Project Management Institute

Project leaders as physicians, treating the whole patient

Kevin Mackey, Senior Associate, Point B

Lisa Owen, Senior Associate, Point B


Project managers should expand their vision to consider and improve the overall health of their organization—not just manage symptoms of the organization's ailments that coincide with their project. Because projects are usually initiated after the organization's objectives and strategy have been established, project managers are often content to deliver their discrete project without full consideration of whether or how the project will achieve the intended business objectives. Just as there are few physicians in the medical field who are willing to treat the “whole patient,” there are few project leaders willing to step back, understand strategy and environment, and drive toward the ultimate business objectives. Until project managers are willing to incorporate holistic strategic thinking into their planning and execution, many projects we think of as successful will continue to fall short of what the organization needs.


What happens when a doctor truly connects with a patient, understands the full extent of her situation, and considers the patient the complex organism—a web full of intricate and interconnected systems—that he or she is, before rushing to diagnosis and prescribing treatment? The patient receives more than a Band-Aid to merely treat her symptoms. She receives a thoughtful diagnosis and a holistic treatment plan. This doctor is treating the whole patient, and ultimately, the patient receives better care and likely a better outcome.

What happens when we overlay this analogy onto project leaders and the organizations they serve? Project leaders are often assigned to treat a problem within an organization. When they take time to connect with the organization and its overarching business objectives and see their project as one part of an interconnected whole, they are better able to treat the problem or condition they were brought on to solve by completing the project and improving the overall health of the organization.

This analogy was born from the experience of a co-worker, whose daughter presented with a myriad of painful symptoms. He spent an inordinate amount of time navigating our healthcare system, weaving in and out of the office of specialists, trying to diagnose his daughter, but finding no clear path toward diagnosis and treatment. Each specialist did his role and addressed his niche, but none invested the time or thought to get to the heart of the issue. His daughter was eventually diagnosed, but not before he decided that the process would have been more successful had she seen a doctor who was willing to examine her symptoms holistically and strategically and take accountability for overall health. Our co-worker concluded what constitutes good healthcare, and he also posed an interesting hypothesis: that many of the same tactics used by doctors who treat the whole patient can be used by project leaders to improve project outcomes and enhance the overall health of an organization.

His hypothesis turned into a discussion, our discussion turned into research that involved a qualitative survey of 35 experienced project leaders, and our research turned into this paper. The following elements were found to be key success factors in projects that achieved the business objectives, and were regularly found to be missing in projects that did not. We discuss how these elements contribute to a whole patient approach to project leadership and how project leaders can promote these elements to improve the chances their project's business objectives are achieved.

These elements include:

  • Clarity and understanding
  • Alignment and focus
  • Accountability and commitment.

What Makes Project Execution Successful?

Projects leaders are often heads-down, delivering their project's specified scope on time and within budget. We suggest that even though these projects are being completed according to specification, they aren't achieving the business objectives to the fullest extent (Kraft, 2007, p. 3). Why? Because we think—and our qualitative survey reinforces our thinking—that for a project to be successful AND deliver business objectives, it must be approached both holistically and strategically. This means making a strong connection between the project and the business objectives of the organization.

Project leaders are good at juggling multiple tasks—at adjusting and fine-tuning constraints to ensure that projects are successful—so why would making a connection between the project and the overall business objectives of the organization be so difficult? It is difficult because project leaders do not typically address strategy. By the time a project leader is assimilated into the organization, a strategy—crafted by somebody else—is often in place, and the project leader is being called upon to deliver upon the scope of work outlined in the strategy.

Project leaders do not have to be part of strategy formulation. There is usually no lack of visionary leadership to craft good strategies worthy of implementation. However, strategy involves much more than formulating a vision. Strategic execution includes three key steps that project leaders must understand and drive for their project to deliver the intended value:

  • Refining and translating the strategy
  • Creating conditions for success in the organization
  • Developing the best plan for executing the strategy.
Strategic and holistic project leadership involves not only defining strategy and vision but refining the strategy, creating the conditions for success, and developing the best plan for execution

Exhibit 1 – Strategic and holistic project leadership involves not only defining strategy and vision but refining the strategy, creating the conditions for success, and developing the best plan for execution.

Recapping our co-worker's personal medical journey helps us illustrate what happens when a physician doesn't treat the whole patient. Our co-worker's young daughter was experiencing severe abdominal and joint pain, and a host of other symptoms including headaches, eczema, anxiety, erratic behavior, digestive issues, and inability to thrive for an entire year. Accompanied by her parents, she was seen by a gauntlet of providers who addressed their respective areas of expertise, but were unwilling or unable to develop a strategy for her overall health. Each specialist spent time with the patient, referred the family to another specialist, and then washed their hands of the case.

Given the number of patients doctors see in one day, they often don't have the time or energy to truly listen and understand the patient and advocate for his or her overall health. They also fall short when they don't invite the opinion of other specialists, perhaps because it slows the process and they don't feel doing so is relevant. With good intention, physicians want to treat their patients quickly but often they don't take accountability for the patient's overall health. They leave it up to the patient or in our co-worker's example, to the patient's parents.

If project leaders are guilty of the same inability to see the entire picture, align their thinking with those that have skin in the game, and be accountable, then their patients—the organizations that they serve—won't have healthy outcomes either (Stanleigh, 2005). How can project leaders overcome these challenges?

Gaining Clarity and Understanding

Clearly stated business objectives, and a universal understanding of how the project will help achieve them is the first success factor.

When we re-examine our co-workers challenge in having his daughter diagnosed, all problems seem to point to the physicians not understanding or not willing to address the core objectives of the patient and her family and not using techniques to gain a true understanding of what is going on with the patient and all factors that could be contributing to her symptoms. The physician wanted to quickly solve the patient's problem, prescribe a treatment, and move on to solving the next patient's problems. However, in this particular case, what the family wanted was to understand root causes of their daughter's symptoms, and they wanted to understand what would cure them in a way that would work for their daughter and the rest of their family. They wanted to gain clarity and understanding regarding why their daughter was experiencing the symptoms and how they could holistically address the problem—not just with medication but with proper lifestyle choices that they could put into practice.

Project leaders can look to this example as a method for understanding why clarity and understanding are so important. Successful projects leaders realize that they must:

  • Immerse themselves in the organization to deeply understand business objectives
  • Help make the business objectives accessible and memorable
  • Evangelize the business objectives to others.

Project Leaders Gain Context by Immersion

To gain context, the most ideal situation is when a project leader can join a project as early as possible to best understand the business objectives, strategy, and business case for the project. This enables a leader to approach the project strategically (Figure 1). Additionally, it enables them to evaluate the project within the context of the current organization and marketplace environment and design a solution with the business objectives in mind, not just the goal of completing the project.

Fully immersing themselves into the organization and understanding all factors also provides the proper foundation for project leaders to either challenge or validate the business objectives. With this context, they can also assess whether the project can realistically achieve the business objective.

If the project seems unrealistic and won't have the intended effect, then project leaders can investigate and suggest alternative ways the business objectives can be achieved. Finally, sometimes pointing out to stakeholders what happens when goals aren't met is a powerful incentive to make necessary changes so that the business objectives can be met.

When getting an early start on the project isn't possible, project leaders must work hard to gain this context, even when the project may already be in flight. Great project leaders unleash their curiosity to understand what led to the current state, how the project is expected to address it, and what pitfalls or barriers could prevent achieving the business objectives. Sometimes this is easier said than done. Project leaders need to assertive to get the information they need, but done artfully to convey the pure intent of making the project successful.

Business Objectives are Accessible and Memorable

Clear business objectives and a clear relationship between how the project supports the objectives help project teams prioritize, focus, and finish projects in a way that benefits organizations. Project leaders can do much to make the business objectives accessible and memorable. They can make sure that the business objectives are well-documented and accessible to stakeholders and project team members. Often this means publishing them in multiple locations to suit favored consumption of team members. Objectives can be regularly discussed at status meetings, highlighted at the top of all status reports, and reinforced by executive sponsors. Turning the objectives into a catchy project slogan and putting on t-shirts for all team members is a gimmicky tactic, but often effective.

In their book, Made to Stick, the Heath brothers discuss why some ideas perpetuate and others die (Heath & Heath, 2007). They also describe the benefit to organizations of crafting missions and objectives so that they stick with people who reference them. Project leaders can benefit from this thinking and help organizations develop objectives that are sticky. Doing so helps team members understand the objectives in terms they understand, remember them, and rally around them.

Project Leaders as Evangelists

Successful project leaders take the concept of sticky one step further to help team members infuse the objectives into their everyday work. They make the link between the project and business objectives part of the daily dialogue. They help the entire team understand how their collective work impacts the objective and go so far as to help individual team members see how their portion affects the bottom line. They also reward and celebrate actions that support the business objectives and not just the completion of a project milestone.

Aligning and Focusing

Alignment and focus are another critical success factor for approaching projects strategically and holistically. Clear alignment creates strong organizational momentum that prevents distractions from slowing progress. Steadfast focus on the business objectives—and not just the end of the project—helps the team adjust the approach and scope along the way to maintain alignment with the business objectives.

Our co-worker's journey through the healthcare system illustrates how crucial alignment and focus are when treating a patient or leading a project. In our co-worker's case, he took his daughter to see a number of specialists. Each of these specialists dove into their own area of specialty and possessed critical information about his daughter's medical case, yet very few of them communicated with one another, and if they did, they didn't share necessary information that would have helped them align on a treatment plan for the little girl. Additionally, there was little alignment between what the specialists considered a cure and what our co-worker and his wife considered a cure.

The same can often be said of project leaders. When they are called upon to lead a project, often, they approach the project from a “here's what I do best” perspective, almost like how a specialist treats a specific area or system within the human body. By working in their comfort zone, they close themselves off to aligning with key players. When a project leader does recognize a lack of alignment, many aren't incented to speak up to project sponsors or executives because it will ultimately affect their ability to deliver their project according to specification.

Successful project leaders:

  • Recognize the two types of alignment and facilitate both
  • Maintain focus on the business objectives and enforce alignment with quality communication.

Recognize and Facilitate Both Types of Alignment

Effective project leaders must acknowledge and drive two kinds of alignment to achieve business objectives:

  • Alignment between their project and its business objectives
  • Alignment between the thinking of all leaders and stakeholders involved.

To facilitate alignment between the project and business objectives, project leaders must ensure that the organization's business objectives, strategy, metrics, and supporting projects all support and supplement each other. Once established, project leaders should regularly assess alignment of project to business objectives by relying on the science of project management and its tools. Key to enforcing this type of alignment is calling out efforts made by team members when their work contributes to the overall business objectives.

To facilitate alignment between leaders, leaders must first build trust and earn credibility. This enables them to influences scope changes, if necessary, to keep the project in alignment with business objectives. Credibility and trust also helps leaders persuade stakeholders when they get out of alignment. To facilitate alignment, leaders should also leverage existing or develop new mechanisms to help leaders aligned throughout the project. The key to alignment is avoiding assumptions. A project leader can't assume anything, and should simplify, repeat and validate all key points with all stakeholders regularly.

Maintain Focus on the Business Objectives and Enforce with Quality Communication

Good leaders keep their eye on the prize and help their teams do the same with quality communication. When project team members want only to put a milestone or project behind them, project leaders understand the value of continually referencing business objectives. They make them central to the culture and dialogue of the team, surfacing them instead of leaving them buried in a hard-to-find business plan. Making business objectives part of the daily conversation requires consistent, quality communications that tie the project activities to the business objectives. Receiving consistent communications that reinforce these messages help team members maintain focus and remind them why they are doing what they are doing.

Creating Accountability and Commitment

The last mile of a project is often the hardest because people are often resistant to adoption and change. However, adopting new norms and adjusting to a new state can be made easier when there is commitment and accountability from team members and executive leaders.

When we consider accountability and commitment in terms of our co-worker's healthcare experience, it was clear that each specialist expected the family to be accountable for finding a solution. The specialists only took accountability for their particular area. In addition, when a diagnosis became clear, the focus became just on prescribing treatment and not a plan that contributed to the little girl's overall health.

Project leaders can learn from this example. Specifically, that they must:

  • Drive executive sponsorship and accountability
  • Make incentives the rule rather than the exception
  • Realize that change is difficult and sometimes emotional
  • Make the end of the project the beginning of a new state.

Drive Executive Sponsorship and Accountability

Throughout the duration of the project and after the project is complete, good project leaders make it clear what all project team members and stakeholders are accountable for. Of particular importance is identifying and communicating the executive leadership accountable for project outcomes, business objectives, and the connection between the two. Good leaders also know that it's not enough to just call out whose responsible but to get them actively engaged and participating in relevant project meetings, working sessions, and communication initiatives.

Make Incentives the Rule

Project leaders must find their incentive in the overall business objectives and not just the completion of the project. Executives must also share this trait. Project leaders realize that this is a tall order because there is often disincentive for individuals to prioritize business objectives ahead of project delivery. People have the tendency to focus on completing tasks and deliverables. Great project leaders choose to carry the mantle of the entire set of business objectives, despite the lack of incentive to do so and despite often being rebuffed for challenging executives or falling behind on project deliverables. Successful project leaders develop incentives—for themselves and their teams—that are tied to business objective achievement.

Realize Change is Difficult

According to our research, and first-hand experience, adoption is one of the biggest reasons business objectives are not met when a project is completed. Great leaders realize that change is difficult and it doesn't take hold overnight. Good project leaders never underestimate the impact of change on the organization and find ways to continually help the organization adjust. Change is usually an emotional process for stakeholders and team members and true leaders design ways to increase the chance of adoption.

Make the End the Beginning

Great project leaders also realize that the end of the project is usually just the beginning. Completing a project is actually just the first step in achieving the business objectives. Project leaders who approach projects holistically and strategically also focus on what happens after a project is complete and how the team can transition to a new state. This can be done by developing and driving plans to adopt or follow-through on the project outcomes.


When we asked our co-worker what he wished he'd received from llis doctors for llis daughter, llis answers were:

  • Strategic thinking
  • Willingness to deeply understand the root cause of the patient's pain
  • Shared understanding and agreement on desired outcomes
  • Great communication and information sharing between doctors and the family
  • Aligmnent between family and doctors and between objectives and treatment plans
  • Willingness to take accountability for healthy outcomes.

Project leaders must deliver these services to our “patients” as well. When we do, we will become known and trusted for delivering business objectives and health—not just projects.

Kraft, T. (2007,November). Systematic and holistic IT project management approach. ISECON Conference, Pittsburgh, PA. Retrieved from

Heath, C., & Heath, D. (2007). Made to stick. New York: Random House.

Stanleigh, M. (2005). Properly aligning projects to corporate strategy. Retrieved on 7/6, 2011 from

This material has been reproduced with the permission of the copyright owner. Unauthorized reproduction of this material is strictly prohibited. For permission to reproduce this material, please contact PMI or any listed author.

© 2011, Ben Burke, Kevin Mackey, and Lisa Owen
Originally published as a part of 2011 PMI Global Congress Proceedings – Dallas, TX



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