Guiding Principles Offer Direction, Add Clarity for Large HIT Projects

The adage ‘preparation makes perfect’, may not be 100% accurate in healthcare information technology (‘HIT’) implementations.  However, there is significant truth to ‘preparation makes better’.  The evidence of thousands of HIT implementations shows that those who effectively organize prior to kicking off a large HIT project have demonstrable improvement in the project success.

The preparation phase typically ranges from 3 to 6 months prior to the kick-off of a project.  This depends on the size of the project.  If it’s a departmental solution, optimization, or expansion of EMR, 3-4 months can be adequate for planning.  However a full EMR replacement should have 6 months of planning and organizing, excluding contracting activities.  Abraham Lincoln said, “Give me six hours to chop down a tree and I will spend the first four sharpening the axe.”  Preparing is crucial to any effort.

Guiding Principles

A key ingredient in the planning stage is to determine a set of guiding principles. Guiding principles are simple rules or value statements that help project teams make decisions when they are faced with a choice or when disagreements arise.

Clear, well-written guiding principles aid teams in making directionally-correct decisions more quickly and with greater autonomy. Guiding principles can also help manage scope as they may lead work groups to exclude certain functionality or to leave a process ‘as is’.

Guiding Principles in Practice

If you’ve participated in major HIT projects, then you’re aware how often issues large and small can cause conflict. I recall leading an EMR standardization project for a major health system in the Midwest where we debated an important design choice about whether to allow non-formulary medications.

The design workgroup was made up of varied stakeholders from throughout the health system. Some represented large urban centers, while others came from small community clinics. It’s important to let different constituencies speak to their experiences and air differences of opinion, but it’s also important to reach consensus and move forward.

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Fortunately, our project charter included a set of clear guiding principles, the first of which was that patient safety would be paramount over individual or institutional interests. These principles allowed us to resolve this (and other) disagreements without escalation to the corporate board.

Writing Your Guiding Principles

Alignment with organizational values is important, so your institution’s mission statement is a good starting point for your project’s guiding principles. The principles should be written early in a project, and should be agreed to by organizational leadership.

Remember that your goal is to provide clarity for decision making, so ensure that your guiding principles offer some specificity—avoid broad generalizations.

Some examples of guiding principles might be:

  • The design of clinical systems will place patient safety over ease of use.
  • User efficiency is a key objective after the safety of our patients.
  • An important attribute of the new EMR, is for promoting effective clinical decision support.
  • Reduce waste and friction whenever possible, by using integrated platforms.
  • All project participants will operate respectfully and propose alternatives on disagreements.
  • We will begin with the end goals of the project in mind, for all system design.

Be sure to have the guiding principles included in the project charter and up-front on your project portal.  Here’s a great example for a current Epic project.

Of course, guiding principles are just one of the ingredients that can lead to improved project outcomes.  In future blog posts, I’ll offer thoughts on other components of the preparation phase that in my experience have proven critical for success.

Jim Beezley is Associate Director of Cerner Solutions for Healthcare IT Leaders. Jim has led multiple, large-scale client engagements, supporting health system leaders with strategic goal setting & road-mapping, migration from legacy systems, implementations, optimizations, and user adoption.

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