Elephant Racing and Clinical Business Intelligence – Do I Have Your Attention Yet?

Recently, I was skimming through travel websites in search of the most scenic route to take from my home town in northeast Wisconsin to a location in southern Indiana where our bi-annual family reunion will be held next month. We have made this trip a number of times and are ready to look out the window at something new during the nine-hour trip. As I scanned the pages, reading traveler comments, (‘Beautiful’, ‘Excellent!’, ’Don’t do it – speed-trap!’) I encountered a phase I have never heard before – at least in regard to road-tripping – ‘elephant racing’.  Next thing I knew, I was six sites deep into the theory of elephant racing as a significant contributor to traffic congestion and road rage. Certainly, a little deeper than was necessary to plan our trip to the family reunion but, interestingly enough, I found some valuable relevance in the concept of elephant racing that we can use to understand and improve information flows in healthcare. Really? Yes, seriously. Let me share…

Elephant racing is term used to describe the very slow passing of one large truck by another large truck on a four-lane highway (two lanes in either direction). The speed of the passing truck is only incrementally faster than the other and thus these two large lumbering vehicles back up traffic for miles as they occupy both the left and right lanes of the highway. Once the only-slightly-faster truck passes the just-a-little-slower truck and returns to the right lane the cars in waiting hit the gas, hard, racing to make up for lost time. Inevitably, they hit the next elephant race a little further down the road only to repeat the process all over again…and again. This exercise, played out on highways throughout the world, results in delayed arrival, excessive energy use, driver frustration and fatigue, and encourages illegal maneuvers or short cuts to achieve placement advantage once the next race begins.

Chances are that unless you have purposefully designed and aligned your Clinical Business Intelligence (CBI) business plan with the True North metrics right along with the clinical and administrative plans and priorities, you are experiencing some of the side effects of elephant racing in your organization.

At the start of the lean journey, energy and excitement are high. Everyone is expecting a positive outcome and there is a desire to move forward quickly, tackling as many improvement opportunities as possible. Lots of employees become engaged in the learning and doing.

It is full speed ahead: visual management boards appear, daily huddles start, quality initiatives are named and rapid improvement events begin. Motivated and empowered teams of dedicated employees begin to build A3’s to capture current state, define future state and articulate the problem they are trying to solve. The next step in their problem solving process is to develop a deeper understanding of what’s happening in the search for root cause and for this, they need more data. It does not take long for project requests for more, better, easier-to-get-at information to begin to pour into the IT or Clinical Analytics departments where …they are busy working on something else. These “somethings” are big, and high priority. They are key to their annual business plan and linked to their budget and bonuses. It is not that the report requests are not important, it is just that they are not AS important. And they will get to them just as quickly as they can free up resources do so. Meanwhile, the project requests go into a queue. They pile up by the dozens. It is not unusual to have a backlog of hundreds of report requests; all waiting impatiently behind the big, lumbering high priority projects in front of them.

The front line quality improvement teams slow down and wait – some of the enthusiastic wind goes out of their sails; the clinical analytics team or IT group is frustrated, too. They are working on the highest priority work, why can’t the user teams understand? Well, at least, it is the highest priority - based on the actions and results their departmental business plan calls for.

Once some programming resource frees up there is a mad scramble to get some of these reporting projects done. They cannot all be in first place and priority is not set on first come, first serve. At this point, the projects that rise to the top are those directly connected to the C-Suite or those from the squeakiest wheel (neither of which guarantees that the ‘right’ projects get done first, but it does take some of the tension out of the air).  These project sponsors have engaged in all sorts of work-arounds to make sure their projects are at the top of the line right behind those big lumbering high priority projects that are holding all of the reporting resources hostage. So, a slot opens, a few reports or dashboards are created. Some other, smaller projects squeeze through and then the next high priority hogs all the resource again. Elephant racing among the high priorities absorbs all the reporting bandwidth (think, for example, of the impact of Meaningful Use legislation) and the quality reports and RIEs requests stall once more.

Meanwhile, those enthusiastic and empowered problem solvers on the front line are once again left to either wait a while longer until the information they requested shows up or find a work-around – a different route, a different resource to get at the information they need. After all, their business plan calls for progress on specific quality improvement priorities.

When IT and/or the Clinical Analytics group operate as a technology silo rather than a fully integrated part of the enterprise strategy the result is chaos and waste. Finger pointing is a frequent response.  It must be said that this situation is the result of a breakdown in planning processes or work flow systems rather than the fault of individuals. Quite often it is simply that these work groups have neither been included in the enterprise strategy development nor expected to take ownership of Key Performance Indicators. It is painful for absolutely everyone involved.

Members of the Clinical Business Intelligence Network (CBIN) have agreed to share their experience and ideas to advance the production and consumption of analytics to improve decision making in ALL member organizations. For the last 18 months, this group of healthcare leaders has studied and experimented with methods to improve information flow and support high value care delivery. Their work indicates that strategic alignment and shared key performance indicators between the Clinical and Business units and IT, and the Analytics group are critical enablers and accelerators of performance improvement. When the clinics and hospital, surgery center and emergency room, the C-Suite and Finance, and IT and Clinical Analytic teams ALL share the same Key Performance Indicators and True North, priorities are apparent and wasteful posturing to move personal favorite projects to the front of the line is no longer productive. The elephant simply leaves the room.

If you are interested in learning more about how the Clinical Business Intelligence Network (CBIN) members are tackling the challenge of integrating CBI with Clinical and Business strategy to dramatically accelerate performance improvement, I would love to talk with you. Contact me at 920-309-2216 or (jbartels@createvalue.org).