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Founding Fathers Health Corporation (FFHC) is a not-for-profit healthcare organization located in the southeastern region of the United States. It includes a staff model health maintenance organization (HMO), a very successful preferred provider organization (PPO), and thirteen hospitals in three states. Colonist’s First Medical Center (CFMC) is a 460-bed hospital with 1,600 medical staff members and is one of two FFHC hospitals in a large metropolitan area in Virginia. Eighty of the physicians associated with CFMC are part of the staff model HMO, while another 120 are members of practices owned by FFHC. Although it is a very large organization, the culture is consensus-driven and characterized as “polite.” While this makes for a very pleasant work environment, it sometimes stands in the way of frank and open discussion. It is difficult to express strongly emotional or differing ideas or positions because of the backlash that could result from clashing with the polite culture. When a problem arises, there is much frustration in attempting to gain the system’s attention. Although consensus is the goal of decision making, the sheer size and scope of the organization means decisions are often made at anonymous and invisible organizational levels. Many find it difficult to find the person or office responsible for correcting a problem when a grievance arises. A tradition of promoting from within has perpetuated the culture of the “civil tongue”—placing limits on career growth for more outspoken individuals. Recently, however, FFHC has been filling more management positions with candidates from outside the organization.These newcomers are more willing to speak out and challenge the established culture. It remains to be seen whether the organizational culture will tolerate them and the change that they might represent. CFMC has been widely regarded throughout FFHC as an early adopter of electronic medical record (EMR) systems. Although it has had some notable failures in the past, it is moving to overcome its history through the establishment and support of a professional informatics department.The chief information officer (CIO), Ben Arnold, has witnessed two failed implementations in the past 5 years. Betsy Ross, R.N., M.S. with a master’s degree in informatics, has had a long history of patient advocacy. She was hired nearly 4 years ago as chief implementation officer at CFMC, shortly after CFMC suffered an embarrassing failure in a poorly planned implementation of an electronic admitting system at the hospital. Since then, Ross has worked closely with a charismatic physician, Dr. John Adams, who was then the director of medical informatics at CFMC. Together they envisioned |
