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Being John Glaser 3/26/09

March 25, 2009 News 6 Comments

What Enables an IT Organization to be Agile?

Years ago, healthcare organizations would develop five-year strategies and have reasonable assurance that those strategies would be viable over that period of time. The pace of change makes such long term strategies less tenable (and possibly delusional). The pace of change does not eliminate the need for strategies, but it does place a premium on agility.

An agile IT organization has means to sense changes in the environment, triage important from spurious signals, alter strategies to respond to new opportunities, and redirect resources to carry out its new plans.

There are six major steps that can be taken to improve agility.

Application selection
The choice of new applications often centers on features and functions. However, those who are selecting a new application should pay equal attention to the capabilities the application has for desired changes. Is it easy to interface or integrate with other applications? Are there robust approaches that allow the organization to develop custom software that extends the application?

Project phases
Rather than waiting 18 months for the organization to see the first fruits of its application implementation labors, efforts should be made to deliver a sequence of smaller implementations. Pilots, staged rollouts, or the implementation of a portion of the application are not always doable. However they enable the organization to shift resources after a specific, smaller implementation phase rather than waiting until a lengthy implementation has been completed.

Staged release of capital and new IT positions
The capital and operating budget process can result in a form of “carved in stone” commitment of resources to specific projects. In contrast, the organization can make an overall IT budget commitment based on an expected set of initiatives. However, the leadership can release that commitment quarterly following an assessment of any needed changes in direction. In effect, there is an annual authorization of the budget, but a quarterly appropriation of the capital and operating budgets.

Cross trained IT staff
Some IT staff positions require deep expertise and it is not realistic to expect that those staff are interchangeable with other expertise-based IT staff. However, there are several IT positions that have characteristics that enable some degree of interchangeability. For example, good project managers can handle financial systems and clinical systems projects. These staff can be cross-trained or cross-exposed to different applications. This cross training can enable these staff to be applied to a reasonable range of projects.

Technology standards
On one hand, standards would appear to constrain agility. They narrow the field of choices for an organization. On the other hand, standards improve agility. In the absence of standards, organizations often make significant investments in attempting to integrate technologies that were never designed to be integrated. The result can be an increase in IT costs (which reduces agility since the financial resources available for other initiatives are smaller) and make applications and infrastructure difficult to change (which hinders agility) because of integration complexity.

IT alignment
IT agility requires that the IT leadership and organization understand the organization’s strategies, challenges, and priorities. With this understanding, the IT organization is in a position to effectively engage in discussions of IT alternatives and approaches.

Related to alignment are the processes the organization uses to make decisions. Governance structures that are fuzzy, opaque, and unsupported hinder agility. Decisions can take forever and run an unacceptable risk of being poorly embraced.

Achieving agility will require tradeoffs with other organizational properties and goals. It’s hard to be agile and efficient. However, agility may be more important than other properties such as efficiency, customer service oriented, or brilliance at project execution.

John Glaser is vice president and CIO at Partners HealthCare System. He describes himself as an "irregular regular contributor" to HIStalk.

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Currently there are "6 comments" on this Article:

  1. From your pen to God’s ears on Project Phases!

    As product consultant and former associate of a vendor, I’ve found that headstrong IT departments frequently refuse to listen to ‘lessons learned’ from other customers, logic or even common sense!

    Prohibiting any live activity until the entire project is “done” defers ROI, emphasizes inter/intra-departmental inadequacies and often prevents focused “process” fixes due to the gung ho deadlines that are established.

    When I find myself working with customers who meet dates and objectives by forcing the software to work like they work and have no consideration for change (We’ve Always Done It That Way Syndrome), I am very disappointed. Advising them to work smarter, not harder seems to fall on deaf ears!

    In my opinion, seeing positive phased results during an implementation provides the foundation for a successful project.

  2. John, right on. A very crisp and focused comparison of the key paradigms, old versus new. At my previous company, as we executed the overall Strategic/Tactical plan each “scheduled / budgeted” project was reviewed before it was funded by a Priority Setting Committee. This provided a timely checkpoint to determine if the project was still relevant. I was surprised how frequently upon final review, circumstances had changed and we were able to use the funds more effectively. This also provided an opportunity to focus on each project in more depth, an activity which often gave surprising insights into sponsor assumptions. Enjoy you essays, even if they are “irregular regular” contributions. Bill

  3. >>> The result can be an increase in IT costs (which reduces agility since the financial resources available for other initiatives are smaller) and make applications and infrastructure difficult to change (which hinders agility) because of integration complexity.

    I’m not sure what you meant by that, but the way I’ve seen things is that CCHIT certification is not about standards as much as for “culling the competition field”, for increased complexity, and for increased costs. This complexity results in less change, more installation failures (~50% in most series), and overall are not wanted and are not being bought by physicians.

    John- what’s the status of your joining in with Obama’s cabinet? Is that true? That would be great; I don’t always agree with you, but you seem like a reasonable guy.

    If so, can you try to reprogram our emperor, dictator, president, Lincoln-wannabe, Castro-with-a-tan, or whatever you wish to call him that forcing HIT onto physicians is not going to work, and will result in increased costs, increased errors, decreased quality, and with a Medicare system devoud of doctors? Thanks!


  4. Agile development has been used for years in IT software development but there are real risks to the health and safety of your development staff if implemented poorly. For a recent retrospective check out the link.

    The same short iterative development cycles we utilize in IT are similar to the quality cycles utilized in health care but you rarely find someone who is skilled in both.

    Now if only we could get some of the major EMR vendors (or new players) to use Ruby (the language) on Rails (the framework) (RoR) combined with an Agile web development model

    Nice to see the possible future ONC chief of staff sharing his expertise from in the trenches. 😉

    shhh. I am incognito today.

  5. Mr. Glaser.
    Godspeed with “part-time position” with ONC in Washington. No small task, that.

    You will have a triad of special interests to deal with…how well that triad is MANAGED will be the chief determinant of success in the HiTech funding program.

    The three stools of the triad are: The president’s healthcare agenda and funding will expect, demand and supposedly incent ONLY successful results; second, EMR vendors, with special interests in their products (over 300 of them!) will lobby hard for the same CCHIT-type certifications (that they have paid dearly to follow the blueprint for) that are having well-documented adoption problems for well-documented reasons; and physicians, such as Dr.Borges, above, representing so many providers, who say existing EMR will NOT be the answer for the BROAD market. It CAN’T be because it makes physicians data entry clerks and slows them down during exams. Incentives won’t change that

    Only two solutions to this conundrum: Force physicians to “get over it”, learn the EMR’s as they are and accept whatever consequences to their practice; OR, force the EMR’s vendors to comply with not only a functionality standard, but a “usability” standard that compares how long it takes to accomplish key tasks during key parts of medical visits.

    To see how the latter would work, look at Hybrid EMR…which was borne of the need for EMR for high performance or high volume practices. HUGE success rate. Usability is the key component in hybrids.

    Without “usability” in the mix, $20 Billion could be wasted!

  6. To Agile plus RoR,

    The original article meant “agile” in the lowercase, dictionary definition-sense of the word, not Agile.

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