3/26/12 - Stinky Kroger (and Healthcare IT)

Near my home north of Atlanta lies the Big Creek Wastewater Treatment plant in Roswell, GA.  The plant treats millions of gallons of water a day. According to the , the plant treats 24 million gallons of water a day, with plans to move output to 38 million gallons a day.

That's a lot of water.

Next to the Big Creek plant sits a Kroger in a commercial strip center.  The grocery store is commonly known in the area, especially by teenagers, as "Stinky Kroger."  The reason?  Dewatered sludge, which may be best explained by another quote from the same county website:  "Treated wastewater from the Big Creek Wastewater Reclamation Facility is discharged to the Chattahoochee River. Dewatered sludge is disposed offsite to landfill."  Whatever the process of trucking away that sludge, the place just smells bad.

Probably the only thing that sounds less appealing than dewatered sludge is the idea of a Kroger sitting next to a water treatment plant that consistently smells.  Just as no parent sets out to raise the biggest deadbeat on the block, to paraphrase Bill Cosby, no grocery store aspires to be christened "Stinky Kroger."  You would think a genuinely bad odor would not help sales at a grocery store.

Yet here we are.

Fast forward to Healthcare IT.  What does a hospital do when it begins a transformational project, such as EMR or ICD-10, and the air starts to smell bad?  Does it truck away its metaphorical dewatered sludge, or does it take a long look at what was intended and what is happening that's not going correctly, and then make changes before it's too late? 

In my career working in real estate development, the single most important role was an owner's rep.  I used a woman named Tammy Bullard, a licensed architect who loved nothing more than pointing out to general contractors any disparities between what was in the construction drawings and what actually showed up in real life.  Inevitably there were mistakes, but what was more surprising was the number of times the contractor never consulted the drawings when going about a project. It was as if the contractor trusted his memory of the first review to keep things moving forward.

The drawings, it seemed, were the starting point, but actual work tended to veer away from it without someone vigilant on the job.  Tammy was that person, and when we paired her with a civil engineer named Bud Arnold, who could do the same thing on land development issues such as whether grade had been properly set on a detention pond, the contractors began to build what was drawn unless what was drawn didn't make sense in real life.  And when that happened, all it took was a quick meeting between the building superintendent and the owner's rep.

In healthcare IT, the construction drawings are the business requirements, and the owner's rep is the lead project manager.  He or she exists to ensure what was designed is built -- no more, and no less -- on time and within budget.  Yet most hospitals do not engage someone extra, that one expert, whose sole role is to protect the hospital's investment.  Instead they task someone who already has a full-time job and add more to their duties.  Then, it's a lot easier for things to not go as planned, for the dewatered sludge to start sending out its odor.

The lesson?  Don't let a project that can transform virtually all areas of your healthcare facility go without oversight.  Don't assume any consulting company is doing what you talked about.  Engage at least 1 person with the full-time responsibility, even on an interim basis, of ensuring that you get what you paid for.

It's certain, whatever your goals, that you do not want to be known as "Stinky Kroger."

Posted at 10:57


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