Margin

I grew up in a family where the expectation was clearly set that you would advance in knowledge beyond what the teacher was teaching at school, the preacher taught on Sunday’s, or any coach could provide.  It was your responsibility to grow in wisdom.   I have carried that thru into my adult life by maintaining a daily “quiet time” to read, study, and grow - setting aside 45 min to an hour each morning. (which happens to be the quietest time available in a house with 4 young boys.)  

A few weeks ago I started a study called “Balancing Life’s Demands” which discusses mental, physical, emotional, relational and spiritual balance.   The study uses the word “Margin” and defines it as the difference between what needs to be done and the time you have to do it.  I will have yet another birthday soon….not real thrilled about it…..so the identification of what one would call balance or margin is becoming a more focused effort.    

The ironic part of this life assessment is over the past 14 years, I have consulted with dozens of hospitals on defining margin for their organization. I analyze the obscure data generated by specific variable workflow activities and give recommendation on utilizing technology to enhance it.  The software we developed automates much of that process and enables continuous improvement.   Aperum uses data visualization to identify the often misunderstood work load driven form theinconsistent demands on their care teams generated by patients.  

I keep telling myself this life assessment should be a no brainer - life margin should not be elusive or nebulous.  I have built an entire business on designing “at a glance visuals” – where the metric quickly and effectively means something to an organization. However, it’s easy to say “I prioritize my family and church first” but if you look at the quantifiable data of hours spent per week – it’s not really a balanced metric.  (Same is true in nursing if you analyze where they spend the most time – you will find it’s not at the bedside so the perception is the main priority is not “direct” patient care….but that’s another blog.)

Strangely enough, I was a week or so in to this new study when Ed Marx posted his blog Bank Life, Not Vacation Days.  I loved that he had thought of a metric for evaluating whether or not he was in check for his commitment to balance – PTO hours accumulated vs PTO hours used.   A simple and easy to define number that encompasses a lot of information.  That’s the key – everyone knows that you have fewer PTO hours than you do total work hours – so it’s not a 1 for 1 equivalent.   It’s a predefined measurement of additional time away from work. Our payroll company generates that automatically and posts it to our online account – I honestly have never looked at it.  Not because I am pretentious and think the walls would fall down without me (I travel enough to know that my team has the operations side handled).  Mainly, I love work and I don’t really think about it unless prompted by my husband that a vacation would be nice.  I took a look after reading his blog…..let’s just say I booked a vacation next month. 

Thanks Ed.

If you are in Health IT and are not familiar with Ed’s blog  –CIO Unplugged –  he is a consistent blogger that has a way of communicating things that present more than just HIT initiatives – he gets “real”.

Hospital CIO series: Steve Huffman of Beacon Health System

I have decided to do a series of blog posts on hospital CIOs perspective on data and analytics and vendors…. I have talked to a lot of industry people (which has been fantastic fun and really great mentorship for me) but now really want to focus on what does the hospital want, need, think…..I believe that we, as vendors, focus a lot on what we think they want and what we think they need. In the world of analytics – there is a lot of newness so there is some providing them with what we “think”. However, how many times are you in a hospital each year trying to gain perspective from end users and from patients? How many times are you actively seeking to identify how your niche really applies to the day to day activity of the nurse or patient?

Recently, I was sitting at Denver International and playing on twitter. A CIO, who always is insightful, was posting a series of tweets on what not to do in a web ppt. As he published his disdain for vendors use of the popular sales medium (I was feverishly taking notes to send to @sphere3kyle) I thought – how many times do we as vendors believe we are enlightening a hospital. I was so inspired, I emailed him and he graciously agreed to chat on the phone with me – what ensued was one of the best conversations I have ever had with a CIO. Probably because I wasn’t selling a thing – I was listening to the perspective of someone who lives it everyday and was willing to share his thoughts.

Steve Huffman has been CIO of Memorial Health System – now Beacon Health System (South Bend, Indiana) since 2008. Prior to working for the health system he worked for the “startup” Medical Manager/WebMD. I rarely call someone brilliant but interviewing him was a lot like when I interviewed Tom Herzog….a wild ride of ideas and statements that each in its own could define an entire blog post. I will focus on a few in this post and maybe pull a few out for another.

One statement that stuck with me (as a vendor and business owner) was this “CIOs who spend more time with vendors than observing what is actually occurring with end users are doing it wrong.” I think back to that scene from Backdraft when Kurt Russell tells whichever Baldwin brother that is “You’re doing it wrong – if you do it that way it will fly open and you will die.” How many CIOs go from meeting to meeting and instead of engaging the end users ?  They are stuck hearing it second hand. If they continue down the exhausting path of being segregated from the actual floor experiences and perspectives of end users and patients...they will in essence die from project failure or burn out. As a vendor my mind immediately went to, how do I facilitate that process more effectively - instead of standing up with a ppt.....

Steve's next statement I will take to all my startup friends.  “Not everything can revolutionize healthcare, and that’s ok.” His cynicism has grown as every excited sales person stands up with a vision of a revolutionary change provided by their product. This is completely contrary to what every academic professor tells you when creating a “High Profit Venture” Steve’s contention was – revolutionizing healthcare cannot be done with a product – it can only be done by those who are working in the hospital. The change is not a technology – the change is an action and while it can be enabled by technology it cannot be caused by technology. Not even the EMR is revolutionizing healthcare, its recording data….which is good but not the change agent needed to meet the expectations that are coming down from the government.

The last thing I asked Steve was for a real world example of how analytics has impacted his career. This was the most exciting part of our conversation. An analytics team was asked by leadership to examine why they were having so many readmissions in the Emergency Department. They began observing and analyzing the EMR data regarding the consistencies of the patients diagnosis. “I was sure it was going to be heart related....”Steve had no idea how heart related it really would become to him. The consistencies were not related to a medical diagnosis that could be healed with pills, the consistent diagnosis was alcohol and drunkenness. So to reduce the number of readmissions, Steve began to seek out where in the community individuals with this challenge could go for help. He found that the local shelters did not accept people who had been drinking or were on drugs – even in the cold weather. That winter a man died in a garage due to exposure to the cold. Steve said “I didn’t hear the audible voice of God, but I knew that He was telling me – you know too much to do nothing.” So Steve and a small team had a mission and set out to find a solution. He and his wife and the small team set out to start a ministry to provide a place to sleep, eat, and be spiritually fed for the down and out of South Bend Indiana. Several churches stepped up to help. Now Steve spends his free time feeding the stomachs and souls of those in need.

For us an experience created a mission for analytics. For Steve an analytics created a mission.  Sometimes it's not about "revolutionizing" healthcare but it's learning to care for others. 

Follow Steve @SteveHuffmanCIO