Or maybe it is CT Lin’s fault. He’s the one who ruined healthcare anyway. He probably did this too. Moreover, his very poor use of Bing.com’s Copilot for drawing images results in the hilarious examples in this post.
You’re an expert! What could go wrong?
Let’s say you’re a physician informaticist. You’ve spent years training in your clinical specialty. Maybe you’re even a subspecialist, like a pulmonologist. That’s TWO boards that you’re certified in. Then, because you KNOW that clinical informatics is the way of the future in medicine, you also train and then board certify in Clinical Informatics. You ARE the doc of the future! Treating patients, teaching colleagues, designing templates and tools to make the right thing easy, to provide outstanding patient care, not only for yourself, but also for your entire clinic, your specialty, maybe your entire organization of 4000 providers.
Whew!
And yet, there are days like this.
Today is a Friday, and you’re staring at the clock. With a sinking feeling, you’re waiting for a busy clinician to deliver to you all the clinical specifications for a new SmartSet for template orders to make it easy to order the right pulmonary function test or inhaled steroid. Or, you’re waiting to design a brand new version of a progress note that has “disappearing help text” that guides clinicians on writing a concise, precisely-worded note that meets all the quality metrics, is easily understood by patients and colleagues, and points the way to high-quality care of a specific disease, say, asthma.
The project was SO PROMISING. This would improve care of asthma patients, reduce unnecessary variation because of the just-in-time nudges you’d construct, increase use of inhaled steroids and increase the fraction of asthma patients with an up-to-date PFT.
You had promised to build the tool so that it could be in use by Monday of next week. You had set aside all of this Friday afternoon to review the subject matter, design some options, consider teamwork and workflow, and then with your ten magic fingers on your magic keyboard, make something amazing come to life. You are a physician builder, and a master of both clinical medicine and the palette of informatics technical tools.
BUT you are staring at the clock at 3pm on Friday,
and no email or document from your subject matter expert has yet arrived. You can’t even get started.
The department chair is waiting to see if you will deliver what you promised. Your reputation is on the line. In fact, because of cutbacks, they’re considering reducing your informatics protected time to work on projects like this because “we just need more bodies to see more patients and generate revenue. We are in the red.”
How did we get here?
I am surprised at how often a version of this story comes up, in my mentor/mentee conversations. Has this happened to you? A better question: how often has this happened to you?
PAUSE HERE. What would you do about this situation? Write it down or say it out loud to yourself before reading on. How do you compare?
What did you do about it? Multiple choice:
- Go work somewhere else
- Pick up the phone and YELL: “YOUR LACK OF PLANNING IS NOT MY EMERGENCY!!!” There. Feel better? Unfortunately, you just made the problem worse.
- Send an ALL CAPS text or secure chat to vent your unhappiness
- Feel guilty that you’re not doing a good job even though it’s not your fault
- Mumble something about this to your mentor
When you’re done venting, stomping your feet, and popping more omeprazole to treat your enlarging stomach ulcer, let’s live the dream and design a future where this happens less often. After all, you can’t completely extinguish it. Like a zombie, this behavior always comes back to life somehow.
Some of the following ideas are good general principles. Others you pull out in extreme cases of non-cooperation. Choose carefully.
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Try this: Start with Why, seek the Win-win
We are all working too hard. Your work colleague is probably balancing several top priorities. If they believe YOU are nice, maybe they’ll work on your project last and do some other critical work. How to change their mind or their priorities?
We sometimes forget to talk about WHY when requesting work.
Stop, and provide the WHY. What is the impact to the patient? To the organization? To you? To them (WIIFM: What’s in it for me)? One of these is sure to resonate with your work colleague. If none of these resonate, then perhaps you seek a different colleague in the future. Seek a win-win arrangement. When you work together on this, what will be the result? Will life be better for both of you? Try your best not to make this a win/lose proposition (e.g. You lose because you volunteer a lot of work for no recognition, and then I win when I build this fun tool). Providing the why and making the effort to be on the same page costs NOTHING and be EVERYTHING to the success of what you’re trying to do.
Try this: Anticipatory Guidance: Precision AND consequences
Your email or in-person request. If you plan to work on this on Friday afternoon, don’t say “Can you get this to me on Friday?” to which your colleague will be happy to start on this at end of day Friday and get it to you in the evening. You spend all day thinking you’ll receive something in the morning, but then get mad when the email arrives very very late, in your perception.
Instead say: “I need the statistics and the specific order details by end of day Thursday March 24th.” Better yet, the Subject line of your email reads: “ACTION NEEDED: need all proposed elements by 5pm Thursday 3/24.” Your email is slightly less likely to be missed or ignored. And if they DO ignore it and deliver late, hold to your consequences. “Then, it will not be built. I have other deadlines and I will have moved on to other projects.” It may feel terrible both to you and to your colleague that time. If you are serious about the consequences, your colleague will learn this about working with you. Or if you are not serious, they will learn this about working with you. Either way, your behavior shapes the relationship.
Try this: Align incentives, apply transparency
In a multi-person project, ensure that the project sponsor knows who is doing what, with which deadlines. Ideally, your work colleague for whom you depend on content also directly serves the same boss. Unfortunately, this is often not the case “I don’t care, she’s not the boss of me.” In these situations, you have to apply creativity: can you rely on your personal relationship to this person? Can you get your colleague’s actual boss to care? Can you trade something your colleague really wants for something you want? “If you deliver on time, then I will fix your template the way you always wanted.”
Try this: Set mile markers and leading indicators
For a multi-week project, set a regular meeting time, even if it is 10 minutes at 8am once a week. Set mini-deadlines (mile-markers) for each person each week, and the entire effort seems more manageable to everyone. And, you get a warning if someone is NOT on track.
Try this: Design for the minimum viable product
Projects tend to spiral bigger during design meetings. “Oh, I know! I’d like it to be painted blue on one side! And, then it should have a disco ball spinning overhead!” Instead, you should be looking for the MVP: minimum viable product. What is the absolute minimum set of functions this thing needs to be immediately useful? “Once we deliver and use the MVP, then we can come back and add your ‘disco ball.’ How would that be?” Then, you’ve got a smaller set of requirements, and better chance that your colleague will finish their requirements.
CMIO’s take? Take your ulcer-generating, teeth-grinding interactions and go upstream to design any future interactions. Anticipate. Be precise. Set consequences and back them up. Seek win-win, Start with Why. Align incentives. Set mile markers. Design for MVP. Yes, these are platitudes, but as per the stories above, they also work.
