Six HCIT Lessons From Steve Jobs

July 31, 2012
Mark Hagland asked me if I would blog about the passing of Steve Jobs and how his genius relates to us working in HCIT. I’m both pleased and honored to do so. Here are my thoughts.
Mark Hagland asked me if I would blog about the passing of Steve Jobs and how his genius relates to us working in HCIT. I’m both pleased and honored to do so. Here are my thoughts.What do the Apple 3, NeXT Computer, and the Newton have in common? They were all ambitious, visionary products for their time that objectively failed, but also set the stage for subsequent, wildly successful products including the iPhone and iPad.As we consider Steve Jobs' life, the overwhelming lesson I draw is that no matter how clear, compelling and exciting a vision may be, to succeed it requires a lot of patience, hard work, and the ability to survive failure. What made Steve Jobs so clearly effective has direct implications for HCIT. Here's my short list:1. Have a portfolio of projects; you cannot tell which seeds will succeed and you cannot predict the weather. We all need to show progress. To do so, we need to have enough alternatives available to effectively determine what technology works in terms of our customers’ needs and wants. The broader your portfolio, the more synergies you create. You can’t hit a homerun every time you step up to the plate, but when you do, your strikeouts are quickly forgotten.The iPod isn’t just an “ecosystem” of a music player, a music store, an iTunes application, and a wrap-around marketing strategy. It created a halo to also sell computers that simply worked better for creative users, and attracted powerful support from and partnerships with companies such as Disney.2. Be clear. There is a tension between brevity and clarity, which is rarely brief! Part of the genius of Steve Jobs was in his dedication to doing the work that created clarity in the form of delivered products and services that have been perceived by consumers as brief and succinct. The words that often describe his results are elegant and well-designed. In contrast, Apple’s competitors often produced technology and support services developed using ill conceived concepts because in many instances they ignored the real needs and wants of end users. In contrast, most of the products Steve Jobs delivered were complete thoughts. How many times have we all witnessed this in HCIT?3. Think end-to-end, and sweat the details of that end-to-end solution. Don't compromise your design effort early on. In my experience, my Mac computers were clearly better designed to run cooler, quieter, faster, and more reliably than equivalent PCs I was also using. The differences were objectively in the Mac's favor. There was a vision and leadership difference since the raw materials and general level of talent of the workforces were comparable. This almost always requires an innovative, and possibly narcissistic, CEO, at least in times of rapid change such as what we’re seeing in healthcare.Healthcare CEOs who understand HCIT and value quality outcomes are, as I’ve observed, always compelling leaders who sponsor and truly respect dedicated, professional people, efficient processes, and clear policies. An easy test is to look at how an organization is approaching problem lists or ICD-10. Is it a casual, tactical approach, or is it an integral part of the long-term strategy for quality care and financial health? A strategic approach to HCIT is not a luxury, it’s a necessity. This takes commitment starting with the CEO – commitment that includes time, talent, investment, and buy in from all stakeholders.4. Don't be lazy. We can all be lazy at times. We also all know the right thing to do. This often demands more of us, is at times initially unpopular, and not likely to be as expedient as taking shortcuts. As a concrete example, almost all of us respond more to new emails than we do to our defined priorities. This is a form of laziness, undisciplined behavior. Jobs' deliberateness was an intrinsic part of his success. It is also critical to evolving the technologies that will help to make each of our hospitals and health systems the best on the planet.5. You cannot do it alone. Choose and invest wisely in your relationships. Steve Jobs worked successfully for over 30 years with a wide range of very diverse and challenging people. His success can be traced back to the influence, both positive and negative, these people contributed to Apple and his other ventures. Steve Jobs was an innovator who invested in collaboration before single mindedly forging ahead with all the force he could muster. HCIT is in a very similar environment. Work done by vendors in collaboratives, using the contributions provided by cross hospital advisory boards, associations, and through regulatory and standards bodies is more important to achieving our goals than ever before.6. Understand and serve the consumer . . . and do it sincerely.Each of Steve Jobs' enterprises clearly invested in trying to understand the end user. The Apple retail store experience provides multiple examples of innovations designed to serve the consumer, from the Genius Bar to the liberal return and service policies, to the broad range of training opportunities, many of which are free and amply staffed.Not only did Steve Jobs and Apple put computers in the hands of non-techies, they made it a sincere, non-computer experience. They brought icons, the mouse, and the wysiwyg (what you see is what you get) concept common before their competitors. The same understanding brought us the touch tablet. Steve Jobs and his teams more often than not recognized what the end users wanted to do, how they wanted to be creative, and then provided them with the tools and services to achieve their goals as simply as possible.HCIT has a similar challenge. Patient engagement and activation, one of the critical elements of accountable care requires the same attention to needs and preferences. This is, of course, much more nuanced in the health space and more complex.That said, extending a portal designed to deliver messages or pay bills and rolling it out as a Patient Portal is a very bland thought. Consumers want and need support for their healthcare and are quickly moving to a demand it be provided via the technology of their choice, i.e. Droids and iPhones, their iPads, and other networked devices, some yet to be invented. With so much of health impacted by diet, exercise, and other behaviors that have rich social and economic contexts, we should retire the Patient Portal in favor of a large life and living consumer experiential model. That's exactly what Steve Jobs did repeatedly in the industries he transformed. We should as well; all the while remembering that first we need the right technology in place to help ensure quality care and patient safety as providers move toward greater emphasis on preventative medicine.We in HCIT need to be innovators who anticipate the needs and wants of our end users. But we must also be wise. That means we must not only anticipate future needs and wants, we must also develop technologies and services that help our customers achieve their real world, near term goals as well. Innovation without understanding produced the “dot-bombs,” not the Mac.I invite your comments.

Joe Bormel, M.D., MPH
CMO & VP, QuadraMed

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“You can't just ask customers what they want
and then try to give that to them.
By the time you get it built,
they'll want something new. ”

Design is not just what it looks like and feels like.
Design is how it works.

Innovation distinguishes between a leader and a follower.

- Steve Jobs

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