Organizational change projects that involve technology sometimes fail, often not because of a poor technology choice or an unresponsive vendor, but because the client failed to understand their own culture or how to use project management methods, controls, and metrics to meet their desired objectives. As a nimble, responsive organization, DIVURGENT Healthcare Advisors provides personalized, professional services in ways that big-box consulting firms cannot match. We spoke to Partners Colin Konschak, RPh, MBA, FACHE, FHIMSS; Philip Felt, PMP, MBA, CPHIMSS; and Lindsey Jarrell, FACHE, the former BayCare Health System SVP/CIO who recently joined the company as a partner.

Tell me about DIVURGENT.

Colin: We are two years old. We’re an entrepreneurial, client-focused company that we are building for the long term. That drives our culture; that drives our decisions; that drives our recruiting. We’re building something for Year 25.

How would you differentiate DIVURGENT from its competitors?

Colin: It’s our people. We spend a lot of time recruiting the best and hiring the best, but you can dig a little deeper into it. We’ve determined two things that make our people successful. One is our culture. The other is a singular focus on project quality and client satisfaction.

Is it harder to keep the right people than to attract them in the first place?

Colin: It’s a combination of both. It’s difficult in a competitive market to attract people. I think if you spend a lot of time as we do, on the recruiting process, retaining the right people is a little bit easier. We’ve spent a lot of time developing the right kind of culture that is going to allow people to do well here.

We have a non-hierarchical, flat infrastructure that allows everybody to contribute. It is teamwork focused. We spend a lot of time making sure that decision making on projects is driven down to the project level to the lowest level person who can make that decision. Empowering them to make project decisions works.

You emphasize project management methodology. Is that something that hospitals take to naturally or do they have to be sold on the concept?

Philip: Project management methodologies are pretty much a given within the healthcare environment. It started with other industries, but healthcare is catching up.

What’s more difficult is convincing clients that, beyond the basic blocking and tackling, project management involves employing quality metrics and change management. The hard part is developing the culture and the quality metrics to make sure that they are aligned for a successful implementation or other project.

Quality metrics are extremely important. It’s difficult just to align the quality metrics, but it’s even more important to align them to the quality initiatives or with JCAHO or other healthcare organizations that are out there. Aligning them with your organization’s goals, because that what your team members resonate with, so your team members say, “We can hit these goals because this is what’s important to us.”

Do you think hospitals think that they are doing formal project management even though they skipped the steps to establish the right culture and the outcomes to be measured?

Philip: Absolutely. PMI and all these other organizations don’t teach you how to do that. It really takes a leader in the organization to look ahead and say, “We’re not going to get this from just checking boxes.” We need to understand what drives an organization and what drives our organization to have a successful project.

There is no secret sauce or silver bullet that will help every hospital with change management. It is defined by the culture of the organization. When leadership believes in change, your project or your program for implementation is going to be much more successful.

There are many methodologies out there. It takes someone in the organization, hopefully from the quality management department, to come in and help define that. Then it’s having your leadership team step in and say, “This is important to us,” and exemplify those metrics and those quality indicators that help everything run smoothly in a project.

How do you convince clients to treat major systems implementations as change management initiatives rather than IT implementations?

Lindsey: There are many successful implementations in the industry that are compelling cases for how successful an implementation can be if it is managed and resourced correctly. I run into a lot of consulting firms and hospitals who still do not understand effective change management.

When the standard implementation cycle changes to design, build, test, change, train, and go-live, we will have started to see a good understanding of the science of change management. I know Kaiser does it well and we did a great job at BayCare. Great change management takes a dedicated team, passionate individuals, and a leadership team that gets it. It is much more than training and it is much more involved than a few PowerPoint presentations.

Roger Ray, CMO at Carolinas HealthCare, and I used to work together. He often quoted Joseph Bujak: “No real change happens absent a conversation.” That is so true. That conversation is just the tip of the iceberg.

Do you help organizations assess their culture and match it with methods that would work best?

Philip: We can explain some of the tools and techniques that can help them overcome this. We collaborate with specialty groups to bring them that expertise.

Hospitals think they understand their own culture because the leadership team talks together and understands what they want. What they don’t understand is the underlying culture that’s out into the departments, with each of their team members, and use of little groups and factions that are out there. That’s what’s hard to do.

We take our organizational development tool out beyond the leadership team. We go out into the departments and to the nurse managers and find out what’s important to them. We have a lot better chance of success if we listen to the people who are actually going to be using the technologies.

Have clients been surprised what you’ve found using your Total Cost of Ownership Model?

Colin: We’ve completed quite a few Total Cost of Ownership engagements, both on the hospital side and on the physician side. From this experience, we’ve developed our own methodology for developing TCO models. We’ve learned that if a client has engaged us and sees value in building a Total Cost of Ownership Model, they probably are going to be less surprised because they self-selected themselves by believing that it’s an important thing to do. Not all clients create Total Cost of Ownership models, though, even for $10, $20, or $30 million projects. We believe it’s a great fist step in the budgeting process.

More often than not, we’re asked to build multiple TCO models as the vendor selection process goes along, possibly for two, three, or four vendors. When the final vendor is selected, that TCO model is honed a little sharper.

The majority of the large integrated network-type clients that we’re working with now are still leaning more towards integrated vendor solutions. For physician practices or one-off solutions applications, cost has definitely become a driver.

We’re working a lot right now with physician practices because of the HITECH monies available in the physician market. Cost is extremely important to them. Aside from meaningful use criteria, cost is probably the top driver for that segment.

Colin, as a pharmacist, what kind of work has the company done with medication projects?

Colin: The most interesting projects we’re a part of now in that area are probably bar code administration. We’re part of projects where clients are either implementing bar code after the fact of their EMR or as a part of the overall implementation.

Integrated with that is CPOE. That brings in a variety of players outside the pharmacy, but it definitely is, as a pharmacist, quite rewarding to participate in content and change management that will transform how care is delivered.

Many of our clients are struggling with the simple technology. Once they incorporate technology, how do they integrate the technology with solutions that are already in place?

Is it a good time for people to go into consulting?

Colin: It’s a competitive environment. If your passion and dedication is not in consulting and not in healthcare, there are easier ways to make a living. Fortunately for us, our passion is healthcare. We’ll spend the rest of our careers in healthcare, so we think it’s a great place to be. If the stimulus monies come out as promised, it will probably be a story of “all ships will rise” as more projects get funded and approved by clients.

We focus on a few core practice areas. We focus on a practice dedicated to project management, hiring tenured, PMP-certified project managers. They do very well in our company.

As a clinician, I place a lot of value in the majority of our consultants having some sort of clinical background. It’s integral to understanding the struggles that our clients are going through and the role that technology will play in the clinician’s life.

Lindsey, you’ve had notable success as CIO at BayCare. What excites you about consulting?

Lindsey: Thank you for that. Our success at BayCare was based on a couple of things. First, working with one of the absolute best teams in healthcare information technology. Second, having great support from the board of trustees and the executive team. They enabled us with resources to plan and implement projects correctly.

I can honestly say that I enjoy constant change. I thrive in it and I am looking forward to getting back into consulting so that I can share back and help hospitals and physicians. I was at Healthlink for seven years until IBM acquired us in 2005. I am looking forward to building a high-quality consulting firm based on key values that guide us in taking care of our employees and clients.

People were surprised that hospitals got involved in integrating with their physicians through their IT systems. What are you seeing that hospitals are doing?

Colin: We’re working with multiple clients that are offering EMR-based technologies to the community as a way to get closer to and integrate with their physicians. Most of the ones that we’re working with are doing so through ASP models.

The biggest struggle we’ve seen is that once you go down that path, you’re a vendor. Hospitals aren’t in the business of being a vendor. We try to educate them on the things that they will need to do very well to act as a vendor and compete in the vendor space. With HITECH funding, the vendor space is becoming very frothy and competitive.

How do you see the HITECH funding changing the industry over the next five years?

Colin: I hope the change is what they are trying to achieve, an integrated, higher quality, increased safety environment. The goals are aggressive. They’ve dedicated the funding to it. If we can achieve everything that our government has set out to achieve with these monies, I think we’ll be in a much better place.

Are clients interested primarily in the financial benefits or in patient outcomes?

Colin: I think it’s an even mix. Our Total Cost of Ownership model gets into the benefits, the return on investment side of things. A couple of years ago, we weren’t hearing many clients talking about the ROI of technology, even EMR technology. It was almost completely about patient safety, quality, and outcomes.

We are seeing more people starting to embrace the idea that there can be ROI. I realize that the jury’s still out with some people, but I’ve worked closely with clients that have demonstrated ROI. If done correctly, there is ROI in these investments.

Are hospitals willing to accept their primary vendor’s systems in high-acuity areas like the operating room or the emergency department?

Philip: If you go to Level 1 trauma centers, they’re going to want the best-of-breed product. When you go to the lower-level Tier 2 and 3, and maybe critical access hospitals, those integrated systems really do the healthcare system better. As much as the physicians may not like it, it’s really an injustice to get too specialized because they’re not really working in those specialized areas as much as a Level 1 trauma center.
What about in practices?

Colin: We are seeing much more interest in specialized systems. We sincerely hope that it’s not going to go down the road that CPOE did. We are somewhat concerned, especially with the smaller physician practices, that the vendor community is swarming around the physicians that will now have up to $44,000 each or more to invest in technology. Some less-than-optimal decisions are going to be made.

What’s it like to run a company?

Philip: It’s exciting. It’s stressful. But most of all, it’s fun. We believe that we have a common goal of making patients’ lives in our communities and in the communities that we serve better. No matter how hard or stressful it is, at the end of the day when we look back at our projects and our clients, we hope we’re making healthcare better for those communities.

How will big companies buying consulting companies change your business? What would you tell customers that would help them choose between one of those companies and DIVURGENT?

Colin: I’ve been a part of this a couple of times. From my experience, the larger company buying the smaller market leader doesn’t work. A lot of client value is destroyed. It’s the nature of our business, though, so I fully expect that trend to continue.

When you’re small, entrepreneurial, and nimble, you can focus entirely on client satisfaction. Publicly traded companies have other interests in addition to client satisfaction. Those that need to share glory from their balance sheets will continue to acquire. I doubt those acquisitions make the company better from their clients’ perspective.

What will hospital CIOs be focusing on over the next few years?

Lindsey: Organizations will continue the electronic medical record implementation cycle. The industry as a whole has a long way to go to get to advanced clinicals.

Second, business and clinical intelligence will be making a bigger splash in the next year or two. We have been talking about this as an industry for a while, but I think we are finally approaching a tipping point where meaningful intelligence is going to become so critical to hospital operations that administrators will start demanding better platforms. The key opportunity for consulting firms is in devising the creation of a solid data governance framework and facilitation of a data model.

Lastly, I think the focus on regional networks and physician/hospital integration will create more of a need for an enterprise master patient index tool that actively assists organizations with identifying the right patient at the right time.

It is going to be another very busy year for healthcare information technology.

Fast Facts

Services
Strategy development, vendor selection, clinician adoption, total cost of ownership model development, benefits realization strategies, medication management services, interim leadership, clinical transformation, project management.

Company
DIVURGENT
6119 Greenville Ave. #144
Dallas, TX 75206
877.254.9794
www.DIVURGENT.com

Notable Clients
BayCare Health System, Sentara Health, Premier, Baylor Health Care System, Catholic Health Initiatives, Lutheran Healthcare, Community Health Systems, Memorial Hospital, Tampa General Hospital, Bon Secours.

The Bottom Line

*  DIVURGENT offers provider solutions to address healthcare reform, shrinking margins, and increasing pressure from regulatory and consumer groups.

*  The company prides itself on offering client-tailored services as a partner, not the “one size fits all” model used by big-box consulting companies.

*  DIVURGENT uses proven structured project and quality management methodologies on every project, applying its experience, tools, and methodologies from project inception to close-out to ensure quality and success.

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