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Hiring for Failure. You Don't Have to be the Redskins to Put Together a Losing Team

September 29, 2009
by James Feldbaum
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Yes, I am unemployed, but I am not whining. While fly-fishing in the river I have plenty of time to think calmly and critically. Over the past few months I have had the opportunity to assess the current state of IT job recruitment. As a consultant, I am always fascinated to ferret out the causes of failure. It is only now that I realize that we can lock in failure and frustration as early as the hiring of our core team. Since you are reading this I will assume that you yourself have been hired, are hiring, or looking to be re-hired.

In a not-so-hypothetical example let me outline a recent job opportunity and point out its failings (disclosure: I had the interview).

CPOE Advisor

The candidate will work closely with Customer’s clinical, technical, and program teams and (Vendor name) subject matter experts to maximize the deployment of (specific software) in Customer’s environment, review, validation and advancement of Customer’s program plan (including gap analysis, risk identification and mitigation recommendations) and assist in documentation of the forward thinking and planning of Customer’s critical care systems. This is a leadership role, and the candidate must be able to guide and coach the client through tactical decisions/change that support their strategic goals.

·Clinical education as RN, Physician or Physician's Assistant
·Advanced degree preferable, i.e., MSN, MBA, etc.
·Must have (Specific product x.o) experience to understand how to guide Customer for future state analysis. Requires a senior-level IC who has experience implementing/configuring Clin Doc and MLMs.
·Experience as clinical consultant with other vendor CPOE systems
·Experience with healthcare IT clinical transformation projects.
·Project experience with design of healthcare IT projects.
·Experience with regulatory requirements from JCAHO, IHI, ISMP, etc.
·Experience with multiple vendor products would be an asset.
·Ability to facilitate meetings (Workshop facilitation skills a plus).
·Effective communication skills.
·Good to excellent skills with desktop software such as PowerPoint, Excel and Visio.
·Report knowledge is a plus with minimally having experience taking an existing report and being able to modify it.
·Interface expertise is a plus with minimally having HL7 experience and basic understanding to review error and message logs.
·Qualified individual needs to be able to answer questions with confidence without having to research every answer, even though they will have access to vendor subject matter experts.
 

First, it will be prudent to point out that no one individual on this planet has this skill set to offer at the 70% discount they are expecting from customary consulting fees. The most glaring defect is the job title “CPOE Advisor” which not only does not align with the skill set, but the hospital system already has CPOE up and running. Go figure…

Next, a hospital system already deep into an implementation should know their own culture well enough to know whether they need a doctor, nurse or PA to assume a leadership role. Most glaring is the requirement for upper management skills, technical skills and even configuring skills. Even if a candidate had the entire skill set it would seem that no one person could have the time in a 40 hour work week to apply those skills at a competent level. If you hire a candidate with these expectations he/she will fail. If you build your expectations and schedules around compliance with this skill set your project will fail. In other words outrageously high expectations will create outrageous failures. As a candidate for such a position I was not shy in pointing out that they seemed to allude more to a team description than an individual. As I confessed after the one hour phone interview, “I have never worked so hard to talk someone out of hiring me.” Where do we introduce sanity into the hiring equation? In this case, I foresaw the certainty of a professional crash and burn. Who set the expectations and where was a reasonable voice of advice? I discussed this event and a few other hiring anecdotes with David Kushan, a managing partner in HealthcareIS, a recruiting firm. David confirmed my misgivings about the present state of hiring over-expectations. Recruiters too, it seems, walk a fine line when advising clients to “tone-down” requirements to an achievable level. Too heavy a dose of reality it seems can drive away clients to competing recruiting firms that don’t share his commitment to achievable hiring. As a consultant, I usually get called in at some trouble spot in an implementation. Maybe a new niche will be in advising start-up hospitals to set realistic and achievable standards and milestones. Starting with hiring.

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Comments

Jim,
Thanks for sharing your experience. It appears that the job description was written by a tactical technologist. They have no organizational investment in true project management (a PMO staffed by a PMP). They have either no organizational clinical leaders, or are completely fragmented from the clinicians. And, probably, all but the senior-most executive are in survival mode (as opposed to growth mode).

I provided a Case Study in my recent SEAK presentation (see Epic Career Changes - Step Three), slide 28. There, I presented the corporate analog of your story, although without some of the deep flaws:

- eager to hire
- addressing some new business plan, strategy, or event
- the organization has a poor track record in prior projects
- several really smart, charismatic leaders in place who are frustrated
- (if managed by a retained search firm), there 3 to 5 qualified candidates
- the hiring process rarely spans less than six months
- there are internal, social-dynamic conflicts that are part of the job
- the org chart violates basic management principles

That list was not drawn on provider organization positions, but I suspect there are overlaps.

My career advice for people early in their careers are on slide 29.

I respect that you, who have successfully served as a "CPOE Advisor," took a first hand look at this opportunity. And used it as an opportunity to exchange value. (I take it that there was no receptivity to restructuring the position.)

James Feldbaum

Jim Feldbaum is a physician consultant specializing in clinical transformation, CPOE, and...