How the Wizard of Oz Can Teach Personal Accountability in Today’s HIM World

By Betty Gossell, BSB/CCS
The challenge for today’s health information management (HIM) professionals is to think beyond the task at hand, to see the big picture of how their performance and expertise impacts the whole organization.
Information is the currency of today’s healthcare ecosystem. The ability to gather, analyze, distribute, and apply data is essential for optimal patient care and the health of the organization. HIM professionals are data’s most critical gatekeepers, ensuring optimal accuracy, structure, and security.
However, hospitals and health systems have traditionally been siloed and fragmented organizations. Healthcare professionals focus on their sphere of influence to the exclusion of other areas, which often results in inefficiencies or a lack of harmonization among all departments in an organization.
How do the strengths of a clinical professional complement the strengths of an HIM professional or a revenue cycle team member, creating a stronger team than any one of them could create on their own?
Lessons from The Wizard of Oz

The Oz Principal, a book written by Roger Connors, Tom Smith, and Craig Hickman, proposed the idea that each of us is already equipped with what we need to obtain higher results for our organizations.
In the 1939 film The Wizard of Oz, Dorothy and her band of friends take the yellow brick road to the city of the eponymous wizard, who they believe is the answer to all their problems.
Powerless on their own, together our band of heroes brought out the best in themselves and each other, able to take charge of their own actions and destinies.
Taking this a step further and incorporating these ideas into the HIM world, let’s discuss how leaders can bring their employees to a place where they have the capacity to work for change and self-empowerment.
Courage of the Lion: Identify the Problem
Before any positive change can be implemented, one must first identify that there is a problem.
Many HIM employees feel that their job is to complete the few functions they were hired for and not ask questions. However, most of these professionals are often in the position to identify a problem first before the situation snowballs out of control.
Do the HIM professionals in your organization feel that they can approach management with problems and feel like they are being heard? Or have they been made to feel that solving problems is the sole purview of management?
It is important for leaders to help the employee feel a sense of ownership for even the most routine of tasks and to be quick to identify problems. Like the Cowardly Lion from the movie, sometimes employees just need to be reminded to open their eyes and speak up when they see an issue or process that could be improved.
Heart of the Tin Man: Own the Problem
It is one thing for HIM professionals to notice a problem, and another to accept when they have played a part in the situation.
In The Oz Principal, the authors state, “Only by accepting full ownership of all past and present behavior that has contributed to current circumstances can you hope to improve your future situation.”
Often, employees feel they must do all they can to cover mistakes and place any blame elsewhere. Managers should work to help employees feel safe to speak up when an error comes from something they did or did not do.
Wisdom of the Scarecrow: Brainstorm for Solutions
Once the HIM employee has identified an issue, it is important for them to feel that their observations and/or experiences make them a perfect member of the team to search for solutions.
Including front-line employees on special committees and providing a safe place for them to express their concerns or ideas will go far in the search for solutions and in the personal development of the employee. Employees should be allowed to be part of the solution whenever possible. Team building and problem-solving can develop creativity and self-esteem within the employees once they feel they are included, and that they are important to the group’s success.
Ruby Slippers: Advancing Change for the Organization
What many people overlook in the story of Dorothy in The Wizard of Oz is that she could have changed her situation at any time by using the magical ruby slippers she took at the beginning of the film.
Our employees come to us from many work backgrounds and with a multitude of talents and ideas. While ongoing education is always a good thing, managers would do well not to overlook even the most unconventional skills their employees possess. Leadership and problem-solving can come in many forms—not just in formalized HIM education and credentials. Managers can work with their employees to develop those skills for best use within the organization.
The Question Behind the Question
Many organizations operate under the mentality of doing just enough to get by and not take risks. This limited thinking is passed down throughout the organization to the front-line employees.
Wise managers should seek to both receive and provide feedback, and to work hard to free people who have locked themselves in a victim mentality. Quality leaders risk their own comfort and security by searching beyond symptoms to discover the core problems that spring from a lack of employee accountability. It is critical to remember that they must always provide a model for those with whom they work or associate.
In his book Personal Accountability, John G. Miller describes the idea of “the question behind the question” (QBQ): “It takes some effort to push aside the junk questions—those that are focused outwardly—and ask [QBQ]. This is more difficult to ask than the original question because it’s the accountable question, the one that explores what I could have done to prevent the problem or what I can do in the future.”
A QBQ is a way for management to reframe our interactions from victim thinking to higher levels of personal accountability. Effective questions such as “What can I do?” or “How can I contribute?” will lead us to doing what is not natural for most of us—living a life of personal accountability.
Over the Rainbow
The Oz Principal summarizes this difficult topic in this way, “Remember, only when you assume full accountability for your thoughts, feelings, actions, and results can you direct your own destiny; otherwise, someone or something else will.”
HIM management can encourage employees to climb out of the victim cycle to benefit from what we have learned regarding the courage to look for improvements, owning their part in the process, working for change, and using skills they already possess.
Connors, R., T. Smith, and C. Hickman. The Oz Principal: Getting Results through Individual and Organization Accountability. Prentice Hall Press: 1994.
Miller, John G. Personal Accountability: Power and Practical Ideas for You and Your Organization. Denver Press: 1988.
Betty Gossell ( is a coding auditor and part of the coding education program at Baylor Scott & White. She has 30 years of coding, auditing, and HIM management experience in a variety of settings.

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