patient consent in advance, where others do not allow providers to participate in this activity at all.  There are a multitude of ethical and risk related concerns related to this activity.  Lambert, Barry, and Stokes speak of these topics in an article in the Journal of the American Society for Healthcare Risk Management.  By allowing providers to correspond with patients in this manner – e-mail, Facebook, Skype, other social media – you are potentially creating an expectation that the provider is available to the patient immediately.  If this patient is having an emergency medical condition, they may try to e-mail the physician instead of heading right to the emergency room as they should.  Also, there is a concern of the boundary of the patient/physician relationship.  By using a social media site to converse with a patient, is a physician crossing that boundary?  This physician seems to think so, and I’d think that many physicians would agree that Facebook is generally off limits to their patients.

Finally, the last major concern is with staff use of digital media.  There are innumerable ethical concerns in this area, as benign as the use of social media at work decreasing productivity, and as serious as sharing of patient information online.  I will share an issue that happened at a local hospital in my area a few years ago.  A staff member took photos of a patient while using the restroom and shared them via text message with other staff members. http://www.wbng.com/news/local/State-Issues-Citation-For-Bingamton-General--143750206.html

This situation was a great example of poor training, poor hiring practices, and poor control on the unit in that particular hospital.  I’m quite familiar with the hospital overall as my husband works in their emergency room, and sadly I wasn’t surprised to hear this happened to this patient.  Policy will not fix this situation, as I’m sure they had policy in place to prevent this.  Training for employees as well as hiring the right employees up front for your organization, and providing appropriate supervision is vital to appropriate application of these types of policies.

The digital age has brought amazing positive things to the health care industry.  There are many ethical challenges as well that must be overcome by health care leaders every day.  Make use of your compliance and privacy resources as they can often be of great help in many of these areas!

Of course I'd hire a Networked Worker!

Networked workers can bring many opportunities to an organization, especially those in a field such as mine.  When I am working from my home office, I spend the majority of my day working online, researching regulations online through various government websites, seeking out advice from colleagues through e-mail, or simply surfing message boards to find out what health care compliance professionals are having difficulty with.  Networked professionals are connected.  They understand how to work the web to their advantage, finding the information out there that is good and putting aside information that is not. 

Connections to colleagues can be used as opportunities, in my business as potential sales.  Corresponding online with a colleague from a provider that is having an issue may lead to my suggesting a webinar or a class that I have upcoming on the topic, ultimately improving business for my company. 

This free and open internet access is not all about productivity however.  For every 5 clicks on my machine to the Federal Register site, there is at least one to Facebook.  Facebook is, in my opinion, the biggest drain on employee productivity to occur since the water cooler and coffee machine.  Some employer sites block access to sites like Facebook, but I have found when that occurs, they simply surf there on their phones instead, still wasting work time.  A simple thought on how to make Facebook tolerable for work time, if it’s going to be allowed - make a company page.  If you are the type of company that can get employees involved on their FB page, answering questions or posting information, allow that.  Otherwise, perhaps have a ‘closed’ group page where employees can post information about office goings-on, such as gatherings, birthdays, what’s for lunch in the café, and other office fun.  Make FB office related as well as simply a social networking site.

We have discussed many challenges of networked workers over the past several weeks, such as always being ‘on’ and the difficulty of the work/life balance.  I face this as a telecommuter and ‘road warrior’, but everyone that is expected to be networked 24/7 can face this as well.  As Madden and Jones state, twenty percent of workers state they are doing some work from home every day.  This is a direct effect of always being ‘on’ and not being able to escape from work. 

Networked workers are simply what you will likely have in today’s professional, like it or not.  In my opinion, as a hiring manager they are the workers you want in order to function efficiently and effectively in today’s business environment.

SIMBA, GIT, and wirearchy, oh my!

Work has been revolutionized by the web, and as someone that works as a telecommuter and a ‘road warrior’, I cannot imagine a productive work life without it.  Having worked from a home office over the past ten to fifteen years, I have seen a major shift similar to that described by Shirky in his TED talk about internet transformation of the government. 

In the ‘early’ days of my work from home writing and editing books, we would simply be assigned a book from our technical director, write or edit that product, and send it back into her in hard copy with an electronic file e-mailed with the changes.  If it was a brand new book authored by us, it was simply e-mailed. Version control was maintained by our director, and it was a system like feudalism, as Shirky mentions the commercial software development worked as well.

Fast forward to 2012 and that feudal system was replaced by a more distributive leadership process.  An online ‘warehouse’ called SIMBA has been created for use by our team that functions much like GIT, and allows clinical technical editors like myself, as well as copy editors to go in and out of products, make changes, comments, and maintain version control all while seeing each others suggestions and commentary.  We all have the opportunity to see each other’s work, learn from one another, and lead projects. 

This SIMBA system, much like GIT, creates a wirearchy.  It allows people without official hierarchical ties to come together and collaborate to achieve goals.  We often swarm with subject matter staff from other divisions to discuss difficult topics or brainstorm new products. Staff are all disparate geographically, so this is all done virtually through messaging and chat software systems, and occasionally through Webex.  Rarely are telephone calls made, but when they are, phones are internet based as well!

These types of systems can allow for more staff to get involved in the leadership process.  This creates leadership growth, ultimately building staff available for leadership succession plans for the future of the firm.

Personally, I find Shirky's discussions fascinating.  The story of the young girl in Scotland and her blog truly captured my attention, and it is this type of story that amaze me.  We are the audience for this child so far away, and she is able to share so much information with us.  In examining her blog now, it appears that she is working very hard to do a great deal of good with her notoriety - and her dislike of school food.   

Like a Grand and Miraculous Spaceship...

In examining the Shirky (2008) chapter regarding publishing and then filtering, specifically his discussion about the evolution of communication, I couldn’t help but think of Dame Judi Dench and her narration of Spaceship Earth at EPCOT in Walt Disney World (http://youtu.be/lP8ByndQSAQ).  For those that have not had the pleasure of riding Spaceship Earth, it is a ride that explores the advances in communication over time.  I was on vacation last week and this ride was a welcome escape from the oppressive Florida heat.

Communication and the learning that comes from that interaction has developed greatly over time, but as Shirky (2008) describes, this knowledge is not always something we need, nor is it something directed at us.  I must admit that I am a bit of a Facebook junkie, and many times I see status posts from friends thinking ‘is he/she talking about me?’ or ‘is that snarky comment directed at ‘X’?’ In the virtual world where there is no filter, it is difficult to determine where information is directed, and exactly what is accurate.  There is also a depth and breadth of personal information available to us via social media, especially from younger people, that is simply more than we need to know – again, no filter. 

There are several aspects of knowledge management at play in my industry, and leadership is an important facet.   I work in the healthcare regulatory environment, and much of our ‘source authority’ comes from the Internet.  Some of it is simply law or regulation, but other portions are interpretations from subject matter experts with the regulatory agencies.   This seems to fit well within the ‘Leveraging Explicit Knowledge’ definition as shared by Dixon.  The organization simply captured the existing documents or some information from subject matter experts and warehoused this information.  As a leader, it is a ‘no brainer’ to consider this information safe for ‘consumption’ and not feel a need to filter this. 

However, as we step to the next levels of knowledge management, Leveraging Experiential Knowledge and Leveraging Collective Knowledge , it becomes more critical that leaders become involved in this discussion.  For example, in my industry many regulations are published that may leave room for interpretation.  In our current world of personal directed learning (http://www.jarche.com/2010/02/a-framework-for-social-learning-in-the-enterprise/), many staff will head to the web to get the thoughts of random law and consulting firms on the latest regulation.  Unfortunately, you can’t believe everything you read on the web, and staff may read a ‘liberal’ interpretation of a regulation when the organization is taking a more ‘conservative’ approach to compliance with that regulation.  It is vital for leadership to serve as that filter, to assist their staff to understand what is good based on organizational policy.  Another good example of this is Wikipedia.  I love the Wikipedia for simply checking out information about a person when I see them on TV and I don’t know who they are.  However, I don’t allow my students to use Wikipedia as a resource for their work, as its sources are questionable. 

Ultimately, it comes down to filtering, and leaders can serve as that filter.  The leader must be knowledgeable about what is available on the web and what their staff/students might be using.  In my industry there are many web based research tools such as MediRegs, MedAssets, and other similar tools, which will provide staff with a reliable source for information.  These will take the guesswork out of research for staff.

On an aside, you can’t believe everything you read on the web, but if a cat can be mayor…

Mayor of Alaskan Town Is a Cat

Reference:

Shirky, C. (2008). Here comes everybody: the power of organizing without organizations. New York: Penguin Press.