Healthcare has a “No Problem” Problem


A physicist, astronaut, lawyer, and he also had a degree in medicine to boot. Impressive credentials. It was at a sit down and roll up your sleeves meeting some years back to discuss launching a new diabetes program initiative. Custom software would need to be built to manage the program since nothing on the market met the initial criteria. At the table was the company medical officer, RN patient advocate, the CEO, the CTO, and some of the development team. That initial requirements gathering meeting lasted the afternoon. It was fun to throw out ideas at the table and see whose ideas stuck and eventually would get built. We wanted to value everyone’s input, especially the astronaut’s, on even par.

What resulted was the team having to grapple with everyone’s ideas and having to kludge something together to be inclusive and not offend. The reality was a project that should have been coded in a few weeks took a year and put the future of the company at risk. Everyone at the table decided what was best for the project, as if the project was run in isolation. The reality was that the project needed to be coordinated with the company’s brick-and-mortor core business of delivering medical supplies to patients. And so resource allocation for the project was a misstep in time and people needed. What I observed was that the people at the table, really smart and talented people from their own disciplines and backgrounds, didn’t take into account the impact of the overall system. The impact of adding and introducing a new program would have to their overall business as a system of people, departments and processes.

Project managers handle this through what’s called change management- a process which is meant to look at overall impact in an organization when new initiatives or new regulatory burdens are involved. That’s the general theory, but reality on the ground with healthcare in making a decision is a bit more complex. What’s different about healthcare is that nothing lives in an isolated vacuum. Something newly introduced ends up at some point touching everything else. Analogous to improper scrubbing before a surgery that can spread infection throughout the entire patient, making it hard to isolate and heal.

"No Problem" is the Problem

The project of developing that new diabetes initiative wasn’t the problem. It was the resource impact it had on the rest of the company. We said “Yes” to everything and thought mission accomplished meant appeasing everyone at the table- the medical team, the patients, and the administration. “Isn’t it the CEO’s job to discern what to do?”, you’re probably wondering. It is, but to the CEO, a medical doctor himself, the pressure of going all out to add all requiremnts for everyone runs deep in the hallways of the Hippocratic Oath. The part about “I will apply all measures which are required” seems, to me atleast, in healthcare to loosely be translated to “Yes we’ll do it, no problem.” For patient care that’s the way it should be. But for taking on new initiatives in IT, we need to start to learn to say “No” to much of the cruff.

There is no better example of a pile of "Yes"es on top of a dustpan, than today’s EMRs. Features that should have been trashed get put back in the proverbial pot, to refry and sell back to healthcare market. Today’s EMR’s are klunky, not because healthcare is so complicated, but because every possible feature imaginable is crammed in. There is no incentive for elegance. Buyers equate the number of EMR features with a product’s value without weighing the whole totality of the product and impact to the clinic buying it.

Managing Impact

The idea of impact management takes system risk into account. What we have to start doing is measuring the size of the impact as it varies in terms of cost and impact on health, human life, or some other critical metric you think is important to your sphere of work.

What happens when your clinic wants to open weekend hours for vaccinations? What is the overall impact when your facility wants to screen everyone over 50 for bone density exams? These are admirable decisions. They fall within the medical mission. But where many healthcare organizations and individual practitioners fall apart is not knowing the total impact these new initiatives will have on the rest of the clinic. Small clinics don’t have a dedicated resource planner or the additional administrative resources, outside of running the day to day operations, to handle new projects. And many private practice owners jump at the first chance of new income opportunities, selling supplements, medical gear etc. thinking it’s what must be done to ‘get ahead’ without even planning for the hidden resources and monetary costs.

Impact on Compliance Change

Once again we’re being asked, by the government, to re-think the fundamental way a healthcare organization works with the transition from Meaningfuluse Stage 3 to MACRA reporting compliance. If you haven’t done so, there is no better time to plan out and predict your organization’s impact on whether or not to participate in MACRA than right now. Carve out some time and take a business planning retreat to do. Backyards, parks, local coffee shop or beaches work wonders.

Your First Report

I can’t offer you advice on whether you should or should not participate in MACRA. If, from strictly a resource planning and impact management persepective, its anything like PQRS monthly and quarterly reporting, you’ll be fine. But with one caveat— your first report will be your hardest because it’s a new process that will impact your whole organization.

What I can guarantee you is that once you do decide to implement reporting as a routine into your organization, just like human resources, accounting etc, the process to participate in ongoing MACRA will be profitable. It’s a simple businesss decision. Can you, on an ongoing basis, using your fixed resources, generate and comply with reporting to attain an ~5% incremental increase to revenue? For any other vertical like retail, hospitality, shipping etc, this would be easy gravy. The challenge here is scaling what could be a complex process, to get started with, down to smaller organizations that may not think they have the resources to do so.

If you do decide to participate in MACRA, commit to your level of participation all the way and plan for it the right way. Otherwise, with any new change to your organization, you will be in a pile of hurt trying to manage it upstream.

This Friday, November 11th at 12 noon EST, I’ll be moderating the Healthstandards twitter chat using the hashtag #hitsm where we will be discussing change management in healthcare with some touch points on MACRA.

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