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Managing Complex Change

August 26, 2008
by Joe Bormel
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Michael Craige offered some data and posed several interesting questions in his post, "

Clinical is the Name of the Game - Hospitals' IT budgets" today. Generally, impoverished organizations do what they can to improve care, with whatever IT budget they can access.

I thought back to this diagram (above) and realized that poorly funded or unfunded hospital IT budgets can impact more than just '

Resources;' lack of funding often impacts


Incentives, and the other green boxes, with the predictable outcomes shown at the right.

Thanks, Michael, for getting me to think about these challenges in a different way.



Michael, the "Managing Complex Change" graphic does not come from a larger document that I am aware of. A year or so back, I tried to find the original source for attribution, both asking people who had it in their Powerpoints, as well as Googling the words contained. In short, I dont have either a source or a larger document.

Part of my goal originally was to place my post as a reply within yours. I was unsuccessful getting the graphic into a reply, but had no problem getting it into a new post. Thanks for finding commenting on it.

Regarding your review of IT budgets, I'd like to share and extend on the concerns you raised. In my experience, smaller hospitals and those with economic hardship are not only less likely to come to HIMSS, they're less likely to take the HIMSS survey. I'm sure our friends at HIMSS have taken precautions to reduce or eliminate bias. That said, statistical power is what it is. ... you captured that entire thought in much more succinctly with "well?" and your statistics, 307 execs (from profitable), 700 hospitals, 431 ave bed.

Regarding IT being #1 investment priority, ... well, maybe their priority. The expressed behavior doesn't always follow, of course.  The competition from new building, new ventures (such as ambulatory facilities, often in partnerships with doctors), and plant maintenance seem often to displace the #1 investment priority of IT.  The non-IT investments are often necessary, self-evident needs.  Perhaps that makes them something other than investments, perhaps something that is, by definition, a higher priority than number one.

Regarding what it means for IT to be an investment priority, that notion, too, is hard to interpret. In what order do you put in PACS, EMR and move to a new facility? The first two are IT investments.

Knowing that IT is a number 1 priority, do I have a clear picture of which sequence I would take on those three projects?

There's a lot to be said for sensemaking!

Joe thanks.......Very interesting diagram. I am assuming that your diagram is apart of a larger document. Would you consider sharing a copy?

According to HIMSS 2008 survey, IT continue to be U.S. hospitals' #1 investment priority, according to a new survey of hospital CIOs. As we know the 2008 HIMSS Leadership Survey is the largest of its kind in the U.S. and offers insights into hospitals' IT challenges and planned IT investments over the next two years.

However, one thing the survey did not do is provide a break-down of "impoverished organizations" and how they are dealing with Financial/IT budget challenges.

The 2008 HIMSS Leadership Survey included responses from 307 healthcare executives (mostly profitable organizations) representing more than 700 hospitals, with an average of 431 beds. Two-thirds of respondents were senior IT executives — 52% were corporate CIOs and 24% were CIOs for individual facilities. Nearly 90% of respondents were employed by either a standalone hospital, a multi-hospital system or a hospital that is part of a multi-hospital system......well?