The Doctors is In: Understanding Telemedicine “Underachievers”

Dr. Robert Cuyler

In my last post, I gave a working definition of telemedicine and introduced some of the under-estimated complexities of developing and sustaining successful telemedicine programs.  A common thread found in ‘underachieving’ projects is that the importance of one or two ingredients in the early stages of a project’s life gets overestimated to the long-term detriment of the initiative.  When the initial ingredients are over-valued, more comprehensive project planning may suffer. As I mentioned before, those ingredients may include grant dollars, a physician ‘telemedicine champion’ or a motivated IT division.

Photo Courtesy of Wikipedia

Having great ingredients to start with is wonderful, but having a great idea for a play (say, a boy and a girl from warring gangs falling in love) does not make for great theatre unless followed by disciplined planning and execution.

In our book Implementing Telemedicine, Dr. Dutch Holland and I tackle the problem of under-achieving telemedicine projects through the lens of organizational change management, using the metaphor of the theatre to view a healthcare organization as “a continuous one-act play performed by a theatre company.”

Through this metaphor, we dig into the causes of under-performing telemedicine programs, finding culprits in one or more of these realms:

  • The Script: The organizational vision and telemedicine business model
  • The Roles: The variety of individuals who will take part in the telemedicine program and the related work processes of all involved
  • Sets and Costumes: Not only the telemedicine technology, but also all the support systems including medical records systems, scheduling, inter- or intra-organization coordination, and technical support
  • Actor’s Contracts and Rehearsals: Training, altered job descriptions, accountability, and compensation

Photo Courtesy of Wikipedia

No amateur theatre company would consider opening a new play without all these bedrock systems firmly in place, yet healthcare organizations too often roll out new telemedicine initiatives without the same rigor, and pay the price in under-performance.

Next time, we’ll start with “Organizational Vision,” and look at the risks to telemedicine projects when senior leadership is insufficiently engaged in the process.  Hint: What is likely to happen to a new initiative if it’s apparent to the rest of the organization that the boss is not fully and publicly behind the project?

Robert N. Cuyler, PhD is President of Clinical Psychology Consultants Ltd, LLP, a consulting firm focused on telemedicine strategy and implementation.  He and Dutch Holland, PhD are co-authors of the book ‘Implementing Telemedicine: Completing Projects on Target On Time On Budget’.  He can be reached at

2 Responses to “The Doctors is In: Understanding Telemedicine “Underachievers””

  1. Cliff Stepp

    With the easing of regulations in California governing telemedicine in 2012, as well as some grant monies that followed shortly, there’s more incentive than ever for healthcare providers to get their “act” together.
    Even fairly simple telehealth programs like the successful “Text for Baby” implementation in San Diego point the way to better outcomes at reduced costs.


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