Keeping a cool head about HIE and HITECH

1 Aug

Use Emotion to Drive Adoption, Not Rejection, of Health IT, a recent post by Lygeia Ricciardi on The Health Care Blog, demonstrates why I am so intrigued with health information exchange in the first place: consumer perception.

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I’m not just a marketer, I’m also an armchair sociologist. This quote from Ricciardi is exactly why I am interested:

The struggle to control public perception will grow more intense as health IT becomes more mainstream via implementation of HITECH. It’s important to get the infrastructure, the policy, and the MESSAGING right if the public is going to participate.

There are many, many potential benefits to health information exchange, as Ricciardi enumerates in her post. And there are downsides too. Some of them may be ugly. All of this will impact health care marketers. We’ll be key in shaping and responding to the messaging that Ricciardi refers to.

That’s why I’m here: to follow along and see how this implemention is shaped for the public, and how consumers respond.


Conversations about the good

30 Jul

Marketing is still an ever-so-slightly dirty word in health care. To some, marketing smacks of sleight of hand, subtle deception and self-interest.

When I began my career in the marketing and PR department of an acute-care hospital, there were still practitioners in the field – and my organization – who felt any advertising or marketing for health-care services was unseemly. Marketing departments dedicated to communicating services to consumers came late to health care compared with almost every other industry: They were almost non-existent until the mid-1980s.

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Much of this reluctance against marketing and its most-visible tactic, advertising, is historical. For decades, the American Medical Association prohibited its members from advertising, originally due to concerns about medical quackery. Since physicians normally play a significant role in guiding and leading hospitals, this marketing stigma bled over there as well. In 1979, the Federal Trade Commission ordered the AMA to rescind its rules banning advertising due to concerns about potential price-fixing, opening the door to the eventual creation over the next decade of hospital marketing, public relations and communications departments staffed with dedicated practitioners.

Some of that stigma remains in health care: Marketing is “bad.” Marketing is not in the patient’s best interest. Marketing is selling. However, I would argue that in acute health care, especially the not-for-profit realm, marketing serves a greater good, informing consumers about services to save and improve their lives.

Much of hospital and health system marketing – my preferred term is marketing communications – is focused on wellness, education and helping patients find essential services and resources. Marketing health care is different than marketing just about any other service.  No one wakes up in the morning and decides to have a cardiac cath. Certainly, letting a potential Type 2 diabetic know about a weight-loss program is “good.” Reminding mothers-to-be about the importance of prenatal care is “good.” A lot of what is labeled marketing in health care is really about communication and education: What are the signs of stroke? What types of cancer treatment options are available in my region? Where can I find a doctor?

Health information exchange will only broaden and deepen these communication opportunities. As health systems begin to use greater amounts of data to reach greater efficiency and promote evidence-based medicine, someone will need to communicate those changes to the people affected, the patients and community. Will it be marketers?

Journey to the land of health information exchange

27 Jul

Doing means learning. Learning means mistakes.
— Jeffrey Pfeffer, Stanford Business School professor

When I first read that quote, long before I knew anything about Jeffrey Pfeffer, it sang to me. It perfectly describes my blog direction shift: I’m about to do something. I know it entails learning – that’s why I’m embarking on the project in the first place. And I know that learning necessitates mistakes.

Back in April, I read an appealing job description. I have 13 years of health care marketing experience, and I’m always looking to expand my knowledge and experience. The job title was “Manager, Health Information Exchange.” Since I didn’t know much about health information exchange at the time, I embarked on a journey to find out.

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By coincidence, three days later I received an email from my MBA program looking for students to work on an independent-study project for the State of Nevada’s Office of Health Information Technology, which is developing the state’s Health Information Exchange Cooperative Agreement, an initiative funded through the American Recovery and Reinvestment Act of 2009. I ended up assigned to lead a student team to explore communications planning for the state’s strategic and operational plan.

This led to reading other states’ plans, and webinars, and watching videos, and questions. I find the privacy aspects of health information exchange, or HIE, fascinating. How will consumers respond once an electronic health record that follows them everywhere is a reality? How will this data be used by marketers within individual organizations? CAN it be used by marketers, and under what parameters? What role will marketers play in communicating their organizations’ HIE policies? Will it give health care providers more time with patients, and perhaps a more personal experience? And perhaps most interesting of all, how will a shift to evidence-based medicine affect health care marketing?

So this is where the learning, and the mistakes, come in. So far, I’ve not been able to find much information on the marketing aspects of HIE – but given how much information is already out there about the policy, IT and operational issues, there’s a lot to comb through. Maybe it’s a non-issue – maybe this will have no impact on health care marketers.

But clues are emerging it might be of interest to healthcare marketers:

And what does the study have to say?

Referrals become an unexpected bonus
It turns out that the same time-saving benefit that brought
all of the EPSC physicians on-board the EHR transition was
also fulfilling an unknown need for referring physicians.
“We started getting a lot of referrals from new sources we’d
never even met,” says Herst. “Our referral base was growing
about 10 percent a year.”

Hmm. Let’s see what we find out.

Five readings to shape your management thinking

18 May

The spring semester, my first in the MBA program, is over — a rich time of learning. It was also rich in reading material, especially in Management and Organizational Science. I have an almost three-inch-high stack of paper to remember the class, with more than 368 pages of case studies, academic articles and news stories. (Not counting the textbook readings.)

When new (or familiar) management problems arise in my work life, I plan to seek out the wisdom of these readings, so I catalogued this treasure trove in a binder for future reference. I decided to create a Top Five most-useful/most-meaningful/most-interesting list while I was at it. You can find links to the original articles (sometimes for a fee) in the posts:

  1. Get Rid of the Performance Review! Samuel A. Culbert, a management professor at UCLA, is on a mission to revamp the performance review, with a book on the subject which came out in April.
  2. Case Study: Compensation and Performance Evaluation at Arrow Electronics. I especially loved the case studies. It was really hard to pick only one, but this one really got my ire up.
  3. Strategies of Effective New Product Team Leaders. If you need to build or rebuild a team, this article provides practical, concrete strategies.
  4. Evidence-Based Management. I titled my blog post My No. 1 Top Hit. It still stands. I’m now a huge Bob Sutton/Jeffrey Pfeffer fan.
  5. The Dean’s Disease: How the Darker Side of Power Manifests Itself in the Office of Dean. While this article may appear at first glance to narrowly focus on academia, it’s broadly applicable to any organization.

Five more readings which almost made my list:

  1. “To a United Pilot, The Friendly Skies Are a Point of Pride; Capt. Flanagan Goes to Bat For His Harried Passengers; Still, Some Online Skeptics.”
  2. Good to Great, or Just Good?
  3. “For Lt. Withers, Act of Mercy Has Unexpected Sequel: U.S. Officer Broke the Rules To Let His Men Take In Young Dachau Survivor.”
  4. The Men’s Warehouse: Success in a Declining Industry
  5. Treadway Tire Company: Job Dissatisfaction and High Turnover at the Lima Plant

The acrid aroma of burning rubber

26 Apr

I’m overwhelmed with a virtual stinky rubber smell just reading this Harvard Business brief case, Treadway Tire Company: Job Dissatisfaction and High Turnover at the Lima Plant. The phantom smell is symptomatic of the problems at the plant, which are multiple. Human Resources Director Ashley Wall needs to identify the root causes of line foreman turnover, and present a plan to resolve it. Stepping into Ashley’s rubber-soled work boots, here’s what I identified as the root causes:

  • Lack of training and preparation for new line foremen
  • Weak support from their superiors: general supervisors and area managers
  • Lack of firing authority/ability to impact union grievances
  • Burden of 12-hour shifts
  • Too many roles for line foreman/too many targets to meet
  • Apparent unresponsiveness of other managers – why is equipment not working at beginning of a shift?
  • Failure of supervisors/managers to act upon line foremen’s requests/suggestions
  • More effort expended on testing potential hires than training actual hires
  • High level of specialty knowledge required

Here’s a mini-breakdown of line foreman turnover by category:

  • Overall turnover = 46%. Almost half leave within one-year period.
  • External hires = a whopping 75% turnover! Half leave voluntarily, half involuntarily.
  • Internal hires = 40%. However, 62.5% of these leave Treadway involuntarily. Meaning that more than three-fifths of employees who were successful enough to get promoted get fired within a year? This points to major systemic problems, probably correlating to issues above.
  • Transfers = 50%. This could be really, really concerning. Half of the transfers from within Treadway leave? However, the sample size is small – only 2 – so this is one is least concerning of the three. However, it should be assessed again using more data.

So how should Ashley plan to address the issues and lower line-foreman turnover? She might want to explore the following in her plan:

  • A detailed budget analysis. The budget has been cut, leaving no money for training. But what is the cost of constantly hiring? Develop a variety of forecasts to show that hiring constantly to account for turnover rate costs more than training would. Forecast losses in productivity, increased time devoted to union matters, increased time for more FLT testing, etc. While only a hypothesis at this point, all this hiring has to cost more than training. Develop the data to prove it.
  • External or college hires are the MOST likely to fail. Turnover is 75 percent within one year. However, it’s important to continue to bring in college-educated potential managers. Propose a temporary moratorium on specifically recruiting external line foremen. Presumably, it costs more to recruit these people as well. Once internal problems are alleviated, the external program could begin again.
  • Focus training on general supervisors/area managers FIRST. These people seem to create the greatest impediments, are the least responsive, and have the most ingrained behavior. Make them share in all targets the line foremen have: We succeed or fail as team. Change needs to come from the top down. Focus on this group heavily first, then roll out …
  • Training for line foremen. Follow Ashley’s original training outline, and add modules in specialty knowledge. Continue sporadic specialty knowledge sessions throughout the year.
  • Review union grievance processes. See if there are ways line foreman can be involved in follow-up and firing decisions.
  • Consider shift adjustments. There were several references to 12-hour shifts causing illness as well as lateness. Twelve-hour shifts work great for some people – they like three days off – and not for others. Perhaps employees could have the option of whether to work 12-, 10- or 8-hour shifts. This keeps costs down and factory running 24/7, but also gives employees leeway. This type of scheduling option is commonly used in acute hospitals, which have roughly the same scheduling issues.
  • Consider giving hourly staff more say. Perhaps they can self-schedule, which would relieve line foreman. (This technique is also used in hospitals.) As Jürgen Dormann of ABB recommends, ask hourly employees for suggestions on scheduling, productivity, broken equipment and other issues. This could also lower the number of grievances over time and help foment better management/union relations.

By George, I’m impressed

21 Apr

It’s funny to consider my reactions to these cases. Recently, we read about Nordstrom, a high-end retailer with beautiful goods. After learning about its practices and how the company treats employees, I came to the conclusion that I wouldn’t want to work there. (Although I’m not in retail so it’s fairly unlikely.) And then we read about The Men’s Warehouse, an off-price men’s retailer, and I am thoroughly impressed. My only previous experience with the company is seeing the George Zimmer commercials, and being aware of the Reno store, but that’s it. And I came to the conclusion I would want to work there, that I would actually be excited to work there. (Although I’m not in retail so it’s fairly unlikely.)

What is so appealing about a men’s clothing retailer? Because it’s not about the clothing, it’s about the culture and the values, and embodying them as managers. George Zimmer has it absolutely correct: If you want your employees to treat customers well, you have to treat the employees well first. You have to value them.

Like my former boss, Lynn Atcheson (who seems to come up again and again on my blog), Zimmer not only espouses servant leadership, but also models it. I was shocked at Zimmer’s 1996 salary as chairman for the company he founded: $420,000. While that’s high compared to a wardrobe consultant’s salary, it’s modest for a chairman, even when adjusted to 2010 dollars. Like Lynn, Zimmer knows how important it is for management to “walk the talk” (an expression I actually learned from her). When I worked for Washoe Med, bonuses were not typical, and only went to the senior management team. When Lynn received her bonus, she shared it with each of us. Because of course, as she recognized, she would not be receiving the bonus without our efforts. How many leaders do you know who would do that? Zimmer has the same idea. He essentially told his compensation committee he didn’t need more salary. (And after all, he does have $100 million in stock. But many leaders don’t let that stop them from asking for more.)

Compare Zimmer’s salary with the disgusting pay package that the venal chairman and CEO of Abercrombie  & Fitch received in 2008. He also happened to be named one of the five Highest Paid Worst Performers of 2008.

My husband is an academic, so he never wears suits. So it was interesting to ask him if he’d ever shopped at The Men’s Warehouse. He said “Yes, I bought my blue blazer there” – which he only wears to one or two academic conferences a year, one of only two formal jackets he owns. So I asked him what he thought of his service experience there, which occurred almost 10 years ago. I fully expected he wouldn’t remember, given it was so long ago. And he unhesitatingly and enthusiastically responded “Excellent!”

Best validation I can think of for the veracity of this case study.*

* 2010 update: The Men’s Warehouse continued to grow its revenues over the past five years. However, in FY2009, revenues were down by 4 percent – given the economy, no surprise whatsoever. It expects to have single-digit profits in Q1 2010. Many of the people mentioned in the 13-year-old case are still with the company, including George Zimmer and Charlie Bresler.

Robin the Rabbit

14 Apr

Assumptions without evidence are dangerous, as outlined in the HBR Case Study The Layoff . Robin Astrigo, CEO of his family’s namesake company, leaps to the assumption, based on ONE quarterly earnings call, that he needs to lay off employees. His leadership team, based on Robin’s dictate, jumps to the same conclusion that yes, layoffs are the only option, and fails to adequately, soundly and rationally assess alternatives. Strategy, and a long-term vision, are both sorely lacking.

Robin’s emotional reaction to the earnings call – described as “excruciating” – appears to be dictating his conclusions. He also seems to live in fear of disappointing his dead father, the company founder, while not factoring in that maybe business conditions are different than in Dad’s day. Perhaps the company wasn’t even publicly held then.

The case says that Astrigo profits dropped by double digits – serious, yes, but the company is still profitable and has plenty of cash. We’re talking about one quarter’s earnings here, and he’s holding a drastic senior leadership meeting at 4 p.m. that day? If the situation is really that dire, the company should be looking at a long-term strategy to dig out, over a period of many quarters or even years. Heck, if it’s that dire, Robin should have started that process BEFORE the call. Instead, he’s just chasing the next earnings call.

There’s another investor-relations possibility why the earnings call was brutal – Wall Street doesn’t like surprises. It’s possible, although not detailed in the case, that Robin has not been forthright with analysts all along about what the company is facing, or giving sound earnings guidance, and therefore is now taking the hit.

Perhaps Robin needs to learn to cultivate Wall Street a little better. As Laurence J. Stybel and Maryanne Peabody point out in their analysis of this case, he should focus on speaking to long-term shareholders, à la McDonald’s. Rather than focus on the quarterly call, which is almost always bound to bring out a naysayer or two, Robin should focus on telling the company’s story on his own terms. One way to do that is to develop a well-honed, well-tested thoughtful strategy first, and then share it with the market via an analyst day or other meeting. He should also try to get himself scheduled as a speaker at as many investor conferences as possible. That way, Robin gets to tell the story of what the company faces on his OWN terms, in less emotional, less combative settings, and also helps adjust Wall Street’s expectations over the next few quarters.

Robin actually seems quite directionless and spineless. He worries about “what the board would think,” and what Daddy would think from beyond the grave. He fails to ask his senior-management team to question his logic or develop other alternatives. His formation of teams of two is a bad idea: that allows a little too much coziness in private dining rooms and not enough questioning. When someone like Marzita Vasquez rightfully questions the company’s strategy, it wouldn’t have been so easy for Bob Slater to shoot her down in a group of three or more. What are the odds Marzita will bring this up again in the larger group setting? With the exception of Vasquez, and non-senior leadership member Sushil Bhatia, Robin’s leadership team comes across as self-interested and simplistic – certainly not servant leaders.

Jürgen Dormann, not surprisingly, got it exactly right in the Case Commentary. Dormann, a real-life chairman and CEO, faced a similar situation at ABB – actually, a much direr situation than Astrigo. Dormann focused on consolidating leadership at the board level, shaking up the executive committee, opening up communication and asking for advice from experts – the employees of the company. Best of all, Dormann espouses servant leadership – Robin must model humility. Instead, he’s running like the proverbial scared rabbit.