Episode 187 – The Best Project Implementation of All Time

Original Air Date

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45 Minutes
Home Manage This Podcast Episode 187 – The Best Project Implementation of All Time

About This Episode

Sami Othman, Lora Niazov, Gubran Ahmed

This is the story of a remarkable project team that decided to go Big Bang with their EPIC project implementation. University Hospitals is a non-profit hospital system in the Greater Cleveland area employing approximately 33,000 caregivers. They introduced a massive initiative focused on the implementation of EPIC, an integrated Electronic Health Record system. Its primary goal is to address healthcare record management issues, aiming to streamline and centralize patient information for improved patient care and efficient healthcare operations. This initiative is substantial in scale, involving significant budget allocation, a vast number of users, and a carefully planned schedule.

Our guests Lora Niazov, Sami Othman and Gubran Ahmed describe the project, including the planning phase, and how they created the guiding principles as the cornerstone of the EPIC implementation. The team shares the story behind the tagline associated with the project: “Best Implementation of all time”. We hear about risk management, a decision to pivot, and the project team selection process. This is truly a remarkable project story brought to us by one of listeners. If you too have an exciting, noteworthy project story, please reach out to us at Manage This.

As the IT leader assigned to the effort, Sami is an Operations & IT Leader who designs and executes breakthrough IT solutions. He is proficient in the full range of the operations and IT leadership function—from M&A integration and change management to process improvement, governance, project and asset management. Gubran is an experienced PMO leader with demonstrated success. He is leading the Enterprise Program Management Office (EPMO) at University Hospitals, with a portfolio carrying a budget over $200 million encompassing 150 active projects. Lora is currently a Director of the Enterprise Program Management Office at University Hospitals. She has over 20 years of experience in healthcare, information technology and manufacturing industries, with expertise in optimizing operational efficiency, streamlining processes, and enhancing the overall patient experience.

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Favorite Quotes from Episode

"It truly took a village to get us to this point. It’s going to take that same village to get us across that finish line. And it’s because of everybody’s involvement because each person that has been involved has made a difference in the best way possible."

Sami Othman

"And that’s a reality that you have to live with as a project manager, always knowing that your scope and those external dependencies are completely out of your control. And you have to be nimble, and you have to navigate that."

Lora Niazov

"One of the skill sets that not a lot of people talk about that you need to have as a project manager or program manager is being a motivator. We all talk about you need to have communication skills, you need to have organizational skills, so on and so forth. But being a motivator, I think it’s missed sometimes."

Gubran Ahmed

The podcast by project managers for project managers. A project story about a massive initiative focused on an EPIC implementation at University Hospitals in Cleveland. Hear why this project to streamline patient information, enhance care, and improve operations has the tagline “Best Implementation of all time.”

Table of Contents

04:29 … University Hospitals of Cleveland
05:11 … The EPIC Integration
07:18 … The Size of the Initiative
09:51 … The Cost
11:21 … Convey Calmness and the Right Mindset
14:47 … The Guiding Principles
18:38 … “Best implementation of all time.”
21:48 … Kevin and Kyle
23:17 … Risk Management
28:09 … Time to Pivot
31:31 … Big Bang Go Lives
32:41 … Project Team Selection
34:23 … Enterprise Program Management Office Perspective
35:54 … PMO Resources
38:15 … Takeaways from the Project
42:56 … Find out More
44:03 … Update
44:36 … Closing

WENDY GROUNDS:  Welcome to Manage This, the podcast by project managers for project managers.  My name is Wendy Grounds, and with me in the studio is Bill Yates and Danny Brewer, our sound guy.  Thank you so much for joining us today. 

We have three guests, which is something new for us, and we’re quite excited to have a really full house on the Zoom studio today.  Our first guest is Sami Othman.  He is an operations and IT leader who designs and executes breakthrough IT solutions that optimize financial performance and efficiency in organizations.  Sami is currently the IT leader assigned to the effort of the project that we’re going to tell you about today.  He’s leading the transformative initiative to move University Hospitals of Cleveland to an integrated electronic health record system.  This is what they call Epic, and it is certainly an epic 600 million investment project that will standardize all hospitals into a common system and streamlining processes and consolidating one patient record.

Another person involved on this project is Lora Niazov, and she’s currently the director of the Enterprise Program Management Office at University Hospitals. Lora has also just become is an Adjunct Instructor of Project Management at the John Carroll University  She has over 20 years of experience in healthcare, information technology, and manufacturing industries.

And then the other person on the project is Gubran Ahmed, and he is an experienced program management office leader with demonstrated success and strength in strategic planning, process improvement and problem solving, change management, and relationship building across many functional areas in organizations.  Currently Gubran is working at University Hospitals and is leading the Enterprise Program Management Office with a portfolio carrying a budget of over $200 million, encompassing 150 active projects.  And he tells us a little bit about that, as well, in the podcast.

BILL YATES:  Yeah.  Yeah he does.  And all three guests are going to provide a unique perspective on what they’re doing with this massive program and how they’re seeing it unfold.  And this is big.

WENDY GROUNDS:  This is Epic.

BILL YATES:  This is Epic.  The name of the software is so appropriate.  There are 29,000 users.  We’re talking 22 terabytes of data and 3 million patient records that are a part of this conversion and implementation.  I can’t wait to get into it, hear some of the nitty-gritty from them, and hear some of their takeaways, their advice from implementation of this size.

WENDY GROUNDS:  Yeah, their project tagline is “Best implementation of all time.”  We really do think so.

BILL YATES:  Yeah, I can’t wait for our listeners to weigh in and say, “Yeah, that does sound like it.”  Or “No, mine’s better.  I’m going to tell Wendy about it.”

WENDY GROUNDS:  Yes.  And listeners, if you have an epic project, if you are working on a project that you think the story is worth sharing, that you’ve got some incredible lessons learned, or you’ve got a project that you think you’d like our audience to hear about, please reach out to us.  Lora sent me an email, and here we are.  So we’re happy to hear from you.

BILL YATES:  There you go.  That’s right.

WENDY GROUNDS: Lora shared some exciting news with us as well, that the University Hospital Department of Enterprise Program Management has just won PMIs top 3 PMOs in the world!  They are going to be in Atlanta at the end of October to see if they are winners of the PMO of the year award. Take a look out for that if you’re following the PMI event at the end of the month.

If you listen up at the end of the show, I am going to give you an update from Lora on their EPIC program and how their “Go Live” is going. So take a listen at the end of the show.

Now, because we have three special guests today, I am going to welcome them each personally.  So first of all, my first contact was Lora.  Lora, welcome to Manage This.

LORA NIAZOV:  Hello.  Thank you so much for having me.  I am very excited to be here.  I listen to this podcast all the time. And I also share it with my team.  And I appreciate you making a little bit of time for us.  Thank you.

WENDY GROUNDS:  Sami, thank you so much for joining us today.  Welcome to Manage This.

SAMI OTHMAN:  Oh, thank you so much for having me.  I look forward to our time together today.  I think we’re going to have a lot of fun together.

WENDY GROUNDS:  Yeah.  We’re excited to hear about this project.  And last but not least, Gubran, thank you very much for being part of Manage This.

GUBRAN AHMED:  Hi there.  Thanks for having us.  I’m looking forward to the conversation, as well.

University Hospitals of Cleveland

WENDY GROUNDS:  So we’re going to jump right in.  And I want you to just set the scene for us of the story of this project.  Tell us about University Hospitals of Cleveland.  How many hospitals and ambulatory locations does this include?

GUBRAN AHMED:  The University Hospitals has been around for more than 155 years.  It has the mission of healing, teaching, and discovering.  And we roughly have a network of 21 hospitals.  That includes five joint ventures, more than 50 health centers and outpatient facilities, and we have over 200 physician offices in 16 counties throughout Northeast Ohio.

WENDY GROUNDS:  This project is encompassing all of that?

GUBRAN AHMED:  Yes, that includes everything.

The EPIC Integration

WENDY GROUNDS:  So now you’ve been working on this huge initiative.  You’ve been implementing an integrated electronic health record system, which you call Epic.  Can you describe Epic to us?

LORA NIAZOV:  Yeah.  So it’s been a wonderful journey.  A little bit about Epic.  It was started by Judith Faulkner in 1979.  It’s a privately held company.  What I find fascinating is that everybody always talks about Steve Jobs and Apple.  And there’s very little buzz about Judith, when really she was a software developer herself.  She started the company in her basement.  It’s a multi-billion dollar organization right now.  The leading hospitals of the world use this software to take care of patients.  It’s a pretty fantastic story from a female leader in software development, especially from the ‘70s.

So what Epic does is it provides an integrated health record system for all of patient data across your entire patient journey and story, whether it’s surgery or a visit with your primary care provider or whatever it may be.  It holds all of your information, and then you can share it across different hospital systems to enable continuity of care for you.  So that’s what we’re implementing.

BILL YATES:  This is so important.  And then thinking about the complexity of that many health centers, that many offices, that many doctors that have to be coordinated.

It is fascinating to me though, Lora, that the company started in 1979.  Just think of all the evolutions that they’ve made.  And it’s amazing that they were obviously able to take on new technology and figure out how do we implement this and still abide by HIPAA and all those things.  And they’re still a successful company and still the market leader today.  That really does speak to their longevity.

LORA NIAZOV:  Yeah, it’s a wonderful place.  They’re based in Wisconsin.  They have over 10,000 employees.  We’ve met many of them, I feel like, at this point, with our implementation.

BILL YATES:  All 10,000, yeah.

LORA NIAZOV:  Yes.  And they have a wonderful fun culture being a software developer, and it’s been a wonderful journey.  We’re lucky that we get to partner with this amazing software.  It’s been a long time coming.

The Size of the Initiative

WENDY GROUNDS:  Can you give us a sense of the size of this initiative?  For example, tell us a little bit about the schedule and the budget and the number of people that are going to be expected to use Epic.

SAMI OTHMAN:  Yeah, sure thing.  So if we back up a little bit and start from the beginning of this program, the board of directors of University Hospitals Cleveland approved this program, the UH Epic program, back in December of 2020.  And then, once we kicked off the new year in 2021, we focused on getting contracts signed with Epic and with our implementation advisor.  So that occurred in that first quarter of 2021.

During the course of the middle year of 2021, we focused our efforts on standing up the actual program team, which is primarily made up of our IT resources.  So we leverage our own resources and just literally transition them over to the UH Epic program team.  So that process took place over the course of a few months.  We kicked off the actual program October of 2021, culminating with the final Go Live, which is scheduled for September 30th of this year.

Now, the first Go Live that we had was March of this year, and it was primarily focused on our primary care practices.  But September 30th really is the rest of the health system.  So all of the hospitals and clinics that Gubran had mentioned earlier, all those locations are going live, for all intents and purposes, as a big bang, if you will, on September 30th.  And that’s pretty much representative of the majority of our 29,000-plus end-user population.  This is significant.  I have been making the argument over the course of the past several months – and Epic has yet to surprise me on this, as well as our implementation advisor – I’m making the argument that we are truly going to be the biggest Go Live in the history of Epic.

Why?  Because if you take into account the total number of locations represented by the hospitals and the clinics and the number of practices, the fact that we’re going live with every single Epic module available to a health system, that’s happening all at once, as well.  I would make the argument that this is truly the biggest Go Live.  And just the order of just the amount of the complexity that’s associated with the fact that we’ve got an academic medical center, and we’re providing quaternary level care to our community, again adds to that order of magnitude, if you will, that is representative of being the biggest of all time, not just the best, but the biggest.

The Cost

LORA NIAZOV:  Yeah, it’s almost a $600 million implementation.

SAMI OTHMAN:  That’s right, Lora.  So if we take into account all the capital expenditures along with the operating expenditures, yeah, it’s in excess of $600 million for sure.

LORA NIAZOV:  And what’s fascinating about that is that that’s not even the software cost.  The software cost is a fraction of that.  Our partners and the folks that are going to be there at every single location to support our providers to make sure that they know how to use the software at Go Live so that we’re not interrupting patient care, surgeries, right, and everything else is really what’s driving a big chunk of that cost.  And then we have to redo a lot of our end-user devices, get brand new laptops, all sorts of things.  So that’s a big piece of the cost, as well.

SAMI OTHMAN:  Yeah.  And if we look at just the software license itself for Epic, to Lora’s point, it’s less than 10% of the total budget.  And so really the bulk of the expense is labor.  That’s what it is.  It’s labor.

BILL YATES:  That’s so interesting.  I can think of some projects that I’ve worked on in the past.  They were like bolt-ons for ERP systems.  And I remember a very large company that had underestimated the – not the software cost.  They knew how much the software would cost.  They had no idea that the implementation was going to cost so much.  So that software got purchased and theoretically put on the shelf because they didn’t have enough budget to actually implement the thing.  They had just missed it at the highest level in terms of their estimating.

Convey Calmness and the Right Mindset

So you guys went into it with eyes wide open.  The number of users, the number of people that are impacted is massive.  That’s amazing.  And I’ve got to say, you know, we have, Wendy and I have the benefit of we can see your faces.  Our listeners can’t.  You guys seem calm.  I don’t see any stress.  You know, there’re smiles.  That’s impressive.

SAMI OTHMAN:  You know, it’s funny you say that because it’s that old expression of the duck in the water, and the feet are just going absolutely nuts underneath the water.  Well, it is so important that, as leaders of this program, that we convey confidence, that we convey calmness, that we convey even a certain level of nurturing, that we’re nurturing our team, that we’re nurturing our operational folks, that we’re listening.  You know, the reality is with something as significant, as complex as this program, there are issues always going to arise.  They’re always going to surface.  You can’t prevent that from happening.

And so as long as you go into it with the mindset that as long as the patient is protected and safe, we can solve any problem, it’s that simple.  And so if we walk into that as one team, and it’s one team represented by the UH IT program team, our Epic partners, our advisory partners, our enterprise PMO represented by Lora and Gubran, as well as our caregivers that have been embedded in the program since day one, we’ll overcome anything.  As long as we work together as one, and we think as one, and we execute as one, we can overcome anything.

Believe me, I don’t have any rose colored glasses on.  We just had our 60-day Go Live readiness event just last week.  And you know, I kicked off that event.  It was a six-hour event with really a basic statement that said, “We’ve accomplished so much.”  I mean, think about this.  We’ve had to make roughly over, at a minimum, 20,000 different decisions that had a direct relationship to a build, to a code, to a configuration within the platform.  All of that was completed.

We had to engage over 1,500 caregivers across the enterprise and keep them engaged over the course of the last couple of years to ensure that we have the appropriate representation around the table as we made these decisions that will shape our future as represented by this platform.  And these 1,500 people were represented by over 80 work groups and councils that were primarily driven by them, not by IT.  We were there to facilitate.

And as you’ll see, one of our guiding principles is IT facilitates, but fundamentally this program is owned by operations.  And we continue to instill that philosophy every single day.  This is not an IT project.  This is your project, caregivers.  You wanted this project.  Well, you got your project.  Now take ownership.  And they have.  They’ve embraced it holistically.

BILL YATES:  It is important when you’re reaching the Go Live date, the end line for some people on the project, it’s helpful to do what you’ve done, look back and help remind people, “We’ve got a final push, yes, but look at all the success we’ve built.  Look at the obstacles we’ve overcome.  Look at the decisions that we’ve made.”  It’s a great perspective.

The Guiding Principles

WENDY GROUNDS:  So can you talk to us about how you created the guiding principles as the cornerstone of your Epic implementation?  You’ve shared with us some of your guiding principles.  Could you share them with our audience?

SAMI OTHMAN:  Yeah, the guiding principles are really based on learnings from any implementations that we’ve done internally as a health system.  They’re based on the fact that we wanted to do things differently in that.  Why are we making this change?  We’re making this change because we want to make sure that our patients, when they connect with us, that it is an optimal experience; and at the same time we are providing them with the best level of care.  And so in order for us to be able to do that, we had to build a platform with that patient-centric, patient-first mentality.  And then with that as our foundation, we built out all these other guiding principles around this idea of patient first.

I mentioned about clinically and operationally led and IT facilitated; right?  That’s another guiding principle.  Another piece that we had to be very, very careful about is because the Epic platform is based on building blocks, if you will.  So as you make a decision, you build that decision.  You make another decision, you build on top of the previous decision.  It’s very much a building block approach.  And so it’s going to be really important as a guiding principle.  When you make that decision, you make it only once.  Don’t retract, don’t go back, don’t try to redo.  There are no redos.  So that was another major guiding principle.

And this idea of the Epic desire, well, that desire surfaced and has been out there for years, and we’re taking advantage of it.  People want this change.  And because of that desire, they are very much engaged.  They want to learn.  And at the same time, you know, we’re leveraging Epic to ensure that we are generating the best financial type workflows, revenue cycle streams.  We are expecting to increase our ability to have greater margins because of Epic, because of the efficiencies that it brings to the table.  Because it’s an integrated EHR, as Lora mentioned earlier, that level of efficiency will increase tenfold once we have it up and running.

 And the fact that we’ll be able to ensure greater accuracy with charge capture because we’re not doing that very effectively today.  And so being able to foster those financially sound practices will come out of that Epic platform.

Let me tell you, I mean, that was one of the major drivers that helped the board make that decision.  We were able to build a business case that said our rate of return or our return on the investment, if I can speak in Lora and Gubran’s terms, our return on investment for this program, we just said it was $600 million.  We plan on making that up in less than five years.  That’s how confident we are with ensuring that this program will be a success.

LORA NIAZOV:  And if I can add to what Sami said just real quickly, I think the fact that so many people internally wanted this change, want to make this, it wasn’t a top-down decision.  It wasn’t, you know, the new guy coming in who’s in charge saying, what are you guys doing?  We want this new thing.  I had it at my previous job.  It’s much better.  Let’s go spend millions of dollars and get it right.  Like we’ve never had that happen before. 

This was very much an end-user, provider-driven, IT analyst-driven, project management-driven, all of our clinicians’ feedback of we need to do better by patients.  We need to do better for patient safety.  And if we want to continue and be successful as an organization in Northeast Ohio, which has a very, very large competitive market for healthcare, this is the right way to go.  And I think that’s what set this implementation apart, too, for success.

“Best implementation of all time.” 

BILL YATES:  I’ve got a question for you guys.  Could you describe the story behind your tagline?  We’re curious about that.

SAMI OTHMAN:  So we put a poll out there to our senior leaders, you know, what should our tagline be?  And some were, let’s just say “cheesier” than others.  And the one we landed with was “Best implementation of all time.”  You know, when you look at it at the surface, you’re thinking, that is pretty cheesy.  It’s absolute in terms of what it’s conveying; right?

But I think the spirit of it really speaks to the fact that we’re going to be leaning on 400 previous Epic implementations and getting the learnings from all of those implementations, the desire by the organization, as Lora just touched on.  And it’s one of our guiding principles, leveraging that desire from our caregivers that they want this change.  When we demoed Epic and the two other major vendors in the market, Epic was chosen 95% over the other two.  I mean, it was hands down.  It wasn’t even a contest.  It wasn’t even close.  So that desire was prevalent.

And then honestly, you know, the third item I would offer up is our talent.  We’ve got very, very smart people in this organization.  And working with folks like Lora and Gubran, I literally learn something new every day.  The fact that everybody’s coming to the table with different skill sets, different experiences, really has made this program special in that the sky’s the limit with how well we can do here. 

And so when it was first agreed that it was going to be the best implementation, I kind of, you know, wink, wink and said, okay, sure, if that’s what they want to do.  I wholeheartedly believe that we are well positioned now to make that happen.

GUBRAN AHMED:  You know, Sami, I think just to add to that, the tagline came from our senior leadership.  So you spoke to this a little bit ago in one of the questions earlier.  But the reason we’re so calm and the reason we’re not freaking out about the implementation is because of the leadership that’s provided above Sami’s level.  From the top down, they’re very engaged.  They’re willing to listen to some feedback.  They’re present at every meeting that we have that’s critical, that brings the whole team together. 

So having that type of leadership involved from the beginning allows you to be calm and have a successful implementation because you need that support in there.  And that’s what we have.

SAMI OTHMAN:  To Gubran’s point, our own CEO, when he does the town halls, he uses an expression all the time.  He says we are changing our nervous system.  We are literally changing our nervous system.  He’s a physician, so he speaks the lingo; right?  So we’re changing our nervous system.  And then he’ll follow up to say to the folks in each of the town halls he presents to, “We listened to you.  We gave you Epic.  Now it’s your turn.  Step up and own it.  Embrace it.  Make it…”

LORA NIAZOV:  Go to training.

SAMI OTHMAN:  Right, go to training.  Attend the road shows, the boot camps, practice in the playground; right?  So that’s the kind of message that’s being conveyed at the senior-most level.  And boy, you know, to Gubran’s point, it does make our lives easier.  It really does.

Kevin and Kyle

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KEVIN RONEY: Earned Value Management does not have to be intimidating to project managers! At its core, EVM relies on three key elements: planned value, actual cost, and earned value. -Planned value represents the authorized budget for the work scheduled, -Actual cost reflects the actual costs incurred, -and Earned value signifies the value of the work that has been performed to date. When you compare earned value against planned value and actual cost, project managers can assess project performance and make data-driven decisions to keep projects on track and sponsors happy.

KYLE CROWE: EVM enables stakeholders to analyze variances, forecast project outcomes, and identify potential risks early on, allowing the project manager to be proactive and make corrective actions. Ultimately, the fundamentals of EVM serve as a robust framework to monitor and control project progress, leading to increased project success rates and improved cost management.

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Risk Management

BILL YATES:  During the implementation, what risks kept you guys up at night?  And then talk to us a little bit about how you tracked and managed those risks.  Maybe you have some tips for the project managers that are out there with their risk register thinking, eh, maybe I could do something better with this. 

SAMI OTHMAN:  Well, I think the biggest risk by far in my mind was the Go Live sequencing schedule.  So we originally had a four Go Live wave, meaning we had a Go Live in March of this year.  We had another one in June of this year.  The third one was scheduled for November of this year, and then the fourth one was scheduled for April of next year.  So that meant that the entire health system would be on two separate platforms for 13-plus months; right?

LORA NIAZOV:  And if I can add to that, Sami, just for your appreciation of what we’re talking about, it’s not like we had one system before.  We’ve had almost 500 software systems, and we are getting rid of what, Sami, 400?  300 with Epic?  So just to give you the scale of the change, and that means that we’re straddling in these four waves, we’re continuing to live in this 500 to one, right, 300 to one.  And of course that drives your risk.  Go ahead, Sami.  I’m sorry to interrupt you.

SAMI OTHMAN:  No, that’s great color commentary there, Lora.  You’re absolutely right.  I think this is something that Lora touches on all the time.  We have a culture that allows for us to speak up and allows us to speak up in a safe way.  And I spoke up on behalf of the program, and I said, “We need to revisit how we’re moving this organization to Epic, recognizing that we would need to build all kinds of interfaces through each of these waves, the fact that folks, our caregivers, would have to work in both systems over the course of 13 months.”

And in my mind, that went against our fundamental guiding principle of keeping the patient first.  Because at the end of the day, we determined the four-wave approach did not do that, did not keep the patient first, that it raised the risk around patient safety and high quality of care and even continuity of care because 13 months we’ll be living with two different platforms. 

And so once we raised that concern, that risk, as you put it, right, we sat down and started to put together a plan to present this argument to various levels of leadership from across the health system.

And what was amazing, and I’m saying this with a smile, what was amazing is how quickly everybody embraced this idea of accelerating the timeline and reducing the number of Go Lives because that meant that everyone would get on the system on the same platform in a shorter period of time, and it will allow our caregivers to truly work as efficiently as possible, ensure continuity of care, work off of one patient record, and to be able to do that in short order. 

So in essence we’re moving the organization from a whole platform of disparate systems that Lora just touched on between March and September of this year.  So in a matter of six months, we are transforming this organization.

LORA NIAZOV:  And Sami, if I can just add a little bit to talk about risk.  You know, what I love about your podcast is the wide variety of topics that you covered.  You did an excellent one on risk mitigation strategies; right?  There’s a special software that you can do.  I can’t remember who the speaker was.  He was excellent.  He talked about the probability of risk and calculations around that and risk assessment strategies and mitigation plans.  And that’s all fantastic.  Every single project needs that.  And if you’re not doing that, then what are you doing as a project manager; right?

But if you don’t have an organization and leadership that allow a culture of trust, that will allow that analyst or whoever to click that virtual red button to stop, maybe it’s the Toyota production line, it’s the hospital Go Live, it’s the Challenger disaster of 1986.  If people are not feeling comfortable in your culture to raise those risks, what was the point of your risk mitigation?  If nobody’s going to pay attention.

So I really applaud, Sami, you, Robert Eardley, who’s our CIO, Terri Keeling, the vice president in IT, and Dr. Sunshine, who created that culture of trust and allowed for all of our risk mitigation strategies to be successful and to have very uncomfortable conversations; right?  Because who wants to talk about risk?  But you have to.

Time to Pivot

WENDY GROUNDS:  Inevitably things do happen, and sometimes you have to pivot.  Do you have a story of when you’ve had to pivot?

SAMI OTHMAN:  Well, I think the Go Live sequencing was a major pivot; right?  So we went from the four waves to the two waves.  You know, as we talk about pivoting or being able to address risk, we meet with various levels of the program team every single week.  We have over 50 individual work streams that represent the program. 

And so for us to really have a good pulse on what’s going on, we will meet directly with the analysts who are on the frontline, building.  We will meet then with their managers.  And above their managers, we will meet with IT leadership, which is made up of, Lora mentioned, the three leaders, as well as all the directors.  So those three levels.

In addition, we are meeting with our Epic leadership team and our implementation advisor leadership team, as well, all in the same week.  We do that every week.  And through these discussions, right, and through this vetting, we’re able to have clarity on what risk is out there and what the associated mitigation plans are. 

You know, as it relates to pivoting, you know, we will pivot when resources need to be moved from one work stream over to another.  We’ll pivot when there’s a need for us to adjust certain, you know, deadlines because it just makes more sense to align a deadline perhaps between work streams because there’s so much synergy.  Maybe one work stream was earlier than another from a deadline perspective, and it made sense for us to pivot the dates so that those dates aligned with each other between those work streams because there’s so much interconnectivity.

So that type of pivoting literally can happen almost weekly as it relates to resource management, as it relates to milestone dates, as it relates to even budgeting.  And budgeting I’m primarily responsible for.  So, you know, $600 million is nothing to sneeze at; right?  So especially on the operating side, because whatever we have for operating budget for the year is all I have.  Capital can go over multiple years, capital expense; right?  But operating, what you have is what you have.  And so the management of the operating has to be done in a very different way.  And at times, I do have to pivot to ensure that we’re spending the money where it needs to be spent.

So we had a 60-day Go Live readiness event last weekend.  We had a panel at the end of the session that was represented by a handful of our clinical chairs.  These are the highest level provider leaders in that particular service; right?  So one particular leader in the service line said – he sat there on the panel, and I noticed that he was there the whole day.  So we were there together for six hours.  And he said to us, kind of half joking, but you could tell there was some level of seriousness, is that he says, you know, “I reconstruct faces every day.  What you guys are doing is a lot harder.”  And obviously it generated a chuckle.

And so when I heard that I thought, mission accomplished.  We were able to convey to leadership the order of magnitude around this program, and the complexity that it represents, and the risk that’s out there, and the fact that we’re going to need everybody engaged to ensure that we’re mitigating appropriately.  And I thought, okay, that was a great day.

Big Bang Go Lives

LORA NIAZOV:  I just wanted to add, Wendy, you know, keeping in mind your original question of the pivot, I think what’s important to call out of our change to go from the four waves to the two is that on one of your other episodes, you also talked about nobody does big bang anymore.  We don’t do big bang Go Lives anymore; right?  We’re all agile, we’re all cool, and we change.  And we’ve got tools and processes to enable us to do that in an organized fashion.

And we collectively, as an organization, this project team has over 300 people on it, decided to go big bang in the second wave.  So the first wave, just like Sami mentioned, is our primary care, which is no small feat.  But what we’re talking about in September is those 21 hospitals that Gubran mentioned, all of our ambulatory surgery centers, et cetera, et cetera, et cetera.  It’s as big bang as it gets.  And that’s why that was the biggest change that we had, but we feel very confident about it.

BILL YATES:  Yeah, you guys are going to storm the beaches.

LORA NIAZOV:  Yes, we are.

BILL YATES:  It’s all hands on deck.

LORA NIAZOV:  We’ve checked the weather forecast in advance.

Project Team Selection

BILL YATES:  That’s good.  Let’s talk a bit about the project teams.  I’ve had a lot of experience in the past working with teams that had internal and external players.  You know, we’d have – as a matter of fact, I was usually the outsider.  I was the contractor coming up.  Talk to us about your project team.  So I’m hearing you said 300 team members.  How did you select your team?  How did you figure out, okay, from our IT group, from the Epic team, how do we pull together and make our project team?

SAMI OTHMAN:  We made a very conscious decision at the very, very beginning, so this would have been right after the board approval, that we were going to leverage our internal talent as much as we can to stand up this team.  And we’ve talked with over a dozen organizations over the course of the last couple of years just to get a take from them on what was their approach with standing up their respective Epic teams.  And it’s amazing.  It goes across the entire spectrum of approaches; right? 

You know, we heard one story where they literally stood up a team represented by all new hires from the outside.  I heard another example where the majority of the team started off as just being all contractors, and along the way they would hire them in, bring in other internal IT resources into the team.

We’re very deliberate in our approach.  We’re going to first and foremost leverage our internal talent.  And the makeup of that team is represented primarily by our internal IT resources.  Now that’s IT.  Of course, we have talent sitting in other areas as well, and Gubran can speak to this from an enterprise PMO perspective.  We needed a lot of project managers.  And guess what?  First shoulder that we tapped on was Gubran and Lora’s.  Gubran?

Enterprise Program Management Office Perspective

GUBRAN AHMED:  Thanks, Sami.  So from an enterprise program management office perspective, we have a lot of talent.  We have over 20 senior project managers on the team.  We ended up providing Sami with, I believe about four or five project managers that were full-time dedicated to Epic.  Whatever the program is or the project is under that program that Sami wanted them assigned to, you know, they handled that piece.

Along the way, there were additional requests that came in for additional support from the program management office.  And we had to prioritize the other projects that are going on, the other requests outside of Epic.  And how do we assign these project managers to the program?  So that was a system to an extent.  We didn’t have the ability to say, you know, this specific project manager had this skill set or this experience.  Let’s go ahead and allow them to be assigned to Epic.  We did a mixture of both.  So right person, right place.  They had that experience, and it made sense to be part of a huge program.  We assigned them.

There’s other project managers that are very skilled, very talented, that didn’t have the experience per se, but they had the skill set to be able to jump into such a large program and participate in it.  So that was also a thought of mine and Lora’s and Sami’s, you know, when we had a discussion about assignment, how do we get this individual the right exposure to help them continue their growth within the health system, but also to help push this program to success.  And that was the thought process from the EPMO perspective.

PMO Resources

BILL YATES:  Gubran, I’m curious, just based on this conversation, I’ve seen this happen before where a PMO, a project management office is supporting an organization.  They have a huge, in our case this Epic program gets implemented, huge implementation comes in, and then I have other ongoing projects.  And they’re coming to me saying, “Hey, don’t forget about me.  Don’t leave me with bad resources.  You know, don’t throw the scraps at me.”  What advice do you have for those working in a PMO when they’re facing that kind of a situation?

GUBRAN AHMED:  You know, I think for me, and I’m not just saying that, I think we’ve been blessed to have very talented teams.  So even when I say, “Hey, here’s the best person, and here’s the maybe the better,” it’s really like you’re still talking about project managers, 20-plus project managers, senior PMs that are performing at the top of their skill and their accreditation. 

To me, yes, there’s a better person than another in a sense, or the experience, but you’re talking about very skilled project managers.  So I have no problem saying, “Hey, I’m giving you Bob, and then I’ll give you John,” for instance, because at the same token, they’re still performing at a high level and very confident in assigning that person for those projects that are ongoing to support the system.

LORA NIAZOV:  And if I can add just a note to that, too, Gubran and I really try to look at project managers as the Swiss Army Knife.  These are folks that can be dropped into any organization, any project, and use the PMI methodology, which we adhere to at University Hospitals to ensure quality and excellence of all of our projects. 

So it doesn’t matter if you are doing an IT project in anesthesia, working with surgeons; or you are working at an aluminum manufacturing firm, and you’re rolling aluminum.  Your project base is the same, your charter, your scope, your risk register, your project plan.  And you have to be smart enough and nimble enough to apply those tools to whatever project.

Of course, it’s important to have some kind of understanding of the topic; right?  Like you’re not going to put an operational project manager into an IT project.  They will struggle.  But the expectation is you should be able to straddle anything that we put you in.  I’m proud to say our team is able to do that successfully.

Takeaways from the Project

WENDY GROUNDS:  As you assess this whole project, and you anticipate you’ll go live, what has been the biggest surprise or some lessons learned that you’ve taken from this project?

GUBRAN AHMED:  You know, for me and Sami, this is something that Sami brought up earlier.  And obviously it’s working out, and it’s great.  But for me the biggest surprise was, you know, coming from a project management background, you’re implementing the project, you want to divide up the implementation.  You want to do phase one, phase two, wave one, wave two, however, break it down so you’re successful.  So when I first heard about the big, huge pivot from, you know, multiple waves to two, I was like, “What are we doing?”  You know, here’s the big bang thing.  And that was the biggest surprise.

But I obviously, looking at it from the outside in, I didn’t understand the true complexity of it, you know, not taking care of the patient at the end of the day and making them suffer throughout this implementation of having them in multiple systems, multiple EHRs.  So, you know, not having the knowledge of the complexity and all the integrations to the systems and the records, it was a big surprise for me.  But obviously learning that later on, it made more sense, and obviously we’re moving towards it very successfully.

LORA NIAZOV:  I think from a lessons learned, Sami and I kind of reflected on this a little bit.  You know, initially when you hear a project, $600 million, 21 hospitals, 3 million patient records, your conversion of 1 million patient appointment, like blah, blah, blah, you’re thinking, wow, this is going to be it.  Like there’s going to be nothing else that University Hospitals is going to be working on for the next three years.  All business is going to stop.  All hands on deck.  There’s nothing more, you know, ROI of whatever, bajillions.  And you believe that because you want to believe that; right?  You go into, “Yes, I’m committed 100%.”

And then COVID happens, and you shut down your elective surgeries, and your budget drops by hundreds of millions of dollars.  The world continues, and nobody cares about your biggest project you’ve ever done.  And that’s a reality that you have to live with as a project manager, always knowing that your scope and those external dependencies are completely out of your control.  You have to be nimble, and you have to navigate that.  That was a big surprise and another lesson learned, as if we didn’t know that already.  But, yeah, that’s the reality that we live in.

GUBRAN AHMED:  Oh, regarding lessons learned, I’m going to say this, and I want to make sure that everybody hears this because one of the skill sets that not a lot of people talk about that you need to have as a project manager or program manager is being a motivator.  We all talk about you need to have communication skills, you need to have organizational skills, so on and so forth.  But being a motivator, I think it’s missed sometimes.  And I think that lessons learned for me, as outgoing as I am on my project calls, this is a learning that I received from Sami.

Sami attends these meetings.  And I’m getting goose bumps right now as I’m talking about it because he is so passionate.  But he is so motivating when he speaks to the group, and he provides updates, and he demands.  He demands a lot.  But at the same time he motivates you, and he supports you.  And, you know, whether he’s starting a call with a joke or with a YouTube…

LORA NIAZOV:  Or a song.

GUBRAN AHMED:  …movie clip or a song.  He also ends them with that.  You can tell when you see the faces of everybody in that meeting just changing from like being serious to smiles.  And I think a lot of the success to this program is due to Sami’s leadership and his ability to motivate the whole project team.  And that is a lesson learned from me, try to be a better motivator as I’m talking to my – to my project teams.

BILL YATES:  Sami’s having a blush as we talk about him.  And the longer the project, the more important that is.  So kudos to you guys for doing that.

SAMI OTHMAN:  Thank you, Gubran, for the kind words.  What I’ve learned, and this is something, you know, for our audience to take away; right?  Everybody matters.  Everybody has skin in the game, and everyone can make a difference.  Truly.  That’s one thing I’ve learned.  Every single person that has been involved in this program has made a difference at some level.  And don’t discount it.  Don’t underestimate it.  Everybody has made a difference to ensure success here.  And it’s a very humbling experience.  And to watch all of it unfold over the last couple of years, it’s just amazing.  It truly took a village to get us to this point.  It’s going to take that same village to get us across that finish line. And it’s because of everybody’s involvement because each person that has been involved has made a difference in the best way possible.

Find out More

WENDY GROUNDS:  If our audience wants to find out more about the project, where’s the best place that they can find out some more about the project or just get in touch with you guys?

SAMI OTHMAN:  We’re more than happy to come back and let you know how things went.  But feel free to get to our University Hospitals website.  There’s information out there about the program.  And of course you can reach out to us individually.  So feel free to share with our audiences our addresses, our email addresses.  And you know, we’re truly a community, and we’re happy to continue to have conversations with folks that are interested in our story.

BILL YATES:  This is an inspiring project.  It really is.  I’ve never been involved in one that had that many stakeholders impacted, not even close.  I get the wisdom in storming the beaches.  Let’s just pick a date and rip that Band-Aid off.  I get it.  But kudos to you guys.  It takes so much planning, so much coordination, and so much continual communication and motivation.  Well done.  Thank you for sharing this story, and congratulations on having the most successful project ever with Epic.

SAMI OTHMAN:  Thank you so much.

GUBRAN AHMED:  Appreciate the time.

LORA NIAZOV:  Thank you so much for having us.  This was so fun.


WEDNY GROUNDS: Here’s a note from Lora that I got this week. She’s says The EPIC go live is going really well! “I am tremendously proud of the team and of the go live support, over 2,500 at the elbow support people have been in Cleveland supporting this massive go live.  No major patient safety incidents and we are posting charges and billing as planned.  It’s been an amazing experience to watch the entire organization come together around this effort.” So thank you Lora and congrats to you guys, Sounds like you are doing an incredible job.


WENDY GROUNDS:  That’s it for us here on Manage This.  Thank you for joining us today.  You can visit us at Velociteach.com, where you can subscribe to this podcast and see a complete transcript of the show.

To earn your free PDUs, you can claim them by going to Velociteach.com.  Choose Manage This Podcast from the top of the page.  Click the button that says Claim PDUs, and click through the steps.  Until next time, keep calm and Manage This.


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