I wrote weekly editorials for a boutique industry newsletter for several years, anxious for both audience and income. I learned a lot about coming up with ideas for the weekly grind, trying to be simultaneously opinionated and entertaining in a few hundred words, and not sleeping much because I was working all the time. They’re fun to read as a look back at what was important then (and often still important now).
I wrote this piece in September 2006.
The VA Outperforms Private Hospitals in IT Vision and Resolve
By Mr. HIStalk
If you work in a non-government hospital, here’s what your patients are reading in this week’s Time magazine: Veterans Affairs (VA) hospitals are better than yours in satisfaction, quality, and technology. Their costs are going down while yours are skyrocketing. Elderly males treated in the VA system have a 40% less risk of death. You can only hope your ED patients don’t run out screaming to enlist in the military.
The article credits the VA’s advanced and fully-deployed information technologies, but commercial software vendors can’t gloat or take credit. The VA built the VistA system itself. It isn’t slick or technically impressive, but it works.
Like a tailor-made suit, VistA was developed to meet the VA’s needs, not those of a vendor’s “average” hospital customer. Just as hospitals talked themselves into buying instead of building (helped along by vendors and risk-averse CIOs,) the industry’s darling turns out to be a homebrew job.
The article pointed out the obvious: every hospital should match the VA in enterprise-wide longitudinal patient records and bedside bar-coding. Beyond that, though, is the implicit message that technology is a change enabler that requires significant process redesign to accomplish anything meaningful. Everybody hates to hear that because it moves the argument from “expensive” to “impossible in our culture.”
The VA didn’t go out and say, “Hey, let’s replace a couple of old systems with these we saw at HIMSS.” It didn’t hire a superstar CIO loaded with prejudices (positive or negative) formed by time spent elsewhere. It didn’t pander to making the “Most Wired” list. Earlier versions of VistA had been around for years before the VA mandated its full utilization. It took a strong, non-IT leader to drive home the mission to 200,000 employees. Information systems were involved, but it wasn’t an IT department project — not by a long sight.
Patients don’t care what tools you use. They care only about results. If your hospital is a good one, you’re probably already delivering fine care using whatever systems you have.
The bad news is for not-so-great hospitals — your IT checkbook can’t bail you out. Bad chefs don’t get better just by spending more on knives. Obvious, yes, but we seem to keep re-learning those lessons with big IT purchases that turn out to be a giant leap –sideways.
Technology’s failure to deliver isn’t usually a vendor or CIO problem, although it’s easy to make them targets. Once the software is up and running, it’s an organizational challenge, one often unfortunately dumped into the wrong laps. You can buy software as good or better than the VA’s, but your mileage will definitely vary.
Let’s give the VA its due. Against improbable odds, it managed to turn an underperforming government agency into an industry-beater, using a little bit of technology and a lot of vision and resolve. Miraculously, the VA did it while making both its patients and government bureaucrats happy. The VA has definitely raised the now-public bar for the rest of us.