It’s interesting to hear the Kaiser experience, I was in training classes in Madison with several Kaiser folks in 2004.

The key to success is training, leadership champions, and operations middle managers willing to take the EPIC IT implementation team by the horns and make them move (with care and empathy of course).

Not only do operations have to learn the tool, but the EPIC team has to listen to operations so that configuration tweaks can be made for the most efficient work flow.

1. We are Stanford, we are all smart, and we know more than anyone else so what we tell you is what will be done. I am paraphrasing but you get the picture.

2. You must include anyone who wants to participate in the IT decisions made for the faculty. Even if the faculty can’t take time to participate you must be ready to make massive changes so that all the staff can be “behind” the system. The key work is behind like – I am behind you and going to push you into the dark void. They are three for three on this one. One roll out of a very simple system took 2 years because half way through they a new doctor joined the project and demanded new functionality or he wouldn’t use it. On another project they got what they wanted and when it didn’t work they all claimed it wasn’t what they wanted. Fortunately the vendor was smart enough to keep good records.

3. If our dysfunctional behavior causes a delay in the project it is not our fault. We are the customer and you are the vendor. That means we are right and you are wrong (see rule #1).

This behavior has spread throughout the various departments and the staff in these departments see every new project as another long implementation that won’t happen on time, will be re engineered by “key” people and so they don’t really bother paying attention to what is going on. I feel for these people.

IT is probably hit the worse. They often didn’t show up for meetings preferring to wait until the 5 committee members and 20 associate members and… to figure out what they wanted and THEN they would come to the meeting to see what kind of hell had been created or them.

They do some amazing work at Stanford. I have a close friend who had a daughter born with a serious heart defect and had it not been for the high quality and very professional care provided by Stanford physicians and nurses she would not have made it. My gratitude to them simply could not be expressed in words.

However, and I say this with a lot of love — stick to the knitting. You aren’t good IT guys.

The entire management team at Stanford has made some very interesting decisions. The merger, creating the reference laboratory (which was then sold) the many, many changes in billing systems that drove AR through the roof…

Everyone vendor wants to be able to point to some large well respected medical center and say that their software was developed with that medical center so many of them (especially the ones that haven’t really had a lot of experience) think that Stanford will give them a boost. Not so.

One last comment. It used to be that Kaiser was considered a vendor killer. Getting a Kaiser contract put you in the big leagues but almost always ended up with a horrid mess. North and South couldn’t agree about anything. It was so bad that Kaiser actually hired some consultants to come in and train them on how to be a good customer and not kill the help. Sitting in on a couple of those sessions was interesting.

Now I tell my clients to watch out for large academic medical centers. They have a lot going on and for every clinicians on staff they will have 5 different opinions.