One Thing Companies Don’t Know Could Save Them

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Businesses racing towards impotence

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

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

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

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

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

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

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

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

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

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

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

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

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

Spilling Tea–Why Your Business May Be Failing

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

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

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

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

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

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

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

The most obvious one for most companies is customer care.

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

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

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

 

Poor Project Planning–Musings of a drive-by mind

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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 me to shout “unclean, unclean” as I passed through the hallways.  Maybe that is why I leave newspapers scattered around the floor of my desk, so nobody can sneak up on me without me being able to hear them.

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

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

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

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

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

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

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

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

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

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

A whimsical solution to illegal immigration

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Another week of conventions got me thinking.  What is all this discussion concerning illegal migration and Borders?

Some people want to build a wall; some want to be the wall.  On one end, Mexico, the problem is illegal immigration.  On the other, Canada, the problem that is not being addressed is legal migration.  However, if not for Canada, we would have fewer comedians and television news anchors.

Here’s my take on the matter, an approach I think that has been overlooked.  If the problem is too difficult, reframe the problem to make it easier to solve.  The government defines the problem as one requiring the US to defend five thousand miles of borders.  Their idea—build a wall.  Perhaps we could outsource the solution to the Chinese, have them build The Great Wall, Version 2.0,  turn it into a sight-seeing opportunity, sort of a destination hot spot, and use the tourism dollars to pay back the Chinese.  This way, English-speaking people from around the world could come see the Wall, take in the Grand Canyon, and Hoover Dam, and leave their tourism dollars in the US.

Instead of wrestling with how to defend five thousand miles of border, what if the border was shorter?  How?  Buy Mexico, and bring the troops home from Afghanistan and overthrow Canada.  If we owned Mexico, it solves two problems.  One, the border we would then need to defend becomes just a few hundred miles, Guatemala and Belize.  They could get all the supplies needed for that wall from Home Depot.

Second, why do people from Mexico sneak into the US?  Because they want to come to America.  If we bought Mexico, Mexicans would already be in America, hence, there would be no need to come to America.  I realize this argument is a bit existential, but the argument might work.

Looking north, if Canada became the fifty-first state—of course we would try to force France to take Quebec—the northern border becomes the Arctic Circle.  At that point, the only people we would need to defend against would be the Intuits and Santa Claus.   If we were to get Canada, our petroleum reserves would increase, and we’d be able to purchase prescription medicines for less money. Heh?

Maybe the feds could learn a few things about security from Borders, the bookstore.  The security at their stores far outstrips the security at our borders.

Why Some Firms Plan to Fail: 4 Warning Signs

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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.

Why You Hate Your IT Systems

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Les choses sont contre nous—things are against us.  The usability of your most critical IT system is akin to the marmalade-and-toast hypothesis, will the marmalade-side will land on the carpet when the toast falls from the breakfast plate, played out in bits and bytes.  Resistentialism is the belief that inanimate objects have a natural antipathy towards human beings.  If one were to view the marmalade-toast through the glasses of resistentialism one would conclude that the likelihood of the toast laying marmalade-side down increases with the cost of the carpet. So it is with your critical systems.  For most of us, our expensive IT system is laying marmalade-side down on a very expensive carpet.

Your critical IT system has created an air of technostalgia with users yearning for the bygone days when the technology involved a number two pencil and a pad of paper.  Now that you are using your system, do you ever wonder how different the experience of using it would have been if someone had asked for your input about what the IT system should do before they built it?  Would merely asking have solved the system myopia that was brought about by those who implemented it, implemented it without involving a single systems designer?

That this problem even exists is demonstrated by the fact that to use the system required hours of training.  Users sat there like sock puppets listening to the buzzword-bingo put forth by the trainers.  This should have been the clue that none of what they were about to learn was intuitive or self-evident.  The reason they offer IT system training is to explain “This is how you get the system to do what you need it to do,” because without viewing it that way it will not do anything.  Said differently, training is the byproduct of a system, made necessary by the idiosyncrasies of poor design.

The IT system has turned a lot of normally complacent users into stress puppies.  To understand how far amiss the functioning of the IT system is from what the users had hoped it would be all one has to do is observe it being used.  How many users have apologized to a customer because of something related to the system?  “Sorry this is taking so long…If you will just bear with me while I figure out how to do this…When my supervisor returns I will get her to show me how to schedule your appointment.”

If ever there was a time to have employed defensive pessimism, the implementation of an IT system was such a time.  Users went into the project skeptimistic—simultaneously skeptical and optimistic, hoping for the best and certain it would go badly.  As niche worriers, users imagined all the ways that the system would under deliver and would make their jobs more difficult, and they watched their stress portfolios rise.  The forgotten task is that nobody mapped out a way to avert the damage.

That this jump-the-shark problem can and should be corrected by something not much larger than a two-pizza team—a team small enough that it can be fed by two pizzas—seems to have escaped the reason of many. 

Unfriendly, poorly designed software—in particular poorly designed user interfaces—impacts customers and employees.  Customers have the luxury of not using the system.  They either walk away from your firm or they burden your call center.  Employees have no alternative other than to use it.  To them the impact of bad software is a drop in productivity.

Many firms are guilty of treating the productivity drop brought on by poorly designed software as a problem with no solution.  If a problem has no solution it is not a problem, it is a fact.  And if it is a fact it is not to be solved, but coped with over time.  There is way too much coping going on.

The productivity drop caused by poorly designed user interfaces can be undone.  It will not be undone by redoing the training.  It will be undone by assessing the human factors and user experiences of those using the system, by researching how they users want to use it, and by reconfiguring the user interface.

This is not cheap, but it is much less expensive than the ongoing cost of loss productivity.

What to do when EHR fails

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Watching the Olympic track and field trials motivated me to lace up the shoes and hit the road—thank goodness I had not been watching synchronized swimming.  I had not run in eight months. 

It had been nine-and-a-half years since my heart attack.  My last run, on a seventy-eight degree day concluded with a no expenses paid ride to the ER in the back of an ambulance.  A cardiology nurse just happened to drive by and spotted my formerly athletic physique sprawled on the lawn of an elementary school.  I was trying to remember what it felt like to breathe. 

This Sunday the temperature was one hundred and two—a dry heat, much like a convection oven.  I ran three miles.  I was in so much pain that even my eyebrows hurt.  My “big bang” approach to starting to run again was the wrong way to attack it.  The next day I reverted to how I learned to run in high school; run five minutes, walk five minutes, repeat.  And guess what, it worked.  Did the same thing today over five miles and it felt pretty good.

Often the old way of doing things is the smartest way.  Take your electronic health records system.  Please. 

I was having dinner with all of the hospital CIOs whose EHR had increased their productivity.  After waiting twenty minutes I realized the other person was not going to show.  My guest was to have been the chief medical information officer for a large hospital group.  He told me that after implementing their EHR the group’s productivity had fallen twenty percent but the group was now running ten percent ahead of their pre-EHR productivity.  Probing, I discovered that the group’s thirty percent productivity improvement was achieved by reverting to the old way of doing things, charting at the end of their rounds.

Recently I completed a review of a large hospital to assess the impact of its EHR.  Net-net, its productivity, as measured by the number of patients seen during rounds, two years post implementation, was down thirty-four percent.  The new steady-state.  Imagine having to explain that to your CEO.  Apparently, it does not require much imagination since hundreds of hospitals have seen productivity decreases of between twenty and thirty percent.

Of those hundreds, how many have implemented a plan to regain their lost productivity?  Dozens are redoing the training—you heard it here first—that will do almost nothing to offset the loss.  The training was done correctly the first time. 

Others are throwing out their first EHR in favor of another application—HIT Rule 101 “When everything goes to heck, blame the software.”  The reason this approach has not worked is because while one group of smart individuals is dumping system A in favor of system B, another group of equally smart individuals is dumping system B in favor of system A.

Why is a productivity loss of this magnitude or of any magnitude so important?  Let us return to basics for a second.  Whether the cost of the EHR was fifty million or a hundred million the argument remains the same.  Most hospitals, rightly so, have discarded the idea of trying to argue for a three to five year ROI—it does not exist.  You’ve done the math.

The next question is whether one can argue that the intrinsic benefits of having an EHR can offset having spent millions of dollars on an IT system with no ROI.  Quality of care.  Safety. 

What’s up with that?  If productivity is down by a third—the number of patients seen during rounds—while the quality of care and safety may be up for two-thirds, one can argue it has not gone up for the other third.  Knowing that the other third are still receiving care, the only way for that to happen is to increase staffing.

So, if your hospital spent fifty or a hundred million dollars on its EHR, and has lost productivity, chances are you feel you are stuck with having only two choices to recover from the productivity loss, both of them bad.  You can either go back to the old way of doing things, or you can hire more clinicians.  Neither approach gives you a positive ROI.

There is one strategy that will work, redesigning the User Interface, the EHR screens the clinicians see.  This can be done in such a way so as to make people want to use the system.  Do this and everyone benefits.

EHR–“Our Lady of Perpetual Implementations”

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“There is no use trying,” said Alice;
“one can’t believe impossible things.”
“I dare say you haven’t had much practice,” said the Queen.
“When I was your age, I always did it for half an hour a day.
Why, sometimes I’ve believed as many as
six impossible things before breakfast.”

There are a number of people who would have you believe impossible things.  I dare say some already have.  Such as?

“My EHR is certifiable.”

“They told me it will pass meaningful use.”

“We’re not responsible for Interoperability; that happens at the RHIO.”

“It doesn’t matter what comes out of the reform effort, this EHR will handle it.”

“We don’t have to worry about our workflow, this system has its own.”

Sometimes it’s best not to follow the crowd—scores of like-thinking individuals following the EHR direction they’ve been given by vendors and Washington.  Why did you select that package—because somebody at The Hospital of Perpetual Implementations did?

There is merit in asking, is your organization guilty of drinking the Kool Aid?  Please don’t mistake my purpose in writing.  There are many benefits available to those who implement an EHR.  My point is is that there will be many more benefits to those who select the right system, to those who know what business problems they expect to address, to those who eliminate redundant business functions, and those who implement proper change management controls.

EHR’s 5 stages of grief

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Being a blogger is not too dissimilar to being a failure’s biographer.  Unless you simply repeat the ideas of your contemporaries, good blogging requires a certain avidity to oppugn those who revel in the notion that theirs was the only good idea.  To me, their Sang-froid calmness has all the appeal of a cold omelet.  Good writing requires that you make intellectual enemies across a range of subjects, and that you have the tenacity to hold on to those enemies.  So let us step off Chekhov’s veranda and bid farewell to the sisters of Prozorova.

The Kübler-Ross model, commonly known as the five stages of grief, was first introduced by Elisabeth Kübler-Ross in her 1969 book, On Death and Dying.  I heard a story about this on NPR, and it made me think about other scenarios where these stages might apply.

My first powered form of transport was a green Suzuki 250cc motorcycle.  My girlfriend knitted me a green scarf to match the bike.  One afternoon my mother walked into the family room, saw me, and burst into tears.  When I asked her what was wrong, she told me that one her way home she saw a green motorcycle lying on the road surrounded by police cars and an ambulance—she thought I had crashed.  I asked her why, if she thought that was me lying on the road, she did not stop.

My girlfriend’s mother, didn’t like my motorcycle—nor did she like me.  Hence, my first car; a 1969 Corvair.  Three hundred and fifty dollars.  Bench seats, AM radio.  Maroon—ish.  It reminded me a lot of Fred Flintstone’s car in that in several places one could view the street through the floor.  Twenty miles per gallon of gas, fifty miles per quart of oil.

Buyer’s remorse.  We’ve all had it.  There is a lot of buyer’s remorse going around with EHR, a lot of the five stages of grief.  I see it something like this:

  • Denial—the inability to grasp that you spent a hundred million dollars or more on EHR the wrong EHR, one that will never meet your needs
  • Anger—the EHR sales person received a six-figure bonus, and you got a commemorative coffee mug.  The vendor’s VP of Ruin MY life, took you off his speed dial, unfriended you in Facebook, and has blocked your Tweets. You phone calls to the vendor executive go unanswered, and are returned by a junior sales rep who thinks the issue may be that you need to purchase additional training.
  • Bargaining—when you have to answer to your boss, likely the same person who told you which system to purchase, as to why productivity is below what it was when the physicians charted in crayon.
  • Depression—you come in at least fifteen minutes late, and use the side door, taking the stairs so you won’t see anyone.  You just stare at your desk; but it looks like you are working. You do that for probably another hour after lunch, too. You estimate that in a given week you probably only do about fifteen minutes of real, actual, work. (Borrowed from the movie, Office Space.)
  • Acceptance—the EHR does not work, it will never work, you won’t be around to see it if it ever does.  Your hospital won’t see a nickel of the ARRA money.  You realize the lake house you were building will never be yours, but the mortgage will be.

The five stages of EHR grief.  Where are you in the grieving process?

True, there are a handful of EHR successes.  Not nearly as many as the vendors would have you believe.  More than half of hospital EHR implementations are considered to have failed.

If you are just starting the process, or are knee-deep in vendor apathy you have two options.  You can bring in the A-team, people who know how to run big ugly projects, or you prepare to grieve.

If it was me, I’d be checking Facebook to see if I was still on my vendor’s list of friends.