A step in the right direction--improving organization PM maturity

Paul Atkin, Chief Executive, Advantage Learning Ltd

Executive Summary

Doctors with instant access to a patient’s complete health records at the click of a mouse will be the ultimate signal that Information Technology has come of age. Our lives are already being revolutionized on all fronts by the new – more efficient – ways we can do things with the seamless integration of hardware, software and the Internet. Healthcare, more than any sector of our society is benefitting from these innovations. But introducing these innovations is no straightforward task.

In the Canadian province of Manitoba, Manitoba eHealth is a provincial program administratively housed in the Winnipeg Regional Health Authority (WRHA). Our organization has undertaken a series of initiatives with the goal of being more customer-focused and establishing best practices throughout the organization. This paper will show how Manitoba eHealth improved project management maturity by deploying structured project management to fulfill its mandate to:

  • Integrate healthcare systems across regions and care sectors
  • Improve and expand healthcare services by managing Information and Communications Technology (ICT) as a single organization capable of achieving economies-of-scale, province wide.
  • Improve efficiency and effectiveness of ICT services by leveraging the benefits of centralized delivery model

History

The Winnipeg Regional Health Authority is an organization of committed professionals who support each other in the delivery of health services and work to protect the health and promote the well being of the people who benefit from these services.

The Winnipeg Health Region serves residents of the City of Winnipeg as well as the Rural Municipalities of East and West St. Paul, with a total population of just over 700,000 people. The Winnipeg Regional Health Authority also provides health care support to nearly half a million Manitobans who live beyond these boundaries as well as residents of Northwestern Ontario and Nunavut who require the services and expertise available within the Winnipeg Health Region

More than 28,000 people work in the Winnipeg Health Region. With an annual operating budget of nearly $1.8 billion dollars, the Winnipeg Regional Health Authority operates or funds over 200 health service facilities and programs.

Mandate and vision

Manitoba eHealth’s mandate is to facilitate the healthcare delivery transformation through the use of Information and Communication Technology (ICT).

Manitoba eHealth offers a single integrated organization capable of providing province-wide solutions under the direction of the Manitoba eHealth Program Council to:

  • Integrate health care systems across regions and care sectors;
  • Improve and expand health care services by managing ICT to achieve economies-of-scale, province-wide; and,
  • Improve the efficiency and effectiveness of ICT services.

Manitoba eHealth is about providing the right information at the right time to the right people so that:

  • People and their families have access to the information they need to maintain their health and to access the services they require;
  • Providers are able to provide high quality services; and,
  • Health system administrators can ensure the sustainability and accountability of the system.

Manitoba eHealth’s key goals

Customer Service Management Processes

▪    Define, communicate and implement principles, processes and roles/responsibilities within Manitoba eHealth to improve the delivery of services to our customers.

Service Level Framework

▪    Develop and implement a Service Level Framework that provides customers with a clear understanding of the services and expectations of doing business with Manitoba eHealth.

Single Intake Process

▪    Create a single intake process that fulfills customer service requests in a consistent and timely manner.

Information Technology Infrastructure Library (ITIL) processes

▪    Implement a best practice framework for Information Technology (IT) services that includes standards for quality and continual improvement planning (based on ITIL V3).

Projects in a Controlled Environment (PRINCE2®) Processes

▪    Implement a project management methodology wherein all projects are delivered in a controlled, consistent and high quality manner.

Enterprise application and infrastructure discovery

▪    Identify and assess the various components of the application and infrastructure layers including the relationships that exist between the architecture layers and support business processes. Develop and implement a refresh strategy for the computer desktop, server, and network infrastructure.

Effective governance

▪    Develop an effective Manitoba eHealth Program Governance Structure that engages key stakeholders in a “board-like” structure, as well as key advisory committees.

Sourcing assessment

▪    Identify opportunities where “outsourcing” of services or “out-tasking” of specific IT responsibilities and services have potential to improve service levels and efficiencies for customers.

Support model

▪    Develop and implement a common support model for customers to include a framework of shared services, support and governance.

Performance metrics

▪    Establish measurement criteria for each of the priority and functional areas as a means to hold Manitoba eHealth accountable for their improvement goals.

Manitoba eHealth is committed to an approach that ensures wheels are not reinvented. Lessons learned are leveraged in future initiatives. Our investments are optimized through various standards. The standards initiated through eHealth projects are leveraged throughout the entire province.

A key element of standardizing and developing mature processes was to develop an approach to project management now called the Manitoba eHealth project management method based on the PRINCE2® methodology. This initiative was “A Step in the Right Direction”

Before a Step in the Right Direction

With IT systems becoming such a critical component of the province’s healthcare, a key objective of Manitoba eHealth’s PMO Director, Debbie Honke, PMP, was to improve customer service. “Customer service is why we exist,” explained Debbie. “One of the ways to improve that was with the introduction of standard, consistent, repeatable processes. If we’re all doing the thing the same way, we’re taking variants out of service delivery and we can focus on quality.”

The PMO employs approximately 40 project managers including employees and contractors. Each project manager has his own level of experience; as a consequence the quality of the output is dependent on the project manager’s experience.

Within the organization there existed a silo culture and poorly defined responsibility and accountability. The PMO had a home grown methodology; as a result project management was inconsistent, information was held in variety of formats, and documentation was not standardized. Information required for decisions making was not readily available and required large amount of effort to compile. There was no established standard for project management training.

Projects seemed overwhelming as there was no structured approach or templates to follow, therefore project managers used whatever worked for them. There was very little focus on the business benefits and the role of the end users.

What we set out to achieve

Manitoba eHealth began the adoption of a best practice approach for its initiatives to improve the quality of service through project delivery to its customers. This required a consistent and repeatable approach to project management to take the variants out of service delivery and focus on quality.

In addition, we created a standard approach to project management training for its employees and vendor partners. A number of Project Managers had gained the Project Management Professional (PMP®) credential, but standard methodology was not used. “We relied heavily on our private sector partners, independent consulting firms, to assist us with project delivery. We found that while we shared an understanding of the project management framework our practice and approach was often very different. Vendors had their own proprietary methodology and it became quite confusing for our customers as they each had their way of doing things. And it was also a problem for us, because we weren’t really able to perform project or quality assurance properly because these methods weren’t ours,” explains Honke.

PRINCE2 was the project management methodology Manitoba eHealth chose. It addressed a number of the common problems identified like governance, quality and planning and allowed consistency to be introduced. “In addition, the PRINCE2 method is well established, it’s internationally respected, it’s a leading, if not best, practice,” says Honke. “There’s a professional certification program associated with it and in terms of ongoing support, project continuity and things like that, it’s already well established.”

With PRINCE2 relatively unknown in Canada, this was a brave step for Manitoba eHealth. However, it was a calculated one. “One of the more important reasons we chose PRINCE2 was because we viewed this as the introduction of significant change. By adopting an internationally recognized standard that relatively few people used, we had no preconceived ideas. We had no negative thoughts. People were all approaching the implementation from the same perspective, the same starting point,” says Honke.

It was also taken as a step in partnership with Manitoba eHealth’s vendors. “People must be PRINCE2 practitioners in order to be project managers in our environment and work on health projects in Manitoba. Now 12 to 15 of our local vendors have adopted the standard as well and we’re now able to pull resources from our vendor community.”

PRINCE2 Methodology

PRINCE® (Projects in Controlled Environments), is a widely used project management methodology. Originally developed for IT projects, PRINCE version 2 is generic and has been adopted by global organization including NATO, the United Nations, Sun Microsystems, DHL and British American Tobacco. At the heart of PRINCE2 are a series of Principles, Processes and Themes

Seven PRINCE2 Principles

The purpose of PRINCE2 is to provide a project management method that can be applied regardless of project scale, type, organization, geography or culture. This is possible because PRINCE2 is principles-based.

It is the adoption of these principles that characterizes whether a project is using PRINCE2, not the adoption of processes and documents alone. The principles facilitate good use of PRINCE2 by ensuring that the method is not applied in an overly prescriptive way or in name only, but applied in a way that is sufficient to contribute to the success of the project.

  • Continued Business Justification: A PRINCE2 project has continued business justification. PRINCE2 is a value-driven method and provides clear off ramps for projects which cannot demonstrate a valid business case throughout their lifecycle.
  • Learn From Experience: PRINCE2 project teams learn from previous experience: lessons are sought, recorded and acted upon throughout the life of the project
  • Defined Roles And Responsibilities: A PRINCE2 project has defined and agreed roles and responsibilities within an organization structure that engages the business, user and supplier stakeholder interests
  • Manage By Stages: A PRINCE2 project is planned, monitored and controlled on a stage-by-stage basis
  • Manage By Exception: A PRINCE2 project has defined tolerances for each project objective to establish limits of delegated authority
  • Focus On Products: A PRINCE2 project focuses on the definition and delivery of products, in particular their quality requirements
  • Tailor To Suit The Project Environment: PRINCE2 is tailored to suit the project’s environment, size, complexity, importance, capability and risk

Seven PRINCE2 Processes

The Processes provide a detailed roadmap of step by step activities to guide the project manager from conception to close. (Exhibit 1)

  • Starting Up a Project: “Do we have a worthwhile and viable project”. A short process before the project begins designed to establish if there is sufficient justification for project initiation.
  • Initiating a Project: Produces the Project Initiation Document – the project baseline or terms of reference. Defines what is to be produced, when and by whom, before committing to significant time and expense
  • Directing a Project: A Senior Management (“Project Board”) process: authorizing work, committing resources, giving guidance and managing communication with the environment outside the project boundary
  • Controlling a Stage: The “daily bread” of the Project Manager – handing out work, making sure it is completed to the agreed quality, dealing with issues as they arise, reporting to senior management
  • Managing Product Delivery: Where the specialist work of the project gets done – driven by the Project Manager in Controlling a Stage described above
  • Managing a Stage Boundary: Looking at the big picture – are we still on track? Are the original reasons for the project still valid? Makes sure the project is focused on delivering business benefits – if not, it can be stopped
  • Closing a Project: Has everything been delivered as agreed? Is the customer satisfied? Handing over any loose ends. Write up end of project reports and record any useful lessons learned
Seven PRINCE2 Processes

Exhibit 1: Seven PRINCE2 Processes

Seven PRINCE2 Themes

PRINCE2’s themes describe universal elements of project management which empower the project manager:

  • Business Case: A document which states WHY the project is necessary – specifically what benefits it will deliver to the business. Keeps the project relevant. If the project is no longer going to deliver the benefits in the business case, PRINCE2 says it should be ended
  • Organization: Roles and Responsibilities of the Project Management team. Projects often involve multiple sites or staff from several organizations who may be full or part time on the project. It is important to be clear who is responsible for what from the start
  • Plans: How to create Plans, when it is appropriate to do so. There is no value in creating a detailed Plan for Year 2 of a project right at the beginning, so PRINCE2 plans close to the time the Plan will be used
  • Risk: Dealing with uncertainty. Projects usually have to delivery something unique in a fixed time period using staff who may not have worked together – so a clear Risk Management strategy is essential
  • Quality: May be different for each project – for example your approach to spell checking may be different depending on whether you are producing a daily newspaper or the Oxford English Dictionary. What the project means by Quality needs to be understood by everyone from the start
  • Progress: Your project needs to know what actually happened, against what was planned. PRINCE2’s Progress theme allows the project management team to monitor progress, review achievements, initiate corrective action and authorize further work
  • Change: Change is inevitable in your project: requests for new features, suggested improvements, problems and concerns - all these must be carefully controlled if your project is to stay on track. The Change theme helps you assess and control potential and approved changes to the baseline.

Comparing PRINCE2 and PMBOK

The PMBOK framework and the PRINCE2 methodology are complementary. PRINCE2 is a series of principles, processes and themes suitable for any size or subject of project. It describes what a project manager should do. The PMBOK is a collection of knowledge areas and process groups. It describes what a Project Manager should know.

Communication Strategy

Hearts and minds are the key to making successful changes in an organization. The introduction of a new way of working is never undertaken lightly, but sometimes it can be hard to make people understand and support the change process fully.

A communications strategy was quickly viewed as an important part of the process to win all those hearts and minds. “To get the attention of everybody, we wanted to introduce it in an interesting way,” explains Marcia Hunt, Manitoba eHealth Communications Consultant.

With a logo of a green foot and a tagline (Exhibit 2): “PRINCE2: a step in the right direction”, it was a high profile campaign which ran alongside the training program.

Program Logo

Exhibit 2: Program Logo

Green feet started to appear everywhere: they were even laid on the carpet leading to the launch venue and soon everyone at Manitoba eHealth was talking about the PRINCE2 program. “It certainly grabbed people’s attention,” says Paul Atkin, Advantage Learning’s Chief Executive Officer.

“From then on the foot represented the journey, the step in the right direction,” adds Hunt. “People really got into that: they immediately recognized the green foot as PRINCE2. So it was creating that awareness initially.” Multiple media were used to market the new initiative including awareness campaign business cards , an elevator speech; regular newsletters, lunch & learn events, a web-site , “Ask a question” stations and Posters

However, once the training sessions started, the rising awareness of PRINCE2 became self-perpetuating. “I think the rubber hit the road once people started going into the training, then they started talking about PRINCE2,” says Hunt. “Once people started to understand what PRINCE2 really meant, the testimonials from our own staff really made a difference. We all talked about what we were doing and encouraged those who took the course – including our vendors – to talk about it as well.”

In fact a new language was being spoken around the corridors of Manitoba eHealth. “Following the training, it was like people had learned a new language and everyone started talking in this language,” adds Hunt. “It really increased communications across the board. Because people were trained to at least Foundation level they were able to work with project teams and use the language. It added a whole language that connected us.”

Honke agrees: “It used to be like the Tower of Babel where you have people speaking different languages. Different vendors had their own proprietary methodologies using terminology that may have had different meanings depending on the context. People heard a word but without a common definition may have interpreted it incorrectly. The creation of the common PRINCE2 language is definitely of benefit to our organization.”

As a veteran of many corporate training programs, Atkin sees the way Manitoba eHealth backed up his company’s sessions as key to the way the organization has implemented PRINCE2. “Adopting such an energetic communications strategy was ideal from the trainer’s point of view. We had delegates walking through the door who were enthused and ready to learn. The strong brand and messaging really made a difference.”

Implementation

The implementation philosophy centered on simplicity. Tailoring the method to suit the specific project was a critical principle. All projects in-flight adopted as much as possible whereas new projects used the method in its pure form. Project managers were encouraged to use as much of the methodology as possible after their training.

Adopting PRINCE2 called for a comprehensive training program to introduce employees, customers, vendors and other stakeholders to the methodology. Manitoba eHealth called on Advantage Learning, a PRINCE2 Accredited Training Organization (ATO) based in the UK to devise, support and deliver the program.

To create the PRINCE2 environment which would suit Manitoba eHealth’s requirements, Advantage Learning partnered with the University of Winnipeg and Schulich Business School at York University in Toronto. “The combination of our local knowledge and on-the-ground support together with the international perspective on PRINCE2 which Advantage Learning has, worked really well,” says Debra Wutke, Program Co-ordinator at the University of Winnipeg.

More than 350 people have been trained – at overview, foundation or practitioner level – since November 2008.

Case Study 1: Provincial Home Care Scheduling

Typical of the work Manitoba eHealth undertakes is the Provincial Home Care Scheduling (PHCS) Project. Designed not only to timetable the delivery of care to patients in their homes, but to record hours worked by staff and facilitate payroll and other Human Resources activities, the PHCS solution will revolutionize the way patients are cared for.

In a two-year project, PHCS application will be introduced in seven Regional Health Authorities (RHAs) creating a province–wide standardized IT system across 11 RHAs. It will replace a variety of electronic and manual systems which have been used to manage the 2,200 home care workers who look after more than 8,000 patients each year. It will replace scheduling methods which were time intensive, error prone and could result in inconsistencies in data and fragmented information.

The new scheduling system is expected to make the management of staff and resources more effective and to make the gathering and reporting of service statistics more consistent. Most importantly it should improve the service being delivered to patients as it will increase the responsiveness of the service to changing client needs and reduce the probability of service interruptions due to human scheduling errors.

Achievements

Manitoba eHealth has been using its new project management method the since January 2009. There are over 31 projects at different stages within the project life cycle. In addition, we have trained over 400 persons including our senior managers and vendors. There are now 84 certified project managers. The consistent use and buy-in at all levels within the organization has underscored the point that there has been a paradigm shift towards a standard approach to delivering projects.

Benefits

Manitoba eHealth employs contractors to supplement the number of full time project managers. The standard project management approach provides a method by which to judge the performance of the project managers and especially contractors. Staff retention on projects is not guaranteed ; however with a standard approach adding or replacing project team members has become easier as all project resources must be certified in the method this enables continuity.

In Manitoba eHealth we are always talking about ‘the customer’, ‘the customer expectation’, and ‘customer criteria’. The new method has been integrated with our existing processes so together it has addressed a number of the common problems that we faced in project delivery, things like governance, planning, communication, and project/quality assurance. The focus on quality has allowed a better quality product to be delivered to our customers.

Already the practical benefits of using PRINCE2 to manage a project are emerging. In the home care scheduling project, it was found that the quality criteria established were inconsistent with the quality of the product being delivered. Cavel Strachan, PMP, Project Manager explains: “When that was realized, the team came together and looked at what went wrong, and decided on proactive action to get that product corrected. Had we not been using PRINCE2, we would have found that later on in the project. So that’s a great benefit of using the methodology and establishing quality criteria upfront.”

The new approach required a change in our organization culture as a whole. The role of the PMO has been more of mentoring and support to the project managers and the organization. The project managers are agents of change

For all tasks, project managers look at it as something with a controlled start, middle and end. This approach helps with time management and splitting the work into manageable parts.

The use of the term ‘products’ has helped make it possible for all stakeholders to know what the project is set up to deliver. All activities are centered on the final outcome of the project and the business benefits.

Honke agrees. “PRINCE2 has exceeded my expectations. It has addressed a number of the common problems that we faced in project delivery, things like governance, planning, communication, and project/quality assurance. And the focus on quality is probably the one that I underestimated. It has allowed a better quality product to be delivered to our customers. No doubt about that.”

In Canada, a PRINCE2 user group has been established to provide support to project managers across the country.

Maturity

Manitoba eHealth has seen significant improvement in the approach to management of projects. The business justification concept has been embraced by the management team and the organization as a whole. The Project Management team is aware of the gated processes to review projects and has been thoroughly engaged in the project lifecycle.

Manitoba eHealth has applied the best practices in ITIL and PROSci PRINCE2 and created its own method to delivery business solutions to its customers. The Method called the ‘Manitoba eHealth Method integrates processes from existing standards and best practices. The method has been integrated with our existing processes so together it has addressed a number of the common problems that we faced in project delivery, things like governance, planning, communication, and project/quality assurance.

These processes and standards are supported by templates and guidelines to assist the project teams in the delivery of the projects.

We are spending about 15% more time in starting up projects than before as a result of the organization’s knowledge on what artifacts must be in place and the success criteria to deliver the right project and a solution fit for purpose.

Before PRINCE2, project quality management was not the central focus of our projects. The organization was at level 1 on a maturity model scale. Where there was no defined and consistent method to deliver projects, the success was based on the experience of the project managers. Most of our project managers have PMP designation as a result they bring this knowledge to the job. With the additional PRINCE2 certification it has created a road map for project managers and has facilitated their transition to the new method with ease.

Today the whole organization has been exposed to a consistent and repeatable method delivered through training and workshops. We are at level 2 on the maturity model. The quality assurance arm of the PMO ensures that project managers use the process while at the same time tailor to meet the needs of the project. The focus on quality has allowed a better quality product to be delivered to our customers.

Manitoba eHealth’s goal is to use standard repeatable processes to remove the guess work out of project delivering so that can focus on providing business value to our customers.

Case Study 2: The Project Manager’s view

“PRINCE2 provides a roadmap for you to deliver on your project,” says Cavel Strachan PMP, Manitoba eHealth Project Manager (PM).

“On a practical level, when you are in an organization that has a structured way to deliver a project, it really makes you more productive as there is a clear process to follow.” Strachan recognizes that PRINCE2 on its own is not the complete solution for the project world. “I’ve used A Guide to the Project Management Body of Knowledge (PMBOK Guide®) and there are areas that PRINCE2 doesn’t try to cover, so the PMBOK Guide® and PRINCE2 provide you with a complete solution.”

An advantage of PRINCE2 from the PM’s perspective is that the Project’s Executive (Sponsor) is the owner of the business case. As Strachan explains,” That takes away from the PM being blamed for things that weren’t right, reason being the PM manages – and not controls – the project.”

For Strachan however, one of PRINCE2’s greatest strengths lies in its focus on products principle. “It allows you – and the team – to focus on the products that are being delivered from the project. One important thing I took away from PRINCE2 is to always have the end in mind. If you are not able to define what the objective is – or what you are trying to achieve – you should not go forward, because you will deliver the wrong product to the customer.”

Lessons Learned

A large number of project managers are certified by the Project Management Institute (PMI®) and are experienced project managers. The new approach complements their approach to delivering projects and provided a structured way to manage the projects.

The senior management commitment helped with to reduce the resistance towards the new approach as they have embraced the method and everyone is speaking a common language.

The Communications Strategy was very successful. The strategy created high level of awareness that contributed to adoption of the new initiative.

The Future

Manitoba eHealth has started to embed the method in the organization and are working towards level 3 maturity by December 2011.

The PMO has acquired a tool to support the PMs in the use of the new approach to project management. Manitoba eHealth has integrated existing process in a method called the Manitoba eHealth Method which is supported by templates for its Project Intake, Change Management, Operations, Release Management and Project Management processes.

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.

© 2010, James Nick & Paul Atkin
Originally published as a part of 2010 PMI Global Congress Proceedings – Washington DC

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