Time Capsule: For Employees in Uncarpeted Areas, Hide Technology Complexity Like McDonald’s Does

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 September 2006

For Employees in Uncarpeted Areas, Hide Technology Complexity Like McDonald’s Does
By Mr. HIStalk

A recent state survey found that El Camino Hospital’s medication error rate nearly tripled after implementation of a supposedly safer, closed-loop type of information technology for medication orders. El Camino, widely recognized as a hospital technology pioneer going back to the 1970s, suffered an embarrassing setback as onsite investigators found actively occurring medication errors that were unknown to the hospital.

Major implementations like CPOE expose serious flaws in an organization’s ability to manage change, to communicate, and to educate — those soft skills often scorned by take-charge caregivers and logical IT types. If El Camino can have problems like these, so can just about any other hospital.

Medical errors, including technology-induced ones, have gotten so bad that some hospitals are actually advising patients to bring along a friend to protect them from staff mistakes. I can’t imagine any other business throwing in the towel and admitting defeat to customers. I’d have just two words for a restaurant waiter who suggests I watch the cook to make sure he doesn’t poison me: “Check, please.“

Walk the uncarpeted areas of the hospital on night shift, where clinicians get dumped because they’re new, working multiple jobs, or desperate to earn shift differential. The variation in practice is shocking to anyone who assumes that policies are consistently followed or that nurse executives speak knowledgably for those folks who toil in the appropriately named “graveyard shift,” where some of the most horrific mistakes are made by tired, under-supported clinicians left to their own devices by the A-team nine-to-fivers. Sometimes they don’t even get computer training because no one wants to come in at 3 in the morning.

Software and medical equipment isn’t designed with these people in mind. Our mental picture of a user is an intelligent, thoughtful person who sits in a quiet room and carefully reads all the screens, labels, and warnings we put in front of them. This paradigm works well in those hospital departments where knowledge management is the key responsibility: laboratory, radiology, and pharmacy, for example. Their employees embrace technology and use it willingly to boost productivity in performing repetitive tasks. The IT track record in those departments is outstanding.

Nurses and doctors don’t work in that world, however, so our efforts and computerizing their work has been spotty. They didn’t go into their professions because they love computers. Much of their work isn’t even all that logical, no easier to computerize than that of a teacher, artist, or mechanic. Rightly or wrongly, how they do things varies by individual or by area, making it highly unlikely that non-personalizable off-the-rack software, as a rigid enforcer of business rules, will ever be fully accepted by those who don’t follow the rules anyway.

For vendors, maybe simpler is better, hiding the complexity like a McDonald’s cash register, where pushing a button with a hamburger picture on it rings up a hamburger. For hospital leaders involved in IT, maybe it’s time to venture out “where the sun don’t shine” – the night shift, uncarpeted underworld of patient care where all of our IT horsepower often fails to protect our patients.