Managing Scope Creep

I have yet to be part of any project that did not experience some level of scope creep. Scope creep occurs when the client or members of the project team “try to improve the project’s output as the project progresses” (Portny, Mantel, Meredith, Shafer, Sutton & Kramer, 2008, p. 346). Scope creep is inevitable, but if change processes are controlled carefully and in a formal manner, scope creep will not be the downfall of a project.

The hospital I work for is implementing an integrated electronic medical record (EMR). This is huge project spanning several years. Part of this project is to implement the EMR in our many outpatient clinics. We have a large primary care network and over 60 specialty clinics. For those of you who may not be familiar with healthcare, the term “clinic” does not always refer to a physical location. Our clinics occur to treat patients with different types of problems and sometimes share space. For example, we have an Orthopedic clinic, a Pulmonary clinic, a Surgery clinic, an Allergy clinic etc. Within these specialties, there are often different types of clinics that focus on different disorders held on different days of the week. For instance, the Pulmonary clinic may hold an Asthma clinic on one day and a Cystic Fibrosis clinic on another.

Each clinic’s EMR implementation is a separate project under the larger umbrella of the hospital’s EMR implementation. Each clinic “Go-Live” has its own project manager and build team from the IS Department. Our team is responsible for training physicians and medical staff; we are part of the Medical Education department. Another team from the Professional Development department is responsible for training nursing and ancillary clinical staff, and yet another team is responsible for training administrative staff on non-clinical applications (billing, scheduling, etc.).

Each clinic go-live project has experienced scope creep. Most often, this is related poor workflow analysis. Unfortunately, the project managers try to employ a “cookie cutter” approach to bringing these clinics live on the EMR.  All of our clinics are unique. They have their own procedures and workflows yet the project managers repeatedly try to use the same plan. Many of our clinics are multidisciplinary meaning that more than one specialty may see them in a given clinic. The project team often does not anticipate this and inevitably leaves people and workflows out. Over the course of project meetings, these workflows and other roles are identified and the project team has to scramble to incorporate them.  In the past, this has led to delays in build, delays in training and delays in implementation.

If I were managing these projects, I would perform more upfront analysis in each clinic. Asking some basic “who, what, why, when, where, and how” questions would go a long way in identifying the unique workflows. I would outline all of the workflows and work to be performed in the “Define Phase” of the project in order to clarify details with each clinic (Portny et al, 2008). I would have this approved in writing by the clinic representatives before work began. Despite performing a better upfront analysis, scope creep is still likely to occur so I would include a change control process in the project plan.  I would ensure that the project stakeholders agreed upon all changes after identifying how the changes would affect the project plan, schedule, and budget.

Thanks,

Brandey

Reference:

Portny, S. E., Mantel, S. J., Meredith, J. R., Shafer, S. M., Sutton, M. M., & Kramer, B. E. (2008). Project management: Planning, scheduling, and controlling projects. Hoboken, NJ: John Wiley & Sons, Inc.