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Of Leaders and Geeks

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WOMEN AND TECH
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Consider these seemingly unrelated developments:

1. An IT failure (healthcare.gov) nearly destroys a president's legacy, while a seeming IT triumph (the National Security Agency's electronic snooping skills) throws his foreign policy into turmoil.

2. According to Michael Lewis' fascinating and scary book Flash Boys, Wall Street geeks make billions through high-frequency trading, running circles around clueless masters of the universe in charge of America's biggest banks and hedge funds.

3. For the second year in a row, the American Medical Association elects a health IT expert as its president.

This could be nothing. But then again, could it be something really big? Could we be witnessing a fundamental change in the requirements for leadership in health and every other sector of society?

We all live with stereotypes and here is one of the most powerful: We have leaders and we have geeks. Leaders change history. They sit atop governments and corporations. They craft strategy, cut deals, rally the troops, and guide humanity into the future. They don't need to understand technology, because they have geeks.

Geeks sit in cubicles off-site somewhere. They spend their days coding, wiring, and rushing to help impatient leaders whose systems are down. Geeks show up when they're needed, and go away when they're not. The technology they manage is like plumbing or electricity. If you don't like your plumber or electrician, there's always another in the wings.

Leaders don't have to manage geeks. They have people who have people who manage geeks.

Like all stereotypes, this one is exaggerated and not wholly accurate, but it makes a point. In health and other areas, leaders sometimes take a kind of perverse pride in their ignorance of information technology and how it works. It's as though familiarity with IT would damage the aura that qualifies them for the huge responsibilities they seek and enjoy. Of course, they may have content expertise acquired during their rise through the ranks. In health care, it may be training and experience as a health professional and/or academician; in business, it may be marketing or finance; in government, it may be elected office or policy expertise. But almost never is an understanding of information technology considered a vital ingredient in preparing leaders to assume their great responsibilities.

There are exceptions. The leaders of some of the world's most successful new companies -- Microsoft, Google, Apple, Facebook -- are or have been technologists. But they run technology companies. It makes sense that for this industrial sector, real geeks should sit in the CEO's office. But for most of the rest of our public and private enterprises, the gap between geeks and leaders persists.

This may be changing. Recent history suggests that at least for health care leaders -- whether in government or the private sector -- a deep appreciation for, and even understanding of, information technology may be a vital asset. How could it be otherwise? In health care, as elsewhere, information is power: not only the power to heal, but also the power to improve quality, efficiency, reliability, safety, and value. And information technology, acting as a health care organization's circulatory system, collects, manages, and circulates that information.

Today's and tomorrow's successful leaders do not need to be technologists, but they do have to own technology policy and problems in a way few do right now. And they have to incorporate into their inner circles of advisers individuals capable of bridging the historical divide between technology experts and leaders. The alternative could be a future full of healthcare.gov launches, or worse, a continuing failure to take full advantage of the power of information to optimize health system performance.