Health IT project failure – is it in the eye of the beholder?
Government IT projects especially are subject to intense scrutiny and review (HealthSMART anyone?) [1,2] and point the finger at planning, procurement and project management as the usual suspects impacting on project demise.
A recent Gartner report  identified the top three reasons that government tech projects fail:
• Business process complexity
• Portfolio management (and IT engagement in that management)
• Governance and risk management
However, caution should be applied when labelling projects as ‘failed’, as defining failure can be a case of beauty is in the eye of the beholder. While many eHealth projects are not delivered strictly on time, within budget or do not meet user expectations; it would be remiss to automatically label these projects as failures. It is perhaps more important to evaluate projects on whether they delivered business and clinical benefits and if they were successful from the perspective of the project sponsor, project manager and the client/end user. System implementation projects in particular can be sensationally branded as ‘failures’ where there is a mismatch of expectations between end users and vendors/implementers. Often the system is blamed when problems arise in the project; but the real culprits might be failed implementation strategies, poor change management, scope creep or a breakdown of relationships.
Project Success Factors
A literature review of studies into the determinants of project success  identifies that regardless of project type a number of factors contribute to project failure including; poor time and budget management, a lack of support from key stakeholders, too many scope changes during the project and an uncoordinated approach within the organisation. As a result of the review, ten critical success factors for project success were identified:
1. Project mission - set clear goals and direction for the project
2. Top management support - to champion the project and overcome challenges
3. Project planning - understand the who, what, how, when and where of the project
4. Client consultation - to ensures stakeholders are engaged
5. People management - to assist with the development of effective project teams
6. Technical tasks - to ensure that the required technology and expertise are available
7. Client acceptance - sign-off of project deliverables
8. Monitoring and feedback - to keep the project on track
9. Communication - to manage expectations internally and externally of the project
10. Trouble-shooting - to catch and resolve issues early
A Complex Situation
It is also useful to consider factors at a project level that directly contribute to project success including; leadership, communication, plan and design, appropriate resourcing and team performance. An additional factor for IT projects is project complexity. Project complexity and associated risks can increase exponentially with the implementation of new technologies, custom developed software, complex system integration and data migration requirements; areas that traditionally lack expertise within healthcare agencies. Trying to automate and consequently standardise clinical processes can also hugely increase project complexity, especially given clinical governance issues where patient safety is at risk.
There is no silver bullet to ensure project success and every project will encounter issues and roadblocks that need to be managed, resolved or worked around. Ultimately, there is no replacement for a solid project management and governance framework backed up by good communication, problem solving and consultation skills to effectively pilot the project through the project lifecycle. No complex IT project carried out in such a challenging business environment as healthcare delivery will ever be without its challenges, setbacks and problems.
Success is a Continuum
The hallmarks of a ‘successful’ project are usually strong business leadership, a single-minded focus on achieving the desired outcome, suitably skilled project team members, robust project management frameworks, combined with effective communication strategies and a strong partnering relationship between all parties. Additionally, the project can sometimes take longer and cost more to achieve the desired outcome than was expected. However, it is the achievement of the desired outcome that should be the primary determinant of project success and not necessarily the elegance of the process by which you get there, nor the achievement of initial expectations regarding project timeframes. It could be argued that projects only ‘fail’ if they are abandoned prior to achieving any of the targeted business outcomes. ‘Success’ should be perhaps be viewed as a continuum, both in terms of the extent of business benefits realised as well as the time it takes to achieve those benefits.
While those of us working in eHealth could probably cite examples of ‘failed’ IT projects, there would be great debate on the factors that contributed to the project outcomes; whether any business or clinical benefits were delivered; and whether the outcome was worth the often sizeable investment. Thus the beauty of project success is truly in the eye of the beholder.
Author - Valerie Thiessen, Consultant, MKM Health:
Valerie has more than 20 years’ experience in healthcare IT in Victoria and is the co-author of the book Project Management in Health and Community Services. She has worked extensively in strategic planning, project management and implementation of IT systems across the public and private sector.
 Project Management in Health and Community Services, Dwyer, Liang, Thiessen and Martini, 2nd Ed., 2013, Allen and Unwin
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