Toolchain Integration and the Flow Framework™ Accelerate Business Value Delivery and Support Rapid Growth for U.S. Healthcare Provider



Improving Quality of Life for Patients

One of the largest providers of specialized hospitals and rehabilitation facilities for outpatient care in the U.S. has grown rapidly since it was founded twenty plus years ago. Employing almost 50,000 staff members to treat tens of thousands of patients per day throughout its network of hospitals, clinics, and health centers, the organization is dedicated to clinical quality and operational excellence. To this end, every new tech initiative is measured against the key principles of delivering exceptional patient and employee experiences.

The Challenge: Rapid Growth in a Competitive Market

In 2016, the organization laid out an aggressive growth plan to serve patients in new markets. The plan required rolling out new EMR (electronic medical records) software, compatible with the health systems used in their partners’ facilities, to several new hospitals each month.

To support this rapid growth, the company’s Information Systems (IS) group was tasked with developing, delivering and operating all the information systems used by employees and patients while reaching a new level of value delivery.

The question was how to do that without a huge financial investment and utilizing existing resources.

The Initiative: Achieving Flow and Visibility through Integration

The organization’s IS group needed to find a way to maximize the efficiency of existing employees while quickly rolling out the new technology without disrupting the medical staff’s ability to provide excellent patient care. Their goal, as always, was to ensure that medical specialists could focus on patient care, not on software issues.

They proceeded to create a plan to reach the speed and scale they needed:

  1. Make prioritization possible: IS would establish a single work intake process, which would give innovation a clear path to execution. Leadership would be able to prioritize the business requests and requirements would flow to the implementation teams, providing them all the necessary information upfront to do the job right.
  2. Tool rationalization: To streamline the way they worked, IS would rely on one set of tools for the entire software delivery organization.
  3. Automated flow: IS would maximize productivity by integrating the end-to-end software delivery value stream. Data would flow seamlessly between their tools, eliminating duplicate data entry, context switching, and loss of data fidelity.
  4. Visibility into value delivery: To create visibility into the execution of the plan, IS would create an executive-level dashboard so leadership could see the real-time status of each project.  

The Experiment: A 90-Day Proof of Concept

IS set off to implement the plan within a 90-day window for one IS team, the team tasked with rolling out the new EMR software to the hospitals.  

First, they developed a web-based application that allowed regional directors and above to submit initiatives directly into the IS group. The form-based submission required that the idea, business value, and high-level requirements be articulated clearly. It also required a definition of how success would be measured. The executive team could then prioritize the initiatives based on what would actually improve patient care and make staff more efficient.   

Next, IS selected the tools they would use across the software delivery value stream. They chose Microsoft’s Azure DevOps Server (previously TFS) for software development and ServiceNow for IT Service Management.

With all that in place, they were ready to integrate their internal application, Azure DevOps Server and ServiceNow using Tasktop Integration Hub, to ensure automated flow of data across tools:

  • An approved idea submitted in their application would flow as an Epic to Azure DevOps Server, where it could be implemented. This direct flow of data ensured developers had all the information they needed in one place, traceable to the originating business request.
  • Incidents opened in ServiceNow that required investigation and resolution by a developer would flow automatically to the appropriate development team’s board in Azure DevOps Server. This ensured that all planned and unplanned development work would be visible from within Azure DevOps Server and could be prioritized properly.

“The connectivity between the tools and the traceability between the artifacts using models were necessary to achieve the productivity gains we were looking for,” explained the IS lead. “The integration layer eliminated waste and provided the foundation for our metrics initiative.”  

Finally, Tasktop Integration Hub’s Enterprise Data Stream feature was used to pump modeled and normalized data from across the software delivery value stream into an enterprise database, from which executive-level dashboards were generated. The dashboards provided visibility into flow and the rate of value creation, in a way that created a mutual understanding between the technology teams and business stakeholders, as outlined in the Flow FrameworkTM, created by Mik Kersten, CEO of Tasktop.

The Results: On-Schedule Delivery and Higher Quality

The proof of concept was a resounding success. The participating team was able to roll out five new hospitals per month, a previously impossible feat, while maintaining the quality of patient care.

The integrated toolchain infrastructure provided by Tasktop helped the organization gain insight into their flow and reap several tangible benefits:

  • The quality of rollouts increased, measured by a significant reduction in escalated help desk incidents. Teams were developing the right thing from the start. This was attributed to the fact that clear requirements were flowing from the ideation phase to the implementation phase. Teams knew exactly which customizations were required for each hospital in advance. Therefore, rework was reduced to a minimum, which meant expensive development resources could immediately be allocated to the next rollout.
  • Work became visible, revealing untenable workloads and the root cause of project delays. The moment the integration between ServiceNow and Azure DevOps Server went live, over 1,200 incidents flowed to a single team’s board, for the first time making both planned and unplanned work visible in one place. The team’s managers could now see just how much incident work from existing hospitals was bogging down the same team that was tasked with rolling out new hospitals. Revealing this overwhelming workload prompted the managers to take immediate action, and within days they implemented a new team structure, with one team dedicated to new rollouts and a second team handling incidents. This change allowed IS to roll out the new hospitals consistently and predictably, eliminating any delay to business value delivery.  

integration metrics case study

  • IT and the business established shared visibility into the software delivery process, thanks to the new set of dashboards based on Tasktop data. The IS group could finally show the business stakeholders all of the work in the software delivery pipeline, which enabled conversations about prioritization and resource distribution. “Gut feelings were replaced with data,” explained the IS lead. “If you wanted to know if we were on track for the quarter or the year, you could see for yourself by going into the dashboard. Also, you could see exactly where your initiative was, how it was progressing and what had been completed. We measured the time an initiative took from inception to delivery as well as the cycle time of each phase, so we could increase predictability and identify our bottlenecks.”

Following the successful proof of concept, IS scaled the efficiencies to the entire organization, getting the rest of the teams on the same tool stack and following the same processes. For every team on-boarded, the organization observed a direct drop in aged defects, due to the fact that the team now had visibility into all the outstanding issues impacting their staff and was motivated to take action immediately.

“Tasktop provided us with a single pane of glass. Now we’re allocating resources correctly to support our users as well as delivering new initiatives or enhancements. We’re delivering a more robust solution to our customers, focusing on the right areas to solve the bigger problems. My discussions with the business about prioritization have been completely transformed, because now they are backed up by data,” explained the IS lead.

What’s Next?

Software delivery is constantly evolving to keep up with the latest technologies and tools. This organization recognizes that and has already started evolving its IS tool chain to include new tools that will help them move even faster. New tools must and will be fully integrated to enable automated flow and eliminate manual waste.

“Tasktop has become our litmus test for selecting software delivery tools. If it doesn’t integrate with Tasktop, we won’t buy it,” he summarized. “Fortunately, Tasktop supports approximately 60 of the most popular tools used in the software delivery lifecycle and hundreds more DevOps tools and utilities.”

The organization is thrilled with the productivity, efficiency and visibility they’ve achieved by implementing robust, model-based integration infrastructure. “We’re excited to take the next steps in our journey with Tasktop. We’re already faster and more productive than we were one year ago, plus we have better alignment with the business thanks to our ability to measure the business value we’re creating. The next step for us will be implementing the top layers of the Flow FrameworkTM, with the ability to generate aggregated flow metrics for each of our value streams and view them in correlation with business results.”


The Flow Framework™ was created by Mik Kersten and outlined in his book Project to Product. The Flow Framework™ is a trademark owned by Tasktop Technologies Incorporated, and we need to protect our ownership of this framework and the value that we create as we develop and bring the framework to the market.

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