This InfoWorld article on why running IT as a business is a train wreck waiting to happen couldn’t have come at a more appropriate time.

If it’s one thing I’ve grown despondent about changing is this pervasive attitude in most enterprise IT shops, but especially HealthCare IT, about how it’s all about making the customer happy – not the patient, but just about everyone else from clinicians to backoffice.

If there’s a more antiquated and downright utterly wrong attitude in IT I have as yet to find it.   It is not all about the customer, I am not a customer service organization, I do not serve the customer. I serve the business, and I partner with the business.

Not for nothing has my first question consistently been: What business problem are we trying to tackle – not – what do you want?

Yet we still persist in playing the masochistic role of Sisyphus, in between Scylla and Charybdis.

This is Heresy some will want to burn me at the stake for, but HealthCare IT and business leaders, as far behind the curve as it is, should especially read this, grok it and work it into their cultural change plans. I have oft been told HealthCare is not an IT business. That’s one of the attitudes that needs to be adjusted as you cannot run a business, any business much less Healthcare, without being plugged in or otherwise have a peer relationship with a trusted technology resource.

Everyone talks about how important HealthCare IT is to cost savings; what they neglect is that one of the root cause issues with HealthCare IT is that it’s culture and approach to problem solving is something that no amount of tangential legislation, or funding will solve – it is an attitude that needs to infect the organization. To be sure there are a handful of healthcare entities that are moving in the right direction with their IT. The vast majority, well over 80%, are either only gradually adjusting or remain stuck in amber.

Here’s some pertinent quotes that should encourage you to read the article:

“Your ticket to the promised land begins with this: No one inside your company is your customer.”

"IT should relinquish its increasing stance as an order taker, and earn and advance its intended role as the qualified engineer of what makes a business hum."

“To achieve a quality architecture, the internal customer of one project pays more so that a different internal customer, some time in the future, receives the benefit.” -- This, by the way, is something that is sacrosanct to me and has been very successfully  evangelized where I’m at – even if it’s not generally or widely understood, I have enough buy-in, and real world results, to backup the approach we’ve taken to architectural quality.

“Chargebacks are an attempt to use market forces to regulate the supply and demand for IT services. If that's the best a business can do, it means the business has no strategy, no plans, and no intentional way to turn ideas into action.”

Instead, they should say, "My job is to help you and the company succeed," followed by "Show me how you do things now," and "Let's figure out a better way of getting this done." -- This is one thing that my team has done since day one. It’s a HUGE culture shock, but we’ve stuck with it. The good news is that it works and with the business units we’ve dealt with the most they’ve embraced it – especially since the results have borne fruit. The disappointing news is that in a $2B/yr multifacility hospital system, it has become a non-cost-effective task to repeat the evangelize\adopt\show cycle with EACH business unit.

“That's what proper governance requires: effective leadership. It's the hard work of turning the company's top executives into a team that agrees on strategy and turns it into a plan for coherent action. IT's priorities are built into that plan. They aren't bought and sold by whomever plays the budget game best.”

“IT's job is to recommend better ways to operate, using technical capabilities business managers might not even know are possible.” – This again is something my team is well known for. The reception varies as does the reputation earned. Invariably some segment will see you as barriers to their success. Reference the points made here-in and through the linked article as to why this doesn’t bother me in the least.

So, you’re choices are this – or build a car with the accelerator and steering wheel in the back, brake in the front, 2 and a half gears in reverse, 3 forward –in other words, a typical healthcare IT solution.