To Far Ahead of the It Curve

1 January 2017

Should the CEO approve a shift to risky new technology or go with the time-tested monolithic system? by John P. Glaser F Daniel Vasconcellos after their squash game, Max Berndt drank iced tea with his board chairman, Paul Le? er. Max, a thoracic surgeon by training, was the CEO of Peachtree Healthcare. He’d occupied the post for nearly 12 years.

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In that time the company had grown – mainly by mergers – from a single teaching hospital into a regional network of 11 large and midsize institutions, supported by ancillary clinics, physician practices, trauma centers, rehabilitation facilities, and nursing homes. Together, these entities had nearly 4,000 employed and af? liated physicians, who annually treated a million patients from throughout Georgia and beyond. The patients ranged in age from newborn to nonagenarian; represented all races, ethnicities, lifestyles, and economic conditions; and manifested every imaginable injury and disease.

Paul – like other board members and some in Max’s management inner circle – was applying constant pressure on Max to follow the example of others in the health care industry: Push ahead on standards and on the systems and processes to support them. “You’ve got all the hospitals doing things differently. You’ve got incompatible technology that’s held together by sweat and ingenuity and, possibly, prayer. Just do what other institutions are doing. Common systems, broad standardization… It’s the competitive reality, and it’s the right long-term play! So, what the hell are you waiting for? But then the iced tea ized practices could have scary patientsafety consequences, and physicians had to be free to form their own judgments about which treatments were best for which patients. Lately, however, worrisome developments were eroding Max’s con? dence that he could hold out against Paul’s brute-force prescription.

Remember The African Queen? Days before, there had been a meltdown of the clinical information system at Wallis Memorial Hospital in Decatur. (Wallis was Peachtree’s most recent addition. ) Since Max had been lunching with his chief information of? er, Candace Markovich, when the alarm came through to her PDA, he drove her over to Wallis to investigate. On the way, Candace reprised her concerns about ensuring uptime and performance quality across Peachtree’s patchwork infrastructure. “More and more, I feel like Humphrey Bogart in The African Queen, trying to keep the blasted engine running on the boat,” she said. “So much of our energy and budget goes into just treading water. And the more we grow, the worse it gets. ” At Wallis, Max saw cold panic on the faces of the IT staff as they rushed around trying to repair and reboot the system.

Doctors and nursing supervisors stood around looking helpless or angry, sometimes a mix of both. Clinicians, having ? nally been persuaded to use information technology as a primary tool in delivering care, now depended on it to work reliably. When it didn’t cooperate, they – and their patients – were basically screwed. Now Max witnessed the routine nightmare that many doctors recoiled from. Talented, hardworking, highly paid people were being kept from doing their jobs by the too-unremarkable failure of what had become an indispensable tool.

Although everyone in IT was working diligently to ? x the problem, diligence wasn’t enough to keep disgust at bay. Wherever Max looked, he saw pain. “You’ve got incompatible technology that’s held together by sweat and ingenuity and, possibly, prayer. Just do what other institutions are doing. Common systems, broad standardization. ” of Wyndham Trust, the region’s leading retail bank and mortgage lender. Having overseen Wyndham’s rapid growth through mergers and acquisitions, he was an avid believer in brute-force standardization. His management team had honed the art of isciplined conversion, changing everything from signage to systems and processes in very short order, “like ripping off an adhesive bandage. ”

Squash courts weren’t the only thing vanishing from Max’s universe. So was a comfortable management consensus about Peachtree Healthcare’s long-term aims and how best to John P. Glaser is the chief information of? cer for Partners HealthCare System, in Boston; a senior adviser to the Deloitte Center for Health Solutions, in Washington, DC; and president emeritus of the eHealth Initiative, whose mission is to improve the quality, safety, and ef? iency of health care through information and IT. He is a coauthor of Managing Health Care Information Systems (Jossey-Bass, 2005). arrived, and Max used the interruption as an excuse not to answer Paul’s question.

They’d been having this conversation for several months – sometimes informally, other times in full board or committee meetings. Max listened, to a point. Eventually, he always fell back on his clinical experience. “You can standardize the testing of ball bearings for manufacturing defects,” he said. But as far as I know, you can’t – at least not yet – standardize the protocol for treating colon cancer. ” As a physician, Max believed that the last word in all matters of patient care should rest with the doctor and the patient. But as a CEO he believed in best practices. So his compromise position was to favor selective (Max called it “surgical”) standardization. Indeed, many areas of clinical treatment – immunizations, pharmacy record keeping, aspects of diabetes care – could safely be standardized around best practices over which there were few disagreements.

In other areas, though, standard- 30 Harvard Business Review | July–August 2007 | hbr. org And yet Max was also that rarity in medicine – a physician leader who recognized and embraced the value in technology. An early enthusiast of telemedicine, he had participated in longdistance, computer-assisted research conferences and consultations on behalf of his own and other doctors’ patients. He had easily been converted to the view that computerized, consolidated patient records were vastly superior to manila ? le folders scattered throughout various specialists’ of? es, subject to eccentric clinical and record-keeping habits. As CEO, he had shown consis- tent leadership in visibly championing IT-based innovation.

And he enjoyed a close, positive working relationship with Candace. Even so, all he was hearing from Candace lately was that the IT infrastructure was consuming so much maintenance energy that further technical innovation was becoming a luxury, an afterthought. At Wallis, Max had gotten to see the nature of the problem up close and personal. Luckily, the situation ended up being resolved without major consequences to patients – this time.

But Max was now convinced that something urgently needed to be done. The African Queen was headed toward the rapids. Medicine Is Different The day after the squash match, Max sat in a budget meeting in his of? ce attended by Candace and Peachtree CFO Tom Drane. Max wanted to know what it was going to cost to rearchitect technology across all of Peachtree’s facilities. Candace and Tom cataloged the results of a request for information Candace had put out earlier in the year.

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