Inside Healthcare Computing has graciously agreed to make previous Mr. HIStalk editorials available from its newsletter as a weekly “Best Of” series for HIStalk. This editorial originally appeared in the newsletter in February 2007. Inside Healthcare Computing subscribers receive a new editorial every week in their Electronic Update.
Punxsutawney Phil aside, you know spring is at hand when it’s time for HIMSS (already?) For those of us who go, it seems like the entire healthcare IT industry is there, most of them angrily checking their watches in the Starbuck’s line or barking self-important cell phone commands to their holding-down-the-fort underlings back home.
If you’re not going, don’t feel bad. It’s a great time to get work done without being interrupted, much like the dead week between Christmas and New Year’s. Or, if your boss will be there and you’re so inclined, to screw off with little fear of detection.
Everyone heads for HIMSS with a firm agenda, pledging this year to get serious work done instead of wasting time like at the previous ten conferences. Demos will be dutifully studied, job-related networking will be pursued, and vendor relationships will be cultivated for the benefit of the employer picking up the tab. You’re here to work. Or, so the rationalizing goes.
All those worthy goals evaporate once the first heady breath of conference air is inhaled deeply, that energizing tang of carpet cleaner, coffee, collateral, and cologne that puts you in conference mode. Like a recovering alcoholic vowing to take just one sip of beer, you’re off the wagon. Before you know it, your agenda looks more like this:
- Plan shopping, golf, or spa time from the tourist literature left in your hotel room.
- Find someone before or during the opening reception who might give you a drink ticket they don’t need.
- Walk the halls trolling for people you know, encouraging a hearty greeting and keen interest about what you’ve been up to, then silently cursing the arrogant jerks when they pass by with a vacant stare.
- Look soulfully into the eyes of vendor booth people and speak profoundly and positively about whatever they’re selling, hoping they’ll dig deep under the counter to furtively slip you an invitation to a really cool party that’s not open to the masses.
- Expect profuse chumminess from booth people who pretend to remember you and harbor no ill will from that time you cut their product from the shortlist.
- Decide just how much honesty everyone else applies when completing their CE forms, figuring that walking outside an auditorium door and catching a couple of words should be worth the full CE credit.
- Blame the speaker’s boring delivery when you decide to bag their talk 15 minutes in, climbing fearlessly over the entire row of knees, in front of the projector, and against the tide of incomers and door-standers, figuring no one knows you anyway.
- Check the agenda and decide to sleep in, leave the afternoon sessions early, and maybe sit out in the sun at lunch.
- Thrust your chest out proudly, knowing that booth people will pretend to be impressed with your title, your employer, and your town, even though they are silently sniggering at all three and looking over your shoulder for a better prospect or an incognito competitor who might hire them.
- Cruise the perimeter of the larger booths, trying to catch the eye of someone who looks like a doctor, executive, or hot rep, steering a wide berth around low-ranking losers who earned a HIMSS trip for some geeky company accomplishment like programming.
- Gather lots of vendor material for take-home study, then chuck it all in your room’s trash can before you leave for the airport.
- Having already planned to skip the Thursday sessions since everyone else does, call the airline on Wednesday afternoon to see if you can get out earlier.
- Wear your Mardi Gras beads home, bring your kids crappy booth junk, and impress the spouse with fake doubloons and a box of Café Du Monde beignet mix purchased at the airport.
Have a safe trip to New Orleans.
This editorial is copyright-protected by Algonquin Professional Publishing, LLC., publishers of Inside Healthcare Computing. Please do not copy, forward, or reproduce this material without prior permission. To obtain permission or for more information about Inside Healthcare Computing’s reprint policy, please contact the Customer Service Department at 877-690-1871 or go to http://insidehealth.com/ihcwebsite/reprints.html.
Mr. HIStalk’s editorials appear each Thursday morning in the subscribers-only version of Inside Healthcare Computing’s E-News Update. To subscribe, please go to: https://insidehealth.com/ihcwebsite/subscribe.html or call 877-690-1871.
Inside Healthcare Computing has graciously agreed to make previous Mr. HIStalk editorials available from its newsletter as a weekly “Best Of” series for HIStalk. This editorial originally appeared in the newsletter in June 2006. Inside Healthcare Computing subscribers receive a new editorial every week in their Electronic Update.
Hospitals realized several years ago that medication errors are rarely the simple screw-up of a single nurse, pharmacist, or physician. They occur because an organizational system of assumptions, processes, and communication fails, the so-called “Swiss cheese effect” whereby a number of usually self-correcting practices sometime line up unfavorably like the holes in Swiss cheese. That alignment of individually unusual circumstances causes errors.
Knowing that’s the case, it doesn’t make sense to fire someone involved in a medication error. The underlying system is still broken. Disciplinary action also discourages others from reporting their own mistakes and near-misses, thereby depriving the organization and industry of the opportunity to learn from them.
Maybe we should think that way in hospital IT. We’re still stuck in the old “fire everyone involved” mindset when projects fail, which is disturbingly often. Software implementation is simply business change with a technology component. Therefore, when a project deviates from expectations, it doesn’t make sense to have a knee-jerk firing of the IT project manager, the CIO, or even the vendor. Supporting cast changes won’t improve the flawed underlying system that allowed them to fail.
A non-punitive IT culture would acknowledge that all executives, not just those in IT, bear responsibility for the success of business changes involving technology. It’s their job to support process change, contribute resources, and participate in project decisions. The kickoff meeting doesn’t happen until they’re on board and they don’t get to go incognito when the project blows up and the CIO lynch party is being formed.
Some of the worst CIO and vendor behavior involves rationalization and ass-covering once projects have failed spectacularly, much like the nurse who kills a patient through a mistake not entirely under his or her control. We’ve built incentives for people to keep quiet, to dodge blame, to avoid risk, and to criticize others. Eventually everyone gets tired of the finger-pointing, so the only remaining task is to ban mention of the project in polite conversation, at least until the same mistakes doom the next one.
When it comes to IT projects, hospitals are more like surgeons than internists. Cutting is the cure: the vendor, employee, or consultant must be removed and publicly blamed to provide closure. Everyone must believe that lessons have been learned and the chances for future success increased. To admit otherwise would require a lot more self-analysis and work, and after all, Men of Action believe in their keen ability to simplify complex problems and fix them with quick, skilled incisions.
We make a lot of mistakes, many of them eminently preventable if we could just learn collectively. Most of them are quietly buried away, often taking a few careers or contracts with them.
Hospitals are mostly non-profit and non-competitive. Maybe we could improve our odds of IT success by sharing our misses and near-misses just like we do for medication errors.
This editorial is copyright-protected by Algonquin Professional Publishing, LLC., publishers of Inside Healthcare Computing. Please do not copy, forward, or reproduce this material without prior permission. To obtain permission or for more information about Inside Healthcare Computing’s reprint policy, please contact the Customer Service Department at 877-690-1871 or go to http://insidehealth.com/ihcwebsite/reprints.html.
Mr. HIStalk’s editorials appear each Thursday morning in the subscribers-only version of Inside Healthcare Computing’s E-News Update. To subscribe, please go to: https://insidehealth.com/ihcwebsite/subscribe.html or call 877-690-1871.
Inside Healthcare Computing has graciously agreed to make previous Mr. HIStalk editorials available from its newsletter as a weekly “Best Of” series for HIStalk. This editorial originally appeared in the newsletter in November 2006. Inside Healthcare Computing subscribers receive a new editorial every week in their Electronic Update.
I didn’t even know Charlie McCall was on trial. The former HBOC chairman was acquitted of one securities fraud charge last week and got a mistrial on six more as a lone juror’s holdout deadlocked the jury. I feel deprived that I missed a blow-by-blow report of his being grilled and then left to await his fate.
Federal prosecutors had worked their way up through the HBOC food chain over the years, leading everyone to speculate: wonder when they’ll get Charlie?
In case you’re a newbie, HBO and Company was the pre-Enron corporate malfeasance poster child, a prodromal symptom of dot-coms in waiting that used its optimistically valued stock to buy everything in its path. The frenzied transacting caught the attention of drug wholesaler McKesson like the mating dance of a spider, which paid a mind-boggling $14 billion for the company in January 1999.
Industry long-timers chuckling knowingly, having watched similar companies take it in the shorts for the same expensive, ill-advised healthcare IT dabbling. Investors scratched their heads after running their calculators and finding no possible way that HBOC was worth that kind of money. The general consensus of all interested parties: what the hell was McKesson thinking? Three months later, McKesson’s stock tanked on charges of book-cooking by Charlie’s crowd. Shareholders lost $9 billion of value in a single day, thereby forcefully proving the true value of HBOC.
McKesson’s executives were perhaps the only people on the planet who weren’t suspicious about the Atlanta high-flyers. Everyone was swapping insider stories. I sent two anecdotes to a healthcare IT publication in 1998 (who missed out on the scoop of the century by ignoring them.) First: I’d heard from an HBOC employee that he was ordered to mail out empty tape boxes to customers for not-ready enhancements so revenue could be recognized anyway. Second: programmers were griping about the HBOC revenue quotas each was assigned (!) since all the Y2K remediation revenue had already been booked by late 1998, leaving the programmers to scramble for new bookings while doing the already-committed work. Recognizing revenue on the basis of a shipping receipt? Oh, my.
You know how it ended. HBOC’s brass were indicted, McKesson’s were fired. Charlie went off sailing (so the story goes.) The reeling McKesson lost many employees, came up with strange ideas like co-CEOs, jumped on the dot-com era right as it imploded (taking with it hastily conceived names like i-this and e-that), and retired the stench-ridden Pathways name. Throw in the nearly $1 billion they eventually paid to settle shareholder lawsuits and the grand total for those few weeks of consensual coupling is $10 billion. What they got for their trouble was a mongrel pack of products that Charlie had hastily snapped up without having any real plan except to keep the printing presses running off stock certificates.
Among those involved were certainly some crooks and some fools, but let’s not forget those who suffered most, those McKesson lifers who had stashed away years’ worth of shares of their unexciting company’s stock instead of risking it on flaky enterprises like Microsoft and Dell. When lonely old conservative widower Dad McKesson brought home a sexy young step-mom named HBOC, she stole the kids’ piggybank. The stock went from the mid-80s to the mid-teens. People I knew glumly tried to estimate how many more years they’d have to work until retirement, with 80% of their investments gone. Even today, after eight years and with good company management, McKesson’s stock has recovered only by about half.
Only the jury can decide whether Charlie McCall and his associates are guilty or innocent, but I can say one thing: if they are found guilty, then I hope the pain they receive is commensurate with the pain they caused.
This editorial is copyright-protected by Algonquin Professional Publishing, LLC., publishers of Inside Healthcare Computing. Please do not copy, forward, or reproduce this material without prior permission. To obtain permission or for more information about Inside Healthcare Computing’s reprint policy, please contact the Customer Service Department at 877-690-1871 or go to http://insidehealth.com/ihcwebsite/reprints.html.
Mr. HIStalk’s editorials appear each Thursday morning in the subscribers-only version of Inside Healthcare Computing’s E-News Update. To subscribe, please go to: https://insidehealth.com/ihcwebsite/subscribe.html or call 877-690-1871.
Inside Healthcare Computing has graciously agreed to make previous Mr. HIStalk editorials available from its newsletter as a weekly “Best Of” series for HIStalk. This editorial originally appeared in the newsletter in October 2006. Inside Healthcare Computing subscribers receive a new editorial every week in their Electronic Update.
I doubt most Misys Healthcare customers are following the company’s corporate drama as it plays out in England. They want to go private. Wait – no, they just want to sell it to someone! The CEO will lead a takeover group. Hold on, he just resigned! Their board chair is optimistic about their prospects. Shhh … did I just hear him say the company’s software was old and non-competitive?
Healthcare makes up about a third of the Misys portfolio. Within that, the lineup is a salad bar of old, mixed-heritage applications from Per-Se, Medic, Amicore, Payerpath, and Sunquest. Sometimes the blended family gets along, but often they don’t (and I’m speaking both technically and culturally.) If you know of any healthcare IT conglomerates where any of the above isn’t true, that makes one of us.
Why did a British financial software company get into the US healthcare IT market in the first place? Well, let’s just say it wasn’t a noble desire to better humankind. From their website, “The main objectives were to reduce the Group’s exposure to a single market (insurance) and to increase its size in an already consolidating software sector.” That’s about as passionless as an accountant’s nimble calculator fingers determining the net present value of three dinners with Myra the secretary vs. the potential payout.
With just two software sectors, Misys is focused, at least compared to bigger conglomerates that dip 1% of their corporate body (a toe) into the healthcare waters. Since Misys is the only company actively considering deconstructing healthcare IT out of the soup, what can we learn?
- The best way to make money as a conglomerate is to break it up into parts that are usually worth more than the whole and are more affordable to prospective bidders.
- Conglomerates often reduce corporate value unless they can harness some elusive benefit in supply chain management, reproducible management excellence, or marketing.
- Conglomerates are fine until you want to sell to someone else who doesn’t share your love for some of the corporate children.
- Product investment matters more than that impressive brand name. You may be getting free milk every day, but at some point, you better start saving up for a new cow.
- In most cases, button-down corporate management saps out the innovation that made formerly independent companies interesting and successful in the first place.
- Healthcare IT divisions of big companies live and die by the quarterly (or twice-yearly) numbers. Ambitious division executives will sell their souls to avoid being called out as company laggards among their peers.
- Healthcare IT customers carry little weight with toe-dippers. Are GE brass more worried about the flat-lining former CareCast or sagging toaster sales at Wal-Mart? Does patient safety come up in Siemens corporate meetings as often as power generators?
Just about every outcome suggests that Misys Healthcare will be carved off and sold. If you’re a foot soldier, hang in there at least long enough to see if the change benefits you. If you’re a suit, well, Misys publicly labeled its healthcare unit as underperforming, which isn’t a highly valued resume bullet for the new owners. If you’re a customer, anything or nothing could happen, but you’re stuck either way. If you’re a prospect, there’s a lot of uncertainty ahead, so act accordingly. And if you’re a vendor focused only on healthcare IT, especially if you’ve resisted the urge to cash out by going public, I say thank you.
This editorial is copyright-protected by Algonquin Professional Publishing, LLC., publishers of Inside Healthcare Computing. Please do not copy, forward, or reproduce this material without prior permission. To obtain permission or for more information about Inside Healthcare Computing’s reprint policy, please contact the Customer Service Department at 877-690-1871 or go to http://insidehealth.com/ihcwebsite/reprints.html.
Mr. HIStalk’s editorials appear each Thursday morning in the subscribers-only version of Inside Healthcare Computing’s E-News Update. To subscribe, please go to: https://insidehealth.com/ihcwebsite/subscribe.html or call 877-690-1871.
