Recently we have been talking with customers about what they see as the biggest obstacles to change at their hospital. The most common thing we hear is that institutions often stop themselves from change. As one clinician put it “we find the most difficult way to do something… and that is the way we do it”.
While I was in business school we spent a lot of time studying Southwest Airlines. It’s a great example of a profitable company with world-class customer service in a notoriously unprofitable industry. Southwest isn’t profitable because they do any one thing well. It’s because they do a lot of little things really well and the little things support a larger strategy of providing low prices and superior customer service. The interconnected strategy of little things create significant cost savings and revenue drivers that other airlines fundamentally can’t match.
Southwest Airlines Strategy Web
When we talk about introducing changes at a hospital, there are lessons we can learn from Southwest Airlines and how little things can make a big difference. Here are four concepts we have seen at hospitals that help create highly efficient organizations and make introducing change more possible. While each concept requires some level of cooperation across the organization, any individual can embrace these ideas and encourage a starting point for change.
- Buy-in and Support from Clinicians: To make a change at a hospital it is important to relate the change back to clinical value. Hospital administrators want to know how a workflow or procedure change is going to improve patient outcomes or contain costs. The best way to relate clinical value is to describe the change in the words of the clinicians. This isn’t about using the right buzz words to get the attention of administrators. It’s about connecting the problem with a solution in a way that will undoubtedly benefit the hospital. Clinicians become the champions for change and there’s no stronger ally for change than when a mutual third party supports it.
- Transparent Communication Across Departments: If you’re trying to make a change, chances are there will be multiple departments and disciplines affected. No one wants to have a new workflow or procedure forced on them. Forget the politics and create a group of stakeholders that you trust and are excited to work with. Be clear about the objectives and intentions of the project. As Meg Whitman, CEO of HP says, “communicate the problem, but focus on solutions”.
- Look for the Small Wins: Every strong project has a vision for success but it’s going to take time to get there. Small wins give everyone confidence in your plan and a feeling of accomplishment – which translates to motivation to keep working together. If you’re working on a project to integrate a checklist into a clinician’s workflow, look for a small win by applying the checklist retrospectively to a group of patients. By identifying instances where treatment could have been delivered more efficiently you and your team can feel confident that change will work for future patients as well.
- Don’t Forget the Mission of the Hospital: No matter the size or location of a hospital, every hospital has a vision and mission for treating patients. Aligning your project with supporting of the vision of the hospital is taking a page straight from Southwest Airlines. If the vision of your hospital is to be an elite Level I trauma center, how does your project support this vision? What type of metrics can you produce from your project to strengthen this mission?
How can you use Southwest Airlines’ business model to affect change in your organization?
 Growth Management [Jukka Ala-Mutka] http://jukkaam.wordpress.com/tag/business-model-2/
The value of Healthcare IT is generally quantified by metrics and statistics on particular technologies. This is something that will be no surprise to anyone attending HIMSS 2014. However, there is a human element that brings value to our clients, communities, and society that goes beyond any one vendor. It is the reason why many individuals seek to be a Healthcare IT professional. Our passion and commitment to the human connection through Healthcare IT is the force that pushes our innovation and improvement forward.
Information Technology (IT) has improved many things in today’s world – Internet, smartphones, cloud solutions, etc. It allows us to work more effectively with the resources we have. It allows us to discover and connect with people and knowledge outside of our day-to-day lives. Whether you are an engineer, computer scientist or other technically minded individual, there is a pull to work in the technology sector. It is the allure of continuous problem solving and manifesting the things we can only at first imagine.
Healthcare is a very real and tangible thing; it impacts individuals, our families and our communities. It touches every person and every phase of life. We empathize with others’ pain and journey through life. Healthcare professionals use their skills and training to value and promote life.
Those who choose to work in Healthcare IT are seeking a higher calling by leveraging technology to improve & save lives. Healthcare IT is the invisible glue that brings knowledge and innovation into the hands of healthcare professionals. It is not always a glorious profession. The road is long and there are obstacles around every corner. It demands ingenuity, a merging of technical and medical skill, dedication, patience, and collaboration. Those who successfully navigate this space with their clients can expect the rewards of transforming patient lives.
The value creation of this passionate group of professionals might be hard to quantify in one metric, but its impact is felt across the healthcare industry and in people’s daily lives. Because it’s about the human connection.
According to a recent article by Jennifer Bresnick on EHRintelligence.com, 51% of physicians regularly use tablets as mHealth tools. Are you impressed with that number or surprised more people aren’t using tablets in the healthcare industry?
The rule of thumb for healthcare technology is that adoption is generally about a decade behind commercially available technology. That trend seems to be changing – especially when it comes to end-point devices. Tablets became popular in 2010 with the first release of the iPad. Just four years later, more than half of hospital physicians are using tablets on a daily basis for work. In fact, most physician lab coats even come with a pocket large enough to fit a tablet.
So what is it about end-point devices that speeds the adoption process? Well for starters, most people use a smart phone or tablet in their everyday lives. It’s not a stretch to think about using your at-home device for work and vice versa.
Tablets specifically give physicians a convenient, fast, and easy-to-use way to “read journal articles, conduct research on patient care and email with colleagues”. If you’ve ever tried to read an annotated journal article on your smart phone, you will quickly learn to appreciate the 4x screen size of a tablet.
While some healthcare technology giants seem to shy away from end-point device adoption, the users are telling the real story. It’s clear that physicians are ready and willing to use tablets and smart phones in their clinical workflow so it’s up to technology providers to make the transition as seamless as possible.
Network Neutrality has been an ongoing issue for the past few years. While an FCC regulatory issue, it has tremendous implications for Innovators in the Healthcare IT space. Essentially Network Neutrality can be distilled into two positions:
1) If Network Neutrality holds true then access to all data on the web is created equal. Everyone has access to the same information highway.
2) If Network Neutrality does not hold then Internet Service Providers (ISP) can limit access to certain Locations or content providers. In other words, now the information highway has HOV lanes and the internet service providers decide where the HOV Lanes go.
Lets talk about what this Means if you use the internet.
Imagine that you want to go to a news website like FOX News or CNN (a content provider). Comcast, the Soon to be even more dominant ISP in the U.S. (http://news.cnet.com/8301-1001_3-57618674-92/not-worried-about-comcast-time-warner-cable-you-should-be/), owns NBC news and wants you to go to their website instead of FOX or CNN.
Without Network Neutrality being enforced, Comcast can give you fast access (HOV Lane) to NBC while giving you slow access to other news sites. As a user, all you see is that it takes 10 Sec. to load each page on FOX’s and CNN’s websites (remember dialup?), while NBC loads at lighting fast speeds. You might just end up changing your behavior and start going to NBC because “it works better.”
The next thing to consider is how does the ISP decide what content providers get preference?
This is not and will not be transparent to the end user, you. A realistic scenario is that ISPs will charge content providers to have preferred access or HOV lanes to their sites. This means an added cost and burden for content providers. The ISPs are already starting to do this (http://money.cnn.com/2014/02/21/technology/verizon-netflix/).
One of the reasons the internet has created so much economic growth and innovation is because it levels the playing field between established companies and new entrants. Almost anyone can start a business or try out a new business model for relatively low cost. And today, more than ever, the internet is how we connect to others, how we learn and access information, and how we execute business.
Lets talk about how this could directly impact healthcare IT innovation.
Small hospitals and specialty practice groups often complain about large EHR vendors because:
1) they are prohibitively expensive
2) they do not meet their specific needs.
Recently there has been an emergence of Cloud based EHR Solutions and services. They are more tailored to the needs of the different practice groups and can often be provided with very competitive pricing models. These companies are helping to both lower healthcare costs and improve quality of care.
These cloud based solutions are highly dependent on the performance and connectivity of the internet connection by which they can be accessed. It is fully plausible that without network neutrality, these cloud based solutions could be crushed or at least their growth could be stifled. With slower connection speeds, these cloud based solutions might be unreliable for certain healthcare applications where time and latency matter. Larger EHR vendors can afford to pay the ISP for improved connection or the large EHR vendor could pay so that their competitors performance is degraded (but that would never happen, right?).
Without network neutrality enforced, small businesses will suffer and be at a disadvantage to bigger players. The playing field will no longer be level and this ultimately will hurt new businesses, new technologies, and new business models from having a chance to succeed and improve healthcare. So take note next time you hear about network neutrality, it may seem like something small and technical but the outcome of this debate will have a big impact on anyone or any business that uses the internet. And with regards to healthcare IT, it has the chance to affect the cost and the quality of care we can deliver in the U.S.
What more information on how network neutrality can impact health, click here.
LATEST Network Neutrality Update:
“Comcast, the country’s largest cable and broadband provider, and Netflix, the giant television and movie streaming service, announced an agreement Sunday in which Netflix will pay Comcast for faster and more reliable access to Comcast’s subscribers.”
For more information on Netflix paying Comcast for faster speeds click here.
An emergent trend at HIMSS 2014 was the concept of enhancing care team communications. This translates into getting targeted patient information to the right group of clinical professionals for an event or alarm. Interoperability between vendors played a major role in this since it requires taking data from data sources, passing it through a data aggregator (often referred to as a middleware vendor) and delivering the solution either to a dedicated piece of hardware or a particular app or website (a bring your own device, BYOD model). We also began to see vendors add optional functionality to their core services. These optional services included rules engines, analysis services, automated clinical decision support protocols and algorithms. Medical Informatics is dedicated to being part of this overall market solution, fitting in along various points of the data continuum to help improve care provider communications and the quality of data they can access.
Overall there was an emphasis on nurse communication rather than physician communications. Vendors offered a range of products and services that aim to help hospitals meet the 2014 National Patient Safety goals on alarm management.
Trying to sort out vendor alliances and product offerings to enhance care team communications can be a daunting task. Below are three examples of how vendors are aligning themselves and adding value to particular steps in delivering care team communications.
Predictions for HIMSS 2015
Looking forward to the next year, we expect to see more vendors transitioning from care communication tools to focusing on more providing “better information” to care providers. This year we already began to see hints of filtering data with rules based engines and “algorithms in development.” Quite a few vendors were offering sepsis decision support solutions or new ways to visualize data found in the existing EMR systems (this included redisplaying vitals or patient chart information). With this years’ communication developments combined with upcoming trends these advancements will greatly improve care provider communications and the quality of data they can access.