I recently finished reading “Checklist Manifesto” by Atul Gawande and “How Doctor’s Think” by Jerome Groopman. I would highly recommend them to anyone in Healthcare IT. Because each book touches on how doctors contemplate change, it got me thinking about how physicians may be thinking about all of the upcoming changes in Health IT. While more physicians are accepting of Health IT as time goes on, I still run into physicians who are very hesitant to move to electronic orders and progress notes. I wondered if there was something that would elicit a similar hesitancy for me.
What if someone asked me to significantly change the way I worked on a daily basis, yet expected me to be as productive, or more productive. What if someone asked me to change the way I dealt with my task list – something that I’ve standardized over the course of the last 10 years.
“Wait a minute Huffman – are you comparing your task list with CPOE and electronic Progress Notes” you may be asking? Not really; I’m trying to get a better understanding of what a physician might be thinking when I ask them to change what they have done for years, to a new way of doing it, even if they don’t believe it will be an improvement. Stay with me for a minute…..
People are very passionate about their task lists. If you ask someone how they track their daily tasks you will get a varied response, some paper, some electronic. Some use systems like “Getting Things Done” by David Allen or “Seven Habits” by Stephen Covey. Some keep their tasks in applications like Google Calendar, Remember the Milk, Outlook or Omnifocus. There are hundreds of applications and dozens of iPhone apps to manage your tasks.
I’ve used the same methodology for tracking my daily tasks for the last 10 years – a standard composition notebook and a pen. I use the same system to track which items are done and which items I need to follow up on. I pride myself in rarely loosing track of an issue or task. I can pull one of my old composition notebooks out from 5 years ago, review it, and get the essence of what was going on that day or week. There is emotion on the page – it isn’t just “12 point Times New Roman” staring back at me. (sound familiar?)
I have had numerous conversations with team members about my “system” and why I use it. While I have tried suggested improvements and different systems they never seem to stick and I move back to a notebook and pen. I’m convinced, for me, that the mighty pen and paper work the best! (again a familiar argument).
The next time I’m struggling with a physician conversation about “change” I can now compare that to someone asking me to forever change how I deal with my task list…..and I’m staying on paper…..unless someone wants to pay me $44,000 over five years to go electronic.
Seek First to Understand, Then to Be Understood. Stephen Covey
Anthony Guerra says
What a great post Steve!
I try and do what you are doing — imagine this stuff from the vantage of the physician. These individuals have gone to school for a dozen or more years to be experts in a craft that is uber-highly specialized. Most of them are also independent businessmen who want to run successful practices that show growth and ever-widening margins between expenses and revenues.
The people who get most frustrated with physicians are those who seem to think that doctors operate not-for-profit entities. They do not. Interestingly, they operate for-profit businesses that do much of their revenue generating in not-for-profit facilities (hospitals).
It’s a fascinating paradigm, and one not changing in the foreseeable future — certainly not since Massachusetts went Republican.
Paul Roemer says
Well written Steve. I think part of what is being missed by Washington is that in their effort to mandate providers move to facilitate a nationalized healthcare model; they have overlooked a few things. For starters, I think the EHR discussion has shrouded the fact that EHR is voluntary. Unfortunately, very few providers look at EHR as a decision they should evaluate—do I or do I not do EHR. Instead, they eschew that question, and view the need to do EHR as a decision that was made for them.
• Two business models are in play, a national model and the one used by providers. In the end game, even though it is only mentioned in the privacy of their own policy rooms—and not streamed on CSPAN—the national model is ultimately being designed to connect every doctor to every patient—one big hospital under thousands of roofs. The other model is the provider’s singular business model. It’s a patient-centric model (the healthcare business) and a business model (the business of healthcare). The two models have different goals and different requirements.
• If the model Washington is pushing were attractive, providers would be knocking one another down tying to be first in line to implement it. Clearly, that is not happening. Instead, Washington is offering billions in rebates, and there are still few takers.
• There is no viable plan on how to get from here to there—none, nada, zip. Instead of a coherent plan coming from them, they have put the monkey on the back of the providers, guiding them with carrots and sticks. Washington launched this idea without a much of a plan, and after the fact saddled the providers with three innocuous stages of rules—two of which remain undefined. They have yet to convince providers that they have a way to make sense out of having 400 different EHR vendors, no set of standards, hundreds of unique HIEs—I know you can’t have hundreds of anything and label it as unique—which bespeaks–the problem–and realistically expect it to work.
Why change your business rules and work flows to try to meet a plan that has stability of having been drafted on an Etch-A-Sketch? There are plenty of valid business reasons to evaluate changing the way providers work. There are huge potential gains in safety, care, efficiency, and effectiveness. These gains vary by organization. They vary based on the unique requirements of each organization. Properly planned and implemented, and EHR program with change management on workflow improvement can facilitate taking the business of healthcare from an 0.2 model to a 2.0 model.
Done poorly, and EHR will prove to be nothing more than a multi-million dollar scanner.
That being the case, you may want to use Steve’s methodology and ask him where you can go to buy a supply of the Composition books he uses.