Moving DCM beyond healthcare: Steven Spear takes a broader look

Editor’s Note: As dynamic case management (DCM) moves into the broader business world, one of its biggest drivers is the need to ensure that knowledge workers have access to the right information at the right time. In this Q & A, ebizQ contributor Christine Parizo speaks with author and professor Steven J. Spear about key trends in DCM’s expansion and evolution. Spear, a senior lecturer at MIT’s Sloan School of Management and a senior fellow at the Institute for Healthcare Improvement, is also the author of The High-Velocity Edge: How Market Leaders Leverage Operational Excellence to Beat the Competition (McGraw-Hill, 2010). This interview has been edited for length, clarity and editorial style.

ebizQ: What do you see driving the evolution of DCM?

Steven Spear:
The general trend—and this is true in healthcare specifically and across many industries—is that situations that one seemed relatively simple and stable have become increasingly complex and fast moving.

In healthcare, for example, in the last decade or two, if patients went in for an ailment, oftentimes they went to a single specialist who [provided them with] more or less the same treatment given to every other patient. And the rate at which the case advanced was enough that the individual who required the specialist could keep pace. That is far from the case now.

So back when the world was simpler and more stable, you could write processes…around what people were doing and trust that the thing you built would be robust over some meaningful period.

The number of pieces which have to come together [and the] technology expertise behind them has gone up exponentially. So that's the simple-to-complex angle. Then you take it one step further, which is the availability of all these different diagnostic sciences and technologies, which means you have to reconfigure the [system and] constantly have to tailor it patient by patient. And that's where you get the fast-moving non-stable problem, which is that the system has to continually reconfigure itself in order to meet the needs of individual patients. That case is illustrative of what's going on more generally.

Enterprises are far more complex than they used to be. [DCM is] a way of managing the flows--the capture flow, consolidation and interpretation of information--which matches the complexity and the fluidity of the environment.

ebizQ: Are you seeing anything in particular as DCM is evolving to manage enterprises outside of healthcare?

It does change the nature of what the IT provider is offering to the marketplace. If we're dealing with operating environments that are more distributed and connected in a more virtual fashion and constantly reconfiguring, then it’s no longer the case that people are coming over to a desk to enter data or retrieve data. What we need are things which work mostly at a distance, that work virtually and work through collaboration in situations where who's talking to whom and about what is constantly reconfiguring.

ebizQ: Can you provide an example?

What's really quite remarkable about drilling oil in the Gulf of Mexico and the BP oil spill [in the Gulf in 2010] is how many different organizations, each responsible for technologies, had to come together in a well-coordinated way in various fashions to set up that particular well. The number of parties involved in extracting a natural resource and the complexity of the operation has gone up exponentially compared to the typical visual cliché of an Eiffel Tower-like rig plopped down on a piece of sand.

It's another instance where the number of functional pieces has gone up exponentially. Connectivity has gone up exponentially. Yet you have to be able to generate, capture, transfer and process information in order to keep in pace with the physical world you're trying to manage.

ebizQ: What are some of the problems that you could run into if you're not implementing the right architecture, for example?

[One key issue is that] the informational architecture has to be moving at the same velocity as the physical architecture; otherwise there's going to be a disconnect.

If you think back to the [BP oil spill], what you find is that there were several activities going on related to that well, but they weren't as well synchronized as they might have been. You want to find the corporate villain in a disaster like that, and it turns out that you actually have a very, very hard time finding a corporate villain.

What you find are hardworking, well-trained, well-motivated people working unintentionally at cross-purposes because the informational environment in which they're operating is not up to speed and not consistent with the physical operating environments. Problems arise not because are people making bad choices, but are poorly informed when they're making their decisions.

ebizQ: It sounds as if a big part of DCM is just making sure that the knowledge workers have the right information in front of them to make decisions.

That's right. That's certainly a challenge, which comes out of this issue of increased complexity and increased speed of the informational tools we use to manage them.

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About the Author

Christine Parizo is a freelance writer specializing in business and technology. She's based in West Springfield, Mass. Contact her at

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