In the late summer of 2004 our city of Ocala, located in the center of Florida, was directly hit by two of the four major hurricanes which made landfall. Due to a combination of lengthy power outages and significant damage to buildings, including the homes of many employees and patients, many medical practices were forced to close (some practices along the coasts were unable to perform surgery for up to several weeks).
Our original timeline placed our EMR implementation around the late summer of 2005, but the domino effect from the storms forced us to push this back a couple of months.
Unfortunately, this would coincide with a couple of other major events in our practice: the addition of two new associates, the departure of another, and the construction of two new satellite offices. Since we knew that the success of the EMR implementation depended on our full commitment and resources, we decided to push our “go-live” time back to the beginning of 2006 (as it turned out, it wouldn’t be until 2007 that we actually went live).
Previously, I wrote about the 10 principles of Change Management in regard to the culture of the organization. Instituting a change management program is a key step in ensuring success of a project.
In this article, I have asked Frank E. Polack, president of Project Management Institute’s Atlanta Chapter, to help describe how a project manager can help a practice plan a process such as EMR and deal with unexpected events:
Just as a good change management program can ensure the office culture adapts to the new systems, the implementation of the system needs a Project Manager. The Project Management Institute (PMI) defines a project as “a temporary endeavor undertaken to create a unique product or service.” Many system vendors will have their own PM; you may consider having one on your side as well.
A good way to start is to create a Project Charter. The Charter documents Why we’re doing this (to avoid expanding office space and to keep accurate records), What we’re implementing (an EMR system), How long it will take (to be running by March 2006), and What it is budgeted to cost (including software and hardware). Also included are Risks (hurricanes, virus attacks, vendor delays), Constraints (we need to wire the building only at night, we have another major project already scheduled at that time) and Assumptions (we assume Dell will have the required servers in stock).
Another important tool is a scheduling tool such as Microsoft Project, but even Excel can be used to track tasks. Also, consider keeping a Risk log (a list of Risks, their probability and impact, and mitigation plan) and an Issue log (items that come up that need attention. An issue is often a risk that occurred)
PMI publishes standards for managing projects that include nine knowledge areas of Project Management. A Project Manager will employ processes from the nine areas to ensure all aspects of the project are covered.
Of the nine areas, three are identified as the triple constraints –
Cost (the Budget),
Time (the Schedule), and
Scope (the work).
If any one of these is changed, the others will also be affected. For example, if you increase the Scope of the project (either through a Change Order or Scope ‘creep’), the Time to implement or the Cost can increase. If you try to lower the Cost, the Scope will need to be decreased or Quality lowered (one coat of paint instead of two), or it may take more Time (e.g. less resources doing the work). Also be aware of dependencies – Task B can’t start until Task A is complete
Quality Management – inspecting along the way to ensure what you’re implementing satisfies the needs defined at the beginning. Don’t wait till it’s done to see if it’s right.
Risk Management – Identifying possible risks; qualify them for probability and impact; then quantify the costs (money and schedule). A Risk Management plan is developed for dealing with the identified risks should they happen. For example, if you were to have an outdoor party, you might mitigate (lessen) the risk of rain by keeping a close watch on the weather report; you might avoid the risk by having the party indoors; or you might set aside a contingency fund to pay for tent rentals in case the weather turns bad. We have also joked with our IT Director (half-seriously) about the impact on the practice if he were hit by a truck. In addition to a second IT employee, we also have a local networking firm in the loop should they be needed. Risks need to be monitored on a regular basis…something that has low probability or impact now may have more impact later on.
Communication Management – what to communicate about the project, to whom and how. Key project team members may need constant updates while the physicians may need less frequent updates. Are these sent by email or memo? How often do you hold meetings and who is invited? Does the practice administrator have to be sent copies of every email?
Procurement Management – make sure you understand the type of contract you enter into with any vendor – is it Fixed price, Cost Plus, or T&M (time and materials)?
Human Resource Management – who is on the project team? who are the SMEs (subject matter experts like cabling or IT folks). Are resources being assigned full-time to the project? Will the project manager have authority over that resource’s time?
Integration Management – taking all the elements above and ensuring that they are all managed throughout the life of the project.
Project managers are available for hire and can lessen the pain and the cost of an implementation. Your local PMI chapter at www.pmi.org can be a great place to start.