The Project Management Office: Putting It All Together
Clinical transformation is a complex undertaking. With millions of dollars invested
in such projects, health organizations are eager to define the characteristics
that ensure success. According to the Gartner Group, one of the critical elements
is the presence of a centralized project management competency. Indeed, Gartner
has estimated that without such a discipline, over 70 percent of projects suffer
from time or cost overruns.
For an organization to maintain the performance advantages gained from clinical transformation, it must create a culture of accountability with a focus on sustainable improvement. This culture can be created by providing a structured way to track progress against goals, examine project status and interim results, and use this information to drive the overall organization to expected results. The set of tools used to drive focus and results within an organization is called the project management office (PMO).
The Project Management Office
An effective PMO operates as a centralized authority to oversee and coordinate single projects or multiple initiatives. It flags conflicts in timing, resources, staffing, or information that can jeopardize the ultimate completion and cost of complex projects. The PMO's authority goes beyond problem identification, however, to create problem-solving forums among the owners or, if needed, refer problems to those with the authority to act. Importantly, the PMO ensures that issues that can jeopardize the timing and success of the project are resolved so that the critical path for the project is protected (see Figure 1).
Figure 1: Scope of PMO Responsiblities and Activities
A fully functional PMO is the repository for all analyses and quantifications of expected benefits (performance, operational, technological, and financial) that led to the decision to undertake the clinical transformation project. This group of analyses collectively is called the business case and provides the rationale for the project.
Since clinical transformation is composed of numerous initiatives, the charters and work plans for each of the initiatives are monitored and controlled from the PMO as well. The PMO acts as the central hub in all communication around the project. Status reports and issue management are handled consistently, so that executives have confidence that they are judging the progress and issues of different projects by common standards.
One of the main benefits of clinical transformation is the shift in organizational culture that can accompany the project. Knowledge transfer is therefore a major component of activity. After the end of the clinical transformation, the reports, skills, and techniques used to keep the project on track can be transferred to operational managers to enable them to focus on key components that drive the overall success of the endeavor. Some of the specific responsibilities of the PMO include:
- Communicates the prioritization of initiatives and projects to all constituencies
- Monitors change requests with timing implications across initiatives
- Monitors work plan variances
- Tracks progress and outcomes across initiatives, actively working to ensure
realization of the expected benefits
- Creates and presents project-level status reports to executives based on
initiative-level reports
- Sets the standards for use of automated project management tools and coordinates
training on tools
- Approves change requests with time or budget implications (with leadership
committee involvement for significant changes)
- Facilitates communication flow between and among initiatives.
- Generates ad hoc financial analysis (determinations of productivity or non-labor
budget variances)
- Monitors initiative staffing commitments to ensure no project budget overruns
Infrastructure
While the specific structure of the PMO must reflect a health organization's individual requirements, there are roles and responsibilities that must be undertaken for all situations. The PMO operates as a central communication, monitoring, and control hub for the clinical transformation project. It has a reporting relationship to the leadership team, which in turn exercises overall direction for the project, and recommends actions to the board of directors. For the PMO to function effectively, certain roles and functions must be staffed. Depending on the size and complexity of the clinical transformation project, this typically requires three to six full-time employees for the duration of the effort. Figure 2 is an example of a typical organizational chart for a clinical transformation PMO.
Figure 2: Typical PMO Organizational Chart
- PMO manager: The PMO manager is typically a seasoned individual
with significant knowledge of the health system and its reporting structure
who is assigned full time to this central role for the duration of the clinical
transformation project. This position assumes direct responsibility for all
deliverables and for monthly monitoring or progress for all initiatives within
the overall project. It is the PMO manager's responsibility to maintain communication
and provide key updates and information to both the leaders of individual
initiatives and the health system leadership.
- Progress-tracking team manager: The progress-tracking team manager
should have a familiarization with health system financial and management
reports or accounting processes. The role of this position is to assume responsibility
for the collection, analysis, and reporting of financial progress toward targets
as well as monthly quality indicator reports. On larger projects, this position
oversees the work of the scheduler and value trackers to create reports on
each project initiative for review and integration by the PMO manager.
- Service team manager: The service team manager reports to the PMO manager and is responsible for ensuring that the project has appropriate human resources and administrative assistance, as well as appropriate communications efforts with constituencies. Such activities might include consistency and adequacy of staff on the various initiatives, as well as overseeing any contracts needed by the initiatives team to support their work. On larger projects, this position would oversee the work of the communications coordinator and the knowledge and training coordinator.
Reporting
The PMO's ability to focus the organization is directly related to its ability to monitor and control the various initiatives that make up the larger clinical transformation project. Specific project management methods and tools are used to create this discipline and ability.
Figure 3 illustrates that reporting begins at the initiative level of the project. Information of various types is rolled up to create both detailed and executive level reports. This is the reason that the PMO must be empowered to serve as the centralized body with the authority to establish reporting standards, and to verify the consistency and accuracy of initiative level reports.
Figure 3: PMO Reporting Process
Some of the types of reports used by the PMO include:
- Status reporting and issue management. Status reports provide clear
and concise updates on specific tasks and deliverables. They are also used
to escalate issues when appropriate to higher levels of the organization for
resolution. Additionally, these reports are used to identify and report on
project progress relating to budget, schedule, and performance; report on
activities with delayed starts or completions; and report on current and anticipated
deliverables.
- Risk management and quality assurance. Risk management and quality assurance reports are used to ensure that deliverables are produced on time, and with expected benefits. Figure 4 represents an example of a risk assessment report. Ongoing risk assessment reports keep the PMO informed of the progress of each initiative, highlighting problem areas. Because many of the initiatives are interrelated, the risk assessment report facilitates the PMO's early intervention, thus preventing a domino effect through other initiatives of the project. Quality assurance is the ongoing review of deliverables from the individual initiative teams at certain critical junctures. Through use of a consistent set of criteria at these junctures, movement to new phases of work occurs when the needed foundation work has passed a quality review.
Figure 4: Risk Assessment Initiative
- Scope and change management: When initiative teams are in the midst
of their work, scope issues always come up. The PMO monitors change requests
and accepts recommendations for initiative leaders. By requiring consistent
reporting on desired or requested scope changes, the PMO can serve as a formal
review and control point. If the scope or change request is approved, the
PMO then has the responsibility of reflecting the change in overall project
and to oversee that individual project managers reflect changes in individual
initiative work plans and other documentation.
- Executive reports: The most summary level of information is that
which is prepared for executives. The purpose of these reports is to keep
leaders fully informed of overall progress, especially with regard to potential
or existing problem areas. In this way, leaders are in a position to understand
the ongoing progress on the project and to intervene in a timely manner when
needed. Figure 5 summarizes a dashboard report, used for such reporting.
- Financial and operational assurance reports: Often after reviewing the executive reports, both executive leadership and directors will want to drill down into the drivers/reasons for the lack of progress within specific initiatives. For instance, if patient care is not realizing the staffing efficiencies desired, they will want to understand which departments are driving these variances. A productivity report is a common tool used to help both executive leadership and directors focus on specific departments. An example of another report reflecting specific departments is the supply chain expense utilization report. This report allows one to determine which departments are responsible for supply expense variances.
Figure 5: Sample Exectuive Dashboard Report A Case in Point
For one health system, using a PMO resulted in changes in project design and management that, while subtle in nature, were significant in impact. In this situation, the health system involved three entities in its clinical transformation project: its existing executives and department managers, a technology vendor, and clinical transformation consultants. The PMO was the central authority through which issues, project plans, timelines, dependencies, and deliverables were tracked, documented, and managed for these multiple groups. The health system appointed a PMO manager who had the responsibility for integrating and synchronizing the project plans from each application/design team.
The health system, very cognizant of the fact that the project management office would not replace or be confused with project management, designed a model to ensure one would complement the other. The goals and objectives of the PMO were consistent with the project's overall goals and objectives and were designed to ensure consistency of performance through the establishment of planning, reporting, controlling, quality and risk management, and knowledge capture standards.
One example of this process involved the creation of a single, comprehensive electronic medical record. To avoid the proliferation of medical records in which many of the documents were electronic but others (received from sources outside the health system) remained paper-based, a design team recommended that all hard-copy documents be scanned to create electronic versions. While this future state design offered many benefits, the current capacity of the health system to undertake the level of scanning required to achieve this goal constituted a change in the scope of the project. The PMO worked with the current project managers, the clinical transformation consultants, and the technology vendor to create a scope change document that supported the business case for the recommendation. This process gave leaders the information they needed to make a decision based on the quantification of benefits and costs. In a non-PMO controlled environment, such a change may have created operational barriers since the recommendation may not have been formalized during a window of time in which solutions were still changeable.
In another example, the implementation of computerized physician order entry (CPOE) originally assumed the use of two different, existing laboratory information systems at two facilities in a hospital system. During the design phase of the project, the actual cost of creating two sets of interfaces and two sets of system maintenance efforts was revealed to be higher than originally estimated. The PMO monitored an "issue" for project management, which was summarized in a decision paper. Four alternatives were considered:
- Continue to use both laboratory systems and interface both of them with
the new clinical information system
- Continue to use both laboratory systems with upgraded interfaces
- Convert one hospital's laboratory information system to the larger hospital's
system
- Migrate the larger hospital's system to the smaller system
The result was a recommendation for investment in a single lab system, from the larger hospital, to be used across the system. While this decision resulted in additional, up-front capital investments, the savings accruing from reduced interface build and a single maintenance effort made the investment well worthwhile. The PMO provided a coordinated approach to measuring, recording, and reporting the value of this issue to the health system executives.
Summary
The PMO concept integrates performance improvement measurements and traditional project monitoring and reporting with behavioral and training concepts. This creates a culture of accountability. In this way, the PMO finishes the transformation represented by the integration of clinical process redesign and information system design.
