The failure of “on-time and within budget”

Updated: Nov 5, 2018

A recent article in the New York Post leads with the headline, NYC’s $764M medical records system will lead to ‘patient death’. It further adds that sources have stated “sooner or later, it will crash,” “there will be patient harm — patient harm and patient death.” There are threats of firing, seemingly inevitable patient harm, and general catastrophic consequences, but the project moves forward. The source added that Dr. Ramanathan Raju, who runs the municipal network has threatened to fire top executives if the project doesn’t launch on time. What is happening here? How did it get to this? And, is hitting a date for the go-live the right measurement of success?

I have worked in the Healthcare IT industry for 18 years, starting as a systems analyst and in 2002 started taking on project management work, earning my Project Management Professional (PMP) certification almost 10 years ago. I have had the opportunity to manage EMR implementations at 6 different hospitals since then where I was responsible for scope, schedule and budgets reaching over $100M. I have served on the Project Management Institute’s (PMI) Healthcare Special Interest Group Board and earned my Master’s in Business Administration (MBA) with a concentration in organizational behavior from Southern Methodist University during this time. I am no stranger to the constraints and need to manage projects to meet delivery deadlines.

I would however, like to the challenge the edict that on-time and on-budget translates into value. Value for the patient, value for the health system or value for community. If that was the case, every project that was completed on-time and within the allotted budget, would be a recognized success. But, that is not what we see. Many projects that come in on time and under budget fail to deliver any value to the organization and in many cases result in black swan wreckage of the business. So, why are we so obsessed with on-time and under-budget? My experience tells me that it is simply because time and money can more easily be measured than value. Measuring the value of the project requries an understanding of how the initiative improves the strategic positioning of the organization, how it will enable delivery of better outcomes, how it will lower cost to provide those outcomes or all of the above. This requires a more thorough understanding of the linkage between the project and the value it is intended to provide. Failure to do this linkage is to simply bet that "if we build it, the benefits will come". A strategy that has repeatedly failed.

This can be done and has been done by many organizations, see Sentara Healthcare, HIMSS Enterprise/Organizational Davies Award winner for 2010, who did a reset of their EMR project, using the same technology vendor as NYC, due to not having clear alignment or understanding of the organizational value the project would bring. There are several others who have also accomplished this. It can be done.

Having a clear vision and clear understanding of what the intended value of a given project is meant to provide the organization is the only way to ensure this value is realized. These are the reasons Ellis & Adams developed the Value-Based Project Management Portfolio. Whether your organization chooses to use of this method or others, it is imperative to invest the time and rigor of defining and aligning the business value contribution of a project. Spend some time and paint a vivid picture of the future and how this project contributes to the realization of that future. Measure something vastly more important than on time and on budget — the value the project will bring to the patients, the providers and the health system. This is the only way to truly realize the intended benefits and stave off time and potential harm imposed by black swan projects.