The project management office in healthcare information technology organizations
Project Management Offices (PMO) have been growing and spreading fast in most healthcare information technology services departments in the provider sector. Some PMOs are large and elaborate others are small and limited in their mandates. This paper elaborates on few key elements necessary for the success of a PMO in healthcare information technology organizations. The issues of governance, strategy, methodology, process modeling, business and clinical acumen, staff development, and other key competencies are discussed.
In healthcare organizations same as in other industries big budgets are allocated to new projects. In many cases these new projects represent a major undertaking that has significant impact on the way business “healthcare delivery” is run in the organization. Because of the significance, impact, and long-term consequences of these undertakings organizations found that having a formal organizational structure – i.e. a project management office – to oversee these big projects contributed to more positive outcomes.
A PMO – a project management office or a project management organization – is a corporate entity with the sole responsibility of ensuring projects are completed on time, on budget, and according to specifications (also known as, with quality and customer satisfaction). To ensure the attainment of this grand goal, PMOs in HIT started building-up their project management expertise and leadership, hired appropriate staff with the needed skill mix, and purchased enterprise solutions software to management knowledge content and status-reporting so as to build a foundation for success. Included in the foundation for success, is clear vision, strong leadership, well defined policies, procedures, and governance, and select tools and techniques.
PMOs in healthcare information technology organizations, same as in other industries, come in many different sizes, shapes, and forms, and with a varying degree of sophistication, projects oversight, and organizational structure and hierarchy.
However, in terms of uniqueness to the healthcare IT industry, the following functions of a PMO stick-out as key areas of expertise the PMO in HIT need to focus on and maintain proficiency in:
- Project governance and oversight, to ensure projects are well managed, stay on track, and achieve their intended outcomes.
- Business processes redesign (BPM), also known as, clinical transformation, systems re-engineering, and change management.
- Strategic planning for the strategic application of information technology in healthcare organizations.
- Adoption of a unified project management methodology, project reporting structure, and key performance indicators, such as report card or dashboard.
- A knowledge foundation in areas unique to healthcare IT, such as physician adoption and integration, CPOE implementation, and clinical documentation. These are few of the key electronic systems that have unique impact on healthcare delivery and patient care, and in order for the PMO to guide, motivate, and complete these projects, they need to develop knowledge and management depth and expertise in addition to an array of unique soft and hard skills needed to reach out to the clinician communities and work with them on achieving these endeavors.
- The HIT PMO is responsible to develop and grow its staff and a cohort of project managers that have the right capabilities (knowledge and skills) to implement system wide projects & programs, and be able to cope with the high stress of healthcare information technology projects.
The focus of this paper is on these key areas of expertise necessary for the success of the PMO in healthcare information technology:
- Governance: for the HIT/PMO to be successful it needs to have a director/vice-president level leader who reports directly to the CIO, this ensures adequate visibility and status in the IT organization. There also needs to be a biweekly or monthly meeting that reviews all key projects, to ensure that projects are progressing on time, on budget, and to ensure that all open issues are getting adequate attention. These PMO/dashboard meetings need to be attended by all project managers, and all IT tower (group) leaders, i.e. technical, applications, operations, etc. With the same token big projects with big budgets, with direct impact on clinical departments and patient care need to have steering committee for project governance. The committee members need to commensurate with the complexity of the projects and its span of control. All key players need to be part of the steering committee, the project executive sponsor (executive leadership), clinical sponsor (clinical department head), IT department vice-president or director level of the area overseeing the project, other project key players need to be part of this steering committee, and the steering committee need to meet regularly to ensure timely discussion and debates and to keep the issues and activities fresh in people's head. All key issues, deliverables, milestones, dates, budgets, vendor issues, and change requests need to be brought to this committee for key decision-making and timely resolution of issues or conflicts.
The steering committee is the highest level of reporting for a project. The lead members / corporate officers serving on this committee report directly to the “C” levels of their organization, the executive sponsor reports to the CEO or president, the IT sponsor reports to the CIO, and clinical sponsor reports to the CNO or the CMO. This committee structure ensures adequate guidance, stewardship of resources, authority for decision making, and accountability at the highest level attainable in an organization.
- Business Process Management and systems re-engineering, also known as clinical transformation, has attracted lots of attention over the last few years. As the need for more information technology solutions became evident, it also became clear that just installing new software, no matter how good it was, or how much needed, without giving enough attention to understanding the current state in the organization, assessing the existing gap and deficiencies, and designing a future state in collaboration with the end users and creating the right procedures to address, handle, and mange change was causing failure and frustration in healthcare IT implementation and adoption. The PMO in healthcare organizations need to encourage, foster, and facilitate workflow redesign, process analysis and improvement, and need to create a mechanism to work with the end-users/customers to assess their current work environment, do a culture assessment or readiness assessment, and evaluate how they deal with conflict, how they make decisions, and establish a structure to introduce and manage change and provide a form for positive debate for effective problem-solving and issue resolution.
- Strategic planning and strategic application of information technology in healthcare organizations, as described eloquently by John Glasser (2002), IT leaders (and PMO leaders) need a strategy for information technology and project management that meets the organization's needs and for this they need to think strategically; there needs to be a clear link between the IT/PMO department strategy and the organizational strategy, with clearly defined frameworks and methods. There PMO in healthcare IT needs to have a clear definition of capabilities, internal assets, attributes, and values. Capabilities and assets composition can range from technology and hardware, to services capabilities, human resources assets, and relationships assets. All this need to be strategically aligned with the organization at large, to ensure meeting the organizations goals and objectives. An example of the healthcare IT/PMO strategy could be made in relation to expensive and complex systems installation as PACs, CIS, systems integration, web portal and share point utilization.
The IT department and PMO leadership need to work closely with the clinical and executive leadership in ensuring that resources (human, technical, and financial) are utilized in a way that best meet the organization's goals and vision, (Isola, 2006).
- Using a unified project management methodology is a valuable undertaking that can only have positive ramifications across the organization. As George Pitagorsky states in an IIL business briefing, “all projects are mission critical”, (Pitagorsky, 2003). Projects when completed successfully provide a new product or service that is much needed by the organization, there is a profit achieved, or compliance met, or a much needed enhancement. In the world of projects and software development there has been attempts by many organizations to provide and advocate the use of a standard. The capability maturity model (CMM) by the SEI, the information technology infrastructure library (ITIL), ISO, and IEEE all advocate the need for a methodology for repeatability and consistency. Also, OPM3®, Organizational Project Management Maturity Model (OPM3® ) is another tool to assist PMO in defining a work process and methodology to implement projects. Having a methodology ensures better performance based on best practices and lessons learned from historical events.
To ensure adopting a unified project management methodology, PMOs need to have development plans, education and training of staff, and means for competency assessment, recognition system, and personal appraisal for the staff. Also, having a methodology usually warrant having sets of tools, templates, and checklist that aid in planning and reporting.
Having a consistent reporting tool (dashboard) provides a great benefit to organizational leadership. It provides a consistent look to reports from various projects, and specific measurement that all PMs report-on covering key performance indicators and expected outcomes. An added benefit to a unified project management methodology, is the relative ease it brings to defining PM core competencies, such as: (1) communications (verbal and written), (2) problem-solving, negotiations, and creative thinking, (3) flexibility and teamwork, (4) leadership and business acumen, and, (5) expectations and relationship management with the end-user / customer.
- Knowledge foundation and specialization in the clinical components – having a physician and nurse on board (and other clinicians as needed), liaison with industry analysts / clinical analysts or experts provides depth and relevance when reaching-out to the end-users. There needs to be a clear plan for clinician adoption and acceptance of change, which could cover a variety of methods to reach-out to the clinicians and understand their needs, opinions, past experiences and worries and fears, and develop a plan to work with them hand in hand, which could start from providing a forum for them to share their input, provide presentations and education, through web access and other assistive tools to meet their needs and time constraints. Also, providing rewards, CME credit, and highlighting the patient-care related benefits in terms of quick access to records, increased patient safety, medication-error reduction, and other benefits that have big significance and major impact on the clinician, patient, and family satisfaction and trust. The PMO in healthcare IT organizations needs to step-up and take-on this additional responsibility to ensures success of the clinical projects and have a positive public image and perception in the organization and among its peers.
- PMO staff development and growth in project management capabilities in healthcare IT, both in knowledge and relevant soft and hard skills. One skill that stands-out in healthcare information technology is the ability to communicate in clear and succinct manner, and the talent to facilitate meetings, debates, and negotiate to reach consensus on sticky issues and make relevant timely decisions. Also, of importance is the ability to reach-out to the end-users and have an open dialogue with them to understand their business needs, partner with them on solutions and initiatives, also, providing depth in understanding the business processes and users needs to perform the duties. In addition to the above, all other PM core competencies as described by PMI in several publications, remain very desirable and are a must for successful delivery on projects. At a minimum, the PMP certification should be encouraged to ensure basic knowledge, common terminology, and general understanding among all PMO staffers and project managers.
From another angle, relationship building and ensuring the presence of good chemistry between the leaders of the organization, the PMO/IT management team and clinicians is essential for project success. The CEO, president, CIO, PMO Director, and the project managers and teams need to have good synergy to work together cohesively. Some of the key characteristics needed in management teams to ensure success are : (1) management commitment and public support to the success of a project/program, (2) political stability in the organization – less turbulence and less change in leadership and staff, i.e. less turn-over, (3) general inclination to cooperate and work together with the end-users and customers to ensure satisfaction, (4) integrated planning for project execution, and (5) experienced, focused, thoughtful assessment of capabilities and realization of limitations. These five key characteristics are generally sought-after or homegrown in an organization to ultimately achieve the grand vision and goals of the organization, (Glasser, 2002).
- In addition to the above core functions, all other project management capabilities, such as, project planning, integration, managing project risk, protection from failure, asset loss or financial loss, cost-benefit analysis, return on investment, managing clients expectations in a reasonable and tactful way, managing public/corporate perception and image, monitoring and control functions of various implementations, attention to quality and voice of the customer initiatives, are all integral components to the mission of a PMO in healthcare information technology organization. PMI has several publications that come handy as a reference to these capabilities especially the recent release of a web-based Organizational Project Management Maturity Model (OPM3® ) a great tool for organizational assessment in the area of organizational project, program, and portfolio management.
In summary, a project management office in a healthcare information technology organization maintains and shares project oversight responsibilities as a PMO in any other industry, however, its repertoire of expertise has to grow to encompass the unique issues facing project management in healthcare information technology organizations, such as the need for physician/clinician involvement and integration in the decision-making processes and adequate project governance and the need to dedicate enough time for planning, assessing, understanding, and improving workflow and other business process management issues. Healthcare organizations are heavily regulated and patient care delivery is very demanding in terms of time, sensitivities and risks involved. Clinical staff in many cases are over-worked and very busy taking care of sick patients and are not readily available to work with project teams, which create an additional layer of complexity in communication and integration. However, staying the course, being persistent and taking the time to plan, communicate, and reach-out usually ensures projects success. The PMO leadership has to be understanding and supportive to the project managers and provide guidance and direction especially when the stakes are high.
PMOs in healthcare organizations need to arm themselves with a unified project management methodology, a well-defined metrics and measurement system and an executive reporting tool such as a dashboard report. Also, of high value to a successful PMO, is an enterprise wide solution for tools, lessons-learned, and knowledge/content management repository where policies, procedures, templates and all other significant documents reside. Continuous education and training, and a genuine interest in staff development and career growth could make a big difference in the performance of PMOs in healthcare information technology organizations.
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© 2006, Laura Aziz, PhD, PMP, RN
Originally published as a part of 2006 PMI Global Congress Proceedings – Seattle, USA