If Clinical Systems Were The Space Shuttle, Would We Keep Launching Despite Frequent Crashes?

Inside Healthcare Computing has graciously agreed to make previous Mr. HIStalk editorials available from its newsletter as a weekly “Best Of” series for HIStalk. This editorial originally appeared in the newsletter in March 2006. Inside Healthcare Computing subscribers receive a new editorial every week in their Electronic Update.

Michigan’s Trinity Health has put their seemingly successful $315 million clinical system implementation on hold. Their announced reason: they are fine-tuning their plan to drive clinical improvements and implement evidence-based medicine.

The industry has been hard-selling “clinical transformation” for years. Hospitals repeat the mantra dutifully (although none ever seem to declare themselves transformed – like vendors’ claims of integration, it’s always just around the corner.) Post-implementation hospitals aren’t necessarily improved clinically or financially. The only predictable transformation is that hospital dollars unfailingly get transformed into vendor dollars.

Who do you blame? Surely not all vendors and hospitals are incompetent. Is clinical transformation (assuming such a thing exists) simply impossible to manage successfully? Maybe the best analogy is the space shuttle.

The space shuttle orbiter is supposedly the most complex machine ever built despite its now-antiquated technology (there’s a parallel right there). It’s not just a flying machine – it’s an industry of pork barrel politics, fat cat contractors, jobs, and national pride. Somewhere in the mix might be a smidgen of science that bears little resemblance to the original promise of an inexpensive fleet self-funded through technology commercialization (Tang, anyone?) We walked on the moon but settled for a scientifically irrelevant low-orbit taxi.

Like the space shuttle, clinical system projects rarely unfold as optimistically planned. They require painstaking planning, unerring execution, outstanding change management, and unwavering focus. None of these are the long suit of the typical healthcare organization. Instead of a handful of astronauts, thousands of busy employees have to be convinced to change their comfortable routine. When the going gets tough, the formerly committed VPs disappear and leave the battle to the IT techies.

Sometimes the project explodes while you watch, like Challenger or Columbia. Even when it doesn’t, interest wanes once the flashy launch is over.

If the shuttle crashed 90% of the time it took off, would we keep launching and irrationally hoping for success? We’d send the engineers back to the drawing board, or maybe even get some new engineers, or ground the program. Or, perhaps we’d just declare the whole thing undoable and settle instead for a high-value subset of the grand plan more within the scope of our capabilities.

Where hospitals are different from the space program is that we don’t learn from the industry’s widespread failures. Hospitals quietly shell out precious millions and unreasonably hope that they’ll find the success that has eluded a long string of predecessors buying the same short list of products. Reality eventually sets in, expectations are lowered, and attention moves on to something else.

Sometimes imaginary victory is declared at HIMSS, proclaimed by ventriloquist vendors whose lips barely move when their customer speaks. One thing’s certain: you’ll seldom hear a discouraging word from consultants, member groups, or rah-rah magazines. They make money from the illusion of mass success.

We need success stories that go beyond a glitzy lift-off. We need someone to actually be transformed, not just implemented, and for those who weren’t to tell us what went wrong. The path to clinical transformation is lined with the smoking debris of earlier missions, each of them offering lessons for those willing to listen.

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