The Dysfunction of Skills Specialization


By Avery Cloud, CIO, Franciscan Missionaries of Our Lady Health System

Gone forever are the days of the Information Technology (IT) generalist who brought to bear a broad knowledge of many technology disciplines to solve problems and innovate. The quest for assembly-line-like efficiencies and other such pressures have ushered in the age of the IT specialist.

IT systems have become so complex; it’s unreasonable to expect any one person to know everything. This is especially true in large IT shops supporting large and complicated corporations. Small IT shops of necessity may still rely on generalists to wear lots of different hats. However, even small IT shops need specialists sometimes and access them through managed services and contract labor.

Although there are many ways to address the dysfunction of specialization, my favorite is the skillful use of team-based problem solving for everything from resolving outages to innovating new technologies, similar to the way law enforcement uses SWAT teams.

Today, we have IT professionals in many specialty areas: personal computers, networks, storage, servers, operating systems, and telephony specialists, as well as Electronic Health Record (EHR) specialists certified in specific modules. Vendors have responded by making certifications available in many technologies of their making. No doubt, this evolution to skills specialization serves its purpose by allowing IT leaders to get the most out of their technology investments by tapping the capabilities of various features and functions of the different technologies. This is of great benefit to organizations when you consider that many only use a small percentage of their software and hardware investments capabilities. Simply put, you won’t use capabilities. You neither understand nor know how to translate into business solutions, so the solution is deep skills specialization.

But for all its benefits, skills specialization brings with its inherent dysfunction. If it goes unrecognized and not intentionally managed, it can create problems. For example, think about the days when generalists outnumbered specialists. If nurses suddenly couldn’t access the EMR, a generalist with her grasp of the many related technologies necessary for EMR access would begin to correlate, associate, and sort the possible failure points. With just enough knowledge about many different aspects of the IT ecosystem, she was able to piece the puzzle together and quickly arrive at some very likely culprits, and then narrow them down to find the solution.

Enter the age of the specialist who may have mastered her technology space but has a limited understanding of the other technologies it connects with that make it possible for the nurse to access the EMR. The specialist probably lacks the insight to identify potential problems in areas outside her skill set. Therefore, fixing the EMR access problem will require more people than it once did.

The emergence of skills specialization is not a bad thing. Still, it requires leaders to recognize the inherent impediments of specialization-based IT staffing, and thoughtfully plan problem-solving methods, procedures, and tools to overcome such weaknesses. The same thoughtful approach is called for in pursuit of innovation.

Although there are many ways to address the dysfunction of specialization, my favorite is the skillful use of team-based problem solving for everything from resolving outages to innovating new technologies, similar to the way law enforcement uses SWAT teams.  If specialists are well-trained and working together, they can function as an effective unit that brings wider vision and stronger reasoning to a problem than even a single generalist could. Such teams often are most effective when they include the right vendor support personnel. But it’s crucial that you communicate clearly the role you expect vendor support staff to serve in the team structure, and to include them in dry runs.

Just as specialization has brought a mix of benefits and weaknesses into healthcare IT, healthcare itself faces similar challenges. It’s comforting to know that the surgeon who is about to perform your back procedure does back surgeries every day — her specialization and deep experience are why she can achieve consistently great outcomes. But suppose your back problems are the result of poor posture brought on by a bad knee, and both problems have caused insomnia that has weakened your immune system, leading to a chronic cough and cold. Even the very best back specialist will have to consult and coordinate care with other physicians for these types of connected problems.

Like the IT shop, the human body is a complex collection of interrelated systems. In recent years, providers have worked on improving coordination and more effectively integrating medicine. But unfortunately, many integrated healthcare teams still lack all the specialists they need to be truly effective at managing health. Over one trillion dollars are spent out of pocket each year by patients seeking complementary care therapies such as dry needling and massage therapy, neither of which are universally recognized by traditional caregivers. There is scientific proof that, in some cases, complementary therapies such as chiropractic care might be a better solution than back surgery. Or, a shoulder surgery might be avoided by a Kinesiologist prescribing a stretching regimen. In fact, some insurers have discovered this and are requiring patients to prove complementary therapies won’t work before the insurer approves expensive surgeries.

So, what can technologists do to help promote more complete care teams that include information from traditional and complementary therapies? A SWAT team without a negotiator is less likely to produce a good result. The same is true of a care team without access to a wide array of information about the patient’s body and complementary therapies. Until then, the patient record will remain incomplete, and decisions will be less efficacious than what’s possible. In this time of value-based reimbursement, there is likely to be more focus on technology to reduce these kinds of dysfunctions in the medical specialization. We would be wise to listen to the patient’s voice in this regard and learn how they want us to serve them.

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