The time is 6:30 A.M., midweek in the month of February. Julia Skown is the program manager for the Time Keeping System (TKS) Program. She is in a conference room looking at the agenda for a program review meeting to assess the status on the TKS program, which is scheduled at 8:00 A.M. In the room with her are Stacey Cook, a payroll specialist, and Tom Black, an IT project manager. They are members of the PCT and employees of General Public Hospital (GPH), and it is obvious that all three are nervous regarding the potential outcome for their program.

There is good reason for them to be nervous. The purpose of the meeting today is a program baseline review (go/kill/hold) with senior management. Go means the program is ready to proceed, kill means the program will be terminated, and hold means the program needs to be reworked and brought back for review. The team is concerned that senior management may decide that the TKS program must be put on hold. This decision will mean that the program will be sent back for rework and lose its priority for available resources. In other words, it may be put on the back burner.

The IT organization for GPH took the lead in championing the TKS program. Operating under the CIO, the group provides various types of services and solutions for both internal (doctors, nurses, students) and external (patients) customers. Some of those services and solutions include the registration system, employees' clock in/out system, payment system for patients, and computing power for medical research, which is among the best in the United States. The vision of the hospital is to be a national and international leader in health care, education, research, and technology development. To help accomplish the vision, strategic goals for the IT group provide the basis for the programs. Generally, the uniqueness of the IT organization is that it operates in one of the few academic medical centers in the United States that employs a "best-of-breed" strategy. Therefore, the group achieves high-quality solutions by using best-in-breed commercial products, rather than developing their own and integrating the solutions in a patchwork fashion. John Menegy, CIO, says, "We work with individual vendors to find the best solutions, and then we successfully integrate the solutions with our existing products."

There are more than 300 employees in three major groups under the applications division director of the IT organization. These three groups include Academic and Research Applications Support, University Applications, and Health Care Applications. The TKS program resides in the Academic and Research Applications Support group as depicted in Figure D.1. TKS is a formal program that has a program manager and a team of skilled and knowledgeable members assigned. All the team members are motivated and committed to the program.

The objective of TKS was to implement a new time-keeping system for GPH. It was a one-million dollar program and was anticipated to take 18 months to complete. The motivation for the program came when the vendor that provided services for the current time-keeping system sold its system to another company. As a result, GPH was forced to make a change because support for the current system would be discontinued by the new vendor. Management had to either purchase a new system from the new vendor, or seek other vendors for time-keeping systems. The first option appeared to offer fewer risks (familiarity with the previous generation of the system) and enabled GPH to keep the front-end system for its employees (for example, tax system, clock in, clock out).

Figure D.1. Organizational chart and TKS program team structure.

Skown, Cook, and Black came to the office early to do last minute preparations before the management review. Still concerned about the outcome of the review meeting, they discussed the major issues.

The discussion turned to adding a new transaction-inquiry feature to the TKS system, which will make the system much more user-friendly—a feature that currently is not in the program plan. However, the new feature imposes more technical difficulty than what the team had expected and will cause an increase in the program cost and schedule.

Cook and Black headed to get coffee. With just a few minutes remaining before the review meeting, Skown used the time to review the various elements of the TKS program.

The structure of the TKS program was a dedicated, autonomous team, including representatives from several functional groups (for example, hardware engineers an intern and five technical services personnel). The technical team consisted of three system analysts, a quality analyst, a project manager, and a database administrator. Customer representatives, such as payroll specialists were also part of the team. Also representing the customers was a focus group that was chosen by the functional sponsors. Most team members were selected based on their skills and knowledge and were motivated and worked well as a group. In addition, the TKS program also had strong support from the PMO which is responsible for developing, implementing, and continuously improving the program management processes and tools to improve program performance, and to assist the IT organization in achieving its business objectives.

The health care industry places a large emphasis on the quality of the products and services it develops. It is translated into the business strategy of GPH, in which it primarily focuses on maintaining a stable, limited line of products or services; it offers best quality with low cost; and it delivers what its customers want. Influenced by the business strategy, program management elements are directed to satisfy customer needs through the delivery of these quality products and the services. The first priority of TKS is to install the system and make it work correctly with all other existing systems. The major constraints are cost and schedule because the program has limited resources and a strict go-live date, previously announced to all employees. The following section lists the program objectives, product definition, valve proposition, and its success criteria.

Closely following the standard process the PMO created, TKS has four major phases to complete: integration and request, program planning, program execution, and implementation and support. There are also three major decision checkpoints: functional review, baseline review, and customer approval (see Figure D.2). The TKS program is currently at the end of stage two—the program planning stage. This standard process is referred to as the program management solution development life cycle (PMSDLC). It was influenced by the organization's strategy of having a stable, standardized, and tested process with quality and customer focus. To ensure the use of the process, management demanded a two-day PMSDLC training class in which all senior management, program managers, and major team members were required to attend. Program and project tools focus on quality assurance, cost, schedule, and performance to success criteria.

Figure D.2. Program phases.

Not all programs within the IT organization are required to go through all the standard phases and milestones. The PLC is scalable upon the type of the programs with keen emphasis on achieving quality with minimum cost. Maintenance programs, which are those that require minimum efforts (a couple of weeks to a couple of months in duration) and are initiated to fix problems in existing products or services, go through an accelerated life cycle. Minor programs are those that require in-depth planning because they involve some degree of risk impact on the organization. A minor program normally lasts from two months to a year in duration and will pass through all phases of the PMSDLC but require fewer steps in Phase 1. A major program like TKS is required to go through the entire PLC. A major program normally takes from six months to three years in duration.

The scope of the TKS program was defined based on business requirements. The program schedule was developed on the basis of standard hour estimates of previous programs. A Gantt chart was created to support the development of the program schedule. The program manager worked with the technical sponsor, the vendor, and the PCT to determine the budget. This included the cost of hardware, software, consulting fees, licensing fees, resource hours, and training. Even though TKS is considered a low-risk program because it involved few new technologies, the team follows the standard risk management process. The program team documents the probability of multiple risks that may occur in the program in terms of dates and/or dollars. The program team created the risk list and developed contingency plans to address and resolve each risk as needed.

In terms of quality, the program has a quality analyst whose responsibility is to ensure that the program will satisfy the needs for which it was undertaken. Activities such as measuring, examining, and testing were performed to determine whether the results conformed to the requirements. Actions are taken to bring defective or nonconforming items into compliance to the specification requirements. Checklists are also used to track quality.

In the TKS program, the means of communication include program meetings, program review presentations, e-mails, and the phone.

The program manager met with the program steering committee to achieve program approval. After approval, the program manager reports the program progress back to the committee periodically through formal meetings that are held once a quarter. The program manager meets with the program team daily, while involving the customers on a regular basis. The program manager holds regularly scheduled meetings and documents the minutes from these meetings with action items for ongoing follow-up by the PCT. In addition, the program has an integration process to make sure that the various elements of the program are properly coordinated. It is done through an iterative process of multiple meetings and consistent communications on a regular basis.

The significant program metrics tracked on the TKS program include milestone completion, risk mitigation, budget tracking, and the number of key program scope changes. Program schedule is tracked using milestones and tasks performed to the schedule baseline. Program cost is tracked by expenditure, account balance, hardware and software cost, consulting fee, training, and staff cost. This cost metric is tracked separately by the program manager in the program reviews and is not shared with all team members. The program risks are tracked by the mitigated risks versus exposure.

In general, the organizational culture is diverse, complex, formal, and relatively inflexible to change. Quality and customer focus are valued highly by all employees.

GPH has a wide array of employee types—physicians, nurses, administrators, engineers, and technicians—which makes it diverse. To control this diversity in styles and personalities, GPH opted for a more rigid and hierarchal form of organizational structure. In addition, most employees in the organization are reluctant to change, especially as it pertains to new technology.

Because the time-keeping system is an emotional subject for everybody in the organization, the TKS program team has to be sensitive to the needs of the customers and convince them to accept the new change. Quality and accuracy is key in the minds of the customers. The program has consistent, regular, and open communication, which contribute to team members and customer representatives understanding their roles and responsibilities.

The door to the management conference room opened and Skown and her team were invited to join the program review committee. The committee consisted of John Menegy (GPH CIO), John Bacon (customer relationship director), and Art Counter (payrol-director).

The focus group joined the meeting. For several minutes, the committee talked to each member of the focus group. They all believed that it was in the best interest of GPH to add the new feature now and proceed with the program execution. However, the committee members were well aware of the significant adverse ramifications to a slip in the schedule for completion of the program. The benefits of adding the new feature versus the costs of delaying the introduction was weighed carefully. Menegy consulted with the other members of the committee and announced to the team that they will need to deliberate with the committee and will communicate their decision in half an hour.

With that announcement, Skown excused herself to go check her e-mail. When she got to her office, she stood for a few minutes before opening her e-mail account and thought to herself, Half an hour—that feels like an eternity! I think the information from the focus group will save the program. At worst, they will come back with a hold decision but no kill decision. After responding to a few e-mails from her program team, Julia returned to the meeting to hear the executive team's decision.