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CONFIDENTIAL AND PROPRIETARY TO THE PARTIES IN DISCUSSION.
HEALTHCARE
MANAGEMENT IS A
DIFFERENT PARADIGM!
CONFIDENTIAL AND PROPRIETARY TO THE PARTIES IN DISCUSSION.
DIFFERENT THOUGHT PROCESS –
ENGINEERS VS DOCTORS
E N G I N E E R S A R E L E F T
B R A I N D R I V E N
Engineering education is by numbers,
graphs and grids.
Whereas Medical education is all by
colors, pictures, shapes and impressions.
Human brain naturally thinks in terms of
colors, pictures, shapes and impressions.
Management paradigms emerged from
engineering disciplines, so they designed
it to work with numbers, graphs and grids.
The technology is yet to develop to a point
where it can mimic the human brain.
D O C T O R S A R E R I G H T
B R A I N C R E A T U R E S
123@,
A+B=#?
, &
Reddish,
Rounded
, Raised
H A R D T O B U I L D A
C O M M O N L A N G U A G E
Healthcare and IT knowledge needs
to exist in the same brain and needs
to be processed together by the same
processor.
The idea of putting a Domain expert
with IT team doesn’t work in
Healthcare.
Healthcare experts talk Greek and
Latin jargon which IT folks don’t
understand.
M U S T I N V E S T T I M E T O
M A K E I T W O R K
A R T A N D S C I E N C E O F
M E D I C I N E
Clinicians think in terms of lists and
rule-out one by one to reach a
decision.
Intuition developed with experience
plays a vital role in decision making.
Whereas engineering discipline thinks
in terms of 2-by-2 tables and makes
decisions based upon numbers from
hard data.
Intuition developed with experience
has no place in engineering
disciplines.
D O C T O R S A R E
T R A I N E D T O T R U S T
I N T U I T I O N
Intuition
Rule
Out
Data
A S S E M B L Y L I N E
D O E S N ’ T A P P L Y T O
H E A L T H C A R E
Healthcare is not an assembly line.
Doctor-Patient relationship is like that
of Priest-Disciple relationship
completely based upon trust.
You remove the trust factor and no
patient will ever want to go under the
knife of a surgeon, no matter what
quality standards are applied.
P A T I E N T S N E E D
I N D I V I D U A L P L A N
C O S T A N D B E N E F I T S G O
I N O P P O S I T E
D I R E C T I O N S
Cost of the Healthcare is Bourne by the
payer [Employer, Insurance or Govt],
whereas the benefits go to the patient.
The payers believe that increase in
productivity will pay for the cost of
healthcare in the long-term; however
this has never been proved.
Cost of Healthcare goes in one direction
and the benefit goes in opposite
direction.
This is exact opposite of what happens
in any transaction based industry.
H E A L T H C A R E D E F I E S
C O M M O N L O G I C
D O N ’ T A P P L Y 8 0 - 2 0
R U L E B L I N D L Y T O
H E A L T H C A R E
Management principles like 80-20 rule cant
be applied blindly to healthcare.
Hospitals earn 80% of their revenue from
20% of the investments.
Rest 80% is spent for treating diseases
that provide 20% of revenue.
Emergency medicines and high-end
antibiotics expire without usage.
Any other industry will optimize on the non-
performing investments and save lot of
costs, but the hospitals can’t ignore these
non-performing investments else morbidity
and mortality will shoot up.
8 0 % O F R E V E N U E
C O M E S F R O M 2 0 %
I N V E S T M E N T S
G O D D I D N ’ T G I V E
S O U R C E C O D E A N D
U S E R M A N U A L S
No one can ever document all the
requirements in Healthcare projects.
Because doctors know only small% of
the human body and rest is guess
work.
All industries except a few like Outer
Space Exploration, deal with things
made by man.
Whereas in Healthcare you are
dealing with a machine made by god!
Variation is by design not by error –
Evolution!
M A N A N D D I S E A S E A R E
C O N S T A N T L Y E V O L V I N G
H E A L T H C A R E
P R O C E S S A R E
D Y N A M I C B Y D E S I G N
Processes in a hospital are dynamic and
change at the drop of a hat.
In emergency doctors need to take over
everything outside the system and then the
systems have to catch-up post-facto.
Process dynamism is need of the process
itself rather than an externality.
Majority of the known systems are
designed for a standard process and
workflow.
Healthcare needs systems that can adjust
itself in response to a dynamic situation.
Human brain is such a system – Any
Other?
C U R R E N T S Y S T E M S
D O N ’ T M I M I C
D Y N A M I S M
D O C T O R S A N D N U R S E S
A R E U B I Q U I T O U S
Doctors and nurses are ubiquitous in the
hospital setting and can be giving orders
anywhere in the hospital.
The orders are executed almost
simultaneously.
There is little time to switch between order
entry system and order fulfilment systems!
5 6 % O F M E D I C A L
E R R O R S H A P P E N A T
O R D E R S S T A G E
*Source: Bates et al JAMA 1995; 274:29-34.
Unique
Healthcare
Management
Paradigm
Healthcare Knowledge
Technology Experience
Management Discipline
G O D D I D N ’ T C R E A T E
T H E U N I V E R S E I N
S I L O S
Learning and absorbing the Healthcare
knowledge takes time.
Therefore quickly training the IT and
management resources in healthcare
domain knowledge and deploying them
on Healthcare projects is seldom useful.
Also rotation of resources is not possible
because you need to lock the Healthcare
experienced resources for higher value
projects.
Healthcare-IT and Healthcare
management resources continue to
increase in value with every cycle.
C R O S S F U N C T I O N A L
K N O W L E D G E I S T H E
K E Y
QUOTE FROM MOTHER OF NURSING
“The effect on sickness of beautiful objects, on variety of objects and
especially brilliancy of colours, is hardly to be appreciated. Such
cravings are usually called the “fancies” of patients but these “fancies”
are the most valuable indication of that which is necessary for their
recovery. People say that the effect is only on the mind. It is no such
thing. The effect is on the body too. Little as we know about the way in
which we are affected by form and colour and light, we do know this:
that they have an actual and physical effect. Variety of form and
brilliance of colour in the objects presented to patients are an actual
means of recovery”
- Florence Nightingale

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HCIT is different

  • 1. CONFIDENTIAL AND PROPRIETARY TO THE PARTIES IN DISCUSSION.
  • 2. HEALTHCARE MANAGEMENT IS A DIFFERENT PARADIGM! CONFIDENTIAL AND PROPRIETARY TO THE PARTIES IN DISCUSSION.
  • 3. DIFFERENT THOUGHT PROCESS – ENGINEERS VS DOCTORS E N G I N E E R S A R E L E F T B R A I N D R I V E N Engineering education is by numbers, graphs and grids. Whereas Medical education is all by colors, pictures, shapes and impressions. Human brain naturally thinks in terms of colors, pictures, shapes and impressions. Management paradigms emerged from engineering disciplines, so they designed it to work with numbers, graphs and grids. The technology is yet to develop to a point where it can mimic the human brain. D O C T O R S A R E R I G H T B R A I N C R E A T U R E S 123@, A+B=#? , & Reddish, Rounded , Raised
  • 4. H A R D T O B U I L D A C O M M O N L A N G U A G E Healthcare and IT knowledge needs to exist in the same brain and needs to be processed together by the same processor. The idea of putting a Domain expert with IT team doesn’t work in Healthcare. Healthcare experts talk Greek and Latin jargon which IT folks don’t understand. M U S T I N V E S T T I M E T O M A K E I T W O R K
  • 5. A R T A N D S C I E N C E O F M E D I C I N E Clinicians think in terms of lists and rule-out one by one to reach a decision. Intuition developed with experience plays a vital role in decision making. Whereas engineering discipline thinks in terms of 2-by-2 tables and makes decisions based upon numbers from hard data. Intuition developed with experience has no place in engineering disciplines. D O C T O R S A R E T R A I N E D T O T R U S T I N T U I T I O N Intuition Rule Out Data
  • 6. A S S E M B L Y L I N E D O E S N ’ T A P P L Y T O H E A L T H C A R E Healthcare is not an assembly line. Doctor-Patient relationship is like that of Priest-Disciple relationship completely based upon trust. You remove the trust factor and no patient will ever want to go under the knife of a surgeon, no matter what quality standards are applied. P A T I E N T S N E E D I N D I V I D U A L P L A N
  • 7. C O S T A N D B E N E F I T S G O I N O P P O S I T E D I R E C T I O N S Cost of the Healthcare is Bourne by the payer [Employer, Insurance or Govt], whereas the benefits go to the patient. The payers believe that increase in productivity will pay for the cost of healthcare in the long-term; however this has never been proved. Cost of Healthcare goes in one direction and the benefit goes in opposite direction. This is exact opposite of what happens in any transaction based industry. H E A L T H C A R E D E F I E S C O M M O N L O G I C
  • 8. D O N ’ T A P P L Y 8 0 - 2 0 R U L E B L I N D L Y T O H E A L T H C A R E Management principles like 80-20 rule cant be applied blindly to healthcare. Hospitals earn 80% of their revenue from 20% of the investments. Rest 80% is spent for treating diseases that provide 20% of revenue. Emergency medicines and high-end antibiotics expire without usage. Any other industry will optimize on the non- performing investments and save lot of costs, but the hospitals can’t ignore these non-performing investments else morbidity and mortality will shoot up. 8 0 % O F R E V E N U E C O M E S F R O M 2 0 % I N V E S T M E N T S
  • 9. G O D D I D N ’ T G I V E S O U R C E C O D E A N D U S E R M A N U A L S No one can ever document all the requirements in Healthcare projects. Because doctors know only small% of the human body and rest is guess work. All industries except a few like Outer Space Exploration, deal with things made by man. Whereas in Healthcare you are dealing with a machine made by god! Variation is by design not by error – Evolution! M A N A N D D I S E A S E A R E C O N S T A N T L Y E V O L V I N G
  • 10. H E A L T H C A R E P R O C E S S A R E D Y N A M I C B Y D E S I G N Processes in a hospital are dynamic and change at the drop of a hat. In emergency doctors need to take over everything outside the system and then the systems have to catch-up post-facto. Process dynamism is need of the process itself rather than an externality. Majority of the known systems are designed for a standard process and workflow. Healthcare needs systems that can adjust itself in response to a dynamic situation. Human brain is such a system – Any Other? C U R R E N T S Y S T E M S D O N ’ T M I M I C D Y N A M I S M
  • 11. D O C T O R S A N D N U R S E S A R E U B I Q U I T O U S Doctors and nurses are ubiquitous in the hospital setting and can be giving orders anywhere in the hospital. The orders are executed almost simultaneously. There is little time to switch between order entry system and order fulfilment systems! 5 6 % O F M E D I C A L E R R O R S H A P P E N A T O R D E R S S T A G E *Source: Bates et al JAMA 1995; 274:29-34.
  • 12. Unique Healthcare Management Paradigm Healthcare Knowledge Technology Experience Management Discipline G O D D I D N ’ T C R E A T E T H E U N I V E R S E I N S I L O S Learning and absorbing the Healthcare knowledge takes time. Therefore quickly training the IT and management resources in healthcare domain knowledge and deploying them on Healthcare projects is seldom useful. Also rotation of resources is not possible because you need to lock the Healthcare experienced resources for higher value projects. Healthcare-IT and Healthcare management resources continue to increase in value with every cycle. C R O S S F U N C T I O N A L K N O W L E D G E I S T H E K E Y
  • 13. QUOTE FROM MOTHER OF NURSING “The effect on sickness of beautiful objects, on variety of objects and especially brilliancy of colours, is hardly to be appreciated. Such cravings are usually called the “fancies” of patients but these “fancies” are the most valuable indication of that which is necessary for their recovery. People say that the effect is only on the mind. It is no such thing. The effect is on the body too. Little as we know about the way in which we are affected by form and colour and light, we do know this: that they have an actual and physical effect. Variety of form and brilliance of colour in the objects presented to patients are an actual means of recovery” - Florence Nightingale