Healthcare Systems Portfolio And Project Management: Aligning Strategy, People, And Process

By Philip Martin, CEO, Cora Systems (www.corasystems.com)

Today, most healthcare systems and networks need to integrate a variety of delivery systems in order to share information, report to agencies, and provide some aspect of health services to their patients. Without the right projects and programs to carry them out, even the most forward-thinking strategies fail.

To help bridge the chasm between high-level strategic vision and in-the-trenches implementation, many organizations turn to enterprise portfolio and project management solutions to help. Enterprise project portfolio management is a way for healthcare networks to manage and evaluate a large number of projects by grouping them into strategic portfolios. Healthcare reforms can present many challenges as they are mandated and must be addressed. These reforms typically cover major health policy creation or changes — for the most part, any governmental policy that affects healthcare delivery in a given place.

As such, major health system priorities involve one or more of the following:

• reform of the acute hospital delivery system
• reform of the Community and Primary Care delivery system
• clinically-led, multi-disciplinary, cross-organization, design authority for integrated models of care
• reform of Finance Systems and Administrative
• better Human Resource disciplines
• meet Meaningful Use Requirements

To manage such reforms, usually an executive team is formed to oversee the wide range of strategic reform programs across multiple care divisions in healthcare where various methodologies, styles, and approaches exist on both a program and project management level.

Overall Approach
To create a sustainable change effort and in order to take into account potential reluctance for a project management system, an overall Portfolio Management Framework should be developed to ensure a professional but practical approach. It will ensure the right program and projects are delivered by the right people in the right way to deliver benefits to the population.

This approach delivers strategic alignment with the core vision of an agenda for reform that will improve health and healthcare and ensure projects are to be conducted in a disciplined, coherent, and consistent manner while at the same time managing the clear interdependencies across such a complex and diverse reform agenda.

The Framework should deliver the overall management approach to the project portfolio. Each element of the Framework requires a tailored approach to ensure a project culture and to build on the strength of the system, which is what we term the “doing phase” (i.e. getting traction on the work of the projects).

The aim is to set out methodologies within the Framework that would not overly burden the system but absolutely:

• ensure the right program of work are chosen
• educate staff on how to use the process and tools
• provide a laser-like clarity on the program/project benefits with an aligned reporting system
• support the management of projects with the goal of building a structured, consistent and useful process
• build a strong monitoring engine and clear line of sight of all programs and projects so that key decisions could be taken at the relevant governance level

Planning And Strategic Alignment
Most healthcare networks do not have a coherent approach to planning and managing a project portfolio that will deliver and support all the healthcare networks’ strategic objectives. What often exist are programs designed primarily to support individual units in delivering key operational demands and their own areas of legal accountability. Ultimately what is needed is the implementation of a planning process for reform at an organizational level and across an organizational scope. This is where decisions about the right programs and best use of resources should be made. To this end, healthcare networks should support a reform that can be underpinned by a clear strategic framework and associated measurement system.

By using a planning framework, it ensures there is:

• a set of strategic objectives that will deliver on the purpose and realize that vision
• a common understanding of purpose and shared vision for the reform agenda
• programs of work made up of projects that, when implemented, would translate the strategy into action and show how each program will describe benefits to help achieve the key objectives
• a performance measurement and a feedback system to ensure progress, when tracked, to keep the associated programs focused on the strategic objectives

Once having selected the strategic objectives, it is important to assess how each objective can contribute to achieving the overall purpose and vision of the healthcare organization. It is important to ensure each objective aligns with the healthcare network’s vision and an analysis is performed.

4 Steps To Manage Project Priorities
The project portfolio of work should be the integration of the strategy plan into a prioritized dashboard of programs and projects that, in time, would achieve each strategic objective and its agreed success measure. A number of stages need to place to achieve a first cut.

1.Individual work with Care Divisions: closely working with each division on evaluation of projects to which should have a reprioritization or be eliminated altogether.

2.Collective Workshops: following the first step, workshops to determine the risk/benefit analysis of programs in place.

3.Introduction of benefits management as a key concept within the healthcare system: tracking of key objectives with benefits to support. A benefits framework and guideline document was developed, along with benefits workshops, to support groups. This has been a useful indication to prioritize work and ensure alignment with business change requirements.

4.Identify key dependencies across the program: key dependency mapping is conducted. This delivers the first snapshot of results of the project management program.

Evaluating Resources And Capacity
One of the greatest challenges right across the project portfolio is the capacity/resource planning aspect, given the financial constraints within many healthcare organizations. An initial key first step is understanding across each division the readiness to commence the programs outlined in the first phase of the project portfolio and also the type of resources the division either had available or required to apply to the prioritized work.

Governance
Good governance is particularly important in a complex system such as health services where it is difficult to identify any significant reform project that does not cross organizational or functional boundaries, or is not dependent on some external factor. In this context, one of the most important aspects of governance is it should ensure and formally enable the structured and explicit involvement of key stakeholders at all appropriate levels of each individual program or project to facilitate decision making, monitoring and oversight. The focus of the governance arrangements is to ensure all activities remain aligned to the shared objectives of the strategy map and that a robust program management approach permeates across the project portfolio.

To this end, it is beneficial to work with a leadership team to design the appropriate governance arrangements that would clarify and enable the decision-making process in an efficient way across the project portfolio, as well as enable the monitoring and reporting of progress and deal with risks/issues at the appropriate level across the project portfolio.

We know governance is critical to success but also that it needs to delicately evolve. To achieve this, there needs to be continuous communication with members of a leadership team to review the value and ensure people feel comfortable working this way. This will make sure people have a collective understanding of the governance requirements, which will ultimately lead to increasingly consistent project portfolio executive information and decision making.

Program Implementation Framework
Ultimately, the effective implementation of the targeted benefits, linked to the reform change initiatives, will determine whether the execution of these strategic priorities has been a success over time. This needs to take place in an environment where there previously has not been a consistent approach to the designing and implementing of change initiatives right across the organization (this is critical from a governance perspective).

To address this, it is important to set out a Portfolio Implementation Framework that would help a health network system’s management (at a number of levels) to allocate resources consistently with the network’s strategic priorities and available resources. It also helps people to be more efficient and effective in the way change is implemented and benefits linked to the change delivered. A number of principles that guides the design on this Framework and should be:

• focused on delivering benefits aligned with strategic priorities that can be rolled out across the organization (both managing change fatigue and capacity/affordability across the organization)
• focused on ensuring all strategic priorities for the organization are addressed through relevant set of programs/projects
• based on transparency of both decision-making and information available on program and projects
• balancing the need for best-practice controls and the current level of controls/documentation effectively in place in the organization
• encompassing a framework that works for both live projects/programs and potential new projects/programs
• demonstrating the benefits of program/project management across the organization
• delivering a consistent flexible approach across the organization that covers both programs and projects

Performance
With such a large undertaking of the project portfolio, it is vital to have a clear line of sight for all key programs and projects in order to track and report on performance. It is also important not to overburden programs or projects to access information and clarification, while at the same time ensuring the health system networks are getting the right information. To this end, it is critical to implement a totally web-based portfolio/ program/project management system that manages strategic perspectives right down to individual paths at a project level. Depending on the user, the views of the system are different and clearly show the service areas they would only be interested in and the projects that they are responsible for.

The system integrates all projects into one single solution and information rolls up from project to program level to project portfolio level. Managers can drill down and report to get specific information if required. Standardized reports at various levels need to be developed to ensure consistency at program level.

There are a number of benefits to using a web-based portfolio/program/project management system that enable the:

• control and visibility of progress on the reform portfolio
• portfolio information to enable key decision-making at relevant governance levels
• a simple, easy-to-use system with clear navigation for staff
• quick identification of change projects
• extensive reporting for various types of stakeholders
• resource management will become much easier in time
• reporting on benefits at the governance level
• escalation of risks and issues addressed easily, across the project portfolio

Summary
A project portfolio that takes into account the aforementioned aspects would be well positioned to achieve the intent of meeting government agencies’ reforms. These portfolios should be analyzed for overall effectiveness and then determine how their estimates compare with actual costs, and whether they align with the larger, strategic objectives of the organization.

In summary, it’s a data-driven process using lessons learned to help a healthcare network decide which types of projects to either keep doing or stop doing or do better. The process involves executives regularly reviewing portfolios to decide which ones make the cut. A project management system looks at how budget is spent, at how much value and ROI each project portfolio delivers, and they ensure there are enough resources to go around. Executives closely monitor the progress of project portfolios in real time by using enterprise project portfolio management software that compares current data with past data.