CHIA D Flashcards
What do leaders do? (7)
Leaders:
• Realistically appraise the leadership scenario and the forces at play.
• Think ahead
• Set directions and accept responsibility for them.
• Communicate with, motivate, empower, align and assign people, and instil a culture.
• Remove barriers and create connections.
• Build critical mass, and get things done through others.
• Keep their eye on the main game.
What characteristics do leaders have? (7)
Leaders:
• Trust and are trusted. They earn respect rather than expecting it.
• Demonstrate empathy and other forms of emotional intelligence.
• Engender confidence and hope, including through volatile situations.
• Build shared beliefs and commitment to a cause.
• Are self-aware, reflect, and adapt their style as required.
• Appreciate and nurture talent and diversity.
• Are resourceful and value resourcefulness in others.
Where skills do leaders have? (7)
Leaders are skilled at:
• Identifying what needs to happen.
• Taking action.
• Listening and providing feedback. Communicating and influencing.
• Thinking critically and making decisions.
• Building relationships and collaborating.
• Setting goals.
• Motivating and mentoring.
Exemplary (or authentic) followers:
• Are knowledgeable and enthusiastic individuals with the capacity to engage in the decision-making process, embrace change and responsibility, and establish trust and enduring relationships.
• Follow and trust a leader and challenge the leader to bring their shared vision to life.
• Distinguish themselves as proactive, responsible and independent members of a team.
the 4 Robert Kelly Role based followers
- Exemplary (Active + Independent)
- Alienated (Passive + Independent)
- Passive (Passive + Dependant)
- Conformist (Active + Dependant)
Limited evidence suggests that engaged staff provide:
safer, higher quality care and are associated with greater patient satisfaction and health outcomes in addition to productivity factors such as absenteeism and turnover
Micro level leadership stratergies
The micro-level concerns the strategies that an individual uses to lead effectively. These include painting a clear picture of the future, engaging and connecting stakeholders, communicating, and developing others.
The crucial factor at the micro-level is to actively select a context-appropriate leadership strategy based on scenario analysis rather than taking a ‘this is how I lead’ approach. In other words, the choice of leadership strategies must be cognisant of the characteristics of the followers.
Macro level leadership stratergies
The macro-level involves creating a leadership map – a strategic pathway that ensures sufficient and effective leadership and followership capabilities will be available as and when needed. Examples of macro-level leadership strategies include building collaboration amongst leaders, developing leadership culture, and optimising balances between leaders and followers.
Steps in undertaking a micro level leadership scenario analysis include:
• Understanding the followers as individuals and a team. Who are they, what motivates and influences them, what values they hold, what attributes they have, and what relationships they have?
• Understanding the organisational context. What is being asked of the team, how much scope will it have to make choices, will it be supported from above, below and by peer groups, how complex will the structural, process and people challenges be, what dependencies are there?
• Understanding the digital health initiative. What’s required, how precise are the requirements, how widely ‘owned’ are they, how big a leap will it be?
• Understanding yourself. How well do the leadership requirements align with your leadership strengths, how will you build up areas of weakness, are you relying on self-awareness or 3600 feedback?
Steps in undertaking a macro level leadership scenario analysis include:
• How many leaders are required, where, and with what qualities?
• The specific leadership knowledge, skills and experience needed to implement the business strategy.
• The collective capabilities required from the organisation’s leaders when they act together.
• The desired leadership culture.
Anderson and Ackerman Anderson identify three types of change occurring in organisations today.
• Developmental change – improving the status quo (e.g., improving workflows to improve efficiency).
• Transitional change – replacing the status quo with something new but known (e.g., decommissioning an existing EHR and implementing a new one with greater functionality but which does essentially the same).
• Transformational change – radical change to a new and unknown future (e.g., shifting from a ‘bricks and mortar, face-to-face’ provider to digital/virtual first). This requires inventing the future.
IT governance (2)
• Is the responsibility of the board of directors, under the leadership of the chairperson (though specific governance responsibilities may be delegated, particularly in larger, more complex enterprises).
• Ensures stakeholder needs are evaluated to determine agreed enterprise objectives, direction is set through prioritisation and decision making, and performance and compliance are monitored
COBIT 2019‘s IT governance model comprises seven components
• Organisational structures – the enterprise’s key decision-making entities for IT governance. These include the Board and relevant board subcommittees, the executive V3.03 June 2023 271
team, key personnel such as the chief digital/information/technology officer, and relevant steering committees.
• Culture, ethics and behaviours – the intrinsic factors that influence why and how people act.
• Principles, policies and procedures – the articulation of governance requirements.
• People, skills and competencies – the enterprise’s human capabilities.
• Processes – the organised set of practices via which governance activities are performed.
• Information – the information required for the effective functioning of the governance system.
• Services, infrastructure and applications – the technologies and resources used for IT governance.
SEI capability maturity model
- Initial - Unpredictable, poorly controlled, and reactive. Organisations in this stage have an unpredictable environment that leads to increased risks and inefficiency.
- Managed - Governance components are in place, but governance is frequently reactive.
- Defined - Governance is well-characterised and well-understood. The organisation is more proactive than reactive, and organisation-wide standards provide guidance.
- Quantitatively managed - Governance is measured and controlled. The organisation uses quantitative data to implement predictable processes that meet organisational goals.
- Optimising - Governance is stable and flexible. The organisational focus is on continued improvement and responding to changes.
Some common and resounding priorities from the literature on IT governance include (6)
• IT is a major contributor to organisational performance from value and risk perspectives. Therefore, IT governance needs to be explicitly on the agendas of organisations’ highest levels of executive oversight.
• Responsibilities at these highest levels include Articulating IT governance responsibilities and assigning them to competent people, Formulating IT plans and policies and ensuring that IT activities align with the organisation’s objectives, capabilities and contexts, Articulating strategic and regulatory compliance requirements associated with / impacted by IT and ensuring these are met, Ensuring that IT value propositions are articulated and delivered in line with expectations, Understanding the organisation’s level of IT governance maturity and ensuring that this aligns with expectations.
• Robust governance processes are required to ensure that there is clear alignment between business goals, priorities and activities and ICT projects and service provision, including:
• Alignment of planning processes is essential
• IT service and project performance level requirements must be clearly articulated and communicated to all relevant stakeholders. Business continuity must be protected.
• IT performance must be measured and managed.
Ethical principles commonly cited in health care include: (7)
• Autonomy. This holds that all persons have a fundamental right to self-determination and is based on respect for individuals’ ability to make informed decisions about personal matters.
• Equality and justice. This holds that all persons are equal and have a right to be treated accordingly.
• Beneficence holds that all persons have a duty to advance the good of others where the nature of this good is in keeping with the fundamental and ethically defensible values of the affected party.
• Non-malfeasance holds that all persons must prevent harm to other persons insofar as it lies within their power to do so without undue harm to themselves.
• Impossibility. This holds that all rights and duties are subject to the condition that it is possible to meet them under the applicable circumstances.
• Integrity holds that whoever has an obligation has a duty to fulfil that obligation to the best of their ability.
• Honesty holds that all persons should be honest (candid and truthful) in all communications and actions since honesty is the cornerstone of trust.
Ethical principles commonly cited in health informatics: (7)
• Information privacy and disposition holds that all persons have a fundamental right to privacy, hence controlling the collection, storage, access, use, communication, manipulation, and disposition of data about themselves.
• Openness holds that the collection, storage, access, use, communication, manipulation, and disposition of personal data must be disclosed in an appropriate and timely fashion to the subject of those data.
• Security holds that data legitimately collected about a person should be protected by all reasonable and appropriate measures.
• Access holds that the subject of an electronic record is entitled to access to that record and correct the record for accuracy, completeness, and relevance.
• Legitimate infringement holds that the fundamental right of control over the management of personal data is conditioned only by the legitimate, appropriate and relevant data needs of a free, responsible and democratic society and by the equal and competing rights of other persons.
• The least intrusive alternative holds that any infringement of a person’s privacy and/or control rights may only occur in the least invasive fashion and with a minimum of interference with the affected person’s rights.
• Accountability holds that any infringement of the privacy and/or control rights of a person must be justified to the affected person in a timely and appropriate fashion.
The Seven-Step Method for Analysing Ethical Situations (Hamilton, 1990) provides a framework for assessing and resolving ethical dilemmas. The method involves answering seven questions – what or who are the
.• Facts?
• Ethical issues?
• Alternatives?
• Stakeholders?
• Ethics of the alternatives?
• Practical constraints?
• Actions that could be taken?
5 Ethical perspectives
The utilitarian approach
Utilitarianism was conceived in the 19th century to help legislators determine which laws were morally best. The most ethical actions provide the greatest balance of good over ‘evil’. Analysis via the utilitarian approach involves asking who will be affected by each action and what benefits or harms will be derived and choosing the action that will produce the greatest benefits for the greatest number and the least harm.
The rights approach
This approach focuses on the individual’s right to choose for themself. It is important to question whether or not the action undertaken respects the moral rights of everyone. Actions are wrong to the extent that they violate the rights of individuals, and the more serious the violation, the more wrongful the action.
The fairness or justice approach
This approach is based on Aristotle’s view that ‘equals should be treated equally and unequals unequally’. The primary measure of this approach is how fair it is as an action: does it treat everyone in the same way, or does it show favouritism/discrimination?
The common-good approach
This approach to ethics assumes a society comprising individuals whose own good is inextricably linked to the community’s interest. Community members are bound by the pursuit of shared values and goals. The focus of this approach is on ensuring benefit to all.
The virtue approach
This approach assumes there are certain ideals toward which all should strive., Questioning via this approach considers: what kind of people/community are we?
ICT -Business streatergy Alignment is a complex task that must consider that:
• Business and information systems strategies require “vertical coherence” – they must be internally consistent.
• Alignment is likely to be required at multiple levels.
• Alignments work in both directions – ICT advances can enable business strategy shifts and respond to them.
The whole strategic environment is fluid, although fundamentally, the business should lead ICT.
The Strategic Alignment Maturity (SAM) model views business-IT alignment as “a continuous process of adjusting activities across multiple dimensions that together results in improved/better alignment” (Luftman, Lyytinen & ben Zvi, 2017, p.31). It posits that six governance activities collectively contribute to business-IT alignment and improve organisational performance.
• Communication – the intensity and quality of the dialogue between IT and business personnel. Listening is key.
• Value analytics – the use of metrics to validate the contributions of IT and the IT organisation to the business in terms that both business and IT personnel understand and respect.
• IT Governance – see chapter D.2.
• Partnering – the nature and level of the relationship between business and IT personnel. Partnerships are typically characterised by mutual trust, commitment to shared goals, and shared risk-taking.
• Dynamic IT scoping – the generation of shared activities that allow IT the agility to enable timely business changes.
• Business and IT skill development – ensuring the organisation’s readiness for change, learning capability, and ability to leverage new ideas.
benefits associated with effective stakeholder engagement include (7)
• Discovery of important relationships.
• Opportunities to discover and validate needs, identify the likely best ways forward and identify and deal with potential barriers.
• Overall, cost and time savings – stakeholder engagement requires resources but can mitigate the likelihood of errors, dead ends, and rework.
• Improved identification and mitigation of risks.
• Improved expectation management.
• Long-term relationship building.
• Enhanced reputation/brand.
principles underpinning effective stakeholder engagement and relationship management 10)
• Purpose – every stakeholder engagement process begins with a clear understanding of the achievements desired.
• Inclusiveness – relevant stakeholders are identified, and strategies are implemented to facilitate their engagement, noting that some stakeholders may be harder to reach than others. Power imbalances between stakeholders are acknowledged and their potential impacts mitigated.
• Diversity of stakeholders and their views is valued.
• Timeliness – stakeholders are engaged from the beginning, and their input is obtained within timeframes that permit its due consideration.
• Transparency – stakeholder engagement is open and honest, and the expectations of all concerned are clear.
• Integrity – relationships feature consistency in decision-making and action-taking.
• Respect – stakeholders’ expertise, perspectives, and needs are acknowledged, respected, clarified, and validated.
• Reciprocity – relationships require that time, effort, risk etc., committed by one party are reciprocated by the other(s).
• Autonomy – relationships require that parties make their own decisions, free of coercion.
• Confidentiality is respected.
AccountAbility (2015) recommends a four-stage process for stakeholder engagement
- Plan
- Prepare
- Implement
- Act, review, improve
Planning for stakeholder engagement typically involves activities such as:
• Identifying, profiling, and mapping stakeholders.
• Determining which stakeholders are the most important to engage with, given the context at hand.
• Determining the desired level of engagement with each stakeholder and the most appropriate methods for achieving this.
• Developing and reviewing an engagement plan tas well as performance measures
Preparing for stakeholder engagement typically involves activities such as:
• Mobilising resources and building the capacities required for effective engagement.
• Undertaking risk analysis and mitigating identified risks.
• Setting and managing realistic expectations.
• Ensuring that stakeholder engagement will be meaningful, fair, and contribute to relationship building.
Implementing the stakeholder engagement plan includes
• Inviting stakeholders, providing them with sufficient time and information to permit meaningful engagement.
• Determining and communicating the ‘rules of engagement’ (procedural and behavioural rules that should apply to all stakeholders).
• Engaging – obtaining the required stakeholder input.
• Documenting the engagement appropriately (consistent with the rules of engagement) and developing and documenting resulting outputs, plans, intentions, actions, timeframes, etc.
• Communicating the outputs.
Acting, reviewing, and improving the stakeholder engagement plan
• Actioning agreed plans and iterating as appropriate.
• Monitoring the implementation of the plan and dealing with issues arising. This includes communicating progress and ensuring comprehensive completion.
• Evaluating the stakeholder engagement, communicating lessons learned, and incorporating improvements into subsequent planning.
Some barriers to stakeholder engagement (4)
• Poor allocation of resources to engagement is often related to low prioritisation (including competition amongst priorities). Some stakeholders may be resource-poor, but this should be identified and catered for in the planning and preparation stages.
• Lack of flexibility in and accessibility to stakeholder engagement processes. Some processes and timeframes may disadvantage some stakeholders (e.g., duty cultural, linguistic or availability issues).
• Failure to secure appropriate representation – e.g., identifying some stakeholders or securing the most appropriate (knowledgeable, empowered) representatives. This may be caused either at the engager or consultee end. For example, some stakeholders may be suffering from consultation fatigue or disillusionment.
• Inappropriate engagement processes that fail to elicit all relevant issues, hear all voices equally, build trust, etc., or are perceived by stakeholders as inappropriate.
Advantages of organising a set of activities as a project include (8)
• Explicit recognition that the activities to be undertaken are not ‘business as usual’ (BAU) informs all stakeholders that change is afoot – that the future state will be different to the current one. Projects typically introduce change.
• The ability to work across BAU lines of organisational management to act on cross-cutting interests.
• The ability to aggregate and secure resources beyond BAU levels.
• The ability to isolate the requisite workstreams from those associated with business as usual may enable fast-tracking, different (more advantageous) reporting channels, and alternate decision-making processes.
• The ability to elevate the visibility of the activities concerned and the capabilities delivered.
• The ability to constrain the associated activities if required – e.g., by terminating the project, changing its scope, or scaling it up or down.
• The ability to measure, research and evaluate a discrete set of activities and learn from them before attempting something comparable elsewhere.
• Provision of a common language for understanding and communicating what is happening when it is outside the norms of business as usual.
General steps in project management
Initiation, planning, controlling/executing, monitoring, closure
PRINCE2 as a project management method
PRINCE2 is a generic methodology that guides project management practitioners on what to do to undertake a project. However, it does not prescribe how to undertake the project work itself. Therefore, PRINCE2 requires expertise to implement and tailor to the specific circumstances at hand.
PRINCE2 is output-oriented – each step has inputs, outputs and specific goals and activities that lead to the project’s deliverables as defined in its business case. Deviations from the business case are either challenges or opportunities.
PMBOK as a project management method
Driven by specific processes
It recognises 47 processes under five groupings and ten knowledge areas.
PRISM as a project management method
PRISM aims to integrate project processes with sustainability initiatives to achieve business objectives while decreasing negative environmental impacts
The critical feature of PRiSM that differentiates it from other approaches is its Sustainability Management Plan, covering five measured elements - People, Planet, Profit, Process and Product. In addition,
Agile as a project management method
The steps involved in an agile approach are similar to those discussed above – the project must be defined, planned, executed, monitored and controlled – but the emphasis is on communication, collaboration and responsiveness rather than processes
In Agile project planning, the project team works with stakeholders to schedule a series of time-boxed iterations via which outputs will be delivered, building a roadmap for delivery. However, change is assumed to be the norm in Agile projects and planning frequently results in reprioritisation as new requirements emerge or existing requirements and delivery capabilities are better understood. As a result, project delivery can involve multiple iterations.
