Why wasn't I consulted?

The need for autonomy is one of the most basic and powerful intrinsic motivators of human behavior. One sees this in the plaintive cry so often heard in institutions, large and small:  Why Wasn’t I Consulted (WWIC)?

A recent experience where I work is a good example. Our medical center has two separate electronic medical records, one for the outpatient world and one for the inpatient world. They do not communicate, with obvious negative impacts on the quality, safety, efficiency and cost of care. In addition, we had experienced increasing difficulties with vendor support for our outpatient record. The need to look for an outpatient record that was better supported, communicated with the inpatient record, and was affordable seems obvious, and that’s what happened. But it didn’t go well. The 200+ clinician users on the staff - the same group who complain most loudly and constantly that the system is not user friendly, that it is inexcusable to have two systems that don’t communicate, that problems take forever to resolve, that upgrades inevitably break important pieces - was amazingly unified in its opposition to the transition.

What happened? They weren’t consulted.

Instead of informing the user community about the plan to find a replacement outpatient record at the outset, and then soliciting input about what aspects of the current system needed to be preserved, what needed to be changed, and what improvements they would like to see, a very small group (with only a minority presence of actual users) met privately and winnowed the 200+ eHRs on the market down to a short list of two. At this point, the project went public and providers were asked to attend sales pitches (but not test by using) about the two products and give input. There was no system for collecting input about specific aspects, no information beyond the sales pitches were given, the selection criteria used to pick these two candidates was not described. Provider input was claimed based on the presence of several providers on the IT work group.

At this point, providers who could rarely agree on whether it was summer or winter were suddenly singing in unison: 

(queue music)   Why Wasn’t I Consulted?

The project has since disappeared from public view, and it’s status is unclear, suggesting perhaps that learning did not occur, and that the users are again not being informed - let alone consulted - about next steps. (Update: the plan is on hold, but no announcement was made to that effect.)

Apart from the obvious management lessons one could learn from this, I think the role of the internet and the cultural changes it has fostered should not be missed. Thirty years ago, there was no reasonable way to consult or involve members of a community in decision making. It was too cumbersome and expensive to disseminate information that needed constant updating, and there were no tools for many:many communication. The internet has changed this. (See for example: Here Comes Everybody,  The Information,  The Difference,  Wikinomics,  Small World Networks,  Swarm Creativity,  Open Leadership,  The Future of Management,  The Future of Work,  Digital Strategies for Powerful Corporate Communication,  Culture of Collaboration,  Cultivating Communities of Practice,  Goal Play,  Designing Care,  Transforming Health Care,  The Innovator’s Prescription among others.) The infrastructure and institutional costs of democratizing information and providing open and archived communication and collaboration tools are infinitesimal when compared to the resultant efficiencies, growth in innovation, improvements in products, and enhanced engagement. The cost of NOT opening up is simple: marginalization and obsolescence.

(I am indebted to this essay by Paul Ford for the idea for this post.)



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