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IT professionals working in health care must pursue excellence in everything they deliver, with a bias for action and quality.  

IT Professionals in Health Care

Are you the average contractor or a trusted consultant?


John R. Snyder, July, 2008

You may have to transform your thinking to meet the challenges of delivering IT services and software in health care. The higher expectations-standards in health care may force a change. In health care no one wants to coach you on what should be done; instead, the expectation is that you will provide thought leadership in your field. In health care you can't survive as just another average contractor-you need to become a trusted consultant for your client.


What's the difference between an average contractor and a trusted consultant? Simply: an average contractor does the job; a trusted consultant thinks beyond the work. An average contractor takes the instruction and runs with it, even if it doesn't make sense. A trusted consultant stops to ask the difficult question: "are you sure you want to do this"? The average contactor sees the customer is struggling with a business problem--but it's out of scope. A trusted consultant offers an add-on proposal containing potential solutions. The average contractor is a worker, expendable; a trusted consultant is a partner, invaluable.


The Comparison

Below is a force-field comparison of the salient differences between the average contractor and a trusted consultant. The sections that follow then elaborate these basic contrasts.


Average Contractor
Trusted Consultant
Assumes that someone else has a plan
Begins by envisioning the end result
Stays away from business issues
Immerses into business problems
Waits to hear the explicit
Listens for the implicit, looks for the tacit
Is this what you want?
Here is what we will deliver


Begin With the End

The average contractor will allow a project to begin and execute without any measures of success. Average contractors march blindly into tasks that have no charter, vision, or without any written definition of the scope. Even in a time and materials arrangement, this is usually damaging to the client relationship in the long-term. Without a written, quantifiable definition of success, everyone associated with the project thinks they know when it's time to declare the grand accomplishment. Unfortunately, each stakeholder's idea of success is different, and there's no way to validate a tacit concept. The average contractor has a myopic view and can't see beyond the next six months.

A trusted consultant will stand firm on the insistence that a definition of success is written. The measures can be in a project charter or a project vision document. The measures of success don't have to be grandiloquent or verbose-but the definition of success needs to be written in terms the project sponsor will sign when the milestones are reached. By focusing on the vision, goals, and business aspect of the task, a consultant creates an aperture into the value the IT project brings for the business.

And when the average contractor does deliver a satisfactory product, what about the operational model? Does anyone have a plan for how the product will be maintained over time? Is that someone else's job? The trusted consultant will have thought beyond the project end date and is ready with plans-proposals for sustainment operations and maintenance.


Immerse in the Business

The average contractor doesn't want to become involved in the problems of the business. The average IT professional wants to be handed unambiguous requirements--so they can get to work churning-out widgets, bells and whistles. Unfortunately, good requirements for software are the exception, and more often than not, even a new-improved version of software won't solve the underlying problems in the business. The end result is often a feature soup of piecemeal functionality that does little to address the customer's real business needs.

A trusted consultant will not be afraid to become involved in solving business-related problems when they clearly present risks to the IT project. No one is advocating going outside of bounds or the scope of work. But if there is confusion in the business area about the mission of the IT project or how the IT project fits-into the goals of the business-it's unlikely the delivered product will be warmly received. The trusted consultant will suggest creating and publishing communications to eliminate confusion for end users and succinctly state how the IT project will benefit the business. The trusted consultant with demonstrate an iron will in rejecting requirements that do not advance the business goals.


Listen for the Implicit

Health care professionals know about spinal injuries and Sciatica. Sciatica is a condition where the patient feels pain in the leg, but the cause of the problem is a prolapsed disk pressing on a nerve in the spinal canal. Treating the area where the pain manifests, the leg, will do nothing to solve the problem.

The average contractor will quickly turn to the obvious and deliver a product that does nothing to solve the real, underlying issue. The condition persists and the customer feels as if the time and money have been wasted. The average contractor sees the problem only in the bright light of solutions that are observable, familiar.

The trusted consultant is not afraid to investigate. It's difficult, but sometimes the best answer is another question: "if we deliver this, what would you do with it"? The trusted consultant asks: "what are you actually trying to do"? Sometimes, the client may not be sure about the organization's plans--but can't say that without being embarrassed. Usually, there are subtle hints or clues that your customer has lost their way:


  • Important decisions consistently deferred in an endless huddle of meaningless meetings.
  • The focus is exclusively on open-ended, present-tense activities without a clear sense of the ultimate outcome.
  • The project goals are tacit.


The trusted consultant knows that some corporate cultures pressure people into withholding information. Not only that, it is often deadly for manager to convey bad news upward through the organization. Recognizing these situations allows the trusted consultant to take ownership of the problem. The trusted consultant is the one who goes up the organization to ask the questions, take the heat. Information is discretely funneled back to the client, who of course, publically knew it all along!


Don't Guess Requirements

The average contractor, after beginning work without a clear, written vision of what is to be achieved, will go into a pernicious cycle of is-this-what-you-want deliveries. In the end, everyone is frustrated.


The trusted consultant, having the written, signed project charter in hand--can be flexible and invoke rapid prototyping or joint application development techniques when requirements are vague. The trusted consultant can use the project scope statement to define up-front what will be delivered. The scope is defined in terms of a precise declaration of what will be inside of the system, and what will be outside. The project scope is kept up-to-date as change occurs. Project goals are defined succinctly; as new requirements are discovered, they are documented into an approved, traceable change control process.


Not Gold Plating

The trusted consultant does not gold-plate requirements. The Project Management Body of Knowledge (PMBOK) describes gold-platting as "giving the customer extras (extra functionality, higher-quality components, extra scope of work or better performance)". The PMBOK position is that "gold-plating adds no value to the project". This is true from the perspective that if the client signed-off a charter to deliver a set of static Web pages for basic use, there is no value in adding multimedia functions if no one will use the multimedia.

On the other hand, when it comes to software it may be impossible to define initial requirements so exacting there will never be room for beneficial change. The trusted consultant doesn't constrain creative developers to follow the requirements so closely and literally that the potential for peripheral benefits are suppressed.

Suppose the requirements call for five clearly specified hard-copy reports; only the average contractor would provide just those reports, ensuring no other data fields are available. The trusted consultant would allow for the consideration of alternatives and build flexibility into the application-without gold plating.


Passion for Excellence

The transformation from an average contractor into a trusted consultant is the realization of a passion for excellence. The passion for excellence is an enthusiastic desire to perform in a way that far surpasses the average. Individuals and teams of IT professionals working in health care should pursue excellence in everything they deliver with a bias for action and quality. Seek out new ways to improve processes, resolve issues and pursue opportunities. Demonstrate the importance of quality and excellence, become a trusted consultant.


Reference and Notes

  1. Atlantic Systems Guild, Adrenaline Junkies and Template Zombies. NY: Dorset House, 2008, p. 143.
  2. Project Management Institute. A Guide to the Project Management Body of Knowledge (PMBOK® Guide) - Third Edition.
  3. Sharyn A. Brotz. The Positive Side of Gold Plating. http://www.pragmatic-systems.com/Pragmatic/Gold%20Plating%20or%20Gold%20Starring.pdf, 2008.