IM/IT Portfolio Management Office

HSPM J713

Portfolio Management

• Context: failures– We want to avoid failures

Learning objectives 1 and 2

• What causes IM project failures• What differentiates– Project management– Program management– Portfolio management

Learning objectives 3 and 4

• Project management – 5 key processes• Project metrics and portfolio dashboards

Learning objectives 5 and 6

• The portfolio management office– Roles and functions

• What actions or changes are needed to “reach the synchronized stage”

Hunter and Cotti presentation

• “IT Disasters: The Worst IT Debacles and the Lessons Learned from Them” ACHE meeting 2006.

• Poor planning• But mainly, poor execution

Hunter and Ciotti’s disaster stories

• Runaway vendors– One healthcare system’s “partner” vendor had 50

full-time consultants on-site at $1200/day each, for years. (H&C: Consultants should be there for months, not years.)

– Getting sold stuff you don’t need. A vendor convinced a healthcare system to get a whole new information system to deal with Y2K.

– The new system had not before been implemented on that scale.

Hunter and Ciotti’s disaster stories

• Outsourcing the CIO– A multihospital system outsourced its IT to an

offshore company• Low price – low-salary programmers• Cultural and language differences – bad

communications• CIO was with vendor – approved vendors expenses• Service-level agreements TBD (to be determined)• Costs rose, system didn’t fit needs

Hunter and Ciotti’s disaster stories

• Rushing to start, leaving details and deadlines for later

• An academic medical center bought new electronic medical records and computerized physician order entry (EMR and CPOE)

• Years went by, and $$ in consultants.• Building, testing, finding bugs, patching,

building, …

Hunter and Ciotti’s disaster stories

• Rushing to start, leaving details and deadlines for later

• Better: – Have CIO with knowledge of how long things

should take. – Fix fee or cap

Hunter and Ciotti’s disaster stories• Over-centralization• A multi-hospital system consolidated IT• But systems were disparate• Single help-desk for the whole enterprise• Lacked knowledge of local systems and

conditions• Distant reporting led to loss of sense of team• Us vs. them• Decentralization with on-site staff (cash rewards

for good reviews) improved things

Hunter and Ciotti’s disaster stories• Over-reliance on in-house expert• A CIO said he could write a better CPOE than they

could buy• Costs started low, but then rose• System crashed• The CIO had no one to help him find the trouble• Commercial systems have had the bugs worked

out, or at least documented [hopefully]• Let someone else be the pioneer, or, at least,

pilot projects first.

Hunter and Ciotti’s disaster stories

• Do involve users in choosing the vendor– Nurses, physicians, staff, …

• Pay attention to staff training• But too many involved may be

counterproductive• Snow job by vendors

Hunter and Ciotti’s disaster stories

• Avoid cutting edge– Budget overruns– Bugs– Delays

• Don’t expect technology to solve all problems– EMR and CPOE can create new problems

Risky

• 29% of IT projects achieve “anticipated benefits” according to a 2004 survey

whether bad IT systems cause medical errors

• Two sentences on this• “… obvious design and implementation

problems indicating that medical errors are caused by human error, not the IM/IT itself.”– True, perhaps, in the sense that computers always

do exactly what they are told to do, unless there is a hardware failure.

– If that’s what is meant by “the IM/IT itself”

Examples

• http://hspm.sph.sc.edu/courses/J713/CPOE%20facilitates%20errors%201197.pdf

• http://hspm.sph.sc.edu/courses/J713/CPOE increased mortaility 1506.pdf

What is an IM Portfolio Management Office?

First, some terms:• Project– Temporary effort to get something done short-

term

• Project management– Planning, organizing, directing a project

Defining some more terms

• Program– A group of projects

• Portfolio– A “collection” of programs and projects

Defining some more terms

• Portfolio management– Prioritize projects and programs– Monitoring– With an eye to the overall goals and needs of the

organization

• Portfolio management office– Centralized organization to manage all projects

and the portfolio of those projects

The PMO is essential

• Because most projects fail• Isolation (“silo mentality”) is blamed, because

there are interdependencies, as shown on next slide

• (Are all failures of this type? – Their examples are of this type– But the articles above indicate problem of

centralization without knowing the user– Compare Ruth Messinger “I see you”)

IT Portfolio

What can happen if you don’t manage the portfolio

• New pharmacy system– Best of breed system– Not easily interfaced with electronic health

records system– Orders to pharmacy had to be printed and then

typed into electronic medical record

What can happen if you don’t manage the portfolio

• Switching phones from analog (old-fashioned regular) to voice-over-IP (sounds digitized, then carried using internet-protocol packets to receiver over existing network)

• Network switch problem meant no phone service to building

Advice

• Measure twice, cut once. More time spent planning means less time lost later.

• Like much in this book, it’s organizational behavior theory applied to IM.

Project management5 key processes

• Initiation – define and authorize• Planning – Objectives, methods• Execution – Do it• Monitoring and controlling – measure results

and spending ongoing, mid-course corrections• Closing – declaring that the fat lady has sung

Long list of project management knowledge areas, p. 102

• Initiation and integration• Scope management• Time management• Cost management• Quality management• Human resources management• Communications management(continues …)

Long list of project management knowledge areas, p. 102

• Risk management• Procurement management

• And cute diagram showing that, with a PMO, integration and quality go up, time and risk go down a lot, cost goes down

Project management software

• Several vendors, including Microsoft Project– Screenshot on next slide shows Gantt chart from

Microsoft Project– Henry Gantt was a management theorist from the

early 1900’s.

PERT diagram

• Program evaluation and review technique

Gantt chart

• critical path is in red• non-critical activities are blue and thin black,

with the thin black representing slack.

Dashboards

• Show all programs/projects so that they can be compared

• 2-D risk and value diagram• Portfolios also displayed by – Expenses– Category of resource use

• http://www.enterprise-dashboard.com/2007/10/30/dashboards-from-an-it-operations-portal/

Portfolio management office

• Communications– Project stakeholders with rest of the organization

• Management and oversight of programs and projects

• Staff to produce analyses that go into• The dashboard– http://www.google.com – dashboard portfolio management

Portfolio management 4 stages of maturity

• Ad-hoc– No formal, consistent, management

• Defined– Projects are known and listed (“inventory”)

• Managed– Projects are evaluated and prioritized• Financial metrics like return on investment used

– Regular reviews

Portfolio management 4 stages of maturity

• Synchronized– Frequent evaluations– Consistent assessment of return vs. risk– Scorecards or dashboards– Lesson learned assessments after projects

complete

Summary

• Lots of pitfalls for IT improvement projects• Most projects fail, at least partly• Identify cross-project dependencies to reduce

failure risk• A portfolio management office with a

dashboard can dynamically shift resources to most worthwhile projects

• [Do the dashboards show interdependencies?]

Web resources

• Online stuff, including• http://pmihealthcare.org• http://ache.org/SEMINARS/ontime.cfm link no

longer works