Fast.Forward. Connecting marketers with innovative ideas (and other marketers)

In this ever-changing digital environment, it can often be tough for businesses and marketers to keep up and maintain relevance to consumers. To help out, we've partnered with The Wharton School to launch <a href="http://www.youtube.com/fastforward">Fast.Forward.</a> This site is full of helpful content, including more than 100 videos from leading industry experts — like our own CEO, Eric Schmidt — and academics like <a href="http://www.wharton.upenn.edu/faculty/windj.html">Jerry Wind</a>, Lauder Professor at The Wharton School, offering their perspectives on the changing world of marketing.<br /><br />You can read all about it on our <a href="http://ytbizblog.blogspot.com/2009/09/fastforward-connecting-marketers-with.html">YouTube Biz Blog</a>.<br /><br /><span class="byline-author">Posted by Cindy Goodrich, Google Business Marketing</span>

Fast.Forward. Connecting marketers with innovative ideas (and other marketers)

In this ever-changing digital environment, it can often be tough for businesses and marketers to keep up and maintain relevance to consumers...

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Why Have Governing Boards Forsaken Their Duties? - Ideas from Silverglate and Malchow

We have posted frequently about the governance and leadership of academic medical organizations. While one would think that health care organizations, and especially academic health care organizations ought to be held to a particularly high standard of governance, we have noted how their governance is often unrepresentative of key constituencies, opaque, unaccountable, unsupportive of the academic and health care mission, and not subject to codes of ethics. How the governance of organizations with such exemplary missions and sterling reputations got this way has been unclear.<br /><br />Now there are new insights from the ongoing discussion of one of the most interesting and controversial cases of disputed organizational governance. We have often come back to the example of Dartmouth College, of which Dartmouth Medical School is a significant component. We most recently discussed <a href="http://www.blogger.com/http//hcrenewal.blogspot.com/2009/04/investment-bankers-strike-back.html">here</a> an ongoing dispute about the extent that the institution's board of trustees ought to represent the alumni at large, or instead, ought to be a self-elected body not clearly accountable to anyone else. (For our take on this complex case, start <a href="http://hcrenewal.blogspot.com/2009/04/investment-bankers-strike-back.html">here</a> and follow the links backward.) The latest development in the case is a lawsuit filed by Dartmouth alumni challenging an increase in the number of self-elected, or "charter" trustees, which they charged broke an 1891 agreement that established numerical parity between alumni-elected and charter trustees.<br /><br />Soon after this lawsuit was filed, an <a href="http://www.dartblog.com/data/media/Silverglate_Malchow_Fiduciary_Duty_9-09.pdf">important article </a>by Harvey Silverglate (one of the founders of FIRE, the Foundation for Individual Rights in Education) and Joseph Malchow appeared. For those interested in the case, the article includes extensive detail, with multiple citations, on all the twists and turns of the case, and is very much worth reading. (See <a href="http://www.thefire.org/article/11058.html">this post </a>on FIRE's Torch blog for more background and discussion.)<br /><br />However, the article also features extensive scholarship on governance of US not-for-profit institutions, focused on academic institutions (including medical academia), and with relevance to other not-for-profit or non-governmental health care organizations. In particular, the article sheds light on how the governance of such organizations has become so degraded.<br /><br />First, Silverglate and Malchow summarized the duties of governing boards:<br /><br /><blockquote><br />Traditionally, fiduciary duty [of the board of trustees] has been understood as having two components: <em><strong>the duty of loyalty</strong></em> and the <em><strong>duty of care</strong></em>. The duty of loyalty requires a fiduciary to <em>act in a manner he or she reasonably believes to be in the best interests of the organization</em>. The duty of care obliges directors to <em>inform themselves of reasonably available information prior to making a business decision</em>. More recently, courts have considered <strong><em>the duty to act in good faith</em></strong> [the duty of obedience] as a fiduciary requirement. This component, similar to the duty of care, is satisfied when a director <em>makes informed decisions without conflicts of interest</em>.<br /><br />The question central to the dispute regarding Dartmouth governance is to what or to whom do fiduciaries owe their duty. Corporate directors have a relatively straightforward task of serving the corporation and its shareholders. In the case of a charitable trust, however, which generally does not have 'ascertainable beneficiaries who can enforce their rights,' <em><strong>the duty of fiduciaries is instead directed toward fulfilling or furthering the organization’s mission</strong></em><br /></blockquote><br /><br />So just to summarize, considerable discussion, scholarship, and I believe some some laws support the notion that the board of a not-for-profit organization is obliged to take reasonable care to make informed decisions free of conflicts of interest to uphold the organization's mission.<br /><br />However, currently, many boards <em>value deference to the organization's (usually hired) top managers and avoidance of internal conflict within the board more highly</em> than these obligations:<br /><br /><blockquote>Dartmouth, to be sure, is far from the only place where <em>fealty to organizational leaders—and the notion of 'going along in order to get along' —has been placed before true fiduciary duty.<br /></em></blockquote><br />Silverglate and Malchow have some important ideas about how we came to this.<br /><br /><em>Not-for-profits became more like for-profit corporations</em>:<br /><br /><blockquote>During the 1980s, traditional nonprofit organizations supported by donations and governed by donors and volunteers became <em>increasingly displaced by professionally staffed commercial nonprofits, supported by grants, contracts, and earned income, and governed by insider boards.</em> The shift in governance was armored by <em>progressively professionalized and entrepreneurial management</em>, which was perceived to be more adept at control of the ebb and flow of funds in the American market. </blockquote><br />Top hired not-for-profit <em>executives assumed more power at the expense of other constituencies, including the professionals who did the work</em>:<br /><br /><blockquote>By the 1990s, with faculty power firmly institutionalized at colleges and universities, <em>a notion that university presidents were bereft of power took hold</em>. The AGB [Association of Governing Boards], in 1996, argued that university presidents <em>needed to regain power</em> with a pivotal document of its own: Renewing the Academic Presidency: Stronger Leadership for Tougher Times. Though this outlook was applied to varying degrees at colleges and universities, an <em>imperative toward greater executive power in universities was thus established.<br /></em><br /><em>Presidential and professorial decision-making power, combined with the rise of the administrative bureaucracy in academia, have generally relegated trustees to a secondary role</em> in campus affairs. </blockquote><br />Attempts at reforming governance were <em>inappropriately based on a for-profit corporate model, and particularly the need to project unity and avoid confrontation among the leadership trumped transparency</em>:<br /><br /><blockquote>Aligning academic boards with the cultural trends of increased critical oversight has obvious benefits, but some boards have <em>moved to adopt the norms of for-profit corporate governance that are simply not applicable to the university context</em>. Admittedly, this is a thin distinction when considered on a theoretical level. But in practical terms, <em>misguided nonprofit reforms—some of which, upon close examination, actually violate an institution’s mission</em>—are readily evident.<br /><br />For example, some nonprofit boards have emphasized the adoption of <em>formal nondisclosure pledges or confidentiality agreements that step well beyond nondisclosure of proprietary information.</em> This is hardly uncommon in the business sector, where bottom-line strictures demand a certain degree of internal accord and non-transparency. And though there is evidence that nonprofit board directors have, from time to time, attempted to hush public dissent, only recently have dominant majorities of some nonprofit boards proposed and ratified binding pledges not to publicly air differences. According to a 2006 BoardSource publication, <em>'If a board member does not support a decision for whatever reason, [he or] she has a responsibility to remain silent or step down from the board.' </em>(Recall the resignation offer made to Zywicki before his second term was denied.)<br /><br />These directives, written in highly influential publications in the realm of university governance, disregard the important role that public discussion has on decision-making at universities and nonprofits in general. 'In the nonprofit context, nondisclosure agreements or the use of 'executive session' rules to curtail debates about policy and procedure depart from established norms. They shut down opportunities for public dialogue and for communication with other concerned and influential parties, including reporters,' nonprofit specialist Norman I. Silber wrote in the Oregon Law Review. </blockquote><br />Emphasis on raising money rather than upholding the mission has lead to board deference to hired executives.<br /><br /><blockquote><em>Fidelity to institutional leaders, rather than institutional mission, is now paramount in higher education, as deviation from accepted decisions is perceived as potentially shrinking the donor base. Administrators cringe at public disagreement</em>; rather than focusing on the long-term likelihood that competing ideas will result in implementation of the fittest, they tend to focus on the short-term possibility that a particular alumni subset may be offended. This shortsighted outlook is not only an insult to the intelligence of alumni and other constituencies, but it is ultimately detrimental to the institution, as established ideas are enthroned and unchallenged. It is also based on false premises: as in the case of Dartmouth, there is no established correlation between public criticism and donor decline. </blockquote><br /><br />Boards are increasingly <em>composed of executives of for-profit corporations</em>, particularly in the finance field, who may grant the same deference to the organizations' leaders that they would like from their own board. That is, <em>hired executives identify more with other executives than with the organizations they are supposed to be leading</em>:<br /><br /><blockquote><br />Judge Cabranes noted that <em>trustees, especially business executives, tend to act toward university presidents as they wish their boards would act toward them—deferentially.</em> And the phenomenon of board members believing they serve at the pleasure of the executive is what one nonprofit attorney and blogger, has termed 'upside down board.' <em>The ascendance of the hedge-fund community, a peculiar province of graduates of elite institutions,</em> has contributed to the prevalence of the upside down board....<br /></blockquote><br /><br />The article suggests some issues that need to be addressed to make governance more accountable, transparent, ethical and honest. Boards need to be reminded of their duties, and that their loyalty should be to the mission, not the organization's executives, or the views of the board's majority. Transparency and open discussion are more important than projecting the (sometimes false) impression of unity. New board members should be chosen for their loyalty to the mission rather than their similarity to and congeniality with current board members.<br /><br />I strongly suggest that anyone who cares about how health care organizations are run ought to read Silverglate and Malchow's full article. It should be required reading for current and would-be board members of academic and health care not-for-profit organizations (but I will not hold my breath waiting for them to read it.)

Why Have Governing Boards Forsaken Their Duties? - Ideas from Silverglate and Malchow

We have posted frequently about the governance and leadership of academic medical organizations. While one would think that health care orga...

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Help and learn from others as you browse the web: Google Sidewiki

As you browse the web, it's easy to forget how many people visit the same pages and look for the same information. Whether you're researching <a href="http://www.google.com/sidewiki/entry/117213073072448275065/id/Fegil0nf8ivzC6iIB8MU0XREs3A">advice on heart disease prevention</a> or looking for <a href="http://www.google.com/sidewiki/entry/oklahomazeppelin/id/Dys9NgtwlW1uI1a1-R8-grlgxOw">museums to visit in New York City</a>, many others have done the same and could have added their knowledge along the way.<br /><br />What if everyone, from a local expert to a renowned doctor, had an easy way of sharing their insights with you about any page on the web? What if you could add your own insights for others who are passing through?<br /><br />Now you can. Today, we're launching Google Sidewiki, which allows you to contribute helpful information next to any webpage. Google Sidewiki appears as a browser sidebar, where you can read and write entries along the side of the page.<br /><br /><object height="340" width="560"><param name="movie" value="http://www.youtube.com/v/CsjJOsx84MA&hl=en&fs=1&"></param><param name="allowFullScreen" value="true"></param><param name="allowscriptaccess" value="always"></param><embed src="http://www.youtube.com/v/CsjJOsx84MA&hl=en&fs=1&" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" width="560" height="340"></embed></object><br /><br />In developing Sidewiki, we wanted to make sure that you'll see the most relevant entries first. We worked hard from the beginning to figure out which ones should appear on top and how to best order them. So instead of displaying the most recent entries first, we rank Sidewiki entries using an algorithm that promotes the most useful, high-quality entries. It takes into account feedback from you and other users, previous entries made by the same author and many other signals we developed. If you're curious, you can <a href="http://googleresearch.blogspot.com/2009/06/large-scale-graph-computing-at-google.html">read more</a> on our Google Research Blog about the infrastructure we use for ranking all entries in real-time.<br /><br />Under the hood, we have even more technology that will take your entry about the current page and show it next to webpages that contain the same snippet of text. For example, an entry on a speech by President Obama will appear on all webpages that include the same quote. We also bring in relevant posts from blogs and other sources that talk about the current page so that you can discover their insights more easily, right next to the page they refer to. <br /><br />We're releasing Google Sidewiki as a feature of Google Toolbar (for Firefox and Internet Explorer) and we're working on making it available in Google Chrome and elsewhere too. We also have the first version of our <a href="http://code.google.com/apis/sidewiki/">API</a> available today to let anyone work freely with the content that's created in Sidewiki.<br /><br />We've been testing Sidewiki with several experts and news organizations for a while and are happy to <a href="http://www.google.com/sidewiki/intl/en/testimonials.html">hear their positive responses</a>. We hope you'll try it for yourself, <a href="http://twitter.com/googlesidewiki">follow our Twitter feed</a>, and let us know what you think!<br /><br />If you're ready to start exploring the web with Google Sidewiki, visit <a href="http://google.com/sidewiki/#tbbrand=GZEG">google.com/sidewiki</a> to download Google Toolbar with Sidewiki and contribute your own entries alongside pages on the web.<br /><br /><span class="byline-author">Posted by Sundar Pichai, VP Product Management and Michal Cierniak, Engineering Lead for Google Sidewiki </span>

Help and learn from others as you browse the web: Google Sidewiki

As you browse the web, it's easy to forget how many people visit the same pages and look for the same information. Whether you're re...

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Picasa 3.5, now with name tags and more

Today, I'm happy to announce that <a href="http://googlephotos.blogspot.com/2009/09/announcing-picasa-35-now-with-name-tags.html">we're releasing</a> Picasa 3.5, a new version of our free photo editing software. This version gives you the ability to add name tags to your photos, using the same facial recognition technology that powers <a href="http://picasa.google.com/features-nametags.html">name tags on Picasa Web Albums</a>. Name tags are designed to help you organize your photos by what matters most: the people in them. Picasa identifies similar faces and puts these into an "Unnamed People" album. From there, you can easily add a name tag by clicking "Add a name" and typing the person's name. After you've added name tags to some photos, you can use your tags to do creative things, like quickly find all the photos with the same two people in them, make a face collage with just one click or upload and share people albums with friends.<br /><br />In addition to name tags, Picasa 3.5 has integrated Google Maps, so you can easily geotag your photos or view the locations of already-tagged photos on a map. And using our totally redesigned import process, you can now import photos from your camera and upload the photos to Picasa Web Albums in one easy step.<br /><br /><object height="340" width="560"><param name="movie" value="http://www.youtube.com/v/gYO2uhrIZJ4&hl=en&fs=1&"><param name="allowFullScreen" value="true"><param name="allowscriptaccess" value="always"><embed src="http://www.youtube.com/v/gYO2uhrIZJ4&hl=en&fs=1&" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" width="560" height="340"></embed></object><br /><br />Picasa 3.5 is available for both PC and Mac, in English for now. You can download and try it today at <a href="http://picasa.google.com/">picasa.google.com</a>.<br /><br /><span class="byline-author">Posted by Todd Bogdan, Software Engineer</span>

Picasa 3.5, now with name tags and more

Today, I'm happy to announce that we're releasing Picasa 3.5, a new version of our free photo editing software. This version gives ...

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Google climate change tools for COP15

In December of this year, representatives from nations around the globe will gather in Copenhagen to discuss a global agreement on climate change. The objective is to reduce global warming emissions sufficiently in order to avoid the most severe impacts of climate change and to support the global community in adapting to the unavoidable changes ahead. Denmark will act as host for this fifteenth Conference of the Parties under the United Nations’ Climate Change Convention, known as <a href="http://www.cop15.dk/">COP15</a>.<br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgUxcjfkItWdSzO9e_yLZOk6dHeL4KXeVYb8Sc7N5DhxawQzzFeMzu7pj4ePfh4_QAp21uv8ykfTUkNofdKy2WIiAUTigpyBICynuDkpPGWb4IiKepmWHO3CmdUKA-oaqEsw7ENXy7Gs2uB/s1600-h/cop15geo_blog_post1.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5384306859347464418" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgUxcjfkItWdSzO9e_yLZOk6dHeL4KXeVYb8Sc7N5DhxawQzzFeMzu7pj4ePfh4_QAp21uv8ykfTUkNofdKy2WIiAUTigpyBICynuDkpPGWb4IiKepmWHO3CmdUKA-oaqEsw7ENXy7Gs2uB/s320/cop15geo_blog_post1.jpg" style="margin: 0pt 0pt 10px 10px; float: right; cursor: pointer; width: 289px; height: 320px;" /></a>In collaboration with the Danish government and others, we are launching <a href="http://www.google.com/cop15">a series of Google Earth layers and tours</a> to allow you to explore the potential impacts of climate change on our planet and the solutions for managing it. Working with data from the Intergovernmental Panel on Climate Change (<a href="http://www.ipcc.ch/">IPCC</a>), we show on Google Earth the range of expected temperature and precipitation changes under different global emissions scenarios that could occur throughout the century. Today we are unveiling our first climate tour on Google Earth: "<a href="http://www.youtube.com/watch?v=jPIo7lteCZk&hd=1">Confronting Climate Change</a>," with narration by Al Gore. Stay tuned for more tours in the coming weeks!<br /><br />Together with the Danish government, we're also launching our <a href="http://www.youtube.com/cop15">YouTube COP15 channel</a>. On the channel, you can submit your thoughts and questions on climate change to decision-makers and the world through an initiative called "Raise Your Voice." These videos will be broadcast on screens around the conference in December and rated by viewers of the channel. The top-rated contributions will be aired globally during the COP15 CNN/YouTube debate on December 15th, and the top two submissions will win a trip to Copenhagen. We look forward to seeing your videos!<br /><br /><span class="byline-author">Posted by Benjamin Kott, Green Business Operations and Jonas Vang, Industry Analyst</span>

Google climate change tools for COP15

In December of this year, representatives from nations around the globe will gather in Copenhagen to discuss a global agreement on climate c...

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A "Safety-Net" Medical Center CEO Gets a Golden Parachute

<a href="http://www.thebostonchannel.com/investigative/20987735/detail.html">From theBostonChannel.com </a>comes this story on executive compensation in a not-for-profit health care organization,<br /><br /><blockquote><br /><em>Boston Medical Center – a financially troubled hospital – gave its outgoing CEO a one-time, <strong>nearly $3.5 million payment</strong>, in addition to her <strong>$1.3 million annual salary</strong></em>, Team 5 Investigates reported Friday.<br /><br />Elaine Ullian, 61, has led the <em>city’s major 'safety net' hospital</em> for the last 15 years. She recently announced she will retire when her contract expires in January.<br /><br />The <em>hospital's financial situation is such that hospital leaders say it could face closure in the years ahead</em>. It is currently suing the Executive Office of Health and Human Services over how it gets paid for treating poor and uninsured patients.<br /><br />Team 5 Investigates discovered, in a review of the hospital’s financial filings with the state, that Ullian was <em>paid $3,466,458 'in recognition of exceptional performance over a period of 15 years.'<br /></em><br />The nearly $3.5 million bonus was on top of Ullian’s 2008 compensation of $1,348,504 including salary and benefits.<br /><br />In a written statement to Team 5 Investigates, Ted English, the chairman of BMC’s board said that Ullian’s 'compensation is set by a committee of the Boston Medical Center Board of Trustees who consult with independent compensation advisors. It is based on her performance evaluation and measurable goals that are reviewed annually.'<br /><br />'The Board considers Elaine Ullian to be one of the most competent and successful hospital CEOs in the country and believes <em>she is primarily responsible for the success of Boston Medical Center</em> over the past 15 years,' English's statement said.<br /></blockquote><br /><br />Boston Medical Center was formed by the merger of University Hospital (the Boston University teaching hospital), and Boston City Hospital, the legendary municipal hospital. (Note: I served as an internal medicine intern and resident in the University Hospital program, and rotated through Boston City frequently.) Thus, as noted above, BMC is the city's primary "safety net" hospital for the care of the poor. BMC has for <a href="http://www.bmc.org/about/who/mission.htm">its mission</a>:<br /><br /><blockquote><br />We will provide consistently <em>excellent and accessible health services to all in need of care <strong>regardless of status or ability to pay</strong></em> – exceptional care, without exception.<br /></blockquote><br /><br />Such generous pay seems inconsistent with this mission and the organization's not-for-profit status. Such a golden parachute seems inconsistent with the current threats to its finances.<br /><br />Any worry about the CEO's retirement finances should further be reduced by her ongoing part-time work on the boards of directors of three public for-profit health care corporations, <a href="http://www.hologic.com/">Hologic</a>, a medical device company specializing in "womens' health," <a href="http://www.thermofisher.com/global/en/home.asp">ThermoFisher Scientific</a>, a manufacturer of laboratory equipment and supplies for health care and research, and <a href="http://www.vrtx.com/">Vertex Pharmaceuticals</a>, a biotechnology company focusing on small-molecule drugs. For her work as a director of Hologic, she received $304,698 in total compensation in 2008, and owned 40,000 shares or equivalent of common stock (per the company's <a href="http://www.sec.gov/Archives/edgar/data/859737/000119312509009496/ddef14a.htm">2009 proxy statement</a>). For her work for ThermoFisher Scientific, she received $275,319 total compensation, and owned 61,068 shares or equivalent (per the <a href="http://ccbn.10kwizard.com/xml/download.php?repo=tenk&ipage=6256980&format=PDF">2009 proxy statement</a>). For her work for Vertex Pharmaceuticals, she received $337,480 total compensation, and owned 79,500 shares or equivalent (per the <a href="http://investors.vrtx.com/secfiling.cfm?filingID=1047469-09-3942">2009 proxy statement</a>). As Robert AG Monks put it, corporate directors are supposed to "demonstrate unyielding loyalty to the company's shareholders" [Per Monks RAG, Minow N. <a href="http://www.amazon.com/Corporate-Governance-Robert-G-Monks/dp/1405116986">Corporate Governance</a>, 3rd edition. Malden, MA: Blackwell Publishing, 2004. P.200.] Therefore, Ms Ullian's directorships seem to pose conflicts with her primary employment as CEO of an academic medical center which must buy products used in womens' health, buy laboratory supplies, and implement basic and clinical research. <br /><br />The BMC board chair's assertion that the CEO is "primarily responsible for the success" of the institution merits special comment. It seems obvious that the main determinant of the success of a medical center is the work done by its health care professionals and support personnel. A medical center cannot provide care, much less good care, without doctors, nurses, therapists and technicians, supported by supply, logistics, cleaning, maintenance, dietary, clerical, medical record, financial and yes, even health care information technology workers and systems (and if I left out an important group of support personnel, I apologize now.) The chair's assertion suggests the hubris central to the ethos of contemporary business managers, but is at odds with the clinical context. (Of course, if the CEO was primarily responsible for the organization's success, she should now shoulder primary blame for its current awkward financial situation, but such consistency may be the hobgoblin of minds too little to understand the gravitas of the C-level manager.)<br /><br />A long time ago, in a galaxy far, far away, health care was a calling. Doctors once pledged to avoid all commercialization (see post <a href="http://hcrenewal.blogspot.com/2009/06/why-did-us-physicians-give-up-their.html">here</a>), and hospital directors or superintendents (not CEOs) did not earn riches, much less become "imperial." (See Ludmerer's <em><a href="http://www.oup.com/us/catalog/general/subject/HistoryOther/HistoryofMedicine/?view=usa&ci=9780195181364">Time to Heal</a></em>.) But in the culture of wretched excess that spread from the financial world, hospital CEOs now seem to feel entitled to become wealthy, as they claim responsibility for all successes, while all failures are blamed on someone else. The current system has made hired managers into an ersatz aristocracy, entitled to fill their pockets while denying any responsibility for ever rising costs, declining access, poor quality and demoralized professionals. In my humble opinion, to achieve true health care reform, health care again must become a calling, lead by people who will put the mission ahead of the accumulation of wealth and power.

A "Safety-Net" Medical Center CEO Gets a Golden Parachute

From theBostonChannel.com comes this story on executive compensation in a not-for-profit health care organization, Boston Medical Center – a...

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Physicians, Even Those Educated in IT and Informatics, Are Not "Real" IT People

<span style="font-size:100%;">I've been participating in the comment thread on the HisTALK heath IT industry news/gossip site at <a href="https://exchangeweb.drexel.edu/owa/redir.aspx?C=6e88815ddf904c1088c4e7892352e56a&URL=http%3a%2f%2fhistalk2.com%2f2009%2f09%2f17%2fnews-91809%2f" target="_blank">http://histalk2.com/2009/09/17/news-91809/</a> . At this time there are 40 comments - mine start at #4. </span><span style="font-size:100%;">(I've also archived the thread in Word format <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/Responses%20to%20HISTALK%20News%2009_18_09.doc">here</a>.)</span><br /><span style="font-size:100%;"><br />It's been quite interesting, demonstrating that many of the harmful attitudes of IT personnel about healthcare I observed more than a decade ago are still around.<br /><br />An anonymous commenter under the title "Programmer" has been forthcoming with views I think are actually common in the health IT field about medicine, science, IT flaws and shortcomings, and physician involvement in HIT. I will let you read them for yourself at the above link.<br /><br />Others have indicated in that comment thread and other threads that "Programmer" is an executive with a large HIT company, but I cannot confirm this.<br /><br />Among other stunning views, this commenter exhibited:<br /><br /></span><ul><li><span style="font-size:100%;">Serious errors in logic such as repeatedly and unshakably mistaking well-documented reports about known rates of IT project failure as a condemnation that all IT projects fail, perhaps reflecting a state of denial;<br /></span></li><li><span style="font-size:100%;">Lack of understanding that in scientific fields such as biomedicine, conclusions generally should be supported by reasonable evidence, not "because I think so";<br /></span></li><li><span style="font-size:100%;">Lack of understanding and dismissal of the value of the peer reviewed scientific literature on health IT, and further, a seeming inability or unwillingness to peruse the "references" section of scientific articles, a profoundly unscientific approach to the world;<br /></span></li><li><span style="font-size:100%;">Dismissal of the written views of organizations such as the Joint Commission, US National Research Council, </span><span style="font-size:100%;">European Federation for Medical Informatics and others on HIT deficiencies;<br /></span></li><li><span style="font-size:100%;">Perhaps most harmfully, dismissal of faulty conceptual and physical data models, inadequate workflow and cognitive support, and IT of poor user interaction design that presents a mission hostile user experience as a real problem in <span style="font-weight: bold;">critical care areas </span><span>such as Invasive Cardiology (specifically, in <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=cases&sloc=Cardiology%20story">this case</a>). Instead, this IT person dismissed physician dismay and rejection of such ill-designed and profoundly unusable IT as a mere <span style="font-weight: bold;">"pissing contest" between IT and clinicians</span>, consistent with narrow, territorial, paternalistic, indeed autocratic IT-centric views and a reversal of enabler (clinician) vs. facilitator (IT service provision) roles in patient care.</span></span></li></ul><span><span style="font-size:100%;"><span style="font-size:100%;"><br /></span></span></span><span style="font-size:100%;">"Programmer" also attacks (from the perspective of arrogant ignorance) the "<a href="http://www.jamia.org/cgi/content/full/16/3/291">Health IT Project Success and Failure: Recommendations from Literature and an AMIA Workshop</a>" white paper </span><span><span style="font-size:100%;"><span style="font-size:100%;">drawing together the thinking at a workshop attended by over fifty informatics experts from all areas of medicine and technology. The role of the medical informatics expert itself, and other issues as well relating to reasons for HIT failure and difficulty are attacked and dismissed.</span></span></span><br /><span><span style="font-size:100%;"><span style="font-size:100%;"><br />(If the person is a fake or "sock puppet", they're doing a mighty accurate approximation of my own uncomfortably-common observations in managing health IT and biomedical research IT projects while working with non-biomedical </span></span></span><span><span style="font-size:100%;"><span style="font-size:100%;">IT personnel, see cases <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=home">here</a></span></span></span><span><span style="font-size:100%;"><span style="font-size:100%;">.)</span></span></span><br /><br />The crux of the matter came out towards the end where "Programmer" maintains in Comment #28 that I am "<span style="font-style: italic;">just someone who likes to talk about IT</span>” and he is a “<span style="font-style: italic;">real IT person</span>.”<br /><br />A "real IT person?" I've heard that before: this is the "<span style="font-weight: bold;">doctors</span> <span style="font-weight: bold;">don't do things with computers</span>" <span style="font-size:100%;">(including medical informaticists) </span><span style="font-size:100%;">type of comment I've heard face-to-face periodically from healthcare IT personnel since I entered the field in the early 1990's, and commented upon a decade ago <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/informaticsmd/tactics.htm#dddtwc">here</a>.<br /></span><span><span style="font-size:100%;"><span style="font-size:100%;"><br />I've emailed Tim, the proprietor of the HISTalk site [mr_histalk AT yahoo.com], to inquire if this poster was real or just a provocateur.<br /><br />Tim's response: "He's real and has been around for awhile, although lately he seems to be enjoying an escalated level of confrontation when he can create one."<br /><br />I maintain -- based on personal experience and that told me by others -- that this person's views are not all that rare in the HIT vendor and hospital IS communities.<br /><br />I also opine that thinking such attitudes can be dealt with by logical argument and persuasion is a belief itself lacking in rigor.<br /><br />IT personnel of views as in the HisTALK comments thread represent an older culture of <span style="font-style: italic;">data processing</span>, dating from the days of card punch tabulators that ran businesses prior to computers. It is a culture that has failed to mature with the times.<br /><br />As I wrote <a href="http://hcrenewal.blogspot.com/2008/05/seedie-society-for-exorbitantly.html">here</a>, the </span></span></span>unimaginative, process over results, tight fisted control, bureaucratic data-processing culture of the business IT (management information systems) world is the lineal descendant of <a href="http://www.columbia.edu/acis/history/tabulator.html">IBM's patchcord plug-panel programmed, card tabulating machines</a> from which IBM made a large portion of their profit in the days before the electronic computer:<br /><br /><br /><div style="text-align: center;"><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgtzPSYfQOl-r_AY2tMvOiNYhzoGThK0-_X7Xy_KAOQYMox-IK8N8u3Lz-n7cwYwbkDrau7lm2ya8P8S_uYDp9EylhKIFfAq-ltb5zgOjz-LSciW7IPT-SLXr4YvJ2KYVpSqpkY1rMh3qBg/s1600-h/tabulator.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5384014906855078690" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgtzPSYfQOl-r_AY2tMvOiNYhzoGThK0-_X7Xy_KAOQYMox-IK8N8u3Lz-n7cwYwbkDrau7lm2ya8P8S_uYDp9EylhKIFfAq-ltb5zgOjz-LSciW7IPT-SLXr4YvJ2KYVpSqpkY1rMh3qBg/s320/tabulator.jpg" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 222px; height: 145px;" /></a><span style="font-size:100%;">Hollerith Type III Tabulator with its control panel exposed. <i>Photo:</i> MNRAS, Vol.92, No.7 (1932). Click to enlarge. </span><br /></div><small><br /></small><span><span style="font-size:100%;"><span style="font-size:100%;"><br />Fortunately, such personnel and their designer-centric, as opposed to user- and work-centric philosophies are starting to become obsolete. This can be observed (as an example) via the mission of the <a href="http://www.ischools.org/">iSchool consortium</a>, of which my organization, the Drexel College of Information Science and Technology, is a member:<br /><br /></span></span></span><blockquote>The <strong>iSchools</strong> are interested in the <span style="font-weight: bold;">relationship between information, people and technology</span>. This is characterized by a commitment to learning and understanding the role of information in human endeavors. The iSchools take it as given that expertise in all forms of information is required for progress in science, business, education, and culture. This expertise must include <span style="font-weight: bold;">understanding of the uses and users of information</span>, as well as <span style="font-weight: bold;">information technologies and their applications</span>. <span style="font-style: italic; color: rgb(255, 0, 0); font-weight: bold;">[the order of these priorities is pertinent - ed.]</span></blockquote><span><span style="font-size:100%;"><span style="font-size:100%;"><br />Unfortunately, the data processing culture and its adherents are not becoming obsolete quite fast enough. There are still too many in the upper echelons of management, including health IT vendors, hospitals and pharmaceutical R&D environments.<br /><br /></span></span></span><span><span style="font-size:100%;"><span style="font-size:100%;">Finally, IT personnel with such attitudes as displayed in the comments, from the lowliest programmer to the CEO and Board, have no place anywhere near where patient care is conducted, or where information systems serving clinical medicine are designed and built.<br /><br />In line with other character types one encounters in healthcare that are often discussed on Healthcare Renewal, clinicians should <span style="font-weight: bold;">not</span> accommodate such IT personnel and these types of views.</span></span></span><br /><span><span style="font-size:100%;"><span style="font-size:100%;"><br />-- SS<br /><br />Addendum:<br /><br />The final (at this time) comment, #40, left by the above commenter states:<br /></span></span></span><blockquote><span><span style="font-size:100%;"><span style="font-size:100%;"><br />#40 Programmer: If I decide to become a medical informatproctolicist, I’m going to specialize in sardonicology.</span></span></span></blockquote><span><span style="font-size:100%;"><span style="font-size:100%;"><br />IT personnel of such views bring to life Lecia Barker's paper "Defensive climate in the computer science classroom":<br /><br /></span></span></span><span style=";font-family:Arial;font-size:10pt;" ></span><blockquote><span style=";font-family:Arial;font-size:100%;" >“<b style="">Defensive climate in the computer science classroom</b>” by Barker et al., <st1:place st="on"><st1:placetype st="on">Univ.</st1:placetype> of <st1:placename st="on">Denver</st1:placename></st1:place>.<span style=""> </span>Link <a href="http://portal.acm.org/citation.cfm?id=563354&coll=portal&dl=ACM">here</a> (subscription required).<span style=""> </span>May help explain the control-seeking culture of IT personnel.<span style=""> </span>As part of an NSF-funded IT workforce grant, the authors conducted ethnographic research to provide deep understanding of the learning environment of computer science classrooms. Categories emerging from data analysis included 1) impersonal environment and guarded behavior; and 2) the creation and maintenance of informal hierarchy resulting in competitive behaviors. These communication patterns lead to a defensive climate, characterized by competitiveness rather cooperation, judgments about others, superiority, and neutrality rather than empathy.</span></blockquote><br />-- SS

Physicians, Even Those Educated in IT and Informatics, Are Not "Real" IT People

I've been participating in the comment thread on the HisTALK heath IT industry news/gossip site at http://histalk2.com/2009/09/17/news-9...

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