By now, many of you are probably thinking, “What exactly is Harvey on about? It sounds like he’s grumbling about outsourcing gone wrong. How bad could it be?”
Well, let me tell you…
I mentioned earlier that I’ve spent quite a bit of time lately looking at “facts on the ground” inside some acute care hospitals. The conventional wisdom is that it’s the hospitals that really have it all together when it comes to managing IT. It’s not hard to find hospital and integrated delivery systems that have done an exemplary job of leveraging IT to excel at providing care and returning value to their bottom line.
But I’m also struck by the extent to which there are the “haves” and the “have nots” among those systems.
Why is it that we see hospitals of all sizes, but especially in the mid-size to large category, that appear to have more money than they know what to do with, that are building palatial facilities, and that are gobbling up competitors at will; while others struggle to keep the doors open? Why do some have IT operations that would be the envy of any business anywhere, while others are a train wreck? Is the latter the cause, or the effect of the former?
I am legitimately interested in others’ insights regarding the disparities. As we seek to build a healthcare delivery system that properly balances costs and outcomes, it will be increasingly important for us to understand the dynamics of the haves and have nots.
If I were doing a scholarly study of the issue, I’d begin with the hypothesis that the biggest difference between the haves and the have nots would be the overall quality of their management and leadership. And that’s where we come full circle to leadership’s commitment to IT as a key tool and enabler of organizational success.
Let me paint you a picture of an organization that has sold their soul and will pay the price accordingly. The scenario that I’m describing is a composite and does not portray any one organization, but I’ll assure you that all of these circumstances do occur in the wild.
Leadership is under qualified, isolated, and inbred.
Perhaps the organization experienced rapid growth in years gone by and outgrew the leadership’s ability to manage. Maybe the leadership style worked for the organization when the healthcare environment was different, but as the industry has experienced tumult and upheaval, leadership was not able to adapt themselves and their organization to the change.
Add to this a lack of leadership accountability. The relationship between the board and executive leadership is overly cozy. The chief executive may have actually come from inside the board to begin with and continues to lead a board that is basically self-perpetuating.
Qualifications? You’d be surprised at how many community hospitals are run by people with limited experience or education in healthcare management. The scenario above of the board member ascending to CEO? That person is more likely to be a successful banker or business owner than an experienced healthcare executive.
That does not preclude them from being successful, but it does mean that they have to force themselves to get out- get involved in industry groups, see how people that are recognized leaders in the industry approach the issues, make sure that they know and understand what the issues are today and are likely to be next year. Take another degree if necessary.
Those who are unwilling to humble themselves and admit what they don’t know will almost certainly refuse to hire talent that threatens them. Developing internal talent is great and should be the rule, but it’s also important to cross pollinate new ideas into the organization from time to time. And if your strategy is to develop your people from inside, you better be developing them. Not making sure their abilities stay one step behind yours.
Leadership is playing outside of what expertise they do have.
Suppose that the organization has managed to find someone who’s a pretty good finance person. They know how to read a balance sheet and have a good understanding of cash flows, expenses, and how third party payments work in healthcare. They become an effective CFO.
Oh, yeah, Mr. CFO, did we mention that IT is also part of your portfolio?
I know that some people will assume that I’m just being self-serving here, but the traditional idea of IT being an afterthought, and an appendage of the organization’s finance division just doesn’t get it anymore- especially in health care and especially when clinical systems are growing more critical.
I love finance guys. If I was stuck in a business foxhole, I’d want our CFO right by my side. But their brain works differently than mine does. You don’t want me making sure that we make payroll. It’s a rare CFO that you want guiding your EMR selection process.
There are exceptions; organizations where IT is part of Finance and is apparently functional. Bo Jackson was a good football player AND a good baseball player.
Bo doesn’t come along very often.