IT Forefront

What CIOs can learn from the 2020 Iowa caucus

by Stephanie Estevez and Andrew Rebhan

Chaos and confusion characterized the February 2020 Iowa caucus because a key technology rollout failed. The Democratic National Committee (DNC) commissioned a smartphone app in an attempt to more efficiently tally and report votes. However, a series of cascading missteps saw the 2020 Iowa caucus suffer from delayed vote reporting, inconsistencies in results, and concern among Iowans that some individual votes weren't calculated.

Checklist: Get started with digital innovation at your organization

The Iowa caucus is the first opportunity for presidential candidates to win delegates for their respective party's nomination. This caucus serves as a litmus test for how candidates will fare during the remainder of their campaign. For example, Barack Obama unexpectedly won a plurality of Iowa delegates in 2008, propelling him to win the Democratic nomination and ultimately the presidency. The failures of the 2020 caucus have undermined the integrity of both this year's results and the caucus' preeminence in presidential elections.

4 takeaways for health care organizations

There are four lessons health care organizations can learn from the Iowa debacle and apply to their own efforts to introduce clinician-facing technology—especially apps—intended to improve administrative, clinical, and operational efficiency: 

  1. Make sure all stakeholders are aligned and adequately prepared to use any new technology.

    According to the CEO of Shadow Inc., which developed the app used for the Iowa caucus, the goal was for all caucus chairs to submit results on Shadow's app, but only about a quarter actually did so. The rest of the chairs dialed in, which overwhelmed understaffed hotlines. Additionally, there was no designated training on how to use the app.

    Establishing organization-wide buy in from all stakeholders is mission critical to ensure the successful adoption of new technology. The goals of any implementation should resonate with everyone from administrative staff, to leadership, to clinicians. Listen to staff’s concerns, and have an answer to the "how, when, and why" to mitigate inherent suspicions whenever a change is introduced. Thorough staff training on actively engaging with the technology can help avoid technical disruptions like those the Iowa caucus experienced (e.g., staff unsure how to log in). Training can also provide opportunities to address staff concerns, refine processes for "how, when, and why" the technology should be used, and offer tactile demonstrations of both the technology's capacity to improve staff's day-to-day responsibilities and to its limitations.

  2. Test. Test. Test

    It's virtually impossible to know whether a new product actually works as intended—and if the organization's infrastructure will support it—without adequate testing. If  party leadership had tested the caucus app prior to rollout, many of the reporting inconsistencies could have likely been addressed earlier on. This does add more steps to the implementation process, but when the wellbeing of patients—or the legitimacy of an election—is at stake, shortcuts are ill-advised.

  3. Communicate early and often.

    In accordance with the practice of Agile IT, some communication is better than none. When staff are left in the dark, misinformation is spread and trust in leadership can erode, making your quest for organization-wide buy in more challenging. It's best to offer insight into both what your organization's new product can do and what it cannot. Even if details aren't fully fleshed out, be transparent about what you currently know and what staff should expect down the road.

  4. Know which questions to ask of and set clear expectations for your vendors.

    It is up to you and your vendor to prioritize the end-user's experience. Make sure that the solutions will benefit your staff rather than having them jump through additional, unnecessary hurdles. For instance, Shadow Inc. deployed the caucus app via a route different from what many smartphone users are accustomed to (the app wasn't available on the Apple or Google stores). Ultimately, health care organizations must insist on a user-friendly interface and implementation process. Wherever possible, probe about alternative options, and ensure that your vendor understands not only why you're purchasing their product but also who will be using it on a daily basis.

Haphazard implementation of a new technology caused problems for the DNC and the Iowa caucus that went far beyond a buggy go-live. Like the DNC, IT leaders at provider organizations have the responsibility to establish a reputation as reliable partners and maintain end-user trust. Taking shortcuts on the path to become a digital health system might lead to time and cost savings in the moment, but the long-term effects can be catastrophic.

Checklist: Get started with digital innovation at your organization

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