True Collaboration Can’t Exist Without Trust

Anthony Guerra, Editor-in-Chief,

Anthony Guerra, Editor-in-Chief,

“So how did the press conference go?” I asked Kate, referring to the CommonWell Health Alliance announcement, a collaborative of Cerner, McKesson, Allscripts, athenahealth, Greenway and RelayHealth. “Anything big?”

“Not really,” she replied. “It was basically an announcement that they were going to have some kind of collaboration about integration, but it was really fuzzy, and I don’t even think they plan to get things off the ground for a while.”

“It’s more interesting for who’s not in than who is,” I remarked, assuming some of the elephants not in that room had declined to participate.

“Absolutely,” she said.

Fast forward to that evening when Nancy and I had stopped by one of Encore Health Resources Pub Night get-togethers.

“So what’d you think of that alliance announcement today?” asked Epic President Carl Dvorak.

“Well, it doesn’t sound like there’s much there yet,” I replied. “Why didn’t you guys join?”

“We weren’t asked,” he said. “And we didn’t even hear the specifics on it until the press conference.”

“Come on,” I said incredulously. “You’re kidding.”

“Nope,” he replied.

And so it was that the “big” story at HIMSS continued to move in the opposite direction from that which the organizing entities had intended. Rather than being about inclusion, interoperability and collaboration, we are now talking about the divisions which separate the main acute/inpatient HIT vendors — divisions which have been exacerbated by the maladroit handling of the inchoate CommonWell Heath Alliance.

When one peels back the onion, the immediate pre-HIMSS flurry of activity around the alliance seems like a halfhearted attempt to rectify glaring, yet just-noticed, gaps in a soirée guest list. And since late invitations carry with them a lack of sincerity, it’s no shock recipients were left wanting. Huge companies, of course, might need more than 48 hours (most them on the weekend) to make such a decision. Thus, a key ingredient for true collaboration —trust — had been undermined from the start.

And trust, according to Stephen M. R. Covey — who spoke at the CHIME Spring Forum in New Orleans on the day before CommonWell made its announcement — is critical to any organization, let alone a “collaborative.” Without trust, he said, everything takes longer, as everything has to be checked and rechecked (the “trust tax”). Perhaps if there was more trust between the entities before the last-minute and post-announcement invitations, everything could have been taken with a grain of salt, but the dearth existed, and so the unfortunate orchestration has only served to drain a bit more water out of that pool.

The bottom line is that, if the oversights (here I give the benefit of the doubt) were caught in an “oops” moment, someone should have pulled the plug on the press conference and reset the process. Sure, this might have meant a few lost dollars and a bit of egg on some faces, but CEOs get paid to make these tough calls. In fact, Steve Jobs felt this was one characteristic that separated great companies from the rest of the pack.

In October 2000, after Apple had finalized the design of its new retail stores — a process that included building out a full prototype — the executive who’d been handling the project had an “oops” moment when he realized they’d gotten the layout all wrong. He delivered the news to Jobs, who was furious at the implications to his plans. But after a few minutes of reflection, Jobs calmed down, realized the executive was right and determined, then and there, to stop everything and start from scratch. “We’ve only got one chance to get it right,” he said.

From Steve Jobs, by Walter Isaacson: “Jobs liked to tell the story — and he did so to his team that day — about how everything that he had done correctly had required a moment when he hit the rewind button. In each case he had to rework something that he discovered was not perfect. He talked about doing it on Toy Story, when the character of Woody had evolved into being a jerk, and on a couple of occasions with the original Macintosh. ‘If something isn’t right, you can’t just ignore it and say you’ll fix it later,’ he said. ‘That’s what other companies do.’”

Who knows, the CommonWell Health Alliance may turn out to be something after all, but it will never be what it could have been, as quickly as it could have been, because some key players weren’t invited in the manner they should have been. And because of that, unfortunately, it will never move at what Covey described as the speed of trust.


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