James Baker, Ronald Reagan’s Chief of Staff, had a famous maxim based around his 5 Ps; Prior Preparation Prevents Poor Performance.
When it comes to managing projects, the things your preparations produce are your baseline measurements. If you want to understand why so many projects in the healthcare sector spiral out of control, this is where to look.
Once you sit down to properly define and scope your project, you need to establish your Performance Measurement Baseline, or PMB.1 This has three components, or what’s often called the ‘triple constraint’.2
The triple constraint
You need to agree on a set of baselines for the project’s scope, its timeline, and its budget. So, what has to be achieved, by when, and at what cost. But the key word here is ‘agree’.
Because what tends to happen with so many projects in the healthcare sector is that, no sooner have the various baselines been established, than they almost immediately go out of whack. And, while there are sometimes external factors that force you to recalibrate those original baselines, the current pandemic being a notable example, that’s not usually the reason those problems arise.
Performance Measurement Baselines are not OKRs
What happens all too frequently is that there is a disconnect between the ambitions of the key senior stakeholders, and the capacity of the slightly less senior stakeholders under them, who are in charge of actually implementing the project. This isn’t done deliberately. Everyone wants the project to succeed. They just create unrealistic expectations.
Say you’re a senior stakeholder in an organization that oversees primary caregiving in the U.S. You yourself are under all sorts of pressures, from the other senior stakeholders, the Board, and the external bodies, often state and federal, that you rely on for funds.
Understandably, you lean towards hope rather than experience when formulating those initial baselines, and they’re all hopelessly optimistic. In other words, they feel more like OKRs.
OKRs are supposed to be ambitious, and you’re not meant to achieve them all. In contrast, your project’s scope, timeline, and cost baselines are supposed to be carefully and rigorously followed.
So you create very real, indeed insurmountable problems when you begin with underestimated baselines. Because you can only realize any benefits from the project if everyone is happy about the way it was implemented. And no one is ever happy when you end up with cost overruns and delays. The way to avoid that is by turning everything upside down.
From the base up
Because the most important element of scoping, it turns out, is not into the details of the project itself. Rather, it’s across departments and between colleagues. So you can all agree on what can realistically be achieved, by when, and for how much. In other words, you need to begin from the bottom up.
By talking to and taking in what each of the various department heads have to say about each of the project’s different elements, you’ll end up beginning with a set of Performance Measurement Baselines that can and will, be followed.
It turns out then that successfully implementing healthcare projects is less about time and money than you might have thought. What it really depends on is changing the culture within the organization. It’s there that you need to begin.