This recent comment about information technology implementation by a reader named Rob was so excellent it deserved re-running.
I’m a technologist. I’ve been implementing information technology
professionally for 25 years. I’ve been doing EMRs for the last five. There
are lots of ways this can go wrong, large or small.
1) Resistance: People hate change. Sometimes they’re correct. Most
often they’re a self-fulfilling prophesy as, without technologists
having support from above, and engaged knowledge from below, we end up
the scapegoat. You can’t computerize people. You can only make
computers part of their job. Just as you can’t make people fit a paper
form.
2) Hyper-acceptance: Problem-solving people with good intent come up
with brilliant ideas that ignore the basic nature of technology. Even
if you include all stakeholders, unless they trust a professional
technology staff, if they ignore good advice, if they simply order
technologists to do as they say, it won’t work. Information Technology
is really People Psychology, and the best of us know something about
both.
3) Technological Eeyores: A large percentage of technology
professionals are about the machine. They’re about the what and the
how. They’re not about the who. It’s easy to fall into the view that
the system was working perfectly before people got to it. Technology is
90% people. What are they doing? What is the real need? Can we do this
without adding a gadget? These are hard questions to ask, and the
broken and cynical among us won’t ask them. Sometimes they’re right
that no one will listen anyway.
It is said that technology is an artifact of all the compromises the
designers made to create it. I disagree. At its best, it is a living
thing that’s part of what people do; it’s an aspect of its users. It
can’t tell us what to do, though. Nor can it ask. This can all go
right, though. It can be successful.
That takes people. They’re expensive. That’s another thing. Can I,
in all candor, ask that we, as a society, stop seeking cheapness and
start seeking shared excellence? To me, that’s the real issue.
Rob here is spot-on.
A very experienced image scientist and engineer I used to work with said “Good enough at the right price will drive out the best.” But things are worse now: we aren’t willing to go for “good enough” any more — we want “just a little bit better at the right price, which of course is much less than the price of good enough much less excellent”.
The management culture in healthcare is all about compliance, not excellence. Nothing will change with respect to technology until this changes.