From Project Management to getting value: Queensland Health Information Division Transformation Program Sabrina Wals

1. From Project Management to getting value: Queensland Health Information Division Transformation ProgramSabrina Walsh CIO Queensland Health Pleased to be here and have an opportunity to talk about my hobby horse Many years in the public sector in a variety of roles � clinician, policy (MH) but most often in m�ment Have seen good, bad and indifferent policy But, in my experience, it is EXECUTION that is the weak point in many public sector organizations Less than 18 months ago was asked to take on role to bring together 4 different IM & ICT areas of QH into a single, statewide service And to FIX IT UP � what ever that might mean I agreed but also lost a few nights sleep I know a fair bit about the health business and management in general I had involvement in health IT initiatives over many years including sponsoring some large projects and participating in National Information Committees I like a challenge and have a record of getting outcomes But I�m no IT expert So, I did the only thing I could - Firstly � talked to everyone I could and found out what the problems were Secondly � got some help and defined a new goal state That took 4 months. The next 12 months was the Transformation journey. That took from Jan to Dec last year. So today I�m going to share this with you � a case study really And it has several aspects to it � all of which are relevant to the theme of this conference Firstly, there is the framework we chose to help us determine a new operating model Secondly, there is the model we chose which is aimed at improving both delivery and value Thirdly, there there is the program of work which got us from A to B � the actual Trans Prog We applied the principles behind the model to TP itself � thereby �walking the talk� and letting people see the principles in action One last thing before I go on � this has been a very successful program. Whilst I�m talking today � this has been a team effort and all credit goes to my exec team and to the external partners that assisted Pleased to be here and have an opportunity to talk about my hobby horse Many years in the public sector in a variety of roles � clinician, policy (MH) but most often in m�ment Have seen good, bad and indifferent policy But, in my experience, it is EXECUTION that is the weak point in many public sector organizations Less than 18 months ago was asked to take on role to bring together 4 different IM & ICT areas of QH into a single, statewide service And to FIX IT UP � what ever that might mean I agreed but also lost a few nights sleep I know a fair bit about the health business and management in general I had involvement in health IT initiatives over many years including sponsoring some large projects and participating in National Information Committees I like a challenge and have a record of getting outcomes But I�m no IT expert So, I did the only thing I could - Firstly � talked to everyone I could and found out what the problems were Secondly � got some help and defined a new goal state That took 4 months. The next 12 months was the Transformation journey. That took from Jan to Dec last year. So today I�m going to share this with you � a case study really And it has several aspects to it � all of which are relevant to the theme of this conference Firstly, there is the framework we chose to help us determine a new operating model Secondly, there is the model we chose which is aimed at improving both delivery and value Thirdly, there there is the program of work which got us from A to B � the actual Trans Prog We applied the principles behind the model to TP itself � thereby �walking the talk� and letting people see the principles in action One last thing before I go on � this has been a very successful program. Whilst I�m talking today � this has been a team effort and all credit goes to my exec team and to the external partners that assisted

2. Overview The context The problem The framework � right things, right way, done well, getting value The new operating model The Transformation Program case study �walking the talk! Lessons learned

3. The Context QH is a large agency � 50,000+ staff Over 1000 IM & ICT staff Largest IT �shop� in Qld Over 300 networked sites 24,000 desk tops $400M capital program over 4 years

4. The Problem: Baseline State � Dec 2004 Distributed operations and help desk geographically fragmented (local IT shops indulging in turf protection) Central operations effectiveness constrained by technology silos Duplication of functions across the operational teams Unclear boundaries & dysfunctional interface between projects and operations Policy and strategy under-resourced Actual work being performed often different from intended roles and JDs Unclear authority and responsibility resulting in slow decision making Multitude of �local� information systems distracting from servicing core �enterprise� business Some projects in the �red� and unlikely to deliver their business outcomes Success achieved by �heroes� not efficient organisation & process design

5. The Framework �Information Paradox� - we are spending more on �info� but not getting the value Right things Right way Done well Getting value Reference: Thorp, J. (2003) The Information Paradox Are we doing the right things? � this question is about the business direction and the alignment of programs with that direction Are we doing them the right way? � this is about org structure and process and the integration of programs into that Are we doing things well? - this is about organisational capability, the resources available and supporting infrastructure to get things done efficiently Are we getting the benefits? � this is about PROACTIVE benefits managementAre we doing the right things? � this question is about the business direction and the alignment of programs with that direction Are we doing them the right way? � this is about org structure and process and the integration of programs into that Are we doing things well? - this is about organisational capability, the resources available and supporting infrastructure to get things done efficiently Are we getting the benefits? � this is about PROACTIVE benefits management

6. After extensive analysis and consultation � a new operating model was developed Under InfoSolutions we have: the Delivery Office Architecture, Analysis and Design Office Development Office Under InfoInvestment we have: Customer and Vendor Engagement Clinical Information Strategy Investment Office IM/ICT Services Planning and Performance Security and Risk Information Management Under InfoOperations we have 3 Service Integration Units Operations Consulting Technical Operations Technical Assurance Provincial Area Management Metropolitan Area Management The model has separate areas with discrete responsibilities as shown above. The Transformation Program was initiatied to get us from where we were to where we needed to be. But before telling you about TP, I will first briefly comment on what we did with governance.After extensive analysis and consultation � a new operating model was developed Under InfoSolutions we have: the Delivery Office Architecture, Analysis and Design Office Development Office Under InfoInvestment we have: Customer and Vendor Engagement Clinical Information Strategy Investment Office IM/ICT Services Planning and Performance Security and Risk Information Management Under InfoOperations we have 3 Service Integration Units Operations Consulting Technical Operations Technical Assurance Provincial Area Management Metropolitan Area Management The model has separate areas with discrete responsibilities as shown above. The Transformation Program was initiatied to get us from where we were to where we needed to be. But before telling you about TP, I will first briefly comment on what we did with governance.

7. Improving project performance AND getting better value It is not JUST about Project Management Critical Issues Need to improve project performance Need for comparative assessment of investments Need to realise benefits Approach Separate IO & DO Build / Operate / Transfer model Before I talk about the rest of the Trans Prog, I want to comment on how we have gone about improving project performance and benefits realization Rather than create a new Projects or Program Office � we split the functions into managing DELIVERY and managing INVESTMENTS. DO and IO have very different roles and we have embedded some tension between these areas which is aimed at lifting performance on both sides Before I talk about the rest of the Trans Prog, I want to comment on how we have gone about improving project performance and benefits realization Rather than create a new Projects or Program Office � we split the functions into managing DELIVERY and managing INVESTMENTS. DO and IO have very different roles and we have embedded some tension between these areas which is aimed at lifting performance on both sides

8. ICT Governance  Define roles, accountabilities / responsibilities Sponsorship & business change Formalise decision points Information Strategy & Investment Board Decision rights & decision points Supported by frameworks, processes and tools Investment Office � Value, Outcomes & Benefits Delivery Office � Capacity, Cost & Schedule Consistent Application Improved information for decision making Portfolio view of investment proposals Individual assessments against criteria ICT Governance Objectives To understand the issues and strategic importance of ICT To ensure that the enterprise can sustain its operations To ascertain that it can implement the strategies required to extend its activities to meet its objectives Program value is a multidimensional measure of the business need, the approach, and the chance of success. This can easily be understood through the four �areas�: Are we doing the right things? Is the business need clearly identified? Are the outcomes and benefits aligned with the organization�s strategy and priorities? Are we doing them the right way? Are the necessary methodologies and standards being complied with? Does the program align and support other initiatives? Is the program activity consistent with achieving the outcomes? Are we getting them done well? Have participants and stakeholders accepted their roles and responsibilities? Has the program been well planned and have sufficient resources? Is the identified scope both necessary and sufficient to achieve the outcomes? Can the scope of work be achieved? Are we getting the benefits? Do the proposed benefits (non-financial as much as financial), justify the cost? How confident are the benefit estimates and is there broad acceptance of them? How dependent are the benefits on factors beyond control of the program? ICT Governance Objectives To understand the issues and strategic importance of ICT To ensure that the enterprise can sustain its operations To ascertain that it can implement the strategies required to extend its activities to meet its objectives Program value is a multidimensional measure of the business need, the approach, and the chance of success. This can easily be understood through the four �areas�: Are we doing the right things? Is the business need clearly identified? Are the outcomes and benefits aligned with the organization�s strategy and priorities? Are we doing them the right way? Are the necessary methodologies and standards being complied with? Does the program align and support other initiatives? Is the program activity consistent with achieving the outcomes? Are we getting them done well? Have participants and stakeholders accepted their roles and responsibilities? Has the program been well planned and have sufficient resources? Is the identified scope both necessary and sufficient to achieve the outcomes? Can the scope of work be achieved? Are we getting the benefits? Do the proposed benefits (non-financial as much as financial), justify the cost? How confident are the benefit estimates and is there broad acceptance of them? How dependent are the benefits on factors beyond control of the program?

9. Summarised illustration of the QH investment governance framework 2 aspects of governance: �Investment Selection� & �Implementation & Value Delivery� Based around key decision points Designed to gather & present �just enough information� to inform the decision being made Investment selection: Is this good idea? Learn a bit more� Is this still a good idea? � up to funding of implementation. Implementation & Value Delivery: Delivery Office or �Project Office� supports delivery The achievement of Benefits is actively managed throughout the life of the project in much the same way project milestones & deliverables are managed. Investment Office maintains a view of the ongoing value proposition of the project both during implementation and post implementation until benefits are realised. Features Just enough governance� to inform the decision being made, enable innovation & decrease bureaucracy � pragmatic application of governance Idea is refined as (if) it progresses through the framework Very Customer & outcome focussed Heavily facilitated by trained �Value Analysts� Work with the Customer to help them define their idea The right resources are key Summarised illustration of the QH investment governance framework 2 aspects of governance: �Investment Selection� & �Implementation & Value Delivery� Based around key decision points Designed to gather & present �just enough information� to inform the decision being made Investment selection: Is this good idea? Learn a bit more� Is this still a good idea? � up to funding of implementation. Implementation & Value Delivery: Delivery Office or �Project Office� supports delivery The achievement of Benefits is actively managed throughout the life of the project in much the same way project milestones & deliverables are managed. Investment Office maintains a view of the ongoing value proposition of the project both during implementation and post implementation until benefits are realised. Features Just enough governance� to inform the decision being made, enable innovation & decrease bureaucracy � pragmatic application of governance Idea is refined as (if) it progresses through the framework Very Customer & outcome focussed Heavily facilitated by trained �Value Analysts� Work with the Customer to help them define their idea The right resources are key

10. Delivery Office 

11. Delivery Office Project Management Service Pool of QH Project Managers Career path for project management within QH Project Officer to Program Director Retention of skills between projects Variable demand management Access to skilled PMs from external Use QH methodology Support roles Resource management Methodology and project coordination Focus on skills and training

12. An Integrated Change Program So back to the Transformation Program as a whole As you can see this was an integrated change programSo back to the Transformation Program as a whole As you can see this was an integrated change program

13. Transformation Program You won�t be able to read this but it shows the original value chain for the Program It shows the outcomes, the initiatives and the assumptions The initiatives are grouped into streams of work, ie sub-programs The program contains all the necessary and sufficient elements to achieve the desired outcomes.You won�t be able to read this but it shows the original value chain for the Program It shows the outcomes, the initiatives and the assumptions The initiatives are grouped into streams of work, ie sub-programs The program contains all the necessary and sufficient elements to achieve the desired outcomes.

14. I�m sure you can�t read all this but this is a one page version of the Trans Prog It shows the activities, outputs and outcomes for each of the streams (read examples in structure and transition)I�m sure you can�t read all this but this is a one page version of the Trans Prog It shows the activities, outputs and outcomes for each of the streams (read examples in structure and transition)

15. TP - Agreed Scope of Work Establish an integrated change program with focus on the implementation of specific change initiatives across ID The change initiatives would be centred around ID�s structure, processes & ICT Systems and the associated transition activities The program�s performance would be measured by the value it delivered not just against schedule & budget Value measured in financial & non-financial benefits delivered as a consequence of the changes The transformation partners would provide their methods, IP & expertise to support the program outcomes and develop a sustainable capability within ID The initial scope of work would be delivered within 12 months

16. Benefits Realisation � Define the business change and identify key benefits The Trans Prog was a benefits driven program. It �walked the talk� for the model we expect everyone to follow. This program had to be self-funded. We knew the Program would need about 40 FTE Half external and half internal � 17 external; 18 internal If the program could not identify benefits (including cashable savings to pay for this it would not continue) Neat piece of risk sharing!! The Trans Prog was a benefits driven program. It �walked the talk� for the model we expect everyone to follow. This program had to be self-funded. We knew the Program would need about 40 FTE Half external and half internal � 17 external; 18 internal If the program could not identify benefits (including cashable savings to pay for this it would not continue) Neat piece of risk sharing!!

17. Benefits Realisation � Formalise the benefits and secure sponsor approval Draft benefit realisation plan � Performance Manager Draft deposit slip � Performance Manager Assure benefit visibility � IDTP Benefit Lead Review and revise where required� Performance Manager Commit to benefit � Benefit Owner Approve benefit - Sponsor

18. Benefits Realisation � Measure, monitor and report progressRealise benefit and complete business change The Trans Prog was a benefits driven program. It �walked the talk� for the model we expect everyone to follow. This program had to be self-funded. We knew the Program would need about 40 FTE Half external and half internal � 17 external; 18 internal If the program could not identify benefits (including cashable savings to pay for this it would not continue) Neat piece of risk sharing!! The Trans Prog was a benefits driven program. It �walked the talk� for the model we expect everyone to follow. This program had to be self-funded. We knew the Program would need about 40 FTE Half external and half internal � 17 external; 18 internal If the program could not identify benefits (including cashable savings to pay for this it would not continue) Neat piece of risk sharing!!

19. Benefits realisation � management of savings bank Identify funding need � requesting officer Define funding requirement � requesting officer Review withdrawal submission � Savings banker Approve withdrawal submission � Sponsor Facilitate withdrawal � Savings banker Use funds as approved � requesting officer Assure benefit visibility � Savings banker We set up a savings bank. And a process for withdrawing from this.We set up a savings bank. And a process for withdrawing from this.

20. Structure Stream - Agreed Scope of Work Definition and creation of the new organisation, functions and roles and their sustainability Organisation Design for Information Directorate Accountability Maps for Levels 1 & 2 managers Master Job Descriptions for the organisation design that have been approved, and completed the JEMS process

21. Deliverables � Dec 2005 Operating Models/ Functional Maps/Accountability Maps Responsibility & Accountability Charts (RACI) High Level Organisational Designs (HLOD) Functional descriptions for Local Organisational Environment (for inclusion in JDs) Detailed Organisational Structure (Org Charts) Functional Split Analysis (enterprise vs. local; project vs. operations) Job Descriptions (+ competencies for technical roles)

22. Outcomes Achieved and Benefits Delivered - New organisation design focused on Integrated Service Delivery - enhanced ability to manage and achieve Service Levels Clear functional separation of policy/strategy; new capability; customer service interface; enterprise operations; local systems management- improved organizational effectiveness Operating Models for InfoSolutions, InfoService Centre, InfoInvestment and InfoOperations- communicating how the new organisation will work HLOD for all branches - rationalisation and alignment of organizational function Flatter structures across ID -fewer management handoffs, faster decision making, reduced management overhead

23. Outcomes Achieved & Benefits Delivered: Tools to support managers in understanding the new organisation and effecting the change eg accountability maps and RACI charts Consistent roles across the organisation � Job Descriptions reduced from 600 to 112 Introduction of competencies for technical roles -Total FTEs required to support Operations after transfer of functions to Districts reduced from 623 in 2004 to 497 in 2006 Improved organizational efficiency and focus on core business Introduction of new capability for critical functions (Investment Office, Delivery Office, Customer & Vendor Engagement, Information Security & Risk)

24. Transition Stream Baseline State � Dec 2004 Key managers briefed on the IDTP and business model ~20% of staff either on higher duties, seconded or temporary appointments % of staff in all sites considered IDTP optional HSD managers largely unaware of IDTP Poor understanding of reasons for change Scepticism that IDTP could / would implement permanent reform Widespread disagreement of enterprise separation Lack of awareness of ID performance and customer perception Role confusion for managers / leaders (staff advocate versus sustaining sponsor) We�re OK, They�re Not OK (We do things right, they have no idea) Siloed functions with largely technical orientation

25. Agreed Scope of Work Allocate ~650 staff to new roles Transition InfoService Centre and InfoOperations to new organisation design Provide Transition methodology, tools, and training to InfoInvestment, InfoSolutions & Business Services Define a role allocation process in conjunction with QH Change Guidelines Provide change support to ID Managers and staff Provide communication support for IDTP & ID Approved and funded staff skilling program

26. Deliverables Produced � Dec 2005 Staff Transition Methodology and Instruments Organisation Design Tool (HR Database) Agreed Transition Principles (plus addendums) Skilling Matrices and skill gap analysis Job Impact Assessments Transition Handover Folders (9) Post Transition Review (InfoService Centre & InfoOperations)

27. Outcomes Achieved & Benefits Delivered: Transitioned 672 staff into new organisation design More appropriate job fit of staff in roles; Streamlined ID workforce & no large scale staff surpluses Branches positioned to harvest benefits of IDTP Seven working groups established involving 31 HSD�s mutually beneficial outcomes for HSD & ID achieved through 88 working group meetings IDTP representatives on site at 28 locations Address management / staff concerns immediately, reduce anxiety / stress in a number of cases Greater understanding of local issues / requirements

28. Outcomes Achieved & Benefits Delivered: 7400 hours of direct time with staff: multiple opportunities for staff to engage directly with IDTP Trained all managers to deliver transition outcomes: managers understand their lead role in change initiatives All staff participated in one-on-one meetings with manager to discuss IDTP impacts: Organisational commitment to supporting staff QIRC endorsement of transition process: tested & approved transition methodology Skilling analysis of technical resources in the Clusters

29. Lessons Learnt? Strong executive mgt support has removed / mitigated program risk�s & issues with the potential to be �show stoppers� Open minds & multiple perspectives (QH, Fujitsu & Arena) have enhanced program scope & performance Involving future ID leaders in the program has removed many roadblocks & prepared them well for their future roles Good resources have delivered good results A collaborative engagement model was a critical success factor, but sheer bloody mindedness delivered the results Limiting timeframe to 12 months made targets real & achievable

30. Lessons Learnt? The time it would take to identify & attract QH staff to work in IDTP was seriously underestimated The degree of parallel activity scheduled by IDTP was unrealistic based upon the available capacity within the ID branches Baseline performance measures are critical in a change program and we should have defined these in more detail at program initiation Realization of short term cashable benefits are difficult in a change program until the organisation structure has been stabilised

31. Some critical success factors Having a framework to ensure we covered all levels: right thing, right way, done well, getting value Comprehensive planning � results chain is a great tool!! ENOUGH resources The RIGHT resources VERY TIGHT monitoring and reporting Working as a team Benefits and savings bank

32. In summary The Transformation Program achieved its outcomes on time and on budget It funded itself � a risk sharing arrangement with the external partners meant that for the program to continue it had to identify cashable benefits We achieved significant IP and capability transfer from our external partners I have just approved TP2006 with a focus on people, partnering and performance!!