EPtalk by Dr. Jayne 6/29/17

Several readers who have ties to consulting or staffing firms have reached out to me regarding my recent Curbside Consult that covered a friend’s layoff following her employer’s migration to a new EHR platform. I am very appreciative of the gesture and it sounds like she has some promising leads.

The piece had several reader comments, with one calling me out for using a full consulting schedule as an excuse to not do business with her former employer rather than telling them I didn’t want to work with them because of how they treated their people.

Like so many large organizations, I suspect here that the proverbial right hand doesn’t know what the left hand is doing, and there is going to be some reorganization that takes place. Eventually someone with their head on straight will be in control and they’re going to need qualified help.

I recall a similar situation with another employer who downsized a division in a way that strongly smelled of age discrimination. Several team members took early retirement. One of the analysts had the last laugh when she came back as a consultant making double her salary while also collecting her pension. She continued working there for another four years. Had her new employer refused to work with them on principle, she might not have had that opportunity for payback.

It’s human to want to sock it to bad people on the way out, but it seldom works out well. I recently coached a former colleague on how to write his resignation letter. He wanted to tell the truth about how the employer was abusive, negligent, and reckless, spurring his decision to leave. I counseled that the standard “This letter serves as my notice, my last day of work will be X” approach would be a much better way to go. He went with the emotional response and ended up being perp-walked through the office without even a chance to pack his cardboard box of personal belongs. His former boss also immediately started attempts to sully his reputation. It’s not to say that the boss might have acted that way regardless, but I don’t think my friend having his say helped the situation.

Even when you’re leaving a job voluntarily, it’s often difficult. Depending on your role and the amount of privileged information you have access to, there are concerns as to whether your resignation will simply be accepted or whether you will be escorted from the premises.

When I left one hospital position, I was fairly confident they were going to do the latter since I had access to their recruiting and acquisition strategies and was going to a relative competitor. I prepared for the resignation for several weeks, slowly moving things out of my office, but keeping enough personal items for it to not appear suspicious. On the day I was planning to deliver my resignation letter, the file cabinets were empty and the medical texts in the book case had been replaced by random binders, coding books, and training manuals.

I had gotten myself to a place where I was mentally ready to be walked out, so it was surprising when they asked me to work through my entire four-week notice period. Several days later they told me that they were going to use my resignation as an opportunity to change the role to a part-time position that would only cover about 20 percent of my job duties. They didn’t plan to continue the kind of change leadership and process improvement work I had spent most of my time doing. They didn’t expect me to perform any knowledge transfer since they hadn’t identified anyone to take the remaining portion of the role.

I spent three weeks doing little to nothing, attending meetings like the walking dead just to have something to do. Finally, they identified someone to take the remaining part of the role and we had three days of frantic hand-offs and a request to extend my employment.

Now that I’m in consulting, I’m constantly in a state of either starting a new job or leaving one. When I really connect with a client, it’s hard to leave, even if we’ve accomplished the goals we set out to meet together. Sometimes, however, the leaving is pretty easy, as it was this week with a client I can only describe as extremely challenging.

They brought me in to do a stakeholder assessment and to look at why they are still struggling with EHR adoption six years after go-live. They’ve got some serious leadership deficits and don’t seem too keen on doing the work needed to move to a place where the physicians have buy-in on what the parent company wants them to do.

Even though I was supposed to be winding things down this week, they spent my last day on site arguing with me about when the physicians should complete their documentation. They allow 10 days for the physicians to finish ambulatory visit notes, which is absurd. They have all kinds of reasons why the physicians can’t complete their notes in a timely fashion and aren’t interested in learning strategies to remediate the situation.

It was like dealing with an argumentative teenager. I think they actually believed I would change my opinion if they continued to badger me. They never seemed to understand that it’s not my opinion that counts — it’s that of CMS, auditors, and their medical liability carrier. I wish them luck defending their policies when an audit or subpoena reveals charts completed more than a week after the fact.

We talk quite a bit about healthcare technology, but sometimes it’s the low-tech solutions that really matter to physicians. I experienced this first hand over the weekend when my stethoscope gave up the ghost. I should have known it was coming since I already had to replace the ear tips and diaphragm. Although I had some spare parts at home, I didn’t have the diaphragm retainer ring that had failed. According to the websites that usually carry spare parts, mine was so old they didn’t stock replacement kits.

I started to despair. I own half a dozen stethoscopes, some of them special purpose (from those neonatal ICU and pediatric rotations) and others that I’ve bought to have a spare or a less-expensive version to take on volunteer trips. But I’ve always been partial to my first stethoscope, my constant companion since the beginning of clinical rotations.

I made a last-ditch effort by emailing 3M about options and was pleasantly surprised to find out that a certain model repair kit would do the trick even though it isn’t officially listed as being compatible. They also sent the handy Amazon link to buy it, so I should be back in business in a couple of days.

What’s your favorite piece of healthcare technology, IT-wise or other? Email me.

Email Dr. Jayne.