Saturday, August 15, 2015

Flow - A Spoken Word Piece about Health Information Exchange

On Monday, August 17th, 2015 I begin a new chapter as Program Director for the new Integrated Care Network initiative at CRISP, Maryland's health information exchange. We will be providing data to healthcare providers to enhance their care coordination efforts and providing additional care coordination tools to some of those providers who don't already have these capabilities in place.

To mark the transition, I decided to make a video of this spoken word piece I wrote in 2012 (originally entitled "A Man among Millions") for my last day consulting for the Office of the National Coordinator for Health IT while I was working at Deloitte Consulting. This piece explains why I am so passionate about making health information exchange work for all of us.

I am grateful for the opportunity to make a difference with an amazing team of collaborators and look forward to providing updates on our progress over the coming months and years.


tick tock
check the clock
it's moving faster
relentless in its quest
to stop us in our tracks

tick tock
can you hear it?
faster than my beating heart
thumping with anxiety
checking over my shoulder
for the reaper
he's on a bender
hell-bent on the hunt
to sniff down and snuff out
those I love

tick tock
time won't stop
or take a break or hesitate
to cut us off at the knees
yet here we stand
for what we believe
can make a difference
if we only make it flow

today we stand for flow --
for what we know is essential to the health
of this thing we call a healthcare system

we stand for flow
for overcoming the inertia of standing still
pushing information out
transforming it from solid state to liquid gold
letting it go where it needs to go
flowing into the chasm that separates us
from the quality we pay for but don't receive
flowing so that the liquid data
cascade and echo
creating ripples of insight
that concatenate to engulf us
in tsunamis of knowledge

and so we implement electronic health records
organizing into exchanges
to make flow a reality
in local circumstances
taking chances with taxpayer dollars
that we could never afford
on our own accord
trying to fix on a massive scale
the brokenness of our system
that we in our confessed complacency
have grown to see as normal

millions --
nameless, faceless
suffering under the burden
of a system uninspired
to go the extra mile --
are saying enough
I have a name
I have a voice
I have a face
I take a stand

here I stand
just one example
of a man among millions
with a family lost in this maze
with a father who died
from cancer of his phantom prostate
that had been removed twenty years before
no PSAs for twenty years
why test for something long removed?
maybe because there's a chance it's not all gone
maybe the answer is there
hidden among the data
to know the answer to the question
of whether it would have made a difference
a life or death difference
this one simple test

here I stand
just one example
of a man among millions
with a family lost in this maze
with a mother slowly losing her way
keeping the memories of her youth
but misplacing those formed an hour ago
her children
long away from their hometown
trying to connect the dots of her care
by remote control
"help! I've fallen and I can't get up"
doesn't traverse time zones
so we rely on old technology of phone and fax
which isn't up to the task
as she rides
from assisted living
to hospital
to rehab
and back again
while her medical records struggle
to keep up the pace

here I stand
just one example
of a man among millions
with a family lost in this maze
with a son who enjoys good health
but has already faced the surgeon's scalpel
at an age too young for his memory to recall
exactly why he has that scar on his back
or how his kidneys lack the full capacity
others take for granted
how will he know
when he comes of age
what this means for him
his records passed down
from his elders
like an oral history
told around a campfire
after a hunt for mastodons

here I stand
just one example
of a man among millions
with a family lost in this maze
with a wife who bravely faces
cancer number four
in thirty-two years
who alone carries the burden
of coordinating care
among the dozens and dozens
of providers who focus on
the particular part of her they understand
who alone carries the records
from place to place
from year to year
from diagnosis to diagnosis
hoping she can keep it all straight
so at the very least they do no harm

here I stand
one of the lucky ones
with coverage
with knowledge
with friends
who stands helpless
to make the system work
for those who are the world to him

here I stand
speaking to my heroes
who possess amazing superpowers
to bend maze corners
into straight corridors
and transform the flow
from a trickle
to a torrent

I don't presume to know what drives you
what compels you to forego
another fifteen minutes sleep
and return to the battle
to do the heavy lifting
to add another line of code
to write another line of policy
to create another decision support rule
to make one more connection
to solve one more problem
to make it flow

but if you need a story to motivate
to steel your resolve to press on
mine is here and free for the taking

better still
forget my story
and tell your own
shout it from the rooftops
or whisper it only to yourself
but keep that image
sharply focused in your mind
to give you the inspiration
to do the work
so we all can be
one among the millions
who survive
no, who thrive
who sail

in the flow

(c)2015 Ross D. Martin, MD, MHA

Friday, August 14, 2015

How to Quit Your Job

"Take this job and shove it."

Sure, it makes a catchy hook for a song and maybe helps us get through some of the rougher work days as we imagine ourselves boldly walking into the boss's office, doling out these choice words, and walking out.

But however satisfying in the moment or the imagination, quitting in a huff certainly isn't the most elegant solution for dealing with a challenging job situation. Not only does it hurt your employer (assuming you were meaningfully contributing to your organization's mission), it can also contribute to your reputation as a quitter or a hothead--or worse.

More typical is the quiet job search where you put out feelers while still employed. Then, after securing a new role, you give notice to your current employer, which can leave them scrambling to fill the gap you will leave after a traditional two-week notice.

I just ended a job using neither of those approaches and it worked out more perfectly than I could have hoped. My departure was such a success that more than one colleague suggested I write about it. Writing about quitting doesn't sound like much fun, but I'll do my best to provide some perspective on where and how you can think about making a carefully crafted transition that leaves both you and your employer in a better position.

I will say from the outset, that the story might have turned out very differently without the amazing partnership and leadership demonstrated by our current President and CEO, Dr. Doug Fridsma, and AMIA's longtime COO, Karen Greenwood. Together, we built a relationship based on on trust and transparency. Without those two essential elements, I would never recommend taking this particular path. But if you can build that trust and maintain clear, bidirectional communications along the way, I believe your chances are high for achieving an outcome that is beneficial for both your career and the organization you are leaving.

The specific circumstances leading up to my decision to seek a new role are better told over a pint. The salient issue was that I had been managing two distinct roles at AMIA, which had been my professional home since 1997 and my employer since December of 2012. As VP of Policy and Development, I was responsible for AMIA's public policy efforts, shaping both the legislative and regulatory landscapes as they related to informatics. I was also responsible for AMIA's corporate membership program. Both of these jobs had been separate roles until about two years ago when our VP of Public Policy resigned. Rather than add another staff member, we decided to combine this role with my corporate relations and business development responsibilities. 

This dual role arrangement had always been challenging, requiring a significant amount of give and take between the two competing interests of expanding AMIA's influence and growing AMIA's bottom line. But with 2015 came a Republican-led legislature bent on introducing new legislation around Health IT, precision medicine, electronic health records, and health information exchange. There was no way I would be able to deliver on both roles effectively. Something had to give. AMIA is a small but mighty professional association, so we couldn't simply add more layers of staff without compromising our budget.

After looking at the situation from many angles, in the fall of 2014 I made a recommendation to Doug (who had just joined AMIA as our new President and CEO) and Karen: split my job back into two distinct roles of policy and business development.

There is an obvious snag in this proposal: I couldn't split myself in two. So my choices were to stay and take one of the two jobs (along with a significant cut in salary) or get out of the way (i.e., leave AMIA) so we could rightsize the roles and responsibilities. I added another point to my proposal and asked that AMIA give me the 2015 calendar year to find a new job, during which time I would keep them informed about my prospects so they could better plan the timing of my replacements and so I would have a long enough runway to do a careful search for a new opportunity. 

The more typical approach of the quiet search was less appealing for a couple of reasons: first, there was a high likelihood that wherever I landed, it would be with an organization that is already a part of AMIA--perhaps even one of our existing corporate members. This dynamic would make a search awkward at best and toxic at worst. Second, and perhaps more importantly, dropping out of these two mission-critical roles for AMIA at such an important time and with little notice would put the organization in a challenging position. I'm not so arrogant as to believe that AMIA would have failed without me, but it would have put a real dent in the progress we made in building a strong corporate membership program and we would have lost some very tangible opportunities to shape the legislative and regulatory landscape. 

Doug took my initial proposal and, as he learned more about the organization and our needs, he added to it. Doug and Karen worked together to develop a new proposed structure for both departments. His first hire was a new VP of Public Policy, Jeff Smith, who as luck would have it, became available from CHIME with deep HIT policy experience and a strong reputation on the Hill and with the media as a strong thinker and analyst. I could spend many more paragraphs describing how Jeff was the right person at the right time. Suffice it to say, he hit the ground running. On his first day, we got a call from the Senate HELP staff about our EHR 2020 paper. Seventeen days later, our incoming Board Chair was testifying before the full Committee at their first hearing on the future of electronic health records. Jeff's been going gangbusters ever since.

I had been keeping my eyes and ears open for opportunities and had started a couple of dialogues, but wanted to wait until June 1st to start my search in earnest. The timing was better for AMIA as it fit better into our natural business cycle, plus it gave Doug time to settle in, get his own sense of what AMIA needed in the roles I would be handing off, and put his own design on the process. I kept both Doug and Karen informed about my progress each week and tried to provide some relative odds about how close to a new employment agreement I was. We looked at some contingency plans about my serving as a part-time consultant to AMIA in the event that they didn't fill the roles as quickly as they hoped, giving us maximum flexibility to move through the transition. This arrangement also gave me the opportunity to consider small-firm or independent consulting, with AMIA serving as an anchor client for the first months of my move. 

It turned out that this transition option was not really needed. A new opportunity with CRISP, Maryland's health information exchange, emerged and received state funding sooner than anticipated. During the interview process, I shared my arrangement with AMIA and included some contingency planning for helping AMIA on a very part-time basis as part of our negotiations. Like most hiring employers, they were eager to have me start sooner than later, but they expressed appreciation for the commitment I was showing to my current employer; I believe this ultimately helped rather than hurt my candidacy. I accepted a role as Program Director of CRISP's newly minted Integrated Care Network infrastructure project. I'll say more about my new job in a future post.

Around this same time, AMIA made its second hire. Jenn Novesky joined the AMIA staff as Director of Corporate Relations on August 3rd, 2015. My last day at AMIA was the following Monday, which gave me a full week to onboard Jenn in her new and admittedly complex role of selling and fulfilling corporate memberships for AMIA using a took I built that we affectionately call The Matrix.

The Bottom Line

Many people measure leadership and success by what they accomplish in a role. I'm proud to say that I grew AMIA's corporate membership program in each of the three years for which I was responsible. And I am proud of the work we did to advance AMIA's policy interests. But I think a better marker of success is how you leave an organization and what happens after you're gone.

So I am even more proud of how I am leaving AMIA, with solid talent in place who are well equipped to effectively do the jobs they have been given and the have room to make these jobs their own. And I am deeply grateful for Doug's and Karen's leadership and friendship as we managed this transition as a team--with transparency, trust and mutual respect. Together, we took a difficult situation and made it work to mutual advantage. 

As I said at the beginning, there are many job situations where this type of transition is simply not possible. But I'm glad to share an example of how it can work when you build healthy and respectful relationships with your leaders, then build on that trust to create a strategic and flexible framework that makes room for a more optimal solution.

Have you had an experience with leaving a job that turned out well? Do you have other suggestions about how to approach a job transition when you're in a critical role? Leave a comment and tell about it!