Friday, April 27, 2007

Deja Vu All Over Again

In my Jan 2007 post "Leadership Position in Health Informatics: MD's Need Not Apply?" I noted an ad seeking an informatics leader that spcifically excuded physicians. I wrote:

My colleague Roy Poses writes about deliberate malfeasance in the healthcare sector. I write about overconfidence and recklessness in management circles in the same sector, focusing on healthcare IT. This overconfidence is an equally expensive and damaging phenomenon that, like Roy's "anechoic effect", has unfortunately been an area where substantive, critical discussion is taboo. This taboo comes, I might add, at the expense of patients.

In this example, one can only scratch one's head at a management ideology that, in essence, operates on the principle that in managing technology investments of hundreds of millions of dollars and a major cultural shift to electronic medical records, a difficult shift that has often proven perilous, there's such a thing as too much talent within an organization.

... I finally reached the recruiter yesterday, and the the response I received was unexpected and disappointing: "the organization was looking for a nurse and they would not even talk to a physician."

I make that same observation today on this ad posted on the American Medical Informatics Association job board:

[Name] Health System is one of the nation’s largest private health systems. We offer outstanding career opportunities in an environment focused on excellence.

Director Clinical Informatics

[We are] actively recruiting for a Director for our Clinical Informatics team. Qualified candidates will:

• Be licensed or eligible for licensure to practice as a Registered Nurse
• Possess a Master’s degree, preferably in Informatics
• Candidates will have leadership experience in Informatics or related computer science/technology field
Nursing leadership experience preferred
• Have demonstrated innovative and strategic thinking skills

The reason I entitled this post "Deja Vu All Over Again" is that I held that exact role in the past at the very same organization a number of years ago!

It was not an easy position even for an MD with formal postdoctoral informatics education and significant experience in challenging environments (e.g., manager of medical programs and medical review officer in country's third-largest public transit agency) to hold.

I sincerely believe blanket exclusions of MD's from Director of Informatics roles via such ads is a strategic error for any healthcare organization, and its rationale (cost savings, winner of position already known, anti-clinician bias in the IT organization, or whatever creative rationalizations the organization can come up with) severely flawed at best.

It's quite sad to see a major healthcare provider continue to fail to adhere to "best practice" in healthcare IT management, that is, find a leader based on qualifications and experience, without excluding any medical stakeholder group from the applicant pool.

As I'd written in my prior post, this exclusion is anything but "above-board, state-of-the-art strategic and tactical planning for major healthcare informatics activities in a large healthcare system."

I find the continual repitition of mistakes in health IT leadership and strategy by healthcare organizations a true example of Einstein's principle:

Insanity is doing the same thing over and over again and expecting different results.

-- SS

4 comments:

Anonymous said...

As a former MD laboratory director who had to deal with physician-wary nurses on a daily basis, I wonder if this organization just wants a nurse for political reasons - e.g. to be able to claim to the nurses that "one of their own" is helping them with IT. If nurses do not embrace an IT system in a hospital, there is usually h___ to pay in trying to make it effective.

MedInformaticsMD said...

wonder if this organization just wants a nurse for political reasons

Perhaps, but I reiterate:

I sincerely believe blanket exclusions of MD's from Director of Informatics roles via such ads is a strategic error for any healthcare organization, and its rationale (cost savings, winner of position already known, anti-clinician bias in the IT organization, or whatever creative rationalizations the organization can come up with) severely flawed at best.

If an organization seeks a nurse and excludes MD's for informatics leadership for "political reasons", they are using the appointment to appease nursing into using an information system that has not sold itself to clinicians on its merits.

This is usually because the system is poorly designed, with poor human-computer interaction or other defects that make clinical care under demanding circumstances (e.g., nursing shortages) even more difficult.

Anonymous said...

There are probably a couple of reasons for seeking nurses. One being hiring many salaried physicians verses nurses would be much more costly for the facility - especially since IT spending in healthcare is far less than other industries. The other reason being that nurses have the most constant contact with patients and hospital operations on a daily basis.
Working in healthcare IT, I will say that IT usually has a few physicians part-time in the department and often consults with physicians on staff regarding clinical information systems. Their opinion is VERY important in decision-making. I suggest finding your IT strategic planning committee to find out how you can become more involved.

MedInformaticsMD said...

There are probably a couple of reasons for seeking nurses.

I don't think "anonymous" read my two posts on this topic carefully.

As I wrote in my posts, there always are "reasons" behind such decisions. It doesn't mean the "reasons" are strategically or tactically sound.

I suggest finding your IT strategic planning committee to find out how you can become more involved.

Example #2 why I opine that "anonymous" was not paying attention to the posting.