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Project management and quality assurance for health care IT projects

Strategies for C-level leaders to safeguard technology investments

INSIGHT ARTICLE  | 

Project success for technology investments is one of the foremost topics on the minds of business leaders. While different health care industry leaders such as those in the finance, technology, internal audit and operations departments look at project success through different lenses, the end goal tends to be focused on efficiency, quality, cost and operational effectiveness for the organization. Information technology (IT) initiatives that are deployed at an enterprise scale can reach 10 to hundreds of millions of dollars in cost, carrying a high degree of risk from a resource, strategy, operations and financial commitment perspective. To that end, many organizational leaders are taking steps to realize the maximum return on investment in technology as well as protect against the risk of adverse project outcomes.

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The role of project management and quality assurance

Given the risks associated with IT initiatives, and the need to get it right the first time, some organizations are taking a major step toward deploying an independent project management and quality assurance (PM/QA) role to monitor project health and obtain an unbiased view of the project. The PM/QA role while powerful, continues to be underutilized in the commercial health care space in comparison to other industries (state and local, federal, aviation, pharmaceutical). There are several different methods that could be applied around PM/QA, and this depends on the scope of the project, and the organizational risk tolerance associated with the initiative.

What is PM/QA?

The PM/QA approach includes the following:

  • Independent review of the project at key phases of the project or program
  • It is performed by an individual or team that is independent of the project implementation team
  • An iterative, ongoing or point-in-time review of the project that focuses on people, process and technology
  • Focuses on relevant project areas that are outlined in the overarching guiding principles (well defined areas that should be assessed) for the project

The project management strategy focuses on key areas under the project life cycle and performs a quality assurance assessment as outlined below.

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Typically, the PM/QA team may work with project sponsors to define the scope of review in order to determine the appropriate level of analysis depending on the risks involved with the project. In some instances, the PM/QA team may be brought in to specifically assist with design, test strategy, and in other cases, to perform an end-to-end project review of overall plan, milestone adherence, risk review, build audit, issue prioritization and go-live operational readiness. The level of effort is derived by an iterative planning process to define scope of review based on the scale and complexity of the project. 

How does PM/QA work?

The PM/QA team implements the strategy by: 

  • Interviewing key project stakeholders periodically
  • Reviewing project documentatio
  • Observing ongoing project meetings
  • Identifying risks and issues proactively and providing detailed recommendations to project leadership
  • Tailoring specific needs of the project
  • Performing iterative project reviews

Example: For a health care organization implementing a new Cerner or Epic electronic health record (EHR) system, or a new Lawson enterprise resource planning (ERP) solution, it would benefit from having a PM/QA role defined and scoped at the beginning of the project. This role would continue to monitor the planning, design, build, deployment and transition to maintenance phases. This independent review would allow project leadership to have direct and targeted insight into the project progress proactively, and provide them with the objective feedback essential to address project risks before they turn into issues.

Key benefits of PM/QA

  • Help management gain an understanding of the clinical and financial systems, integration risks, infrastructure and business process changes resulting from the upgrade and implementation
  • Identify the key risks associated with the upgrade and implementation efforts to make decisions before risks turn into issues
  • Assess the controls in place to mitigate these risks, including the oversight through project monitoring
  • Review the controls in place for the project by utilizing the PM/QA toolkit (predefined focus areas that uses questionnaires and other tools defined by the PM/QA team).

Having firsthand experience in running and managing PM/QA projects, we have seen tremendous value to health care leadership by having this role defined in high-priority projects. It not only serves as a reporting mechanism, but more importantly serves as a risk identification method. The PM/QA team is able to provide objective and independent recommendations on how to mitigate risks and manage issues, and serve as a knowledgeable and experienced resource that sits across the table from the system integration vendor, providing the outside eye and supporting the provider organization.

Flavors of PM/QA

There are different methods of independent reviews performed on projects in order to identify and report progress and performance. Note the following:

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Management should seek to deploy the appropriate level of PM/QA involvement in projects based on risk and impact in order to not overburden the project team while still providing them with the appropriate support in managing their projects.

PM/QA success factors

  • Having a robust set of tools, templates and techniques that can be customized for the specific project needs
  • Participation of the project team with the PM/QA team, and active involvement of the project sponsors
  • Having an experienced team performing PM/QA reviews to efficiently meet goals with minimal disruption to the ongoing project activities
  • Having a defined methodology and structured approach that have been agreed upon prior to initiation
  • Maintaining independence from the project team as this helps uphold the integrity of the findings and the unbiased nature of the recommendations

Having a well-defined strategy and focus for the PM/QA team, and inclusion of the project team right from the start of the project is key to the success of this role. It is important to properly communicate why this role is part of the project, and have the project leaders understand the value of having PM/QA support throughout the project.

PM/QA value proposition

Financial benefit
The financial benefit of an independent PM/QA function more than compensates for project overruns, or not having a solution that fully meets its goals such as physician satisfaction, disjointed workflow, incomplete reporting, delays in billing, meaningful use and other regulatory compliance. A PM/QA function ends up costing between 1 to 5 percent of the project implementation cost (depending on the level of involvement); however it could also lead to significant savings in the long run. A typical health care IT project may have up to 20 percent or more overruns in cost due to delays or other functionality issues. The long-term impact of quality issues can end up being significantly higher should the product not meet the business needs.

Maintenance benefit
Post go-live maintenance and operations is a significant factor for every hospital chief information officer, and often not clearly accounted for in the risk matrix for a project. We see that maintaining a new technology solution often times exceeds the cost of implementation in the years to come; therefore, it is important to focus on long-term operations while still meeting the needs of the business. One of the key functions of PM/QA is not only to look at implementation activities, but also look at risks from a future maintenance perspective to keep costs down, and maintain efficient and practical user-focused support functions. The role that PM/QA would play towards project transition is to focus on making sure that the project team not only meets the go-live finish line, but also has a well-defined support model, and there is adequate support staff to run the post go-live functions, such as issue resolution, system upgrades, downtime planning, new user training and onboarding.

Project quality benefits
The PM/QA team will diligently look out for the quality of the product being delivered, and focus on the functionality and capabilities of the solution in order to serve the best interests of the business needs. A key aspect of the PM/QA function is to help monitor requirements, designs and testing processes to ensure that the agreed-upon needs are being met and delivered to the business. For instance, during an EHR solution implementation, an activity as little as ensuring that reimbursement stakeholders or nursing stakeholders are heard, and their feedback is effectively documented during the design and build process could make a big difference in the quality of care, end-user engagement and outcomes.

Conclusion

The PM/QA role will meticulously review and analyze outcomes, question and recommend processes, and diligently protect the interests of the health care organization. The benefits derived from deploying a PM/QA role not only help with a better implementation of health care technology, but also go way beyond into the operations phase of the solution where a higher-quality product is delivered, which improves the operations of the organization in the long run, while being managed more efficiently. This role can be viewed as an effective risk mitigation strategy to deliver a project on time, within budget and in accordance with the guiding principles. Identifying the need for a PM/QA function can be a game changer for some projects that are risky in nature or need the added monitoring and advice through the project life cycle to achieve the intended outcomes. More importantly, it is vital for business leaders to determine the right level of assistance needed from this function depending on the factors outlined above.

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