work package and the schedule was reviewed weekly during project
meetings. The schedule and other project documentation were also
posted on an HIM SharePoint site for staff to view progress.
Simply sending out the project schedule via email does not
facilitate accountability and responsibility. When you convene
the responsible parties in person, they are more likely to complete tasks or alert the project manager to roadblocks versus
publicly report “no update.” This process requires a strong project manager who can firmly push team members who have not
completed tasks in a timely or appropriate manner.
Sturm: Communication is key throughout any project. Our
team established regular touch points to provide progress on
deliverables. Timeframes were created to meet each goal while
specifying the resources required to complete the milestone.
Our project progress reports used the stoplight rating system to
quickly see the status of each task.
Rose: Describe any challenges with scope creep and how
you addressed them.
Biesboer: There are forces and tendencies toward scope creep
in every project. However, scope creep can be avoided by taking
these four steps:
1. Clearly document what is in scope and what is out of scope.
2. Have project sponsors and business owners sign off on the
document that includes scope definition.
3. Respond to any requests outside the scope document with
a discussion. Scope can be changed, but sponsor approval
is required along with clear and documented understanding of how the change impacts budget, timeline, schedule,
and other key projects.
4. Walk through all implications of any scope change and ensure stakeholders walk in the shoes of affected users.
One project is never an island. The enterprise (and vendor)
view of priority, time, and resources must be taken into account
when considering scope change.
Carey: I have yet to participate in a project without scope creep.
In pursuit of the perfect future state, some tasks may be too costly
or too dependent on external factors beyond your control. For example, during our contact center project, the team wanted to build
an elaborate, cost-prohibitive tree hierarchy. We had no budget for
the added functionality. In this case, scope creep was easily averted. To properly handle the situation, I took the following steps:
1. Identify the driver of the project—cost, quality, or time.
2. Measure any change to the approved scope against that driver.
3. Evaluate changes to determine additional costs.
4. Submit a request for additional funding if the change is
Sturm: In the early stages of the project, I asked my HIM colleagues to share their ideal ROI resources and build a wish list of
references for everyday use among our teams. This list became the
goals or proposed output for the project. Those same colleagues
formed a work group to combine skills, ROI practice tools, and
expertise to develop the requested references. This work defined
a set of standards, which helped to minimize scope creep.
One project challenge involved the instances of ROI that occur
outside acute care HIM. The scope of the project was intended
to address only acute care and we had to scale back opportunities to include other areas of our organization. In future phases
of the project, we may be able to share resources or increase the
scale of the ROI operations.
Rose: As an HIM professional, what was your biggest challenge in managing a large implementation project?
Biesboer: A big challenge is keeping all disciplines moving forward at the same pace and understanding the status of each group’s
progress. During EHR implementations, I asked each specialty (
hospital and vendor) to estimate a percentage of completion each week
during the build/configuration stage. We documented weekly estimates to measure forward or backward movement, identify underlying factors, and determine how other groups could help keep efforts
on track. We avoided blaming and focused on moving forward.
It is easy to get bogged down in issue resolution. Here are sev-
Using HIM Skills to Lead
Pat Biesboer, RHIA, MSS, PMP,
senior project manager
Susan Carey, MHI, RHIT, PMP, FAHIMA, system
director of HIM at Norton Healthcare
Emilie Sturm, MA, RHIA, CHPS, senior revenue
management consultant at Trinity Health