Epic and the Non-Compete

My google alert for the QA class action lawsuit notified me of something interesting this week. Apparently, some of the local consulting companies were poaching from Epic. Thanks to some shady practices which have all been mentioned in the comments on this blog, Epic got Vonlay (which is in the process of being bought by Huron Consulting Group in Chicago) to agree to a two year non-compete for ex-Epic employees. Read the article here.

There are several noteworthy items. I've italicized quotes from the Isthmus article.

1. The Healthcare IT world knows that Epic underpays and overworks its employees. As soon as the ex-employee goes to consulting, they start to make double the pay with fewer hours. "You can make $180,000 to $200,000 a year," says a consulting executive, compared to the $100,000 that same employee might have made back at Epic. "And for us, it's 40 hours billable, maybe 50 total including travel."
2. Non-competes are bad for job-seekers, bad for companies looking for qualified staff, and bad for communities. There is, in fact, compelling evidence that broad no-compete clauses suppress economic activity and damage wage levels, according to the Ewing Marion Kauffman Foundation, which promotes entrepreneurialism. It reports that "job creation and economic growth will be hindered" by the clauses, and workers subject to strict noncompete terms suffer "lower compensation in their next job, skill atrophy and a degradation of professional networks."
3. Epic is shady. Epic had successfully intervened at the 11th hour to insist that Huron not hire Epic employees within two years of them leaving the company. 
4. Epic operates with questionable legality. [Speculation] circles around Epic fearing it might be treading on federal antitrust laws and being accused of anti-competitive business practices.
5.  Epic doesn't want what's best for its customers or what's best for its employees. Epic only wants what's best for EpicJudy. Epic enforces its no-hire clause through "conspiring" with its customers, which include all of the hospitals and major physician practices, and through the third-party consulting companies.  Epic... effectively dictates job terms and other matters to the consulting companies, whose business is augmenting staff and fine-tuning software for Epic clients once their system is up and running. If those consulting firms fail to toe the Epic line, the company can deny them access to the technical documentation for a health system's Epic software. And that means the consultants can't do their job.
   Clients, on the other hand, are rewarded for agreeing to honor Epic's noncompete clause in their own hiring -- in the form of receiving substantial "preferred customer" discounts to their yearly maintenance fees.
   In the end, this means a hospital can't turn around and hire the young Epic whiz kid who just spent two years installing its Epic software. Nor can that Epic wiz kid quit her job and walk across the street to work for an Epic consultant who might have a contract with that hospital
6. If there were enough backlash, Epic might back down further on the non-compete. Huron and Vonlay officials did not respond to queries, but Epic spokesman Brian Spranger confirmed that Huron had agreed to a two-year noncompete term. And then the shocker: "This is being reverted to a one-year term." Spranger offered no explanation in his email for the reversal. "We'd rather not comment on the policy as a whole." 

This was one of the more interesting articles I've read about Epic in a long time. Perception is reality, according to the pre-staff meeting powerpoint slides. I wonder how Judy feels about her company being perceived as a shady, strangleholding, antitrust-worthy corporate giant.

Epic's Principles, Part 10

Epic's 13 principles
1. Do not go public.
2. Do not be acquired.
3. Expectations = reality.
4. Keep commitments.
5. Be frugal.
6. Have standards. Don't do deals.
7. Create innovative and helpful products.
8. Have fun with customers.
9. Follow processes. Find root causes. Fix processes.
10. Don't take on debt for operations, no matter how good the deal.
11. Focus on competency. Do not tolerate mediocrity. 
12. Teach philosophy and culture.
13. If you disagree, dissent. Once decided, support.

We've arrived at the final installment, and the one I'm least qualified to write about, as my tenure at Epic predates this principle.

Business books describing streamlined, high-functioning teams or companies generally agree that there is value in hearing all viewpoints regarding a given issue. Leaders don't always have the best view of what's happening on the ground, and smart leaders like to know if they're rapidly progressing to a cliff. Also, a team cannot be high-functioning if its members are working at cross purposes. Once the decision-makers have had their say, the team must unify their efforts. This is a sound business principle, and a good idea.

However, this requires that leaders be able to admit that they're wrong. I don't think Epic's leadership has that ability. Those stillborn ideas that I remember from staff meetings were never spoken of again, and no documentation existed in the first place. I can't imagine any of the power holders at Epic admitting that they thought developing a Farmville-esque Facebook game about healthy kids* was a good idea. For dissent to be valuable, leaders have to listen to it, and to listen to it means they have to acknowledge that they may be wrong. Epic's culture doesn't permit the rank and file to question authority.

I saw this article about the Pontiac Aztek, and it seems appropriate.

The 13th principle is a good goal, but I don't see how Epic can actually follow it--they'd have to change a lot about their culture and philosophy to make it happen. It's admirable that Epic has considered it, and that Epic is encouraging it (at least on paper), but I don't see their cultural inertia changing directions any time soon. On behalf of all current and future Epic employees, I'd love to be proved wrong here.


*I remember Judy talking about this idea several times over a period of a couple months.

Epic's Principles, Part 9

Epic's 13 principles
1. Do not go public.
2. Do not be acquired.
3. Expectations = reality.
4. Keep commitments.
5. Be frugal.
6. Have standards. Don't do deals.
7. Create innovative and helpful products.
8. Have fun with customers.
9. Follow processes. Find root causes. Fix processes.
10. Don't take on debt for operations, no matter how good the deal.
11. Focus on competency. Do not tolerate mediocrity. 
12. Teach philosophy and culture.
13. If you disagree, dissent. Once decided, support.

If Epic actually meant "philosophy and culture" as it's understood by most people, then it's an abject failure. But if they meant "Drink the kool-aid until you drown in it," then they're doing pretty well. Paraphrased as "Teach Epic's philosophy and culture," then the principle makes perfect sense.

Epic has a particular philosophy and culture which many businesses don't adhere to, so the business philosophies that new Epic employees just spent 4-6 years studying in college don't always apply. Epic has to instruct these new employees in the specific way that Epic runs. Sometimes Judy provides this instruction bluntly in the monthly staff meetings, at other times the employee just picks it up by diffusion.

One of Epic's unique business philosophies is that "it's better to hire someone with no relevant experience and train them from the ground up than to hire a seasoned software developer and have them unlearn everything so they can do Epic development." As flawed as I think that belief is, it is fully in tune with Epic's philosophy, and it is definitely taught.

I'm drawing blanks on other examples of Epic's philosophy. Add your own in the comments.

As for Epic's culture, they don't teach this as explicitly. In theory, it's laid back (e.g., no dress code) and  flexible (work hours). In practice, there is a distinct dress code that successful Epic employees follow--nice blue jeans and at minimum, a nice-looking "casual" shirt. Holey sweat pants and Packers jerseys might work once in a while if worn ironically, but if you show up every day looking like that, you're not going to work there long. The flexible hours (as I've written before) amount to "Come in as early as you'd like before 9 am, and stay as late as you need to after 5 pm." You either learn the culture and drink the kool-aid, or you leave the company.

Epic does teach its philosophy, but it doesn't teach its culture. You're expected to learn and follow both.

Epic's Principles, Part 8

Epic's 13 principles
1. Do not go public.
2. Do not be acquired.
3. Expectations = reality.
4. Keep commitments.
5. Be frugal.
6. Have standards. Don't do deals.
7. Create innovative and helpful products.
8. Have fun with customers.
9. Follow processes. Find root causes. Fix processes.
10. Don't take on debt for operations, no matter how good the deal.
11. Focus on competency. Do not tolerate mediocrity.
12. Teach philosophy and culture.
13. If you disagree, dissent. Once decided, support.

Principle 10 is interesting--it used to be "Don't take on debt, no matter how good the deal," but apparently Judy had to buy some buildings on credit. It's nice that day-to-day fiscal responsibility is a priority, but unfortunately, I'm in no position to know how well Epic is doing on that. The company is privately owned specifically to keep this kind of information out of the public.

Epic gets a bye on this one, due to my lack of insider information.

Because of that, you get a twofer this week. "Focus on competency. Do not tolerate mediocrity." As with most things, Epic takes an inconsistent approach to this.

Judy most assuredly does not tolerate perceived mediocrity in its employees, but she sure is happy to have the least mediocre EHR out there. There's a difference between Best and Least Bad. Epic is adequate, but the volume of user complaints and bug reports preclude any claims of excellence. Epic does try, though; they're just hampered by how they enforce their ban on mediocrity.

I'm talking about how Epic churns and burns through its employees. New employees are trained to a level of adequacy, then left to sink or swim on their own. If they start to sink, rather than fish them out of the pool and enroll them in swim lessons, Epic lets them drown.

Most business knowledge that I've come across (google: retraining vs replacing employees) advocates that retraining is the more sound business decision. In terms of lost productivity and monetary expense, replacing costs more. Consider Epic: When I was there, communal wisdom stated that it took about 9 months for a TS to become self-sufficient after being hired. Retraining the under-performing employee should take about a month or two of concentrated effort. Replacing that employee starts the 9 month counter over. If most people are leaving sometime between 1.5 and 2.5 years, then the customer is getting minimal competency from their TS.

If training were better, and could be compressed into a shorter time frame, that would help Epic live up to its principle. Get the employee competent faster. If Epic retrained the underperformers--time management skills, prioritization, troubleshooting shortcuts, etc--then they wouldn't have to give up 9 months of non-productive time. Epic wouldn't have to pay that new employee for 9 months on the promise of only a couple months of productivity after that.


While Epic tolerates mediocrity in their product, they are quick to fire mediocre employees, which is a no-tolerance response. Epic has historically struggled with getting its employees the right training, and Epic never retrains. Competency is assumed, never questioned, and never corrected if necessary. There's little proof of a focus on competency. Epic fails on this principle.

Epic's Principles, Part 7

Epic's 13 principles
1. Do not go public.
2. Do not be acquired.
3. Expectations = reality.
4. Keep commitments.
5. Be frugal.
6. Have standards. Don't do deals.
7. Create innovative and helpful products.
8. Have fun with customers.
9. Follow processes. Find root causes. Fix processes.
10. Don't take on debt for operations, no matter how good the deal.
11. Focus on competency. Do not tolerate mediocrity.
12. Teach philosophy and culture.
13. If you disagree, dissent. Once decided, support.

"Follow processes. Find root causes. Fix processes."

This one has always bothered me from a semantics angle. What is the Epic Employee to do with the knowledge of the Root Cause? Why was the employee told to find it? What if the process wasn't the root cause of the problem? I would have rephrased it to "Follow processes. Find root causes of problems. Fix root causes."

Epic has a lot of processes that need fixing, and since several of these processes have been flawed for the better part of a decade (at least), it's clear that Epic has no interest in fixing them. The most obvious example of this is their HR practice. Epic follows the practice of hiring the best and the brightest of the inexperienced. Shortly after the employee becomes competent with solo work, the load gets bigger until the employee either buckles under the strain or decides that the strain isn't worth it. At that point, the employee starts looking for work outside of Epic, taking all that experience with him.

The root cause of that problem is firing the employee instead of investing in their growth. Since Judy has gone on record at a staff meeting to lament their employee retention numbers, she could kill two problems by fixing one root cause.

Then there's the problem of Epic's development. Everyone who's gotten a peek behind the curtains knows that Epic's code base is held together with chewing gum and baling wire. A bona fide Patient Safety Escalation comes out every other week, and there are about a dozen Care Concerns each week.

Development processes were followed; Epic has numerous checklists for that. Problems were introduced into the product. Root causes were discovered by the Patient Safety committee. The problems were fixed after the fact (mostly), but the processes that allowed those issues into the software weren't modified.

The root cause of a given PSE is relatively easy to discover, and the code change required to prevent that specific problem from occurring in the future is manageable. However, the root cause of Patient Safety issues in general hasn't been looked at. How can Epic prevent buggy software from going out? I've heard suggestions (and posited some of my own), but nothing has changed.

While Epic talks a big game about fixing processes, they don't really deliver on that.

Epic's Principles, Part 6

Epic's 13 principles
1. Do not go public.
2. Do not be acquired.
3. Expectations = reality.
4. Keep commitments.
5. Be frugal.
6. Have standards. Don't do deals.
7. Create innovative and helpful products.
8. Have fun with customers.
9. Follow processes. Find root causes. Fix processes.
10. Don't take on debt for operations, no matter how good the deal.
11. Focus on competency. Do not tolerate mediocrity.
12. Teach philosophy and culture.
13. If you disagree, dissent. Once decided, support.

Epic has a slide, so I guess that's got to count for something.

Seriously though, there's a fine line between having fun and frivolously wasting money. UGM walks that line nicely. There are loads of customer-centric events that (to me, at least) never appeared to be gross misuses of money. For customers visiting Verona's campus, Epic follows this principle pretty well.

However, for Epic employees visiting customer sites, fun with customers usually isn't a priority. While visiting Epic staff could suggest going out for a meal during lunch or after work, many Epic customers prefer that visitors' time be devoted more to resolving issues than extra-curricular socializing. Given various legal and ethical issues around vendors paying for clients' meals and vice-versa, the Epic employees that I've dealt with are doing the right thing, even if it's not necessarily following Epic's 8th principle.

Out of 8 principles so far, Epic's actually following 3 ½ of them (and two of those are gimmes).

Epic's Principles, Part 5

 Epic's 13 principles
1. Do not go public.
2. Do not be acquired.
3. Expectations = reality.
4. Keep commitments.
5. Be frugal.
6. Have standards. Don't do deals.
7. Create innovative and helpful products.
8. Have fun with customers.
9. Follow processes. Find root causes. Fix processes.
10. Don't take on debt for operations, no matter how good the deal.
11. Focus on competency. Do not tolerate mediocrity.
12. Teach philosophy and culture.
13. If you disagree, dissent. Once decided, support.

"Create innovative and helpful products." Having recently spoken to some brand new Epic users, I could have some fun with the "helpful" part of this, but since I did drink the kool-aid pretty heavily for my tenure at 1979 Milky Way, I'll abstain from most of the snarkiness.

When used well, I do think Epic is really helpful. As a MyChart user, it's great to be able to see my lab results whenever I feel like it. It's convenient to schedule appointments without having to wait on hold on the phone. As someone who's watched clinicians ooh and aah when they were able to see other providers' notes on their patients, it's obvious that Epic can be helpful.

However...
A couple of things have to align for Epic to be helpful: The customer has to have implemented the software correctly, and Epic's code has to work. It's not a principle, but it's shown at every staff meeting: "Rule #1: Software must work. Period." Judy used to enjoy mentioning how the Cerner CEO thought that was a personal dig directed at him, but I've seen enough Patient Safety Escalations and Care Concerns coming from hastily coded Epic software to say that Epic is guilty of breaking Rule #1, too.

Software that doesn't work isn't helpful. When Epic works, it's beautiful, but when it doesn't work it's downright dangerous. Epic needs to work on the safety of its products. That, in turn, will increase the helpfulness factor.

I'll give Epic half credit on the helpfulness bit of Principle 7. As for innovation, there's a good mix of innovation and stagnation happening in Verona.

On the one hand, they haven't done much that's truly groundbreaking since taking over the entire industry. Their new products are primarily focused on providing an Epic option for specialty software that used to be sold by best-of-breed vendors. On the other hand, MyChart is really cool, as is Haiku and Canto.

Meriam-Webster defines innovation as merely an improvement over something existing. By that definition, Epic is constantly innovating, as their software is consistently getting better over time. However, my own exacting standards demand more. I feel that innovation needs to be more earth-shattering, like what the iPhone did to the cell phone industry. Giving patients easy access to their own health records was that kind of game changer. There's a Chronicles quote that says "Talent hits a target that no one else can hit. Genius hits a target that no one else can see." MyChart was genius. Beaker, Phoenix, Beacon, Thumper or iHeartHearts or whatever they're calling Cardiant now--those  all stem from talent. Innovation requires genius, in my book.

tl;dr: Epic does a pretty good job with innovation and helpfulness, by the dictionary definitions. I wish they would do more and try harder to be more helpful and innovative.