Publications

Hefner, D., & Malcolm, C. (2002). 15 essential steps of IT project management. Healthcare financial management : journal of the Healthcare Financial Management Association, 56(2), 76–78.

Healthcare CFOs often experience trepidation when presenting major information technology (IT) initiatives to their organizations’ boards for approval. The CFOs typically are concerned about whether such a project can be completed on time and within budget.
There is good reason for concern. A survey examining the results of 175,000 major IT projects in diverse businesses worldwide found that only 16 percent were completed on time and within budget. (a) Moreover, fewer than half of all projects (42 percent) delivered the intended functionality and nearly one-third (32 percent) were cancelled before completion. The survey report identifies poor project management as the largest factor contributing to the high failure rate.

Confronted with such low odds of success, a healthcare CFO should be circumspect when
considering which major IT projects to present to the board. Before promoting an IT initiative, the CFO needs to understand what project-management steps will be needed to optimize the chances for success. Effective IT project management generally depends on implementation of 15 essential steps.

1.Thoroughly evaluate project feasibility. Too often, haste to gain approval and begin a project may cause management to give minimal attention to this step, leading to unexpected problems in implementation, substantial cost and time overruns, and the tarnishing of the implementing department’s reputation. Requiring that a thorough project-feasibility assessment and informed-consent process be performed for all IT projects may slow the approval process, but it will help avert project failure later.

The feasibility analysis should include a list of preliminary architecture and design
specifications and a project-management plan proposal enumerating assumptions, required resources, constraints, and timelines. The informed-consent process should be conducted to obtain commitments from affected individuals and departments regarding staff and space availability, training schedules, approval processes, and competing priorities. Such a process also allows project designers to consider potential political and user-acceptance issues that could impede progress.

2. Clarify the project objectives and scope. Before initiating an IT project, the proposed timeline, cost and quality objectives, scope, and deliverables should be clearly defined and accepted by all potential participants. Failure to verify that all stakeholders agree to these basic project parameters can lead to confusion, wasted effort, needless duplication, and ultimately, project failure.

3. Make a single sponsor accountable for project success. Reporting to large steering
committees does not foster personal accountability among project participants. A clearly
identified executive sponsor should be responsible for the success of the overall project
implementation. The sponsor should be charged with monitoring progress constantly and
resolving issues that impede progress. This person should be supported by a steering
committee that provides oversight and serves as a forum for communications and problem
solving.

4. Appoint a full-time project manager. One individual should oversee the day-to-day
management, execution, and delivery of the project. The project manager should track progress and report results to the project sponsor. The appropriate candidate for this position should have broad experience with similar projects and should utilize well-tested processes and tools. A common mistake is to make a top performer in another area the project manager as a reward for good service. Without a manager experienced in IT implementation, a major IT initiative is almost certain to fail,

5. Establish a project-management team that can exercise real authority. A project management team should be formed as soon as the project sponsor is authorized to proceed. Although team membership will vary according to the specific project, the team should include interdisciplinary senior staff with sufficient analytical, technical, and project-related expertise to guide the project to completion.

Team members also should be capable of accessing the enterprise resources needed to ensure the project conforms to enterprise architecture from the applications, infrastructure, and technology perspectives. This team should have sufficient authority to control the activities and resources necessary to complete the agreed-upon deliverables within the set time frame.

Initially, such authority should be granted by the CEO and the board upon plan approval.
Obtaining the additional authority required to successfully complete a major IT initiative,
however, will depend upon the team’s ability to negotiate effective agreements with vendors and suppliers and build organization-wide acceptance over time by meeting commitments, recognizing and rewarding people for exemplary work, and developing trust with individual and department stakeholders.

6. Create a detailed project plan. A comprehensive project plan should be developed as a guide to all major activities (ie, those requiring 80 hours or more to complete), project deliverables, rollout timing, roles of team members, key risks, interdependencies, and approval processes.

The plan document should incorporate all formal, written agreements with external suppliers, internal suppliers, resource owners (eg, department managers), and end-users regarding their roles in the project.

7. Secure committed staff resources. The project manager should obtain formal, written commitments from department managers to allocate time for their staff to work on the project. Similar commitments regarding time and specific deliverables should be obtained from all assigned staff The need for such commitments should be sanctioned by executive leadership, thereby giving the project manager authority to demand that commitments be met. Managers will need to plan ahead to free up designated staff and secure additional staff resources as necessary to meet daily operational requirements.

8. Obtain commitments from vendors and suppliers. The project manager should be responsible for obtaining contractual commitments from all vendors and suppliers whose performance is required to complete the project and for monitoring vendor compliance with such commitments.

9. Divide project into manageable segments to reduce complexity. Complex projects can be simplified by separating them into clearly defined segments and assigning each to an individual or small group of team members for completion within a designated time frame. The segments should be easily combinable when finished.

10. Establish clear performance measures and report progress regularly. To assess project performance, a specific set of performance indicators should be identified. Useful measures that should be continuously monitored are achievement of milestones by target dates and accomplishment of tasks in accordance with defined expectations. Other performance measures should focus particularly on high-risk areas, such as end-user acceptance, satisfaction of the project sponsor, and whether changes and issues are being resolved expeditiously

Performance generally should be tracked at the task level by team members involved in performing the tasks. Reports then should be combined and summarized for presentation to the immediate supervisor. Supervisors then should present summaries to the project manager, who, in turn, periodically should prepare an overview of performance to the project sponsor and steering committee (with links to details that allow for drilling down again to the task level).

The project manager should be fearlessly honest in assessing and reporting performance and overall progress to the project sponsor. Discrepancies between expectations and actual performance should be discussed with the project sponsor and the team to reinforce personal and team accountability and develop contingency plans to correct problems, as necessary.

11. Take decisive, corrective action sooner rather than later. Resolve any performance variances quickly and decisively When project performance deviates substantially from the plan, the factor causing the problem should be quickly identified and eliminated (eg, an underperforming team member), or if it cannot be eliminated, steps should be taken to mitigate the factor’s negative effects (eg, reassignment of team members to provide additional support in areas where needed). If the problem is insurmountable, changes to the project budget, schedule, and/or deliverables should be negotiated without delay.

12. Establish and manage a formal change-control mechanism. Effective project management depends on diligent management of inevitable changes. All changes should be documented and incorporated into the project plan so everyone knows when and why the change was made. Such documentation should include the date the change was made and its effect on the approved plan. Failure to document changes can lead to confusion and team members working at cross purposes.

Changes beyond certain predetermined thresholds (eg, raising the cost above a designated amount, substantially delaying completion, or redefining deliverables) should require approval by the steering committee and be formalized in writing.

13. Proactively manage risk. IT projects typically involve a number of significant risks and controversial issues that can prevent the team from moving ahead. These issues often tend to be political in nature, reflecting some organizational constituents’ resistance to change or unwillingness to accept some of the facts of the project. For example, physicians may resist accepting an automatic order-entry system simply because they are accustomed to using manual processes.

The project manager should deal with such issues using formal, trackable processes, including escalation processes (ie, from within the project office, to the project sponsor, to the steering committee, to executive leadership, and finally, if necessary; to the CEO). In addition, all team members should be trained to recognize and monitor risks.

14. Develop a communication program to promote organization wide acceptance of the program. Managing organization change is a critical element of any program. Ongoing communication among project participants, stakeholders, and end-users should be promoted throughout the institution using multiple channels, including newsletters, e-mails, department meetings, and user focus groups. Early, clear, and consistent communication with stakeholders is critical to managing end-user expectations. Care should be taken to ensure all communications are audience-appropriate.

15. Celebrate successes. The project should have high visibility throughout its duration, and each milestone should be celebrated organization wide. Publicly acknowledging successes and demonstrating project momentum are effective ways to foster team coherence and the values that are intrinsic to high performance.

Conclusion

Major IT projects are risky for any healthcare organization. It is the healthcare CFO’s responsibility to minimize that risk by ensuring that such projects are managed effectively That begins with implementation of all 15 essential steps to IT program success.

David Hefner, MPA, is vice president, CSC’s Global Health Solutions Group, Chicago, Illinois.

Christine Malcolm, MBA, is vice president, CSC’s Global Health Solutions Group, Chicago, Illinois.

(a.) The chaos Report, west Yarmouth, Massachusetts: The Standish Group, 1994.

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