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Time Capsule: I’ll Have What He’s Having – Why Hospital Software Selection Is More Lemming than Deming

August 10, 2012 Time Capsule 5 Comments

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 October 2007.

I’ll Have What He’s Having – Why Hospital Software Selection Is More Lemming than Deming
By Mr. HIStalk


It’s a wonder that any hospital IT systems are on the market today. Somebody had to actually start using those systems without the benefit of endless hand-wringing with peer hospitals. How do you like it? Would you buy it again? How’s it ranked? How is the response time, support time, and implementation time? Can we come see it at your place?

Hospitals gripe about lack of vendor innovation, but salespeople can’t wedge a foot in the CIO’s door unless at least 20 hospitals have been live on the system for five years. Half of those customers need to be within 20 percent of the prospect’s bed capacity and one of them should be in the prospect’s state or an adjacent one (geographic disparity must be ruled out). It’s like the collective migration of lemmings – everybody just blindly follows someone else who seems to have a clue.

Hospitals can be like indecisive restaurant patrons who point at someone else’s plate and tell the waiter, “I’ll have what he’s having”. If you develop a cure for cancer, you still may not be able to find a brave first hospital customer. I’m told that this rampant me-tooism is stronger in healthcare than in any other industry and I don’t doubt it a bit. That’s why healthcare IT is both wonderful and aggravating.

Here are some thoughts on why we play follow the leader:

  • Hospital executives always (and sometimes rightfully) feel less competent than their private business counterparts. Therefore, they’re not about to lose one of few local jobs they’re qualified for just because some vendor has a risky product that could provide big benefits. If you can’t get promoted, at least don’t get fired.
  • CIOs are too busy or indifferent to figure out for themselves whether a product is appropriate for their setting. The easiest course of action is to let someone else do the legwork, i.e. buy only those things that someone else bought or that a hopelessly broadly composed committee voted for. There’s mediocrity in numbers.
  • Hospitals are not good at writing contracts that align incentives and hold vendors accountable, so they spend the effort instead buying the lowest risk products, which are usually those with the least potential to pay off big.
  • Nobody wants to build software, even though many (most?) applications on the market started out as a custom development project for one or more hospitals. It’s easier to buy stuff that probably won’t work than it is to get exactly what you want, especially if you don’t really know what you want anyway.
  • The urge to buy something often outweighs urge to do something. Grinding out years of hard process redesign is much less satisfying than throwing a software Hail Mary, one of few chances the IT department has to be decisive.

So, to clarify: hospitals want and expect massive improvement driven by sophisticated software, as long as it doesn’t require messy organizational change, risk, unproven technologies, or executive engagement. If you follow quality guru W. Edwards Deming, you’ll identify one way or another with his statement: “The timid and the fainthearted, and the people that expect quick results, are doomed to disappointment.”

While a conservative position is understandable given how busy everyone is, it does assure that averages aren’t skewed upward by risk-takers who improbably succeed wildly after a gamble on brilliant but unproven information systems.

Einstein defined insanity as “the belief that one can get different results by doing the same thing.” Add “… as every other unsuccessful hospital” to the end of his statement and you will have described hospitals seeking the software silver bullet – more lemming than Deming.

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Currently there are "5 comments" on this Article:

  1. Let’s not talk about the state of clinical software either as a whole. It is amazing how bad clinical software still is, considering it’s 2012. So, add Russian roulette to Lemming or Deming.

  2. The marketplace that HITECH (Hitech?) created is unprecedented in both its opportunity for vendors and its real impact on stifling innovation.

    I fear that we’ll need to wait until HITECH runs its course before there are incentives (for vendors and healh systems) to build and aquire the next generation of usable, interoperable health IT that are really need to improve care.

    In the meantime, Epic will dominate, KLAS will sell lots of reports, and CIOs will choose among a list of a couple of decent (not great!) choices, a few mediocre systems and lots of bad ones.

  3. In my opinion, it’s about leadership, at the middle levels, it’s not there. They have been promoted from operations (nurses), so they are “accountable” to their old nursing units or they are lifelong IT guys who are great technologists but lack the Business savvy.

    It relates back to org chart…examine your bullets.

    1. Messy org chart changes. These are difficult discussions and you need let friends go, retire or move out of the way. CIO’s are scared to do this (in my limited experience, 3 IDN’s and a stand alone).
    2. CIO’s are too busy, correct, so they source the decision to the guys in #1, who want to preserve their place in the org chart.
    3. Not good at writing contracts, correct, the guys in #1 do that poorly as well, they are status quo guys..can’t see the vision, the leap, so they take a step instead.
    4. Building software takes strong leadership and processes, Healthcare IT has neither (I know, generalization), too busy working nursing tickets.
    5. So you buy it.

  4. I think you hit the nail on the head toward the end.

    Improving hospital processes has little to do with the software chosen and a lot to do with true executive and physician led process improvement. The software takes a dollar investment but the true benefits come from real process imrpovement which takes leadership. It may be better to the software (any of them) only as a catalyst to get leadership to step in and drive the improvements.

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