The 1 through 10 of Healthcare’s Mission to Margin


Bull-series, Lichtenstein

Roy Lichtenstein, Bull I-VI

Healthcare is one of the oldest industries around. We need it. Good news for me on the job security front, but a little more concerning when I consider the big picture: In the US, we can’t afford rising healthcare costs and the horizon is shifting yet again, which means, wait for it… more costs!

How did our healthcare ecosystem become this accidental wasteland, and how do we slow rising costs when we need to keep changing?

When I started working in HIT, it was 2005. I was a 22-year-old college graduate who took a job at an EMR company as a software implementer and project manager. My team’s assignment: transpose the clinical workflows of a mission-driven, multi-facility IDN into the coded language of an integrated electronic medical record.

(By the way, my degree in business was one of the more applicable ones on our vendor team. Basically, we were cowboys, shooting from the hip! Okay, it wasn’t quite as Wild West as I’m making it out to be. We had a plan, an idea of what we were doing it just… shifted from time to time.)

I quickly found a mentor in the IDN’s nursing leader; let’s call her Jill, so I don’t embarrass her with flattery, or hold her to stuff she said 10 years ago. Suffice to say, I got lucky. She and her team members were the kind of nice, hard working, Midwestern-folks I’d grown up with. I liked them.

I’m not sure why Jill liked me. If I had to guess, I’d say it was my drive and sincere desire to help her accomplish her goals (because I didn’t know much about healthcare, and my experience with software was almost purely generational.)

Thankfully, she was patient with me, and nurtured my curiosity about the problems we were solving. She gave me a rare opportunity to learn the intricacies of clinical workflows. I didn’t waste it. I asked her so many questions!

Jill explained, and re-explained, the competing priorities of providers, administrators, insurers and even the dynamics among providers caring for patients. I learned that stakeholders sharing an intention to provide “the best” care didn’t mean they agreed on how to do it.

That was a big challenge for us. We needed deeper understanding of several perspectives to build consensus, if we wanted to get it right. I now call that change management roadmap to understanding the “1 through 10” and it’s all about clearly defined priorities, requirements and criteria. I had less experience with it, then.

Patient safety was Jill’s primary driver; she would not compromise it. She was transparent about that. At times, it meant she had challenging conversations with dissenters to build trust and influence their perspectives. Other times, it meant saying no and agreeing to disagree for the sake of progress. When that happened, Jill was careful to explain why.

One of my favorite tenets of Jill’s leadership-philosophy was called progressive elaboration. Progressive elaboration is the notion that we make the best decisions we can with the information we have available to us, and when we knew better, well… we do better, then.

It empowered us when weren’t certain. During the course of our project, it became a sort of shorthand or slang for admitting when we’d made a mistake and needed to change a decision.

In our shared office space, you’d occasionally hear someone mutter, “When I know better, I do better…” under their breath while walking by, presumably to go do better. We lived it. We were continuously updating code to more fluently speak the language of their care model.

I smile now with new perspective, but at the time, I saw myself on the front lines of the biggest change healthcare would ever see: a Windows-based EMR!! Modern Healthcare Magazine even traveled to our first community hospital to cover the “finish” of our three-year clinical EMR implementation: Go-Live. They counted down with us (10… 9… 8… 7… 6… 5… 4… 3… 2… 1…) to the New Way.

We toasted sparkling grape juice.

There was a big spread about us in the magazine.

It all worked. Sometime before the midnight countdown we’d accomplished enough of the 1 through 10 to make it. Everyone was safe. Clinicians didn’t revolt. Our project was completed within budget. The mission was accomplished! We hadn’t actually achieved any specific ROI metric proving the value of the investment, but, hey, mission over margin, right? It was 2008, and everybody was doing it.

Like I said, good people, and together, we did big things – bigger than any one of us could have dreamed of alone. You wouldn’t know from the article that our team was a bunch of rookies. I still marvel at our resolve to figure out the “1 through 10” when I’m daunted by the unknown.

Seven years later, a lot of providers are live on EMRs, and the idea that it would take Jill and her team three years to bring a hospital live is laughable. They’ve learned so much, and can do in weeks what it took us years to do then.

They know the 1 through 10: thanks to progressive elaboration and a lot of hard work.

Unfortunately for Jill’s team, time didn’t stand still while they mastered the EMR rollout. Healthcare organizations are facing yet another TACTONIC shift, another New Way.

This time, their hustle is in reaction to the Affordable Care Act and pressure to reimburse providers based on performance rather than services rendered. Organizations, like Jill’s, are now struggling to prioritize margin the way they intuitively prioritized mission.

Whether or not you’re a fan of ARRA, the intent behind the legislation was to catalyze change. It’s been disruptive, but disruptive doesn’t have to mean negative, it simply refers to something innovative or groundbreaking. Negativity lives in our mindset.

Innovation is about change management, the 1 through 10, and the how.

We just have to plan through it: adopt a new mindset, hone our relevant skillsets, and use our toolsets to make it happen.

Let’s dig in, and start at Groundhog Zero, because the times, they are a changing.

And so we must, too.

During the next 90 days, we’ll publish an intentional review of the healthcare ecosystem’s value-based horizon, using our “1 through 10” roadmap. Every step.

We’ll show you how we wade through chaos by organizing the priorities, requirements and criteria for success for IDN leaders like Jill, insurance executives, employers, consumers, providers, and technology vendors who are all feeling the pressure to slow emissions in healthcare’s Accidental Wasteland…

And since we know we aren’t always right, we’re counting on you to help us get it right: comments welcome!

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