“New & Improved” Isn’t Innovative

(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?

Spilling Tea–Why Your Business May Be Failing

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.

 

Why Some Firms Plan to Fail: 4 Warning Signs

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.

Patient Experience Management is abi-normal

I remember the first time I entered their home I was taken aback by the clutter.  Wet leaves and small branches were strewn across the floors and furniture. Black, Hefty trash bags stood against the walls filled with last year’s leaves. Dozens of bright orange buckets from Home Depot sat beneath the windows. The house always felt cold, very cold. After a while I learned to act normally around the clutter.

There came a time however when I simply had to ask, “Why all the buckets? What’s the deal with the leaves?”

“We try hard to keep the place neat,” she replied.

“Where does it all come from?” I asked.

“The open windows, the stuff blows right in.”

I looked at her somewhat askance. “I’m not sure I follow,” I replied as I began to feel uneasy.

“It’s not like we like living this way; the water, the cold, the mess. It costs a fortune to heat this place.  And, the constant bother of emptying the buckets, and the sweeping of the leaves.”

Trying to assume the role of thought leader I asked, “Why don’t you shut your windows? It seems like that would solve a lot of your problems.”

She looked at me like I had just tossed her cat in a blender.

When you see something abnormal often enough it becomes normal. Sort of like in the movie The Stepford Wives.  Sort of like Patient Experience Management (PEM). The normal has been subsumed by the abnormal, and in doing so is slowing devouring the resources of the hospital.

Are you kidding me? I wish. It’s much easier to see this as a consultant than it is if you are drinking the Kool Aid daily. When I talk to people about a statistic that indicates that 500 people called yesterday about their bill, and everyone looks calm and collected, it makes me feel like I must be the only one in the room who doesn’t get it—again with The Stepford Wives.

If I ask about the high call volume they always have an answer, the same answer.  “Billing calls are usually around 500 a day.”  They say that with a straight face as though they are waiting to see if I will drink the Kool Aid. It’s gotten to the point where no matter how bad things get, as long as they are consistently bad, there not bad at all.

This is the mindset that enables the PEM manager (I know you don’t have one—I am being facetious) to be fooled by his or her own metrics. When is someone going to understand that repeatedly having thousands of people calling to tell your organization you have a problem, means you have a problem?

It would probably take less than a week to pop something on your web site, and post a YouTube video explaining how to read the bill.  Next week, do the same thing and help patients understand how to file claims and disputes—granted, you may need more than a week for this one.

How to push the EHR into the cloud

For those wondering if the fact that I have not written recently is a result of me having mellowed or having found the world more to my liking, not true.  I have been busy earning minus points as I tried to get it sorted in those wide open spaces of my mind.  It is difficult for me to find much comfort in sleep when I think all the leftist gremlins are in cahoots—I see two masons shaking hands and I think conspiracy.

Now, before this begins to read like I wandered too far from the republican rest home, I note that some of my best friends actually know democrats; so I am not as close-minded, or perhaps clothes-minded, as I would like to be.

Some are slow to adapt ideas to a changing world, aimlessly swatting new ideas away with a no-pest-strip as though they were plague carrying mosquitos.  Their thoughts, frozen in time, move so slowly they have been overtaken by a skateboard—and that skateboard was under someone’s arm.  These are the same individuals whose ability to play outside of the comfort of their own sandbox has not been seen since the internet was powered by steam.  It is a little like being a dinosaur while those around you are still floundering in the primordial bisque, still trying to wrap their synapses around the cold ideas distilled in the anecdote.

That is not to suggest that others do not think.  I am sure they have dozens of thoughts scribbled on the inside of their head, but those thoughts are erased each time they play with their hair—brains not big enough to swing a cat in without giving it a minor concussion.  There are fomenting alchemies of thought nuggets, but never quite enough to turn base metals into gold.  Sometimes, when the lighting is just right, you can see their curve of illogic thought arching overhead like static electricity.

In normal prose, I tend to be few of words.  I can get through entire days uttering no more than ‘uh-huh,’ a condition to which I attribute having exited the womb not fully-formed.  Writing is different than the spoken word.  For one thing writing is infinitely easier and more pleasingly voyeuristic, for it can be more entertaining to write about venomous ideas, not enough to kill my prey, simply to stun it.

Where then do ideas originate?  They are not like sex in a packet where all you have to do is add water.  The lack of thinking has led us to a tragic age most refuse to take tragically.  Thought patterns are aborted before they germinate, as though the thinker was taking intellectual contraceptives.  But believe it or not, I often find myself hoisted high on the petard of my own self-induced mesanic naivetés.  When a spark of a thought enters my mind, I rarely let it go quietly into that good night.  Instead I tear at it like Henry VIII coming off a forced diet—I know I mixed the metaphor, but I liked it.

I know rarely how my mind moves me from thoughts A to B.  Today proved no different.  Take the Poken.  This device is the newest technological mind-nibblet—a tiny jump-drive device about the size of prune whose purpose in life is to help two individuals sync their personal contacts by pok-in’ their respective Pokens.

You have got to hand it to them, for it sounds like it could be more entertaining than syncing one’s Blackberry.  If I understand correctly the concept, if my Poken pokes your Poken the Pokii mate—Pokii may or may not be the correct form of the plural, but it will have to do for now.  Once the mating process has ended, and before mine finishes its cigarette, I have your contact information and you have mine.

This could be an interesting way to swap business contacts, but as I live in the land of the Jabberwocky my mind does not work that way.  “Then he got an idea, an awful idea. The Grinch got a wonderful, awful idea.”

I jested about the Poken a few days ago, and then I thought about how this device could be made to work in healthcare.  The Poken is a communication device, sending and receiving secure requests to the cloud to permit one to access and update contact information.  Not much of a healthcare offering doing that, but what if?  What if instead of letting me share my contact information with someone I select, it, or something like it, allowed me to share my personal health record with my physician?  What if my physician was able to update my health record using a similar device?

The EMR and PMR applications would be in the cloud.  The Poken would provide the “handshake.”  One fully functional EMR.  The rest is history.  Thanks for playing along.

Is Your EHR More Like iPhone Or iTunes?

Below is my latest post on healthsystemcio.com.  Let me know what you think.

Times are perilous, and they ain’t a-changin.  As Europe focuses its attention on whether the Euro will become a collector’s item, and the Middle East eagerly awaits the chance to lower the amount it pays for air conditioning because of the surplus of electricity that will be available from all of Iran’s nuclear reactors, America is all a-twitter about what Angelina Jolie was wearing at the Oscars.

No wonder the impact of the billions being spent on healthcare IT has taken a back seat.

Ask yourself, how good is your EHR? Does it do what you want it to do? Does it do it in the way you need it to do it? If it was your decision, would you have spent a hundred or two-hundred million dollars for it?

Okay, get the smirk off your face.

I have been writing recently a lot about the difference between user acceptance (UA) and the usability of large business systems like EHR systems. A business system is a lot more than an IT application. It also includes process and people — users.

Achieving high user acceptance is easy. Implement one system and make everyone use it. Check the box. User acceptance only involves the IT application: the EHR. UA does not measure the value of the business system to the users; it simply measures the percentage of users.

Usability is a testament to whether or not the system, in this case the EHR, adds value to the organization, to its users. Does it make them better, more effective, more efficient? The secret sauce towards achieving good usability is the addition of design.

Here is an example of a company with two business systems depicting the difference between UA and usability. The company is Apple, the two business systems are the iPhone and iTunes.

iPhone system:

  • Phone, camera, game player, GPS, email, SMS, MP3 player
  • One button
  • No training required
  • Great usability

iTunes system:

  • Web shopping program for purchasing services to use on Apple products
  • Full keyboard
  • High learning curve
  • Poor usability, poor user experience
  • High UA — users have no other choice

Brothers from different mothers. Their usability is so different that it is difficult to believe both business systems came from the same company.

  • One business system lets you do everything using one button; the other barely lets you do anything using 61 keys.
  • One is intuitive, one is anything but

I am willing to bet your EHR reminds your users more of iTunes than it does the iPhone. You can choose to accept it as is, or you can make it better. The great thing about business systems, unlike products, is you can choose to apply design to a poor business system and gain tremendous value for little investment. Or not.

The Physics of EHR

To read and complete this post you may use the following tools; graph paper, compass, protractor, slide ruler, a number two pencil, and a bag of Gummy Bears—from which to snack.  The following problem was on the final exam in my eleventh grade physics class.  Let us give this a shot and then see if we can tie it into anything relevant.

A Rhesus monkey is in the branch of a tree thirty-seven feet above the ground.  The monkey weights eight pounds.  You are hunting in Africa, and are three hundred and twenty yards from the monkey.  You have a bolt-action, reverse-bore (spins the shell counter-clockwise as it leaves the gun barrel) Huntington rifle capable of delivering a projectile at 644 feet per second.  The bullet weighs 45 grams.  The humidity is seventy percent, and the temperature in Scotland is twelve degrees Celsius.

At the exact moment the monkey hears the rifle fire it will jump off the branch and begin to fall.  Using this information, exactly where do you have to aim to make sure you hit the monkey?

I used every piece of information available to try to solve this.  I made graphs and ran calculations until there was no more data left to crunch, computing angles and developing new formulas.  I calculated the curvature of the earth, and the effect Pluto’s gravitational pull had on the bullet.

The one thing that never occurred to me was that since the monkey was falling to the ground, so was the bullet—gravity.  The bullet and the monkey both fall at the same rate because gravity acts on both the same way.  So, where to aim to hit the monkey?  Aim at the monkey.

All of the other information was irrelevant, extraneous.  The funny thing about extraneous information is that it causes us to look at it, to focus on it.  We think it must be important, and so we divert attention and resources to it, even when the right answer is staring us in the eye.

Attempting to implement EHR is a lot like hunting monkeys.  We know what we need to do and yet we are distracted by all of this extraneous information that will hamper our chances of being successful with the EHR.  Two of the most obvious distractions are Meaningful Use and Certification.  The overarching goal of EHR is EHR; one that does what you need it to do.  If the EHR does not do that, everything else has no meaning.