Thursday, January 13, 2005

1001 Dalmations

When seasoned medical informaticists apply for hospital-based positions, they are often amazed by the diversity of negative or diversionary responses they receive. These responses are often tied around the themes of "you don't have enough experience", and often originate in the primal fear of the business IT types (who typically lack legitimate qualifications to be leading clinical tools implementations that directly impact clinical practice) protecting their own hegemony in the hospital MIS departments.

The variety and creativity of the responses is amazing. It's as if hospital management tries very, very hard to prevent themselves from hiring the people who can actually help them avoid typical healthcare IT debacles, for example as chronicled here.

I term this the "1001 Dalmations" phenomenon. One never knows what variation of the same set of spots to expect.

Here's an example that just occurred to a colleague with credentials comparable to my own. He's turned expensive clinical IT chaos and failures into major successes recognized by national figures in subspecialty medicine, implemented complex EMR in a cost-effective, team-building manner along with required work redesign in large multi-hospital academic and non-academic healthcare systems, and actually demonstrated improved outcomes and cost savings for the organizations where he's worked.

A large city hospital system announced a new position:

Director, Operations Improvement/Clinical Work Redesign
The Director will provide leadership, support, and guidance to the system during implementation of a seven-year enterprise-wide IT strategic plan. He/she provides operational input into the CIS Selection Process. The Director will serve as the primary contact and liaison for CEOs and their leadership teams, providing Clinical Work Redesign content expertise in the specified areas. The Director will be a Team Leader and Major Change Agent leading multiple Redesign teams.

The informaticist applied to the position, highlighting his having achieved recognized success while saving significant money for the organizations he'd worked for.

The following "1001 Dalmations" response was received from the recruiter:

Thank you for your message regarding the opportunity for a Director of Process Improvement/Clinical Work Redesign ... [Unfortunately], we are seeking someone who could not only assist in selecting and implementing the system, but who has significant process improvement/clinical work redesign expertise in a very large, complex academic medical center or multi-hospital system. Do you know anyone with those qualifications?
One sometimes could believe that seasoned people with formal NIH-based Medical Informatics credentials and superb resumes must come knocking on the CEO's door on a daily basis.

I leave it to the reader to determine what the Informaticist might have responded.

1001 Dalmations is but a specific species or instantiation of the more general phenomenon known as "healthcare mismanagement." Closely related are a variety of stereotypes and politics that impede informatics leadership in hospital settings, not to mention micromanagement of informatics professionals by hospital MBA types, a severe species of mismanagement in its purest form.

-- SS

1 comment:

Russ Maulitz said...

As usual, SS hits the nail on the head. Offline, he and I have discussed this phenomenon--one of several fairly stereotyped genres of HC mismanagement--on several occasions.

(Stereotyped in the sense that the spots change, but there's always a lot of them, and it's always a Dalmatian!)

Anyway, the reason this keeps happening is because no one--not Dr. Brailer, not Mr. Kennedy, not Mr. Gingrich--no one who's touting EMR, has it in his interest to blow the whistle on this constituency-mongering.

The particular flavor of constituency-mongering going on here, as SS implies, is an unsually pernicious one: it involves a standardized aversion to knowledgeable "science types" by a group that long ago wrested control of hospitals from physicians.

Except in a few cases. It will be interesting to see whether, in those few residual (and in some cases recrudescent) instances of physician-run hospitals, the outcomes are different, vis-a-vis EMR implementation and effectiveness. Watch this space!