John Glaser

At a Glance

It's possible to gauge a hospital's IT functions in one day by hiring a consultant to review three key areas: infrastructure and application performance, execution, and alignment. To do so, the consultant should speak with:  

  • The hospital's CIO
  • Members of the IT department
  • Three senior members of the leadership team
  • A small sample of front-line managers
  • A sample of front-line users who were involved in recent implementations

Let's assume that you are confronted with the following scenario: You have been hired for a senior leadership position at a new organization.

You are, of course, very excited about this opportunity. A significant increase in responsibilities. A nontrivial jump in salary. A truly deluxe office.

But there is one dark cloud in this otherwise cloudless, sunny sky. You have been given responsibility for the organization's IT department. The organization, recognizing your wary reaction to this prospect, has given you the services of the world's best IT consultant group to assess the department. However, you have access to this consultant for only one day. What areas would you have the consultant examine?

The answer? Guide the consultant to look at three areas: infrastructure and application performance, execution, and alignment.

Infrastructure and Application Performance

Organizations and departments can become quickly paralyzed if the infrastructure and applications are experiencing high levels of downtime or slow response times. Failure to stay current with application and base technology upgrades can leave the organization in peril, because vendor support may have become nonexistent. Poor security controls can make the organization vulnerable to viruses and hackers. Failure to perform backups of data can result in the devastating loss of data should a server fail.

Infrastructure and application performance and management are the first place of assessment, because crippled applications, networks, and databases can severely disrupt operations. Many organizations have faced significant revenue losses and bankruptcy because of major IT malfunctions. It's almost impossible to engage an organization in discussion of new applications if the current applications are not functioning adequately.

Because of the one-day time limit, the consultant should concentrate on the following steps.

Examine external and internal auditors' reports on IT controls and management. These reports and management letters will note any issues of significant downtime or substandard application and infrastructure performance. Reports also will document any failure to perform adequate management of the data center, such as backups or routine upgrades of core technologies. Additionally, the audit report will include an assessment of security controls and the documentation of procedures. The consultant would not need to read the entire report, but rather, could focus on key findings.

Gain perceptions of a small sample of front-line managers. The consultant could ask several managers to comment on system performance. How often does the system go down? Are there days when the system is very slow? Are managers aware of any times that the system was brought to its knees by a virus attack? These managers should come from different parts of the organization, such as finance, patient care services, and outpatient registration. If there have been problems, you can be sure that these managers will remember them well, because they would have dealt with operational difficulties stemming from a damaged IT system.

Talk with the organization's CIO. During this meeting, the consultant should ask the CIO several questions: Do you track downtime-and what do the data tell you? Are you current with vendor releases? How do you manage virus protection? When the infrastructure has problems (and all infrastructure will have problems), what are the procedures for responding? The consultant will be looking for evidence that the IT group has implemented sound management and technical practices to minimize infrastructure and application performance problems.

Executing IT Strategy

Assuming that the consultant began the day at 7 a.m., it is now 10 a.m. Time to examine the next area: execution.

Execution covers two classes of activities: the implementation of new applications (and associated changes in processes and workflow) and the day-to-day support of users. Although problems with IT infrastructure can quickly undermine the organization's ability to function, the cumulative effect of execution problems can be equally damaging, even though they take longer to cause damage. Execution is generally more important than strategic alignment. There are few organizations in which all of the system's IT projects have nothing to do with the organization's strategy. There are many organizations in which the execution of IT projects is mediocre-or worse.

The implementation of new applications is where "the rubber meets the road." Desired improvements in processes and information management must be assessed. Applications must be examined to determine their ability to bring about the desired changes. Workflow must be changed. Users need to be trained. The organization must manage the short-term disruption that will inevitably result.

Within the execution function of the IT process, the consultant should look at the IT department's ability to accomplish the following.

Achieve desired outcomes. The consultant should meet with three senior members of the leadership team, as a group, and ask several questions: Picking three recent implementations, what were the objectives? To what degree were the objectives achieved? If the organization fell short in achieving objectives, why did this happen? Was the implementation on time and on budget? Did the implementation go relatively smoothly?

The consultant will look for evidence that the organization does reasonably well in the implementations of those systems that leaders believe are important to the organization's overall strategies and plans. No organization is perfect, and all will have implementations that are over budget and did not achieve 100 percent of the objectives. However, significant time and budget overruns, as well as a consistent failure to achieve objectives, point to major problems with IT execution.

Engage users effectively. The consultant should meet with a sample of front-line users who were involved in some of the implementations cited above. The consultant should ask users several questions: Did the implemented system improve the operation of your department? Was the training good? Were the IT group and the vendor responsive to issues and problems? Was the representation of users effective on various task forces and project teams?

The consultant will be listening for evidence that implementations were user-driven (mindful of the overall organizational goals) and responsive to needed changes in application capabilities and workflow. Training should have been well done. Any changes in policies, procedures, roles, and workflow should have been well designed, and users should believe that the implementation resulted from a true partnership.

Manage the implementation. The consultant should meet with members of the IT team to talk about the methods and procedures they use to manage implementations. The consultant will examine the use of project charters, project management tools, techniques to communicate project status, and approaches to issue resolution. The consultant will look for evidence that the IT group (and the organization as a whole) follows the appropriate project management disciplines.

Support for IT Services

Application implementation is not the only aspect of execution. Support must be provided every day. This support can take the form of responding to personal computer troubles, applying enhancements to applications, talking to department leadership about how IT might resolve operational issues, and examining new technologies.

What should our consultant look for? Two areas involve front-line support and departmental liaisons.

Front-line support. IT staff deliver service every day, such as providing help-desk support and creating databases for small applications. The quality of these services has a significant impact on the organization's perception of the IT group and the ability of IT staff to do their work.

The consultant will meet with the IT managers who provide front-line support. During the meeting, the consultant would ask a number of questions: Does the IT department measure its service? For example, do IT staff measure the percentage of help-desk calls that are "closed" within 48 hours? Has the IT department established service goals? Was the organization's management involved in setting those goals? Does the IT department regularly solicit feedback on its service?

Department liaisons. An IT department should have staff who form liaisons with major functions within the organization, such as nursing and finance. IT liaisons should ensure that IT issues and problems confronted within their focus areas are understood and communicated to the rest of the IT organization, and that appropriate follow-up occurs. In addition, liaisons should ensure that IT plans and opportunities are communicated to users within their focus areas.

The consultant also would meet with a small group of midlevel management from these functions and ask them a series of questions: Who is your IT liaison, and does the liaison do a good job? Can you give me some examples of issues that you have raised with the liaison? Were those issues well resolved? Does your liaison do a good job of keeping you up to date on IT plans? Do you consider this liaison to be a member of your team?

Aligning the Agendas

By now, it is 2 p.m. Our consultant used a working lunch to hold some of the discussions mentioned above. The consultant is close to completing an analysis, but has two more topics to cover.

IT links to organizational strategy. Organizations develop strategies. They develop plans to improve performance. The IT agenda for application acquisition, implementation, and infrastructure improvements must be well-linked to the organization's strategies and plans. If not, the IT folks may be executing well, but focusing on the wrong things for that organization.

What should our consultant look for?

The consultant would meet with the senior leadership of the organization and ask leaders to present the organization's IT strategy. During this presentation and discussion, the consultant will probe the team with the following questions: Can you take each item in your strategy and perfor-mance improvement plans and point to the IT initiatives that support these undertakings? If there are IT initiatives that cannot be mapped to organizational strategy and plans, could you discuss why you approved these initiatives? Is there a regular senior leadership discussion of the IT agenda? Does leadership take responsibility for making decisions about which IT initiatives to fund? Does the CIO take the lead in bringing new information technologies to the attention of the management team?

If the organization has a documented IT strategy, the consultant should review it. However, the documented strategy is less important than the ability of the leadership team to be active, informed participants in the discussion of IT strategy.

Governance. Governance refers to the organization's structures and processes for assigning responsibilities, making decisions, and defining policies and procedures. The organization must make IT-related decisions on a regular basis. Some of these decisions relate to strategy, but not all of them. Decisions will need to be made about priorities, IT policies, and topics such as roles during system selection.

The consultant will review the processes and committees used to set priorities within the organization. Is the process for setting the IT budget well understood, efficient, sufficiently rigorous, and perceived as fair? Is there a well-accepted approach for acquiring new applications? Do the IT project teams have well-defined roles and methods for implementing new systems?

The Final Analysis

Our consultant's review is complete. It is 5 p.m.: time to give you an overview of the conclusions and recommendations, perhaps over dinner.

We don't know the conclusions, although most likely, the consultant will be direct and insightful. It may be that the organization is in good shape despite areas that need improvement. Or the organization may have much work to do.

While great consultants can be invaluable to any organization, there is nothing that precludes an organization from asking these questions of itself. This form of self-appraisal can guide the management team's determination of where to focus efforts to improve its IT prowess-and, if necessary, highlight the need for consultant expertise with specific areas of concern.

John Glaser, PhD, FHIMSS, is vice president and CIO, Partners HealthCare, Boston (

Publication Date: Sunday, January 01, 2006

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