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Getting Out of the In-Formation IT Department (Jon Velez)

Employees in the department were valued for doing what they were told and saying ‘yes sir,’ says Jonathan Velez, MD, Chief Information Officer of Memorial Health System in Colorado Springs.

“When I took on the leadership role, IT was known as the place you went to be told ‘you can’t have that.’ There is cultural legacy of top-down, command and control.”

As CIO, Jon is working shoulder to shoulder to transform the culture with system CEO Larry McEvoy. They are dedicated to creating a more collaborative relationship-centered organization. Both Jon and Larry are MDs trained as emergency medicine physicians. They appreciate the importance of trust, coordination, and autonomy among team members to accomplish goals quickly.

Shifting the dominant command and control culture is a dragon with two heads. Hospitals are filled with experts that embrace control. Not only the expert information technologists but also the busy nurses and doctors can over-use command-and-control behaviors. For many of their challenges including and unleashing others is unnecessary. To solve certain technical IT problems and to provide “simple” acute medical care, customers and patients don’t need to be trusted partners to succeed.

Immersion Workshop, Novices to Expert Contributors

Nonetheless, Jon and Larry have big ideas. Their strategy is to shift patterns in internal operations (e.g., information technology, finance) as well as support for a patient-centered Bedside Trust Initiative.

With the goal of unleashing innovation novices to become expert contributors, everyone from top-to-bottom in the Memorial Health System IT department was invited to a LS immersion workshop.

130 members of the department (plus 40 of their internal customers from finance and clinical departments) spent 3 days together, applying LS methods to the challenges they care about most.

Since the workshop in fall of 2010, innovations have been sparked in a widely distributed pattern: from advancing clinical transformation (e.g., Bedside Trust Initiative, physician partnerships) to redesigning the IT request process to radically shifting how mundane meetings are conducted. Jon and other users have their favorite Liberating Structures. Progress has come in patches across the organization. 

Staff meetings are now fun. It feels like magic because people contribute in ways they did not anticipate."

Jon regularly uses 1-2-4-All, Min Specs, and W³ Debrief. He reports, “Staff members moved from the assumption that ‘my idea is not that important’ to seeing that not only did ‘my idea’ add value but also others are thinking along the same lines. Once everyone believes their contribution matters, the team gets much smarter about solving complex challenges.”

Mountains Beyond Mountains

However, there are still boundaries to overcome. It feels like mountains beyond mountains. The legacy culture runs very deep: the unwanted dependent tendencies to wait for someone else to take responsibility, game the system, and blame managers for what is wrong linger. He wants more interdependency and shared accountability everywhere in the department.


Colorado Springs sits at the feet of the Rocky Mountains.

Even when Jon is doing his best to let go of over-control and invite more self-organization, old behaviors pop-up. “The other day, two employees referred to themselves as peons,” says Jon. “I cringed.” Though encouraged, some employees seem unable to believe that this cultural transformation is anything more than talk. “On one hand, employees want to make more decisions. On the other hand, when invited to create an IT decision making council—made up of non-management employees and with the responsibility of making some important decisions—the response has been less than enthusiastic.”

Not deterred, Jon keeps the focus on culture and behaviors. There was big success in responding to a federal Medicare inspection. To comply with confidentiality and safety regulations, the visit revealed a long list of tasks and fixes with a deadline. The work was done in record time with few flaws. Jon asked the staff “Why? How can build on this success?”

He had his own answers in mind. Precisely four. He convened the team using 1-2-4-All. Quickly the answers expanded from 4 to 8. “Four of the key factors were not on my list. I was thrilled although that doesn’t mean I liked everything I heard.”

Jon and the team discovered the success hinged on tapping elements of the old command-and-control culture. Jon shared, “They said it felt like we met in the war room. The general laid out strategy and tactics to get all the tasks done. The chain of command helped us move quickly and accurately.” A surprising paradox indeed.

Wicked Question has emerged: how can I invite and insist on liberation throughout the department?

The revelation left Jon wondering, “Does the organization need a break from working on interdependency or do I need to push harder? It seems counterintuitive but I am contemplating telling them to just do it. A Wicked Question indeed. Liberate yourselves now!”

Paradox: Leaders Stepping-Up While Stepping-Back

Jon is transforming along with the IT department. Individually and collectively they are mutually shaping a way forward. His original idea about transformation is not as simple as stopping command and control and starting liberated self-organization. Rather, he is working with two opposing tendencies: control and letting go. Depending on the situation, comingling can create robust and productive results.

“In some places, the culture seems to be stuck in a dependent rut,” Jon muses. “You can tell a team about a better way to work together and even get agreement. What you don’t always get is movement. In other words, I might need to dictate ‘Come one, we’re moving out of the rut!,” to get a team unstuck.”

These paradoxical tendencies make it hard to know when to step-up or step-back. More importantly, Jon can see his group is learning a new pattern for themselves. Now there is more than a single command-and-control formation to achieve results.

Coltishly, a new culture that transcends and includes the old is coming into existence.