C r i t i c a l S u c c e s s F a c t o r s o f
P r o j e c t M a n a g e m e n t P l a n n i n g
Kathy Schroeder, RN, PMP, Senior Director, Tenet Healthcareand
C o n f l i c t o f I n t e r e s t
K a t h y S c h r o e d e r , R N , P M P a n d L i z C o f f e y , P M P
H a v e n o r e a l o r a p p a r e n t
c o n f l i c t s o f i n t e r e s t t o
L e a r n i n g
• Identify the critical success factors for “go-live”
• Apply the success factors
• Review specific assessment processes used to help
ensure success factors are achieved
– The go-live readiness assessment
– Pre-live conversion assessment
Te n e t
· 49 hospitals in 10 states · More than 100 outpatient
centers
· 57,000 employees
· $8.854 billion net operating revenues (CY'11)
· 515,693 admissions (CY'11) · 4 million outpatient visits
Chronology of Clinical System Strategy and Our
2013 –Beyond
• Expand scope
of advanced
clinicals
2010 - 2012
• Advanced
clinicals
initiatives
2005 - 2009
• Legacy
replacement
Pre-2005
• Current state
assessment
As Our Clinical System Culture Evolved,
Our Project Complexity Grew
The Search for
The Search for
Success
Success
HIT MYSTERY STORIES
Finding out how to replicate
success and avoid pitfalls when
implementing an electronic
health record
Searching for Success
•
Evaluated/researched past implementations
•
Delineated common traits
•
Developed a scorecard to evaluate the
criteria and how much each contributed
to success
· Conceptualized key criteria for a successful implementation
· Reviewed project information to assess achievement
· Included 2 categories of measurement:
- Did the criteria exist within the project plan and in the correct time sequence?
- Was there a documented project deliverable (evidence) for each criteria?
· Documented findings for each hospital on project review template
What We Found:
• Every hospital had a project plan and project deliverables
– Although substance and quality varied, every hospital had a project
schedule with tasks and some level of project deliverables included
• Technical tasks were clearly defined
– Project Managers had consistent tracking of vendor-specific tasks and
timelines (e.g., testing)
• Internal status reporting was good
– There was consistent evidence of project
status reporting
O p p o r t u n i t i e s f o r I m p r o v e m e n t a n d R e c o m m e n d a t i o n s
O p p o r t u n i t i e s f o r I m p r o v e m e n t a n d R e c o m m e n d a t i o n s
• Project plans included both generic and vendor-specific plans;
multiple entries and dates for the same tasks
O p p o r t u n i t i e s f o r I m p r o v e m e n t a n d R e c o m m e n d a t i o n s
• Sign-off process and sign-off documents were not included
for each deliverable, such as project charter, scope
statement, and test plan and execution
O p p o r t u n i t i e s f o r I m p r o v e m e n t a n d R e c o m m e n d a t i o n s
• Evidence of limited issues reporting
• Definitions and terminology were inconsistent in project
documents
O p p o r t u n i t i e s f o r I m p r o v e m e n t a n d R e c o m m e n d a t i o n s
• Limited evidence of Transition-to-Support information, training
plan, go-live support plan, etc.
•
Recommendation: establish consistent criteria and document specific
dates in project plan
•
For example, what has to be included in the
transition-to-support information or the go-live
P o i n t s t o …
E x a m p l e s
R e s u l t s
T h e R i g h t L e a d e r s h i p
• Executive Governance
• Clinical Process Improvement Committee (CPIC)
• Physician Partnering • Communications
• Governance formed early in project with regular meetings
• Added a dedicated Clinical Informaticist to the team
• Added a Physician Champion to the team
• Timely decisions and change management
• Leadership commitment fostered clinician buy-in
• Hospital got the message this was something done “with” them and not “to” them
E x a m p l e s
R e s u l t s
• Vendor system and clinical standard alignment • Accurate and complete build
• Data accuracy • Charge master
T h e R i g h t B u i l d
• Added a dedicated current state assessment organization to the team • Performed build audits to ensure
complete and accurate content
• Accurate build for testing and training • Less frustration
• Match between training and production
E x a m p l e s
R e s u l t s
T h e R i g h t E n v i r o n m e n t
• Testing, training, and mock run system environments • User equipment
• Interfaces
• Work and training space
• Hardware/technology assessments, including:
– Workstations on Wheels (WOWs) – Isolation Rooms
• Plans for delivery and storage • Equipment testing executed
E x a m p l e s
R e s u l t s
T h e R i g h t F u t u r e S t a t e
Meaningful Use (MU) Plan
• Conducted an MU road show early with subsequent visits involving leaders/team to be aware of “why” and “how”
• Prompted hospital leaders’ decisions, such as identifying MU sponsor, MU
• Established liaison to home office focusing on timely communications as changes ensued
• MU coordinator could communicate and address the information
E x a m p l e s
R e s u l t s
T h e R i g h t Te s t i n g
& P r e p a r a t i o n
• Comprehensive testing
• Appropriate and timely training • Immersion/Mock Run Methodology
• Followed a comprehensive unit, application and integrated testing methodology, including impacted non-clinical systems such as
admitting, billing, and HIM
• Used a variety of training methodologies depending on the volume, user population, and infrastructure
• Conducted mock go-live with super user roles, command center, 24-7 shifts
• Allowed practice in the application with the future state clearly
painted
• Answered: How is my day going to look on Day 1 of activation? How will I interact with my patients and new system?
E x a m p l e s
R e s u l t s
T h e R i g h t R e s o u r c e s
• Super user planning
• Comprehensive go-live plan
• Super user “commitment contract" was created, detailing expectations, timeline, milestones, and overall commitment
• Leadership supported super users’ having no patient care responsibilities during the course of project and at activation
• Team and leaders were prepared for what the project entailed
including backfill for key positions • Trained, practiced, and
knowledgeable "organic staff" were available to address issues • Confidence gained early for and in
Go-live Readiness Assessment
• Focuses on input from the local project team
• Defines and reports status on
progress of meeting the 16 success factors
• Prepares for the detailed/operational assessment which is conducted at a later time
• Focuses on detailed (clinical and operational) areas
• Conducted onsite
• Audience may include project sponsor, PM, CI, hospital leadership team,
super users, managers, directors, training lead, staff, nurses, end users
Pre-Live Conversion Assessment (the on-site clinical readiness assessment)
P r e p a r i n g f o r S u c c e s s
P r e p a r i n g f o r S u c c e s s
•
Reviewing specific criteria early in the project allowed time to react
and reduce areas of risk
•
Understanding that local project teams often had different views
than providers, SMEs, managers, and end users - used approach to
align gaps
•
Focusing on the 16 critical success factors increased adoption and
satisfaction at go-live
Kathy Schroeder, RN, PMP,
Senior Director, Tenet Healthcare
Kathy.Schroeder@tenethealth.com
Liz Coffey, PMP,
Service Line Executive, Global Services,
Encore Health Resources
The 16 Factors
C r i t i c a l S u c c e s s F a c t o r s D e f i n i t i o n s
Success Factor Description Evidence
Clinical Process Improvement Committee (CPIC) Process Established The effective integration of process and build activities. During the CPIC meeting, the current/future state analysis status reviews reflect gaps, the process, and/or P&P changes according to the project timeline Gap analysis report closure, updated P&Ps Vendor System and Project Standard Alignment Ensure that the vendor standard and Project standards are in sync. In the initial gap analysis, gaps are identified and a plan is formulated to address. Key stakeholders are engaged Charge Data Master, Pt. Types, Service Types are validated. Sign‐ offs for critical activities, such as project charter and scope, testing documents, super user planning documents, training, etc. are
Success Factor Description Evidence Accurate and Complete Build Ensure that build is completed to standard, audit vendor system reports against catalog. Build completion checkpoints are reflected in the build status updates. Unit, application, and integrated testing rounds occur according to the project timeline. Unit and application testing result failures=0, scripts completed and reviewed, issues report and resolution, vendor system report reviewed Super User Planning Super users are identified and documented on validated project schedules. Nurse Managers have validated patient care staffing schedules to ensure that super users are not included in patient care Evidence of super user assignments on planning documents, staffing schedules published
C r i t i c a l S u c c e s s F a c t o r s D e f i n i t i o n s
Success Factor Description Evidence Comprehensive Testing Environment and Plan • Ensure comprehensive test scripts for application and integrated testing: • Reflect current & future state workflows • Include patient type scenarios with extensive functionality for each • Ensure that a complete testing environment is available (or workaround defined) with an adequate equipment testing plan • Coordinate and conduct load test • Obtain evidence of information flow from bedside monitors/MDIs into the test environment through the iBUS and MDIs • Ensure results validation with HIM • Maintain and update testing environments Evidence of review and test script sign‐off. Testing issues reported, reviewed, and resolved before next round of integrated testing. Vendor system, hospital information system, electronic pharmacy cabinets, and materials management/charge capture information included in test scripts, planning, and execution. End user device set‐up, printer routing, wireless coverage and
C r i t i c a l S u c c e s s F a c t o r s D e f i n i t i o n s
C r i t i c a l S u c c e s s F a c t o r s D e f i n i t i o n s
Success Factor
Description Evidence
Training Plan Establish appropriate training environment and tracking process. When in training, ensure that end users are not assigned patient care responsibilities. Ensure that training plan is defined against scope, job roles, and staffing Training planning and logistics are in place. Evaluated competencies and attendance for super users and end users. Updated basic computer skills assessment. Identified super user trainers conduct teach‐backs prior to conducting end user training, WBT, vendor training domain, and security/roles reviewed and validated Immersion/ Mock Dress Rehearsal Ensure knowledge transfer through immersion plan Formal training immersion plan, practice sessions, training system patients are regularly refreshed and clear plan to test competency in place. Walkthroughs in department, tips and tricks posted, mock run/dress rehearsal planned and executed
C r i t i c a l S u c c e s s F a c t o r s D e f i n i t i o n s
Success Factor Description Evidence
Comprehensive Go‐Live Plan Plan and prepare for go‐live criteria. Ensure that go‐live conversion assessment is documented. Ensure that dashboard reviews, issues tracking, and reporting are in place. Complete hospital schedule, project schedule, and command center planning. Ensure live cut‐over plan Positive go‐live readiness assessment results, cut‐over plan/schedule, and go‐live staffing plan
Charge Master Ensure that all Charge Master updates are current and validated
C r i t i c a l S u c c e s s F a c t o r s D e f i n i t i o n s
Success Factor Description Evidence
Communications Communications with nursing, physicians, hospital leadership and hospital staff regarding go‐live activities and preparatory events (testing, mock, training, immersion, cut‐over, go‐live events, and go‐live support) Formal communication plan in plan and communication tools prepared. such as letter from CEO to hospital staff, posters, table tents, and diagrams Physician Partnering Ensure that physicians know how their daily routines will change. Identify and communicate changes/impacts to reports. Understand where physicians will look up information and if that will change. Document and educate on what is changing Conduct presentations to medical executive committees and quarterly medical staff meetings
Success Factor Description Evidence Interface Plan Ensure syncing up of interfaced or stand alone systems relying on vendor data Hospital Information System CDM, ED and RT orders, and Pharmacy Electronic Cabinets (formulary) Ensure Data Accuracy Validate data accuracy and formatting in systems receiving data from vendor (or vice versa) Integrated testing results validation by non‐project vendor areas
receiving or sending data, such as HIM, RT, ED, and the hospital information system Meaningful Use Plan Validate workflows and data collection required to support Meaningful Use Document a plan that details what data elements are needed, where they will be collected from and how they will be collected
C r i t i c a l S u c c e s s F a c t o r s D e f i n i t i o n s
C r i t i c a l S u c c e s s F a c t o r s D e f i n i t i o n s
Success Factor Description Evidence
Equipment Plan Hardware assessments are based on clinical needs to support online clinical documentation and results reporting resulting in a hardware device checklist Ensure that adequate devices and device placement to support the clinical workflows are validated through walkthroughs and sign‐off. Hardware checklist is validated with department directors Smooth Support Transition Ensure smooth transition to production support Transition plan, optimization team plan with established dates and times
