MSIA: Sharing the lessons learnt: A vehicle for engagement and fast tracking eHealth adoption
There is a lot of stock in the listening to the lessons of failure. However, there is greater engagement and fast tracking of uptake of lessons when they are integrated with the stories of success.
The software industry is full of optimistic people. They are excited about an evolving and changing world. They often are working on developments that they can see benefit clinicians in the way they deliver care, and for patients in how their care and health can be improved. They are glass half full people. Some are happy when even the glass is only a quarter full. They are still excited about opportunity when there is more air in the glass than actual refreshment.
The Deloitte National E-Health Strategy in 2008 gave the industry great hope with its talk of:
- “Market driven” projects and solutions
- National infrastructure, legislation and standards
- A 10 year implementation roadmap: communicate, collaborate, consolidate
- An incremental and distributed approach to development and implementation of Individual Electronic Health Records
The National E-Health Strategy received further endorsement in 2009 with the release of The National Hospital and Health Reform Commission Final Report. Significantly, Recommendation #123 from the report states: “There is critical need to strengthen the leadership, governance and level or resources committed by governments to enable a National E-Health Plan.”
Leadership is the key lesson to moving Australia along an effective eHealth agenda. Leadership is different from management in that it inspires. Leadership finds ways that no one else has thought of. Leadership focuses on outcomes and strategies, how to get there with effective planning and consideration. Leadership is effective problem solving that uses problem solving as part of the engagement process.
One of my favourite business management books is Alexander the Great’s Art of Strategy by Partha Bose. Alexander’s leadership skills are unquestionable. This book is a great read as it provides many lessons in how to look at problem solving and strategy that gives one the best chance of success. It speaks of stories of success under great adversity and clear and articulate leadership. It speaks of how, in conquering an empire larger than the Roman Empire was to become, Alexander the Great was actually great at engaging, listening and respecting all opinions and ideas. This allowed his armies to be effective in quite difficult situations where his forces were considerably outnumbered, and to achieve the unexpected. The focus was about a successful outcome, what would prevent that, and how approaches could be used to deliver the desired outcome. This made it clear to his forces what they needed to d0, even when things became tough. The author provides a good historical account of Alexander’s exploits and at the end of each campaign point it discusses how the strategy and approach provides us with valuable lessons in problem solving and achieving success. By engaging the reader into a historical account — and quite a good story — it gives us lessons and inspires us to achieve greater things in our working lives.
The underlying premise of Bose’s narrative is to challenge any proposed strategy and look at how that strategy could fail rather than listening to the people who are only interested in why it will work. This is not a negative stance. Rather it is a dose of reality, looking at how to mitigate against the unexpected and often turning those into positives. It also allows one to get a sense of success as you realise you are now armed with greater tools and techniques than you previously were. It builds a team through all the ranks. This is particularly evident in Bose’s lesson of listening to the local goat herders and the front line foot soldiers. This lesson tells us that listening to the Generals while sipping tea in the tents well away from enemy lines does not give us the real valuable insights into local conditions. Wasting resources at the frontline is uninspiring, and not many others will want to join the frontline. Listening to those who know the conditions gives a better outcome. Progress and success brings greater participation than failure.
I am sure we all remember lessons that were uninspiring, negative, complex and irrelevant to what we were interested in. These lessons do not inspire us to change or participate. Being lectured at is uninspiring. White boarding, work shopping and exchanging ideas, arms the participants to ‘go and do’. When the lessons learnt process is to increase participation amongst vendors to get to a tipping point, lessons should show vendors what is possible. It should excite the market place which, to be honest, doesn’t need much to get excited. The lessons should show how easy successes can be achieved, while dealing with problems that can be resolved from working the problem over with like minded people.
Recently I was shown a list of some of the early lessons from the Health Identifier developments in the field. While it is important to understand, for example, the value of a middle name field in clinical software to improve patient identity matching, it is not that exciting, even to those who are glass quarter full people. To be successful in eHealth we want the market place to see the wave starting to form. Let us not give them reasons to not want to get involved.
Lessons have to be timely when there is a heightened sensitivity and interest. Leaving the lessons to some time down the track will make it harder to engage people to catch up when compared with having them going along for the ride from the outset. Many documents speak of the lessons learnt from the Health Connect days. I always found it hard to get a simple list of those lessons and it was not until in the last 12 months that something that sort of looked like a list surfaced. That is many years after the event. If we want people to be engaged and firing by 1 July 2012, we need to know the lessons as they are being learnt.
The premise of the PCEHR is the right information at the right time. Many electronic decision support systems designers talk about information ‘just in time’ or real time. Yet when it comes to information about the PCEHR program it seems that it is the wrong information at the wrong time.
The more effective the engagement, the more sharing of experiences, the more likelihood that the strategy will be challenged and alternate favourable solutions and successes will be found and implemented. Remember, if you are part of the solution you are much more likely to implement the solution.
Dr Geoffrey Sayer
BSc(Psychol), MCH, PhD
As well as being President of MSIA, Geoffrey is Head of Operations, HealthLink. He has spent the past 20 years working as an epidemiologist. For the past 10 years Geoffrey has occupied senior management positions in medical software companies.
Posted in Australian eHealth