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Kris Saling's avatar

I was introduced to the 3 horizons method by the Google rapid innovation team when we were crashing on a talent management project and I wish I'd learned about it earlier! It very much challenges the linear planning frameworks and operational design we were taught, and focuses on adding real purpose to the incremental change rather than letting us take the easy out of making an incremental change and calling it done. Great article!

Coach's avatar

The problems you're describing aren't new, and they're not unique to the military. This same pattern has played out for decades, in and out of uniform.

Horizon 2-, 1984 style:

As a young GI in 1984, our Air Force base in New Mexico got its first Zenith 100 with a hard drive. Three of us, an enthusiast (SSgt Blair), a Computer Science major (MSgt Moore), and me, a SSgt with a Computer/Communications AFSC, decided to automate a huge chunk of daily manual work and the enormous checklists generated during exercises. It cut what had been up to 12 hours of hand calculated paperwork per aircraft generation down to about 30 minutes a plane.

The program spread like a slow-motion virus, copied floppy to floppy, carried from base to base by whoever transferred out. Within two years, everyone had a version, and everyone was modifying it to fit their own needs. I once saw a copy that had stripped out all the useful features just to do the bare minimum. That's Horizon 2- in a nutshell: every base building its own hacked variant, entrenching the same broken underlying process instead of fixing it.

Horizon 1 pushing back

The real obstacle wasn't the tech, it was an O-6 from the inspection team who refused to let us use it because he couldn't personally watch us hand calculate every number, so how could he trust it? I nearly said something I'd have regretted; thankfully MSgt Moore stepped in and talked him through it, because my sarcasm toward people who don't understand computers tends to leak out at the worst moments. He still didn't approve it on the spot, but we had sign off the following week. That colonel simply could not accept anything outside Horizon 1. Paper and hand calculation was the system, as far as he was concerned.

A late, partial Horizon 2+

It took the Air Force until 1995 to field an official system that actually worked, and even then, only for stateside F-16 bases. Years later, I talked to an F-15 maintainer who'd found his own workaround to bypass the official generation module in CAMS, because it still didn't handle their aircraft. So even the "official" fix just pushed the workaround problem down a different runway. I'd like to think Horizon 3 eventually arrived for them. It did for me. I moved on to better things.

The civilian side: healthcare's version of the same wall

I've spent years on the information side of healthcare, and the same three horizons show up there just as clearly. To this day, no one has a truly holistic view of a patient: acute care, hospital visits, chiropractic, dental, mental health, physical therapy, and wellness all stay siloed. It's been attempted repeatedly and never sustained. First it was older clinicians distrusting computers. Then it was well intentioned privacy regulation that made data sharing hard to build around. Every stakeholder group went its own direction, and by the time data sharing agreements became feasible, the underlying systems had diverged so far that interfacing them was slow and expensive, with no billing model to pay for integration work that mainly helps early diagnosis, while later stage care needs it least.

In 1997, at St. Alphonsus Medical Center in Boise, we tried anyway, a genuinely H2--- effort, stitched together largely by hand, with about 100 patients who'd agreed to participate as long as we masked their identities. One of the oncologists reviewing the combined data wanted to speak with a specific patient. We couldn't give him her name directly, so we contacted her and connected them ourselves. By combining data sources that normally never touched, he spotted a trend pointing to early ovarian cancer. It was caught and treated.

Almost twenty years later, we still don't have a comprehensive system to do this, not even inside fully integrated delivery systems.

The point

The path to Horizon 3 may be expensive, maybe even prohibitively so in some cases. But that's not a reason to stop reaching for it. If we actually document the steps from where we are to where we're trying to go, we hand systems engineers, data analysts, and programmers a map, not just a workaround to copy onto the next floppy disk.

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