CHAPTER 10Ice Station Zebra MedicalHow Agile Methods Solved a Messy Health-Care Data Problem

The journey of a thousand miles begins with one step.

—Lao Tzu

In the summer of 2008, a group of employees filed a lawsuit against a multisite health-care system. (I call that organization Ice Station Zebra Medical or ISZM here, although it’s a pseudonym.* )

The crux of the matter: ISZM had systematically underpaid overtime to thousands of its current and former nurses over the past decade. The employees’ attorneys alleged that ISZM owed their plaintiffs potentially millions of dollars in back pay, interest, and penalties. In the process, ISZM may have violated the Fair Labor Standards Act. Beyond that, the lawyers intimated that the U.S. Department of Labor might be interested in what was going on there.


Odds are that you don’t know a great deal about paying nurses. I doubt that you’ve ever thought about it. Sure, you imagine, they can take sick, vacation, and holiday pay like the rest of us. That’s true, but things quickly diverge. No, the process is not “rocket surgery” and it hardly rivals Google’s almighty search algorithm. Still, paying nurses is far more complicated than paying the average layperson.

With rare exception, hospitals do not compensate their nurses based on fixed, 40-hour “regular” workweeks, occasionally tapping into their paid time off plans. On the contrary, many other factors are at play with these folks. (For this very reason, most large health-care ...

Get Analytics now with the O’Reilly learning platform.

O’Reilly members experience live online training, plus books, videos, and digital content from nearly 200 publishers.