Something I haven’t written much about — and that I’m asked about often — is my work as an analyst at a public health system in Ohio. I plan to write on it more, so if you’ve got any questions or ideas, please let me know in the comments.
Today something dawned on me that I had to write about.
Working with healthcare data is challenging. Besides the obvious reasons of scale, privacy, etc., I believe there’s a personality and resource component.
Hospitals Need Hedgehogs
Isaiah Berlin’s famous essay may have its best example in the hospital.
I’m a fox. I’m a liberal arts grad, I know a little about everything. That’s what draws me to the healthcare industry — it’s dynamic and complex. In my role as an analyst, I do everything from modelling the impact of potential acquisitions to designing physician compensation metrics.
Healthcare providers — they’re hedgehogs. They know one big thing — and it isbig.
Interesting, then, when the hedgehog moves to a fox position — or even manages the fox. It can be painful for everyone. Healthcare managers with a strictly medical training can struggle with business. They’re often frustrated, too — they’d rather be seeing patients than sit in budget meetings.
It’s fascinating to work with hedgehogs — they’re bright, but just in one big (important) thing. Healthcare management often struggle with business and operations — they’re hedgehogs, cast in the role of a fox.
Foxes run the healthcare data rodeo
Analysts in all industries spend the majority of their time “wrangling” data — that is, transforming it into something more useful for analysis.
If the average percent of time all analysts spend on this is 60%, it’s got to be 80% or more in healthcare.
I started my career in retail, with SKUs, departments, and transactions that were all easily defined and categorized.
Not so, healthcare. Every encounter is different, services are more dynamic, and it can be difficult to even define the data, let alone prepare it for analysis. This gets into health informatics. That healthcare has a field in itself devoted to the use and storage of data shows how difficult it is.
Foxes are adept at merging insights from disperse data sets. But the size and scope of healthcare data requires solid IS tools for these pursuits.
Foxes don’t save lives — they keep the lights on
My biggest challenge as a healthcare analyst is data management.
Very few data sets interface, leaving analysts to design ad-hoc data storage systems.
Meanwhile, EHRs become more complex and flexible. It’s rare for clinics to run via paper charts these days — yet Word docs and photocopies are still common data storage solutions in many healthcare finance operations.
Why the divide? I believe the fox/hedgehog divide is a factor.
Hedgehogs see patients. Hedgehogs literally save lives.
Foxes don’t save lives. They do provide essential services, like keeping the lights on and running payroll. Hedgehogs forget about these tasks because they’re focused on one big thing (did I mention it’s big?).
IT investment favors the hedgehog — for good reason. But foxes need tools, too. Without adequate information systems, hedgehogs struggle with their work and make mistakes — thus seeming even more irrelevant to hedgehogs, who focus even less on fox problems, beginning a vicious cycle.
Because the data problems analysts face are more of a business than a clinical problem, it is often difficult to convince clinicians — usually at least part of the top of the ladder at hospitals — to allocate resources to fox pursuits.
The Wrangling Fox
End-user generated interfaces can be ugly, but it’s a common reality for analysts — especially in healthcare. Had I known this in school, I’d have taken some database administration or data warehousing courses.
But technical challenges often have a human component — and in healthcare, I believe it’s the fox/hedgehog divide.
Healthcare professionals: did I miss the mark? Let me know in the comments! Healthcare novices — any thoughts, questions or suggestions?
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I disagree that IT investment favors hedgehogs. I’ve spoken with numerous medical professionals; they were *unanimous* in saying that IT investment makes their jobs *harder.* Govt mandates EMR designed for bureaucrats’ purposes, insurers follow suit, IT depts implement systems for their own convenience, and providers and patients are stuck with the resultant mess.
Thanks, Dr Steele, for that important observation. I had not considered how healthcare investments are regulation-driven vs. an actual priority. It is true that with meaningful use, ACOs, etc, we are shifting much more attention on EHRs and surveying patient experience.
As a finance analyst, I am really struggling to keep up with these changes — a lot of our personnel records are still basically managed via paper chart. I had thought these things were for the good of the patient/benefit of the provider, but maybe not. How ironic, then, that these less-regulated back-office tasks could actually benefit from IT investment and don’t get it!