As the saying goes among software industry veterans, the cost burden of a highly customized product is applied to the customer “up-front and over-and-over, every day, inside and outside.”
Hospitals and other companies need to be somewhat aware of commercial software development economics, as it applies to buyers, since they are buying so much IT these days. A software product company does best when the high cost of developing the software is spread across many customers that use the same software as it is. Customization changes that. It requires each customer for which customization is done to bear the distinct and direct costs of that development that is uniquely done for them. There may be ways to economize the process, but it becomes substantial when much of the delivered software is customized. When the Total Cost of Ownership (TCO) for the software customer is considered, as it should be, customization costs becomes a big concern.
That is broken down as:
Up-front – The customer starts paying from contract-signing, before they can even access the product and long before they can really understand what will result from the process and assess its value.
Over-and-over – In that mode, customers usually think up and request additional changes from time to time. That then costs additional project dollars, and changes sometime become a continual process.
Every day – All enhancements that the company routinely makes to its base product must be specifically tailored to the unique version each customer is using. Looking at such effort for all of its customers and the additional overhead of tracking what software changes everyone has, this customization-focused approach, overall, is a more expense way to run the business of the software provider. That ongoing additional expense is reflected in all the pricing and fees the software company charges its customers.
Inside and outside – In addition to the costs paid to the software provider (outside), a significant customization effort requires that the hospital’s own (inside) employees – often some very busy key employees – are required to spend time documenting their needs. They must explain their work to the software companies analysts and review the output of various stages of the custom development lifecycle.
Some may suggest, and others believe, that major customization is the only way to obtain software that users in a variety of hospitals can effectively and enjoyably use in their particular environment, but that is simply not the case. Users don’t customize Microsoft Office applications like Word and Excel but are presented with many options to pick preferences and configuration settings, and provide localization data used by the application. Long term, users and the companies that buy applications come to understand that very particular choices that are applied in major customization efforts don’t really change the value of the use of the application in ways that could not have been done with truly good workflow and user experience design, by professionals, up front. And, overall, the idea that customization is some kind of norm has to be considered in a broader context. What other non-software products that healthcare providers, or the individuals who lead it, buy are customized ? Probably not many because of its being cost-prohibitive when the impact of custom development is considered against what can be achieved with readily available options and configurability.
The long-term, strategic and most insidious cost of customization is the bad habit that it enables among management. Faced with a truly innovative product, which necessarily represents change, leaders and staff in hospitals can, and do, customize their new products back to the familiar appearance, sequences, artifacts (forms,reports, etc.) and activities that they have used for decades, nullifying expertly-designed process innovation. Because that which is familiar is relatively comfortable. Can anyone calculate the total cost of healthcare’s infamous resistance to change ?
The approaches outlined below have earned for our ActionCue® Clinical Intelligence product very high user satisfaction scores, many spontaneous statements of praise and 100% customer retention from its inception. Cost conservation is addressed at every part of the application and our operation. So, it doesn’t mean that we don’t listen to customer input or modify the product for it. We simply are prudent in making changes that truly make the product more valuable and the customer experience more rewarding.
If I write something on a piece of paper and put it into a file cabinet, I can go back and retrieve it whenever I want it. This is how most healthcare information systems work. It is really important, and pretty challenging, but it is also long past time that healthcare executives and buyers of healthcare IT demand far more for their (millions of) dollars. This limited input/store/retrieve model is as outdated as punch cards.
A user of such an outdated system can’t ask a complex or developmental question and receive a refined answer, nor request analysis to enhance understanding or knowledge. With a giant digital file cabinet, it’s up to the human to do all the complex tasks and analyses—often a time consuming and possibly error-prone undertaking.
The workaround for healthcare delivery organizations is the hiring of data analysts to work between clinical managers and the system. This ignores and exacerbates two really big problems: the Total Cost of Ownership (TCO) for the solution, which is seldom discussed frankly (or remembered from previous experiences); and the delay and disjointedness in the workflow of clinical and senior management in trying to gain insight and make decisions.
Users should demand that the systems they use automatically process information rather than just store it. They need simple and fast access to insights that are understood and anticipated by system designers. They need what they get out of the system to be of higher value than what they put in. And, as much as anything, clinical experts and managers should not have to turn into technical data analysts, or work through them, to do their own jobs.
It should come as no surprise that the key to incorporating more complex abilities resides in the system design. A well-designed system could be instrumental in transforming the processes and culture of the entire enterprise, simply by the way it works and the way in which users interface with it.
System designers’ involving users is the right thing to do. However, as in many things, the critical part is in how and how well one does the right thing. When software developers follow the input of hands-on users verbatim, the results are frequently disappointing and almost always lacking in innovation. Users should inform the design process about their environment and objectives, about what insights will help them do their jobs better. They should not be the final word on how forms should be laid out or data presented, because there is a tendency to recreate the past in terms of paper forms and the processes built around them. This will only bring inefficiencies from previous systems into the current one; it may look familiar on screen, but it’s not going to be the powerful analytical asset that it could be.
To be of most value, system design needs to take the whole enterprise into account. It must consider processes and workflows that cross departments and functions, how the technology can do as much mechanical stuff for users as possible, make navigation and workflow intuitive, and chain together steps that make up users’ typical working functions. This takes a more holistic, flowing and comprehensive view than the more linear and choppy collection of tasks that many software developers tend to take. And it takes a little art thrown in with the science to figure out how to organize and analyze the information that gets put into the system so that the most people get the best use of its useful, insightful finished products.
System design must move beyond the “giant file cabinet” paradigm in order to achieve a better solution. The good news is that many software companies are doing just that, and we will see very positive outcomes as more and more hospitals move beyond simple input-storage-retrieval and use technology to enhance understanding and insight.
AORN’s New Surgical Attire Recommended Practices: Five Points to Know
The Association of Perioperative Registered Nurses has released an updated version of recommended practices for surgical attire, providing guidance on what to wear in or around an operating room. An article from the AORN Journal detailed some of the practices outlined below:
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The converse side of saving money from the implementation of performance improvement, incident reporting systems, and a culture of quality, is losing a whole lot more due to bad outcomes, poor incident management and patient readmissions.
According to a report out by the Agency for Healthcare Research and Quality (AHRQ), between January and November 2011 hospitals spent $41.3 billion treating patients readmitted within 30 days of discharge. Of that number, nearly 1.8 million readmissions cost the Medicare program $24 billion, 600,000 privately insured patient readmissions totaled $8.1 billion, 700,000 Medicaid patient readmissions cost hospitals $7.6 billion and uninsured patients were readmitted at a cost of $1.5 billion.
Highlighting the need for the healthcare industry adopt new means of tracking adverse incidents, the AHRQ said in the study, “[I]dentifying conditions that contribute the most to the total number of readmissions and related costs for all payers may aid healthcare stakeholders in deciding which conditions to target to maximize quality improvement and cost-reduction efforts,”.
It is this simple task of tracking adverse events which most hospitals have no efficient means of recording and acting on. Recent statistics report that nearly 75% of all hospitals in the United States are utilizing antiquated systems, relying on paper or spreadsheets, for their Risk and Quality Management. However, healthcare is coming around to performance improvement technologies pioneered and perfected in other industries — such as manufacturing — which provide real-time, accurate insight into a hospital’s quality program.
At first it takes some time to understand why an IT approach, to what has traditionally just been a passive reporting method of quality improvement, is preferable. But, it is the real-time insight that a thoughtful algorithm, within an Incident Management Software like ActionCue Clinical Intelligence, can provide which is so invaluable.
In today’s day-and-age, it is no longer necessary for patient safety and hospital management data to be delayed by days, weeks or months. Inexpensive, web-based systems, like ActionCue, deliver immediate information to staff at all levels of a hospital’s organization, allowing for a prompt and precise response to patient safety and healthcare quality issues — improving patient care and reducing hospital costs.