Comfort is a tricky thing. We all want it, complain when we don’t have it, and build our long-term goals around finding it. Yet, for all its glory, comfort is most often found in our daily lives as a convenient way to rationalize the tough decisions we are forced to make. Comfort is effective because it bypasses complex organization dynamics: The best choice is usually the one that makes the most (or the most important) people comfortable. This has led to the phrase “I’d be more comfortable…” becoming the harbinger of death for new and innovative ideas everywhere.
So how does something become “comfortable”? The short answer is anything can be comfortable if it is readily available and scalable. Take Healthcare - if you need to do something patient related, use the EMR. If you need evaluate financial contracts, use the HCIS system. And if you need to track just about anything else, just use an Excel spreadsheet. These tools rose to prominence because they promised the highest level of availability (i.e. “everyone can use it”) and required hospitals to make an equally high investment to get access to that availability. This clever business model then incentivizes hospitals to create a never-ending cycle of “we bought these tools for everyone, so they should be the solution for every problem,” and shifts the burden of success from the tools
to the people using them. After all, it cannot be the tool’s fault because their capabilities are endless, so the real limitations lie in the skills and effort of the people using it. Once that alternative reality takes hold, a simple management equation emerges – the more people use the tools, the more comfortable they will be with them, the more comfortable they are, the more problems they can addressed using the tools. This mindset is fine if you’re a hammer looking for a nail, but hardly seems effective for the ultra-dynamic, people focused, world of healthcare.
The real question I think healthcare should be asking about their technology is – Does FEELING comfortable with technology provide the same value as MAKING us comfortable when we use it? So far that answer appears to be a resounding no. The proof? No one (at least that I’ve ever met) gets up in the morning and is excited to spending their day working on a spreadsheet or entering data into an EMR. That is because these ubiquitous tools, with all their touted capabilities and promises, are little more than one-size-fits-all tools for organizations. Like that free T-shirt you get at sporting event or conferences, it’s pretty apparent that one-size-fits-all doesn’t fit most of us well.
So how does healthcare break the cycle and move away from its comfortable one-size-fits-all technology? Honestly, I’m not sure it can right now because the switching costs are too high. But the industry can use new tools to find areas/processes where value of technology increases only as peoples’ effort decrease.
Spreadsheet based processes are at the top of the value list for two reasons:
1. The effort required to extended spreadsheet beyond their intended purpose (sorting and storing data) is very high and that creates several organizational problems.
2. The number of people that can quickly and effectively utilize spreadsheets is very small even within big organizations like hospitals/health systems.
In my opinion, spreadsheets may be one of the most tragic examples of “too much of a good thing” in the history of healthcare. At their most basic level, there is no better way to sort and store a small amount of information than spreadsheets – just type it in, add formulas and let the system provide the answer.
However, it does get slightly harder to use when the amount of information get larger…Is it better to add more tabs or just start a whole new workbook? Will the formulas link across all the workbooks? Did those changes save before the computer just froze up? (I really hope so.)
It gets harder still when the spreadsheets have to travel. What folder should it be saved in? Did the right version get uploaded/sent? Has anyone even looked at it yet? (I knew I should have turned on Read Receipts)
All of this anxiety and effort comes about because we’ve grown comfortable contorting spreadsheets to fit our purpose. Yes, they may be capable of holding and sorting 16,000 columns of data, but without the ability to easily personalize that information, a spreadsheet’s massive capacity is nothing more than the ocean gently rocking the boat while we lay there dying of thirst. Worse still, the act of contorting spreadsheets actually ends up becoming the main accomplishment for people in many cases. They proudly tout their Circ Du Soleil like efforts to create a new process built entirely around a simple spreadsheet and in doing so often don’t realize that so much of the time and effort they exerted was really done to work around barriers created by limited technology. But it’s also hard to blame them, after all its always more comfortable to promote the effort it took to clear a path, than it does to consider if that path was the best path to follow. It is like that old joke about Cold War astronauts – America celebrated the investment and innovation that went into creating a pen that astronauts could write with in space…meanwhile the Russians just gave their astronauts pencils.
For example, if administrator is tasked with doing a time study for physicians and clinical staff, they will almost certainly create the spreadsheet process in ways that feel most comfortable to THEM. This isn’t selfishness on their part, it’s actually logical thinking. After all, the administrator will be the one that is ultimately responsible gathering the data once the study is complete, so the more comfortable they are with the spreadsheet, the faster they can close the study. But the administrator’s spreadsheet process likely won’t feel very comfortable for the physicians and staff, and as a result they will be less inclined to actively participate. The lack of participation leads to both a longer study and more invasive maneuvers from the administrator to get the information (Yes, the dreaded “reminder emails” will be flooding your inbox soon). Then at the end when all the study information has finally been gathered, everyone collectively looks back at the whole process and only remembers how long and painful it was to do, and how much they aren’t looking forward to it next month. That’s where the REAL problem starts because the administrator, physicians and staff are now comfortable being miserable during time studies! They’ve stopped looking for ways to improve the process and instead resolve themselves to suffer one week per month. Then all the unnecessary time and effort required to do time studies every month transforms from the REASON TO CHANGE to a JUSTIFICATION NOT TO CHANGE. Now that is some irony that even Alanis Morissette could sing about.
The best solution I see to solving these issues is specialization. Healthcare needs to use spreadsheets to do the things they do best (just like they do with physicians) and start getting comfortable looking for innovation for their administrative processes.
The search won’t be a hard one as administrative innovation has already moved into healthcare. Krystal Ball spends everyday building new technologies that can be tailored to actually meet both the needs of individual people as well as collective needs of the organization. This is the new path of game changing technology – we don’t create one size fits all product, we create a product that fits YOU and then we do that process for each and every person. Its called scalable customization and you can find it in some
many places outside of healthcare. Look at your phone, and the apps you use every day: Facebook, Amazon, Netflix, Google…each of these companies works very hard to make sure each time you open their app, everything you see is specifically relevant and interesting to YOU. It should be no surprise then that they also happen to be the four of the largest companies on earth.
I’ll end by saying healthcare’s foundation is famously built upon the Hippocratic Oath of First, Do No Harm, but there’s a lesser-known quote of Hippocrates that’s I think also is worth considering:
“Healing is a matter of time, but it is sometimes also a matter of opportunity.”
So, the question for the healthcare world is - will time or opportunity bring you the most comfort?
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