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Healthcare / Multi-Site Operations

IT Operations Transformation

~9,000 employees, ~400 sites, ~370 clinics

75% backlog reduction

The Challenge

  • IT operations fully outsourced to a third-party provider (Reflex) with limited visibility into service quality or cost efficiency
  • Significant technical debt in Microsoft Active Directory — inconsistent naming conventions, orphaned accounts, and no automation
  • No SLA visibility or reporting — leadership unable to measure IT service delivery performance across 400+ sites
  • Slow clinic onboarding process — new hire Day 1 setup taking days instead of hours due to manual provisioning
  • Password reset tickets consuming a disproportionate share of helpdesk capacity with no self-service option

The Approach

Our Approach

This was a fundamental transformation: taking IT operations from a fully outsourced model to a high-performing insourced team with ITIL-based processes, automation-first principles, and 24/7 coverage across 400+ sites. The goal was not just to replace the outsourced provider, but to build a scalable internal capability that would improve over time.

Phase 1: Assessment & Team Build

We started by auditing the existing service delivery: ticket volumes, resolution times, escalation patterns, and the true cost of the outsourced model. The findings were stark — no SLA reporting existed, Active Directory was riddled with technical debt, and the outsourced team had no automation in place for common tasks.

The insourced L1/L2 team was built in parallel with process design:

  • ITIL-based incident, request, and change management processes were established before the team went live
  • 24/7 on-call rotation with documented runbooks for every critical system
  • Escalation paths clearly defined from L1 through L3 and vendor support

Phase 2: Automation & Self-Service

With the team operational, we attacked the highest-volume ticket categories through automation:

  • Self-service password reset portal — eliminated 80% of password tickets, the single largest ticket category
  • Automated onboarding/offboarding — Dayforce integration triggers Azure AD account creation, group assignment, and application provisioning on new hire start date
  • Enterprise automations integrating Dayforce, Azure AD, Concur, and NetSuite — each new automation created a compound effect, multiplying the value of existing integrations

Phase 3: Active Directory Remediation & SLA Governance

The final phase tackled the technical debt: standardizing AD naming conventions, removing orphaned accounts, implementing group-based access policies, and establishing automated compliance reporting. SLA dashboards gave leadership visibility into IT performance for the first time.

Within one quarter, the helpdesk backlog was reduced by 75%, SLA breaches dropped to under 5%, and new hire Day 1 setup went from a multi-day manual process to same-day automated provisioning.

System Architecture

Technology Stack

Azure ADDayforceConcurNetSuitePowerShell AutomationITIL Framework

Key Outcomes

0%

Helpdesk Backlog Reduction

Reduced outstanding helpdesk ticket backlog by 75% within the first quarter of insourced operations

<0%

SLA Breach Rate

Service level agreement breaches reduced to under 5% through structured ITIL processes and monitoring

0%

Password Reset Reduction

Self-service password reset portal eliminated 80% of password-related tickets from the helpdesk queue

Same-Day

Day 1 Setup

New hire provisioning reduced from multi-day manual process to same-day automated setup via Dayforce integration

What Made It Different

  • Insourced model designed for scalability — built internal team capabilities rather than creating dependency on another vendor
  • Automation-first philosophy: reduce repetitive ticket volume through self-service and automation before adding headcount
  • Dayforce platform ownership alongside IT operations — HR system integration as a force multiplier for identity management
  • 24/7 on-call rotation established with clear escalation paths and documented runbooks for every critical system

Lessons & Transferable Patterns

  • Insourcing IT operations requires building the team and processes simultaneously — hiring without ITIL foundations creates chaos
  • Automating password resets and onboarding/offboarding delivers the fastest ROI and immediately frees helpdesk capacity
  • Active Directory cleanup must happen before automation — automating on top of inconsistent data propagates errors at scale
  • Enterprise integrations (Dayforce, Azure AD, Concur, NetSuite) create a compound effect where each automation multiplies the value of others

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