planning

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.

“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.

Business Innovation: Hamsters Only Bounce Once

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Hamsters only bounce once—next time I will read the fine print.  This was the lesson I learned today from my thirteen-year-old son as he tried to hold my nine-year-old son’s hamster—I keep wanting to insert a ‘p’ after the ‘m’, but my inability to spell will not affect the hapmster’s condition.

So, from hamsters to the Soviets—those too young to remember the Soviets, Google it.  I am reading a book about the latter years of Stalin’s reign.  In the book Nikita Khrushchev, while dedicating a school, reportedly stated the USSR needed highly productive, healthy scientists, engineers, and gold-medal athletes.

The implication of Nikita’s pronouncement was the country did not need any poets, philosophers, and priests.  It needed productivity that could be measured and quantified; success that could be timed with a stopwatch.

Perhaps it is the cynic in me, but those few paragraphs reminded me immediately of how individual American corporations are run.  After all, is not that what our firms do?  We measure and quantify and time.  Whether it is earnings per share or inventory or supply change.  We tend to think and act that business success is all about the numbers, that if we study them hard enough, we will divine how to move forward.

How well is that working?  The hamster wheel is no longer spinning.  How many new ideas have resulted from the approach of quantification?  Every company can measure.  It just so happens what they have been measuring is declining revenues.

Things that do not measure well include strategy and innovation.  Firms cannot increase innovation by twenty percent or execute strategy fifteen seconds faster.  Perhaps there is merit in placing less emphasis on quantitative efforts.  Is it possible that a more qualitative focus would improve the quantitative results?

Innovation 101

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The world continues to revolve and to rotate, and yet some mornings, like today, I find myself asking why bother.

Moammar Gadhafi—the name does not even pass Word’s spell check which should tell him something about his popularity—dressed in his Michael Jackson garage sale Thriller outfits is discovering quickly that his Lawrence of Arabia shtick is about as effective as is Congress’ pretense at leading from behind.  Speaking of which, now that Congress are back from Nebraska’s beaches, maybe they can save the country.

What else?  Kim Kardashian is married—whew, I thought that would never end, Jimmy Hoffa has sworn off drinking tea party, and Chaz, minus some of the important parts will be appearing as a man on Dancing with the Stars.  I will be appearing as a giraffe on Animal Planet.

The country keeps getting curiouser and curiouser and where does that leave your business in an economy that has gone Byzantine?  It appears choices are somewhat limited.  Firms can wait until the unknown influencers become known, they can wait for Washington to sort out who’s on first, or they can decide to innovate.

When I think of innovation I think of it as follows: knowledge plus need equals innovation.  To renew or change.  From a firm’s perspective, before innovation can have application, questions must be defined and answered:

·         What is the need:

  • Declining market share
  • Uncertain markets
  • Poor economic conditions
  • New technologies causing obsolescence
  • Entering new markets

·         What knowledge is required

·         What can be renewed

·         What must be changed

Doing today what you were doing yesterday is not the picture of innovating.  It is the first day of the last days of your business.  Moving your production to China, or your call center to India is not innovative, it is cutting cost.  Anyone can cut costs, until there are no more costs to cut.  Then what?  The most effective way to cut costs is to turn off the lights and lock the door.

Healthcare IT: Musings of a drive-by mind

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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 that I 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, between pizza slices.

Case in point—trim touch ups.  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 it happens, 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, or, I can let you borrow mine.  You explain that it looks like that 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 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?  The exercise of obtaining HER champions and believers is difficult.  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 think I know with certainty is that I now have half-times all to myself.

Healthcare IT meets Ben & Jerry’s

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The idea for this blog came about after reading a PowerPoint presentation by Doctor Alberto Borges.  All mistakes can be attributed to me.

When one is witness to the number of external influencers trying to shape policy on healthcare, reform, and healthcare IT, the best one can hope for is that hidden somewhere under the pile is a pony.

But let’s be real—the pony has suffocated.

While it is okay to point the finger of blame at the usual suspects—payors, lobbyists, and the lawmakers—let us not forget to ensure to point out the role paid by the healthcare IT applications vendors.

“Who me?” You ask.

Decrease costs, increase quality, decrease errors.  I did not invent these words; they are written on your websites.

Prior to 2008 the value of EHR vendors’ stocks plummeted.  Look at them now.  How does one explain the difference?  Can the gains be attributed to vendors having rewritten their applications?  New technological innovations?  If not, what else could it be?

Meaningful Use.  Meaningful Use tied to Medicare payments and a twenty billion dollar incentive to get providers to do something they otherwise would not have done.  Could life be any better if you are sitting in the EHR Tower’s corner office?

What if we think about the issue this way?  Let us suppose all of the leading ice cream manufacturers lobbied Congress to push for including ice cream machines in all new cars starting in 2012…silly idea, but then again, so is Meaningful Use.  Not only do the ice cream machines have to be installed, but they have to be able to communicate with one another.  That way, if I happen to rent a car, the ice cream machine in my rental will already know what type of ice cream I like to eat.

Now we already know that no car buyers and no car builders will think much of being forced to buy or make cars with pre-installed ice cream makers.  But, perhaps there is a way around that.  Maybe in some self-serving way the Cookies and Cream lobby can convince Washington of the merits of pushing through their agenda.

Time passes, and still the idea is not getting much purchase.  What happens next?  The ice cream manufactures get Congress to pass the Ice Cream Tech Act—ICTA.  And as part of the ICTA Act, Ben and Jerrys, Baskin Robbins, and Haagen Dazs convince our friends to offer the auto manufacturers a twenty-billion dollar rebate for building cars with built-in ice cream makers—ICTA Initiatives.

Now, why would the Ben’s and Jerry’s do this?  Good question.  They will do this because they know that without offering a large financial incentive the car company executives will not do what they want them to do.  Now to insert ice cream makers, you can imagine that the car companies will have to go way off message, will have to change their strategy, and will have to incur all sorts of costs that have nothing to do with selling cars.

And that brings us back to the start of this story.  There is a reason why EHR vendors needed to lobby Congress to put forth more than twenty billion dollars of lottery money, and that reason is healthcare providers would not be doing EHR the Meaningful Use way unless there was a monetary reason to do it.  There certainly is no business reason to do it.

And for the most part, if providers calculate an ROI on EHR, even factoring in the incentive payments, there is still no reasonable financial argument that can be made.  In fact, when the cost to meet Meaningful Use is factored in, the financial argument worsens.

So, what will happen?  Here is what we know so far.  The Meaningful Use deadlines draw closer, meaning there is less time left to get the incentive dollars.  Implementations of EHR continue to falter, be redone, and under deliver.  The result is that the purchase of EHR systems will slow, and many EHRs will be uninstalled.  When there is no time left to get the incentive dollars, only then will EHR implementations be driven by the needs of the providers, and the government will no longer be driving the process.

 

EHR: the wisdom of crowds

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According to National Geographic, a single ant or bee isn’t smart, but their colonies are. The study of swarm intelligence is providing insights that can help humans manage complex systems. The ability of animal groups—such as this flock of starlings—to shift shape as one, even when they have no leader, reflects the genius of collective behavior—something scientists are now tapping to solve human problems.  Two monumental achievements happened this week; someone from MIT developed a mathematical model that mimics the seemingly random behavior of a flight of starlings, and I reached the halfway point in counting backwards from infinity–the number–infinity/2.

Swarm theory. The wisdom of crowds. Contrast that with the ignorance of many to listen to those crowds. In the eighties it took Coca-Cola many months before they heard what the crowd was saying about New Coke. Where does healthcare EHR fit with all of this? I’ll argue that the authors of the public option felt that wisdom.  If you remember the movie Network, towards the end of the movie the anchorman–in this case it was a man, not an anchor person–besides, in the eighties, nobody felt the need it add he/she or it as some morphed politically correct collection of pronouns.  Whoops, I digress.  Where were we?  Oh yes, the anchor-person.  He/she or it went to the window and exhorted everyone to yell, “I’m mad as hell, and I’m not going to take it anymore.”  Pretty soon, his entire audience had followed his lead.

So, starting today, I begin my search for starlings.  A group whose collective wisdom may be able to help shape the healthcare EHR debate.  The requirements for membership is a willingness to leave the path shaped by so few and trodden by so many, to come to a fork in the road and take it. Fly in a new flock.  A flock that says before we get five years down the road and discover that we have created such an unbelievable mess that not only can we not use it, but that we have to write-off the entire effort and redo it, let us at least evaluate whether a strategic change is warranted.  The mess does not lie at the provider level.  It lies in the belief that hundreds of sets of different standards can be married to hundreds of different applications, and then to hundreds of different Rhios.

Where are the starlings headed?  Great question, as it is not sufficient simply to say, “you’re going the wrong way”.  I will write about some of my ideas on that later today.  Please share yours.

Now, when somebody asks you why you strayed from the pack, it would be good to offer a reasoned response.  It’s important to be able to stay on message.  Reform couldn’t do that and look where it is. Here are bullet points you can write on a little card, print, laminate, and keep in your wallet if you are challenged.

  • Different standards
  • Different vendors
  • Different Rhios
  • No EHR Czar

Different Standards + Different Vendors + Different Rhios + No Decider = Failure

You know this, I know this.

To know whether your ready to fly in a new direction, ask yourself this question.  Do you believe that under the present framework you will be able to walk into any ER in the country and know with certainty that they can quickly and accurately retrieve all the medical information they need about you?  If you do, keep drinking the Kool Aid.  If your a starling, come fly with us and get the word out.  Now return your seat backs and tray tables to their upright and most uncomfortable positions.