Back to basics— practical magic for project management success

The Interior Health Authority in British Columbia recently completed two major IT implementations. The key to their success was simplicity — understand what you need, and keep everyone in the loop.

By Tara Wyllie

The number of articles, books, and conferences that tout a quick fix to project management challenges is staggering. There’s a reason for it, though. Many managers are looking for new and improved ways to navigate through their projects and end up with the successful end results their proposals promise.

There has also been increased pressure recently on managers to juggle their resources more effectively — to do more with less — which creates high stakes for all managers involved with a project. Put yourself in the position of an IT manager and the stakes go up even higher. Senior executives want IT solutions that are cost effective and offer a quickly identifiable return on investment (ROI).

Pat Ryan, CMA and chief information officer with the Interior Health Authority (IHA) of British Columbia is familiar with the compounding pressures. And yet, in a time when many organizations are reining in their IT investments, he has found his own way to get the commitment he needs and push through significant change. To do this, he took the project management model back to the basics. He established common sense principles and followed those principles throughout the implementation.

Over the past two years, Ryan and his team managed two large-scale IT implementations, which were conducted simultaneously. Both reaped significant financial and clinical benefits across the enterprise. Solid business sense and a tailored applied project management methodology for both implementations have proven solid techniques for Interior Health.

The BC healthcare environment has recently witnessed major upheavals. The IHA was created just over two years ago through the amalgamation of five health regions and 14 health councils. This new authority found itself saddled with a number of challenges, not least of which was the need to fuse 19 disconnected business systems and clinical systems, which were functioning on a number of different technological platforms. A new, integrated system would have to operate efficiently, while bridging the vast geographical distances of the operations. The IT department would need an innovative e-health strategy. But more than that, it needed the right approach to see the changes through.

Proper alignment

Every project starts with a need. In IT departments, the need for a particular innovation is often warranted and the project justified, but many innovations fail to materialize because the managers driving the initiative are unable to link it to the rest of the organization. Aligning any project with the overall vision and goals of your organization should be considered critical. Without this, the true benefits of the project are unlikely to materialize.

For Ryan, the planning process started with consultations with the executive on both projects to ensure that the initiatives didn’t contradict the overall business plan and strategic vision of Interior Health. Executive sponsorship was critical to these projects — the executive maintained its accountability, helped resolve issues, eliminated barriers and supported the project teams.

Once the projects lined up with Interior Health’s directives, the IT department had to ensure both projects had solid planning and business-case principles backing them up as they moved from preparation and planning into deployment.

Business case justification

Mal Griffin, director of applications and information development for Interior Health, championed IHA’s business systems implementation project (BSI).  The BSI involved merging 19 disparate business systems with more than 100 non-integrated financial applications to create a single enterprise-wide system that gives the health authority the necessary internal financial controls and one consolidated financial statement.

Ryan kept the project objectives simple, SMART (specific, measurable, attainable, realistic and timely) and well documented throughout the planning phases. Software vendor partnerships with Meditech, Microsoft and Total Care Technologies were established, and through consultations with these companies, it was determined that Interior Health could, with an initial investment of $3.2 million, deliver .3 million in annual savings to the organization.

Interior Health’s clinical systems implementation (CSI) followed suit. Norma Malanowich, director of electronic health records development, championed this project. The need for a single, efficient solution was extended beyond business systems through to end users and patients. In this case, the charge was to create a system that would consolidate and standardize the electronic health record (EHR) of individuals within the health authority and make it accessible from both on-site and off-site locations. This evolving record of an individual’s health care history information, when standardized and available to authorized clinicians and physicians within Interior Health, provides vital and current patient information when and where it’s needed.

The business case here stressed that any proposed system would have to bridge the distance between multiple facilities and regions within the Interior Health’s vast geographical framework. The solution eventually chosen would include an investment of $20 million in IT and EHR initiatives.

With the plan in place and the technology partners on board (Meditech, IBM, EMC, Telus, VODA and Picis), the next step was to embark on the process of establishing standards and retraining an entire organization.

Effective teams, empowered teams

Getting managers to commit to a large scale IT initiative and sticking to the plan is half the battle. The other half is empowering those managers — challenging and stretching them to find ways for continuous learning through the process, and adapting to roadblocks along the way. To do this, ensure that there are open channels of communication, hold frequent project reviews, and select managers that have the foresight to circumvent risks before they happen. All of these are effective ways of empowering your managers to work with you toward an end goal. Ryan states that “one of the keys to success in both of the IHA deployments was the strong foundation of teamwork based on these concepts.”

Project teams were established from the top down, starting with the executive. The project steering committee for the BSI was made up of project managers from each specialized area required for the different modules of the business system. The committee met and submitted reports bi-weekly to the executive sponsor, and submitted quarterly reports to the board.

This type of organizational structure, while typically hierarchical, represents how the pieces of this project were broken down and responsibility assigned to ensure adequate levels of support and accountability. It maximized project flow efficiency by focusing on frequent and effective communication that flowed through all levels of the project teams up to and including executive sponsorship. This was deliberate and successfully avoided potential roadblocks by keeping all participants aligned with senior management. Initiative project manager Mal Griffin adds, “Never underestimate the importance of communication. Communicate often and use many forms.” 

The CSI project was more formal, though it still allowed some creativity through workshops for everyone from project managers through to end-users. The project managers developed project charters in a facilitated workshop setting, creating a strong commitment to the plan and a sense of ownership in the process. Formal communication and risk management plans were developed and tools such as decision and issue documentation were used extensively.

Norma Malanowich developed and executed a communication plan, which targeted key stakeholders via multiple communication channels throughout the project. Change management workshops were held for team members, and later, front line staff received the same training. Malanowich insists that this approach, which demanded of everyone to think differently about processes and delivery methods, was critical to its success.

“Creativity is crucial to define new ways to meet goals and objectives when the project isn’t proceeding as planned,” she says.

Cohesive teamwork drove the success of the first two phases of this project. It took 34 project teams led by 123 individuals planning and executing consecutively to implement the EHR. Despite the fact that all systems went live simultaneously, there were no major issues or downtime. All projects were completed and implemented on time and under budget. There were no occurrences where project scope was decreased. In some instances, however, additional scope was authorized. For example, a physician payments system was added and completed.

Measurable benefits, real results

IT initiatives are commonly beset by cost overruns and poor delivery — companies just don’t get what they’re told they should expect from a system. Demonstrating the ROI on IT projects has often been considered difficult, but successful project managers now accept that it’s crucial for getting projects off the ground and for proving the benefits of the system once implemented. The investment must be justified by demonstrating clear business results — cost savings, time and efficiency improvements etc.

The IHA integration took approximately 14 months to deliver, and the BSI project now generates $4.3 million in annual savings for the organization. Savings came from the elimination of approximately 100 redundant jobs and from contract consolidation savings. Communication was crucial to the success of the project, but Ryan also attributes the smooth transition to keen project managers who monitored all variables that had the potential to upset or delay the project. Areas Ryan found required close attention included the tight management of vendors and suppliers, and cultural issues within the organization. If not managed well, both can introduce change management implications large enough to derail an initiative of this magnitude.

The integration of disparate business systems for the IHA has shown the anticipated benefits in both time and cost savings, operational efficiency and consolidated and improved financial information. These efficiencies extend across the organization, providing improved organizational effectiveness and customer service to Interior Health’s employees as well.

Interior Health’s CSI project has progressed through a multi-phased, geographically based plan encompassing numerous facilities and health service areas in both urban and rural settings. With phases one and two of the plan complete, 70% of the organization’s physicians now use the EHR from both facilities within the authority and from off-site locations. Sixty-two per cent of all facilities have now been converted to the system at this point. Phase three went live in March, and the final and most complex phase due to number of facilities and largest geographical area, is scheduled for April 2005.

The statistics and progress for the CSI project are impressive, but it’s the high level of user adoption and acceptance that is the real success story. The health industry is typically considered slow to adopt new technologies. Staff and physicians accessed the EHR system almost 500,000 times in a three-month period, which shows how the technology has been embraced to enhance medical decision making.

Back to basics

For Pat Ryan and Interior Health, going back to basics by focusing on the principles of organizational alignment, business case approaches, teamwork, and proven benefits have been practical magic for their large-scale IT initiatives over the past two years. The projects have not only been approved in the midst of a cautious economic atmosphere, but ran smoothly to completion. Both implementations, when plugged into IHA’s project management method, were completed on schedule, under budget, with direct and measurable financial and clinical benefits.

Reflecting on both projects, Pat Ryan boils it down to this — “having great people, applying practical, common sense approaches and working hard to ensure IT alignment with all levels of the organization is what it’s all about. What we’re really doing is laying a foundation for business intelligence to support the organization as a whole.”

The best practices that IHA’s team has sifted out of the volumes of those out there seems to be working for Interior Health, establishing them as innovators in the Canadian healthcare market.

Tara Wyllie (twyllie@telus.net), BA (Communications), is a freelance writer and Web content consultant based in Westbank, BC.

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