program governance structure & stakeholder...

CONFIDENTIAL – Contains proprietary information.Not intended for external distribution.CONFIDENTIAL – Contains proprietary information.Not intended for external distribution.

Service Line Stakeholder Management & Governance StructureKaty LangeBridget Malaney

PMI Nashville March 12, 2019


So why are you glad you came to this lunch? (besides the pasta)

Today you’ll learn a way to develop a new service line within a large, complex organization, beginning with a stakeholder management strategy and a strong governance structure

CONFIDENTIAL – Contains proprietary information.Not intended for external distribution.

Background• In 2018 & 2019, HCA’s

Clinical Services Group identified the need for two new large programs o Medication Diversion Control

o Laboratory Service Line

under an already complex organizational structure

• Leaders requested project management support to establish the service lines

PMI Nashville Luncheon


Program purview• Each of the programs

directly impact:o HCA’s United States Hospitals 185 total, across 21 States

o Surgery Centers, Free Standing Emergency Rooms & Urgent Care Centers 1,000+ sites



Which means…• Decision makers on the

program have to consider and act in the best interest of: o HCA’s United States Hospitals 185 total, across 21 States

o Surgery Centers, Free Standing Emergency Rooms & Urgent Care Centers 1,000+ sites



So, where to start? From Stakeholder Analysis to Governance Structure


Stakeholder Analysis 101• Project stakeholders are individuals, groups, or organizations who may affect, be

affected by, or perceive themselves to be affected by a decision, activity, or outcome of a project.

• Stakeholder analysis is a technique of systematically gathering and analyzing quantitative and qualitative information to determine whose interests should be taken into account throughout the project […] It also helps to identify stakeholder relationships (with the project and with other stakeholders) that can be leveraged to build coalitions and potential partnerships to enhance the project’s chance of success.


Identify Analyze Assess


IdentifyHelpful questions to ask yourself & your business owner(s)

• Who are the people affected by this project?• Who has influence or power over the project? • Who has an interest in the successful or unsuccessful conclusion of the project?• Who is paying for the project?• Who are we missing? (Keep asking, especially with complex projects) • How do you imagine these stakeholders interacting with each other?

Tips:o If identifying individuals is too tricky up front, it can be good to start high level (teams,

departments, or groups instead of specific people) and narrow to individuals with the input of your business owners & other leaders. More about this later.

o Remember to consistently iterate the stakeholder analysis throughout the project life cycle as stakeholders may change.



AnalyzePower/Interest Grid

• A Power/Interest Grid can be a helpful tool to visually organize stakeholders by their power over your project and their interest in your work. This will help you customize your engagement and communication approach.


High Power, Less Interest• Keep satisfied

High Power, High Interest$$$• Engage & manage closely

Low Power, Less Interest• Monitor (minimum effort)

Low Power, High Interest• Keep informed

Power

Interest


AssessHelpful questions to help you understand your stakeholders (& keep them happy)

• What financial or emotional interest do they have in the outcome of your project? • What motivates them? • What information do they want from you? What is their preferred means of

communication?• What is their current opinion of you/your work? Is it based on good information?• Is this person likely to be influential to other stakeholders? • Who is this person likely to be influenced by?

Tips:o It’s a great idea to do some research on your own, but don’t be afraid to ask your

stakeholders these questions as a means of initial introduction/engagement. People are often open about their views and asking for their opinions and input can be a good first step in building a trusting and successful working relationship. Finding personal things in common can also help.



Our spin: Stakeholder analysis via governance structure

• Instead of jumping straight into stakeholder analysis for these programs, it is important to first identify the overall governance structure.

• Defining the purpose and objectives for each level of the structure helps ensure that only the most appropriate stakeholders were included.

• Here is an example of the different governing tiers of a program:



• After further discussions with business leads, the program governance structure looks like this:

Executive Awareness

Clinical Subcommittee

Operational Subcommittee

Contracting Subcommittee

Informatics& Technology Subcommittee

Governance Committee



• Highest Power & Highest Interest

• Presidents & VPs• Decision makers on

recommendations put forth by subcommittees

• Leads identified by the members of the Governance Committee

• AVPs, Directors, etc.• Subject Matter experts/

“doers”

• Company President



• As the governance org chart is being developed, it is key to make sure that every Committee has a clearly defined purpose and objectives to work toward, as well as an understanding of what their commitment to the effort requires (time, input, communication, etc.).

• A simple table can serve as a “mini charter” to keep thoughts organized:


Committee Purpose Initial Objectives CommitmentGovernance Committee

• Decision-making body • Set & approve strategy of the service line• Prioritize work efforts• Ensure appropriate resources and funding are in place• Provide barrier resolution

• Bi-monthly meetings

ClinicalSubcommittee

• Assist physicians in making optimal laboratorychoices for patients in order to reduce unwarranted clinical variation and enhance standardization and efficiency of related diagnostic processes

• Identify clinical metrics/data to measure success• Identify best practices & opportunities to scale across HCA• Prioritize clinical work efforts & track execution

• Monthly meetings• Document review• Workgroups

Operational Subcommittee

• Determine the operational standards & benchmarks for HCA laboratories

• Identify markets and opportunities for centralization

• Address gaps with resources within the lab

• Set communication strategy• Identify & implement operational standards across HCA• Create consistency within HCA cost center expenses• Develop inspection readiness program


Contracting Subcommittee

• Focus on areas associated with enterprise-level contracting for pathology & laboratory services

• Align HealthTrust and HCA contracting processes & purchasing opportunities

• Participate in vendor annual reviews


Data, Informatics & Technology Subcommittee

• Establish the “source of truth” for sustainable data delivery to the enterprise

• Data QA (lab & pathology)• Data definitions & visualizations• Security evaluation of lab interfaces

• Monthly meetings• Data collection• Workgroups



• Finally, it’s time to fill in the people that will make up these committees. Starting from the top down, start speaking with program leaders to get names of appropriate stakeholders for each committee.

• Keep asking questions until representatives are selected that can fill all necessary knowledge areas.

Tip:o Not every subcommittee has to include the same number of people or have exactly the same

structure. For example, some may include ad hoc members or have separate workgroups that role up under one subcommittee umbrella.



So I know the people we need…what next?Be organized, Be excited & Ask nicely


Communications 101• Excellent project communications can serve as a catalyst for transforming

stakeholder perceptions of a project from good to very successful. Conversely, poor project communications can transform stakeholder perceptions of a project from excellent to mediocre.

• Once the structure of the governance team is created and the necessary team members identified, they have to be invited. And the way the invitations are structured (the “ask” is extended) is a key way to set the tone for the program.

Tip: o Don’t be afraid to lean on your executive leaders for input on the initial communications. In a

large organization with many ongoing initiatives and new ones popping up all the time, a message straight from a senior leader is invaluable to emphasize importance and accountability.


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Support & Encourage Audience Perspective• Members are fulfilling commitments and actively working toward the

program objectives and goals

Objective• Consistently emphasize the program’s importance. Ensure needs are

met so members can fulfill their commitments

Channel• Meetings, newsletters, conference calls, etc.

ConnectAudience Perspective• Members are officially committed and ready to participate

Objective• Program organizers to document membership and share next steps

Channel• Targeted communications with team members including all materials

needed to level-set and prepare for moving forward

Engage & InspireAudience Perspective• Members have been approached and asked to participate – are

considering the “ask” and whether they are the ideal candidate

Objective• Senior leaders and other committed members share why the program is

important and why the potential member will be a key contributor for success

Channel• Personal conversations or emails with program leaders and other

program champions

Spread the WordAudience Perspective• Potential team members (aside from the most senior leadership) have

not heard of this program yet and aren’t invested

Objective• Senior leaders to announce new program and begin strategic

recruitment of team members

Channel• Personal conversations with senior program leaders

Communications PathwayInvite your team


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Let the good times rollaka “what have I gotten myself into this time?”aka “wow, that’s a lot of meeting invites” aka “do I get paid more for this?”


Tip: o Have your meeting/call/presentation cadence

set ahead of time and send out everything together after the team is assembled

CONFIDENTIAL – Contains proprietary information.Not intended for external distribution.19 PMI Nashville Luncheon

Spread the wordSocialize the heck out of it

Tip: o Remember: Just because you’ve been

eating, breathing & sleeping in your project world for months doesn’t mean everyone else knows the history. Use tools like newsletters, emails, and intranet sites to announce the kick-off


Questions?

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