Implementation management: Focusing on the end-user

At a recent symposium, a panelist from a large multihospital system estimated that not more than 30 percent of their large projects ever get implemented completely. During a planning meeting between senior CNOs and IT executives at another very large health system, the System CNO expressed her frustration that she sent out an important new policy and procedure to be deployed across all hospitals, but fewer than half the hospitals had done even a reasonable job of implementation. It seems many healthcare companies share a common challenge – the need for better implementation management.

Every healthcare organization launches new hardware, software, clinical equipment, or technologies on an increasingly regular basis. And nearly every organization finds itself trying to resolve a myriad of post-launch problems for the ensuing months or years – problems that largely could have been avoided if the more robust approach of an Implementation Management Office (IMO) was overlaid on the traditional Project Management Office (PMO) approach. Whether implementing a major technology solution using experienced project managers, or relying on senior managers to institute new policies and procedures, satisfaction with the outcomes is too often poor. The primary reason for most of these failures is the focus on the process rather than on the end-user. Instead of a PMO, perhaps we need a more end-user focused IMO.

Project managers may be found in many different departments of an organization, but most associate a project management office with an IT department. The PMO approach to managing IT projects is very well-structured. It can be applied to software upgrades, hardware installations, converting to a new collaboration platform, or bringing in a more sophisticated technology – like an electronic medical record.

The typical project management plan includes:

• Project description
• Major tasks
• Overall project schedule
• Quality assurance and testing requirements
• Budget
• Project management team, including end-user participation
• Project progress monitoring, with milestones and dependencies
• End-user training
• Assumptions, risks, and contingency plans
• Acceptance criteria

A PMO’s main goal is to make sure its IT department gets projects done on time and on budget. Success in one project enables the PMO to move to the next project. That approach is effective and efficient for the IT department.

But just because the IT department’s goals are being met doesn’t mean the end user’s needs are. Enter the Implementation Management Office.

Introducing the implementation management office

The new Implementation Management Office concept goes beyond process-oriented project management with its timetables, checklists, and resource requirements. The IMO requires a focus on the end-user’s ability to not only employ what has been installed (basic training and education), but it takes into account their ability to accept and adopt to the alterations in workflow (change management), their ability to be a participant in the planning process (employee engagement), and a champion of the final configuration of their workplace environment (culture change).

Implementation management requires a new way of thinking and a different set of skill than traditional project management. Project management can still provide significant value when it comes to ensuring the successful completion of projects, but implementation management takes it a step further, maximizing the outcomes and ensuring long-term sustainability.

The paradigm shift from project management to implementation management can be compared to the movement from volume-based, fee-for-service medicine to value-based population health management. Both outcomes require a major modification of the traditional business model. In medical care, the model is moving from being provider-focused to being patient-focused. Here, success is improved health quality measures versus a completed encounter. In IT, the model should similarly move from being process-focused to being focused on the entire population of end-users. Here, success is a more effective workforce versus a completed checklist when it is time to go-live.

Table 1: Paradigm shift from PMO to IMO

The IMO is typically a function housed outside of IT. Depending on the needs and size of your organization, it may be an independent department, or it could be a department housed within a high-utilization area, such as Nursing.

The IMO approach is applicable to large-scale implementation of policies and procedures across a large health system, pharmaceutical or life science organization, or a commercial insurance company. The IMO role goes well beyond bringing improvements, upgrades, and installations of new tools and technology that are traditionally shepherded by the PMO. For large-impact projects – like implementing a new electronic health records (EHR) or patient care technology across all inpatient and outpatient settings, for example – the IMO and the PMO should partner, with the IMO representing the needs of the end users/organization and the PMO representing the needs of the IT department.

The benefits of the IMO

What does an IMO offer that the common PMO approach doesn’t? The average PMO plan includes a description of the project’s impact on the end user. The IMO plan prepares end users and manages the tools and processes to ensure a positive impact on people, workflows, adoption, and acceptance.

First, the IMO makes the end user, and sometimes the entire organization, the focus of the total effort. This means that IT and many other departments, services and vendors are in supporting roles rather than dominant roles. This is an important distinction.

Next, its project leadership is fully conversant in policies, procedures, workflows, interdepartmental dependencies, and capabilities of the end users – often because they were part of the end user’s organization at one time. This is essential in giving the IMO credibility and ensuring its ability to communicate, assess, plan, and implement more comprehensively.

The IMO begins the process earlier than the traditional PMO because they include end user readiness for the forthcoming changes, involve influential end users in the planning and communication process, and use them as champions to gain broad-scale adoption and acceptance.

 The key ingredients of a strong IMO plan

As a result, the IMO plan (in addition to the contents of the traditional PMO plan) includes:

• Project leadership: The project leadership team comprises trained managers who have in-depth experience in the departments they serve. Working in partnership with IT project managers, they add valuable perspective and guidance to planning, resource allocation, and resolving any risks and issues that may arise.
• Change management: This is an uncommon skill set, in spite of what most executives, managers, and supervisors imagine. Effective change management is not dictatorial or directive. It requires engagement, involvement, readiness, and consensus building. It also requires an awareness of cultural dynamics and how to account for them during planning and execution.
• Employee engagement: The traditional PMO approach tends to assume that all employees will adapt to the new situation. It also assumes that the management overseeing the end user departments will prepare their employees and ensure their readiness to use the new technology, policies, and workflows. A good IMO will understand the complexity of this, and take the steps necessary to maintain employee productivity and satisfaction.
• Customer engagement: Rarely does a traditional project checklist take into account the end-user’s acceptance and adoption of the required workflow changes. However, if the new technology, tools, policies, or procedures will require a change in how end-users interact with other departments or outside customers, the IMO plan provides solutions that may involve additional policy and procedure documentation, end user training, and customer communications.
• Communication plans: IMO communication planning and tools go beyond announcements and progress reports. Communication is an integral part of creating awareness, readiness, involvement, ownership, motivation, and adoption and acceptance – for end users, the organization, the organization’s customers, and sometimes the community.

Evolving from a traditional IT PMO to an end-user focused IMO

At first, employing the IMO model seems like a lot of additional work for activities that should be part of the existing skill set of all executives and managers. And that’s true, to some extent. Senior leaders and managers are capable of doing any of these IMO roles for a short time or against a limited project scale. The key difference is scale and sustainability.

Many small and mid-size enterprises may elect to outsource one or more elements of the IMO planning and execution. Larger enterprises will have the resources to establish their own internal IMO somewhere in the organization, and augment with outsourced resources for larger initiatives. Bottom line – however you approach your IMO model – making end-users the focal point of implementations will significantly increase your chances for success and sustainability.