Implementing a PMO in a healthcare setting
lessons learned for all industries
First there was chaos, then came project management and then there was organized chaos. The Department of Clinical Research Informatics at the NIH implemented a PMO and it has grown along with the number of projects being requested. Lessons from this experience can be applied across industries.
Are you considering implementing a PMO? Where do you start? How do you even identify the need for a PMO, especially in a clinical setting? Even if you are not in healthcare, the lessons learned from the implementation of our PMO can be applied to any industry. The National Institutes of Health (NIH) has been using an electronic health record (EHR) since 1976, but it wasn’t until the EHR was upgraded in 2004 that the need for a PMO was identified. The implementation of the new system involved efforts from functional and technical areas. Although each group worked well individually, it became clear that there was a need for a formal process to manage these projects as a whole within the Department of Clinical Research Informatics (DCRI). The PMO was established in 2005 with two project managers who employed a basic methodology with minimal requirements. The PMO defined roles, responsibilities, and processes, but as each project was completed, additional projects were defined. The methodology, which was initially only used for large and complex projects, was expanded to all projects, regardless of size. By early 2007, the PMO expanded to five project managers with a more enhanced and defined methodology. The project management methodology, defined by DCRI, has been requested by other non-IT departments, including the Nursing Professional Development department and the Office of the Director. Education was provided to help expand benefits of the PMO throughout the Clinical Center. The “start small and expand” approach worked extremely well for the NIH. However, as with any new venture, the success of the PMO did not come without some mis-steps. The lessons learned by the NIH, both positive and negative can be applied across all industries
Creation of the PMO
Previous State of the Department
The NIH had been using an electronic health record since 1976. This was the primary system for all patient encounters at the Clinical Center, one of 27 Institutes and Centers that makes up the NIH and where the inpatient units and outpatient clinics are located. The system in use was called the Medical Information System (MIS) and was supported by DCRI. New implementations, upgrades, or requests for changes to MIS were assigned without any standard implementation process. Each team had their own way of doing things and was often dependent on what the application vendor required.
The decision to replace the old MIS with the new Clinical Research Informatics System (CRIS) made many members of the department nervous. Only a few remembered implementing the original system and this was much larger than anything they had attempted since. NIH hired a consulting company to be the ‘Integrator’. Their primary role was to ensure all efforts are integrated and completed on time and within budget. They also provided staffing to enhance the skill set of the department. The project manager of record was the CIO; although with a project this large and his workload, he was unable to focus on the level of detail required. The Integrator followed a standard methodology while focusing on the daily details to ensure everything was completed as planned and worked closely with the CIO throughout the project.
As the CRIS project ended, DCRI was going through some change of its own. A few years prior, DCRI was split into two areas of expertise: technical and clinical, and now it was merging back into one. The need for a change in how the department supported systems and the reorganization provided a new opportunity. The CIO agreed that there was a need for project managers and a standard methodology. The concept of a PMO was approved.
Developing the PMO
The concept of a PMO was approved; now it needed to be defined and operationalized. The first step was to research how others have built a PMO and extract and employ any lessons learned from their efforts. The research included internet searches, industry-specific organizational websites, books, magazines and people working in the project management field. As the information was gathered, the pieces that fit into the NIH organization were filtered and used. The initial step was to define the goals and objectives of the PMO, which helped to sell the concept beyond the CIO and led into the methodology. The goals and objectives identified for the PMO were to provide a standard and consistent approach to managing projects of all sizes, to provide education, consultation and mentoring for staff, and to provide tools, techniques and methodology to support project management best practices.
One research outcome was to identify and create the staffing model for the PMO. This document defined the recommended roles, responsibilities, skills and backgrounds for each. The document focused on the roles that fit into the NIH culture. This was presented to the CIO for approval so that the roles could fit into the PMO’s methodology document.
The Project Management Methodology document included the following sections:
- Definition of a Project
- Process Overview
- PMO Roles and Responsibilities
- Project Management Process
The PMO Roles and Responsibilities documentation summarized the main roles approved by the CIO. The Project Management Process section defined each phase of the project from Initiation through Closing and what activities and documents were expected for each. This process followed the Project Management Institute (PMI®) methodology. At this time, there were only 1.5 full-time equivalents (FTEs) that were dedicated to project management in the PMO. Due to the limited resources, the role of a project leader was created to manage some unique smaller projects, with the support of a project manager. Using a standard process for managing projects was new to the project leaders and the department. For this reason, the methodology was defined to require limited official documentation. These include the following:
- Scope Document
- Requirements Document
- Communication Plan
- Roles and Contacts
- Project Plan (MS Project or MS Excel)
- Status Meeting Agenda/Minutes
- Scope Change Management Plan
- Issue List
- Lessons Learned
- Project Completion Document
The CIO was excited about having a formal process for managing projects and approved the methodology. The next step was to explain the PMO purpose and the new process to the staff. Presentations were given to all staff involved with projects and the purpose and benefits were stressed. Some thought this was a good idea and were excited, while others were skeptical and felt they were too busy for the extra work that would be required. A more detailed presentation on how to manage projects using the methodology was given to anyone who might be a project leader. This included hands-on education for completing the documentation and facilitating the project through the phases.
This process took 7 months from conception to staff education. Through this time, the staff of the PMO was also managing some of the initial projects that came up. Since the full-time project manager was involved in all projects at some level, all projects followed a standard methodology based on previous experiences while the process was being defined.
Once the PMO had been created and the methodology defined, the office was faced with a quandary: the implementation of CRIS brought about the opportunity to add new, integrated systems with additional features and capabilities that would make it a model system for other hospitals. At the same time, the PMO was still limited by the number of project managers. For now, smaller initiatives were handled by team leaders while larger-scale projects and new implementations were managed by the PMO.
The first of these projects was a major upgrade to the laboratory information system. It involved a variety of different resources that were both technical and clinical within the department, as well as the integrator and end users being heavily involved with testing. The project was scheduled to last a full year from start to finish and estimated to take 2,500 hours to complete. A project of this magnitude would be challenging in itself, especially considering the recent changes to the department’s organization. Initially, the project was not run by the PMO, but rather a team leader that had a specific skill set for supporting the lab system, interfaces and upgrades. The department quickly learned that this process did not work well because the team leaders were good at focusing on the details, but had some difficulty seeing the full picture. Thus, the PMO was called in to support the project from a higher-level management perspective. This is where the full support of upper-level management and the CIO was crucial to the success of the PMO.
As the lab upgrade was being planned, other implementations were being requested from a variety of areas. A new scheduling system was needed to help hospital operations run more efficiently, and the surgery department was looking for a new information system that would be able to link directly to CRIS. These projects would prove to make the lab upgrade a walk in the park, as the scheduling system required over 6,000 hours of work, and the surgery system ended up using well over 20,000 hours of work from resources across the Clinical Center. These new implementations required the primary interface engine to undergo a major upgrade. In addition, as with any information system, no sooner had the CRIS system been implemented, a new project was started to upgrade it to the next version. Even with a PMO that consisted of less than 2 full-time project managers, all of these major projects were completed successfully within two years of their start date.
As those major upgrades and enhancements were taking place, a large array of smaller projects were being requested from users across the board. At the same time, the entire NIH Clinical Center was relocating to a new building on the NIH campus. This initiative was also supported by the PMO. There was now an essential need to expand the office. However, just a year past the implementation of the CRIS system, the CIO of the Clinical Center, and the head of the department, announced that he would be leaving the NIH for other opportunities. Thankfully, his replacement was even more supportive of the efforts of the PMO and provided the opportunity to expand the office to support additional initiatives and projects.
Expanding the PMO
Expanding the Methodology
As the new CIO of the Clinical Center was settling into his role, the existing projects continued on their scheduled courses, particularly because the change in leadership did not significantly impact the long-term goals of the department. As end users became more and more familiar with the power and versatility of the CRIS system, the requests for new features and enhancements continued to climb. Small enhancements, such as new medication forms or changes to reports, were handled under a separate change management process, rather than by the PMO. Requests that required some additional development and testing staff were coordinated by team leads and supervisors that were familiar with the subject matter. Over time, it was clear that some of the work required one centralized person that could oversee the entire project from start to finish. Therefore, with strong support from the CIO, the PMO began to expand its role within DCRI.
The first step was education. The PMO expanded the original methodology to incorporate the lessons learned from the CRIS, lab, and interface upgrades, and used that knowledge to provide an overview of the role of the PMO to the entire department. By working very closely with the technical operations team, the PMO was able to easily gain support from that area of the department, especially given past successes. In order to gain continued success for a PMO, there must not only be upper-management support, but also buy-in from the people that will benefit from it. It is crucial that staff view the PMO as a tool that can be used to their advantage, rather than another form of “management” that gives tasks and deadlines. By educating the department about the role of the PMO early on, there was much more acceptance when it came time to begin work on new projects. Of course, remedial training and education is always a must.
The department became familiar with the office, and the PMO began to manage some smaller-scale projects. Some of the first projects included the addition of new interfaces between CRIS and existing ancillary applications. Since the PMO still had a limited number of project managers, project leaders were used to assist with the day-to-day work that was required for planning and coordinating the tasks. Using the lessons learned from the past, the project manager ensured that the project leader was not also a member of the core team. The project manager retained the primary role to oversee the status of the project and stepped in where necessary. The project leader / project manager relationship provided the perfect stepping stone necessary to add additional staff to the PMO team.
In early 2007, the PMO obtained approval to hire several new project managers, bringing the number of FTEs from 1.5 to 5. Some of the previous project leaders were now project managers of their own projects, and the original project manager was now the central project officer in charge of the expanded PMO. The additional staff helped to coordinate the new project requests that were coming at a substantial rate. In just a few months time, the number of active projects doubled. Soon, the methodology was expanded further to include all types of projects, regardless of their size. From this point forward, anything that was considered a project was managed by the DCRI PMO.
Beyond Project Management
Project management was only the beginning for the PMO. As more projects were being completed successfully, the CIO and other staff requested that new initiatives be coordinated by the PMO. These activities included everything from migrating databases between servers to installing the latest version of Internet Explorer on all Clinical Center computers. By assuring that all types of projects and initiatives are managed by the same group of resources under the PMO umbrella, an organization can maintain standard and successful processes using common best practices.
It is also important to review the methodology of the PMO on a regular basis. The addition of new project managers provided the opportunity to bring new ideas and suggestions to the PMO methodology and expand it where needed. For example, every project management template, from minutes to activation checklists, were reviewed by all members of the PMO to provide feedback on what, if anything, could be done to make the information more viable to the reader. The expanded use of requirements was explored, as well, to make project requirements applicable to both the department and vendor, where appropriate. The PMO has recently begun work on developing centralized databases to track risks and issues of projects. By using COTS products, such as Serena TeamTrack, the PMO was able to develop a custom-built workflow to capture the development and progress of each project electronically.
The PMO processes were also expanded beyond the boundaries of the centralized DCRI project management office. Expanded services have been offered to other departments within the Clinical Center to teach staff how to effectively and efficiently manage projects. For example, the Nursing Professional Development team has recently worked with the DCRI PMO to develop their own methodology for their own needs. Thoughts and ideas have been shared through project management workshops, sticky note meetings, and brown bag lunches. There has also been a request to share the same concept with the Clinical Center Office of the Director to assist with their strategic initiatives.
Today, the PMO continues to expand, and is seen as a central hub for all coordination activities within the department. To help maintain standards of operation within the PMO, the project managers meet on a regular basis to share thoughts and strategies. Each project manager also works on projects that do not necessarily match their specific skill set, thus helping to promote the idea that a project is a project is a project, regardless of the activities that are involved with accomplishing the end goals. This has been demonstrated when a project manager takes leave, and another is able to step in to facilitate meetings and provide management support without causing any delay to the project itself. Additionally, the PMO always has a second project manager that is available as a backup for activations or other major project milestones. In this way, the extra project manager can help to coordinate predetermined tasks in an activation checklist while the primary project manager is available to resolve issues that may occur.
The PMO is also actively involved with furthering the education of the project managers and project leaders. Each project manager is currently taking identical online classes to obtain a certificate in project management. This online class is also a prep course for PMI’s certification. By leveling the playing field and including the entire PMO staff in regular meetings, the project managers can maintain a steady approach to project management issues while following the same standard methodology.
As of this summer, 2007, there are almost 300 active or pending projects and initiatives approved for implementation over the next two years by DCRI teams. About half of those will be coordinated or managed by the PMO. To help facilitate priorities and scheduling, the full list of projects are reviewed on a regular basis by all project managers, the CIO, and other team leaders. This strategy has proven effective in managing workload for the department staff while still satisfying the customers in the Clinical Center. Over the next several years, patient care will only become more and more dependent upon the abilities and functionality of information technology. The key for the PMO at the Clinical Center is continual expansion of resources, processes, and methodologies, which will help to solidify the PMO for years to come.
Some of the most important lessons learned from the creation of the DCRI PMO at the NIH Clinical Center are:
- Start small and expand – The PMO started with less than 2 full-time project managers and a standard methodology. Only large projects were managed by the PMO, while other smaller tasks were coordinated by team and project leaders. Over time, the methodology could be expanded to add new resources to cover additional initiatives.
- Senior level support is a must – Without the support of the CIO, the PMO would have never been accepted by the staff within the department and would certainly not have the opportunity to expand. When staff need remedial training on the PMO’s purpose, it is essential for their managers to support and enforce the methodology of the office.
- Schedule for continuous review of methodology for process improvement – The project managers are able to provide new lessons learned with each project’s implementation that can be applied to future efforts. No matter how well a process works, there is always room for improvement.
- Providing an overview of methodology and project managers’ role helps with buy-in – All staff, senior-level managers and beyond, need to be aware of the PMO’s role as it relates to their work. Although training may need to be repeated, it is extremely helpful so that they will be able to follow the process and, more importantly, understand why it is there and the benefits to them.
- Templates help to keep things consistent – Each project manager should use the same standard template for all documentation, from scope and requirements to minutes and checklists. Project documentation should be reviewed on a regular basis so that it can provide the most benefit to the end readers and users.
- Consistent training for all project managers – This helps everyone to have a standard base from which to build upon and allows the project managers to learn the same thing at the same general time. A study group allows everyone to learn from each other and understand each other’s strengths.
- Need to make a decision on where the PMO will report – The centralized point of report (CIO, CNO, CEO, etc.) will significantly impact the focus of the office. The reporting official should be someone that is in full support of the success of the PMO. This decision will impact the types of projects managed as well as the relationship between team members – clinical and technical.
- Documenting responsibilities and skills for each role will assist with hiring – By understanding the required skill sets and responsibilities for the project mangers, it is easier to place the right people into the PMO.
- The process gets easier once you have some successes – Once you are able to successfully complete a few projects, it is easier to obtain buy-in from others. Those who are skeptical when you discuss the benefits become less so when the process is shown to work successfully.
- Be prepared for success – With success brings more work. Once it is shown that the process works, more and more initiatives will be sent to you to manage. Plan for an increased workload after the initial successes. Develop a process to evaluate and prioritize incoming requests prior to having a long list.
- Treat team members as Subject Matter Experts (SMEs) – It will go a long way if you treat the team members with respect and as the SMEs that they are. This is especially true for the ones who are not buying into the concept of project management. Often those who are skeptical are concerned about the project manager telling them what to do when they already know how and when to do it. Constantly demonstrating that the project manager role is to facilitate, not dictate, will help improve the situation, even if it is a slow progression.
© 2007, Susan M Houston, Ryan D Kennedy
Originally published as a part of 2007 PMI Global Congress Proceedings – Atlanta, Georgia