I find swimming to be an effective analogy for the way hospitals and health systems work, so often frame my blog posts from that vantage point. For instance, I recently ran into a pool friend I’ve gotten to know over the years and asked him what he’s been up to. He excitedly replied, “I actually hired a swim coach. We spent an afternoon where he filmed my swimming and then we reviewed my stroke. He gave me eight things to work on.”

After a pause, his enthusiasm suddenly faded and he added “… And I’m not doing any of them.”

This sounds like a classic consulting engagement at many hospitals. A team of domain experts come in and study the hospital for a few weeks. They ask for reams of data, interview team members, and gather direct observational evidence. This culminates in a powerpoint with eight things to work on. These will inevitably be thoughtful and accurately reflect the years of experience of the team. But like my swim friend’s coaching experience, it’s overwhelming. There are simply too many moving parts with complex relationships to one another. With no good way to monitor progress on these tasks or see if improvements in one place come at the expense of degradations somewhere else, nothing gets done.

I developed my swim technique in high school where I had regular coaching. Every few weeks, my coach would give me one thing to work on and, when that skill had improved, he’d give me something else. If I got stuck and wasn’t making progress, he’d try a different approach. Over the years, these incremental changes accumulated into good stroke habits that have survived well into adulthood. We never did all-day “swim clinics”. It was continuous and steady small tweaks that improved my stroke.

Software as a service is better than single-serve consulting engagements because the data pipeline has been fully operationalized for continuous performance monitoring. We’re not taking a snapshot of an instance in time. Instead, we’re setting up systems to keep track of key performance indicators. This allows staff to work on one thing at a time, such as early discharges or reducing long length of stay observation patients. Progress can be tracked in real time and hospital leadership can monitor whether there are unintended consequences such as miscoding or increases in readmissions. When staff is ready, they can move on to new projects.

My swim friend knows in his heart that if he really wants to improve his stroke, he needs to go back to master’s swim – a structured program for adults that features regular coaching. Yet, these half-day “swim clinics” persist because of the hope for a quick fix. Maybe he’ll pick up a skill or two but chances are it won’t become a habit.

Software as a service to drive hospital operational efficiency is like electricity. It gets installed and then becomes part of the workflow. It’s not an “engagement” or something you use for a period of time, and then go back to how things were, hoping that some of the benefit will be sticky. It becomes part of the daily tactical routine, as well as longer term strategic planning. It’s this kind of approach that drives the kind of long-term cost and patient services benefit that hospitals crave.


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