Turning Off The Escalator

Anthony Guerra, Editor-in-Chief, hsCIO.com

“Let me go in the back and see if they are ready,” said the owner/operator of my favorite bagel shop. As he journeyed into the kitchen to see if the flagels were done, I knew I had a 50/50 shot at receiving good news.

Jim, the owner, is a young entrepreneur, runs a very nice shop, and is doing well. I’ve chatted with him quite a bit over the last six months and we’ve developed a nice rapport. Though our work is very different, we talk about the challenges of having your name on the door and your hands in the work. Since I show up at the same time every morning, the hit-or-miss flagel availability showed me things were not quite humming along.

Thus, it gave me pause when, on a few occasions, Jim talked about his plans to open a second shop. “Hold on, Jim,” I’d caution. “Why don’t you get this place perfected before you expand? Opening another shop before you’ve got everything streamlined here is dangerous, because you won’t be able to personally get things back on track when they go off — you can’t be in two places at one time.”

When I combined the aforementioned product inconsistencies with the fact that Jim personally runs around to refill the coffee dispensers, restock lid towers, and ring up customers, and that large catering orders completely blow up his operations, I knew expansion was premature.

On both the provider and vendor/consultant side, I’ve talked to those who run the best of the best, and I’ve listened. A few common themes are that they took time to grow, always put people first, and maintained the highest standards — with a real mission to achieve 100 percent client referenceability. It’s easy to see how those three are intertwined.

While some, like Jim, who have the luxury to take their time may not avail themselves of it, others are ordered to take the next hill before the one just occupied is secure. The government — through its escalator dynamic of healthcare IT uptake — is essentially ordering you on tackle its next set of projects before the ones currently initiated have grown the roots they’ll need to survive.

In an off-the-record conversation, one CIO recently described HHS’ never-ending programs as a “layering on” of regulations and requirements that left his team both unempowered and overworked. “Where do we have any room to develop our own physician-affinity strategy?” he asked.

And let’s not forget those most frustrated by projects that lack adequate post-implementation support are the same docs whose affinity hospitals need to survive. While Jim and I have our customers, physicians are yours, meaning your goal must be for every single one to be referenceable. A program of rapid-fire initiatives that leave IT stretched to the brink isn’t one likely to produce such an outcome.

What’s a CIO to do? Where and when you can, slow it down. Work both to ensure your current projects receive the investment they need, and to refine and streamline your existing operations and governance, before taking on new challenges. While a Pyrrhic victory is one in which the costs outweigh the benefits, healthcare IT shops, as a result of government piling on, risk declaring hollow ones. For those to whom results trump checkmarks on a to-do list, the time has come to greet the next incentive program with, “Not now,” the next penalty threat with, “Oh well.” The time has come to turn off the escalator.