Curbside Consult with Dr. Jayne 4/29/13

Mr. H posted a question in the Monday Morning Update about the decision-making habits of healthcare IT leadership. It brought in a fair amount of reader comments and I thought I’d contribute my two cents.

First, to the original question/comment:

Healthcare IT leadership seems unable or unwilling to take meaningful actions that would benefit their organizations … In a corporate world, leaders who don’t act on revenue opportunities or cost savings don’t last long. Is it asking too much for healthcare IT to make responsible decisions to avoid wasting money?”

Many of the so-called leaders I work with suffer from analysis paralysis. It’s not just IT leaders – it could be finance, revenue cycle, practice operations, or just about anyone. They spend so much time thinking through various options that they ultimately miss the opportunity to make a decision that would make a difference. There’s no understanding of the concept of opportunity cost.

I tend to see this more in so-called non-profit health systems where the business just isn’t run like a business at all. Sometimes I think altruism or the thought that everyone is “trying to do their best” becomes a smoke screen for failure to lead.

It’s not just analysis paralysis, but there are quite a few healthcare leaders I’ve worked with who are simply ineffective. I’ve worked for and with people who range from passive-aggressive to missing in action. One group I worked with in a consulting relationship had an EHR project head who was missing in action. His favorite pastimes included casino gambling and hanging out at the local coffee klatch with a group of wealthy retirees. He’d come to steering committee meetings completely unprepared and expected his subordinates to bail him out. His direct reports were rewarded by having their one-on-one meetings canceled and receiving performance evaluations that were written by other division directors because he was unable to meaningfully assess their performance.

Inept leadership isn’t the only thing that contributes to poor decision making. Awkwardly constructed team structures can be a factor as well, where different verticals end up unknowingly (or intentionally) confounding the needs of other teams. Teams where leadership obviously doesn’t like each other or share any kind of mutual respect can lead to bickering and efforts to block others just do be difficult. When teams don’t get along, it’s up to the next level of leadership to demand cooperation and congeniality or let people go.

Although I agree that the level of involvement (read: interference) of government in medicine makes it difficult to say ahead of the curve, that often sounds more like an excuse than a reason. I’ve seen more than enough healthcare organizations that have no concept of the true cost of the care they’re delivering, and instead of focusing on the bottom line, spend their time whining about payers. Physicians underestimate the value of their time and shift resources the wrong way, taking on additional work rather than “burdening” their staff members. I see too many administrators who are penny-wise but pound-foolish, trying to do complex projects in-house due to perceived cost savings when a team of experienced consultants could have delivered higher quality product with fewer errors, delays, and cost overruns.

Another major problem that leads to ineffective (or no) decision making is failure to understand the value of active change management within an organization. Sometimes unpopular decisions need to be made, but rather than using a formal change management program to smooth the transition, leadership elects to make no decision at all. Guess what, folks? This isn’t high school. You’re not here to be liked — you’re here to do a job and improve patient care. It’s not a popularity contest.

I also see a fair number of “leaders” who don’t understand their core business or its needs. My favorite corporate “stupid human trick” is the lateral outplacement move, where you take someone who is ineffective in your vertical and move them to another vertical in the organization where they may know even less about the business line. Just because someone knows the inpatient setting doesn’t mean they know beans about ambulatory care, and vice versa.

In the same vein, I also see too many people that place stock in certifications and degrees over experience. I’ll take an experienced CMIO who has had to work with the DBAs to resurrect an enterprise app in the middle of the night, whether they have fellowship papers or not. In my neck of the woods MBAs are a dime a dozen and I continue to watch hospital administrators hire people with no healthcare experience at all, then feign surprise when failure occurs.

Is it really that much worse than other industries, though? I’m not sure. Having worked in healthcare most of my career (unless you count a string of fascinating summer jobs), I don’t have a lot to reference against. My friends in non-healthcare IT seem to have managers and decision trees that are as crazy as those I deal with every day. Sometimes running away to become a rodeo clown looks pretty good – until I remember that’s what I already do every day.

E-mail Dr. Jayne.