Month: September 2011

Social Media: The Elephant in the Bored Room

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Pardon the idiom, and yes, the misspelling was deliberate.  You may want to grab a sandwich, this is a long read.

For the longest time it has occurred to me that most companies find themselves in a state of what I like to label Permanent Whitewater. As they careen through the rapids, it is anybody’s guess as to whether they will capsize.  And the philistines they have appointed as commissioners would be more appropriately described as Ommissioners, as they have omitted themselves from understanding the world and leading their charges.

Now, what does that have to do with anything?  Thanks for asking.

For those of you who can find Vietnam on the map, you will recall the great turnip boycott of the nineteen seventies—I know they boycotted grapes, but I like grapes and do not like turnip, so I choose to have my own protest.  Anyway, this boycott worked, and as a result, the working conditions for migrant workers improved albeit only modestly.

And here is the kicker.  An entire industry was brought to its knees.  That is not the surprising part.  The surprising part is that all of this change was brought about at a time when there were three television channels and when people actually subscribed to newspapers.

From where I sit, social media can be divided into two camps, those who have not slept since the launch of Google+, and the far larger camp of those who have not lost a minute of sleep.  Businesses, for the most part are well entrenched in the latter group.

Part of the reason why businesses are slow to adopt social media can be attributed to their lack of belief that social media matters or can impact their business one way or the other.  And frankly, I think that has a lot to do with why our economy continues to rejoice in its malaise.

So, how to those of us in the first camp get those in the second camp to see the world our way, how do we get them to jump head-first into social media.  The answer is simple.  We need to create our own turnip debacle.

They say it cannot be done, so let us show them.  The one thing that would get companies to embrace quickly and unashamedly social media would be if there was one less company.

Companies, big ones, fat ones, firms that climb on rocks—feel free to finish the tune without my help have the following issues, they think they:

–       control their market

–       own their customers

–       are managing their customers

Companies are wrong about those three assumptions and the use of social media can and will prove this.  I would ask for a volunteer, but that would take too long.

If ABC, CBS, and NBC were able through their coverage of the grape boycott, bring about change to an entire industry, imagine with me what impact a committed bunch of savvy social media users could do to a single firm.

Here is what I propose.  Let us pick one firm.  The characteristics of this firm should be that it is well known and not well liked—this way we can argue that we acted on behalf of a greater good.  It should also be a firm associated with technology, a firm that ought to at least be able to spell social media.  If I were asked which firm I would choose I would pick a firm in some aspect of telecommunications, say a firm like Comcast or Verizon.

Now, the idea of our little social project will be to provide a heads-up to all of the other companies about the start date of our little social media experiment.  Let’s tentatively agree on the first of November unless there is a game on television I want to watch.

The goal of the project is to demonstrate that the bourgeois, the working class, with its harmless set of social media tools, can create affect enough of a disruption to an organization to make it sit up and take notice, or to disappear.

I am sure you remember the YouTube video of the Comcast technician that fell asleep on a customer’s couch.  It went viral, but Comcast did not, and that was simply a single posting by a single customer.  What would happen if the social media mavens decided to use the tools at their disposal and concentrate their efforts at or against a single firm?

Crowdsourcing 101.

I think the end result of such an effort would have a significant impact.  The impact could easily bring about more fundamental change as to how firms view and use social media than was brought about by the grape boycott.

Sometimes something has to be sacrificed on behalf of the greater good.  Although a rising tide lifts all boats, but it can ruin your day if your firm is the one chained to the pier.

What are your ideas?

Why IT projects Fail

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The mind is a terrible thing.  Last night I stumbled across part of the movie Kill Bill Volume 2. There is a character in Volume 2 named Esteban Vihaio, an eighty-something Mexican—for lack of a more erudite word—pimp.  His is a small role, but performed beautifully.  Uma Thurman, our ninja protagonist, meets Esteban and asks him ‘Where’s Bill?”

With a thick, refined Spanish accent, Esteban repeats the question, drawing out the name “Where is Beeeeeeel?”

Anyway, today I am on the phone.  And can you guess the name of the person with whom I am speaking?  That’s right, I was talking to Beeeeeeel.  He did not have a Spanish accent; nonetheless, I could not stop the voices in my head from trying to translate every phrase so that it sounded like Mr. Esteban.  Needless to say, the call went downhill rapidly.

When I think about software implementations the phrase “Help, I’ve failed and I can’t get up” comes to mind.

For many people, the goal of a software implementation is to get to the end, to see the vendor leave.  In many minds, that signals that the work is done, and the departure of the vendor signals that the software was implemented correctly.  Not true Mon Chéri.

In case you did not get the email, IT has become big business in most corporations, and it takes a group of highly paid bureaucrats to administer it.  And you know what happens when you give the bureaucrat a clipboard and ask them to oversee the implementation of a new email system, by the time the dust settles you have spent a few million dollars on a new sales force automation tool—Rube Goldberg on steroids.

Once you start spending it is difficult to stop.  And people do not keep spending in the hope of reaping additional ROI; they do so in order to try to salvage a project that in its current state is a white elephant.  Most of the cost of an IT project is to get it to do what you thought it would do.  This is a classic example of when you are in a hole, stop digging, or at least let me hand you a bigger shovel.

When Good Projects Go Bad

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What are the EHR fail-safe points?  The points of no return, beyond which you can’t recover without exploding the budget and the  schedule?

Although there are several, my take is that the most important one is the planning process.  Without the right plan, an organization is entering its permanent whitewater moment.

What plan do you have to rigorously evaluate the plan before you step off the EHR cliff?  Are you stepping off with a parachute or a bag of rocks?

My best – Paul

Step away from the computer

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Our middle school child is in the middle of a family consumer science project (home economics) to organize one room in our home.  He has redefined the project so that he reorganizes during commercials, and he is seven hours into a project involving our walk-in closet.

While watching the news it occurred to me that something is missing from my life, I do not belong to a gang, not even a little one.  So, I have decided to start one, a white collar gang of consultants.  A rough and tumbled, manicured group of professionals.

Instead of gang emblem, I am thinking each member of the gang will have their own embossed business card.  We will come up with creative gang nicknames.  For myself I am vacillating between ‘Dr. Knowledge’ and ‘The Voice of Reason.’  Instead of Harleys, we will roll through town to our national rallies on monogrammed Segways, and instead of leathers we will dress in Armani.

Mothers will hide their children from us as we power noiselessly down Main Street at four miles an hour, and their CPA husbands will turn green with envy.  We might not win many fights, but we will have the satisfaction of knowing we are smarter than those who beat us to a bloody pulp.

Sounds too good to be true, doesn’t it?

There are days when it doesn’t pay to be a  serial malingerer, and when it does, the work is only part time, but I hear the benefits may be improving as I think I heard somebody mention healthcare is being reformed.

I don’t know if you are aware of it, but there are actually people who have taken an Alfred E. Newman, “What, me worry” attitude towards EHR.  For the youngsters in the crowd, Alfred was the poster child for Mad Magazine, not Mad Men.

Just to be contrarian for a moment–as though that’s out of character for me–most providers have no need to fear–does this happen to you?  You are writing aloud, trying to make a point, and the one thing that pops into your mind after, ‘there’s no need to fear’ is “Underdog is here.”

Anyway, since many providers haven’t begun the process, or even begun to understand the process, there is still time for them to lessen the risk of failure from an EHR perspective.  Many don’t want to talk about it, the risk of failure.

Here’s another data set worth a look (The Chaos Report).  They went a little PC on us calling them ‘Impaired” factors.  EHR impairment.  Step away from the computer if you are impaired, and take away your friend’s logon if they are.  These are failure factors.

Project Impaired Factors % of  the Responses
1. Incomplete Requirements 13.1%
2. Lack of User Involvement 12.4%
3. Lack of Resources 10.6%
4. Unrealistic Expectations 9.9%
5. Lack of Executive Support 9.3%
6. Changing Requirements & Specifications 8.7%
7. Lack of Planning 8.1%
8. Didn’t Need It Any Longer 7.5%
9. Lack of IT Management 6.2%
10. Technology Illiteracy 4.3%
11. Other 9.9%

My take on this is with overall “failures” so high, several respondents could have replied to “all of the above.”  Also of note is that these failure reasons differ from the ones listed previously.

Who knows, maybe if we multiply them by minus one we can call them success factors.

Why You Should Never Trust the Vendor’s Brochure

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We were being entertained at a friend’s house whose interior looked like it had been designed by one of those overly made up, energetic divorcees who only take cash.  The walls were painted a stark white; the overstuffed club chairs and the couch were upholstered in a soft white leather.  The white carpet was thick enough to hide a chiwawa.

The hostess locked askance at me when she saw me seated in the club chair.  Perhaps my outfit did not look good on white.  A paperback which looked out of place lay on the end table next to my glass of Ovaltine.   I picked it up and began to read the back cover to get a feel for the storyline…which got me thinking about writing and authors.

The paperback story filled five hundred and seventeen pages.  Whether they were well-written, whether there was a story nestled inside, could only be learned by reading the book.  I read many books, and I read often, especially when I travel.  When I am unprepared I am forced to purchase a book at one of the shops in the airport concourse.  The purchase decision lasts only as long as it takes to read the back cover—the publisher’s only chance to make a first and last impression.

Those first impressions have fooled me often.  Ten minutes into the book I wind up stuffing it into the kangaroo pouch in the seatback in front of me.  More often than I would like, I find that the person who wrote the book summary on the back flap is a better writer than the person who wrote the book.  The summary writer is able to create an interest in the story and a need to see how it ends, an interest and need for which the book’s author is unable to deliver.

The book is rarely better than the back cover suggests it will be.  Often it is as good, sometimes it is not.  The book summary is the upper limit for what you can expect by way of enjoyment.

It works the same way in business only instead of paperback books they use brochures.  Never trust the brochure.  Whatever is written in the vendor’s brochure is the upper limit of what you can expect to receive.  Those who remember the dismantling nuclear arms remember the adage ‘Trust, but verify.”  When it comes to dealing with vendors, I suggest ignoring the part about trusting.

Take software vendors for example.  What’s not to like?

The product never leaves you feeling the way you felt after reading the brochure.  Remember the photos?  Pretty people, smartly dressed, ethnically diverse.  Their teeth bleached so white the reflection of the monitor is visible in their incisors.  Seated in their clutter-free offices, they are all smiling.

Did your users look like them when they started to use the product?  Did you get your brochure moment?  In order to find customers, vendors have to position their product in the most positive light.

Maybe there should be a cigarette-like warning printed on every software vendor’s brochure, something like this:

  • We hired the people pictured in the brochure—nobody is ever that happy
  • Most of you will never learn how to use all of the functionality
  • To have any chance of getting the software to do what you need it to do will probably cost you twice as much as you contracted
  • There is no way you will implement in the timeframe you discussed

They know, and we know, nobody implements brochures.  If we did, IT departments would be much smaller.  Maybe that is why vendors give away pens and T-shirts to all of their customers, to soften their sense of guilt.

“Improved” never sold anything.

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(AP) Redmond Washington.  After a much heralded launch, the buzz around Microsoft’s launch of Windows 8.0 is centered on the fact that when the computer crashes that users will no longer see the blue screen of death.  Instead, users will now see a friendly screen requesting that they restart their systems.

“Which is why we have decided to close the company at the start of 2012,” said CMO Droid Nelson.  “I mean when you spend two hundred million dollars just to market 8.0 and the only chatter is about the crash screen, the time has come.  We have not offered anything of interest to early adopters since 1997.  After all, what are we supposed to do?  If we continue on at this rate sooner or later we will hold a news conference for Windows 17.0 and Office 2024 and nobody will care.

How many times can we put a new ribbon around the same old software?  It is not like we can make it run any faster or any easier to navigate.  And Office is still Office.  When was the last time we added anything to that suite?  Most of our customers already cannot use half of the features we built, why should we keep building until we get that figure up to eighty percent?

The innovation train left the station around the time Starbucks came out with their half-caf-decaf with a double shot.  We made ourselves irrelevant.  Hell, I use an iPad and Google Docs.”

Can you name what Microsoft launched the last time you were willing to tailgate to be the first one to own it?  Nobody can.

Can you name the last time your customers were willing to tailgate to be the first one to purchase your firm’s newest offering?  Didn’t think so.

The thing to remember about new and improved is that it isn’t either.  If it was so brand spanking new, you wouldn’t have to tell anyone.

New is not a feature.

Improved is not a feature.

When Apple launched the first iPod their pitch was something along the lines of every song you every wanted to listen to in this little box.

Customers stand in line for innovation.  Is there a line outside your door?

Your company needs a CFO–Chief Failure Officer

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Willingness to make mistakes, trial and error, the idea comes first

To me, one of the great unknowns about Albert Einstein is the question of what he did when he was not publishing his theories.  Assuming you are not among those who read People Magazine, the average layman has probably heard of his Theory of Relativity.  Fewer still can state the theory, and only a small number of people have any idea of its implications.

So, he’s got a couple of theories to his credit.  I’ll ask again, what did he do with all of his non-theory time?

He failed; prolifically.  Einstein always began with an idea, something simple like explaining the entire universe with a single equation.  In between the idea and the equation were years of trial and error—lots of errors.

Einstein planned for failure.  If he did not fail nobody alive would know his name.

Who is in charge of failure at your firm?  Whose career hinges on making colossal failures?

Everyone in business fails.  Somebody didn’t me plan.  A large customer went elsewhere.  The new plant in China is two years late.  Joe was 1.3% over budget.  In the grand scheme of things, those failures are irrelevant, they are rounding errors, errors which over time have little impact on the bottom line.

There are two types of failures; operational—like above—and strategic.  Given the choice I’d opt for strategic failures every time.  To fail strategically means somebody is at least trying to do something.

Don’t place someone in charge of making sure everyone is on budget.  If you want to be innovative, make sure you have someone overseeing failure.

How to survive a business meeting

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I probably spend way too much of my time trying to find answers to difficult questions, questions like how gravity works in a vacuum, why people like Celine Dion, and how companies survive without innovating.

Scientists trying to prove the existence of negative energy need look no further than watching the level of effort made by my son as he cleans his room.  Alternatively, they could be a fly on a wall in one of the millions of meetings that take place every day in American businesses in our post-Potter world.  Death by a thousand cuts.

We have all been in those meetings, the ones where you wish they were held outside so you could at least come away from the meeting with a tan.  You are a member of the warm-chair attrition cadre of the value-subtracted reseller for whom you work.  You enter the meeting room, your eyes scan from left to right to find the bagel-therapy and BIY (buy it yourself) cheapuccion—there are none.

You wish silently that this meeting will be the black-swan, a rare and unexpected meeting that proves to be worthy of your time.  The negative energy in the meeting room is palpable.   Most of the time, the only person vested in the outcome of the meeting is the person who called it, the person trying to unload their baggage-malaria.  Everyone else is wondering just how do I occupy an hour of time while still looking attentive?

Aren’t laptops wonderful?  You boot yours, angle the screen so the person next to you cannot see what you are browsing, and all of a sudden your mind is elsewhere—sort of like working from home only without the pajamas—the pajama-hadeen.  If you set it up correctly, the top of the laptop’s screen should be high enough to allow you to make eye contact and wide enough to help you carve out your laptop-zombie space.

If your connection to the internet fails, you become a digital nomad, a WiFi-squatter forced to use your cell phone.  You hope the next hour will not be a repeat of the last pancake meeting—one with a lot of breadth but little depth—but maybe an hour of downtime allowing you to further your hobby.  You are a Palintologist, following her tweets and texting until you are intexticated.

You scan the horsemen of the apocalypse to see if you can determine which are the hot-tubbers, the me-sayers who will co-ruminate, those individuals who want to sit closely to the adorkable meeting savant so as not to miss his wave-a-dead-chicken solution to the problem at hand.

You have employed information triage in the belief that if you pay attention to only the first and last words spoken you will be able to recombobulate ninety percent of the important content.  The meeting-gelincal, with his agenda, laser pointer, and PowerPoint charticles—his meeting-bling—announces the topic.  Translated loosely, it is nothing more than backlog-management, a rehashing the same topic as the last meeting albeit with a different slide deck.  You immediately begin to battle meeting-apnea.

There is a built-in disconfirmation-bias to ensure that the statements from any precariat—someone with little or no job security—attempting to sway belief away from the proletarian confession of faith suffer meet-lashing at the hands of the secret elitists.

The best way to avoid this mess is to skip the next meeting.  When nobody notices, skip another.  Your productivity will increase and your boredom will drop.

 

Certification: Myth or just plain stupid?

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EHR certification inspectors will be dropping in on hospitals like UN inspectors looking for WMDs, only they’ll be slightly less congenial.

Why is this a part of the overall plan?  Is this planned failure?  Do they have reason to believe that a certain percentage of EHRs will fail the inspection?

Of course they do.

Permit me to begin with a C-Suite IQ test. Given the choice would you rather have:

  1. A certified EHR that resulted in a productivity loss of 20%
  2. An uncertified EHR that resulted in a productivity gain
If you picked ‘1’ reading further is useless.

Let’s describe two failure types; certification and Full test.  The certification test, by definition, is necessary.  The Full test is both necessary and sufficient.  It is possible to pass certification without passing the Full test.  Therefore, the Full test is a stricter test.  Build out to pass the Full test, and by default, one should pass the Certification test.

What is the full test?  Same as always.  Fully functional, on time, within budget, and user accepted.  Functional, for purposes of this discussion includes updated workflows, change management, and interoperability, and a slew of other deliverables.

Here’s what can be concluded just based on the facts.

Fact:  One-third to two-thirds of EHRs are listed as having failed—this statistic will get smaller over time.

Opinion:  The reason the failure rate will get smaller is that the failure rate will be artificially diluted by a large number of successful small-sized implementations.  Large implementations, those have far-reaching footprints for their outpatient doctors, Rhios, and other interfaces requiring interoperability will continue to fail if their PMO is driving for certification.  (Feel free to add meaningful use to the narrative, it doesn’t change the result.)

Fact:  Most large, complex, expensive IT projects fail—they just do.  This statistic has remained constant for years, and it is higher than the percentage of EHR projects that have failed.  Even a fairly high percentage of those projects which set out to pass the Full test.

Opinion:  Failure rate for large EHR projects—let’s say those above $10,000,000 (if you don’t like that number, pick your own)—as measured by the Full test, will fail at or above the rate for non-EHR IT projects.)

Bleak?  You bet.  Insurmountable?  Doesn’t have to be.

What can you do to improve your chances of success?  Find, hire, invent a killer PMO executive out of whole cloth who knows the EHR Fail Safe Points.  EHR Fail Safe Points?  The points, which if crossed unsuccessfully, place serious doubt about the project’s ability to pass the Full test.  The points which will cause success factors to be redefined, and cause one or more big requirements—time, budget, functionality—to be sacrificed.

This person need not and perhaps should not be the CMIO, the CIO, or an MD.  They need not have a slew of EHR implementation merit badges.  The people who led the Skunk Works had had zero experience managing the types of planes and rockets they built.  They were leaders, they were idea people, they were people who knew how to choose among many alternatives and would not be trapped between two.

The person need not be extremely conversant in the technical or functional intricacies of EMR.  Those skills are needed—in spades—and you need to budget for them.  The person you are looking for must be able to look you in the eye and convince you that they can do this; that they can lead, that these projects are their raison d’etre.  They will ride heard over the requirements, the selection process, the vendors, the users, and the various teams that comprise the PMO.

A certified EHR is all it never was.

What do you think?

Your EHR: Is it Well & Good?

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There were four of us, each wearing dark suits and sunglasses, walking uniformly down the street, pausing at a cross-walk labeled “consultants only”—I think it’s a trick because a lot of drivers seem to speed up when they see us. We looked like a bad outtake from the movie Reservoir Dogs. We look like that a lot.

Why do you consult, some ask? It beats sitting home listening to Michael Bolton or practicing my moves for So You Think You Can Dance, I tell them.

Listening to the BBC World News on NPR whilst driving, there’s one thing I always come away with—they, the British, are always so…so British. No matter the subject—war or recession—I feel like I should sit up straight and having a proper pot of tea and little cucumber sandwiches with the crusts removed; no small feat while navigating the road.

Today’s NPR conversation included a little homily about the Gordian knot with which the company Timberland is wrestling, questioning whether as a company Timberland should do well, or do good. (Alexander the Great attempted to untie such a knot, and discovered the knot had no end (sort of like a Möbius strip, a one-sided piece of paper–pictured above. (For the truly obtuse, among which I count myself, the piece of paper can be given a half twist in two directions; clockwise or counter-clockwise, thereby giving it a handedness, making it chiral—when the narrative gets goofy enough, sooner or later the Word dictionary surrenders as it did with chiral.))) I’m done speaking in parentheses.

Should timberland do well or good? Knowing what little command some have of the English language, NPR’s listeners must have wondered, why ask a redundant question. Why indeed? That’s why I love the English, no matter the circumstances they refuse to stoop to speaking American.

Back to Gordo and his knot. That was the point of the knot. One could not have both—sorry for the homonym. Alexander knew that since the knot had no end, the only way to untie it was to cut it. The Gordian knot is often used as a metaphor for an intractable problem, and the solution is called the “Alexandrian solution”.

To the question; Well or good. Good or evil. Are the two choices mutually exclusive? For an EHR? They need not be, no matter how intractable the EHR. The question raised by the BBC was revenue-focused (doing well) versus community or green-focused (doing good). My question to the reader is what happens if we view EHR with this issue as an implication, a la p→q.Let’s review a truth table:

if P equals if Q equals p→q is
define requirements increase revenues

TRUE
play vendor darts increase revenues

FALSE
ignore change management increase revenues

FALSE
no connectivity increase revenues

FALSE
new EHR software increase revenues

FALSE
change processes increase revenues

TRUE
eliminate waste increase revenues

TRUE
decrease redundancy increase revenues

TRUE
Strong PMO increase revenues

TRUE

From a healthcare provider’s perspective the answers can be surprising; EHR can be well and good, or not well and not good.  The Alexandrian solution for EHR is a Alexandrian PMO.

Have your people call my people–we’ll do lunch.