SmileMD, a venture-backed healthcare technology-enabled services company serving patients across five states, was growing quickly with no technology function behind it. As the company's first Chief Information Officer, I had to establish IT, engineering, product, design, and business intelligence from the ground up, and I needed a strategy that would tell a new team where to invest. Patient volume was the business; the strategy had to explain how technology would increase it without sacrificing quality, and it had to be measurable enough that every team could see whether its work was moving the company's north star.

I built the strategy on two ideas, the theory of constraints and the customer journey, and expressed it as an IT North Star the whole company could use:

• Company North Star: Anchored the strategy to the company's north star, to increase patient volume while improving quality, measured by patients per day, patients per case day, patient cancellation rate, and case day incident reports.
• Customer Journeys as the Map: Mapped how providers, practices, and patients experienced the service, the work later detailed in the Service Design case, so that friction and constraints could be located rather than guessed at.
• Theory of Constraints as the Lens: Treated capacity constraints as the primary limit on growth and directed technology investment at relieving them in order.
• Three Strategic Levers: Stated the technology goals as three ways to increase patient volume: reducing customer friction, alleviating capacity constraints, and supporting new service lines.
• Named Measures for Each Lever: Defined how each lever would be measured. Customer friction by customer acquisition cost, lifetime value, first contact resolution, and net promoter score. Capacity constraints by recruiting velocity, sales velocity, and capacity and efficiency per capability. New service lines by time to market, total cost of ownership, and impact to shared services.
• Strategy into Roadmap: Translated the levers into the Outcomes-Driven Roadmap, with goals and success metrics for providers, practices, patients, payers, and teammates, so that teams calibrated their work against the strategy every sprint.

The strategy gave SmileMD a technology direction that compounded:

• 5x Patient Volume: In my final year, annual patients served grew from 5,000 to 25,000 and revenue doubled, reaching $12M a year, while gross margins held. The strategy did not produce that growth on its own; it set the direction, and the function, process, and technology built against it carried the scale.
• Three Levers, Each Executed: Customer friction fell as providers and practices gained self-service, with an 81% reduction in provider requests and a 96% reduction in practice requests through the Provider App and Practice App. Capacity constraints eased as patient-clearing cycle time fell 50% through the Care Coordination App. New service lines were supported on a platform built to scale, with Salesforce Health Cloud cutting cycle times for dozens of tasks by 80%.
• Measures That Held: Because each lever carried named measures from the start, the Outcomes-Driven Roadmap could report results against goals, and the team exceeded every roadmap target.
• A Function Built to the Strategy: IT, engineering, product, design, and business intelligence were established from the ground up as a team of 15 organized around the levers, including the BI practice that identified and recovered $1.3M in missed billable claims.