绕过决策摩擦：Kaiser Permanente 如何在不到三小时内将12个 EHR 实例削减至2个
Bypassing Decisional Friction: How Kaiser Permanente Cut 12 EHR Instances to 2 in Under Three Hours
Neil Cowles，Kaiser Permanente 首席信息与技术官如今，CIO 被要求加速技术转型，同时仍要管理遗留技术的成本与复杂性。各组织正争分夺秒地跟上变化步伐，并投入数十亿美元实现平台、数据和 AI 的现代化——往往是同时推进。然而，当转型停滞时，根本原因很少是技术问题。更常见的是执行问题。
技术可以赋能转型，但执行决定转型能否成功。在规模化运营中，各组织需要清晰的决策机制、问责机制，以及专注于成果而非活动的运营模式。文化并非独立于执行之外。当优先事项发生冲突、时间线被压缩、权衡变得困难时，文化会塑造组织的行为方式。
真正的约束不是技术，而是执行
医疗保健组织几十年来一直在这种张力下运营：一方面采用能够改善成果的先进技术，另一方面在高度监管且高风险的环境中控制成本。在 Kaiser Permanente，这一现实因我们的组织结构而更加突出。我们既是健康计划组织，也是医疗服务交付组织，技术已经融入医疗服务的提供方式和体验之中。
在推进现代化之前，我们重点明确 IT 在整个体系中的作用，以及如何通过 IT 创造价值。这项工作形成了三个运营目标：简化、标准化和提高标准。这些表述经过有意设计而保持简单，但其背后的经验并不简单。
大规模转型中的大多数延误并非技术性的，而是决策性的。职责归属不清、流程碎片化以及相互竞争的优先事项会造成摩擦，而任何平台都无法解决这些问题。这并非 IT 独有的问题。哈佛商学院的一项研究显示，只有约20%的员工认为其所在组织擅长决策，而缓慢的层级化流程仍是最常见的障碍。
执行纪律在压力下显现
当领导者简化工作进入系统的方式、标准化决策制定方式，并扩大有效做法的应用范围时，他们就能减少这种摩擦。当团队信任决策模式时，速度便会随之而来。文化体现在共同的行为、决策规范，以及 IT 与业务每天的协作方式中。
一个例子是我们的消费者支付体验项目。该项目要求对关键基础设施进行现代化改造，并更换数百个地点的药房销售点系统，同时继续处理每年数十亿笔交易并支持数百万次交互。最初的时间线大约为三年。团队在12个月内完成了交付。
这一成果并非仅靠努力取得。它源于工作推进方式的改变：减少依赖关系、改善关键链路中的流动，并标准化决策与部署的协调方式。由此得到的启示是，速度并不只取决于投入程度；它取决于运营纪律。
规模化可靠性是一种文化成果
我们看到，同样的模式也适用于企业级规模。Kaiser Permanente 将12个独立的电子健康记录实例整合为两个，在持续提供不间断医疗服务的同时迁移了数十年的患者数据。切换在不到三小时内完成，患者护理或运营均未受到干扰。
由此得到的启示是，规模化可靠性并不只是技术成果。它来自通过团队间的紧密协同、标准化决策以及充分准备实现的严格执行。在大型企业中，当团队能够在压力下依赖运营模式时，信任便得以建立。
从技术交付到业务赋能
对于 CIO 而言，这一模式是一致的：当文化与运营纪律协同工作时，转型才能实现规模化。领导者需要清晰且一致的决策机制、与业务利益相关者尽早达成一致、降低工作流复杂性，并致力于将可靠性视为业务责任，而不仅仅是 IT 指标。
将创新视为技术部门职责的 CIO 很可能会陷入停滞。那些利用技术在规模化范围内推动组织纪律与协同，并从技术提供者转变为真正业务赋能者的 CIO，则能够实现突破。最强大的技术组织会有意识地扩展以下行为，包括系统思维、客户导向、严谨的创新、持续学习、信任以及跨职能合作。
随着数字能力变得更加易于获取，以及 AI 融入工作完成的方式，差异化程度将越来越少地取决于能否获得技术，而更多地取决于围绕成果实现协同、更快地做出更好的决策，以及作为一个系统共同执行的能力。
归根结底，IT 组织拥有的最强大平台可能并不是其云基础设施、数据架构或 AI 模型，而可能是员工的集体行为，以及将这些行为转化为更好执行、更佳体验和更好成果的纪律。
关于 Neil Cowles Neil Cowles是Kaiser Permanente的高级副总裁兼首席信息与技术官。Cowles 是一位充满活力、以解决方案为导向的业务与信息技术领导者，致力于服务 Kaiser Permanente 的1260万名会员以及我们所服务的社区。
他负责制定并执行与 Kaiser Permanente 企业战略和优先事项保持一致的清晰技术愿景。他负责监督 Kaiser Permanente 业务、临床和医疗服务交付 IT 系统的日常管理，以及支持这些系统的 IT 团队。他负责强化和保护 Kaiser Permanente 的数据，通过简化平台和技术推动可负担性，并利用 AI 等不断发展的技术进行创新，从而提供具有实际影响力的解决方案，更好地支持 Kaiser Permanente 的会员、护理团队和员工。
Neil Cowles, Chief Information and Technology Officer, Kaiser Permanente
CIOs today are being asked to accelerate technology transformation while still managing the cost and complexity of legacy technology. Organizations are racing to keep up with the pace of change and investing billions in modernizing platforms, data, AI — often all at once. Yet, when transformation stalls, the root cause is rarely technical. More often, the challenge is execution.
Technology can enable transformation, but execution determines whether transformation succeeds. At scale, organizations need clear decision-making, accountability, and operating models focused on outcomes rather than activity. Culture is not separate from execution. It shapes how organizations behave when priorities compete, timelines compress, and tradeoffs become difficult.
The Real Constraint Isn’t Technology, It’s Execution
Healthcare organizations have operated under this tension for decades by adopting advanced technologies that improve outcomes while managing cost in a highly regulated, high-stakes environment. At Kaiser Permanente, that reality is amplified by our structure. We are both a health plan and a care delivery organization, with technology embedded in how care is delivered and experienced.
Before advancing modernization, we focused on clarifying the role IT plays in our system and how to drive value through it. That work led to three operating objectives: simplify, standardize, and raise the bar. Those phrases are simple by design, but the lesson behind them is not.
Most delays in large-scale transformation are not technical. They are decisional. Unclear ownership, fragmented processes, and competing priorities create friction that no platform can solve. This isn’t unique to IT. In a study from Harvard Business School, only about 20% of employees say their organizations excel at decision-making, and slow, hierarchical processes remain the most common barrier.
Execution Discipline Shows Up Under Pressure
When leaders simplify how work enters the system, standardize how decisions are made, and scale what works, they reduce that friction. When teams trust the decision model, speed follows. Culture shows up in shared behaviors, decision norms, and how IT and the business work together every day.
One example was our consumer payment experience program. The effort required modernizing critical infrastructure and replacing pharmacy point-of-sale systems across hundreds of locations while continuing to process billions in annual transactions and support millions of interactions. The initial timeline was roughly three years. The team delivered in 12 months.
That outcome did not happen through effort alone. It came from changing how the work moved: reducing dependencies, improving flow through the critical chain, and standardizing how decisions and deployments were coordinated. The takeaway was that speed is not a function of effort alone; it is a function of operating discipline.
Reliability at Scale Is A Culture Outcome
We have seen the same model apply at enterprise scale. Kaiser Permanente consolidated 12 separate electronic health record instances into two, migrating decades of patient data while maintaining uninterrupted care delivery. The cutover was completed in less than three hours, with no disruption to patient care or operations.
The takeaway was that reliability at scale is not simply a technology outcome. It comes from disciplined execution through tight alignment across teams, standardized decision-making, and extensive preparation. In large enterprises, trust is built when teams can rely on the operating model under pressure.
From Technology Delivery to Business Enablement
For CIOs, the pattern is consistent: transformation scales when culture and operating discipline work together. Leaders need clear and consistent decision-making, early alignment with business stakeholders, reduced workflow complexity, and a commitment to reliability as a business obligation—not just an IT metric.
CIOs who treat innovation as a technology department will likely stall. CIOs who use technology to drive organizational discipline and alignment at scale and move from technology providers to true business enablers. The strongest technology organizations are intentional about the behaviors they scale, including systems thinking, customer focus, disciplined innovation, continuous learning, trust, and cross-functional partnership.
As digital capabilities become more accessible and AI becomes embedded in how work gets done, differentiation will depend less on access to technology and more on the ability to align around outcomes, make better decisions faster, and execute as one system.
In the end, the most powerful platform an IT organization has may not be its cloud infrastructure, data architecture, or AI models. It may be the collective behaviors of its people and the discipline to turn those behaviors into better execution, better experiences, and better outcomes.
About Neil Cowles Neil Cowles is Senior Vice President and Chief Information and Technology Officer for Kaiser Permanente. Cowles is a dynamic, solutions-oriented business and information technology leader who is committed to Kaiser Permanente’s 12.6 million members and the communities we serve.
He is responsible for creating and executing a clear technology vision aligned to Kaiser Permanente’s enterprise strategy and priorities. He oversees the day-to-day management of Kaiser Permanente’s business, clinical, and care delivery IT systems as well as the IT teams that support these systems. He is accountable for fortifying and safeguarding Kaiser Permanente’s data, driving affordability through simplified platforms and technologies, and innovating with evolving technologies like AI to deliver impactful solutions that best support Kaiser Permanente’s members, care teams, and employees.
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