INCREASING PRODUCTIVITY

On February 16, 1967 (Stardate 3142.8), Ricardo Montalban (playing Khan Noonien Singh) said in the Star Trek episode “Space Seed,” “Improve a mechanical device and you may double productivity. But improve man, you gain a thousandfold.” Khan was referring to genetic engineering, but behavioral healthcare organizations certainly don't have that option available to improve their employees' productivity! Instead, they can use technology to increase their workers' productivity.

History has many examples of technologic improvements increasing productivity. Computer technology has its roots in the 19th century (circa 1820s), when mathematician Charles Babbage created a programmable computer. The first electronic computers, built in the 1930s and '40s, used thousands of vacuum tubes, which were replaced by transistors in the '50s. Early computers could perform math and accounting tasks (e.g., transaction processing). Therefore, banks, insurance companies, large corporations, and governments were early adopters of computer technology, as electronic transaction processing increased worker productivity.

Computerized transaction processing has not changed much in the past 50 years, except that it is now available to everyone and computers handle virtually all repetitive tasks. While many behavioral healthcare organizations have not implemented fully functional electronic health record (EHR) software, it's unlikely that any are maintaining patient accounting data exclusively on paper ledgers. Computerized transaction processing has reached into every behavioral healthcare business office no matter how small, as this technology is so productive that no business can afford not to use it.

The 1980s ushered in electronic spreadsheets, a level of computerized decision support. A spreadsheet program such as Microsoft Excel provides transaction processing because it efficiently manages lists and implements formulas. Spreadsheets provide opportunities to record, store, and manipulate data in ways inconceivable using paper and pencil. Spreadsheet programs can even perform “what-if” analyses, which leverages worker productivity.

Yet something more than transaction processing and spreadsheet programs are needed to truly increase the productivity of today's behavioral healthcare practitioners. Providing healthcare services is an information management task, not a transaction processing task. Professional clinicians are knowledge workers, not production workers. Their decisions are based on judgments, not number crunching. Their value is not measured by clinical charts' word count.

And no “what-if” analysis can predict an individual patient's outcome. Good patient outcomes are the functional result of effective clinical decisions, which are the product of subject matter expertise and practitioner experience. Therefore, EHR software that addresses expertise and experience will increase practitioner productivity.

Today's information technology enables sharing of the subject matter expertise that forms the basis of professional healthcare practice. IT now allows the most talented and highly skilled clinicians and supervisors to leverage their ability to gather and effectively use information throughout an organization. For example, effective EHR software assists new employees or trainees with clinical assessments. EHR software supplies lower-skilled practitioners with subject matter expertise using electronically stored clinical libraries created by highly skilled clinical supervisors. Using these libraries, lower-skilled employees perform assessments nearly as well as their supervisors. Thus, EHR software leverages expertise and experience, increasing organizational productivity when lower-skilled employees function at this higher level.

Effective EHR software also supports multidisciplinary clinical teams. EHR software enables practitioners to easily search electronic charts, and multiple practitioners can access a chart simultaneously, making an EHR a fountain of shared information. Moreover, electronically charted information is immediately available to the treatment team, which is especially important when treating high-risk patients.

Behavioral healthcare organizations must adapt to changing IT or else fade away, just as any organization in any industry. IT today is no less than incredible, but the fast pace of change and the massive leverage effect that IT exerts on organizational productivity make today's IT decisions difficult and risky. The correct technology decisions will leverage success, but the wrong decisions will leverage failure.

John Leipold, DBA, MBA, is Executive Vice-President/COO of the Valley Hope Association/VHA-IMCSS.

To contact him, e-mail jleipold@valleyhope.com.