CIO Straight Talk - Issue 4 - 36
Several years back, one of our doctors wanted a way to
track "near misses": clinical mistakes that are caught
before they seriously harm a patient. Did he come to us,
the experts in IT, to place his request? No, he went to his
next-door neighbor. Together they created a simple iPad
app that now provides our whole company with information that has greatly improved the quality of the care we
provide our patients.
This is an example of one of the most significant
trends in IT today, what I call "innovation by amateurs."
At Vanguard, two forces have intersected to drive the
open IT innovation process. The
first is our team of highly
educated and entrepreneurial
physicians, most of whom
operate as independent contractors. The second is what I refer to
as the "Applification of IT." Apple
made the computing experience
both simple and appealing, and it
has become extremely easy for
people to research, implement,
adopt, and scale solutions.
Suddenly, CIOs find themselves
on the back side of the R&D
curve, with key constituents way
out in front.
Rather than try to bend the
curve or regulate behavior, we
decided to make the curve work
for us. Since joining Vanguard as CIO, in 2011, I've
encouraged our user base to find and vet solutions, and
to look at IT as the arm that will industrialize and scale
them in a way that makes sense for the rest of the enterprise.
vetted it in a traditional R&D way, and then came to me
with a proposition to scale it across the enterprise. We
have lots and lots of clinical specialties that have gone
through the same exercise.
This is a huge shift. During my previous stint in the
hospital space - about nine years ago, at Stanford
Hospital, where I was the director of IT - this kind of
activity was verboten. Something like this would have
been considered a rogue application, and we had policies
and procedures, up to and including termination, that
forbid this kind of behavior. We had an R&D group that
worked on building or buying
solutions; nothing got into
production without coming
through that group. Today at
Vanguard we don't have an
R&D team; instead, we have
one R&D guy who is essentially the gatekeeper for other
Of course, we're still something of an outlier. The hospital industry overall is very
founded and are run by a serial
entrepreneur, and that's in our
DNA. Many of my peers -
especially in for-profit hospitals - think very differently.
But this will change. And I
think the kind of experimentation we're engaged in will
become more common in many industries, from financial services to retail to transportation.
If I'd grown up as a
getting yelled at six times
a day, I'd probably be
much more risk averse
than I am.
Those Persistent Calls from the OB Nurse
One of the early examples of this kind of innovation was
with a group of our obstetricians in San Antonio. Every
blip in the labor and delivery process tended to trigger a
call to the doctor from the OB nurse, who would try to
explain what he or she was seeing on a paper strip
coming out of the fetal monitoring equipment. The
doctor would have to figure out if it constituted a
problem that required immediate attention. Imagine
you're delivering multiple babies at the same time -
that's really hard to do.
So this group of physicians went out and found an
OB-monitoring waveform application built by a local
physician. They installed it and got some IT folks to
populate it with monitoring data. They fell in love with it,
because it eliminated many of the phone calls and alerts,
they no longer felt detached from their patients, and they
didn't have to worry about what was going on if they
weren't getting any calls. It helped them make sound
clinical decisions remotely and become more efficient in
Think about it - what I've just described is the
world's best self-funded R&D scenario. The doctors went
out and identified the problem, identified the solution,
40 CIO Straight Talk
Managing the Process
Early applications, like the one created by the OB
doctors, created a bit of a floodgate effect at Vanguard.
We had to convince people that our welcoming their
ideas wasn't an anomaly - it was going to be our new
way of operating. But once it was clear we were serious, a
deluge of ideas came pouring in; I think people were
afraid that the floodgates would be closed again once we
came to our senses!
Our next step was to define a governing process to
deal with the introduction of new ideas. It had to be
understandable, and we had to let people know this
wasn't an opportunity for us to say no but a way for us to
say yes, at scale. We wanted everyone to understand that
there would be a commitment from us to scale their ideas
once they passed through the appropriate gates.
We have a dedicated vice president of technology
innovation, growth, and strategy who vets these ideas
according to criteria we've developed:
1. Is this a solution that we could scale to solve many
2. Can it make it across all the regulatory hurdles?
3. Does it fit into a reasonable support model? (If someone comes across an esoteric system and I have 50
esoteric systems that we have to integrate it with, it
won't be economical to scale.)