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Time Capsule: Can’t We All Just Get Along? Why IT and Clinical Jobs are Different

April 4, 2014 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 April 2010.

Can’t We All Just Get Along? Why IT and Clinical Jobs are Different
By Mr. HIStalk


I worked several years in hospitals before I went over to the IT dark side, spending time in both frontline patient care and operational management. It’s a lot different than working in IT. For those who’ve spent their entire healthcare careers sitting at a desk in front of a monitor, I thought I’d point out some of those differences as I see them.

The most dramatic difference is the timeline. IT people are the Pentagon generals fretting over long-term plans and organizational structure. Clinicians are the ground troops who are under siege by an enemy of superior number, hoping only to survive until the end of their shifts. Picture the soldiers in “Platoon” sitting in on a Pentagon press briefing — that’s how IT project meetings go down when clinicians are invited. Fragging is inevitable.

The biggest divide between IT people and patient care employees is that those people on the front lines don’t get to eat lunch out. Ask a surgery nurse about good restaurants and they’ll only know about close-by Chinese buffets willing to box up group order takeout clamshell boxes for 20 co-workers. Meanwhile, the IT people know all the fancy places with great appetizers and patio dining, although they don’t always know the prices since vendors often pick up the tab and even drive (anyone who knows anything about hospital parking will see the value in being picked up and dropped off curbside).

Team relationships are different for the front-liners. Clinical job skills are theoretically interchangeable, so the biggest difference between one nurse and another doing similar work is their attitude and work ethic. They don’t get to coast because they’re the only Oracle DBA or the last surviving in-house COBOL programmer. Out on the floors, nothing matters except what you got done during your last shift and how well you supported those around you. 

In my experience, IT’ers stab each other in the back a lot more. It’s an organizational behaviorist’s dream to put a bunch of Type A IT management people in a conference room and watch them skillfully undercut each other, lobby for suck-up points with the ranking person in the room, and dodge ugly assignments, all without being obvious.

Non-IT’ers are not nearly as subtle in the art of war. If they get mad, there will definitely be shouting, scowling, and storming out of the room. Their blow-ups are more spectacular, but are over almost immediately and everybody makes up, most likely with immediate hugs all around and a cake brought from home the next day (frontline workers eat on the job a lot). Come to think of it, that matches the timeline above — IT people are playing an intricate, involved chess game while the frontline workers go right for the boxing gloves.

Clinical people are blunt compared to their reserved and polished IT counterparts. If an application sucks, they’ll tell the CIO directly. They don’t mind ripping the "helpless” desk in front of the people who manage it or to complain that all the IT’ers are fast asleep in their beds when the network crashes at 2 a.m. Out on the floors, communication is urgent and potentially life-saving, so the ability to be soothing and politically correct is not valued. IT skin toughens a little after dealing with crusty night shift nurses who call people by their last names or that 25-year OR veteran who can make cardiac surgeons cry. You might as well expect eye-rolling and watch-glancing if you drag out a 45-minute PowerPoint that’s more propaganda than useful information.

Floor people don’t know or care about C-level management. To 90 percent of hospital employees, "management" means a nurse manager, supervisor, or ancillary department manager, not the $500K suits sitting in the really nice offices. They have probably never seen a hospital office that had good furniture, secretaries, and carpet on the floor. They also question (probably rightfully so) whether those suits really understand what it’s like to actually deliver the services that hospitals are paid to deliver. To the frontline worker (and, truth be told, probably to patients as well), nobody is vital to the mission if they aren’t working weekends and holidays. That’s why IT executives make a big show out of bringing in donuts at 6 a.m. during go-lives.

The biggest dividing line is salary, of course. IT pays better than actually delivering patient care, so IT is always stealing clinicians away from the bedside. That doesn’t win friends and influence people.

I can’t say one job is better than the other. Working on the floor is great because you can go home on time tired, but knowing exactly what you accomplished and you get to start over the next day with a clean slate. IT is a slog because it’s just the same old thing day after day, with little feeling of progress or individual accomplishment.

All things considered, though, I’d take the higher salary. Plus, eating lunch out whenever you want is undeniably cool.

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Currently there are "5 comments" on this Article:

  1. I think this article presents a prime reason why more nurses are needed in IT. But you can’t just move nurses into IT for the sole purpose of having nurses in IT. These nurses have to be dynamically skilled and valuable in IT.

    I disagree with your statement about IT employees stabbing each other in the back more often. Nurses can be brutal and each each other alive. IT can be the same way. IT’s all about the environment, stress level, and tolerance of the management and the organization.

    Enjoyed this article. 🙂

  2. Enjoyed the article. One thing I have seen that differs is that nurses earning a ton of OT are getting paid more than their IT and clinical informatics counterparts in several different communities. When we do bring nurses (or other clinical specialsts) into CI or IT, we target the strong personalities that can hold their own with stubborn programmers, doctors or clinical managers.

  3. Health care IT is at the very least 10 years behind any other industry in which I’ve worked. The low quality of IT performed is nothing short of appalling. Having worked with a major health care system that had issues with deploying windows updates, following government regulation, even something as basic as having orders match the CORRECT patient or storing the Doctor that actually entered the order has really opened my eyes to the central issues with health care in the United States.

    Meaningful Use is a great example of shear government waste. Any other industry would be encouraged to improve based on market forces. In health care, it’s dictated largely by government officials heavily influenced by the health care IT industry instead of real need. Just look at the dollars wasted on HIE implementations that benefit very few. Patient portal usage is required despite the fact patient’s typically have no need or interest in having their health information online. The solution to affordable health care isn’t more IT, but less regulation with realistic liability caps. Health care IT should be dictated by clinicians, not the government or health care IT workers.

    As a patient, I’m glad that I know to only go to facilities that run Epic as my experience with other EHRs are terrifying. For what the government is spending on Meaningful Use incentives, they could have built a cloud based EHR that gave high quality EHR tools to everyone and probably saved a few billion. As much as health care workers would like to deny it, health care has costs and it’s time that those costs and fees be transparent to the patient. Will there be individuals that are negatively influenced by this transparency? Absolutely. However, by sharing what procedures and visits actually costs gives people the choice to determine their care. It also forces real competition and moves us away from the most expensive health care system in the world.

    As an American that believes in freedom, I take great pride in knowing that I can fly to Beijing and buy authentic medications for whatever I need. It’s time we start asking how our American values apply to health care. It’s also time we look at the supply side of health care and not just demand. Let’s set an easy target of having a medical school per 1 million Americans. This would require almost doubling the number of medical schools in the United States. By eliminating ridiculous regulation on health care IT and focusing on the supply side of health care, the growth rate of costs for care in the United States would dramatically change.

  4. PM_From_Haities–with the lack of quality controls for products from China, would you really want to rely on Chinese medicines? Sure, I could understand going to Canada for your meds, but China?

  5. Would I buy meds from just any Chinese producer? Probably not. My point wasn’t that I would buy Chinese produced meds, just that I could buy any medication I felt I needed without a prescription (hence freedom of choice). It may very well be I’d buy American produced medications in China.

    However, given the large variety of goods we purchase from China, it won’t be long before their medications are just as reliable as ours.

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