Anthony Guerra, Editor-in-Chief, hsCIO.com
“We’re leaving … now!” said my wife, with my son in her arms and tears in her eyes.
Though I’d been urging her to let him continue with his soccer sessions, I knew it was time to throw in the towel. A few weeks prior, she’d discovered a soccer class at her gym that accepted kids as young as his 2.5 years, and we both thought it would be great fun. While there was no pressure put on him by the “coach,” it turned out the class’s activities and duration were both a little too complex and long for him to handle, leaving him frustrated, tired, and noncompliant. Watching this, she became very embarrassed and upset.
For my part, I offered the usual male, “We don’t raise quitters,” mantra, but little else. After the first few classes, she counter-offered some wiser thoughts, “We don’t want to set him up for failure by putting him into situations he’s not ready for.”
Ironically, the next day we were at an indoor play area with the boys when I got to talking with another father of two. “Yeah,” I said, “I’m hoping to get him potty trained by the time he’s 3, but it’s not looking promising.”
“Three?” the guy laughed, “My older one didn’t get there until he was 5, no matter how I tried to bribe him. Don’t force it,” he said, “You’ll wind up making him afraid of the whole process, and it will take even longer.”
It’s commonly said that any job is easy if you have the right tool; I’ve learned that teaching kids is much easier if you wait until they’re ready to learn. As CIOs, you know that implementation of any clinical system is (relatively) easy if the culture is ripe for the transformation you’re about to initiate. The problem, of course, is that those late to the EHR game (say, February 2009), haven’t had sufficient time to institute the kinds of educational and outreach programs that are the underpinning of cultural change.
We interview CIOs all the time — invariably and naturally it tends to be those closer to of the top of the HIMSS Analytics EMR Adoption curve. They are the savviest of the savvy and work at organizations that were on the march to Meaningful Use before that term was ever coined. More than a few times — as in my soon-to-be-published interview with Montefiore Medical Center VP/CIO Jack Wolf — I’ve heard something akin to the following:
We’ve been at this for a very, very long time. We’re in good shape, but it’s still very complex and intense. I can’t imagine how those late to this game are going to fare.
Most critical in the above passage is the phrase, “at this for a long time,” which equates to the aforementioned cultural transformation. And such transformation cannot be crammed — no matter how enticing the incentive check, no matter how exquisitely refined the vendor’s implementation methodology. Culture, as we all know, eats that stuff for lunch.
The most courageous call today’s CIO can make is to formally recommend that the organization cannot make, and thus should not try, for one of the Meaningful Use stages, for the reason that it simply isn’t able to absorb the kind of change required. Few would argue that it makes sense on all levels — especially a financial one — to forgo the government largess in favor of keeping your operations flowing smoothly.
Some things cannot be rushed, no matter how deeply we want to achieve them. My wife taught me that overaggressive goals aren’t good for anyone. I’m going to take her advice and not set my children up for failure. Consider doing the same.
jbormel says
Nice post, Anthony. I’m seeing the same patterns, at work and at home.
As a vendor, we do our best to deliver the happy meal. Everything you need: nuggets, fries, apple slices, a container of milk, and, of course, a toy. In the case of a MU vendor, that’s software and services, with shrink-wrapped starter sets of content, and terse guidance on transformation. Clients, even those who have already installed other EHRs and are socially well-networked, plan to consume these meals as you might consume fast food.
This year, the early majority, ready-or-not-here-we-come implementation teams are entering hospitals, clinics and small practices with MU-enabled EHRs, hot from the grills and deep friers.
Fortunately, the metaphor does break down to a degree. The discipline to maintain and communicate problems, allergies and medications reliably and electronically is long overdue. The ONC and the collaborative community process leading to the rules were excellent. Not enough people stop to applaud the content of Stage One, and the process.
To your point, there is a speed-of-change; see the classic book, Managing At the Speed of Change, by Daryl R. Conner (http://www.amazon.com/Managing-Speed-Change-Daryl-Conner/dp/0679406840/ref=sr_1_1?ie=UTF8&qid=1332172785&sr=8-1). It typically requires a minimum of three months per phase for awareness, acceptance and execution-based commitment. By those standards, we’re all running late!
As you point out, one big difference is that those we serve, doctors, nurses, service line managers and so forth, didn’t order that meal. They didn’t order any meal. They weren’t even hungry. And, if they were, many adults wouldn’t select the happy meal. The work of transformation is clear. And, you’re right, it cannot be rushed. Of course, that doesn’t open the door to delaying the transformation work!