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Clearing The Deck

June 18, 2010
by Joe Bormel
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Clearing The Deck

Four Steps to Lead, Survive and be Relevant in the HCIT Storm

Those of us who work in healthcare IT, by whom I mean to include the readers of this blog, are
intensely aware of how long it takes to get simple tasks accomplished. We're unapologetically obsessive about doing small things fast, or even not doing them at all, if they can be automated. We have more sympathy than we let on when our end-users complain about the seemingly unnecessary extra keystroke or click for something we do multiple times per day, or the four-second hourglass entertainment we don't value.

This is an extremely important topic that impacts, or should impact, system selection, implementation, testing, use and adoption marketing campaigns. It's initially about the user experience and usability, but still more than that. This is evolving into our psychology and the psychology of those we serve. There are
legitimate times to be intolerant. So, let's delve into it a bit further.

The two-minute rule: All of us have more to do than we have time to do. If this weren’t the case, we'd be getting home, work completed, before dinner. And it’s true, whether we're practicing physicians, managers, executives, or any other knowledge worker. Our EMRs, as well as life itself, deal us a list of things that need to be addressed. Results review, patient sign out, knocking delinquencies and deficiencies from whatever the source. When faced with each task, we all know the drill: do it, delegate it, or defer it. The three Ds. And, anyone of those three might require a hand-off, face-to-face, by phone, e-mail, or moving the task to a tracking list or process. If we can’t complete the task within two minutes, and it wasn't adequately scheduled, that usually means that we must delegate or defer it . . . in under two-minutes. (See GTD work flow map section graphic,
full map here)

There’s no such thing as focusing on everything: That brings us to the fourth D, don't do the task. Well, many of us are obsessive compulsive, retentive, MBTI
Js, or DISC High
Cs. Whatever the profile, deleting things from our “to do” list, undone, is painful, and at times, unsafe. Most of you readers will appreciate that “unsafe” is a code word for avoiding getting to know our in-house legal council face-to-face! It's the responsibility and imperative of clinical and technology leaders to ensure that the predictable two-minute tasks in our worlds, and those of our users, can be done in under a hundred seconds. Otherwise, we won’t be able to “clear the deck” for the next wave of incoming, unavoidable tasks coming our way.

Doing things fast and reliably is more than a nice-to-have: The magic of clearing the deck is system-level awareness, design and training. Each is worthy of its own post, article or book. To get you started, this post seeks to raise "Clearing the Deck" to the level of an explicit goal,
worthy of a page or two in your project charter. The design needs follow two required parallel courses.

First, we need to explore our own habits and bring them into the 21st century. Read "
Death by Meeting." Most organizations can dramatically reduce e-mail traffic simply by instituting good meeting hygiene. Another great technique is experimenting with a
Personal Quality Checklist (from the book, "Quality is Personal" by Harry Roberts), a technique used by Thomas Edison among others to raise the quality of self-management through focused awareness. This was first recommended and used by Don Berwick in his Quality Improvement teaching 15 years ago. Every year, Don brought Harry to lecture at Harvard about how to improve on personal quality. If you don't maintain personal quality, forget about coaching your subordinates!

Second, have you inventoried your own two-minute tasks and those of your key stakeholders? Have you optimized today's three D paths in your world? Just do it!

4. It's all about a trusted system: (
This concept and implementation guidance is available in multiple forms at David Allen's Web site.) At the end of the inevitable information and workflow redesigns, are you comfortable that you and those you serve will see that they can trust these designs? Here's a test. Can they interact with their task lists (which may be called patient lists, results review lists, sign-out lists, etc.) from mobile devices, including handing them off efficiently to the right place? If not, forget about your solution being trustable since it cannot be reliably accessible. This is an area where some HCIT executives and physician's have found that
iPhones, iPads, and other popular mobile devices can be indispensable.

Based on my experience, it's the minority of my clients, friends and colleagues who have a system today they can trust. And although it's a work-in-progress for those who have such a system, this is not only important, it’s the only way to clear the deck in our HCIT world and help those we serve do the same.

What do you think?

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