Lessons Learned About Healthcare Project Management
By Karen Lawson
What can be done to keep initiatives moving forward in today’s healthcare environment? We’ve all been there. A well-planned implementation starts off with all the right elements, only to fade slowly with lost enthusiasm and dwindling resources, eventually resulting in a project “on hold indefinitely”.
Lesson learned #1: never, ever presume project goals to include winning commitments
Winning commitments drive project resources and priorities. They elevate project importance to a level of visibility that ensures milestones are met. Winning commitments can be required and made by influencers at many levels in an organization.
Example: Working with a busy health system CIO, the question was asked about defining goals for a technology initiative. The CIO articulated a few very clear, very specific operational and strategic goals. A follow-up question about personal goals for the initiative surfaced key objectives that would ensure commitment through the lifecycle of the implementation initiative. Those personal goals that were surfaced by asking the follow-up question became the drivers of the commitment that became vital to re-establishing priority for the project in the face of several significant implementation barriers. By establishing the CIO’s personal objectives, a winning commitment was gained that ensured the success of the initiative.
Lesson #2: small, visible improvements drive transformation
This lesson is probably one of the most effective I’ve discovered. People get really excited about the benefit of small changes. Pointing out the benefits and acknowledging change agents compounds momentum.
Example: A medium size specialty practice undertaking technology implementation with an extended implementation cycle of several months. Early project milestones involved documenting existing process. No fan fare kind of stuff. During the course of documentation, staff discovered redundancy they were able to eliminate, resulting in reduced workload and available resource time to tackle overdue tasks. The benefit of completing the documentation task was tangible to staff as well as providers. This small change, along with accompanying acknowledgment resulted in a morale boost that drove the next milestone forward.
Lesson #3: managing detractors can be far more critical than winning over champions
Ever noticed how people become fascinatingly entrenched in being right about the position they’ve taken on a subject? In the course of change, hot button issues sometimes become the focal point for those with important influence on the success of an initiative within an organization. Those who become emotionally invested in being right about an issue that affects their realm of work pose a much greater threat than those who have chosen to invest in the success of an initiative.
Example: A very large health system identified operational challenges related to efficient patient communication and responsiveness that could be positively impacted by implementation of technology solutions. The administrative and clinical leadership of the organization were outspoken about the investment and commitment being made to change process and make room for the new technology.
At the same time the implementation team was focused on developing super users and project champions, key ancillary staff with tenure in a few departments began grouching about potential vulnerabilities of the initiative. They successfully convinced mid level managers to delay implementation until concerns were fully addressed, which stalled the initiative and resulted in significant poor morale. It became critical that mid level managers were provided with conflict resolution skills and process that allowed them to openly address the concerns that had mounted, and include the ancillary staff in crafting appropriate protections that allowed them a comfort level to move forward.
Many projects experience this (or similar) risk, which can be effectively anticipated by inviting and addressing stakeholder concerns early so that resources can be allocated to resolve concerns at the same time that champions are being won.
Lesson #4: take time to identify skill sets early
People tend to be reluctant in most all social situations to admit personal weaknesses, and in healthcare (especially) highly intelligent, educated individuals can feel extremely exposed and uncomfortable when having to learn new skills on the job.
Example: Many months of advance planning leading up to deployment of healthcare practice technology in a primary care group practice failed to effectively motivate physicians and licensed staff to undertake training and practice workflows ahead of system go-live. Physicians counted on others in the group to answer questions and believed they would be able to learn interfaces on the fly. The result was a highly stressed out team with lots of grumbling that decreased morale.
Preliminary introduction and observation of staff performing fundamental technology navigation could have surfaced much of the skills gap that wound up being issues during go-live. Super users with advanced existing skills could have been identified and leveraged to a larger degree if the project advance planning had built in resource skills assessment. By taking the time to prepare those with weaker skills and allocating super user access in advance, the implementation could have been a much more positive experience for everyone!
Lesson #5: stakeholders take risks based on their most recent memory of failure
Many healthcare organizations evolve over time to develop powerful risk aversion. For any number of profoundly valid reasons, groups adjust to a culture that tightly controls risk at any cost. In some cases, the cost of risk aversion results in stagnating, unproductive, declining performance along with equally dismal morale. On the bright side, there are strategies that can influence stakeholders to “stick their necks out” and embark on a degree of phased risks when set up appropriately.
Example: Mechnology implementation had resulted in a very public failure for a medium size medical group. Most of the clinical and administrative staff who invested energy and lived through the failure were still employed and faced with (yet another) proposed deployment of a similar system. Pre-implementation planning included a long-overdue “post mortem” process that exposed the critical points of failure in the initial implementation attempt. Appropriate risk management strategies were discussed in advance and timely check points were built into the project plan to specifically measure the degree to which failure point contributors were being managed and/or addressed.
By providing a comfort level among the stakeholders and ensuring that known risks would be properly attended before they became repeated points of failure, the group was able to move deliberately through pre-implementation and enjoyed a great degree of personal satisfaction at having learned and applied lessons that resulted in a successful practice technology transformation.
Lesson #6: power of “business fit”
Technology strategies in healthcare are frequently introduced to stakeholders as a means of solving problems and improving things, yet many times they lead to “ solutions looking for a problem“.
Successful projects require that time be taken to well-understand the business cases to which solutions have been matched and have applicability – before pushing forward with implementation. Unfortunately, clarity as to specific business fit for project goals can leave a team cycling through frustrating challenges without the necessary clout to obviate obstacles as they crop up.
Example: a large regional hospital executive team had established strategic value for achieving a level of technology capabilities that would qualify for program recognition by a national accrediting body. Having this distinction was important to their competitive positioning. There was a timeline involved, and specific departments were targeted as key spokes in the technology strategy.
By the time pre-implementation and deployment project activity reached managers and front line staff, there was a gap. Communication was lacking about how new technology work flow changes related to the major goal set by the organization. As a result, people perceived changes as being “optional”. The business fit behind the chosen technology and it’s capabilities needed to be communicated and marketed to directors and managers. These people needed to appreciate the potential for solving problems and support organization’s commitment to achieve national program recognition to be effective in driving successful implementation.
Lesson #7: understand the healthcare “animal” early
Healthcare business transformation is a hot topic. Economic and government influences have brought the subject to a boiling point, driven by heavy pressure to reform the fundamental constructs of enterprise as well as the delivery of care. A project manager responsible for implementing transformation initiatives must well-understand the unique and complex healthcare environment.
Excluding non-profit business organizations (the structure of many healthcare systems actually being not-for-profit), healthcare is unlike any other enterprise model in that the essential deliverable cannot be quantified. The health of a human being is not measurable in terms of any value metric. Yet the profitability, and bottom line of the business organizations that operate for the purpose of treating people’s health is absolutely the financial concern of enterprise leaders.
Stakeholders within healthcare environments frequently identify with one of two “camps”. They tend to fly a primarily clinical/philanthropic flag, or the flag of enterprise marketplace viability and sustainability. Inserted within the same environments are all kinds of external stakeholders with an eye to gain for their own organizations. Many times convoluted relationships between these internal and external stakeholders become limiting factors to a transformation initiative.
Example: a community based health system had maintained significant market share over a long period of time and was successfully building its financial resources through the work of a non-profit foundation. The leaders of the foundation were well-regarded by many internal stakeholders, but now-and-again they were at odds with the hospital leadership on key initiatives. Any healthcare business transformation project that had potential to succeed required the broad support from leadership and staff within both organizations. Understanding this “animal” well was a major key to the trusted adviser relationship built with a handful of external stakeholders and partners whose organizations benefited by being frequent recipients of project implementation opportunities. By knowing the relationships and priorities well, partner executives approached transformation initiatives by approaching them so they worked for everyone at a strategic level.
Lesson #8: the cost of waiting
While we may think of the cost of a project delay as one that eats into the bottom line, or increases resource expenditures, there is a looming hidden cost that needs to be recognized and tightly managed throughout. The cost of losing momentum.
Momentum is a premium when it comes to project success. Declining enthusiasm for (what once was) a priority initiative costs dearly. People lose interest and move on to the next exciting thing. Left in the wake are all-to-often over tasked project resources with competing demand for their time and energies.
Example: a physician seeking growth of his suburban medical practice was referred by a colleague to attend a cutting-edge practice marketing workshop. The strategies he learned really fired him up and he decided to make a financial commitment right then and there to a good sized multi media campaign. Initial phone meetings with the agency were upbeat. Drafts of a new graphic identity, brand images and collateral copy started flowing. The practice experienced a couple of unexpected emergencies and, in a matter of weeks, the project had been delegated by the physician to a staff person who had no time or frame of reference to give approvals or discuss campaign next steps. The project stalled. Six months passed, and the physician lost enthusiasm, questioning why marketing media wasn’t being circulated at his busy time of year. The cost of the delays to the project ultimately became a refund and cancellation of the contract. A year later, the practice was producing slightly decreased revenue and little growth had taken place.
Lesson #9: beware adversarial stake-holder relationships
Project management is as much a relationship management proposition as it is any other discipline. The very best technical execution of a project is bound to fall flat without expert orchestration of the delicate balance of satisfying multiple stake-holder expectations.
The reality is, that within any group of people, there will be spoken (as well as unspoken) agendas. A good project manager is one who can leverage existing understanding of this landscape by tapping a relationship manager resource. This is particularly needed when managing a project as a third party to the core organization. Previous experiences and personality issues contribute to a landscape of either cooperation of divisiveness. Building project teams absent critical understanding of how to navigate these conditions can become points of failure within the project.
A regional health system had gone through major reorganization of ambulatory leadership structure that resulted in addition of leadership personnel who had been recruited from a competitor organization. Within the ambulatory group were individuals who had parted ways with the competitor and now found themselves working side by side with leadership they resented. The project teams required to support a restructuring of administrative systems necessitated interaction between these people. It became apparent that the hidden agenda of the ambulatory mid level managers was to allow the newly-acquired leadership to fail. These interpersonal resentments surfaced in the form of missed milestone deadlines and key omissions in project scope work.
It became necessary to re-establish new project teams and remove two of the mid level managers from the project. Efforts to confront the resentment agendas that were impeding the project were unsuccessful. Once the project teams had remediated the project gaps related to corrected scope details and began operating effectively with new leadership, milestones began being achieved and the systems conversion goals were accomplished.
Karen Lawson is a business and communications specialist with over fifteen years expertise as a leader and program manager in healthcare technology, practice management and marketing. She has held strategic account management responsibilities with a focus on branded business development strategy. Her professional objectives include positively impacting successful business metrics in client practices as a trusted adviser. Karen’s personal goals are to establish and maintain strong relationships based on integral understanding of client vision and priorities.