Electronic health records systems and other information technology projects have moved to the top of the agenda at many hospitals and other healthcare facilities. However, the track record of such projects is not encouraging. Technology projects are often subject to high failure rates, extensive cost overruns, and wasteful delays. Even projects deemed "successful" often do not fully realize their promise or meet user expectations.
With an unprecedented number of technology projects planned, underway, or anticipated, the challenge for healthcare executives is not only for projects to be delivered on time and on budget, but also that they meet real user needs and remain relevant even during protracted development cycles that could encompass years.
We faced that challenge at Texas Health Resources when we launched an EHR project in 2005. With 14 hospitals, 18,000 employees, and 3,600 physicians who practice on the medical staffs, Texas Health had an enormous paper database that needed to be converted. At the same time, we needed technology, processes and procedures that could be easily and efficiently used by physicians, nurses, admissions, and other staff.
We benefited from a strong internal project management process that kept the implementation on course. We also found that it was equally important to look beyond the technical execution to how the project's objectives were being met. We repeatedly learned that a critical factor in keeping a project not only on track but also on mission was strong leadership in the form of an executive sponsor.
The EHR project, like others now underway, benefits from a senior management official who "owns" the project and is responsible for making sure that it achieves its value and user expectations. An effective executive sponsor is necessary in complex organizations such as ours, with intersecting organizational charts, overlapping responsibilities, and key stakeholders who are not employees and may have conflicting priorities.
An executive sponsor can improve a project's chances for success by providing leadership, direction, and problem-resolution skills. The ideal sponsor alternates between advocate and arbiter, manages upward and downward, and can clearly communicate the value of the initiative to the business side of the organization.
It is important to recognize that executive sponsors are not meant to replace project managers. Sponsors' focus should be on the bigger picture not on day-to-day implementation and decision-making. The sponsor should complement the project manager and provide the resources and senior management attention the project needs to succeed. Sponsors should also serve as a guide to the project manager, ensuring that the product will continue to be relevant to end users even after the "go-live" date.
But appointing a sponsor is not enough in itself: Organizations must select the right person, with the right skills and authority, and empower him or her to make the necessary decisions to maintain project agility and progress. Here are seven attributes we, at Texas Health, learned were important when selecting an executive sponsor.
Choose a sponsor who will drive the project as a clinical and operational initiative, not as an IT engagement. The temptation when selecting an executive to oversee a multifaceted information technology project is to look for someone capable of understanding the technical aspects of the job. Understanding the intricacies of a project is important. But even more crucial is an ability to recognize how the project fits into the organization's business and its core function of providing care for patients. All too often, technology managers lose sight of the bigger picture and go off track, wasting resources, and ending up with products that do not meet real-world needs. A good executive sponsor, focused on the operational and strategic aspects of a project, can help keep management on track.
Appoint the person, not the position. The choice of executive sponsor should be made on the basis of interest, personality, leadership skills, knowledge, and even availability. A more junior person could be valuable if she or he has the energy, the time, and the commitment to be more than a figurehead. At the same time, the sponsor must be of high enough rank that he or she can command the attention of those higher and the respect of those lower in the hierarchy. Ideally, the sponsor should be someone who understands the project, believes in it, and can champion it effectively.
Identify sponsors early. As a large and complex organization, with 13 acute-care hospitals and one long-term care hospital, Texas Health has a sophisticated governance system with a rigorous budgeting process. Major, resource-intensive projects, such as many of those involving information technologies, are often assigned executive sponsors during the budget process. Even smaller projects are routinely assigned sponsors, although not necessarily at the executive level. Having a champion early on in a project's gestation provides important support during budgeting that translates into a greater likelihood of approval and receiving adequate resources.
Begin oversight immediately. In order to ensure that projects are moving in the right direction, an executive sponsor should work closely with project management from the initiation of the work. This includes establishing user expectations, setting milestones, agreeing on reporting procedures, and putting in place a regular meeting schedule to review progress and share information about any evolution in project needs.
Build a deep bench. One way to balance the concerns of competing units within an organization is to appoint one or more associate sponsors--other well-qualified individuals who are connected to the overriding mission driving the project, but may be of lower rank. The associate sponsors can, even in a subordinate role, articulate their organization's interests, and can be leveraged for political reasons. This can provide an appropriate role for technical experts--chief information officers, chief medical information officers, and others. This also builds a deeper bench of talent, preparing individuals to step in should the executive sponsor be preoccupied with other demands or leave the organization.
Make sponsors the eyes and ears of project management. As projects get underway, managers can become ensnared in the daily details of implementation and lose contact with the needs of their internal clients--the end users of the technologies they are putting in place. Sponsors need to work on fact-finding, meeting with physicians, nurses, admissions officers, billing and coding clerks, et al., to make sure that the project continues to be aligned with the expected value. This is especially important in fast-developing fields such as information technology, where the industry's capabilities are constantly increasing and end user needs change frequently. For example, a medical coding and billing system that does not include an ability to adopt the forthcoming ICD-10 standards will be dead on arrival.
Encourage sponsors to take full ownership. In large, complex organizations with multiple stakeholders, it is understandable for senior executives to defer to one another when their interests conflict. While such collegiality is understandable, and even desirable to a point, it also can result in stagnation with progress slowing to a halt as any and all concerns are addressed. Executive sponsors need to take full ownership of their projects, remembering that their loyalty must be to the project's end users, not to any individual department. They should drive their projects forcefully, lest they be pushed aside in favor of those with more aggressive champions.
Healthcare organizations must remember that technology is not an end in and of itself. Instead, it is a tool that helps staff do its work more efficiently, safer, and with higher quality--whether that means doctors and nurses in a clinical setting, admissions and clerical staff in the front office, or administrative and billing staff in the back office. There have been many successes and failures in the implementation of EHRs and those that do demonstrate success are clinically and operationally driven projects--the executive sponsor should be chosen, and act, accordingly.
The senior sponsor will want to leverage industry best practices. Opportunities exist to learn from other institutions, hire and acquire talent that can bring leading practices, and have independent and knowledgeable third parties provide guidance. At Texas Health, we took advantage of all of these and saved ourselves from some missteps that might have occurred without this expertise. For example, we engaged PricewaterhouseCoopers to do periodic quality reviews of our EHR project.
In the end, the executive sponsor should ensure the project meets its value objectives, enables the users, and that the necessary resources, budget, and project governance are available and functioning. Project managers can be responsible for seeing that projects are delivered on time and on budget, but the executive sponsor needs to ensure that, in fact, they meet the organization's business and strategic needs. The sponsor's role, therefore, is cross-cutting, including not only oversight of technology implementation but also of the organizational and process changes that come part and parcel with major system changes.
By taking full ownership of these projects, executive sponsors accept responsibility for keeping the projects on track to generate the expected results for the affected clinical and administrative processes. Such accountability, even if informal, is rare in many organizations today. Because of that, it can be enormously empowering, giving sponsors the internal credibility and influence to successfully deliver results.
Stephen C. Hanson is senior executive and vice president system alignment and performance for Texas Health Resources. He can be reached at 682-236-7900 or 1-877-THRWELL. For more information, visit www.texashealth.org.