Work Flows

What should you budget for change management and work flows?

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fruitflyhumor

They came in waves from just over the horizon, each wave approaching from different elevations, and different points on the compass. They were legion; too many to count, too many for which to be able to set a winning defense. We marshaled our forces, knowing we were helpless. As I sat there awaiting the final assault I was reminded of some of the great World War II black and white movies; Midway, Twelve O’clock High, Tora, Tora, Tora. Wave after wave of Japanese and German fighters attacking the apparently helpless US forces.


Our defense perimeter established, we waited and watched. The first wave circled twice above the cellophane covered bowl. Tiny holes were cut into the cellophane allowing the fumes from the apple cider vinegar to waft upwards. The lead fruit-fly banked left and made his assault on the target. He bounced off the cellophane, as did most of the initial flight. One by one, they recovered and made their way through the pin-prick holes. The second and third waves approached the half-covered Tupperware that held the pineapple slices. After several minutes passed we slapped the lid onto the container, trapping scores of them.

“It’s those Concord grapes,” my wife asserted, implicating the helpless grapes.

“Don’t blame the fruit,” I replied. “They’re just fruit.”  Here’s the segue, try to stay with me.

If you’ve ever flown into Chicago’s O’Hare airport you may have witnessed scores of planes stacked in the air space awaiting permission to land.  I recently made reservations for a trip to Chicago. I used Southwest’s web site to make my flight to Midway—they don’t fly into O’Hare but the illustration still works. I’m the type of person who is more suited to using a well-functioning online service to complete my business. Even so, it would not be unusual for me to be having an animated one-way conversation with my computer. I started talking to the website after having to enter the same data time after time. Don’t get me wrong; I got a great deal on the airfare—three tickets for less than I paid for one last time. The site’s design allowed me to book a hotel. I entered data to reserve three rooms to coincide with the dates of my flights. A nanosecond later, I had a confirmation code for one non-refundable, no cancellation allowed room for the night before my plane even went to Chicago. By now I was speaking to my computer in tongues.

Like with the fruit, don’t blame the computer. The software did as it was programmed.  A lot of healthcare providers are going to be amazed by what they do and don’t see from their EHR system.  The system will do exactly what it programmed to do.  That’s great news if your organization’s work flows are an exact match for those built into the code.  We both know they aren’t.  That when it becomes necessary to build work arounds.  Unfortunately, you’re building them to match your work flows to their code.  For those new to the process, you are now designing your organization to move even further away from how it presently runs.  The further away you move, the more you will require change management.  Unless you budgeted correctly months earlier, you have probably already run out of funds for work arounds and change management.  If that’s the case, your EHR system is approaching its do-over point.   For each dollar of IT spend, it probably makes sense to budget at least two dollars for these tasks.  I guess you can budget those dollars for EHR 2.0, but it may be someone else whose running the implementation.

black saint 2

Pay attention to patients even when they’re not at your office.

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human-hamster-wheel-300x300

The wheel’s still turning, but the hamster is dead. One Brady short of a bunch. I like the ocean one because it reminds me of a bit done by the comic Ron White. In the bit he talks about the time he met a woman who was wearing a bathing suit made of sea shells which he held to his ear to find out if he could hear the ocean. Maybe you had to be there.

All day I’ve been operating as though I was one Brady short of a bunch—I actually have cufflinks with Marcia Brady’s picture on them, but we’ll save that for another day. The day’s highlight revolved around my daughter’s doubleheader field hockey matches–third and fourth grade girls. Their opponents looked better, older. In fact, I thought I saw one or two of them drive themselves to the field. Forty-eight degrees, first game at 8 AM. Not enough time to grab breakfast and get to the game on time. I dropped my daughter at the field and headed to a nearby convenience store to buy her a donut. As I pulled into the parking lot I noticed that I needed gas, so I figured why not multi-task it. I inserted the nozzle in the tank, went into the store, purchased a donut, and proceeded to drive away.

For the metrics lovers, those who like order over chaos, those whose desk is always neat, have you discovered my Brady moment? My purpose in going to the store was to buy a donut, not gas. My mind was focused on the donut, not on the gas. Once the donut was resting safely on the passenger’s seat my mission was over, or so I thought. Something was gnawing at me as I pulled away from the pump, something that flared at me in my rearview mirror. I knew what it was a full second before my body got the message to react to it. “Hit the break,” my mind screamed. I could see what remained of the black gas pump hose as it pirouetted helplessly behind my car. I fully expected the entire gas station to be consumed by a giant fireball like the one at the conclusion of the movie Rambo. Once I was convinced that neither I nor–it turns out that neither nor does not violate the rule of using a double negative in a sentence–anyone else in the vicinity was in mortal danger, I exited my car and walked to the pump.

My first reaction, and I don’t know why, was to see if the pump was still charging my credit card. Selfish? That means that subconsciously I had already made the decision to flee, but that I didn’t want to flee if my charge card was still open. I retrieved the severed hose from the ground and inserted it in the pump, thereby closing out the sale on my credit card. I looked around. There wasn’t anyone who had witnessed my little AARP moment. Since they hadn’t, I figured why bother anyone. Kismet; my turn on the hamster wheel.

I’m convinced it’s the little things that determine whether your initiatives succeed or fail. It’s usually nothing tricky, nothing that requires two commas worth of new technology. It’s being focused and being committed to excellence in the menial tasks which comprise each patient interaction, especially those that occur outside of the office. What little things are being overlooked in your practice?  Could social media solve some of these?  In a heartbeat, and for a cost that would surprise you.

Oh, and don’t forget to hang up the hose when you’re done.

black saint 2

Conversations with a Wildebeest

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my neighbors

my neighbors

Today’s narrative follows directly from yesterday’s tale of the wildebeest, so it may be helpful to revisit to prior post.  Suffice it to say that the Neiman’s set wasn’t thrilled to learned I  compared them to our cloven friends.

One rule of the Kalahari is that the pursuer must approach the prey stealthily. Picture if you will a David Attenborough looking and sounding chap, more suitably attired to attend a formal tea than a desert trek, inching towards that same Baobab tree we discussed in a prior narration. Bands of perspiration rim his pith helmet, darkening it. He pats his forehead with a freshly pressed linen handkerchief and returns it to the breast pocket of his Khaki shirt. The wildebeest have moved from the shade of the tree to the nearby watering hole. While some stand guard, he notices that a few at a time quench their thirst. For protection the youngest of the wildebeest ensconce themselves in the middle of the circle. The narrator moves the boom of his microphone towards the herd.

“Did you see the Greatest Looser last night?”  Inquired the group’s leader.

“I TIVO’d it.”

“Can I come over and watch it with you?” asked a third as she quenched her thirst with a half-caf, mocha frappachino iced latte. “I totally spaced.”

The circle of soccer moms seemed to tighten as they saw me approach. “Still blogging?” coyly asked the wildebeest—cum soccer mom–wearing the Lilly Pulitzer capris.

All wildebeest aside, here’s the deal. I want to have a conversation with you. I need your help. Here’s my premise. Somewhere along the way we lost our edge, our hunger for excellence. There was a big push twenty years ago, a lot of attention was paid to the topic, and a lot of people cleaned up writing books and giving seminars. I want your help in understanding what brought about the loss of excellence and what can be done to turn it around. I’d like to learn what you’ve seen and heard. You don’t have to name the organization. I won’t name names, yours or the organization. You can send me a message, a private email, or post it for everyone.

Some ideas for comments include but aren’t limited to:

1. What’s broken
2. Why isn’t it being fixed
3. Where does the breakdown for excellence occur
4. Why patients leave
5. What makes them mad
6. Why do they hate a given provider
7. Do patients think they matter
8. Who has the power to solve the problems
9. Do providers want to be excellent business people
10. Is excellence profitable
11. What 3-5 things can a provider do to get on the right path
Thanks in advance.

How does this impact EHR?  It has everything to do with it.  If you only remember one thing, let it be this: It’s not about the EHR.  The EHR is a vehicle.  It can either be a vehicle for change, or it can be used to hamper change.  All the EHR really does it automate certain things.  It’s easier to automated inefficient and ineffective things than it is to automate efficient and effective things.  Why?  Because the bulk of the work lies in making them efficient and effective.  That’s where the change management and workflow efforts come into play.

My best- Pauleddiesmal