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Culture Eats Strategy for Breakfast


I saw this quote yesterday on LinkedIn and it made me harken back to my “Captain Quality” days at the old HBO & company here in Atlanta. My interest in in TQM (Total Quality Management) was driven by what I saw in the field as a national sales leader for the mainframe group within HBOC. Talking and interacting with both customers and prospects it became clear to me that what we were creating in software wasn’t meeting the needs of the customers. What software we were producing were reconstituted versions of what we already had in a new wrapper. In hindsight, we allowed the pressures of being a public company to overly influence decisions around the products and the technology. Couple that with the fact that in “those days” we believed that our customer was the hospital and the physicians and they were, we begin to understand our current dilema. In my simple brain, I always considered the end user whether they are in admitting, in A/R, on the docks, to nurses and physicians were the focus of our efforts. Notice I said nothing about the patient/customer because at this point in our history they were merely cogs in the wheel of healthcare. All quality programs are built around their customers and removing barriers to producing a high quality product for the lowest possible price. My intent in becoming “Captain Quality” was to educate our people on not only the concepts of TQM but also how to we as an organization needed to view our responsibilities to our customers. In 18 months we trained every employee we had and I thought we were on our way. As it turned out it represents the worst failure I’ve ever had because while the training was a success, the roll-out failed.

The key to quality is data, and the courage to use it in a way that gets the best result. This is where culture comes in. As we all know, culture starts at the very top of the organization, which means the Board, CEO and direct reports, middle management all the way down to the janitorial staff. If any level doesn’t take the cause to heart and lives it and breathes it, the likelihood of success diminishes very quickly. In this case the top leaders were going to use the program as a method to trim headcount, as at the time our financial results were less than stellar. And while there must be a balance between your current reality and the direction you’re going, people have to believe that all the hard work that accompanies these kinds of effort will benefit everyone and most especially the customer. Focusing on the financial took precedent over everything else so the values and the processes we were trying to improve never really took hold. The old adage of success has many fathers while failure is an orphan is very fitting to my experiences. And while I hate that we didn’t get where we wanted to as an organization, the experiences and the history of what followed taught me many lessons, which still influence me to this day.

So the mission I started in 1990 still lives on here at G2 Works. I honestly believe that our industry is finally in a place where the concepts of TQM or whatever it’s being called today can be exploited. My biggest concern is that our industry is the only one I know where our data is both an asset and a liability. Most other industry’s data breaches certainly have market implications and legal fallout. Healthcare data breaches are in a class all their own and the full ramifications of which none of us truly understand as yet. To really get at lean concepts the data has to be democratized so decisions and processes that need to be improved can be in real time. I’m not sure as an industry we’re there yet which means that we may have to crawl before we walk and walk before we run. I’m not sure how quickly healthcare can get to real time but I do know that until you do we’ll find it hard to bend the cost curve down. The speed with which our industry is now changing is really breath taking for someone who has been at this for 35 years. When I first viewed the “Internet of Things” back in early 2000’s from work out of MIT my eyes glazed over with all possibilities. Then I remembered I was in healthcare. As all of us know the healthcare highway is littered with the bones of Technology Company’s large and small that believed that their product would be the silver bullet that our industry has been waiting for. Only to find out that healthcare isn’t simple and it’s always the last to adopt emerging non-clinical technology.

Will the next few years be different??? I really do believe so. My hope is that the work I started way back when may finally pay some dividends. If you’re at HIMSS16 – come see me at Booth #4443.

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