Time Capsule: The Incentive Misalignment Between IT Leaders and IT Projects: Why CIOs Set Unreasonable Expectations
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.
A recent Canadian report provides a good overview of the how clinical information systems are (or more precisely, aren’t) improving patient safety. As simple as it sounds, one recommendation struck me as being profound: “Expectations for EHRs and patient safety must be realistic.”
Why that’s interesting: big clinical system projects would never get done unless the CIO takes an internal salesperson role, not much different than the salesperson who sold the hospital on the (unrealistic) system benefits in the first place. In other words, CIOs have to set false hopes to get projects going. If users knew what was coming, they’d opt out.
Users (played by Tom Cruise): “I want the truth.”
CIO (played by Jack Nicholson): “You can’t handle the truth!”
Maybe that’s why system users become disillusioned, vendors feel customer heat, and CIOs get fired. Everybody has an incentive to overstate the likely benefits, right down to the point where those benefits don’t materialize. Then, let the finger-pointing begin.
Systems have gaps of various sizes between what customers expect and what they actually get in the form of real, working software that they’ll use optimally. How big the gap is depends on two things: (a) the product, and (b) the customer. The money’s been spent, though, and the higher powers want to see the results that everyone agreed to in that innocent, long-ago moment of pre-purchase euphoria.
The result: disappointments and delays must be glossed over. IT types huddle behind closed doors with the same fervor as vendor marketing departments, carefully crafting the message, singling out project friends and enemies, and enlisting shills to vouch for inevitable wonderfulness of it all. The IT department knows the ugly underbelly of what’s ahead, but a grin-frozen face must be presented so users won’t panic. IT and its users have become uneasy enemies.
Beyond even that irrational exuberance, CIOs are sometimes create further damage. They push automation as a great way to implement organizational change because that’s what IT cheerleaders are supposed to do. They override popular voting for which system to buy. They overestimate the capabilities of their own stretched department to implement and support new applications. And worst of all, they sometimes unwisely let themselves be cast as project champion or owner.
You don’t want to own something you can’t control. You’ll be constantly begging everybody else to donate their resources to what has suddenly become your project. Executive supporters suddenly can’t spare their own folks to get it done. Before you know it, it’s CIO Giant Sucking Sound 2.0.
Hospital operational executives can’t control clinicians day to day. It’s CIO hubris to think that a tiny, stretched IT department can lead organizational change from the cheap seats. That’s never happened and it never will.
The project champion must be an operational leader who’s responsible for most of the affected areas and who can deliver the expected results. That person, along with a team of stakeholders, should define the need for automation, lead the selection process, oversee implementation, and set and measure benefits and outcomes. They should also weigh the inevitable (and often justified) objections of clinicians worried about patient safety.
It’s a shame that the only way to convince users and departments to change is to paint a falsely rosy picture of the likely result. If organizations had more willpower and focus, the need to deceive them to get projects done would be greatly reduced.