The Vendor Engagement Matrix

This is post 2 in my series on why to participate in the standards process: a reason why Vendors should engage with standards

Professional Societies

One strong feature of the healthcare eco-system is professional societies. Everywhere you look, there’s another one. See here, and here, and on wikipedia. Or for Australia, here. (And none of the ones I’m involved with – HISA, ACHI, AACB – are even listed). For professionals in healthcare, the reasons to be involved in these are obvious (see, e.g. “Top 10 reasons“). In fact, in most places I’ve worked – whether clinical labs, research labs, government agencies, or vendors, membership of and engagement with professional societies is expected (or even required) if you have a leadership role.

And most employers enthusiastically support their employee’s involvement and leadership in professional societies (witness the employer affiliations for board members of ACHI, AIIA, AMIA). It’s obvious why employees participate in professional societies, but why do employers support this, even to their apparent cost (funding time, travel, sharing implicit IP, etc)? For example:

Some employers claim that there is no time for such efforts, or that it could prove too expensive. Many worry that all they would be doing is enhancing employees’ skills for a future employer. They ask themselves what would happen if they encourage professional development and some of their employees leave.

Those are all valid concerns. But:

A better question would be to ask what would happen if they ignore professional development and their employees stay

I’m quoting from the Society for Human Resource management there. Do read the whole thing. I’m just cherry picking a choice quote:

One critical reason given for seeking employment elsewhere was that although the employees valued mentoring, training and coaching very highly, their employers were falling far below expectations in those areas.

Finally, I’ll note that it’s when an organization must trust the choices that it’s employees make on their behalf that professional societies are most compelling – in fact, that’s when they become necessary: employees are inspired and pressured to apply professional excellence in ways that an employer cannot easily reproduce. And that’s why they’re a big deal in healthcare (and IT).

Most vendors I know encourage their staff – and particularly their leaders – to be involved in professional societies. It’s a tangible demonstration of their commitment to excellence. And the vendors that don’t encourage their staff to get involved?… they’re signalling to the market where they sit on professional engagement: it doesn’t matter. And, more importantly, they’re signalling to their staff about that as well, and I’ve seen that companies that don’t do this suffer from a steady erosion in their culture.

Choosing a Vendor

When it comes to choose your enterprise information system (EIS) providers, the quality and culture of the EIS vendor really matters. It all comes down to what you are buying. If you’re buying a widget, where the delivery of quality goods is feasible to measure, and the goods are a commodity, then it makes absolute sense to choose the lowest price you can get in the market. But once you start buying things where the quality is not easily measured, or you have a high transaction cost to change supplier, you have to think differently about your choice. And EIS’s really are the epitomy of these problems (e.g. changing EIS frequently costs more than the cost of the system, and the vendor pretty much does nothing but make decisions on your behalf, ones you can’t really review).

Because of this, thoroughly understanding the culture of the vendor of the EIS – who you are effectively marrying for the duration that you’ll depend on them to assist you manage your organization – is critical. As technical lead at Kestral, I always believed that our potential customers, when choosing a vendor, focused their scoring too highly on the current features of the widget they were buying (the EIS), and not on the relationship they were entering into – because the system they were buying was not static, and a key feature of their future success was how well their EIS vendor could support them to grow their business by delivering on their future interoperability requirements. (And, if I’m not mistaken, lack of delivery on interoperability features a little in the news at the moment….)

But the problem is, how do you choose a vendor that consistently delivers based on a culture of professional excellence? well, one way is to count what % of the vendors key employees have leadership roles in professional societies. And asking the vendor to report that should be a standard feature of all EIS RFPs, and it should be scored enough to weight it against the long list of feature the EIS is being scored on.

But, you say… that’s easy for a vendor – it’s not really very costly in the overall picture to support an employee’s involvement in a professional society, and there’s no need for that to make a meaningful difference to their culture. And that’s actually partly right. Which is why the real question is not about the professional societies of their employers, but the vendor’s membership of professional societies for the vendor itself. That’s where the rubber really hits the road.

And professional societies for healthcare EIS systems are standards organizations (or their derivative, informal open source collaborations).

Involvement in Standards Organization

This means that a vendors involvement in standards is a key indicator of it’s aspiration to enduring professional competence. And it’s deep involvement over time that matters, along with consistent delivery of the standards being worked on. It’s not a magic bullet, but it’s tangible evidence that the vendor has a deep commitment to it’s own professional standards to deliver a quality product in regards to more than just the feature list that appear on sales materials.

And this is something that institutions should ask about in their RFPs: what tangible evidence can you as a vendor show that you have an organizational commitment to quality? Now obviously there’s more answers to this than just involvement in the standards process, but involvement in the standards organization not only is one good and measurable marker, it’s a particularly relevant marker given an organizations inevitable future dependency on the vendor to deal with ongoing interoperability requirements.

All this suggests that we could define a Standards Engagement Matrix which can be used to score how involved a vendor is in the standards process. It might look something like this:

SDO Membership Gold Membership Organization leaders Technical Leaders Contributions Delivery
One row for each relevant SDO 5 points for being a paid member 20 points for paying high level fees 3 points for each board member, or chair of an organizational committee 4 points for each technical committee chair

5 points for each editor of standard

5 points for major contributions of tools, drafted documents.

10 points for donating patents to the SDO

10 points for each standard implemented during the trial phase in the last 4 years

3 points for proving conformance to the standard by a recognized testing authority in the last 4 years

Then divide the point totals to the log of the company revenue, and you have a the “Standards Engagement Matrix score”

I need to be clear here: this is just a straw man to make people think about how you would score something like this. I’m sure it needs more adjustment around vendor size/income. And you’d absolutely need some kind of adaptive score for the meaningfulness of the SDO itself. And note, of course, that as vendors grow, their organization and business interests broaden, and different parts of the organization could behave differently, so again, there’s no magic bullet here.

But if we had a working consensus on something like this, then providers buying a healthcare EIS could ask, as part of their RFP, ‘what’s your standards engagement matrix score?’, and know that the score is a very good indication of their organizational commitment to excellence. Which is actually more relevant than even vendor financial viability to the long term happiness of the purchaser, in my opinion.

 

p.s. The exact same logic applies to whether providers and institutions are willing to share patient data – it’s a key indicator to their own staff of their commitment to professional excellence, not just short term profit-making. And we should be educating patients about that.

5 Comments

  1. Michael Legg says:

    I agree entirely and, like you, value this highly. A really useful blog Grahame. Hope the are some good listeners to benefit from your advice

  2. Thomas Beale says:

    Interesting idea I have to say, but I think you are greatly over-estimating the amount of rational thinking that goes into choosing vendors for flagship products like EHR/EMR. My experience is that large procuring organisations want a big partner who will (they think) take away all risk and remove all need to innovate for themselves locally – it’s literally a relationship intended to remove risk and take away the pain of thinking. These are done as you know in giant tender situations and I’ve never heard of any mention of professional memberships of vendor staff in such tenders. I don’t think such things are on the radar of procuring organisations.

    For specialist products and small dedicated companies it might be a bit different, but the trend in a lot of places right now is toward the top-end generic vendors, which is killing health informatics as we know it today.

    My feeling is that making vendor staff professional memberships a criterion for procurement isn’t viable, but that the use of standards based conformance points in tenders is viable, and somewhat used today. The problem is that the procurers are too focused on ISO or ANSI or so-called official profiles (e.g. HL7 Functional spec). These are not very useful because they are too coarse-grained, just wrong, or in the case of functional profiles, not connected to semantic platform architectures.

    So I would say that the thing that needs to change is for better quality standards-based conformance criteria to be published in a form usable by procuring orgs – and it must be connected directly to semantics of information and service models – if not, it’s worse than useless.

  3. Grahame Grieve says:

    well, you know, the last point is the summary of a future blog: if you don’t participate in the standards process, then they won’t do what you want.

    As for procurement practices: there’s always an option to change for the better

  4. Dave Shaver says:

    Interesting blog; thanks for sharing, Grahame. I wanted to point to a related blog I wrote back in 2013 when I was on the HL7.org Membership Task Force: “Health Standards Community Membership Archetypes: Who uses HL7?” It was helpful to me to help work though the idea of “standards implementer” — a term which means many things to many people. I tried to pull apart the idea of a “true” implementer who has access to the source code, database, and team of internal specialists creating the software and the integrator that buys such a product and modifies it to meet local requirements.

    http://healthstandards.com/blog/2013/08/06/health-standards-community-membership-archetypes-who-uses-hl7/

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