Your company needs a CFO–Chief Failure Officer

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.

How to survive a business meeting

I probably spend way too much of my time trying to find answers to difficult questions, questions like how gravity works in a vacuum, why people like Celine Dion, and how companies survive without innovating.

Scientists trying to prove the existence of negative energy need look no further than watching the level of effort made by my son as he cleans his room.  Alternatively, they could be a fly on a wall in one of the millions of meetings that take place every day in American businesses in our post-Potter world.  Death by a thousand cuts.

We have all been in those meetings, the ones where you wish they were held outside so you could at least come away from the meeting with a tan.  You are a member of the warm-chair attrition cadre of the value-subtracted reseller for whom you work.  You enter the meeting room, your eyes scan from left to right to find the bagel-therapy and BIY (buy it yourself) cheapuccion—there are none.

You wish silently that this meeting will be the black-swan, a rare and unexpected meeting that proves to be worthy of your time.  The negative energy in the meeting room is palpable.   Most of the time, the only person vested in the outcome of the meeting is the person who called it, the person trying to unload their baggage-malaria.  Everyone else is wondering just how do I occupy an hour of time while still looking attentive?

Aren’t laptops wonderful?  You boot yours, angle the screen so the person next to you cannot see what you are browsing, and all of a sudden your mind is elsewhere—sort of like working from home only without the pajamas—the pajama-hadeen.  If you set it up correctly, the top of the laptop’s screen should be high enough to allow you to make eye contact and wide enough to help you carve out your laptop-zombie space.

If your connection to the internet fails, you become a digital nomad, a WiFi-squatter forced to use your cell phone.  You hope the next hour will not be a repeat of the last pancake meeting—one with a lot of breadth but little depth—but maybe an hour of downtime allowing you to further your hobby.  You are a Palintologist, following her tweets and texting until you are intexticated.

You scan the horsemen of the apocalypse to see if you can determine which are the hot-tubbers, the me-sayers who will co-ruminate, those individuals who want to sit closely to the adorkable meeting savant so as not to miss his wave-a-dead-chicken solution to the problem at hand.

You have employed information triage in the belief that if you pay attention to only the first and last words spoken you will be able to recombobulate ninety percent of the important content.  The meeting-gelincal, with his agenda, laser pointer, and PowerPoint charticles—his meeting-bling—announces the topic.  Translated loosely, it is nothing more than backlog-management, a rehashing the same topic as the last meeting albeit with a different slide deck.  You immediately begin to battle meeting-apnea.

There is a built-in disconfirmation-bias to ensure that the statements from any precariat—someone with little or no job security—attempting to sway belief away from the proletarian confession of faith suffer meet-lashing at the hands of the secret elitists.

The best way to avoid this mess is to skip the next meeting.  When nobody notices, skip another.  Your productivity will increase and your boredom will drop.

 

Certification: Myth or just plain stupid?

EHR certification inspectors will be dropping in on hospitals like UN inspectors looking for WMDs, only they’ll be slightly less congenial.

Why is this a part of the overall plan?  Is this planned failure?  Do they have reason to believe that a certain percentage of EHRs will fail the inspection?

Of course they do.

Permit me to begin with a C-Suite IQ test. Given the choice would you rather have:

  1. A certified EHR that resulted in a productivity loss of 20%
  2. An uncertified EHR that resulted in a productivity gain
If you picked ‘1’ reading further is useless.

Let’s describe two failure types; certification and Full test.  The certification test, by definition, is necessary.  The Full test is both necessary and sufficient.  It is possible to pass certification without passing the Full test.  Therefore, the Full test is a stricter test.  Build out to pass the Full test, and by default, one should pass the Certification test.

What is the full test?  Same as always.  Fully functional, on time, within budget, and user accepted.  Functional, for purposes of this discussion includes updated workflows, change management, and interoperability, and a slew of other deliverables.

Here’s what can be concluded just based on the facts.

Fact:  One-third to two-thirds of EHRs are listed as having failed—this statistic will get smaller over time.

Opinion:  The reason the failure rate will get smaller is that the failure rate will be artificially diluted by a large number of successful small-sized implementations.  Large implementations, those have far-reaching footprints for their outpatient doctors, Rhios, and other interfaces requiring interoperability will continue to fail if their PMO is driving for certification.  (Feel free to add meaningful use to the narrative, it doesn’t change the result.)

Fact:  Most large, complex, expensive IT projects fail—they just do.  This statistic has remained constant for years, and it is higher than the percentage of EHR projects that have failed.  Even a fairly high percentage of those projects which set out to pass the Full test.

Opinion:  Failure rate for large EHR projects—let’s say those above $10,000,000 (if you don’t like that number, pick your own)—as measured by the Full test, will fail at or above the rate for non-EHR IT projects.)

Bleak?  You bet.  Insurmountable?  Doesn’t have to be.

What can you do to improve your chances of success?  Find, hire, invent a killer PMO executive out of whole cloth who knows the EHR Fail Safe Points.  EHR Fail Safe Points?  The points, which if crossed unsuccessfully, place serious doubt about the project’s ability to pass the Full test.  The points which will cause success factors to be redefined, and cause one or more big requirements—time, budget, functionality—to be sacrificed.

This person need not and perhaps should not be the CMIO, the CIO, or an MD.  They need not have a slew of EHR implementation merit badges.  The people who led the Skunk Works had had zero experience managing the types of planes and rockets they built.  They were leaders, they were idea people, they were people who knew how to choose among many alternatives and would not be trapped between two.

The person need not be extremely conversant in the technical or functional intricacies of EMR.  Those skills are needed—in spades—and you need to budget for them.  The person you are looking for must be able to look you in the eye and convince you that they can do this; that they can lead, that these projects are their raison d’etre.  They will ride heard over the requirements, the selection process, the vendors, the users, and the various teams that comprise the PMO.

A certified EHR is all it never was.

What do you think?

Your EHR: Is it Well & Good?

There were four of us, each wearing dark suits and sunglasses, walking uniformly down the street, pausing at a cross-walk labeled “consultants only”—I think it’s a trick because a lot of drivers seem to speed up when they see us. We looked like a bad outtake from the movie Reservoir Dogs. We look like that a lot.

Why do you consult, some ask? It beats sitting home listening to Michael Bolton or practicing my moves for So You Think You Can Dance, I tell them.

Listening to the BBC World News on NPR whilst driving, there’s one thing I always come away with—they, the British, are always so…so British. No matter the subject—war or recession—I feel like I should sit up straight and having a proper pot of tea and little cucumber sandwiches with the crusts removed; no small feat while navigating the road.

Today’s NPR conversation included a little homily about the Gordian knot with which the company Timberland is wrestling, questioning whether as a company Timberland should do well, or do good. (Alexander the Great attempted to untie such a knot, and discovered the knot had no end (sort of like a Möbius strip, a one-sided piece of paper–pictured above. (For the truly obtuse, among which I count myself, the piece of paper can be given a half twist in two directions; clockwise or counter-clockwise, thereby giving it a handedness, making it chiral—when the narrative gets goofy enough, sooner or later the Word dictionary surrenders as it did with chiral.))) I’m done speaking in parentheses.

Should timberland do well or good? Knowing what little command some have of the English language, NPR’s listeners must have wondered, why ask a redundant question. Why indeed? That’s why I love the English, no matter the circumstances they refuse to stoop to speaking American.

Back to Gordo and his knot. That was the point of the knot. One could not have both—sorry for the homonym. Alexander knew that since the knot had no end, the only way to untie it was to cut it. The Gordian knot is often used as a metaphor for an intractable problem, and the solution is called the “Alexandrian solution”.

To the question; Well or good. Good or evil. Are the two choices mutually exclusive? For an EHR? They need not be, no matter how intractable the EHR. The question raised by the BBC was revenue-focused (doing well) versus community or green-focused (doing good). My question to the reader is what happens if we view EHR with this issue as an implication, a la p→q.Let’s review a truth table:

if P equals if Q equals p→q is
define requirements increase revenues

TRUE

play vendor darts increase revenues

FALSE

ignore change management increase revenues

FALSE

no connectivity increase revenues

FALSE

new EHR software increase revenues

FALSE

change processes increase revenues

TRUE

eliminate waste increase revenues

TRUE

decrease redundancy increase revenues

TRUE

Strong PMO increase revenues

TRUE

From a healthcare provider’s perspective the answers can be surprising; EHR can be well and good, or not well and not good.  The Alexandrian solution for EHR is a Alexandrian PMO.

Have your people call my people–we’ll do lunch.

Business Innovation: Hamsters Only Bounce Once

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

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.

A manly dog?

On weekends I put my mind on hold and write things that have nothing to do with business. If it gets either of us to smile it was a good use of my time.

A few years ago when I returned home from a 10k race in DC I discovered my wife had purchased a dog, a Bichon.  That may have been its scientific classification, but it looked a lot more like a feather duster.  She named it Lorenzo, after the name of the dog in the Wizard of Oz—I know that dog was named Toto, but telling her that was not going to correct the situation.  I learned she spent twice as much on the dog as I had on my first car.

I did not object—at least verbally—that her dog was about the size of an underfed gerbil.  We had a family of large turkey vultures living in the woods behind our house, so I often encouraged the dog to play outside and get some exercise.  My thought process was simple; perhaps one of the vultures would mistake the dog for a petit four.

Man-dogs should be big.  Big enough to go on runs, large enough to take up most of the bed, and require the use of a drool cup.  They ought not to be the size where one day you may find them inside the bag of your vacuum cleaner.  To be man’s best friend, they need to be friend-sized.  I do not have any friends the size of a throw-toy.  Lorenzo is sized more like something you would expect to find as the prize that comes with a Happy Meal.

What I did object to was taking the gerbil to Pets Mart for a haircut.  After all, the store was only a few miles from our house, and chances were I might run into someone I knew.  It was not healthy putting Lorenzo on a leash, as the weight of even the smallest leash could dislocate his shoulder.  It would have looked like I was walking a Q-tip, so I carried him into the store.

Face it, I was embarrassed, and concerned someone would see through the disguise I was wearing.  The store was full of manly dogs, most of whom were making fun of me.  A stunning blonde was being led down the dog toy aisle by a Great Dane.  I hid inside an eighty pound bag of puppy chow until she disappeared around a corner.

The dog stylist delivered the newly coiffed Lorenzo to me, pink ribbons affixed to his ears–the dog’s ears, not the stylist’s. I told the dog “either take off the ribbons or walk home.”

Turned out Lorenzo was a pretty good dog.  He died at the age of five.  Whoever created dog-year math was wrong on this one.  My first car, a Corvair, lived longer than that.  It’s not like we found him doing the back-stroke in the fish tank, but he was equally as dead.  It was not easy explain that to three children under the age of ten.  There were plenty of tears to go around, and photos of Lorenzo were taped as a eulogy around our house.  I mounted his collar in a small diorama box and placed it on my wife’s desk.

Well, taking on the role of Super-dad, I went out and adopted what appeared to be Lorenzo’s stem-cell clone.  I let everyone know that this time the dog would get haircuts at home, thereby eliminating the need for me to go skulking around Pets Mart.

The status of my lifetime membership in the He-Men’s club is being reconsidered by the membership committee of the Philadelphia Chapter.  To make matters worse, yesterday my client walked into my office and caught me listening to James Blunt.  I think it is time for me to quash the idea of going out to select new drapes.

10 Things Ever Man Should Know

There remain a few things which separate men from the no-opposable-thumbs crowd, but they are in rapid decline.  These come to mind for me, please feel free to add your favorites.

  1. Fitted sheets.  If they were meant to be folded neatly, there would be instructions printed on the package.  They are folded when you buy them because they popped out of a machine that way; give me the machine and I will fold them.  Otherwise, that is why linen closets have doors.
  2. The reason grocery stores went from using paper bags to plastic is because men do not like to do things more than once—like making repeated trips to the car to carry in the bags.  The volume of a grocery cart is designed to hold an amount of food equal to that which a man can carry from the car in plastic bags in a single trip.  Things laying on the bottom rack of the shopping cart do not count in the trip equation—items like eighty pound bags of dog food, cases of soda, and bulk purchases.  If you are unsure if an item is to be counted against the one trip rule, do not purchase it.
  3. Housekeeping. No cleaning is required of any item whose height is one inch higher than that of your spouse—if it cannot be seen it cannot be dirty.  If the cord of the vacuum cleaner was meant to be coiled it would have a built-in coiler.  Your time would be more productive if you did not waste time coiling and uncoiling, a task with zero value-add.
  4. Standardized tests.  Answering questions with the same letter more than three consecutive times will cause your head to implode.  The days when you could score an 800 on the SAT simply by placing your name on the scoring sheet are over.
  5. There is nothing wrong with arguing, until you get to the point in the argument when you know you are wrong.  That part stinks.
  6. Men will communicate better when Microsoft develops a sarcasm font.
  7. If you don’t hear what someone says, and have to ask them to repeat themselves, that is okay—it is a Mulligan.  You get one Mulligan per conversation.  If at the end of the second telling you still have no idea what was said you are responsible to nod your head and act like you get it—this is what is meant by active listening.
  8. On driving.  If a car is attempting to move into your lane, and the driver is not using their turn signal, you are not obligated to let them in.  If the men in other cars notice this violation, it is permissible for the group of men to align their cars in a ‘moving pick’ formation to block the other car from entering or passing.  If the violating driver begins to signal you by using sign language, you are obligated to maintain the moving pick formation even if it means missing your next several exits.
  9. Friends never let friends wear Speedos.
  10. 10. There is no reason to know how to iron or sew on a button.  That’s why there are stores.

 

Healthcare IT: Musings of a drive-by mind

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.

The relationship of EHR to mobile health

Why not see if we can muddy the waters even further?  Is this a true statement: EHR is to the N-HIN of HIT applications, as wireless health devices and their apps are to the HIEs?

The good news is that in the last two to three years more variety, flexibility, and adaptability have been demonstrated by these mobile devices and their related software applications than has come out of traditional healthcare systems since Mr. Gore built his first lockbox.

The bad news is that in the last two to three years…(ibid).