consulting

One Thing Companies Don’t Know Could Save Them

Posted by

2

A lot of companies need to go to the doctor.  Whether the firm suffers from malaise, ADHD, or depression is not really important.  Companies do not get ill, companies do not suffer.  Their employees do, get ill that is; companies merely serve as incubators of the malaise and facilitate it.

We have all seen it.  Remember Sally?  Her office was the down the hall, third door on the left.  Crayon drawings from her granddaughter hung from her credenza.  An imitation Tiffany desk lamp with a cracked shade was to the left of her monitor, and a half-dead philodendron in a clay pot grew through the slats of the Venetian blind.

Sally was always the first one in the office.  She was the person who cleaned the coffee pot and made the first pot of the day.  She filled her ceramic mug, the same one she had used for twelve years, and using her pinkie finger like a swizzle stick stirred in two packets of artificial sweetener.

Each year Sally organized the Christmas party—at a time when companies were still allowed to call them Christmas parties—she was the person who let everyone know when it was somebody’s birthday, and she was the person who sent the flowers from the company if someone was ill or had a baby.  To many employees, Sally was the human face of the company.

Sally was let go, was downsized, was laid off, was fired.  There are numerous words for what happened, and all of them are uncomfortable.  Some guy named Bob now sits in Sally’s office.  It will never be Bob’s office.  It is as though Sally never even existed; the firm marches on without her.  Her perfume no longer drifts down the hall.  Bob let her philodendron die.  The drawings are long gone along with the imitation Tiffany lamp with the cracked shade.

If you are the first one in the office you stand in the snack room trying to figure out who is going to clean the coffee pot.  Rather than cleaning it yourself, you have learned to make do with a cup of some sort of chamomile tea that smells of lavender.  You no longer know whose birthday it is or who just had a baby.

The entire workplace changed and everybody simply went along with it.  First Sally, then Mr. Withers who worked in tax.  Two people in sales left on the same day.  It feels like there should have been a wake for them or like the survivors should be wearing black arm bands.  Everyone looks like they are either going to a funeral or are just retuning from one.  You cannot remember the last time anyone went to lunch together.  You have seen the malaise and the malaise is in you and him and her.

Companies spend millions of dollars trying to figure out how to boost earnings per share, how to improve productivity, or customer satisfaction.  They hire firms like BCG and Bain thinking maybe the answers are buried in the two hundred thousand dollar white paper they never read or in the multi-million dollar supply chain project or the hundred million dollar ERP system.  The end result—mistakes are made faster because they have been automated.  During the process of automation, more people along with their half-dead philodendrons were voted off the island.

It is as though those people never existed.  The only difference between those who never existed and those they left behind is that those left behind yet to learn that they never existed either.  In many companies the employees are no more real than laptops, and perhaps less valued.  Inventory of assets: 35 accountants, 72 programmers, one hundred and seven laptops, and six half-dead philodendrons.

One need not hire BCG or Bain to recognize the problem.  Look at the condition of the coffee pot sitting on the warm burner.  Look at the months of undelivered reports that are stacked outside of Sally’s office.  Look at the faces of those in the meeting with you or those who reluctantly came to the holiday party because they thought their boss was making a mental note of who did not attend.

Companies do not need a data warehouse or a business intelligence initiative to improve their performance.  People perform; data is nothing more than a collection of numbers.  People are what make data relevant. People are what make customers like a company or leave it.

Too many companies treat their employees as disposable and replaceable assets; like philodendrons.  Customers will never see, nor will they interact with your data warehouse.  They will assess the company based on their interactions with the employees; the receptionist, the person on the phone—the one paid the least, the one coached to smile while they talk, the one coached to get the customer off the phone as quickly as possible so they can get the next person in the queue off the phone as fast as possible.

These people did not break the company; the company broke the people.  The company created and sustained an environment of malaise and only the company can fix it.  The malaise will not improve by implementing casual Tuesdays, or by placing an employee suggestion box in the cafeteria.

Employees are a lot like customers—they are smart and they want to feel valued.  Wanna bet that there is a high correlation between customer satisfaction and employee retention?  If companies want to instill an attitude in their employees such that employees would be willing to die for the company, the first thing the company needs to do is to stop killing them.

Businesses racing towards impotence

Posted by

0

Things that fly in the face of public opinion often leave a big welt.  Sometimes we forget that anarchism is a form of leadership led by an anarch—noblesse oblique.

There is a smartphone app that allows you to erase random people from your photos.  I have a team of programmers working on an upgrade for it that will enable me to erase random people from my life.  Imagine a farfetchual situation; sitting in a meeting and with the swipe of a finger being able to do away with the person sitting across from you—the Ron Burgundy character with the seventies hair and moustache.

Anyway.  Have you noticed that too many people view fixing business problems as rocket surgery?  These are the same people who confuse motion with movement.  These are the same people who come to work each day and work on what was happening yesterday.  Who is working on what needs to be happening tomorrow?

If your own employees view going to work and company functions with less enthusiasm than they would have going to an all-day, outdoor Celine Dion concert in the dead of winter, is it any wonder that customers are running away in droves?

Businesses begin to die the day they open their front door—ask GM.  What then is the secret sauce to remaining viable?

As different as businesses are from one another, the common factor among all businesses is one thing—customers.  Hospitals, professional services firms, manufacturers, software companies all have the same mission statement, one they do not publish—We do stuff for money.  Guess who has the money—customers.  Businesses only remain in business by being able to one thing; getting those with the money to give their money to them.

Without OPM—Other People’s Money—there is no business.  We do stuff for money.  If that is true, should not every activity, every plan, every process, and every investment somehow contribute, somehow add value to the transaction of transferring OPM from them to you?  Are activities that do not add value to that transaction wasteful, redundant, or unnecessary?

With the exception of altruistic activities, every business decision, every strategy, every acquisition, and every hire should be evaluated in terms of whether or not they increase the firm’s ability to increase the amount OPM captured.

If this idea sounds too simple, that is because it is.  There is nothing complex about focusing on the customer.  But you would never know that from scanning the internet job boards.  Companies are looking to hire for a cornucopia of customer related positions; CRM, CEM, customer for life, customer first.

What do these companies need?  Business intelligence, a data warehouse, a chief marketing officer?  Hardly.  Marketing keeps trying to figure out ‘how do we get customers to pay attention to us?’  What they should be asking is “what do we have to do to pay attention to them?”

Most company executives would not know a customer if they sat next to one on the bus or in their Mercedes.  They may know about the customer; income, age, social stratification, number of children, but they do not know why they are a customer or why they were a customer.

Customers leave all the time.  They leave to find a company that either treats them better, or one with which they do not have to interact.  Welcome to the land of customer initiated virtual RFPs.  Instead of companies deciding to whom they sell their stuff or their services, customers decide from whom they are going to buy.

CRM is dead and companies killed it.  Customers know when someone is trying to manage them and they do not like it.  Now customers are managing the sellers using tools like Twitter, Facebook, and YouTube, and they do not need multimillion dollar systems to do it.

Spilling Tea–Why Your Business May Be Failing

Posted by

0

Years ago the word Lubyanka was enough to bring normal Russians to their knees in terror.  Lubyanka is known best for being the headquarters of the Soviet secret police, then called the KGB.  The basement of Lubyanka housed a prison which had one hundred and eleven cells, cells that were used to hold and interrogate political prisoners during Russia’s purge.

Two times each day the prisoners were given tea.  A prisoner in each cell would place a teapot outside the cell. Another prisoner, carrying a bucket filled with tea, would pour tea from the bucket into the teapot.

Tea spilled on to the floor.  The prisoner would clean the spilt tea with a rag.

Lubyanka’s prison operated for twenty-seven years.  Tea was served to the one hundred and eleven cells and spilled in front of each cell twice a day, seven hundred and thirty times a year per cell.

Two million one hundred eighty-eight thousand spills during those twenty-seven years.  The same number of cleanups.

Someone somewhere made the decision that it was easier or cheaper to spill and clean the tea 2,188,000 times than it was to use buckets with spouts on them.

What are the buckets in your company?  What dumb, wasteful, redundant activities and processes have been left unchanged?

The most obvious one for most companies is customer care.

It is easier to take 2,188,000 calls each year about a given problem than it is to fix the problem.

And do you know where the fallacy in the argument is?  The fallacy comes from the erroneous belief that by having a call center, by answering calls you are actually providing your customers a service.

You are not.  All you are doing is wiping up spilt tea.

 

Poor Project Planning–Musings of a drive-by mind

Posted by

0

It takes a lot of energy to dislike someone, but sometimes it is worth the effort. It is not easy being a consultant.  One client required me to shout “unclean, unclean” as I passed through the hallways.  Maybe that is why I leave newspapers scattered around the floor of my desk, so nobody can sneak up on me without me being able to hear them.

I have a knack for complicating simple things, but the voices in my head tell me that is better than simplifying complicated things.  Either way, I appreciate those of you who continue to play along.  Just remember, if you choose to dine with the devil it is best to use a long spoon.

You’ve probably figured out that I am never going to be asked to substitute host any of the home improvement shows.  I wasn’t blessed with a mechanical mind, and I have the attention span bordering on the half-life of a gnat.

I’ve noticed that projects involving me and the house have a way of taking on a life of their own.  It’s not the big projects that get me in over my head—that’s why God invented phones, so we can outsource—it’s the little ones, those fifteen minute jobs meant to be accomplished during half-time of a football game, between pizza slices.

Case in point—touch-up painting the trim in your house.  Can, brush, paint can opener tool (screwdriver).  Head to the basement where all the leftover paint is stored.  You know exactly where I mean, yours is probably in the same place.  Directions:  grab the can with the dry white paint stuck to the side, open it, give a quick stir with the screwdriver, apply paint, and affix the lid using the other end of the screwdriver.  Back in the chair before the microwave beeps.

That’s how it should have worked.  It doesn’t, does it?  For some reason, you get extra motivated, figure you’ll go for the bonus points, and take a quick spin around the house, dabbing the trim paint on any damaged surface—window and doorframes, baseboards, stair spindles, and other white “things”.  Those of us who are innovators even go so far as to paint over finger prints, crayon marks, and things which otherwise simply needed a wipe down with 409.

This is when things turn bad, just as you reach for that slice of pizza.  “What are all of those white spots all over the house?”  She asks—you determine who your she is. if you do not have one I can let you borrow mine.  You explain to her that it looks like the way it does simply because the paint is still wet—good response.  To which she tells you the paint is dry—a better response.

“Why is the other paint shiny, and the spots are flat?”

You pause.  I pause, like when I’m trying to come up with a good bluff in Trivial Pursuit.  She knows the look.  She sees my bluff and raises the ante.  Thirty minutes later the game I’m watching is a distant memory.  I’ve returned from the paint store.  I am moving furniture, placing drop cloths, raising ladders, filling paint trays, all under the supervision of my personal chimera.  My fifteen-minute exercise has resulted in a multi-weekend amercement.

This is what usually happens when the project plan isn’t tested or isn’t validated.  My plan was to be done by the end of halftime.  Poor planning often results in a lot of rework.  There’s a saying something along the lines of it takes twice as long to do something over as it does to do it right the first time—the DIRT-FIT rule.  And costs twice as much.  Can you really afford either of those outcomes?  Can you really afford to scrimp on the planning part of IT?  If you don’t come out of the gate correctly, it will be impossible.

Back to my project.  Would you believe me if I said I deliberately messed up?  Maybe I did, maybe I didn’t, but the one thing I know with certainty is that I now have half-times all to myself.

Why Some Firms Plan to Fail: 4 Warning Signs

Posted by

0

I have always felt there is much to be learned from the mistakes of others, like knowing when a spate of trouble is heading to town like a flock of pigeons to strafe your statue.  Take for example coal miners.  Coal miners use canaries as safety measures; when the canary dies, the pigeons cannot be far behind.

Given the poor leadership skills demonstrated by of some of today’s business leaders, maybe businesses should invest in canaries. Build a little arboretum in the lobby. When the canary dies plan on taking the next decade off.

The Wall Street Journal published predictions of ten businesses that will fail in 2013.  Included on their list are American Airlines and RIM (Blackberry).  Another article suggests Dell, Sears and Rite Aid may want to hold their Christmas parties earlier this year.  Those of us with our fingers crossed are hopeful that Facebook will soon join the list.

Did the clairvoyants forget a firm or two?  Perhaps.

Some businesses fail from no fault of their own.  The economy tanks, the price of raw materials goes through the roof, or a competitor develops a less costly way to deliver a product or service.

Other businesses fail simply due to their own ineptitude—hubris born of arrogance, leadership with a self-imbued apotheosis.

Some businesses work hard to fail.  Hypothetically, assume a certain firm is the market leader in its field.  Market conditions are normal, and the firm is not set upon by any of its competitors.  In any given year the firm’s leadership knows it should expect to make a small profit.  But its leadership, which is incapable of hiding their own Easter eggs, knows from experience that nothing they do seems to be able to grow revenues significantly.

A segue.

Permit me to foment a notion—any firm having a self-labeled “leadership committee” should already begin covering its statuary to protect it from the guano.  To move away from the pigeon metaphor momentarily, leaders who believe they need to label themselves as leaders already have two strikes against them.  Real leadership is observed, it is apparent; it does not require a label.  Leadership does not a consistory—an ecclesiastical council—make.  H. Norman Schwarzkopf and Jack Welch didn’t need a leadership committee to attest to their raison d’être.

At one time or another we have all seen this scenario played out in our offices.  Sally asks.  “Have you seen Mr. Metcalf?”

“He’s in the leadership meeting,” replied Bill.  “I’ve heard he’s toast.”

Metcalf was the senior vice president of sales.  Traditionally, the CEO, who chairs the leadership committee, taps his victim three times on the head with a hammer to signify the individual has been fired.  Bill held Sally’s hand and they waited to see if the smoke coming from the chimney of the conclave was white or black.  White smoke would mean Metcalf’s successor had been chosen.

Yahoo’s new CEO just did the hammer tap on their CMO yesterday.  She had to do it by phone because the CMO was on vacation—the CEO told the woman she was relieved of her role only ten minutes prior to the press release announcing the CMO’s replacement.  In an attempt to appear human, or to assuage her guilt, the CEO then asked to former CMO to remain at Yahoo.

I digressed, did I not?

To boost revenues, said firm, the one with the leadership committee, was in the market for a savior, someone all too willing to tell leadership what they wanted to hear.  Leadership wants to double revenues, and lo-and-behold they find the one person on the planet capable of convincing them that he can do what they were unable to do.  It never occurs to the leadership that hiring a hand-picked, self-anointed savior flies right in the face of the premise “there ain’t no free lunch.”  It just goes to show you that if you go looking for trouble you are sure to find it.

Cue the white smoke.

“Please welcome to the firm Vlad the Impaler, our new Jekyll and Hyde turnaround agent and part-time bon vivant,” implores the firm’s short-lived CEO.

The underlings, who dubbed the savior Skippy, learned quickly what Skippy had in his bag of tricks.  Trick number one is that every email sent by Skippy began with the word ‘team.’  There is no “I” in team, but there is “me”, as in “This is Entirely About Me”.  There was no team, but Skippy knew that by using the word he would be viewed by leadership as having created a team.

“I am here to help.”  Trick number two.  Say anything enough times and people will believe it.  The cynics in the group are keeping a tally sheet of all of the revenues created by Skippy.  Total additional revenues created by tricks one and two—zero.  But leadership was happy.  They now had a ‘team’ and they had someone who could ‘help’.

Trick three; be wary of anyone who claims to “have your back”.  More than likely this means they are standing behind you.  Anyone who has ever used a garrote knows it works best when applied from behind.

Skippy’s best trick was his ability to perform remarkable feats of prestidigitation with spreadsheets.  Skippy’s use of color and his ability to use the text-wrapping feature was known to elicit tears during the leadership meetings.  What Skippy knew that none of the leaders knew is that by overloading the chart with numbers, and by splashing generous amounts of color in the rows and columns, he could create the illusion of success—visually perceived images that distorted objective reality.  Trick the eye and the executives by making them look where you want them to look.

One way to spot whether failure is alive and thriving in your organization is to look at the other employees.  If half of them look like they are going to a funeral and the other half look like they just came from one, things are not well.  When your colleagues stand around the coffee room intermingling like strangers at a wake, the time has come to send someone to the lobby to check on the health of the canary.  Unfortunately, sometimes narcissists shoot the canary just to brighten their day.

Project Management’s Biggest Mistake

Posted by

0

Today’s headlines; Paula Dean drops two pants sizes and, based on six years of research in the Pacific Northwest, graduate researchers at Chicago’s School of Anthropology have confirmed that in fact, consultants do eat their young.

Observation may be one of our best teachers, but we often ignore what can be learned from it.  Here is a real-life example that occurred to me from having watched a human interest story on the local news about neighbors banding together to try and rescue someone’s pet cat which they surmised was stuck in a tree.

Here is the observation; how many cat skeletons have you seen in trees?  What can be learned?  Maybe cats do not need rescuing.

Project management and business in general have many similarities with cats stuck in trees.  Somebody thinks there is a problem, and like good little workers, we throw resources at the problem trying to rescue it.  We establish committees, have meetings, and create reports.  We discuss the problem, we recall what happened the last time we had this type of problem, we bring in experts whose skills are particularly attuned to solving this problem, and then we attack it.

The one thing we fail to do is to validate whether the perceived problem is really a problem.  Chances are that the cat in the tree is doing just fine and does not require any help. If it does, there is always gravity.

 

EHR–WWOD (What would Oprah do?)

Posted by

0

So, I’m watching a football game on television and it suddenly strikes me, there are probably a lot of people trying to understand what it is a consultant does that we can’t do for ourselves.

For those who have a life, those who missed the game, Alabama opens the game with several well-scripted opening plays and grabbed an early lead.

Their first ‘n’ offensive plays were brilliant.  They were planned perfectly.

It became apparent they had not planned the however many of the ‘n + 1′ plays.  Their plan failed to go beyond what they’d already accomplished.

How does that apply to what you do, what I do, and why I think I can help you?  It is best described by comparing your brain to a consultant’s brain.  Your work brain functions exactly as it should.  It’s comprised of little boxes of integrated work activities, one for admissions and registration, one for diagnosis, another for care.  There’s probably another box for whatever it is the newsletter stated IT was doing three months ago and how that impacts what you do.  That’s your job.

Your boxes interface in some form or fashion with the boxes of the person next to you in the hospital’s basement cafeteria who is paying for her chicken, broccoli, and rice dish that reminds you of what you ate at crazy Uncle Bob’s wedding reception.  That interface is the glue that makes the hospital work.  It’s also the synapse, the connective tissue—I know it’s a weak metaphor, but it’s a holiday weekend—give me some slack—that tries to keep healthcare functioning in an 0.2 business model.

There are names for the connective tissue, you know it and I know it.  It’s called politics.  It’s derived from antiquated notions like, “this is how we’ve always done it”, “that’s radiology’s problem”, and “nobody asked me”,

At some point over the next week or two the inevitable happens; the need arises for you to add some tidbit of information.  Do you add it to an existing box, put it in an empty box, or ignore it?  This is where you must separate the wheat from the albumen—just checking to see how closely you’re following.

Your personal warehouse of boxes looks like the final scene in Raiders of the Lost Ark—acre after acre of dusty, full boxes, no Dewy-decimal filing system, and no empty box.  There are two rules at the hospital; one, bits of information must go somewhere, and two, nobody can change rule one.

The difference, and it’s a big one, is that consultants have an empty box.  It’s our Al Gore lockbox.  We were born that way.  It’s like having a cleft chin.  We also have no connective tissue to your organization.  No groupthink.  No Stepford Wives. No Invasion of the Body Snatchers to turn us into mindless pods.  Consultants may be the only people who don’t care.  Let me rephrase that.  We don’t care about the politics.  We don’t care that the reason the hospital has four IT departments is because the hospital’s leadership was afraid to tell the siloed docs that they couldn’t buy or build whatever they wanted.

Sometimes it comes down to your WWOD (what would Oprah do) moment.  Not ‘what do they want me to do’, not ‘what would they do’, not ‘what is the least disruptive’, not ‘what goes best with what the other hospital did’.

At some point it comes down to, what is the right thing to do; what should we do.

Big, hairy healthcare IT projects come out of the shoot looking like Alabama did.  The first however many moves are scripted perfectly.  Heck, you can download them off Google.  Worse yet, you can get your EHR vendor to print them for you.

The wheat from the albumen moment comes when you have to come up with an answer to the questions, “What do we do next,” and “Why doesn’t it work like they said it would?”

That’s why consultants have an open box.  You know what we are doing when our brain takes us to the open box?  Thinking.  No company politics to sidetrack us.  Everybody knows the expected answers, but often the expected answer is not the best answer.  Almost everybody knows what comes after A, B, C, and D.

Sometimes…E is not the right answer or the best answer.

The Joy of Sox–deliver a great presentation

Posted by

0

It is an interesting exercise taking apart a one hour speech and repackaging it as a five minute talk—Twitterizing.  It goes to the quote, “I would have written less if I had more time.”  The corollary for presentations may be, if it does not fit one slide, it’s not properly thought out.

I think what a lot of presenters miss is having an understanding of what makes for a good presentation.  Here are a few of mine.

Presentation Rule 1—never bore the audience.  They are pulling for you to do well for your sake and theirs.

Presentation Rule 2—most of the audience can read.  If your slides are filled with text and bullet points, their natural inclination is to read what you’ve written.  They are doing this while you are reading aloud the very same text.  If they are reading, you become superfluous.

Presentation Rule 3—the audience cannot walk and chew gum at the same time (they can’t read your words and listen to you.)  For those presenters who favor text on their slides there are two choices; read from the slides, or try to offer commentary about the slides.  For those who do not read directly from their slides and want to offer commentary it gets even more awkward.  You look at the audience and see them reading the slide.  Your natural tendency is not to interrupt their reading because you are trying to be polite and you do not want them to miss your words of wisdom.  Then your mind starts to wonder if what you are about to say is so important if you should have written it on a slide.

Presentation Rule 4—if you wear wild looking socks, you had better be delivering one heck of a good talk.

Seth Godin’s philosophy about presentations is not wanting people taking notes based on what is on his slides, hence he uses pictures to convey an idea.  I have adopted his approach, choosing to hand-draw concepts from which I can then speak.  Since there is nothing of import on the slides, people start staring at you, something which will make a lot of presenters even more nervous.

The downside of this approach is that since everyone will now be listening instead of reading or writing, you better have something to say.  The issue then becomes how to craft your words in a way to get your audience to remember your message.

I favor analogies, examples, and the occasional cliché.

Will these steps work for you?  I hope they do.  I felt they were working pretty well for me last night right until the end.  An attractive woman approached me and said, “You look like Jack Nicholson, only not as unattractive”—so at least I’ve got that going for me.

Is it time to fire Winston?

Posted by

0

I was reporting to the board—or bored—sometimes it is the same.  The mission: figure out what was wrong, and then fix it.

I spent weeks talking to everyone from the executives to the receptionist.  I interviewed patients and physicians.  The doctors were not happy, the patients less so.  Costs were up, charges were down, and quality was down.

Of all the gin joints in all the towns…

The problem was easy to decipher.  I presented my findings.

“What do you recommend?” asked the chair of the audit committee.

I tried to look lost in thought.  “I fired Winston,” I replied.

“Why Winston?”

“Winston was where it all led; quality, cost, satisfaction.  Winston was responsible for the failures.”

Several members of the board nodded, and spoke among themselves.

After several minutes I jumped back into the fray.  “The more I think about it, the more I think Winston may be salvageable—not in the same role but somewhere else in the organization.  The employees really like him.  Besides, it’s the holidays.  Do you really want to be the reason Winston is not able to buy presents for the kids?”

The board held an in camera discussion.  “Agreed.”

I knew they would.  I started with my actual presentation.  “There is no Winston.”  The Winstons scattered around the table looked perplexed.  They were looking for the easy answer to the problems in their organization, they were looking for themselves.

Who are your Winstons?

HIT: Your most solvable big problem

Posted by

2

Two incompatible things are a type A personality and heart disease—I speak from experience.  I usually run six miles a day, three miles out and three miles back.  A few weeks ago I started hitting a wall after two to three miles and found myself having to jog/walk back to the car.  Wednesday I hit the wall after a mile, hands on my knees and gasping for air.

The air thing bothered me because that is what happened during my heart attack in 2002.  As I tried to make it back to my car I had to stop every few steps to catch my breath.  As I made it to a field and lay down several people stopped to ask if I needed help—this is where the incompatibility I mentioned comes into play.

I did not want to impose.  One of those who stopped happened to be a cardiology nurse and she was not taking no for an answer.  Dialing 911 she stated “I have an older gentleman, 60-65 having trouble breathing.”  That got my attention—all of a sudden my age seemed to be a much more important consideration to me than whether or not I could breathe.  “I am 55,” I corrected her.

Knowing how close I was to my home I tried unsuccessfully to get the EMTs to stop by my house before going to the hospital so I could get my laptop.  After three hours of tests, and without concluding why I had trouble breathing, they ruled out anything to do with my heart and sent me home.

I think knowing when to ask for help and accepting help relates a lot to healthcare IT; EHR, Meaningful Use, ICD-10.  These are each big, ugly projects.  There are several things that can happen on big, ugly projects, and most of them are bad.  This is especially true when the project involves doing something for the first time and when the cost of the project involves more than one comma.

Now we both know there is nobody with years of experience with Meaningful Use or ICD-10, and there are not many people who have one year’s experience.  So why ask for or accept help?  The truthful answer is because there are some people who know enough to know what to do tomorrow, and from where I sit the toughest part of every project is knowing what to do tomorrow—how to get started, and what to do the next day and the day after that.