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Training Can Get You Started-But a Good Coach May Be Necessary to Finish and Win

March 9, 2012
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A good coach can have a profound effect on your EMR to improve quality care and patient safety

In working with my team to evolve EMR technology, one of our most important considerations is to provide the flexibility users need to customize the system to meet their unique demands and organizational policies.  To accomplish this goal, we often depend on those users to guide us in creating the functionality they feel is important to derive the greatest benefit for their hospitals and patients.  

Over time, I’ve learned how important it is to periodically have a coach help me to ensure I can keep growing in my profession by refining my actions, often by simply holding up a mirror.  I find it very therapeutic.  In looking at your needs and goals for the EMR in your hospital, I think you can benefit from the experience of a CMIO I know, which will be the focus of this blog.

Dr. Ken Stevens (pseudonym), CMIO at one of the most progressive hospital systems in his state, was working on the next system rollout.  Ken had his analyst building tables to support the care of patients with congestive heart failure.  They included problem lists, flow sheet displays, orders, and feedback report profiles for the physicians he serves. 

In prior months, Ken had reviewed his health system’s heart failure data from the last several years.  He considered quality indicators, case volumes, case mix, severity measures, reimbursements, costs, and patient satisfaction survey data.  Even the meeting minutes from the clinical services team were reviewed.  Ken is a talented hospitalist who maintains an ambulatory practice, in addition to his management and CMIO roles.  He knows what patients with heart failure need, as well as the needs of clinicians taking care of those patients.  In short, Ken did a thorough and thoughtful job of identifying and documenting the needed requirements.

During the course of reviewing the analyst’s proposed EMR screens in the development system, Ken found several clinical data elements missing.  Elements that Ken had painstakingly documented.  When he asked his analyst about the omissions, Ken was told the information in one case that needed clinical data elements was simply not available.  In another, he was informed that a physician user could drill down in an exhaustive catalogue view to find the information.  That is, if it happened to be available for the patient whose chart was open. 

Dr. Ken was extremely frustrated.  He was frustrated by the ignorance of the analyst that the details mattered, and his attitude, which seemed contemptuous of clearly stated requirements.  He also found it incredible that in 2012, a user should have to seek out whether new information is available through active navigation, effectively well buried.  This would entail, for example, clicking over to ask for a specialized report or view in case there might be clinically relevant information there.  At times, that buried information would be critically important.

Where does this lead us?  To Ken’s fascinating response to his frustration.  He sought out coaching on what to do, because the problem was a little more complicated than simply ordering a subordinate to change his behavior.

The New Yorker recently published a PERSONAL BEST article by surgeon Atul Gawande entitled “Top athletes and singers have coaches.  Should you?”  In it, Dr. Gawande discussed tracking his performance against national data.  “My rates of complications moved steadily lower and lower,” he wrote.  “And then, a couple of years ago, they didn’t.  It started to seem that the only direction things could go from here was the wrong one.”  Atul Gawande solicited help from a coach.  Read his story:  http://www.newyorker.com/reporting/2011/10/03/111003fa_fact_gawande
The point is we all need coaches, whether it’s to improve our active listening, structure how we look at situations like Ken’s, or simply using the technically uninformed sounding board of a peer.  We need those external ears and eyes.

In Dr. Ken’s case, the external coaching led to multiple improvements for him and his entire extended community.  His frustration level dropped as he learned how to better interact with subordinates to achieve the desired results.  His analyst, in this instance, responded by being more receptive to building all of the required elements in an efficient, user-friendly format that satisfied the needs of both physicians and patients.  The rollout was a success, and the system was recognized as a highly beneficial tool to treat heart failure.   

Often, a good coach simply holds up a mirror.  The results can be very powerful.  They can also have a profound effect on your EMR to improve quality care and patient safety.

When was the last time you sought coaching?  

Joe Bormel, MD, MPH
CMO and Vice President
QuadraMed Corporation
"mailto:jbormel@quadramed.com" jbormel@quadramed.com

Coaching helps you take stock of where you are now . . . and how that compares to where you would like to be. 

   - Elaine MacDonald



I couldn’t agree with you more about coaching, especially when it comes to major healthcare IT projects.

Every project I’ve ever worked on where the hospital CIO thought he or she could do the planning internally and supervise the implementation without a “coach” turned into an expensive fiasco. And they cost several CIOs their jobs. The exception, at least for me, has been RCM, where CFOs seem to be a more cautious lot and seek out external expertise.

What hospitals need to understand, too, is that projects other than EMRs and financial systems also require coaching to one degree or another. Take the transition to ICD-10, for instance, or an MPI cleanup. Although smaller in scale, these are complex undertakings where the internal staff needs expert guidance. And let’s not forget about physician group practices now that accountable care is here. Those groups that choose to not merge with or be acquired by a hospital need to have a coach to ensure they qualify.

You’re really on target with this blog. I’m going to tell all of my clients to read it.


Thanks Jack.

Per my comment above, managing complex change requires attention to

. Vision ->
... Skills ->
..... Incentives ->
....... Resources ->
......... Action Plan

... along with steady handed surveillance, using dashboards. I'm not talking about operational dashboards although they, too, are critical. I'm referring to RACI stakeholder dashboard, outlining who are responsible, accountable, consulted and informed in each step, from vision forward.

Do each of the stakeholders need a coach? (rhetorical)

This was a great post Joe! Getting a coach is applicable in every walk of life, and especially when it comes to work place performance. I can't wait to read the Atul Gawande story!

Thanks for the kind words.

You nailed it with your insight that it's "every walk of life."

Part of why healthcare informatics is especially reliant on coaching is "the vision" thing. It's critical that we each have a vision for what we're trying to improve or revolutionize. In part, to refine and vet the vision. In part to gain the support of both leaders and followers. Vision is the first step in successful change management. It establishes scope and roadmap.

Articulating a compelling vision falls in the realm of healthy and effective narcissism. But narcissism carries with it the tendency to not listen, to become blind, and often full of anger and/or rage. Here's where coaching becomes essential, required and priceless. A trusted, dispassionate third party, holding up a mirror is invaluable. A skillful coach is a magical thing.

Thanks again.