Rants & Musings

Spilt Tea: Why companies choose to fail

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At one time the single 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.  The basement of Lubyanka housed a prison which contained one hundred and eleven cells, cells used to hold and interrogate political prisoners during Russia’s purge.

Tea was provided to the prisoners twice each day.  A prisoner within each prison cell would place a teapot outside the cell. A prisoner, carrying a pail filled with tea, would pour tea from the pail 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.

Two million, one hundred eighty eight thousand spills.  The same number of cleanups.

Someone somewhere made the decision that it was easier or cheaper to spill and sop the water 2,188,000 times than it was to make pails with spouts on them.

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

The most obvious one for most companies is call centers.

It is easier to take 2,188,000 calls each year about your bills than it is to fix the bills.  It is easier to take 2,188,000 calls each year about the bills than it is to get rid of the bills.  The same argument applies to a number of other processes.

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.

Who Killed CRM?

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I once said to my client in Madrid “Well, she’s no rocket scientist,” commenting on the performance of one of his team members.  Turns out I was wrong—she had a PhD in astrophysics.

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.  Do you ever wonder 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 Celine Dion concert in the dead of winter, is it any wonder that your 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, banks, 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?

Every business decision, every strategy, every acquisition, 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.  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 of 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 the 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 and they do not need multimillion dollar systems to do it.

If you are interested, this link goes to a presentation I have given on CRM:Dead or Dying?  Feel free to use it or to leave a copy on the desk of your CEO.

http://www.slideshare.net/paulroemer/crm-dead-or-dying

Is your company ADHD positive?

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It ain’t easy always being the one dumb enough to write the words on which others dread to tread.  “Get Paul to write it.”

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 and 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.  Some guy named Bob now sits in Sally’s office.  It will never be Bob’s office.  Today it is as though Sally never even existed.  Her perfume no longer drifts down the hall.  Bob let the 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 company has changed and everybody went along with it.  First Sally, then Mr. Withers who worked in tax.  Two people in purchasing left on the same day.  It feels like there should have been a wake for them or like you should be wearing a black arm band.  You cannot remember the last time anyone went to lunch together.  You have seen the malaise and the malaise is 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 electronic health records 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 have not yet figured out that they never did exist.  To many companies the people are not any more real than the laptops, and perhaps less valued.  Inventory: 35 accountants, 72 programmers, twelve hundred 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.  Customers will never see nor will they interact with the 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 their employees to instill an attitude in their employees such that the employees would be willing to die for the company, the first thing the company needs to do is to stop killing them.

Showing Initiative–learning the hard way

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Were one to judge America by what they read from scanning the headlines of the magazines in the supermarket’s checkout lane, the only items of note are that Jennifer Aniston may or may not be pregnant, and that another one of the Kardashian’s was getting married—no word as to whether or not she is pregnant.  The headlines provided no indication that we are at war or that the economy has been outpaced by my daughter’s lemonade stand.

Anyway.  I have been reading Solzhenitsyn’s The Gulag Archipelago, which should be on every reading list for Genocide 101.  In the book he describes numerous offenses which could get a Russian sentenced to Stalin’s gulags.  Some estimates suggest more than sixteen million people were purged under Stalin’s regime—enough people whereby those in power had to continuously invent new offenses.

In one such description Solzhenitsyn recounts a conference for Stalin’s supporters.  Every public gathering was attended by several members of the NKVD, the bad guys.  At the conclusion of the conference its chairman called for a verbal salute to Stalin which resulted in all of those attending applauding.  The vigorous applause continued for eleven minutes because everyone was afraid to be the first to stop applauding.

To stop applauding was to show initiative, was to be an individual.  Exhausted, the chairman finally stopped clapping; immediately, so did everyone else.  The chairman, a loyal communist, was arrested.  During his interrogation the interrogator told him “Don’t ever be the first to stop applauding.”  Darwin’s natural selection, and how to grind people down with stupidity.

Nonetheless, we return to Beaver Cleaverville.

Do you ever sit in a meeting thinking it would be easier to design a revolving sliding door than to agree with or understand whatever is going on in the meeting around you?  You scan the room eying the flock of sheep each of who think of themselves as lions.  Once again, the Pickle Factory’s leader had confused motion with movement.  You scribble yourself a note using your favorite crayon—the cerulean blue, ‘I have seen our future and it needs work.’

“Well, here we are,” says the moderator outfitted in her J C Penney imitation Vera Wang pantsuit.  For years her mind had run just fast enough to enable her thoughts to always be in the same place.

“Yeah, here is where we are,” you mumble into your cupped hand. “We have been here before and we will be here again and again.”  The person across from you seems to be humming “It’s a long way to Tipperary.”

These meetings make about as much sense to you as the game the Afghan Pashtun tribesmen play—buzkashi—sort of like polo except instead of using a ball they use a headless goat.  The executives rampage through the offices each day dragging the headless carcass of their business strategy to meeting after meeting hoping to score, and the more meetings you attend the more you feel like the goat.

“What are we supposed to accomplish today?” You ask.

“Your guess is as good as mine,” replies the moderator, her mind making its way back from its visit to the land of ultima Thule.

“No, your guess is better than mine,” you say.  “It is your meeting.”  ‘Lock the gate,’ you are thinking, ‘before the village loses its idiot.’  Everything is running behind and the team wants to make up for lost time.  Your job is to try to convince them that you cannot make up for lost time; the best you can hope for is not to lose any more.

You have always known that companies which do not tolerate dissent have a tendency to ignore dissenting information but they remember the dissenters—the first person to stop clapping. In a company lacking second sight and new ideas, the old ideas are often divided evenly among the employees.  The death spiral of silence—people avoiding threats of being voted off the island have a tendency to refrain from making any statement that may show them to have an original thought.  Showing initiative can result in your being sent to the company’s gulag.

Have you noticed that the more a firm’s competitive edge erodes, the busier the firm appears to be?  Once you have fallen through the looking glass the only way out may be for you to walk back the cat, that is travel backwards to see how it is you and the others became trapped in this house of mirrors.  The problem with that strategy is that to undertake it requires you to show initiative.

The firm’s gulag is filled with people like you.  At least when you get there you will be able to commiserate with people of a similar ilk.

 

One thing your IT vendor will never tell you

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Permit me to let you in on a little secret—most firms have no idea how to manage their IT applications vendors.

In turn, this means they are managing you.  By the way, this is a bad thing.

The best way I have found to understand this problem is to liken what IT vendors tell you to what magicians tell their audience.  Bear with me.  If you have ever attended a magic show or watched one on television you will note that the best magicians tell you prior to their performance that they are going to lie to you.  In order for a magician’s performance to work on you any magician has to get you to suspend your belief.

A magician tells the audience that everything else you are about to hear and see is a lie.  And then they tell you they are going to cut someone in half, they do it, and your eyes are so amazed that somehow your brain forgets the bit about being lied to, about being led down a path of suspending your beliefs.

The difference between magicians and IT vendors is that IT vendors forget to mention at the outset—or at any other time—that not everything they tell you is true.  Things like what their system will cost, what it will do and how long it will take.

And because they do not tell you they are lying, once you have suspended your belief, you forget to unsuspend it.  Hence, you are caught up in their fantasy world and you foolishly believe what they tell you.

For the most part, IT vendors are not the people you want next to you in the EHR, ERP, or any IT foxhole.  In the dog-eat-lemming world of IT, never forget that the term ‘partner’ is an oxymoron.  IT is a business and the goal of every business is to maximize profits.  The best ways to maximize profits are to reduce costs and to increase revenues.  The only way to do so is for vendors to increase your costs.

Keep your eyes and ears open the next time your vendor offers to cut someone in half.

EHR: What Bugs You About It?

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16This is the time of year in the east when cinerescent caterpillar nests hang thickly from the trees, peppered tufts of cotton candy.  During these long, flavorless August days, the sky is a similar achromatic color.  My nine-year-old is concerned because I told her we are having caterpillar soup for dinner tonight—watch out for the crunchy bits.  Once again, it seems I’ve gotten off message.

I wonder how much of the difficulty surrounding EHR has to do with getting off message, much like we seem to have done with the reform discussion.  What difficulties?  Got time?  You can name more of them than can I.

What is off message?  It’s that the day-to-day tactics of implementing EHR office by office, and hospital by hospital have overshadowed the strategy, have displaced the business driver behind the mandate.  The focus became internal, not national.  Bits and bytes have overshadowed charts.

I doubt few, if any, can articulate a believable explanation of how a few years from now your medical records will accurately and expeditiously be delivered from where you live to the lone clinic on Main Street, Small Town, USA, to the nurse practitioner who at midnight is giving you an EKG.

It’s that fact, that we are not able to define how we get from A to B, let alone do so with multitudes of A’s and B’s, that to me suggests we are building something of which we have little comfort will do what we set out for it do.

Clearly, there are hundreds if not thousands of very talented and dedicated professionals focused on finding a solution.  However, it seems their efforts remain handcuffed by hundreds of competing products, no well-defined overriding set of requirements that would enable anyone to say with certainty, “Yes, that is it.  That captures what we need to do.  When we have done that, we are done.”

Until that time, I think we all need to be concerned about the crunchy bits.

What do you think?

EHR: When you’re in a hole, stop digging

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rappelling_1_1I was thinking about the time I was teaching rappelling in the Rockies during the summer between my two years of graduate school.  The camp was for high school students of varying backgrounds and their counselors.  On more than one occasion, the person on the other end of my rope would freeze and I would have to talk them down safely.

Late in the day, a thunderstorm broke quickly over the mountain, causing the counselor on my rope to panic.  No amount of talking was going to get her to move either up or down, so it was up to me to rescue her.  I may have mentioned in a prior post that my total amount of rappelling experience was probably no more than a few more hours than hers.  Nonetheless, I went off belay, and within seconds, I was shoulder to shoulder with her.

The sky blackened, and the wind howled, raining bits of rock on us.  I remember that only after I locked her harness to mine did she begin to relax.  She needed to know that she didn’t have to go this alone, and she took comfort knowing someone was willing to help her.

That episode reminds me of a story I heard about a man who fell in a hole—if you know how this turns out, don’t tell the others.  He continues to struggle but can’t find a way out.  A CFO walks by.  When the man pleads for help the CFO writes a check and drops it in the hole.  A while later the vendor walks by—I know this isn’t the real story, but it’s my blog and I’ll tell it any way I want.  Where were we?  The vendor.  The man pleads for help and the vendor pulls out the contract, reads it, circles some obscure item in the fine print, tosses it in the hole, and walks on.

I walk by and see the man in the hole.  “What are you doing there?”  I asked.

“I fell in the hole and don’t know how to get out.”

I felt sorry for the man—I’m naturally empathetic—so I hopped into the hole.  “Why did you do that?  Now we’re both stuck.”

“I’ve been down here before” I said, “And I know the way out.”

I know that’s a little sappy and self-serving.  However, before you decide it’s more comfortable to stay in the hole and hope nobody notices, why not see if there’s someone who knows the way out?

Merely appointing someone to run your EHR effort doesn’t do anything other than add a name to an org chart.

EHR: Every time you redesign, God kills a kitten

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Again on the project failure?  Yes.  Why?  Trying to head it off at the pass.  Source, The Bull Report.

Fifty-seven percent of failures are due to bad communication.  What’s that?  Poor grammar?  No.  Not enough meetings?  Doubtful.

It’s about PMO.  A hired gun?  Perhaps.  An advocate who will manage the vendor on your behalf.  What’s the rest of the hired gun’s job description?  It is all the blue stuff in the graph.

And now it is time to view this discussion in light of healthcare.  The chances of your ‘two-comma’ project failing are legion.  Why? Nobody has a good history of having done EHR; if they have experience it is likely because their first implementation failed.  EHR is not like implementing ERP.  The is no ROI at the end of the rainbow.  The business driver seems to be Meaningful Use which has caused many hospitals to glide over things like process improvement and change management and breaking down the tribal barriers among organizations.

The good news is that being a bad dresser will not hurt the project.

 

 

EHR Certification: Less valuable than a turnip

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I was asked to give my opinion during an interview for an article on EHR certification.  As you know, I could benefit from the advice that implores one to keep their mouth shut less the whole world know you have nothing to say.  I had the right to remain silent, just not the ability.

I tend to think the certification process was something invented and supported by the large EHR vendors as a way to make the small vendors less relevant and as a way to slow the development of standards. As standards come into play, the EHR vendors furthest away from the standards, including the largest vendors, will become less relevant.

There is no legitimate business reason for having to certify a system AFTER having spent several hundreds of millions of dollars implementing it.

The logic behind the comment about there being no raison d’être for the existence of certification is as follows.

Certification, to be of value, must imply that the act of certifying–like the Good Housekeeping Seal of Approval–is intended to show that a certified EHR is somehow better (for healthcare) than a non-certified EHR.

The post-implementation impact of EHR is that far too many nine-figure EHRs have resulted in productivity losses of between ten and thirty percent. In English…a hospital spends a hundred million dollars on a system and as a result of having spend that money is only able to handle fewer patients than it could if it had spent a dollar on a turnip.  That same hospital, now operating less effectively, can do so with a certified EHR, and can qualify for Meaningful Use.

The certification process has failed to justify its existence or to bring any value to the process.  However, it has not failed to get hospitals to spend additional millions to comply.

According to the hospital CIOs and physicians I have spoken with it means the hospitals (physicians) are able to see fewer patients. This is because the physicians must spend more time searching, navigating, and typing. My cardiologist who works at a very prominent hospital in Philadelphia told me two memorable things about their $200 + million dollar EHR:

  1. The data is excellent if you are a patient or insurance company. You now have excellent data with which to sue us.
  2. My productivity is down thirty percent. The hospital has taken its most expensive and time-constrained resource and made us spend the majority of our time interfacing with a keyboard instead of our patients.

I would encourage you to ask others what additional benefit, if any, certification has brought to them and would they not have received those same benefits without implementation.  Certification is the lottery ticket hospitals must purchase to enter the Meaningful Use sweepstakes.  Meaningful Use has no Meaningful Use. Many hospitals will have purchased that lottery ticket but will not meet Meaningful Use. Hence, the cost to attain certification and the cost to attempt to meet Meaningful Use are wasted dollars.  Meaningful Use is binary Sudoku, you either get it or you do not.

The real impact of the EHR resource shortage

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(AP) New York.  It is Reservoir Dogs 2.0 only this time the terrorists appear to be a clean-shaven group of EPCI subject matter experts. Reuters is reporting that early this morning the group of EPIC consultants, each one armed to the teeth with iPads and wireless mice and Blackberrys was last seen forcing a rag-tag group of hospitalists and CIOs into a windowless, upper floor room of the convention center.  It is rumored that a senior analyst from McKesson was also a member of the terrorist group, albeit in a non-billable role.

CMS has long been suggesting that with the huge shortage of skilled EHR specialists that sooner or later those with the knowledge would rise up and hold the providers hostage.

A spokesperson for the terrorists with a background in CPOE released a list of their demands.  They demand to have their rates tripled, to have an organic smoothie machine placed in the hospital cafeteria, and the right to remain employed even though the EHR will drop productivity by thirty percent.

One terrorist who demanded anonymity stated “I do not know why everyone looks so surprised that their EHR software does not work.  Nobody asked if it would work, they just wanted us to install it.”