IM/IT Portfolio Management Office
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IM/IT Portfolio Management Office

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  • 1. IM/IT Portfolio Management Office HSPM J713
  • 2. Portfolio Management
    • Context: failures
      • We want to avoid failures
  • 3. Learning objectives 1 and 2
    • What causes IM project failures
    • What differentiates
      • Project management
      • Program management
      • Portfolio management
  • 4. Learning objectives 3 and 4
    • Project management – 5 key processes
    • Project metrics and portfolio dashboards
  • 5. Learning objectives 5 and 6
    • The portfolio management office
      • Roles and functions
    • What actions or changes are needed to “reach the synchronized stage”
  • 6. 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
  • 7. 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.
  • 8. 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
  • 9. 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, …
  • 10. 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
  • 11. 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
  • 12. 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.
  • 13. 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
  • 14. 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
  • 15. Risky
    • 29% of IT projects achieve “anticipated benefits” according to a 2004 survey
  • 16. 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”
  • 17. Examples
    • increased mortaility 1506.pdf
  • 18. 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
  • 19. Defining some more terms
    • Program
      • A group of projects
    • Portfolio
      • A “collection” of programs and projects
  • 20. 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
  • 21. 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”)
  • 22. IT Portfolio
  • 23. 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
  • 24. 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
  • 25. 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.
  • 26. Project management 5 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
  • 27. 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 …)
  • 28. 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
  • 29. 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.
  • 30.  
  • 31. PERT diagram
    • Program evaluation and review technique
  • 32. Gantt chart
    • critical path is in red
    • non-critical activities are blue and thin black, with the thin black representing slack.
  • 33. 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
  • 34. 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
      • dashboard portfolio management
  • 35.  
  • 36. 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
  • 37. Portfolio management 4 stages of maturity
    • Synchronized
      • Frequent evaluations
      • Consistent assessment of return vs. risk
      • Scorecards or dashboards
      • Lesson learned assessments after projects complete
  • 38. 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?]
  • 39. Web resources
    • Online stuff, including
    • link no longer works