Epic Rollout Commencement
Starting in 2008, Mount Sinai began a long-term Epic rollout to their expanding network of facilities throughout the New York Metropolitan area, including seven hospitals campuses, 13 free-standing joint venture centers, and 300 community clinic locations. For the past several years, Mount Sinai’s IT Project Management Office (PMO) has managed new ambulatory Epic rollouts in yearly waves. In addition to annual waves, 70-100 yearly “off-cycle” Epic requests – focused on new provider on-boarding and rollouts to new locations with limited scope – were handled by a team of analysts outside of the PMO.
In the middle of 2017, Mount Sinai faced a growing backlog of off-cycle Epic requests. Without a clear project management approach in place to prioritize, plan, and execute upon these requests, rollouts had slowed, and providers were experiencing longer Epic implementation delays.
Addressing the Challenges
Mount Sinai engaged T2 Tech Group (T2 Tech) to streamline these rollouts using an Agile project management framework because of their notable healthcare IT track record and unique Agile-hybrid project management methodology.
A Growing Backlog of Projects
Projects that fell outside of the PMO and were not pre-budgeted, began to accumulate over time. Unfortunately, poor visibility and misunderstanding of noncapital projects indirectly affected the PMO resource management process.
A Formal Process
To address a growing backlog of projects that fall outside of the capital budget, T2 Tech Group developed a formal intake process which included: categorization, prioritization and resource allocation. To execute, an iterative cross-functional process was established following Agile principles.
With an established intake and execution process, teams were empowered to have operational sustainability, resulting in the lowest overhead possible. This process also resulted in a reduction in time from project request to execution, self-managed resources, better quality deliverables, and increased stakeholder satisfaction.
Transparency of availability is crucial so teams do not end up overcommitted on other pre-planned/capital projects. Following Agile principles, stakeholders and team members regularly collaborate and remain empowered. Teams are provided with all the tools and support, and are trusted to accomplish project goals.
Implementing a Standard Project Intake Process
Shortly after reviewing a list of outstanding off-cycle requests, T2 Tech determined that the intake process for Epic rollouts was not functioning as Mount Sinai intended. Various teams and departments were regularly submitting informal requests outside of the intake process, resulting in missing request information and multiple decentralized repositories for rollout requests.
T2 Tech recommended migrating the intake process to Mount Sinai’s ticketing system as soon as possible, and ultimately assisted with the migration. In the interim, the team implemented a centralized project backlog to house all requests and a simple, standardized questionnaire to collect important scope information for each project.
Using these tools, Mount Sinai was able to evaluate and prioritize all new off-cycle requests and scope changes, in the same manner, moving forward. T2 Tech and Mount Sinai also leveraged the new intake process to identify and correctly reassign several projects to the PMO.
Prioritizing the Project Backlog and Implementing Agile
After merging all existing off-cycle requests into a centralized project backlog and collecting missing scope information, T2 Tech and Mount Sinai prioritized the backlog of Epic rollouts. The team then selected the first few rollouts and implemented a two-week Agile sprint framework to streamline planning and improve execution.
Because these rollouts were repetitive in nature, it was a perfect opportunity for Mount Sinai to leverage Agile’s iterative approach and constant reflection to improve project performance and effort estimates over time. Using each rollout as a hands-on learning experience, T2 Tech led the Mount Sinai team through multiple Agile sprint cycles.
Improving Planning and Effort Estimates
First and foremost, T2 Tech lead Mount Sinai through an initial sprint planning meeting where the entire project team gathered together to confirm their availability and define what tasks they would accomplish over the next two-week period – the sprint backlog. This process enabled greater accountability because each team member committed to work based on their own estimates.
One of Agile’s central tenets is empowering team members to define their own project tasks and effort estimates. This approach often feels unnatural to project managers who are used to telling team members what they need to accomplish over a fixed time period. However, no one is more qualified to define tasks and effort estimates than the individual responsible for the work at hand (especially if they have completed similar work in the past).
By producing a detailed task list with realistic estimates, Mount Sinai was able to provide more accurate completion dates for each Epic rollout and set realistic expectations with each clinic. Over time, these estimates continued to improve through regular refinement driven by the sprint process.
Streamlining Project Execution
Once the sprint planning meeting was complete, the team focused on completing the tasks they committed to. Every morning, T2 Tech’s project manager led a brief scrum call where each team member identified:
- The tasks they had accomplished the day before
- The tasks they would accomplish today
- Any roadblocks which were preventing them from completing their work
Because the team committed to accomplish the entire sprint together, this approach struck a great balance between individual ownership and team collaboration.
Daily scrum calls provided ongoing transparency into project progress and empowered T2 Tech’s project manager (also known as the scrum master) to quickly remove roadblocks which would have impacted project performance. Moreover, the team’s focus on a daily list of prioritized tasks, improved project execution, and catapulted each project forward towards completion.
The transparent nature of the sprint process also provided Mount Sinai with clear visibility into team member commitments, which enabled management to maximize resource allocation and empowered employees to say no to work that distracted from their sprint tasks.
Increasing Buy-In and Transparency with Stakeholders
At the end of each two-week sprint process, the team held a sprint planning session to define the tasks they would accomplish over the next two-week sprint. After the planning session was complete, the team prepared a presentation for Mount Sinai stakeholders. Within this presentation, the team demonstrated the work they accomplished over the previous two weeks and discussed the work they planned to accomplish over the next two weeks.
Stakeholder presentations provided Mount Sinai stakeholders with transparency into project progress and an opportunity to provide critical feedback to the team. This proactive feedback ensured that changes in priority were reflected in the go-forward project plan, keeping the team on course.
The team also sent bi-weekly status reports to stakeholders, which provided visibility into estimated project completion dates, current project status, and critical roadblocks. Mount Sinai stakeholders valued the transparency and used the reports to help escalate and resolve issues, such as resource constraints and outstanding information requests, which would have otherwise delayed rollouts.
Delivering Results through Continuous Improvement and Iteration
To conclude the two-week sprint, T2 Tech held a sprint retrospective with the project team to reflect on the last sprint iteration. Due to the repetitive nature of each Epic rollout, the team was able to reflect on their previous sprint, identify areas for improvement, and further refine their approach and effort estimates for the next rollout. This marked the end of the sprint cycle, which was repeated every two weeks until the project backlog was completely burned through.
Over time, T2 Tech and Mount Sinai identified seven recurring use cases for ambulatory Epic rollouts. These use cases were discovered as the team identified unique implementation requirements when rolling out Epic to different types of providers. The team developed templated task lists for each use case as a bi-product of the detailed tasks developed in the sprint planning sessions. These templated task lists streamlined similar implementation in the future and provided Mount Sinai with valuable tools to use as they ultimately transitioned towards managing rollouts in an operational fashion long-term.
Using two-week sprint iterations to continuously improve upon the Epic rollout process, T2 Tech and Mount Sinai cut the duration of each ambulatory rollout in half without increasing the number of resources dedicated to each project. Within four months T2 Tech and Mount Sinai burned through 38 Epic rollouts, including an initial backlog of 23 requests and 15 new requests which were submitted thereafter.
Handing off the Agile Framework
After guiding Mount Sinai resources through numerous sprint cycles and clearing the entire project backlog, T2 Tech handed off the Agile framework to Mount Sinai. With hands-on experience and a well-documented process, the off-cycle teams were well-equipped to self-manage the Agile framework moving forward without a project manager. This process provided an appropriate structure with no additional overhead.
Because the off-cycle teams were correctly sized, and their work was efficiently prioritized, Mount Sinai was able to complete future off-cycle request as they came in with no delay. In fact, Agile worked so well, Mount Sinai engaged T2 Tech to partner with their IT PMO to leverage its benefits on their larger, more complex annual Epic waves.