Technology pilots are a proven way for vendors and skilled nursing providers to try out new products before bringing them to market or full-time in-house. It’s generally rich with reward and light on risk.
What rarely gets reported are the times when a pilot fails in the rollout. In many cases, it happens when a provider loses interest, fails on its commitment or simply gets cold feet, to name just a few reasons.
It affects players both big and small.
When the CMS Innovation Center was getting off the ground in 2010, several professionals issued a report asking the agency to take a better approach to pilots designed to test models that improve care, lower costs and better align payment systems to support patient-centered practices. The report came after a Medical Health Support Program pilot designed to help reduce costs by better managing chronic conditions, such as diabetes and heart disease, was plagued with startup problems, including participant selection snafus. The efforts all but eliminated any short-term cost savings, and resulted in paying large sums to private disease management companies.
Taking the leap
Cheryl Field, chief product officer for Prime Care Technologies, likens the process to buying a pair of new jeans: While they may look good in the catalog, it’s much different after trying them on.
Avoiding those kinds of inconvenient surprises, however, is no easy task.
Most pilots would likely work better if both parties looked before they leaped. Following are a few key ways vendors suggest that can happen.
Ask: What’s in it for me?
“Providers need to make sure they have a clear and measurable understanding of how the project will benefit their organization,” says Doron Gutkind, chief software architect for Lintech Software.
“From the perspective of the technology vendor, early on in the process there needs to be an open and honest discussion about, ‘What is this worth to you?’” adds Kyle Adamo, product manager at Dude Solutions. “This will give insight into future pricing and inform the scope of the project.”
Andrew Carle, president of Oak Hill, VA-based Carle Consulting, believes many pilots fail because providers’ appetites are bigger than their stomachs. “Providers need to focus on ‘big impact’ technologies,” says Carle, who also is implementing a first-of-its-kind graduate concentration in senior living administration track, as part of Georgetown University’s Master’s in Aging & Health degree. Those include medication management programs designed to reduce errors and rehospitalizations — “things that can provide measurable outcomes, improve staff productivity, and help a community position for future reimbursement systems,” he says.
Be strategically consistent
“Pilots can be great in terms of getting something off the ground, but providers need to ask themselves if a pilot is consistent with their organization’s strategic vision,” says Jay Schultz, director, technology solutions, Sanford Health/Good Samaritan Society.
Avoid shiny objects
“Probably the most critical decision at the outset is avoiding being attracted to ‘bells and whistles’ technology and assessing the true value proposition. For example, how will this improve quality of life if utilized directly by your residents?” poses Carle.
Failure to manage expectations can doom any project. “The most critical decision providers make is taking the time to understand what they’ll need to do to make the pilot successful,” says Chris Larco, senior director of enterprise sales and solutions consulting for SmartLinx. A pilot is successful only if it achieves results, which can encompass various factors, not all of which are financial, he adds.
Align expectations around some sort of ROI
“If it turns out that the provider is only willing to pay $500 annually to solve a complex technology problem, that can dramatically impact what’s feasible on the product development side of things,” says Adamo. “If a shared consensus on problem definition and ROI on solving that problem is not within sight, both the provider and the technology vendor should be prepared to pull the plug and go back to the drawing board.”
Providers would also do well to ask if they will eventually be rewarded as a co-developer if the pilot is successful, especially if the technology is in the early stages, adds Majd Alwan, senior vice president, technology, for LeadingAge and executive director of LeadingAge Center for Aging Services Technologies.
Know thy partner
Savvy providers will do their homework on prospective partners. This includes exploring the history of the current relationship with the vendor, its organization structure and ownership, as well as its reputation or that of the technology in the industry, according to Mona Hohman, vice president of nursing and clinical services for the Good Samaritan Society.
Before signing on the dotted line, providers need to honestly assess all of the necessary resources to ensure they can live up to their end of the deal. This includes time, money and people, and in the case of software, the right IT infrastructure.
Schultz advises providers to build in an adequate amount of time to do all of this assessing. This includes obtaining legal review of the arrangement and approval at the requisite levels of leadership within the organization, he adds.
Having buy-in from staff is key.
“Without taking the time to communicate and involve the staff in what’s in it for them, staff can resist the change and want to remain status quo,” says Jody Harbour, senior vice president of product management for American HealthTech.
Facilities that are part of large chains have the luxury of outsourcing with third-party vendors to be the boots on the ground for initial implementation,” adds Hohman. “Understanding the training model is also critical. With turnover, that can compound pretty quickly.”
It’s also imperative providers ensure they have adequate funding on hand to cover things like staff overtime, outside help and the like, even if it’s free. The risks are even higher when a new vendor is underwriting the costs.
“More than 95 percent of start-ups fold within five years,” says Alwan. “Even venture-backed companies have a high failure rate of 75 percent.”
And as Schultz notes, having to go back for additional funding can sometimes grind a pilot to a halt.
Experts also advise providers to solicit internal feedback and internal buy-in as early as possible. This could stave off potential problems down the road.
At the end of the day, the decision to participate in a technology pilot can sometimes be like jumping into the pool’s deep end in the dark.
“It is definitely a leap — a leap of faith and commitment,” says Teresa Chase, president of American HealthTech. “Faith that their software partner has done their part in ensuring the product has been tested and functions as designed. A strong, collaborative relationship is key before a pilot is even considered.”
Rubber, meet road
Even after all of this exhaustive preparation and the initial stage results in a quantifiably successful pilot, the hardest part is yet to come.
What dooms a pilot?
As Gutkind observes, there are the usual road hazards like disruption of business processes and service, staff and resident frustration and seemingly endless delays and false starts.
Then come the surprises.
Once a decision to ramp up is made, providers may come across challenges from a technology vendor that can no longer provide the technical and program support when additional users come on board, says Scott Code, associate director for LeadingAge Center for Aging Services Technology.
Overreaching is another. It happened when Alwan observed a consortium of providers attempt to create a comprehensive suite of integrated products.
“They stepped out of their competencies in providing services into a highly technical and thorny issue of technology integration,” he says. “That effort crashed and burned and a lot of money was lost, driving one of the lead provider organizations close to bankruptcy.”
“In some cases, enthusiastic organizations and vendors can over-support a project, creating a model for short-term success that is not sustainable in the long term,” adds Brian Buys, senior director, product management for PointClickCare. “In this scenario, phase one shows great results, which fade the moment implementation in a ‘real world’ scenario is attempted. Unfortunately, in this scenario it’s also very difficult to measure the ‘real’ value of a solution.”
For so many participants, the scaling up part is tantamount to a failure to seal the deal. Field says she has seen some pilot participants follow a successful software pilot, only to allow the software to sit unused and uninstalled because of staff turnover or procedural delays. Field and Carle both agree these kinds of issues could be avoided by assessing and anticipating such roadblocks before a pilot launches.
“Providers should assess how well the technology will be received by the general population of employees and residents,” Carle says. “Will staff feel it’s just another layer of duties being added to the position? Will residents be able to easily adapt to its use? Will there be corporate support to implementing, monitoring, and modifying as needed — or will it just be dumped on the communities with an instruction manual and note that says, ‘Please use!’?”
The key is preserving the momentum that led to the initial pilot.
Designating a pilot champion early on is one answer. Stable leadership is another.
“With no one prodding people to accept it, it’s just going to sit there not being used or adopted,” says Field.
Champions can drive change management, adds Chase, especially if the project dramatically affects existing processes and, ultimately, staff.
“How do you have the discipline to keep the course and remember why you signed up for this initially, and not allow people to lose that energy?” says Schultz. “If the discipline isn’t there, and a pilot started as that shiny object and it’s easy to get excited, it’s easy for bumps in the road to happen.”
Field advises less experienced providers to “have an out. If you really want to test the software, be willing to sign a long-term contract with a short out,” she says. “Vendors need to know you’re going into a three-year deal and generally don’t mind giving you a 90-day out if you’re really unhappy. If I can’t make a customer happy in 90 days, I really don’t want to keep them as a customer anyway. It’s not fair to either party.”
The best advice Field has for any “newbie” is to have realistic expectations. For example, roll out a pilot in three locations instead of 10.
“Listen carefully to what the software can do right now, as opposed to hearing what you think the software can do next year,” she says. “If you buy into a pilot on some promise of features to come, you’ll probably just be frustrated if those features don’t come fast enough. People are really surprised just how long development takes. It’s not because vendors are slow or not smart enough.”