By Kelley Horton amp; Guy Beaver
The Premier healthcare alliance brings nationwide knowledge to improve local healthcare. It does this by providing solutions to collect and analyze clinical and financial data from its more than 2,200 member hospitals and 64,000 non acute-care members. By doing so, Premier unites a fragmented, chaotic and inefficient healthcare system to enable hospitals to provide patients with reliably high-quality healthcare at the lowest cost. Premier uses facts to determine the best practices and products that drive the best patient outcomes.
The Corporate IT PMO was created in mid-2006 and its initial focus was basically to get 'containment' on all IT project initiatives underway and transition them to a new release life cycle model that aligned with a new 'matrixed' organization structure.The PMO began to manage projects as part of a larger portfolio with dependencies versus many separate initiatives that frequently collided with each other.The IT organization began to mature into a project and process based culture.Projects were driven through a phased and partially iterative life cycle approach that resulted in several deployments, but usually with some level of drama along the way (SWAT teams, added resources, escalations to leadership and the inevitable finger-pointing when issues arose).Challenges remained, but there was now an approach to managing major pain points; the front end of the life cycle (priorities, initiation, alignment of teams), lengthy release cycles, cumbersome change control, minimal metrics and subjective status reporting.
In October 2008, Todd Wilkes, VP of Healthcare Informatics Application Development, shared some early successes his team was experiencing after introducing Lean-Agile principles and coaching from industry experts, with Bob LaPorte, VP of Corporate IT Application Development. LaPorte's interest was peaked and he decided to leverage the same experts to present an overview of Lean-Agile to his leadership team, which included directors of Application Development, Business Analysis, Quality Assurance, and PMO.
Prior to the Lean-Agile transition,Premier had been using a modified waterfall methodology with overlapping phases and a series of code drops into QA testing followed by User Acceptance Test cycles and then deployment. While having reasonable success, they knew there were many opportunities for improvement –
- Communicating status across a portfolio of more than a dozen project teams in a language that was not meaningful to Business stakeholders
- Prioritizing and working on items based on technical limitations and resource availability versus being driven by business value
- Escalations to senior leaders due to long release cycles or missed commitments
- Difficultly in tying budget spent to value delivered
- Cumbersome change management processes due to length of release cycles and shifting market needs
- Late feedback from customers on what was developed causing rework and deployment delays
Susan DeVore, then COO and now President and CEO of Premier, was challenging her employees to ‘think and act’ more like an enterprise. She was encouraging breaking down the walls of Premier’s business unit silos and working more as unified teams with common objectives to deliver innovative solutions that would ‘wow’ their hospital members (customers). The Program Management Office easily made the connection between Lean-Agile principles to Susan’s call and to the Core Values of Premier –
- Innovation =Understand what is ‘valuable’ to the Enterprise and let the Team find a way to deliver it quickly, with high quality and obtain early feedback.
- Passion for Performance = Eliminate waste, reduce cycle time, deliver high quality
- Focus on People =Respect, Empowered teams, self-managing, self-improving
- Integrity = Full transparency of all work through visual controls
In this particular instance, when it was apparent that the transition was to a system that aligns teams with disciplined practices to discover business-driven priorities for development, the PMOquickly stepped up and took accountability for driving execution and learning during the first pilot.The pilot Scrum Master was a senior program manager who had demonstrated a passion for empowering teams, with the required discipline to understand why the principles worked, and then trust and stick with a process.
It became clear that Lean thinking would provide a solid foundation to get various functional groups to focus on what was missing: clear prioritization of objectives and projects, initiating project work at the right