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Go-No Go

April 18, 2011
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Why my hospital chose to indefinitely postpone an EHR implementation at the last minute

To call me a bad project manager would be an understatement. My brain just does not think logically in that manner, and I bristle under the process. In fact, I would rather stick little needles in my eyes than PM a project. Of course, my own inadequacies make me respect the skills in others even more. Great project managers (just like great bedside nurses) have saved me from myself many times.

In our EHR implementation project plan, we had built in a specific “go-no go” decision point. This decision point was scheduled prior to the start of training as, once we were scheduled to begin training, it would mean the expenditure of a whole lot of time, energy and cash. Prior to the “go-no go date,” IT owners meet with all the business owners, review the current module and issues and obtain physical sign-off. This is an actual John-Hancock-on-the-paper, come-to-Jesus type of meeting, but in most projects, it is a formality. Most sign easily, though occasionally, I have had business owners just refuse to sign.

But most recently, they all signed…and then several picked up the phone to call me. The conversations all went something like this:

“I just signed off on the project but I am nervous about it. If I am the only one who feels this way, then I will work through it. We can add some staff maybe or just train really carefully…But Bobbie, there are a lot of work-arounds. It might not be safe, I am just not sure. It is going to be really tough.”

In other words, the proverbial death by a thousand paper cuts.

The project managers started to put all the “show-stoppers” on the wall on flip-charts. Some teams had no issues, especially the financial teams who were working on a more mature code set. The clinical teams, on the new code, had a lot of issues. Before too long, the flip-chart paper was covering the entire wall surface. It was clear to us four days before the start of training that class would be cancelled.

After extensive discussion, we decided not to simply push back the date once again. There were broad concerns that we needed to take a look at our enterprise vendor strategy comprehensively. We had been with the same vendor for a long time. A lot has changed in the last 15 months in healthcare, much less the last 15 years.

Much of the organization called IT and the Executive Team brave for pulling up so long into the project. I do agree that in some ways it would have been much easier to move forward; I'm just not sure it was all together fearless. We just followed the process.

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