MD Leader 1/15/09

Successful Projects

With the use of project management methodology, Ministry Health Care has consistently improved the success rates of IT projects. Any effort installing new software or requiring more than 100 hours of IT time is considered a project. Even using project management, 25% of our closing reports reflect a failed project; one that was not managed to the agreed upon timeline, scope or budget.

Before you start thinking your projects have a better success rate than ours, here is what we define as failures:

• Actual expenses varied by more or less than 10% of budget
• Total project hours varied by more than 10% of planned hours
• Completion date varied by more than 15% of the original completion date
• Two or more material scope changes
• Less than 80% of project objectives attained
• The project’s impact on the organization was not anticipated or was not effectively communicated

Business leaders often bristle at being told their project was a failure because they brought a project in under budget or with fewer project hours than budgeted (the cause of the majority of failed projects). However, we are managing a portfolio of projects limited by resource constraints. If all our projects come in 20% under budget, that means the organization accomplished 20% less than it could have with the same resources.

We also do an additional evaluation at least six months after the closing report evaluating if the project achieved its long-term objectives. Many failed projects are subsequently vindicated. 

I recently completed a Physician Executive MBA ( PEMBA) at the University of Tennessee. My classmates were physician leaders from across the county and numerous foreign countries. Their experience with IT projects was uniformly negative. In general, they thought IT was done to them rather than with them. These leaders reaction to IT should give us all a pause to evaluate our implementation strategy.

Will Weider, our CIO, recently listed Ministry’s "lessons learned" based on 2008 projects:

• Test thoroughly
• Good process and leadership trumps bad software
• Roles should be clearly defined and consistent with our Lean and Six Sigma engagement and acceptance strategy
• Business leaders should fully understand current practice and issues before new software or process change is considered
• Hours are consistently under budget due mostly to the assignment of unnecessary contingency in the project plans.
• Formalize Lean and Six Sigma activities in EHR project plans

We did have one perfect project last year (on time, one budget, satisfying all objectives): a medication reconciliation project at one of our internal medicine offices. This project was not initially supported by our CIO because it was a duplication of effort. We are in the process of implementing CattailsMD electronic health record, but this site will not go live for some time. The CIO correctly pointed out the existing software that was utilized will be replaced by CattailsMD.

The Project Team, comprised of nursing and clinician staff, rightly argued the software was the easy part; the tough part was establishing a standardized process for medication reconciliation. A standard process can be adapted to the future software solution. The team was lead by a Black Belt utilizing lean methodology to map out a future process flow and then used standard change management tools to achieve stakeholder engagement and acceptance. IT and project management played a supportive role. The project was done with the clinicians rather than directed at them.

Our deployment of the EHR will be accomplished with the same techniques used in our medication reconciliation project. Ministry Medical Group will own the implementation assisted by IT and Project Management. While the organization will establish certain high level standards, each practice site will use lean methodology to define its own standardized work flow. A system-wide rollout the EHR software will be accomplished through multiple small work site-centered projects allowing clinicians and staff to improve and own their work flow.

With the new year starting, sit back and evaluate the success of your projects. Share with us your lessons learned, the common characteristics of your successes and how you were able to achieve the acceptance and engagement of your stakeholders. I look forward to hearing from you.

Peter Sanderson, MD, MBA is a family physician and Director of Medical Informatics and Operations and Executive Sponsor, EHR Program, at Ministry Health Care. He can be reached at pete.sanderson@ministryhealth.org. He also blogs at MD Leader.