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

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.