Do Hospital Executives Use Their IT Vendors as Scapegoats?

Mr. HIStalk, spurred on by a reader's comment about how hospital administers may use their IT vendors as scapegoats, responds with some pearls of wisdom. Copied below verbatim is first the comment followed by his response:

Reader: [B]laming vendors [for hospital inadequacies]: Hospital administrators seem to be using clinical systems as an excuse for poor outcomes instead of their own poor management and operational workflows. I have seen hospitals bleed money because they refuse to fix workflow while demanding to replace a current IT system. The attitude that a system should fix these problems is absurd.

Mr. HIStalk response: Why do people believe they no longer have to think?” Ever since systems were first sold. In my experience:

• Hospitals like the idea of solving a problem by buying something — a piece of equipment, the services of a consultant, or a software application. It seems so much more decisive than the unglamorous chore of fixing poor organizational habits or culture.
• Hospital project management is usually iffy and IT portfolio management and governance even worse. IT should not own or run any IT project except infrastructure, yet you see IT departments claim they are going to lead clinical transformation. Not likely.
• Once the switch is flipped, everybody walks away instead of starting the long-term work of wringing value out of the technology.
• Hospital buy applications to avoid confronting employees for subpar job performance and managers for poor job definition. Hospitals almost never fire salaried employees, so nobody feels much pressure to change.
• Every area within a hospital thinks they are too different to allow conformance (especially pediatrics and surgery). Every hospital with an IDN (especially the flagship one) is convinced that nobody has a better idea.
• All that said, it’s easier to blame your vendor and then dump them than to look in the mirror to see who’s really responsible. I rag on vendors because I know they could do better, but when you paint an ugly picture, it’s ludicrous to blame the paintbrush you willingly chose. Every vendor’s product is wildly successful in at least one site, so that pretty much validates that it works when implemented and used correctly.

There is little that I can say to improve on this set of assertions. I obviously endorse the idea that central hospital IT should mainly provide infrastructure. I also believe that most hospital CEOs and COOs are skilled primarily in managing hospital reimbursement, cutting merger deals with other hospitals, and planning new construction. They will obviously turf all IT projects to their CIOs who often have worked their way up through some hospital IT department. CIOs often tilt primarily to the technical side, which is bad, or to the managerial side, which is also bad. They will often buy one-of-everything and then can't integrate these diverse systems or purchase most of their major IT systems from a dominant vendor and end up with functionality deficits. Throwing federal money at healthcare IT problems will not solve them if managerial talent in a hospital is scarce or the systems themselves are inadequate.

Comments

[lis person]

The vendor is always the scapegoat.