Time Capsule: In a Capitalist Society, Somebody Will Always Sell a Fat Man a Speedo or an Unprepared Hospital a Clinical System

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 March 2008.

In a Capitalist Society, Somebody Will Always Sell a Fat Man a Speedo or an Unprepared Hospital a Clinical System
By Mr. HIStalk

One great thing about capitalist America is that people will sell you anything you can afford, even if you’re likely to do something stupid with it. Klutzes can get chainsaws. Fat guys can buy Speedos. Elected officials can hire prostitutes.

And hospitals with minimal chance of success can buy clinical information systems.

Any IT system can be misused. It’s the clinical ones that usually create the most awe-inspiring mushroom clouds, however. They come with irrationally high hopes, require the unwavering participation of stressed clinical users, and push the competency limits of both vendors and hospital IT shops.

The hospital loses millions. The vendor loses reputation points. Patients lose the chance for better or less-expensive outcomes. Money talks, however, so the customer signs on the line which is dotted, gets one last handshake from the salespeople they’ll never see again, and eventually realizes the magnitude of what’s required to get value from their big-ticket purchase. Gulp.

Would-be clinical systems customers are like that crazy 16-year-old driver down the street, except no learner’s permit or exam is required, just cash. Hospitals perform endless vendor due diligence, but those vendors don’t return the favor by saying, "Our analysis tells us that you’re going to be an unsuccessful customer who will bad-mouth us for your own shortcomings, so we’ll pass."

Let’s stretch reality by pretending that vendors might actually turn down prospects that are sure to fail. What kind of questions should they ask?

• Can you provide a list of at least three big, successful change management projects you’ve done in the last five years?
• Do you monitor and publish IT metrics, including those that measure user satisfaction?
• Are your physicians compliant with rules involving the drug formulary and chart completion?
• How standardized are your order sets?
• How standardized are your forms and how do you manage them?
• Can you document participation and results of your clinical committees?
• When was the last time your executives communicated a big vision that inspired cultural change?
• How dissatisfied are your users with current manual and paper processes?
• Are you so desperate to keep nurses and other short-supply employees that you let them break all but the most serious rules?
• Are you willing to take a productivity hit while users are being trained?
• Where will this project fall on the "most important organizational project" pecking order?
• How often are operational VPs involved in big change projects?
• Who does or doesn’t agree that this solution is the best answer to the problem we’ve identified?
• Have you set aside money for ongoing support?
• How mature is your project management function?
• Do you maintain an IT strategic plan that aligns with the organization’s overall strategic plan?
• Have you identified who gains and who loses power and prestige with this change?

Smart consultants could develop an easy hospital self-assessment tool that would predict with 90 percent accuracy whether a hospital’s implementation of a given system is likely to be successful. Vendors won’t develop it, though, because it would discourage prospects. Hospitals won’t either, because if they were smart enough to ask that question, they would be smart enough to already know the answer.

The current environment is simple to comprehend. Vendors sell products, customers use them to deliver results. Unfortunately, we’re seeing lots of the former, but far less of the latter. Everybody blames vendors, but let’s be honest – a guy who buys an extra-large Speedo should know better.