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Curbside Consult with Dr. Jayne 7/27/15

July 27, 2015 Dr. Jayne 3 Comments

There are many reasons to use consultants. Sometimes an organization needs an expert resource that they don’t have on staff or don’t have time to develop. Sometimes they need staff augmentation for a critical project. Sometimes they need an outside opinion to validate their goals and the plan to achieve them.

At least in my current consulting practice, however, most of the organizations I’m working with just need a consultant to save them from themselves.

Healthcare has always been a fairly dysfunctional business. The emphasis on shifting models of care and the relentless pursuit of technical tools has added stress to an already challenged system. Although a couple of my clients were referred to work with me early when things started heading in the wrong direction, my newest client waited until they hit rock bottom. I’m never one to shirk a challenge (particularly during the slow summer months when other clients don’t want to do much because too many key staffers are on vacation) but this one is a doozy.

This client was referred by one of my existing clients, who I had worked with on creating policies and procedures for Meaningful Use-related workflows and making sure that they had solid workflows prior to their reporting period. They had been a dream to work with. I knew that the physician owner had a brother who was also a physician, but in a different specialty.

Scope of practice not withstanding, the two practices couldn’t be different. My existing customer was a dream to work with. The new client called me incessantly demanding we set up an initial call. He apparently didn’t listen to my outbound greeting which explained that I was on vacation and would not be returning any calls until a certain date.

One of the benefits of working for yourself is being able to set your rates however you feel is appropriate. From the tone of this physician’s calls (increasingly desperate), I suspected he would be in my top billing tier. I also knew before even talking to him that if I did decide to take him on as a customer, it would be for an extremely limited engagement.

When we finally were able to have an initial discovery call, he had calmed down quite a bit and our discussion was entirely reasonable. We discussed the services he was requesting and what an engagement would look like.

His situation is not unusual. He is an independent physician who accepted subsidies from a health system to implement the EHR they were offering. Now he has decided to move off that platform and needs assistance with selecting a new system and actually making the transition.

One red flag, though, is that he wants to leave the hospital’s EHR system due to “philosophical differences,” which can mean a variety of things when you’re a high-profile surgeon. As far as finding a replacement, he’s already been largely swayed by a couple of vendors who should be easy to work with. I’m always happy to take any complications out of the mix.

Despite his desperation in trying to contact me initially, he had no problem dragging his feet when it was time to execute our consulting agreement. My standard contract is pretty simple – less than two pages – and spells out exactly what will be done and on what timeframe. He wanted to argue about the duration of the engagement (as a rule, I never do more than a six-month engagement the first time I work with a client) and didn’t seem to understand that in this situation, the consultant has the power. I don’t have to work for him and don’t have to agree to his terms.

He eventually figured that out and agreed to my proposal, so we jumped right in to his system selection problem. If I thought my contract negotiation with him was a challenge, I can’t imagine what it’s going to be like for him to execute a software agreement. I haven’t worked with either of his top choices (both are specialty-specific offerings) so am not able to give him much guidance in how best to work with them.

He’s still trying to decide and hasn’t been very receptive to my advice on how to weigh the pros and cons of different vendors and features. He refuses to use checklists or document his thoughts immediately after demos. When he can’t remember what he saw or what he thought about it, he just demands another demo, which results in a lot of schedule juggling. I’m fortunate to have a retired project manager I can throw at the problem so we can start to document for him and reduce the overall craziness.

In the mean time, we’re working to clean up the data in his existing system and create a plan to extract the data he wants to load into his new system. A good chunk of his documentation was dictated and he still has the original text files, so those will hopefully be easy to add to the new system. It’s the first time I’ve ever been grateful to not have very much discrete data.

He also didn’t attest for Meaningful Use yet, so I’m grateful to not have to deal with archiving that data for audits or dealing with how to synchronize his reporting period with the migration to the new system. I’ve got a young informaticist working with me who is excited about dealing with what data there is, so that is off my plate as well.

It’s a little strange to be delegating this work when I’m used to doing so much of it myself. It was one thing to delegate when I was a CMIO and working for a large health system, but it’s another thing to delegate when your name is on the door and it’s your company. Right now, though, my main function is to “handle” the customer and make sure we meet his needs. I’m OK with that. I’m not sure the people assisting with his engagement feel the same way, but we’ll have to see how things unfold. If nothing else, it’s putting experience under our collective belts.

How do you handle difficult customers? Email me.

Email Dr. Jayne.

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Currently there are "3 comments" on this Article:

  1. More often than not it’s a consultant to save them from themselves. Sometimes its to tell them what they need to hear and not what they want to hear. Sometimes it’s just a person to look thoroughly baffled when the consultant realizes they have a committee that’s never made a decision on anything ever.

    “Wow, this group is functioning well” – said no consultant ever.

  2. You forgot a big one.

    Problematic or controversial items are often left to consultants. If the recommended change works, management gets to claim credit. “We clearly made the right decisions here!”

    If the recommended change fails, management has a plausible external scapegoat. “We are angry that the consultants made bad decisions and only wish that we had been informed sooner!”

    The need to externalize risk and blame is a strong motivator.

  3. Document, document, document! Then document some more! As a consultant, you shouldn’t make major client decisions; you should provide them with the alternatives, risks, and recommendations, then let them make the most informed decision. If they don’t choose your recommendation, which should be the best alternative with manageable risks, document the decision! Yes, many clients like to use the consultant as the scapegoat, but if you have the proper documentation, you have the necessary defense (sad to say, that’s what it comes down to).

    I had a good client where communication between my contact and her management was poor, due to their internal battles. She made an off-the-cuff comment that was misinterpreted by upper management, resulting in an unexpected email from a very disgruntled CFO. I had all my documentation, including detailed status reports, but within the literal first 60 seconds of a call with the CFO, my Director and me, the CFO was apologizing. He went on to explain in great detail their internal turmoil, but the point is that I was well prepared if he’d gone in the other direction.

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