Why projects fail to live up to expectations
There are a number of reasons for underperformance and lack of innovation, including not using the right resources at the right time, and the failure to document the current process. A recap:
- Failure to document the existing process and its problems for vendors who have been engaged to automate a process. This is universally recognized as a key to success, but it’s rarely done without the right outside help.
- Failure to use information technology expertise to help the people re-engineering a process to discover what’s possible, and to truly innovate.
Two factors:
Cases in Point
Example A: Implementing a Large-Scale Web-based Workflow Management System
An Alaska state agency engaged PGS to define, codify and implement best practices in the issuance of six different kinds of permits. Six different permit processes and three different regional offices were involved. As you can imagine, that meant considerable differences in the processes. It also resulted in a lot of complaints – from applicants and legislators.
Using teams of employees who were involved in the work in the three different offices, we found a solution.
The solution: More applicant input; management via the Internet
This solution used an information technology (IT) enabler that made it possible to manage all the work via the Internet. It also called for the applicant to do a substantial amount of work on the front end. Together, these innovations streamlined the process and reduced state costs, dramatically.
The solution turned out to be very successful
In fact, the model and software application was ultimately implemented by other states, and worked very well in each application.
That’s the good news.
But it might have been even more successful
We also learned some valuable lessons (in hindsight). In this case, both factors 1 and 2, described above, were at work. The design of the innovative process, completed by teams of people who actually did the work in the existing process, did call for a Web-based workflow management system, but those teams had no access to IT expertise at the time. That expertise did not become available until later in the game. In defense of the state agency, it was not known -- in advance -- that information technology would be such an integral part of the design. But that’s often the case, especially where EHR is concerned. As a result, we lost considerable time and money.
In terms of EHR, information technology is always an integral part of the solution.
It took days to make up for this oversight. Weeks, really, if you include the time it took to get it all scheduled and to repeat the work we’d already done. We had to walk the
IT consultant through the entire existing process and point out its flaws, and then we had do the same with the new process.
Once oriented, the IT consultant was able to offer suggestions about how technology could be better applied to make even more innovation possible.An expensive oversight
I would estimate that at least six months and 30 percent of the overall budget was lost because we had not engaged the technology resource from the beginning. If the IT resource had been part of the teams, we could have made sure he was fully familiarized with the existing process and its problems, and the teams would have had the benefit of IT expertise in designing an innovative solution.
Example B: Implementing EHR in a community health center
The second case involves a CHC that selected and engaged a vendor to implement an EHR system. Unfortunately, the CHC had neither documented the existing system, nor had it sought appropriate innovations to address problems.
- Because it had not documented the existing system (factor 1), it lost time and expenses increased, because the software vendor was not "in the picture." The EHR vendor didn’t know what problems the CHC had been having, so it was a challenge to get a grasp on them. In other words, it took more time -- and cost more money.
- Because the CHC had not identified problems with the existing system and developed innovative solutions for them (Factor 2), it had no basis for:
- Increasing productivity
- Improving service to patients
- Increasing satisfaction of patients and staff
In effect, there was a danger of trying to automate processes that weren’t working at all, instead of considering a pre-identified solution and then seeing if the software could enable the identified solution, or even contribute to a better solution.
EHR investment could have produced much more
If the existing system had been documented by flowchart, and if providers and other staff had been engaged in a process to codify its problems and seek innovative solutions, the EHR investment would have realized a much greater return on investment.
Prepare for the unknown
Because the existing system had not been documented nor had problems and innovative solutions sought, the CHC team had to backtrack to reach agreement on how the process should perform, before it could ask the EHR provider to customize the software. While working with the center as it went through this process, it became clear that having the EHR consultant involved opened new possibilities for providers that they did not realize were feasible.
So, although the situation and the approach to this project was quite different from the first one, the project underperformed (meaning it did not achieve optimum improvement in process, and it exceeded minimal cost.
