IT Vendors: What’s not to like?

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 of 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?  Attractive 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.

When IT projects Fail

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 Hispanic bon vivant.  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 Bill’s 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 event 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.

Project Management’s Biggest Mistake

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’s Two Types of Failure at your Hospital

"Kinetic productivity"

I have been rereading John Eldredge’s book Wild at Heart.  It seems his purpose for the book is to help men cope with their feelings of not measuring up to their father’s expectations.  It delivers its punch at much the same level as the last scene in the film Field of Dreams when the father and son have a chance for one last catch.

(I am pausing parenthetically for a moment for the men to wipe their collective eyes.)

Here comes the segue, so hold on to your EHRs.  Let us spend some time dealing with lost opportunity and failure.  What if we define two types of failures; kinetic failure and potential failure?

Kinetic Failure: the failure to achieve the possible

Potential Failure: the failure to achieve the probable

Viewed from the perspective of productivity, let us define X to represent the service provider’s pre-EHR productivity; the distance from P to A represents the productivity loss brought about by the EHR, and the distance from A to K represents the opportunity loss.

P——————————A—————————K

One can argue with some degree of reason that the purchase of an EHR was made with the reasonable assumption that in addition to improving quality and patient safety the EHR would improve productivity to some degree.  In fact, assuming the provider did any sort of cost benefit analysis or return on investment calculation, any ROI, if it exists lives somewhere along the path between A and K.

If productivity is not improved, the service provider incurs an opportunity loss, a kinetic failure. At that point the best a service provider can hope to achieve is to not suffer a productivity loss.

One can also argue that the purchase of an EHR was made with the reasonable assumption that the implementation of EHR would not reduce productivity.

In many service providers EHR has resulted in a double hit to productivity; not only did they not achieve the productivity gains that were possible, they lost productivity.  A lot of people raise complaints when they speak about how much productivity costs.  One thing that is for certain, productivity costs a lot less than lost productivity.

This lost productivity, the kinetic failure, is the elephant in the service provider’s waiting room.  It has been poking its trunk through the door, and the only thing it wants once it gets its trunk through the door is to get all the way in the room.

Well, it is in the room, all the way in.

Part of the confusion facing providers is due to the fact that no matter how bad the productivity loss, a provider can still qualify as a meaningful user. That fact has led many providers to believe that since they can still qualify as such, that perhaps the productivity loss cannot be all bad news.

Let us look at a real example from a client of mine, a hundred and forty physician practice.  This practice had hit a barrier in terms of its ability to add patients, doctors, and staff.  It was running consistently an hour to an hour and a half behind with its patients.

The practice spent millions to implement an EHR.  Several months post implementation the practice was still running an hour behind.  Automating bad practices resulted in only one thing; the bad practices were completed faster.

To have any hope of avoiding kinetic failure and potential failure a healthcare practice must address how it runs its business.  Some business processes are duplicative, some are outdated, and some are wasteful.

Every one of those eats away at possible and probable productivity.  EHR was not designed to be a productivity windfall, but it clearly shines a spotlight on lost productivity.

Fortunately, even if your EHR has led to a productivity loss, all is not lost. Kinetic productivity can be regained, and potential productivity can be captured.  The path to productivity slices right through how the EHR is being used.  User Experience, UX, and usability, can and should be examined, redesigned and deployed.  This is not for the squeamish as it will cut through constraints like ‘We can’t do that’ and ‘We have always done it this way.’

Can’t and always must become productivity’s road kill.

The Cat in the Hat’s EHR Philosophy

My mind is a raging torrent, flooded with rivulets of thought cascading into a waterfall of creative alternatives. (Hedley Lamar—that’s Hedley)

Let’s see if we can tie this collection of thoughts into something that won’t waste your time or mine.

The sun did not shine.  It was too wet to play.  So I sat in the house all that cold, cold, wet day.  It was too wet to go out and too cold to play ball, so I sat in the house and did nothing at all. (Dr. Seuss)  It was around that time when my wife decided maybe this whole sitting around thing wasn’t optimizing my time, so she decided “we”—which can also be interpreted to mean “me”—should caulk the master shower.  Personally, I thought that why God invented the Yellow Pages, you know, the whole thing about, “Let your fingers do the walking.”

I notice we just blew through an entire paragraph without accomplishing anything.  Sorry.  I got my designer tool belt, the same one I’ve had for twenty years—still looks the same as the day I bought it.  Today’s Roemer Minute—the less you know about what you’re doing, the more important it is to dress the part.  (This does not seem to work with the people whom I’ve told that I’m studying cardiology.)

Tool belt.  Tools—caulk taker-outer, caulk puter-inner.  Paper towels—the need for these will become clear.  Worse case, this is a ten minute job, but if I finish too quickly, there will be additional assignments coming my way.  The trick with caulking is that the success or failure can all come down to how much of the plastic tip you circumcise (can I say that on TV?).  Too much and caulk is everywhere, not enough and it is nowhere.  I made the incision and started to lay down the first bead.  It was quickly apparent that I should have used clear caulk as the white stuff stared back at me like bleached bones—I try and add a little medical flavor wherever I can.

I’ve watched the same shows as you.  Sometimes people spread the caulk with a tool, others prefer a wet finger.  I am equally unskilled with both, so I went with the finger method, smoothing the caulk into the joint.  I wipe my sticky white finger on the paper towel, place the towel on the limestone tile, and return to work, only to notice that although the caulk looks good, my finger created to parallel lines of caulk on either side of the repair, sort of like a snow plow does.  I grab another piece of paper towel and begin the process of trying to remove the excess caulk, finally tossing the paper towel to the side.

Fast forward twenty minutes.  The caulking is done.  My hands are so white it looks like I am wearing a pair of Mickey’s gloves.  (That’s spelled M-O-U-S-E.)  As I wipe my hands with a used piece of towel—there are no more clean ones—I unknowingly step on one of the pieces.  The piece sticks to my shoe.  I retrieve the other pieces and notice that the caulk which had been on the paper towels is now spread all over the tile like someone had a food fight with smores.

Whatever I touched only exacerbated the problem.  I am immediately reminded of the Dr. Seuss book, “The cat in the hat comes back.”  In the book, the cat goes from good intentions to spreading a pink stain over everything—sort of like me with the caulk.

Sometimes good intentions don’t add up to much.  I’d wager that everyone in the EHR process has good intentions.  Sometimes it’s more important to pair good intentions with good skills.  Let’s call EHR one of those sometimes.  Good intentions are okay up to the point when you’re dealing with two or more commas on the cost side.

Here is today’s thought, the one reason you keep coming back to this site. Why did you implement EHR?  The answer will surprise you.  You did it for one simple reason, to get people, doctors and nurses, to do what you want them to do and to do it in a way you want them to do it.  EHR will modify their behavior.  I am sure yours did, but did it modify it in the way you wanted?

Most times it’s good to call a professional before you start tracking caulk across the floor.

Why IT projects Fail

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.

Step away from the computer

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.