Enhance project pipeline management for Healthcare

How to create outlook signature

thank you everyone for joining us for another learning lunch hosted by format approved my name is Brian Johnson I'm the senior director of online education with Foreman approved and I'll be your moderator today 's learning lunch title is winning at Healthcare through project portfolio management today's learning lunch is sponsored by integrative project management IPM has led over 3 500 projects at more than 300 clients in healthcare and other Industries we thank them for sponsoring today's event and encourage you to visit .ipncinc.com to learn more we're joined today by Richard Panico the founder president and CEO of IPM Rich has a wealth of experience in project management and health care and we're pleased to share his expertise with you today before we go on thank you for joining us today rich well thank you I'm looking forward to uh to the discussion and hopefully sharing some of the kernels of our wisdom with with the listening audience this morning all right great well let's just go over some quick housekeeping notes before we get into the presentation and we'll let the audience look at the questions we're going to address today but before we begin just some quick housekeeping notes like I said remember that you can ask questions of our presenter at any time during today's session by entering them into the chat area we'll usually hold those questions until the end of the presentation and then we'll allow our expert to address as many questions as time allows if we do run out of time don't worry about it we'll submit all of those written questions to our expert and he can get back to you in writing also remember that all registered attendees of today's session will receive an email with links to both the slides and the recorded version of the event so people are always excited to get their hands on the slides don't worry about that as soon as the event is over we'll send those materials out to you and you can share them with other people and review them for yourself all right well let's get to the presentation then and let's address our first question what are some key challenges for today's Healthcare leaders well I can tell you certainly are plethora of challenges and I'm sure that all those who are online have their own long lists but these are some of the things that we've certainly seen in the in the past 27 years and looking at various Industries but specifically Healthcare in the last decade uh the the amount of competition is has increased tremendously of course regulatory requirements there's this whole Aura of continual change in in uncertainty that just is kind of enveloping the whole industry uh certainly Acquisitions and consolidations we're seeing a whole bunch of those kind of things I can share with you that our own health care Advisory Board consisting of of some CEOs from hospitals in the Chicago area when asked the question uh three years ago on our board meeting whether that there would be a a Resurgence or an emergence of private equity and for-profit challenges within the industry none of them of that time thought that that would be the case I can tell you a couple years later asking the same question that we're all very focused to the impact that private Equity would have as well as the for-profit entities within Health Care additionally we have you know the Dynamics associated with consumers who certainly are much more inquisitive have access to so much more data which has raised the competitive bar for competing Health Care organizations and it's something that I I really want to point out is this failure to identify the point of inflection and simply what that means is that if we look at the trends going back even even 10 years or so ago it would have become pretty obvious that Health Care would be faced with major changes in if those models if the models did not change to be able to accommodate the the changes in the in the markets in the consumer consumers understanding of the services and some of these other factors that are identified here that they would fall behind and ultimately have a greater greater difficulty in competing so what other Industries has seen these challenges already and what was their response well interestingly enough I had pointed this out at a conference just a year ago to uh to 26 Hospital CEOs and I had pointed out uh what you know what our are some of the uh the challenges the ones that we had just covered and I asked them if this sounded familiar and they said oh absolutely this is Health Care well my next slide identified that that those those factors the factors we just covered were not at all Health Care they were the auto and Steel Industries issues uh in the period from about 1975 to 2000 and if you look at at those Industries particularly the Auto industry you'll see a great similarity in the challenges faced by that industry and what health care has has and will be experiencing probably over the the next decade some of those include you know quality and recalls the automobile industry at 1975 to 85 tremendous number of recalls and in in healthcare we've got the corollary with readmissions and how critical it is that we address readmissions so and you know back in the auto auto and steel industry there was a a an influx of total quality uh being introduced to those Industries to help them really address quality as an ingrained process as opposed to something that was a check at the end of a process so really embedding Assurance of course that was Associated was also accompanied by quality circles later Six Sigma lean Six Sigma and we certainly have seen Health Care particularly over the the last I would say five to seven years undergo a similar transformation by applying particularly Six Sigma methodologies I can tell you that even as uh as as recent as probably seven years ago so when we were trying to introduce Lane lean Six Sigma methodologies to healthcare Executives there was a significant reluctance to employ what they believed was not uh was was not a process that could be effective within Health Care they viewed those as as processes that applied to other Industries and as you know and I'm sure our listeners understand that now lean Six Sigma is really the proven methodology within Healthcare to to improve efficiencies but some of the other uh some of some of the other challenges increase regulatory requirements for the automobile industry and steel industry it was EPA and OSHA I mean the the number of regulatory requirements that bombarded those Industries During the period of uh from from I would say late 1970s through mid 1990s a tremendous amount of capital was spent as well as cultural transformation to be able to to get these organizations to prepare themselves for new standards and of course we're saying similarly in in healthcare with CDH and and FDA and Medicare Medicaid some of the changes uh that have either already been implemented or those that really are being anticipated that are going to require both cultural and process changes within these businesses you know and lastly probably the most difficult for I think some of the healthcare leaders to accept is that the many of the business models that were established for Health Care were established you know five six decades ago and one of the advantages of the private Equity groups have is that they in effect are starting with a clean sheet of paper and they're designing a business model that is relevant under current and anticipated conditions which is much easier than taking an existing model on existing culture and trying to evolve it and we'll talk a little bit more about you know how you do that but these I think it is critically important for for particularly the healthcare leaders to not only look at processes within the model but also look at the model itself to make sure that these models truly are going to be applicable applicable and efficient to address current state and future State challenges and opportunities all right well how are Healthcare organizations then responding to these challenges well on the positive side I can tell you that again particularly over the I would say the last five to seven years it certainly has been a a a very uh strong and positive response I mean part of that is kind of a Do or Die mentality in in some cases it is just that Health Care specific systems and independent hospitals have really been strapped with tremendous challenges nonetheless of which are just Financial liability so some of the things that they've done uh that certainly have been good is addressing performance and process Improvement I had made mention to the the application of lean lean Six Sigma I will tell you that earlier on many of the hospitals actually placed a greater focus on Six Sigma which is primarily you know an approach to improving quality uh of course involves a lot of analytics and statistical process control uh that unfortunately I think that some of that influence has died off with a priority to implementing lean approaches and I think that's most appropriate because I think that that will be most effective as organizations really look to to hone their efficiencies uh the the other things that we're seeing discovering portfolio and project management and we're going to be talking a lot about this as this as this presentation uh our discussion proceeds but the project management portfolio management is is late to be discovered within Health Care compared to the other Industries specifically the portfolio component of it which I'll be getting to in detail and I will make a case for the criticality of portfolio management and project management because they are both absolutely essential to effect change to assure execution and as we know the greatest strategies in the world produce little and no value if you cannot execute and sustain performance also one of the more common approaches to dealing with major issues are for for independent hospitals and Hospital Systems to to combine so you see these consolidations that create larger scale um I'm probably not as optimistic as as many that this will have sustainable positive results because if you study again the the experiences in history associated with other Industries like the Auto industry like to steel industry we saw a plethora of of this type of activity with organizations as an example Chrysler with uh with jaguar and um I mean I'm sorry Ford with Jaguar Chrysler with Mercedes we saw some of the uh some of the model lines going away but in effect creating larger scale and that can be an outstanding strategic approach however it also tends to to hide a lot of sins and inefficiencies so larger scale is is not always a good solution and you know my recommendation for those who have chosen that path is to make sure that there's a focused optimization and assuring that the assumptions assumptions that drove that scale are pursued with Vigor so that those leveling up leveraging opportunities truly are realized and of course service line rationalization in all Industries is critically important I think it organizations have to decide what they're good at focused to those things make sure that they're generating you know those those margins from the revenue from from the from the revenue stream before they decide to expand service lines um in in an adopt a new new approaches and processes to serve potential new customers on the not so good size of course all organizations tend to focus to tools and can you give me a tool we're often asked well can you give us a process and when in effect the the organizational change component the culture uh and the the Inhibitors around cultural Tendencies you know are not provided sufficient Focus uh resistance to change I already mentioned some of the resistance to the early introduction of of lean lean Six Sigma some resistance that we see to portfolio management today uh that certainly does does nothing but further exaggerate you know the the impact of of current challenges and something that I I would expect that the the group online is is interested in is this whole concept of dilution and we see this not only in healthcare with so many organizations that treat everything as a priority yet they have processes in place that are in effect supposed to effect a product prioritization of of workload specifically projects so what they end up doing is you know applying this concept of level loading either by Design or by default which means that you take on more things and you spend a little time on all those things which means that those projects that could have a real immediate impact in the organization have realizable benefits that end up being way Downstream besides the effect that this has on on organizational performance it can be a tremendously demoralizing to organizations and something that we often speak to and I'll jump way to the end here and and this concept of never finishing the last five percent which seems you know like one of the minor points here but I will tell you so many organizations suffer from this from this compression the impact of compression and they move on to new project and yet the organization has not been left with a sustainable process the adoption curve still is is on the upswing which makes it very very vulnerable to failure so you know my my advice to those online is make sure that at last five percent of a project is completed that means that it's operationalized there's sustainable momentum and that everything is in place so the organization can truly benefit from the ROI the payback that was projected that's a great point and I also everything is a priority making nothing a priority is certainly a good advice to offer people there when you um when you talk about making an effective response what are the key ingredients to doing that well I think that the uh and let's walk through these I mean first first of all my advice when I had the opportunity to speak with Healthcare Business Leaders and others because this really applies to all Industries is you know really face face the facts and what is the state of the business and let's not reject you know the reality of the situation if things are bad they're bad and it's a good start starting point it's like the alcoholic of realizing and admitting that he or she has a has a problem and I think it's it's true with business as well and I think once you've done that you have the opportunity to to truly go through an exercise to really determine you know what are the uh what are what are the the highest threats to to the business and what do we have to do what what can we do in order to to impact these these threats and these opportunities which then leads to a great challenge for management and that really is identifying you know the Strategic priorities now again trying to drive organizations uh to those things that are going to have the greatest impact within the time frame that that is required you know establishing this list of strategic priorities and making sure that the associated initiatives with those priorities are understandable understandable at all levels within the organization so that context can be created around these important initiatives now if we load all of those together we establish what we refer to as a a project portfolio and if this is done right and I think further on in the in the discussion here we'll look at the relationship between strategy and portfolio but if this is done correctly you should be able to draw direct lines from the company's overall strategy and those those threats and those opportunities you should be able to draw a direct line between in correlation between those the list of projects and programs that compose a project portfolio the uh you know at that point in time you're probably 30 percent there and I say 30 percent because as I said earlier you know nothing nothing matters if you can't execute and this is where project management and change management become critically important and we're seeing this this Evolution now occurring in healthcare where there's greater acceptance of project management I think there certainly is a recognition for the importance of of change management I believe where many organizations are still missing the boat however is making sure that they are that they are Staffing this discipline appropriately in my estimation the skills required to be able to do this well are the same skills that are required to lead any department requires extraordinary amount of leadership understanding of of process and application of process you know uh and and Leadership being the key and then rapidly executing and completing projects uh you know the focus on rapidly I think organizations are are inspired and energized when you do things quickly precisely and efficiently and and get them 100 percent done as as I had made reference to earlier and of course embedding a a process Improvement uh component to it learning from from those things that were done well and those things that weren't done so so well but in the end it's against focusing planning you know having an obsession with execution embedding change management is appropriate and then making sure that you're getting the return too often we learn that organizations aren't going back and really measuring whether they got the value that was intended on measuring the ROI and Payback so how are strategy project portfolio management and project management intertwined why did uh alluded to this uh a little earlier uh but this this diagram I think explains it I don't need to go into too much of the detail here but the portfolio should be born out of and supporting directly the strategy that is established by the executive team you know I think most organizations do a good job of understanding you know what the threats and opportunities are in developing a strategy or Direction uh I think that that many of them as they try to transform strategy into kind of the portfolio of programs and projects start to kind of lose lose focus and structure to it but the portfolio again you should be able to draw direct correlation between the portfolio and the list of programs and projects in the portfolio to that strategy and I'll go a step further to create real context for an organization and to be able to have or to drive toward a high performing organization that is extraordinarily flexible responsive which is certainly the key to survival and then high performance in healthcare and in any industry I think that context has has to be created by you know engaging the individuals through whatever performance process is put in place for those for those people so that they can draw a direct correlation between that strategy to either projects programs or if not through their job responsibilities back to that that overall that overall strategy so what is Project portfolio management then well I would I would expect by now that that most on the line already have an idea of what it is but the bottom line it's about taking you know that list of of the most important projects and programs and giving putting them into a an organized repository uh it's simply about making sure that the organization and its capacity and capabilities which also includes you know their their their their their their funding abilities or the resource capabilities uh you know their process capabilities focusing those things to the projects that are going to have the biggest impact you know on on their future and of course uh you know project and Port project and program management subset of that portfolio management and and key to all of this is making sure that you have an effective Resource Management uh process that is embedded why is portfolio management then a critical core competency okay well I think it uh certainly the simplest and most uh impactful reason is you can't do everything no organization can do everything although so many of them try to do everything the the best bang for the buck is to do those things that encount most uh it's it's you know making sure that you're deriving value from those things that are going to have the greatest impact on an organization this depiction here that that is titled the value of project portfolio management certainly helps really just describe this describe why this is so critical because you've got this you know this fear that we call realized value and what is done there really is is the derived impact of doing those things that are going to have the best impact or the most positive impact on an organization so as you uh easy to understand here that if you improve project portfolio management your realize value is going to increase significantly I think something that that organizations feel and feel immediately when implementing a good portfolio management system is that one there's much more clarity around what's really important you diminish this dilution that is a killer in performance even high performing individuals given too much to do will ultimately begin to compromise in performance will deteriorate that's true at an individual level it's and it's true at an organizational level what are some fundamental project portfolio management disciplines any health care or manager should employ well when we I talked about strategy and it is very very important uh that I think the executive leadership uh realized that the greatest benefit is in aligning the organization and those things that are most important particularly since uh what we are describing here are projects in addition to work that's being done every day so core responsibility uh managing you know the clinical and operational components that kind of keep the doors open and also take care of take care of our patients so these are things that are in addition to those so it makes it even more important that the entire organization is a line of these things something that we we often see use the word compromise is the the justification and business case for for many of the projects that are identified within the portfolio whether it be a formal portfolio or not I can tell you we've had experiences where we've been asked to come in and submit you know a proposal to manage a particular project and we've asked for the specific business case that would help us understand you know the the rationale why are we taking this on and it has really I've been amazed at how often there's not a formal written business case which would make it virtually impossible to prioritize a portfolio if there are not specific business cases in in and more often than not these don't have to be extraordinarily complex I mean it's a correctional for for undertaking these initiatives I think that is really really important and a great place to start it even if you don't have a portfolio to to make sure that these business cases are are clearly defined so the expectations and outcomes are clear developing schedule on budget estimates you know some organizations are better than others at doing this but again more often what we see is a dictate on when something should be done without you know reference to what it will take to get something done so it's a it's an imposition often uh not really uh uh associated with any particular justification to the the schedule or budget and I would say that that's more predominant on the schedule side as opposed to the budget side again we've we've walked into situations where we were told well this has to be done by such and such a time frame and in pushing back and trying to understand it it was really Warnick an executive dictate based on either a perception or a a want as opposed to a need with a corresponding rationale behind it another concept that we're trying to influence more as as uh you know we work across the healthcare spaces this understanding of of opportunity costs in many Industries uh this is real uh the the CFOs and the you know the finance people uh certainly influence Focus to what is the opportunity cost in other words if a project is not done with any certain certain time frame you know have is is there a real cost to it a good example would be if they're let's say there's a new service line uh and an Associated Revenue stream that's been identified for for every day that that is not in place there is a cost it's a true opportunity cost uh the understanding opportunity cost often helps justify either getting additional resources on projects or providing you know uh the capital expenditure that is needed but it's often not not addressed or not addressed significantly to influence sufficiently to influence to influence executive management resource requirements assessment of resource requirements I already spoke to dilution organizations are well served to to begin to understand what the magnitude of of uh of of Manpower required in order to to get a project or a program completed but then looking at the entire organization devoid of being able to communicate in some way to Executive management what the resource burden is uh allows management to continue to assume that there is a bandwidth and again I would guess that many on the line have been uh you know certainly been I'll use the word victims of of this kind of mentality where where well no one's complaining or there's nothing to inform me that our organization is at full capacity so instead of instead of re-establishing priorities and balancing workload and maybe deciding to not do some things or stop doing things that are less priority things just keep getting added added to the plate and an assessment of risk I mean there are some some very good uh logical approaches to assessing risks within the portfolio within individual projects I think understanding clearly what the risks are associated with with any project provides great insight to the executive team as well as to the the project manager the individual who is going to be leading enough for it allows he or she to also put in put in place the risk mitigation measures that will lend toward a greater probability of of success Brian so what are some fundamental project management disciplines any Healthcare Executive or management should imp managers should employ and I'm sure that this will align well with what you're just describing well the uh and this is focused to those who are managing projects we often don't think about project managers having their own portfolios but they do because more often than that when when uh you know when we are meeting with clients they will ask us well how many projects do your people manage uh that really is somewhat of an absurd question because it really depends on the magnitude of of the projects being planned and executed by the project manager but I think that project managers within Healthcare environments would do themselves a great service by kind of understanding their own portfolio and even if the organization itself does not have a portfolio management process one way to kind of influence and effect change within that environment is to take the projects that you are working on as a project manager prioritize those based on the information that's been provided to you information associated with alignment to the Strategic priorities of the organization and if you can't do that I think you need to ask questions around some criteria development of criteria that would allow you to prioritize your own portfolio and then you know create the business cases if they haven't been created even for existing projects and and then of course following some what I'll call very classical tools doing doing a resource assessment of how many hours or days or or weeks it's going to take to undertake a specific project what are the risks what are some of the other resources that need to be involved so in effect that you're creating these kind of mini portfolios under the under the uh the the the the the the the the organization's uh strategic portfolio you're asking questions uh I think you know again I alluded to this you know what is the Project's business case how does it tightest strategy and uh as as obvious as it seems too often the question of of what does success really look like that question is not asked and puts project managers in a pretty precarious uh pretty precarious situation if you do an outstanding job hitting the wrong target with great accuracy and uh you know even early in my career I I always made it a point to to try to put myself in a position where I did now I'm not allowing Executives excuses for uh really communicating very clearly what their expectations were so they don't do that I think it's incumbent on on the project manager to do that you know we talked about identifying and managing risk we talked about you know completing a project 100 percent and critically important within Health Care particularly during this you know these very turbulent times because organizations as as I alluded to already it's it's not enough to improve processes we we have to look at at the model the culture and there are cultural tendencies that are debilitating and you know we're truly going to evolve this industry in a specific hospital or system we really need to understand the change management components that need to be embedded integrated into the project plan if the results are to be sustained Brian so when is change management then when is it optional and when is it absolutely essential well great great question and uh you know I had been preparing for this and we we have a change management center of excellence and you know we're continually looking at you know how to evolve our own ability to help organizations through critical change but I would say it's essential when when human intervention those things that require the involvement of people as opposed to you know just the kind of Technology doing its thing when that human intervention is being modified from long-established normal Tendencies it's another way of looking at this is when it impacts uh that the habitual components of our roles and responsibilities uh that's that's uh I think that that requires change management in order to be able to to influence adaptation and and adoption values and policies uh when when these values and policies are influencing behaviors change so if if a project clearly is is it going to be making a change or influence saying what the organization has communicated as as its core values or policies those become very personal to individuals uh it's it's you know we're changing the rules of the game and we're changing rules of the game they need to understand why how it affects them personally you know if we're talking about changing the business model or organizational structure you know where we're talking about either new roles and responsibilities uh changing responsibilities within the roles of individuals uh then I believe clearly that change management is essential and boy I tell you if there's one that really is critically important when it impacts pay and position that is extraordinarily personal so if the if if what you're implementing within an organization has the potential impact someone's pair position security and their role critically important that they understand you know why this change is being undertaken and uh specifically you know what impact it's going to have on them and I would say uh you know when when is change management optional well if I'm the person that's uh that's introducing a change and it only affects me and there's a business justification for it no change management is uh is required or if a group of us decide that we're going to look at a particular process we want to improve it it impacts our roles we are we are the stakeholders we are the sponsors no need to do anything dramatic from a change management standpoint I'd say another situation is when the the the benefits the obvious benefits from the chain exceed whatever adaptive impact there is so if I have to learn new ways of doing things but it is so obvious that I am going to be a key benefactor then there's probably a little reason to introduce a change management process um and when when there's no skill enhancement required that could be another potential scenario where change management is is not is not required and maybe it's a process somewhat ancillary to what I'm I'm doing uh so in that case there it's a it suffices for me to just understand uh that we're making some changes it doesn't impact what I'm doing it doesn't impact you know the skills that are required for me to continue to do my job well all right well we got through our presentation right on schedule so there's plenty of time for questions from the audience please feel free to follow up that was a lot of um fairly complicated material although I think Rich did a great job of presenting it so do feel free to ask questions of our presenter if you have them and there are some that I can share with him already uh one of the questions we have rich is what are some good strategies for assessing resource requirements yeah that that clearly is a very very good question it's one that's asked often of us and I would say that uh you know the starting point is to estimate what it's going to take in order to achieve a particular objective or project in in this case and there really are no shortcuts to it for those online who will understand the concept of a work breakdown structure that is really an identification of the activities uh and then in the beginning those those prime prime activities so it doesn't necessarily have to be in a microscopic format but what are the key activities that need to be undertaken and buy home in order to accomplish an objective very difficult to do this without experience but for those online who have a responsibility for a project and they have not had experience doing a similar project it can still be done what you do is determine which resources have experience managing or being involved in some of the activities that you've identified as important to achieve an objective and then it's a matter of adding up you know the the hours and days that have been estimated for those activities along with the composition of the team summarizing it and determining the resource requirements for that endeavor but then adding that to others if we're talking about a portfolio you would have to look at at this the cumulative impact of all of these estimates on on resources and this is where prioritization becomes critically important now I will tell you in my days with Johnson and Johnson as the chief engineer for one of their divisions and I know that this is done in a lot of industries that we always refer to above the line and below the line and above the line meant that these are the projects that we could manage effectively with the resources that we have and it would be this big red line whether it be on a capital and expense summary or or in a in a overall company portfolio and would drop below the line uh would not be done unless Executives provided additional head count either internal or external or they de-prioritize a project above above the line I have not seen this happen effectively in health care yet I can tell you that it will happen It ultimately will happen and and the trajectory is certainly headed in that direction yeah I wonder along those lines if you could tell us more about your experience with Healthcare organizations trying to do everything you were saying that they probably or at least they pretend that they're prioritizing everything and the result of course is that nothing is truly prioritized or that you just sort of accept you know a not very well considered priority uh list can you tell us more about what you've seen in that area and um why you're hopeful that it's improving okay well I'm going to share with you a very recent experience with a major system we were brought in to help them develop portfolio management process but in in some of the uh the preliminary discussions uh leading to the engagement we learned is that their entire executive team a group of over 20 individuals all went through extensive training is very expensive it was remote from their facility and the whole purpose was for them to be taught portfolio management fast forward two years later we're called in to help them with portfolio management and as we kind of learned the history what we discovered is what we often often do discover it's not that they had a bad process but the failure was an executive compliance and let me be very clear and specific portfolio management does not work without executive compliance a key two prioritization is for the executive group to Define criteria that drives prioritization um pretty easy to plug plug in those considerations once they're defined to determine how projects rank however uh as a function of their roles Executives have to apply discretion based on changing conditions uh it is it is a it is a key responsibility within in the role however what we learn in this situation and we've learned in every situation where portfolio management has failed is that the discretion becomes something that's applied in every situation so before long the The credibility of the considerations evaporates totally in the organization goes back to trying to to manage based on input from various Executives and what they believe to be the priority at any point one point in time so the instead of taking this this Matrix of executive leadership and creating a system that harmonizes based on those priority considerations you end up having silos with individual priorities and just wreaks havoc on an organization so I hope that that answered your question yeah so then things just get sort of tugged back and forth in different directions without any kind of Rhyme or Reason to it yeah very critically important for the executives to again to buy in and and apply discipline to the process again understanding that there will be exceptions but one exception is because the norm that becomes the process regardless of what stage gate you put in place or any other process before you emphasize the importance of having your ju your justification or your business Case established as kind of the first step I wonder if you could expand on that and give us a typical example of of you know a scenario that a healthcare organization would face along those lines I again I can share one that that was real and probably goes back about six months ago where we I received a call from CF open organization um looking to uh to have us uh plan Outsourcing several of the service functions within the hospital they had recently undergone you know a merger and so we met with the in the with the the CFO directly and I asked for a copy of the business case I wanted to understand we wanted to understand you know what were the assumptions uh that led to this being a good idea for this organization now I will tell you we had in our background you know experience with one of our clients who had already done this and who later within within a few years later ended up insourcing many of those same functions again um and the the CFO was embarrassed to not be able to provide me with the business case and there tends to be a there there's a tendency and this is not specific to health care but most industries that are undergoing you know great change and challenge to to follow others and uh you know there's so you develop these Trends based on what others are doing they're not always good or not always good for you what may be appropriate for one organization is not necessarily appropriate for for another um and in in the end this case that I'm referring to it never went forward because based on the questions that we asked the the initiative was just put on hold and I believe it is still still on hold I just don't know but in that particular case by us asking for the business case why does this make sense uh what do you hope to achieve if there are savings what are the savings what are the risks uh how are those risks going to be mitigated unfortunately those those questions weren't asked and were not addressed that's really interesting because uh I think that you're absolutely right that people tend to follow what others are doing so there's almost a you know if you're having a merger then of course you're going to Outsource a bunch of stuff but I've heard from so many uh I've seen so many examples where companies do go through this they Outsource and then after a couple of years they realize that the mistake and they insource again and all of the money and upheaval of that is is basically wasted true true and you know it it may be uh you know in some cases uh the Outsourcing may have been a good idea but the parameters are performance parameters uh were not defined clearly uh we see this often too where uh what we refer to as the governing document was not created you know by the requester it was uh it was provided by the service providers on the fact they're writing their own contracts which is something that we certainly uh Warn and try to discourage you have to identify what you believe your needs are and often you know it's not a matter of writing specifications in the in the real sense of specifications but again identifying the performance uh the performance expectations of the service provider and that can be done in in business Language by those who know the business best and that is uh you know the hospital or the system here we have a question about opportunity costs which you touched on and the question is I thought opportunity costs meant that you're not able to do something because you've taken on a project but you talked about it differently is that understanding correct or or what would you say to explain opportunity costs better would you please repeat that they were saying that their understanding of opportunity costs was that it means you can't do a certain project because you've already committed to another project but then they thought that what you were saying was a different definition of it well there certainly is an opportunity cost associated with what you just described if you can't do one project because uh there there is another one there you know there's an option the option is to bring on bring on more resources if clearly there's a benefit you can plug in with the cost of that additional resources and state see if there's still you know a a a a a benefit based on a positive variance associated with with opportunity with opportunity cost but at any time that well let me let me give you maybe a different example all right uh often you know organizations will decide to stretch the organization to get something on takes a longer period of time to to to get the project done and in some cases it may maybe uh significantly longer than it would have taken any benefits that would have been realized from that undertaking are going to be postponed whether they be you know Financial whether they be quality related or or other there are not good mechanisms and my point was they're typically are not good mechanisms within health care that measure those things so that when executives are either diluting the organization by asking them to do too much or when decisions are made to not proceed with a a certain project that there can be a a rebuttal based on some real measurable positive business impacts do you see them and you've alluded to this throughout that do you see more of this Quantified approach coming to health care and it sounds like these are kind of encouraging times that there is more of an analytical approach being taken by Executives in healthcare yeah it absolutely will happen uh you know the the there's a a curse and a benefit to to experiencing tremendous Market challenges the curses you you either become very proactive adaptive identifying what needs to be done and you get at it and you develop a competitive advantage you know or you wait for things to go back to what they were which will never happen and you just die uh the in-between Point uh we see a lot of that happening within the healthcare Arena where uh there is the decisions are postponed postponed postponed or say the response is postponed up until there's no decision to be made when the only alternative is is to be acquired or to worst case scenario to shut down an operation but it will absolutely happen yeah there's unfortunately sometimes decision by not making a decision is the way people go before we conclude we've got just a few minutes left could you tell us more about how IPM is able to help Healthcare organizations cope with changes because this is the source of your expertise and I know that there must be people on the call who would like to learn more about what a company like IPM can do to help them sure well I'd like to take you back to the to the beginning 27 years ago when when I started the company and I had I had done research into projects in the public and private sector this is well before project management was really recognized as a science or profession but in my career what I recognized is again the simple concept if you can't execute nothing matters and what I learned from my analysis was that even the bus companies in the United States struggled with execution and it was pretty obvious uh you know I'm going back to the early 80s the world was shrinking competition was increasing and we would truly lose our footing if we did not develop a better approach to planning and executing initiatives and um so what what I did is establish a model based on what I learned that really focused to to planning and executing critical initiatives and we still refer to kind of three legs of our St of the stool today being process discipline and Leadership these are keys they are key organizational competencies they're they're key competencies for a project management office for a project for a project manager today our clients still uh call upon us when uh failure to execute absolutely cannot be tolerated many of the engagements that that we are involved with you know are with organizations that really are having to evolve they've either if if they've been if if they've really been proactive and strategic they're at the Leading Edge of that they so they want to improve their own internal capabilities so we help them improve their own planning and executing competencies we help them set up their project management offices we help them with portfolio Management in many cases we work hand in hand so that we are not only helping them put these processes in place but we're also working hand in hand to execute help them execute um you know in most cases we're helping them lead we're leading our we're helping them lead their complex projects but what what we like to see most is this win-win where we are not only helping them evolve their capabilities um but helping them sustain that so with with many of our clients when they have needs that exceed their capacity or capabilities they bring us in and it allows them to evolve as well as have a kind of this capacity throttle uh that creates extraordinary flexibility for them so are you suggesting then that uh in a way that they are able to live then with some of the strategies that you uh teach them is what it sounds like to me that they're able then to continue to employ some of those project management strategies as they move forward uh not only can they I think it's essential that they do and and our approach is uh we're you know we're all about helping them learn you know what we know it helps us develop great relationships with them they may not need us today that they may need us tomorrow we have our repeat business as well in the 90 90 plus percents and it has been consistent for our entire history but we're willing to share whatever we know so they they can continue to evolve and since we are experiencing you know we're experiencing the market as it relates to competitive influences within project management you know our our clients and their pmos aren't experiencing you know that what else a direct competitive threats to project management so it's much more difficult for them to evolve on an ongoing basis within that particular expertise they tend to evolve in areas where they are feeling direct competitive pressure and it may be you know the deliberative Clinical Services would be an example it's always much more difficult for an internal function that is not exposed to external competition to evolve even with the bust of efforts so by working with us they're able to continually evolve because we'll bring whatever it is that is is best in class uh that we've developed or that has been developed in and integrated within our processes and systems we'll bring that to our clients well I know there must be so many Healthcare leaders out there who would greatly benefit from this sort of assistance and uh work that your company does so for those of you out there who would like to learn more please do visit .ipmcinc.com and you'll see the link there on your screen when you get the slides of this event you'll be able to just click on any of the IPM links and they'll take you to that page and then you can learn more and discuss your situation with them they would love to hear from you thank you so much Rich for sharing your expertise with us this was really fascinating to me and I know that our audience got a lot out of it well thank you Brian thank you everyone who is online and I just want to extend the best wishes to all of you God bless you and your families thank you thank you again and for to all of our attendees remember that you're going to get the slides I I always say it one more time we're going to send out a follow-up email and so there will be slides for you there will be a link to the video recording of this event you can pass it on to others that you think may get value from it also keep an eye on your email box and our home page for other upcoming learning launches you can also just go to .foremedlearning.com and see the list of upcoming events these events are always free and open to the public so we encourage you to go check out the roster and sign up for our next one thank you everyone to join for joining us again and we hope that you will join us for our next session thank you