Focused, detailed planning of large healthcare information technology (HCIT) projects can avoid the pitfalls encountered when the steps are not well thought- out.
The cost of time, attention, and resources can be diminished if the planning for these projects is given stewardship that goes with ethical, responsible planning and management.
Following the steps provided here will help you to overcome what may start out as seemingly simple challenges but can easily develop into major roadblocks.
Step 1: Use the ‘early time’ prudently
Approval for a new IT project, especially large ones, can be a prolonged and uncertain task. However, the early phase of creating a case, establishing budget and timeline, and securing approval at various levels can be an opportunity to ensure the project will be set up for success. The “early time” actions help to fuse the project sponsorship and champions together, defining goals and roles in a shared sense of purpose.
Step 2: Clearly assess the current state
In most cases, when an implementation takes place, one technology suite is simply replacing another, or replacing finely tuned paper processes that have existed for years. This situation requires that change management is a primary task of the project; and change management requires a baseline.
Understanding the baseline state of the organization is a very detailed process.. The larger the organization, the more likely there are a variety of practices. While there is no one functional style that is best, the differences add to the scope of the project. A thorough current-state analysis is the best insurance possible against last-minute surprises.
Step 3: Clear, complete project planning is imperative
The project plan must be complete, first and foremost. Key documents include project charters, timelines, governance structures, budgets, staffing matrixes, and communications structures. All of these must be completed and approved broadly.
Decision-making templates need to be tested and evaluated and processes for input must be practiced. The pre-kickoff time is an excellent opportunity to set and practice meeting structures, risk management activities, and status reporting. While none of these replace doing the project work, practice and refinement in these areas will pay off many times over when the work is at hand.
Additionally, these early activities help to educate and prepare the project team. When the building, testing, and training kick into high gear, teams need to work in parallel silos, relying on other teams to stay in sync. Management oversight and planning help, but the more that teams review the work to be done and feel confident with the plan before the heavy lifting starts, the more likely the project will succeed.
Step 4: Establish effective governance
No large IT project proceeds without change. New scope, unexpected organizational change, new regulatory or financial requirements, staff turnover – all of these and more will happen in the months following kick-off. Consequential decisions must be made, and organizational buy-in to those decisions is critical.
The early planning for a project must include the establishment of effective governance. Governance for a project must not only arrive at good decisions, but it must include methods which ensure those decisions are effective, well-documented, and trusted.
Effective IT decision-making means that not only are the IT questions answered, but the decision is endorsed by the operational and clinical leaders who have the authority to enact the needed organizational change.
These are the people sitting at the table making the IT decisions who will then direct their doctors, nurses, and staff to carry out the new plan. Critical failures of effective governance occur when technologists make decisions that are not supported operationally.
Closely coupled to this is the documentation of decisions. When a choice is made, particularly if it changes a previous stance, the documentation must clearly explain the decision. When the rationale for the decision is part of the overall documentation, it is more likely it will be understood and carried out in the years that follow implementation.
Every organization is different in its people and its politics. This inevitable fact of life means that every organization arrives at confidence in the decisions of its leaders differently. A governance plan for a major IT initiative must consider these issues and match the decision-making style of the organization to the decision-making style of the project. Thoughtful planning of the committees, authorities, and executive scope will produce great dividends.
Step 5: Be able to manage failure
In large healthcare IT projects, there is no perfect implementation. The complexity, cost, and tight timeframes will present challenges that threaten the project. Project plans that ignore this reality turn small issues into large ones, and large ones into organizational legends.
Anticipating and managing failure in the project plan means considering every step, understanding the risks involved, and building mitigations into the project structure. These can be as simple as ensuring adequate contingency dollars or as complex as requiring every key leader to have an “understudy” who can take over in the case of incapacity. Allowing for date flexibility, ensuring time after testing for fixes and updates, and ensuring that additional staff are available at key times are all measures to be considered.
It is important to document any failures as “lessons learned”. Mistakes made and the information gleaned are crucial assets produced by well-run projects and can add value in the long-term.
Conclusion:
Large HCIT implementations will have challenges. Recognizing this fact at the outset, and planning for the challenges as well as the successes, will reduce risks and delays. Proper planning sets the stage for success.
