Stewardship 1/6/2013 9:29:03 AM

As we continue our journey together this coming year and strive to add value to our company and enhance our careers in return. I would like to share a few thoughts around one of our companies values, stewardship.

Stewardship is about building a better, stronger company for future generations. It means building a malomatia of tomorrow that is better than the malomatia of today.

Being a steward doesn’t mean that you are completely selfless, though. Rather, being a steward enables you to take control of your career in a significant way. And while it seems that stewardship applies to malomatia’s Executives and leaders, anyone—at any level—can be a steward. Here are some things we can all do to build the future malomatia:

1. Reflect. Before you act, ask yourself these questions:
• Am I doing this for the right reasons?
• Am I doing this the right way? Am I helping to create a positive work environment, or am I feeding into negativity which lowers morale?
• Do I look ahead and focus on what we can achieve together?
• Am I truly present with people in meetings—or am I multi-tasking or distracted?
2. Coach and mentor.

If you coach someone just because you are a PM or supervisor and you have to, that’s not stewardship. True coaching or mentoring happens when you truly want to help someone, whether they ask for help, whether they’re creating a solution for a client, or whether you want to learn something yourself. And don’t think that you can only coach someone who’s at a lower level than you; we learn from people at all levels.

malomatia’s strength — our core for adding value to our clients—is our people. When you share your knowledge and help others build a network in malomatia (or outside of it) you truly are helping to shape the company. Take the time to mentor: walk a new team member through malomatia’s admin procedures; give the inside scoop on how things ‘really work around here’; share what you know and who you know with those around you. Mentoring and coaching shouldn’t have a ‘one size fits all’ approach. Look for ways to mentor in a way that is meaningful to the individual.

3. Give them wings — but provide a net.

Others learn, and so will you, when you delegate stretch tasks and empower your team to take risks. But be sure that when you delegate you are close by supervising the task and are ready to provide a safety net when needed.

4. Listen, answer, and move ahead.

A true steward is honest. When things don’t go as planned or when there is bad news to be delivered, a true steward states the facts, listens, and answers questions with candor. And then he or she takes it a step further, helping the team move ahead without getting caught up in the negativity that can accompany bad news. True stewards help the team reengage and move forward.

5. Keep Your Eyes Open.

It is sometimes hard to see opportunities for people to grow given a current project or workload, but stewards keep their eyes open for their team members—looking for opportunities for them to try new things, or perhaps transition to a new opportunity on a different team. Those are hard decisions to make in the short term. It isn’t always to your immediate advantage to move people and let them try new things, but stewardship requires you to support new opportunities for those who seek them.

Bottom Line: Are you making choices every day that are in the best interest of your company and your people? Are you looking for ways to create a positive workplace? Are you encouraging people and showing them the possibilities here?

This is what stewardship looks like — stewardship creates an energetic and, yes, more fun place to work for everyone.

Wishing everyone a joyful and blessed new year.

Faris

If you would like to comment or provide some feedback, please email me at fabdelmuti@malomatia.com

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Software Testing - Why should we test? 12/12/2012 1:46:44 PM

Software testing is the process of validating and verifying that a computer program, application or product:

• meets the requirements that guided its design and development,
• works as expected,
• can be implemented with the same characteristics,
• and satisfies the needs of stakeholders.

Here are two powerful examples of why software testing should have its dedicated time in a project life cycle:

1. The recent headlines across the world – Apple Maps could be life threatening, police warn (Courtesy Gulf News 12th Dec 2012)

   How could a map be life threatening? This is what they had to say:

   Using Apple’s new maps system could be potentially life-threatening, police in Mildura, Australia, have warned, after a number of people trying to find the town of 30,000 people have become hopelessly lost in scorching temperatures. Getting lost in the (national) park around Mildura is potentially deadly: “There’s no water, and you can get bogged down in the sand. Temperatures go up to 46 degrees and there’s no water.”

   Mildura lies outside the park, as the police indicate on their own site. Apple’s Maps correctly identify the location of Mildura Airport - but do not offer it as a destination for people searching for “Mildura”.

   The problems have only occurred since Apple updated its maps, the police said.

   Other mapping services, including Google’s Maps and Nokia’s here.com maps, show Mildura in the correct location.

    

   This is just one example of testing that has not happened efficiently after an update of a computer system. There are a number of benchmarks/resources based on satellite images or positioning systems which could have been used to conduct testing.

   Maps, although just a mobile software application, could potentially also have an impact on the life of a person by stranding to a location that is so extreme.

    

2. 2012 London Olympics

   I recently read an article about software testing for the London Olympics 2012. We may ask “what has software testing got to do with sports?”

   The answer is that in modern sporting events the technology runs everything, from the timing of track events to the logistics of moving athletes around. It took approximately 2 years to complete the development of software for the Olympics, one year to test and one year in operation to validate the products before they were used at the Grand Olympics 2012!

   What if this were not tested correctly?

   Years of hard work, effort, sacrifice, and dedication for many of the sportsperson might have been wasted with dreams and hopes dashed.

    

So much of importance to the Software in sports and mobile applications! How about the Healthcare sector? This might make us reflect a little more deeply.

Many people are dependent on health services and the clinicians who work in the healthcare sector to prevent illness, to treat and cure diseases, and to repair injuries.

In turn clinicians rely on technology in life-support systems, cancer treatment systems, medical imaging systems, diagnostic equipment and the computer systems that support their decision making. If these tools are not thoroughly tested before they are put into service the results for any of us could be unpredictable and disastrous.

Software systems are an increasing part of life, from business applications (e.g. banking) to consumer products (e.g. cars). Most people have had an experience with software that did not work as expected. Many websites may even be an embarrassment to the companies who put them up as they fail to deal with our needs. Software that does not work correctly can lead to many problems, including loss of money, time or business reputation, and could even cause injury or death.

Software systems are designed, built and deployed by human beings and, as we all know, human beings are fallible.

Defects can occur for a range of reasons, a system may not do what it should or it may do something that it shouldn’t. A system may work with a particular set of inputs but may not work if some of the inputs fall outside the range that the designer expected.

In Qatar we experience such problems regularly when on-line software prompts us for a compulsory postcode/zip code (Qatar doesn’t have postcodes or zip codes).

And not all defects are easy to find; complex code, complexity infrastructure, changing technologies, and many system interactions and interfaces increase the complexity of software testing. This is why when we test software or technology we perform “unit” testing to ensure that the device or the piece of code works as we expect it to. Then we perform “system” testing to ensure that the device or software performs its role as a part of a larger and interdependent system; we perform “integration testing” to ensure that the unit and the system work in the context of human processes and procedures; and finally we ensure that “user acceptance testing” is completed and the user is happy to sign off (and pay for) a final deliverable.

With the help of testing, it is possible to measure the quality of software in terms of defects found, for both functional and non-functional software requirements and characteristics (e.g. reliability, usability, efficiency and maintainability). Testing can give confidence in the quality of the software if it finds few or no defects. A properly designed test that passes reduces the overall level of risk in a system. When testing does find defects, the quality of the software system increases when those defects are fixed. By understanding the root causes of defects found in other projects, processes can be improved, which in turn should prevent those defects reoccurring and, as a consequence, improve the quality of future systems.

Testing should be integrated as one of the quality assurance activities (e.g. alongside development standards, training and defect analysis). Deciding how much testing is enough should take account of the level of risk, including technical and business product and project risks, and project constraints such as time and budget.

Testing should provide sufficient information to stakeholders to make informed decisions about the release of the software or system being tested, for the next development step or handover to customers.

And last, but not the least, the very validation based on which every client pays its vendor’s.

If you would like to comment or provide some feedback, please email me at ‎svijayaraghavan@malomatia.com

 

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Inclusive Healthcare – Taking charge of our own healthcare 9/24/2012 7:39:20 AM

How often are you aware about cost and quality before attending a care provider? Does your provider ‎involve you in your healthcare decisions?‎

For most of us, these questions wouldn’t elicit a positive response. Historically we have been used to ‎unidirectional doctor patient communications wherein the individual patient has been passive, ‎underutilized, or excluded from choices about care in a complicated system and sometimes masks ‎data information about safety, price, and quality. ‎

However, in the face of increasing economic pressure in public and private systems, no one can afford ‎to ignore the transformative potential of informed, empowered consumers. Patients are transforming ‎into health care consumers with growing use of technology for medical shopping and health ‎engagement

One health services research organization, has completed a survey which may reveal some interesting ‎insights on the growing healthcare consumerism. According to the study, conducted on 2,200 mixed ‎group American citizens, virtually all (99%) of them want to play a role in medical decisions about their ‎care while the remaining 1% outliers wants the doctor to be completely in charge of treatment ‎decisions.‎

However, consumers vary in just how much of that responsibility they want to assume in decision ‎making. More than a third (35%) of the group wants to make final decision with shared inputs from ‎physicians and others. Equal numbers want to be completely in charge of their decisions (28%) or ‎make a joint decision with equal input from their doctor (29%). Only 7% want their doctor to make the ‎decisions and this group is comprised of mostly elderly people. Younger people prefer to have more ‎control over their healthcare than older people do it seems.‎

Apart from participation in healthcare decision making, consumers are keen to investigate more on ‎provider quality (39%) and seek information on cost of service (42%) before choosing where to go.‎

However the survey also pointed that these two health behaviors was more likely among people with ‎excellent health compared to those in poor/fair health. Also, most consumers trust their doctor and ‎also believe (76%) that their doctor would “never” recommend an unnecessary test or procedure. ‎

What’s concerning in the study, is that the poorer health the consumer perceives, the less consumer-‎empowered that individual feels. While those in excellent health (75%) say they’re confident they can ‎reduce costs of care by shopping for better prices, only 30% of those in poor/fair health are confident ‎in doing so. ‎ Relatively healthy and young individuals are prone and willing to engage yet it’s those in poorer health ‎who tend to be higher cost patients.‎

Role of technology

To accelerate engagement in the management of their own health, patients face barriers caused by ‎information asymmetry and a tradition of paternalism in provider-patient relationships. There is an ‎acute lack of credible and ‘neutral’ source of price and quality information or treatment options ‎available for the healthcare consumers while the available ones are often inaccurate marketing ‎information. ‎

Communications technology plays a prominent role in erasing barriers and enabling consumerism in ‎health care. The internet, smartphones and online networking have changed the way we live and use ‎technology. The Digital Innovation in Healthcare Report from the Global Health Policy Summit ‎estimates that there will be three billion internet users by 2016 and this is transforming business ‎models and forming new delivery channels. ‎

The past decade has seen several entrepreneurial companies positioning as neutral sources of ‎healthcare cost and quality information. Some other services aim to provide an online forum for ‎patients to interact and share experience breaking physical boundaries. ‎

Another facet of the transformation is an increasing group of consumers interested in measuring and ‎tracking the metrics that are important to them. Devices that let consumers measure workouts and ‎track them, are a good example of this. Yet other self-service decision support tools have algorithms to ‎identify potential health risks. They are an indication of the way people want to take charge of their ‎health and decisions surrounding it.

These online platforms have harnessed the “power of the crowd” by optimizing the broader base of ‎intellectual capacity. Even though the business models need more maturity and clarity on how the end ‎users benefit, these indicate the changing face of the industry where consumers are being ‎empowered by more information, choices and larger share of voice.‎

Organizations from the public and the private sectors are using digital platforms to target specific ‎populations, promote broad-based campaigns across sectors, and facilitate interactive ‎communications to prevent disease and promote health. These are digital initiatives for social impact. ‎A prominent example is Michelle Obama’s Lets Move campaign, a multi-year, multichannel initiative to ‎reduce childhood obesity.‎

The demand for these technology enabled ventures has been constantly on the rise. If, as suggested ‎in the study referred to earlier, 35% of computer and smartphone users have used these technologies ‎for finding a doctor while 19% have downloaded a health app then comparative shopping for health is ‎in its nascent stage now. However, it is poised to have substantial growth as health insurance ‎exchanges and consumer-driven health plans put citizens into the role of health shoppers

If you would like to comment or provide some feedback, please email me at ‎nmajumder@malomatia.com

Niladri Majumder
Business Analyst – eHealth

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The patient journey, how important is it? 9/17/2012 7:43:24 AM

For much of my career in public healthcare I have heard the mantra that "the patient should be at the centre of our work". This desire for a patient-centric approach to everything we do makes complete sense.

As healthcare professionals, or allied healthcare professionals, all of us should have three key goals:

1) to improve healthcare outcomes;
2) to improve the patient's journey through the healthcare system; and
3) to enable, support, and engage in continuous improvement in healthcare to further enable the above.

It is not relevent whether you are a doc, nurse, administrator, manager, ambo, cleaner, accountant, planner, chief exec, cook, pharmacist, or surgeon. If you work in the public healthcare system, your success should be tied to how closely you are able to align to these goals. 

I have been criticised in the past for this statement, from accountants who feel that their key focus is "managing money" to public health officials who have lost sight of why public health is important. I reject the criticism, it is this simple folks, three objectives, in the order shown. Everything else that we do in a large public healthcare system, if we are doing the right thing, including providing IT support, and managing our resources wisely, should support these three objectives. 

So why is it that so few of the professionals we encounter in our day to day work in healthcare seem unable to clearly make a connection between the patient experience of the healthcare system and their own behavior? 

Examples abound, from the patient who visited one of the UK's largest hospitals to have three vertebrae fused and was made to stand and wait, in pain, for around an hour while a bed was made for her; to the inpatients who, daily, have multiple blood samples taken because no one checked the computer system to see if they had already been tested; to the folk who contract hospital acquired infections or suffer as a result of lack-of or the wrong-kind-of care in our healthsystems. 

So why is it so hard to get this right? Why is it so hard for healthcare staff who work with patients to put themselves in the patient's shoes and work out how the experience could be improved? 

I worked with a colleague once who felt strongly that everyone who worked in a hospital should experience a patient journey through that facility, the wait in the emergency department, investigations in laboratories and x-ray, the transfer to an inpatient ward, the operating theatre, recovery, discharge, the journey home and the followup care. But this is of course impractical and, as with any complex system every journey is different and each patient has their own needs and special concerns. 

As I have travelled and visited many facilities around the world I think I have seen some of the best examples of care in terms of improving the patient journey. I will try to highlight some examples.

- At one University of Pittsburgh Medical Centre (UPMC) hospital they have, outside the operating theatres, live television displays in the waiting room showing for relatives and friends of patients, the status of their loved-one's procedure - pre-operative preparation, in theatre, in recovery, and so on. of course information is anonymised but the recipients receive a small card showing the patient number that they need to interpret the screens.    
- At the Freeman Hospital in Newcastle Upon Tyne in the UK nurses record their activity when they give medicines to patients. The event is timestamped and compliance with medication regimes can be monitored and tracked.
- Patients in Wellington New Zealand can, via the internet, book their own appointment with a private doctor after reviewing the slots available in the doctor's schedule themselves.   
- In the outpatients department at Surrey Memorial Hospital, near Vancouver in Canada, patients can self-register for their outpatient appointments. Updating incorrect information and noting their arrival. This helps to ensure more accurate information and shorter queues.
- In Taranki Base Hospital in New Zealand, medicines are dispensed to nurses from a ward-based machine as and when they are needed by the patient. The medicine requested is checked against the patient's medical record every time to minimise the chances of the wrong medicine going to the wrong patient.
- In at least one dental surgery in Doha, Qatar, the dentists chairs have built in massagers to relax patients should they wish to use them, and televisions in the ceiling. Porcelain crowns and inserts can be manufactured, on-site, while you wait. Meaning only one local anaesthetic for a procedure and no return visit is necessary.
- In Western Australia, waiting times in emergency departments are publicly available, on the Internet and updated in real-time for all public hospitals

Many of these things are becoming increasingly common and, indeed, might be considered "no brainers" when it comes to planning a patient-centered service. I am still bemused though at some of the following practices that still occur so regularly:

- Patients left in fouled beds overnight because carers either don't know or don't care that the bed needs changing. No electronic monitoring of the situation.    
- Slips, trip and falls being a major cause of injury and even mortality in hospitals because frail patients left their beds without this being detected.
- Paper medical records being used in healthcare facilities (with all the attendant issues associated with security, lost and missing files, lack of legibility and difficulty of access)
- Duplicated patient information across departments and facilities within a single health care system resulting in files in one place not containing information from another, disjointed patient journeys and gerneral confusion.
- Patients in hospitals pressing nurse-call buzzers for hours to try to get attention because response to the buzzers is neither monitored or managed.
- Lack of simple facilities such as television and wireless Internet in patient waiting rooms
- Patients are discharged from hospital into the care of a hospice or other community care facility where information regarding their hospital and past medical history is not available to support their care. Hospice records are not available to the hospital in the event of a return visit.
- Abnormal high incidence of elderly patients suffering kidney failure as a result of dehydration after orthopaedic surgery due to lack of proper post-operative care I could go on but it is not valuable to labour the point.  


While researching this blog entry I was not surprised to find many reports on the patient journey and its value in improving health care. Perhaps typical of these reports is that of Sue Baron BSc., RN, from June 2009 Evaluating the patient journey approach to ensure health care is centred on patients in which she identifies the following recommendations that could have broader implications for practice as examples produced during the project:
   
- Improved information systems are needed between primary and acute care to reduce the risk of patients falling through the net, for example in GP referrals, patient discharge and outpatient follow-up;
- NHS uniforms should be standardised to enable everyone to readily identify staff;
- A centralised patient record should be introduced – one place for interprofessional documentation to reduce risks to patients from misinformation or lack of information. This would also reduce duplication and time wasted searching for information;
- NHS management should have a higher profile through talking to staff and patients – for example with ‘walkabouts’;
- Greater recognition should be given to the value of the patient’s voice.

I could feel my blood pressure rise as I read this, it all so obvious, all so much "more of the same".

The solutions seem so easy and yet, at the same time are so often NOT put into practice. Perhaps what is needed is reasearch into why, when we know the answers, our healthcare systems are unable to effectively respond and, in doing so, to meet our needs. 

If you would like to comment or provide some feedback, please email me at asnoxall@malomatia.com  

André Snoxall
e-Health Consultant

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The biggest wave of change that IT has ever seen, the cloud will transform IT and businesses 9/13/2012 7:59:53 AM

13th Sep 2012

Yesterday I attended a trade event called EMC² Forum 2012 - Transform IT, Business and Yourself. 

The venue was the Ritz Carlton Hotel in Doha and the event was hosted by EMC². Apart from the unfortunate decision to allow people to smoke in the exhibition area (this is 2012, not 1912, guys) I very much enjoyed the event and the opportunity to hear the challenges facing my colleagues today and how similar these are to those we faced twenty years ago in IT.

The thrust of the conference was that the data that is being collected and stored electronically is growing at an increasingly exponential rate, that this is a resource to be mined by enterprises, and that there are opportunities for many people as a result. The key opportunities are as follows:

- the opportunities for companies to transform themselves through their ability to harness the information that is now availabel to them;
- the opportunity for IT Departments to transform themselves to support the businesses that they serve through effective adoption of cloud technologies; and
- the opportunity for individuals to transform themselves by effectively recognising and reacting to the data-driven, as opposed to technology-driven, world.

Bearing in mind that the conference was hosted by a hardware solution vendor and its partners, the content was nevertheless, often stimulating and thought provoking. Sadly much of the material that was presented was very similar to that many of us have seen before, the labels have changed, but the messages are the same.

Takeaway 1: Moore's Law can be shown to be a good basic predictor of demand. It can be used to plan how you will deliver your IT Services; or how you should structure your outsourcing contract

Some of the rhetoric, that the growth in data will cause the "biggest wave of change that IT has ever seen" and that "the cloud will transform IT AND businesses" are clearly hyperbole. Motherhood-and-apple-pie-type statements that any of us who have spent any significant length of time managing IT services will recognise as being rolled out annually by vendors.

We know that the rate at which we can store, collect, move and process data will continue to increase exponentially and that the costs to do so will NOT. This has been true for three decades and we have seen whole new industries and business-models spring into existence and old paradigms die as a result.

We are seeing the impact on the book, movie and music industries as I write this.

Hopefully CEOs and Boards today are considering how they will transform their own businesses to take advantage of this information-age fundamental. They probably don't need a hardware vendor to point out the bleedin' obvious; whether or not the message will filter back to the top from the large technical attendees is somewhat questionable.

Takeaway 2: IT Operations is NOT core business for most companies and internal IT Departments don't cope well with the need to change

Another fact (which has been rolled out regularly since the 1990's) is shocking in its implication; "70% of the effort in the IT Department is keeping-the-lights-on and only 30% is spent on innovation and developing new capabilities". This quote apparently comes from the Forrester Research organization although no date is attributed to it. Again this is hardly news, I remember similar figures being floated by Gartner back in the mid 1990's.

What is really frightening is the fact that so many companies still maintain in-house IT Departments.

These dinosaurs attempt to provide IT services using in-house resources and consequently contribute little, if anything, positive to the company's bottom line. My bottom line on this matter: if it facilitates or supports, but doesn't contribute to, improving your business - it's not core business - outsource it.

Smart management should be concentrating on increasing business, quality, and profits, not keeping the lights on. Have a look at the statements below:

- We need to run our helpdesk in-house because the healdesk staff need to know our business intimately
- Our need for data storage is different to our competitors, we should keep it in house and manage it ourselves
- Our IT needs are different, we have specialists who know our business and no one can provide IT like we can
- Outsourcing is too expensive
- We can run IT better and more efficiently than an outsourced provider
- Cloud services are not secure, stable or trustworthy
- We would lose control of our intellectual property / company secrets if we put it "in the cloud"
- Our information security needs make us special, they are not the same as others
- Our user's requirements are different to other industries/companies/organisations

If you are a CEO of a large enterprise and your IT Director is telling you any of these things the I know a nice piece of Queensland swampland that you might be interested in buying.

If you have an IT, Informatics, or information management department at all they should be working with functional heads to figure out how information resources can be most-effectively leveraged to improve the business. They should not be delivering IT Operations (management of IT related incidents, problems, security, availability, reliability, and capacity).

Takeaway 3: We are nearly all consumers of cloud services, and yet we are still talking as if there is a choice as to the right way to go.

IT organisations must be able to make intelligent decisions about where and when to use private, public and hybrid cloud services. Since the late 1990's I have been using service such as Microsoft's Hotmail and MSN Messenger. In all that time I have never had to worry about whether or not there is enough hardware, processing power, or memory for me to use these applications. Never have I had to speak to a helpdesk person to obtain a username and password, have these reset or recover lost data. In more than 12 years I have experience less outages of these services than you could count on one hand.

The technology that is used by Microsoft, Google, Yahoo, Youtube, Facebook, Amazon, and the myriad other companies that provide cloud services has been available to purchase for a decade. And yet...

IT Directors are still debating the merits of cloud! Guys and gals, the cloud is just familiar technology with a new name.

With sound engineering and end-to-end planning backed up by a clear strategy and framework for delivering service cloud can be delivered by anyone to anyone, securely. If you can't do it in house, and most IT departments simply can't, give it to someone who can. All the big outsourcing companies, the companies whose very existence depends on service, provide services using cloud technologies. Why? You figure it out.

Takeaway 4: IT is just a service. I don't expect my Facilities Manager to manage electricity generation, I don't expect my IT Director to run operational IT.

The headline tells the story, however running IT as a service takes a special set of skills. The skill to ensure that service levels meet the needs of the business. Not just today but tomorrow and into the future.

The skills to ensure that information and technology are properly leveraged by the enterprise to improve the way that business is done, and the skill to identify trends and to forecast the opportunities and impacts in-time to effectively do something about them. Sessions like that offered by EMC² are valuable and gratefully received. They stimulate thoughts and ideas and give us all a chance to reflect on what should be.

If you would like to comment or provide some feedback, please email me at mailto:asnoxall@malomatia.com

André Snoxall
e-Health Consultant

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