Monday, June 8, 2009

Why consultants use PowerPoint … and other pearls of wisdom from 26 years in the healthcare management consulting industry.

Neil Seeman interviews Neil Stuart . . .

Why consultants use PowerPoint

With a newly minted PhD in health policy from Brandeis University, Neil Stuart joined Price Waterhouse as a fresh-eyed consultant in 1983. “It seemed like a good place to be for a short while – I’d learn a lot and maybe figure out how I could get a ‘real job’.” Twenty-six years later he would emerge as one of Canada’s most respected strategic advisors and health policy visionaries. The world of consulting has changed dramatically since 1983, Neil Stuart recently told a large gathering of former colleagues, clients, and mentees upon his retirement from IBM Canada’s healthcare consulting practice. (We would have needed a Hubble-powered fisheye lens to jam every well-wisher there into a single photograph).

1. How would you define the business of “healthcare consulting”?

Neil Stuart: “Any consulting to health care organizations that in some ways is about the business of health care or health care delivery – assisting with studies, plans, reviews, evaluations, solving problems, designing or implementing new approaches.”

2. What sorts of character traits make somebody well-suited to the healthcare consulting business? Who is not suited for it?

Neil Stuart: “To be a good consultant, exceptional analytical, problem-solving and communication skills are essential. But the thing that really distinguishes a great consultant from the rest is an ability to see things from the client’s perspective to understand their issues – the consultant who really figures out what the client is looking to deal with and focuses their energies and imagination on this. In my experience, one of the most common scenarios for consulting jobs getting off track is when a consultant gives a client something they did not ask for or sets out to solve the wrong problem.

If someone is the kind of person who already has the answer or who is “on a mission”, they might find consulting a frustrating path to take.”

3. How has the business changed over the last 25 years – for the better, and for the worse?

Neil Stuart: “The big consultancies have become much more sophisticated with well developed consulting methodologies and more refined tools for running their business. Twenty-five years ago, consultants were more likely to be ‘flying by the seat of their pants’. The contracts and scale of projects have grown too. A lot more of the work is related to information technology. Twenty-five years ago much of what consultants did was advisory in nature, e.g. reviews that led to recommendations. Today, there is much more hands-on work with bigger projects where consultants are involved in building and implementing large solutions and helping to manage associated change processes.

With bigger consulting projects, bigger teams and bigger practices, the roles in these consulting practices have become more specialized – with some individuals focused just on selling consulting work, some on project management, some on change management, some on process redesign, some on IT architecture and so on.”

4. How do these changes affect how and when healthcare organizations should hire consultants?

Neil Stuart: “Health care organizations need to be clear on why they need the help of a consultant. Is it for an independent or expert opinion? Is it to do a job for which they lack the specialized resources internally? Is it because they are in ‘trouble mode’ and need outside help? There are many different kinds of consultants and consulting skill sets. Health care organizations should make sure they are clear on what they are looking for and be sure to hire the consultant or consulting team that can meet their needs. If in doubt, would-be clients should check with others who have used consultants recently for similar work and learn from them.”

5. How do you respond to the critics of healthcare IT consulting who complain about some projects going over-time and over-budget?

Neil Stuart: “More often than not these situations could have been avoided if there was greater clarity on the project requirements. It is true that some times when consultants are competing to win projects, they can over-promise. This is where the client has to be crystal clear on what they are looking for and what they are contracting for.

In the case of IT related projects, it is really important that there be a clear focus on the health care benefits of the IT. There must be meaningful business reasons for introducing new IT. The health care leaders (not just the people in the IT group) must be involved in and driving these initiatives. They have to believe that health care itself will be improved by the IT. And as the IT solutions are being designed, built and implemented there must be an overriding emphasis on realizing these health care benefits.

Ontario is currently poised to try a very different approach to procuring large e-health solutions. They are looking to Infrastructure Ontario to help channel such procurement through consortia that include the IT vendors and consultants, but also include a party who will finance the project. They have called this approach Alternative Financing and Procurement (AFP). It offers a way of addressing many of the risks traditionally associated with big IT initiatives.”

6. In all your years as a trusted advisor to healthcare leaders, what qualities do you think make the best leaders shine?

Neil Stuart: “Vision, an ability to inspire their team, a grasp of the critical strategic issues – all have to be at the top of this list. Many of these qualities touch on being able to anticipate new opportunities and mobilize organizations to prepare for the future.”

7. What qualities make for dysfunctional healthcare leadership?

Neil Stuart: “Maybe the biggest pitfalls lie in becoming too focused on the narrow interests of one’s own health care organization and losing sight of what is good for patients and what the bigger health care system needs to be taking on.”

8. Why do consultants use PowerPoint presentations so often? Will the madness end?

Neil Stuart: “You have a point – no pun intended. PowerPoint has been a great tool to help consultants quickly summarize their analyses and findings and pull together a presentation. But PowerPoint can also be a real handicap if people rely on decks that are just an amalgam of slides originally prepared for other purposes. And there are some downsides in getting caught presenting from slides someone else has prepared. PowerPoint is often a used as shorthand to frame a richer, more detailed story. The presenter has to have the story and if they don’t, PowerPoint will not give it to them.”

9. What was your best experience as a management consultant and leader in the industry?

Neil Stuart: “Consulting gives one an opportunity to assist client organizations at some of their most exciting and formative moments, as well as sometimes their most vulnerable moments. Consulting can sometimes give one an opportunity to contribute to breakthrough changes and real innovation. This can be very fulfilling. But the consultant’s role is often beneath the radar. It will always be the executives in the health care organizations, or sometimes government, who own the initiative and deservedly wear the success.”

10. Would you recommend consulting as a career or even a career step for a young professional entering the health care world?

Neil Stuart:Absolutely, I can think of no other place a fresh MBA or MHA graduate could go where they could get the same variety of experience, the insights, the chance to be part of so many innovative projects, to be in an environment that so values learning, and (if they are good) to move ahead so fast.”

Neil Seeman is Director and Primary Investigator of the Health Strategy Innovation Cell at Massey College, University of Toronto.

Neil Stuart may be reached at:

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