Tough Job for the PM. Herding Healthcare Stakeholders.
If you peruse any work or project management methodology, you’re bound to trip over the term “stakeholder” within the first few paragraphs, just before the intense boredom puts you to sleep. Basically, stakeholder is shorthand for saying “a person or group with a vested interest in a successful project outcome.” It has nothing to do with vampire hunting or your Fourth of July BBQ.
In any case, stakeholders are a key constituency in a project manager’s life. These folks are courted, their requirements documented, opinions weighed and their expectations managed. In order for a project to be a success, these groups or individuals need to accept the project outcome.
In many industries, stakeholders are primarily all on the same page. They are looking for the right project outcome that will provide a general set of benefits that will please most of the parties involved. There are always some disagreements, but the 80/20 rule applies.
Healthcare is a different animal. Especially in large enterprise projects, factions vie against other factions in order to control a project outcome or to scuttle the effort altogether. Personalities and politics often trump clearly stated objectives arrived at by cut and dry analytics. But why?
In order to understand this drama, we need more data. Total healthcare expenditures in the U.S. are around $3 trillion dollars or 18 percent of GDP. This is expected to grow to $4.8 trillion by 2021. A wide variety of players are fighting over this enormous pie and nearly all have competing interests.
To add some gravitas to this article, I refer to Healthcare Project Management and the New Economy by John Schlichter and Dr. Dominic Thomas to define these healthcare stakeholder factions. They can be broken out into four categories:
- Providers: Hospitals, Physician Practices, Clinics, Doctors, Nurses, etc.
- Payers: Individuals, Businesses and Government Entities
- Fiscal Intermediaries: HMOs, Insurers, Government, Benefits Managers
- Purchasers/Producers: Drug and Device Manufacturers & Distributors
Healthcare Stakeholder Environment – Nothing Complex Here!
With this panoply of competing interests, it is easy to see why healthcare IT and clinical projects can become so difficult to manage.
It becomes even more chaotic when you look at how these stakeholders relate to one another in the healthcare ecosystem.
As you can see by the diagram, stakeholders are directly or indirectly tied together by financial transactions, cost containment or products and services. This makes the project manager responsible for guiding these individuals to a common solution a herculean task. A perfect example of this is the Affordable Care Act (ACA) and its implementation.
Let’s breakdown the ACA at the highest level, along project management basics. It can be argued that the ACA law was a project “requirements” and system design document, as terrible a thought that is. The stakeholders that created that document came from all four of the previously discussed categories and external to that system (government).
These requirements were then passed to a project team that encompassed over 55 vendors whose performance was circumscribed by continuing requirements and design changes mandated by external stakeholders (government).
The cherry on top was an October 1, 2013 delivery date for a national integrated system with 50 states, multiple legacy systems and untested new systems with a process wracked by intense stakeholder disagreement. Pretty much anyone who had done software development project management saw this as a looming crisis, especially with a short three year delivery date.
So what is the solution for managing all these competing stakeholder interests? I’ll go in-depth on that topic in my follow up article to this post. But, one piece of advice I can immediately give is to find an proactive project champion at the highest levels within each of the four areas (if appropriate), to break through the inevitable flak that a healthcare project manager will encounter.
I am very interested in hearing your opinions so please drop me a comment below if you have a question or if you wish to debate the subject.