Straight-shooting, tough, provocative and discerning. That’s you. These words should describe your M.O. when vetting any firm or individual your hospital is considering for an HIT consulting engagement.

Consulting is big business, which could mean a big investment — or a big waste of money and time. We’ve put together a a list of ten indispensable questions and other words of advice that will help you ensure a sound vetting process before you sign on the dotted line.

Almost every healthcare organization sometimes needs outside help, particularly in the complex area of IT. An external consulting firm can offer strengths that your internal staff doesn’t have, but only if it is right for your project and your organization. A superior consulting partner will offer:

• Objectivity. Since the consultant is an “outsider” and his or her role is intended to be temporary, his analyses and advice are not skewed by hopes for political advancement or promotion. To make sure candidates are on that page with you, clarify the expected parameters of the project. Many consultants hope for add-on business from the their first interview —  better known as scope-creep.
• Broad frame of reference. The most effective consultants are those with broad knowledge and experience derived from multiple past hospital engagements. They’ve seen and analyzed a wide array of issues, and developed creative, cost-effective solutions based on their clients’ circumstances.  On the other hand, many in-house IT staff have literally grown up with the hospital. This is a plus on a day to day basis because they know the environment very well, but their longevity will have inhibited their breadth of specialized knowledge and experience. The qualified consultant should bring a myriad of new knowledge and experience to the table. You have no time or money to waste on trial and error.
• Best practice assessment and project management methodologies and models that will help ensure no stone is left unturned during the engagement. These best practices will also provide a well-documented analysis and detailed solution-based road map for going forward.
• Deep knowledge of the healthcare industry, especially current technologies, vendors, issues (e.g. security, population health management), compliance requirements and looming trends.
• A broad, strategic problem-solving orientation that is difficult for internal staff mired in the hospital’s day to day activity to intellectually switch over to. The big picture of a hospital’s overall effectiveness, costs, risks, prospects and needed change is highly affected by information technology. Any major IT project must be analyzed as impacting a forest, not viewed as pruning a tree or two.
• Knowledge transfer to internal staff, including documentation and training that will facilitate sustainable change. When a consultant has completed his or her work,  he should be leaving a reeducated internal staff that is ready to take over seamlessly because of the consultant’s diligent and thorough training.

Why Should You Be Wary?

Consultants outnumber CIOs today! How do you choose the right one for your needs?

Healthcare is such a “hot” field of opportunity that a lot of shingles have been nailed on doors by individuals and companies that have few, and sometimes NO credentials in our very unique healthcare IT arena. Some consultants may claim to have experience in a hospital’s particular area of concern, e.g. revenue cycle, Meaningful Use / MIPS, MACRA, data analytics, IT operations management, security or particular systems — when in fact, they may only have passing knowledge. Some may never have physically worked in a hospital, but will tell you that their superior breadth of knowledge across other industries makes such vertical experience “unnecessary.” Lack of in-hospital experience severely hampers exercise of the “broad, strategic problem solving” skills noted above, as the consultant will have little understanding of the ramifications of change in one department across the rest of the organization.

For some consultants, claiming greater capabilities than they have actually exercised makes a certain convoluted sense. Why? Our healthcare IT environment is extraordinarily fluid, so consultants must either keep up with constant change, die — or catch up on the fly when presented with a potential lucrative engagement. The latter option is an increasing enticement to some in the very competitive consulting world. But it presents a great risk to achieving your hospital’s objectives.

Here Are Our Recommendations:

A rigorous selection process like your hospital’s efforts when hiring a senior staff member is key.  First, this means an in-depth interview, preferably by more than one hospital representative. A pleasant lunch or dinner where you share names of all the people you mutually know, your schools and anecdotes (often designed by the candidate to impress) is not recommended, at least until your selection has been made. Initial engagement should be a business meeting that you control — including location, attendees, and agenda.  That needs to include a methodical, intensive interview that digs deep and asks tough questions. Some candidates may be non-plussed, but professionals will be able to take anything you throw at them.

Four caveats before moving to our ten essential interview questions:

• Don’t rely on the consultant’s reputation, resume, charisma or even a friend’s recommendation. Whether your candidate represents a Fortune 1000 company or a recent start-up is irrelevant. Such representations may be out of date, embellished, subjective or just plain irrelevant.  Remember also, HIT consultants are sales people. This is not to disparage them, since we count ourselves among the best, and have worked with the best. Nevertheless, all consultants are in business to make revenue, and must sell themselves.
• Be as knowledgable as possible about the problems the organization needs help with and their ramifications within the organization. Depending on your role, you may or may not have much much IT knowledge; if not, spend some time with your CIO or IT Director to determine the best questions to ask (and to understand the answers!).
• Do your homework. Check out your candidates online or have someone do it for you. The company’s website, LinkedIn, former clients, press releases — all can give you an advance taste of the candidate’s offerings.
• Never neglect getting solid references.

Ten Essential Questions:

1. This first may surprise you. Ask: “Why do you work in the healthcare IT industry, as opposed to others?” The candidate should be able to differentiate between the obvious choices that are available (e.g. financial, retail, manufacturing, technology industries — most of which are more lucrative for consultants), and indicate reasons for genuine interest, commitment and concern for healthcare. Passion defines the best work of most of us, and that includes these road warrior consultants. Identify that passion if it is there. If you don’t see it, it isn’t there. Beware.
2. Ask: “What methodologies do you use for situation review, problem analysis, and recommended solutions — and can you provide documented samples?” This is a no-brainer. If the candidate cannot detail the methodologies to be applied to the engagement verbally, and/or provide samples, you can’t be confident that he won’t be coming in on a wing and a prayer. Claims of confidentiality should not win out. The best consultants do not work on instinct alone or without methodical approaches, and should be glad to provide “scrubbed” documentation.
3. Ask: “What are the greatest strengths you can offer our organization?” This question sounds trite, but the answers could make or break your decision. Best answers should reference specific experience on projects similar to yours; appropriate experience in hospital environments; effective analytical skills, including drilling down to fine details without losing sight of the bigger picture; providing deliverables on time and within budget; ability to relate well to staff at all levels — from service desk agent to the CEO; and knowledge of future trends. A variety of other strengths that matter strongly to you and relate to your specific needs may also need exploration. Asking for examples is key here; do not rely on generalizations or fuzzy talk.
4. Ask: “Where do you think healthcare and healthcare IT is going in the next ten years, and why?” If the candidate company or individual cannot verbalize an intelligent, logical big picture analysis of healthcare over the coming years, you should question whether the consulting engagement will give you the benefit of deep knowledge of the industry, including new technologies, changing fee models, interoperability and population health goals, demographic impacts, security considerations and more — all of which are changing with lightning speed. A good consultant should be able to relate important trends to your hospital’s business goals, as well as its information technology and operations.
5. A related question: “How do you think hospital IT issues and planning should relate to the organization’s strategic goals, and vice versa?” The answer should clearly indicate that the consultant grasps the centrality of IT in many organizational strategies, and discuss how IT can further those goals and potentially reduce costs. Again, references to healthcare trends should be included. And, ask for examples of working knowledge.
6. Whatever your needs are, ask: “What is your experience in like hospital organizations with federal healthcare IT initiatives and compliance issues?” If the candidate consultant or consulting organization cannot be highly specific and describe more than you would ever want to hear, qualifications are suspect. Federal initiatives like new healthcare programs, Meaningful Use / MIPS, MACRA and compliance requirements like HIPAA security affect every area of healthcare IT.
7. Ask: “In your past engagements with hospital clients’ staffs, how have you managed being an ‘outsider’? The mere presence of an outside consultant can be threatening to your in-house staff, and can hinder open discussion of existing IT issues and problems, especially those hidden in cracks. The candidate should be able to provide examples of past successes that include demonstrating the courage to speak up about unpopular topics, while creating staff trust and willingness to collaborate on finding solutions.
8. Next: “What will need to happen to make this engagement a success?” The candidate’s answer should include receiving visibly sponsored support by the right people and the freedom to talk and collaborate with key staff, including executive staff as needed.  External candidates cannot be high-handed or act independently; they need employee and executive input and support to genuinely understand the organization’s challenges, goals, budgets, resources, existing IT infrastructure — and to support necessary changes. The candidate should also request sufficient transparency from you and your staff, and perhaps ask what internal impediments will have to be overcome.
9. Probably the most important question you can ask is a hidden killer: “What questions do you have of me?” Consultants must be curious people. After decades of hiring staff and consultants, I am still astounded by the seemingly well qualified people who respond that the hospital “has told them enough,” and the consultant may “have more questions once onboard.” This response indicates lack of engagement or curiosity — or even arrogance that you don’t need. Once on the job, one of the most important jobs of a consultant is to ask questions and make no assumptions. The answer to your ninth question should be a myriad of very intelligent and intuitive questions.
10. Ask for a proposal that is focused on achieving well-defined business outcomes. The proposal should not be vague or simply task-oriented, e.g. doing surveys and interviews, offering answers to questions, or outlining options. The candidate should be able to present you with a detailed proposal that outlines the project’s purpose and scope, and drills down on methodologies, accountabilities, service levels, progress reporting, specific deliverables, timing, backup resources that may be used, and fair pricing. In turn, it is your obligation to disclose the business outcomes you need to achieve, along with related issues and factors (e.g. budgetary constraints, future plans and more). Don’t forget to provide a proposal deadline that you and the candidate agree upon. You also should require signing of a non-disclosure statement if the intelligence you provide warrants it.

A trusted advisor. A strategic partner. In the end, that is the job of a consultant. Even if your interview questions have been answered well, you still must ask yourself: How is the chemistry between you? Will you, your staff, and company leadership get along with and respect the consultant and his/her company? Is there a cultural match?

As a longtime healthcare IT consulting organization, we know that being trusted by our client partners is a requisite in providing superior deliverables. That trust must be earned. Our clients’ successes are the bottom line definition of our success — not revenue, profits, or basic 9 to 5 attention.  Every consultant you hire should be ready to hit the ground running with equally high enthusiasm, standards and purpose.

If you would like to learn more about Phoenix’ consulting services, please contact us.