Is your hospital’s strategy like everybody’s?

In high school when my mother thought I needed to come down a peg or two she would call me, “Never Wrong Roemer.”  Today I prefer to go by, “Dr. Knowledge” or “The Voice of Reason.”  You can just call me Paul.

During my senior year of track I competed in the pole vault and I anchored the mile relay.  In the interest of transparency, I think it more appropriate to say I ran the fourth leg of the mile relay—anchoring implies more speed than I actually possessed. On good days, we fielded a mediocre team.

I never enjoyed running the 440.  It is for sprinters, and I am a distance runner.  One day however I unwittingly became a sprinter.  We were in a dual meet against Wilde Lake High School.  As always, the mile relay is the last event.  If we won the relay we would win the meet.

The fourth runner from Wilde Lake received the baton several seconds before me and had me by twenty yards.  I made up the distance between us midway through the first turn.  One inconsequential factor I did not know at the time is that two years later he would be participating in the Olympic trials in the 440.

It turned out not to be so inconsequential.  What happened after I pulled alongside of him remains a bit of a blur; the same kind of blur the Wile E. Coyote saw each time he thought he had caught the Road Runner.  Turns out I had outsmarted myself.  I was caught up in the moment which is nothing like being caught up in the reality of the situation.  I was in a competition I couldn’t win and I did not know it until it was too late.

Business is a lot like that.  Leaders get caught up in the ferocity of what is going on around them.  You’ve seen them; you work with them.  These are the same people who don’t have an opening on their calendar for six weeks, the same people who are busy putting out last month’s fires, who are hurriedly building defenses for whatever may be around the next corner.

Some of those intelligent and well meaning leaders are so focused on catching the runner in front of them that they lose sight of the race, lose sight of their role as leaders.  Some leaders approach healthcare strategy as a series of directionless sprints while others view it as a marathon in a pack of lemmings.  If everyone is running in the same direction, how wrong can their strategy be if they stay with the pack?

I think we will discover in the next several years many of those marathoners will drop out or be disqualified.  They are approaching a poorly marked turn, and if they fail to take it they will be overcome by one or more of a multitude of factors that will eventually lead to their demise.

While it is impossible to disprove a negative, time will tell.  My advice—next time you see a fork in the road, take it.

Then there was the time I asked my mother to drop me off a half mile away from my girlfriend’s house so she would think I ran the full eight miles to come see her.  But, we will leave that story for another time.

saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942
paulroemer@healthcareitstrategy.com

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EHR market share

The link below takes you to a post written by Software Advice’s Chris Thorman regarding the market share for inpatient and outpatient EHRs.  It is designed to be a collaborative piece, and Chris is asking for feedback and correction.  I found it to be a well-written and helpful piece, perhaps you also will.

http://www.softwareadvice.com/articles/medical/ehr-software-market-share-analysis-1051410/

saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942
paulroemer@healthcareitstrategy.com

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Contact me: Google Talk/paulroemer Skype/paulroemer Google Wave/paulroemer

If only doctors were meerly apathetic about EHR

For those who remember the television show M.A.S.H., this brief bit of dialogue was from Henry Blake to Hawkeye after one of Hawkeye’s patients died.

“There’s two rules about war.  Rule 1–in war young men die.  Rule 2–doctors can’t change Rule 1.”

There’s a similar way to apply that logic when it comes to EHR, HIT, and new IT systems.

Rule 1.  If doctors don’t use them, the systems will die.

Rule 2. Simply having an EHR doesn’t change Rule 1.

A survey by Nuance Communications shows that 90% of doctors are concerned about the usability of EHR.  Those results underscore the importance of process and changemanagement and training.

As I wrote previously, it’s not about the EHR, it’s about what you can do with it.

My person struggle with usability–We have a piano in our home even though nobody plays it.  For some reason I’m not permitted to understand, we pay to have it tuned twice a year.

saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942
paulroemer@healthcareitstrategy.com

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Contact me: Google Talk/paulroemer Skype/paulroemer Google Wave/paulroemer

Revising your work flows?

revised work flowAs a parent I’ve learned there are two types of tasks–those my children won’t do the first time I ask them, and those they won’t do no matter how many times I ask them.  Here’s the segue.

Let’s agree for the moment that workflows can be parsed into two groups—Easily Repeatable Processes (ERPs) and Barely Repeatable Processes (BRPs). (I read about this concept online via Sigurd Rinde.)

An example of an ERP industry is manufacturing. Healthcare, in many respects, is a BRP industry. BRPs are characterized by collaborative events, exception handling, ad-hoc activities, extensive loss of information, little knowledge acquired and reused, and untrustworthy processes. They involve unplanned events, knowledge work, and creative work.

ERPs are the easy ones to map, model, and structure. They are perfect for large enterprise software vendors like Oracle and SAP whose products include offerings like ERP, SCM, PLM, SRM, CRM.

How can you tell what type of process you are trying to incorporate in your EHR? Here’s one way. If the person standing next to you at Starbucks could watch you work and accurately describe the process, it’s probably an ERP.

So, why discuss ERP and BRP in the same sentence with EHR? The reason is simple. The taxonomy of most, if not all EHR systems, is that they are designed to support an ERP business model. Healthcare providers are faced with the quintessential square peg in a round hole conundrum; trying to get BRPs into an ERP type system. Since much of the ROI in the EHR comes from being able to redesign the workflows, I think either the “R” will be sacrificed, or the “I” will be much higher than planned.

What do you think?

saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942
paulroemer@healthcareitstrategy.com

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How to improve profitability of the OR

Ever wonder why it is so easy to make fun of everybody else’s business?  We have no problem picking on the phone company, the hardware chain store, and the airlines.  Do you suppose those people do the same thing when it comes to healthcare?

The airlines make it quite easy for us to pick on them.  After all, nobody knows what it costs to fly from Philadelphia to Atlanta on different airlines.  Heck, nobody who works for the airline or even the people on the same flight can tell you what it costs.  There is probably a higher likelihood that you and the person in the seat next to you have the same birthday than there is that you paid the same price to fly to the same place.

How far away is elective healthcare from adopting the airline’s business practices?  In many offices, we already have built-in delays, just like on flights.

I am thinking it would work something like this.  I call the hospital to schedule to have my ACL repaired.

The scheduler asks me when I would like to have the procedure, telling me the possible dates. “If you book it on-line, I can offer you a five percent discount.  Two weeks in advance takes off another ten percent.  There is a ten percent surcharge for Mondays and Wednesdays, and it is twenty percent more if you request a surgeon with more than ten years experience.  Surgeons from Ivy League schools are an additional three percent provided they graduated in the top fifty percent of their class.”

“If you have been cut on by us before, your hospital points may entitle you to free cable television or a fruit cup with your breakfast.”

“You should be aware that this is a very popular operation, so we may over schedule the OR—that means you may be bumped.  However, we also have had a number of no-shows which is why we require payment at the time you book the procedure.  Of course, that is not refundable.  Alternatively, there are other less popular procedures you may wish to consider.”

“Come again?” I asked.

“Something like a face lift, appendectomy.”

“But I don’t need an appendectomy.”

“That is a person problem, Mr. Roemer.  We are not permitted to discuss that with our patients.”

“What will this cost?”

“I can’t tell you.”

“Is this like I can’t tell you or I will have to kill you, or is it, ‘I can’t tell you?’”

“I can’t tell you.”

saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942
paulroemer@healthcareitstrategy.com

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Is your mission statement web site parsley?

What is your organization’s mission, your vision, your goal?  Can you articulate it?  If yes, write it below in the space provided.

Okay.  Why do you have a mission statement?  Is its purpose merely website parsley, or is it actionable?  What does it tell you to do?  Is it something to which all of your employees can contribute?  Can you measure if your actions helped meet the mission?  Does the business strategy result from the mission statement?

Here’s one you probably haven’t thought of.  Let’s say every one of your employees puts your mission statement into action.  Does that improve your organization, or does it bring it to its knees?  Your mission statement either communicates your mission or it does not.  What does it say to your employees, to your customers?  If it does not create a message that makes you unique, fix it or dump it—or say, “We are just like those other guys down the street.”  Just because it communicates, does not make your mission sustainable.

Here are some real examples of hospital mission/vision statements.  Read them and see if you begin to understand why I think the hospital business model is in trouble.  I have not published the name of the hospital, as that is not what is important to this discussion.

Providing exemplary physical, emotional and spiritual care for each of our patients and their families

Balancing the continued commitment to the care of the poor and those most in need with the provision of highly specialized services to a broader community

Building a work environment where each person is valued, respected and has an opportunity for personal and professional growth

Advancing excellence in health services education

Fostering a culture of discovery in all of our activities and supporting exemplary health sciences research

Strengthening our relationships with universities, colleges, other hospitals, agencies and our community

Provide quality health services and facilities for the community, to promote wellness, to relieve suffering, and to restore health as swiftly, safely, and humanely as it can be done, consistent with the best service we can give at the highest value for all concerned

To participate in the creation of healthier lives within the community. * To provide healthcare services in a fiscally responsible manner which contribute to the physical, psychological, social and spiritual well being of the patients and community which it serves. * To provide assistance to the whole person in a Catholic spirit of equality and interfaith serving all regardless of age, color, creed or gender.

We are caring people operating an extraordinary community hospital.

Ensure access to superior quality integrated health care for our community and expand access for underserved populations within the community. Create a supportive team environment for patients, employees, and clinical staff.

Let’s look at some of the million dollar words in the mission statements of some highly regarded hospitals.  Ensure, foster, promote, participate, create.  Comprehensive.  Involved, responsive, collaborate, enable, facilitate, passion, best, unparalleled, .  These statements were written by well paid adults.  These statements are awful.  They are awful because they are fluff—unachievable.  They are well intentioned but meaningless euphemisms.

Here’s my attempt at writing a concise mission statement based on the business models I’ve seen.  We will buy every piece of technology and hire any specialist so we can treat any problem.

Hospital mission statements are very inclusive.  They also seem very similar.  If a perspective patient read your mission statement and read the mission statement of the hospital down the street, could they tell which one is yours?  Probably not.  Who among you has a mission statement which excludes anything?

So, let’s say your board is debating if you should buy the machine in Monty Python’s hospital skit—the machine that goes “Ping.”  Which of the mission’s goals does that support?

How do you make them better?  For starters, make them short. Very.  One writer wrote, “If I had more time, I would have written less.

Southwest Airline’s mission statement—be the low cost carrier.

Dramatic pause.  Something either contributes to the mission or it does not.  Leather seats and free lunches do not.

saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942
paulroemer@healthcareitstrategy.com

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The mathematics of change

“There are three people in the ER. One of them is a physician, one of them is an executive, and one of them is a consultant.  They see a machine unplugged and standing against a wall in the waiting room.  And the physician says, ‘Look, the technology in this hospital is not used.’  And the executive says, ‘No. There are machines in the hospital of which at least one is not used.’ And the consultant stood there in silence knowing neither of them really cared what he thought about the machine.

At least one.  A mathematical term meaning one or more.  It is commonly used in situations where existence can be established but it is not known how to determine the total number of solutions.

How many things can be changed regarding the business of healthcare that would have a positive impact on your business model?  At least one.

saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942
paulroemer@healthcareitstrategy.com

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The Monty Hall hospital business strategy

The Monty Hall problem is named for its similarity to the Let’s Make a Deal television game show hosted by Monty Hall. The problem is stated as follows. Assume that a room is equipped with three doors. Behind two are goats, and behind the third is a shiny new car. You are asked to pick a door, and will win whatever is behind it. Let’s say you pick door 1. Before the door is opened, however, someone who knows what’s behind the doors (Monty Hall) opens one of the other two doors, revealing a goat, and asks you if you wish to change your selection to the third door (i.e., the door which neither you picked nor he opened). The Monty Hall problem is deciding whether you do.

The correct answer is that you do want to switch. If you do not switch, you have the expected 1/3 chance of winning the car, since no matter whether you initially picked the correct door, Monty will show you a door with a goat. But after Monty has eliminated one of the doors for you, you obviously do not improve your chances of winning to better than 1/3 by sticking with your original choice. If you now switch doors, however, there is a 2/3 chance you will win the car.

I think selecting a business strategy along those same lines is at least as productive as whatever business strategy your organization has chosen.  Let us assert that behind two of the doors are bad strategies, and behind a 3rd door is a winning strategy.  Your current strategy is behind whichever door you select.  On your behalf, I reveal to you what is behind one of the two remaining doors—a strategy destined to fail.

The question becomes, do you stick with the strategy you’ve selected knowing that you have a 1/3 chance of it being a winning strategy, or do you switch your choice to the strategy behind the door not chosen, knowing with certainty that doing so improves your chances of being correct to one in two?

Most people, like most businesses, stick with their original choice.  Change is difficult.

saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942
paulroemer@healthcareitstrategy.com

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Why business strategies are so rigid

From mathematics–In a Nash equilibrium, no player has an incentive to deviate from the strategy chosen, since no player can choose a better strategy given the choices of the other players.

My rewording of the corollary, “No employee who disagrees with the corporate strategy remains an employee.”

saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942
paulroemer@healthcareitstrategy.com

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Can HIT solve the healthcare cost problem?

The following is my new post in HealthsystemCIO.com http://ow.ly/1JLmO

What do you think about the idea?

saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942
paulroemer@healthcareitstrategy.com

My profiles: LinkedInWordPressTwitterMeetupBlog RSS
Contact me: Google Talk/paulroemer Skype/paulroemer Google Wave/paulroemer