Subterranean. Guerrilla tactics. Under-the-radar informatics.
Are there times when you feel like your organization doesn’t support you, or the projects you want to do? Do you feel like no one understands you, that no one understands what informatics can do? ARE YOUR COLLEAGUES ALL IDIOTS? (answers: yes, yes, yes, no)
Then, perhaps subterranean informatics is for you.
There have been times in my career, when, stuck in a rut, I have turned to subterranean tactics:
- 2000: trying to promote patient access to test results and progress notes to across many clinics in my organization, and getting nowhere
- 2004: trying to deploy computerized physician order entry (CPOE) in our hospital, but the software, and our clinical leadership were not ready
- 2013: trying to deploy “indications of use” for radiology orders and finding that the juice is not worth the squeeze, that good intentions and poor design are not good partners.
In each case, I pivoted to smaller, more achievable projects:
- 2000: Conduct a study about online patient-physician communication in one willing clinic, write it up and publish it
- 2004: If CPOE was not ready, help deploy nurse bar code medication administration instead, proven to improve patient safety
- 2013: Spend time redesigning EHR new physician/provider training, with an excellent training department interested in co-development
If you are stuck, take a hard look at yourself and think: WHY?
- Am I hard to work with? Do I need new skills?
- Is my idea too big? Do I keep hearing “no”?
- Is my idea not a strategic priority?
- Do I have a burning platform? Do I need to make one?
- Do I need allies?
Sometimes, asking these hard questions can redirect your efforts.
I need new skills. THEN: Learn. Sometimes you have to think outside your own box. Read like hell. Read Crucial Conversations. Or Managing Transitions. Or Good to Great. Turn on your learning mode. Build skills and alternative approaches.
My idea is too big. THEN: Minimum viable product. If your project keeps getting stuck in committee, or can’t get funded, or needs too many permissions, look how you can scale down. What is the smallest version of your idea that might work? Keep your project small and complete it. Then write it up. Write a 1-pager [blog post on 1-pager] that describes the problem, your creative approach, what you actually did, and how you measured the outcome. Save this write up in your resume or CV. Deliver this to your boss to demonstrate your capabilities. MAYBE: you are recognized for this work and are given more opportunities. OR you switch topics, looking for other opportunities. OR you start looking for another job. In all of these cases, you are moving yourself forward.
Not a strategic priority? THEN: Re-invent yourself or your priorities. Consider that you may have to re-invent your own job. No one says that you have to stay in your lane. Go exploring! You know your company culture and have a sense of what opportunities are available.
No burning platform. Do you need to re-read Leading Change?
I need allies. Find them in your organization or elsewhere. Are there peers with similar interests? A groundswell project that is popular with clinical colleagues that you could do yourself with low or no cost? A pre-intervention survey project so that you can demonstrate the need for your intervention? An analyst or trainer who you have befriended, who is willing to work on a small but interesting project on the side, where you can share the credit, while both of you continue to work your regular jobs? Can you make another leader grateful for the work you do for them? Maybe they will advocate for you at some later time. Do you belong in another department, or another organization?
Any one of these ideas may spawn an interesting project or a collaboration, even without a Boss’s explicit assignment or agreement. Rarely, a boss may be offended that you worked on something without authorization; more often a boss will be impressed with your initiative.
Good luck!
