It's the Process, Stupid—or Is It the Stupid Process?

June 2011
By Capt. Joseph A. Grace Jr., USN (Ret.), SIGNAL Magazine

A week ago, I spent three nights in the hospital with my 17-year-old son, who was suffering from severe headaches and uncontrolled nausea. One test after another revealed nothing, and we ended up with a diagnosis of, “Get him some rest, keep something down and hydrate him with IVs [intravenous fluids], and we’ll see.” Needless to say, his dad—a trained submarine nuclear officer and former chief information officer of Navy Medicine—was ready to stand the watch in the hospital. “Get him some rest and fluids…”—a simple assignment—or so it seemed.

The IV machine had a series of alarms and features that, I’m sure, made it expensive and efficient. However, it seemed to sound its alarm if it was happy, if there was a blockage, if the protocol was completed or just because it was two o’clock in the morning. Interestingly, it didn’t alarm at the nurses’ station; it alarmed only in the room. At first we just endured the alarms, until finally the “nuke” in me gave in, I read the manual and decided to take control. For the next three days and nights, Capt. Grace, USN (Ret.), turned the alarms off and on and played nurse.

Out of this experience, several key observations emerged. The device was “network-enabled” and had the ability to be plugged into the hospital’s systems. There were network plugs on the wall and on the machine. So I wondered, if this is the case, then why does the machine sound an alarm only in the room and not out at the nurses’ station? I also found that the nurses usually are not at that station because they are out making their rounds, so they would not be able to do anything about an alarm they could not hear or see. Alarms were going off all the time in all the rooms, and many subsequently were ignored.

Again the nuke in me was horrified. If it’s worth having an alarm on it, then it’s worth responding to. With all of the technology in that hospital, why didn’t it alarm on an iPad or on a mobile device on a person’s hip, or perhaps even with a videoconference capability, because the rooms there had Internet and TVs?

So, we have incredible technology that is network-enabled, but we have not taken the extra step to make it useful or productive. This prompted me to think of so many other cases where we just did not change the business process to make it work.

We buy voice recognition software to eliminate dictation costs, but we never go back and change the process—teach people how to use the software and cancel the dictation contracts. We end up paying for both. We pay millions of dollars for electronic medical records, but we never replace or reassign the desk clerks waiting to retrieve and move the paper medical record. We do not use the electronic system to check in; instead we do that on paper that has to be hand-keyed into systems that do not link with that expensive electronic record.

We buy wireless laptops and PC tablets, but never put in the wireless nodes or rewrite the archaic policy to allow us to use them. We ask for all military members, their dependents and retirees to manage their world on our military websites, but we make it almost impossible for them to access their accounts. We approve remote access to our systems, but we make it almost impossible to access them unless the person is in a .mil environment. If by chance access is compromised, or a person’s Common Access Card is turned off, then users physically must go to the nearest personnel support detachment—which are few and far between, especially for the Reserve Component—to re-set their access, even though policy exists to allow remote registration.

We buy SharePoint, but we fail to train people on the technology and we continue to choke the network with large files and PowerPoint documents. We buy enterprise licenses for code-level security so that our development teams will write secure software, yet we fail to deliver those same licenses or any training to the very developers for whom we bought the technology. We purchase licenses for innovative technology, but then we fail to buy any training or to certify it for the network. The result is that we have boxes of unopened and now outdated technology with a proven track record of performance and improved user satisfaction that expires on the shelf.

In most of the cases where we have found a new technology, we automatically assume that we are able to install, integrate and train on that technology. So, we fail to purchase these vital services. We have millions of dollars of unused technology lying around our offices and commands that could have made a significant impact on the business at hand. Add to that the compounding effect of the “sponsor” of the technology rotating out of his or her position every two to three years, and the result is the combined “junkyard of fantastic vision and technology.”

If we do not plan how our technology will impact our processes and business—or, if we do not go back and change our processes, our policies and our way of doing business—then any new technology will be “too hard and just another really good idea.” No one seems to want to do the really heavy lifting that takes expertise, long hard work and a complete review of how we manage our world. Without that effort, we will continue to have alarms going off in our hospital rooms that effectively keep us from getting the very sleep that these systems were designed to provide. It’s the process, stupid; and it’s time to fix the stupid process.


Capt. Joseph A. Grace Jr., USN (Ret.), is the president and chief executive officer of Grace and Associates LLC and a former chief information officer for Navy Medicine. The views expressed are his own and not necessarily those of SIGNAL Magazine.

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Spot on. Process needs to include implementation plan, or do not procure.
2003: Asked for barcode reader - too expensive. Ingress period of two weeks per shipment is ok.
2008: New lower cost barcode reader request accepted - PBO found two readers were purchased and received in 1998. Was stored because nobody learned or "wanted" to use them. New ingress time became 3 hours.