A Leadership Role for Informatics

Nosing though my copy of the Harvard Business Review this month, I read a really interesting article on my caBIG friend and colleague, Dr. Laura Esserman. Laura is a cancer surgeon and the director of the Carol Franc Buck Breast Care Center at UCSF. What is really cool is that she is also the Associate Director of Medical Informatics at the UCSF comprehensive cancer center. This is not only a remarkable achievement, but is also an important demonstration of what it takes to get biomedical informatics onto the agenda of the clinical and medical research leadership within academic medical centers like UCSF. By bridging the two worlds (and by playing a serious game of hardball, as per the HBR piece) Laura has been able to make significant progress in her efforts to develop meaningful informatics-backed translational research and bring it to the forefront in fighting cancer.

This closely matches what we hear in the field- informatics teams that are closely tied to the specific needs of their stakeholders, and have strong support from their academic and administrative leadership at the highest levels can do really remarkable things. Those that are either far removed from the medical and scientific community at their institutions or do not have the ear of senior leadership have far less success in their institutions, and are less able to participate in the kind of exciting change that Laura and her team have been creating.

The funny thing is that getting the ear of senior leadership and being in a position of working closely with the clinical and scientific stakeholders in an institution is not as hard as you might think. In fact, as one of my mentors told me many years ago- if you want to see your ideas flourish, and have informatics and IT participate in the strategic development of the company, you have to first "make sure that email works." This mentor was the CIO for many years at one of the largest personal products companies, and as such had a lot of experience dealing with leadership for whom IT was not always considered a key part of the corporate mission. By knowing what the simple necessities are for the scientific, clinical and administrative leadership and making sure that they work consistently and well is the ticket to allowing informatics and IT to more fully participate in the mission of the institution and to realize the amazing progress that is possible- just like Laura has.

Thinking about the Shift Index

The concept of the "Shift Index" has been making the rounds of management strategists and consultants, and I have been thinking about how it applies to biomedical informatics. For those who keep track of such things, American companies have lost as much as 75% on their "Return on Assets"," or ROA, since 1964. That is a pretty stunning number, and a recent article in the Harvard Business Review discusses some possible reasons why that is. Hagel et al., the authors of the piece, identify a shift of power to both consumers and to creative talent as one of the prime motivators of the change. In many ways, such large shifts in ROA can also be attributed to a much more competitive landscape, in which over the last forty years, companies outside of the United States have become more competitive, and are increasingly putting business and pricing pressure on domestic companies. This, also, as the Hagel and his colleagues point out, is the result of increasingly rapid shifts in what they call the "Foundation Index," a measure of underlying technology changes. These Foundational Changes are currently driving much of the overall Shift now, but the authors believe that this will eventually be eclipsed by other metrics which measure information flow and its impact.
The article and an associated paper with more details both talk about the need to increasingly structure organizations to enable staff beyond the "Creatives" (as per Richard Florida in his book, The Rise of the Creative Class) to dynamically contribute to the business. In bioinformatics, this is analogous to developing processes and systems that extend access to biomedical data beyond just the software engineers and other IT professionals, to the laboratory and clinical researchers at the front lines of science. Enabling those people to make effective use of the volumes of data generated by both internal and external sources will be a key differentiator between companies that leverage the shifts in knowledge flows that Hagel et al. are talking about and those that do not. Fostering the dynamic flow of useful information both to and from the front-line scientists and clinicians gives those most knowledgeable about the underlying processes the capability to derive useful information from what is out there, enabling conversion of that information into products efficiently and effectively. This is what will ultimately drive increasing Return on our scientific and bioinformatics Assets.