Electronic Health Reporter

By Bill Slama, business consulting senior manager; Philip Handal, business consulting senior manager; and Jamie Morisco, business consulting experienced manager, Grant Thornton LLP.

Healthcare organizations are scrambling to harness the potential of digital technology to transform their business and gain a competitive edge in the marketplace. Whether they are looking to modernize their back-office systems, optimize their electronic health record, or leverage smart medical equipment and IoT for advanced data analytics, health systems are constantly engaged in transformational projects and programs. According to reports, 25 percent of these technology projects fail outright; 20 percent to 25 percent don’t show any return on investment; and as many as 50 percent need massive reworking by the time they are finished.

But the question is why: Why is it that such a high percentage of these technology enabled transformation projects fail? Studies show that poor project and change management is to blame for 54 percent of failed projects – while only 3 percent can be attributed to technological problems. Having an effective program and change management strategy – and the resources to implement and sustain that strategy – is critical to ensuring the project is on time, on-budget, and aligned with organizational goals and culture.

Change management means understanding the holistic impact of a change and encouraging and empowering employees to adopt and own that change. Without proper change management in place, projects can become burdened by: increased end-user stress and frustration, resistance to new technologies or processes, decreased adoption, and lower financial and operational returns on project investments.

One of the most common change-related reasons projects fail is due to lack of active and visible sponsorship (i.e., sponsors who are engaged, participatory, and of relevant standing/influence). Setting the tone at the top while maintaining consistently visible and active commitment from sponsors and relevant leaders is the foundation of a successful change and ultimately transformation project.

A common mistake is making the assumption that having a kick-off meeting means you’ve effectively communicated the scope, approach, purpose and goals of the project to all the primary stakeholders. Projects are dynamic – change happens on weekly, if not daily, basis – it is critical to engage and stay engaged to truly manage, communicate and effectively enable change through transformation. Stakeholder communication should always outline the benefits, risks and opportunities the change presents to their groups. Doing this with regular cadence across various channels of communication helps establish a network of change agents throughout the organization that can be relied upon to champion change and fully integrate change into the strategy and culture of the organization.

Enabler #1: Change Management

Change management activities should be integrated into the overall project plan through four critical phases:

1. Awareness – Creating awareness that change and/or transformation is coming and informing those impacted of the timelines and tasks associated
   • Organizations should provide advance notice that significant change is on the horizon – whether it be a new business application, emerging technology, or automation of manual processes. This step is critical to successful change adoption. Advertising the macro-level timelines and micro-level tasks required to implement and sustain related to the impending change allows those impacted to be better equipped to navigate the change and minimize the impact on their day-to-day operations.
2. Understanding – Communicating the genesis of the change, why it’s happening, and its impacts/benefits
   • Those impacted by the change (e.g. user community, stakeholders, sponsors, etc.) want to know why the new change is occurring – especially if the old way of doing things seemed to be working just fine. Fostering a culture of transparency, sharing the impetus for change and its expected impacts, and affording those affected by change the opportunity to ask questions or voice concerns allows everyone impacted to feel more involved in the process. It helps to establish a culture of togetherness and collaboration, and conveys the message that those impacted are part of the solution rather than an impediment to progress.
3. Adoption – Acceptance and willingness to support and participate in change
   • Creating ownership of the change allows those impacted to see change is not “being done to me”, but rather “with me”. This can create enthusiasm among those impacted to adopt because they have an ownership stake in the success of the change.
4. Commitment – Dedication to sustainment and enablement of change over time
   • The more people feel as if their contributions, ideas, thoughts, work products, and more positively contributed to the success of the change and/or overall program, the more eager they will be to adopt and sustain that change over time.

Always remember change – and ultimately, transformation – does not happen because of the implementation of new and emerging technologies. People drive change and transformation. Without their support, endorsement, and acceptance, change and transformation are not possible.

Enabler #2: Project Management

Project management is the process of overseeing a temporary activity with specific objectives measured in terms of time, cost, quality, compliance, and customer satisfaction. Projects are often multi-faceted, complex, and require a high volume of planning and monitoring. Effective project management ensures there is a proper plan in place to execute on the strategic goals of an organization. Additionally, project management serves to forecast and mitigate risk through effective planning, organizing, and controlling of activities in accordance with the agreed upon timeline and project lifecycle.

Over the course of a typical day, a project manager may be asked to facilitate meetings, schedule stakeholder communications, develop and/or review deliverable documents, assess risks, and on-board additional staff, in addition to a multitude of other dynamic tasks or action items. Keeping these tasks organized and prioritizing them in a manner that returns the most value for a project can be overwhelming. Having a clear understanding of the five phases of a project and how to organize competing project activities accordingly can make all the difference between a successful or failed project.

Five phases of a project

1. Initiating – Defining scope, purpose, goals, risks, timeline, and deliverables
2. Planning – Creating a set of governance documents to guide the project team through the execution and closure of various project tasks and phases
3. Executing – Intended product or service is delivered to the client for approval
4. Monitoring and Controlling – Processes required to track, review, and reconcile project performance and progress
5. Closing – Delivering formal documents (i.e., final deliverables) and transferring relevant knowledge to complete the project

When tasks are properly organized and performed per phase, the probability that a project will run smoothly and facilitate sustained transformation increases.

Enabling successful transformation

As discussed, the people aspect of projects is often viewed unilaterally and is the cause of many stressors throughout the project lifecycle. In addition to asking “do our people have the skills required to execute and sustain this change,” project managers need to ask “what impact will this change have on the culture of our organization?”

To understand the cultural impact, stakeholders and end users must be informed of what is happening, how it impacts their day-to-day, and what will be asked of them to help see the project across the finish line. The project is not happening to them, it is happening with them. Promoting this project team culture will engender higher stakeholder and end-user feedback and promote higher rates of adoption. Any process or technology can be implemented, but projects are only successful when the changes are adopted.

Once a change is implemented and adopted, project teams can then focus on monitoring and documenting project successes. Using tools like surveys, dashboards, and budget trackers, teams are able to monitor client satisfaction, improve collection rates, reduce cost, increase compliance with regulatory requirements, and more. As part of initially scoping out the project and change, there will be a clear understanding of the “from,” allowing project teams to pivot, and documenting the “to,” presenting the benefits in a “like for like” format.

Project and change management should be treated as their own work streams within every project. By making this a requirement that is tracked throughout the project lifecycle, project managers position themselves, their teams, and their organizations for higher rates of success while establishing a reputation for excellence and enabling sustained transformation.