The Role of an Executive Sponsor in implementing Large Scale Change in a Health Care System

According to the Institute of Medicine, immediate steps must be taken across the United States to educate and train the healthcare workforce to work collaboratively to address the needs of the growing older adult population. The Geriatric Practice Leadership Institute (GPLI) was designed to support professional teams working in acute and post-acute care in transforming their organization into a designated Age-Friendly Health System. The program was built around the Institute for Healthcare Improvement's Age-Friendly Health Systems 4Ms framework. This framework focuses on What Matters, Medication, Mentation, and Mobility (the 4Ms) in supporting care for older adults. The GPLI program is an online, seven-month team-based program with four to seven participants from one organization per team. Additionally, each team selected, developed, and completed a quality improvement project based on Age-Friendly Health Systems 4Ms. The curriculum also includes organizational culture, leadership, and interprofessional team-building modules. Using a post-completion survey, the experiences of 41 participants in the GPLI program were assessed. All respondents found the information in the program 'very' or 'extremely' valuable, and their executive sponsor 'very' or 'extremely' valuable in supporting their team's involvement and project. The GPLI program has trained over 200 healthcare professionals and teams that have successfully implemented projects across their organizations.

Abstract The BC Ministry of Health (BC MoH)’s Health Technology Assessment unit is part of the Partnerships and Innovation Division. Our interest in this project concerns the status of ATs and the health technology assessment (HTA) process. The role of AT implementation as a key feature of the potential for new ATs to maximize health impact for older adults is something the Ministry sees as critical to meet the goal of enhancing healthy ageing and sustaining independence and autonomy. Methods: From the beginning of the project, as Executive Sponsor, the Partnerships and Innovation Division helped to co-create the research program and played a key role in developing partnerships with health authorities and other stakeholders. With monthly meetings and several other research activities, the project has provided multiple opportunities for genuine policy engagement. Results: The results so far have seen the project extend the scope of its partnerships with key stakeholders in BC. The Ministry was on a local reference group of knowledge users for a rapid realist review of participatory co-design, and Mr. Saini is a co-author on a publication based on that work. The project received additional funding from the BC MoH, and recently the Ministry collaborated on a successful University of Victoria Research Acceleration Fund grant application. Conclusions: The BC MoH sees this as a key implementation science project, which will provide guidance to the HTA process, as it inevitably confronts increased demand for the public provision of ATs for older adults, particularly vulnerable and disadvantaged groups.

ABSTRACT Analytics success has delivered superior customer value, higher revenue growth, and enhanced profitability to organizations. However, a large percentage of organizations in each industry has failed to realize such analytics success. Past studies have identified the antecedents of success and failure of business analytics projects. Executive Sponsorship was rated as among the top-success enablers. There has been limited attention to how executive sponsors influence business analytics success. To demystify Executive Sponsor’s role, we applied Deductive Thematic Analysis to the narratives recorded from key informants for 21 successful and 20 failed analytics projects covering 14 industries. This study identified four influence domains that span the project lifecycle and recommends the Executive Sponsor’s involvement in each of these. The influence domains are Project Initiation, Organization culture, User trust, and Deployment enablers. Our informants found the influence domains comprehensive to explain the outcomes of their projects. The influence domains can help articulate the role of the Executive Sponsor better and set expectations. They can also be used to analyze projects, identify causes of failure, and plan corrective actions.

George A. Mashour, M.D., Ph.D., Recipient of the 2021 Excellence in Research Award

Megaprojects are failing at a rate that affects national economies as well as millions of people. The role of the executive project sponsor is merely one of the decisive factors in the success of these projects, but it is still much neglected in project management literature. This paper investigates attributes required by executive sponsors of megaprojects. The paper reports on the perceptions of 26 executives who played key roles in six recently completed megaprojects. The findings include essential attributes that an executive sponsor should have in order to improve the probability of a megaproject's success. The single most significant attribute is seniority and power.

Megaprojects are failing at a rate that affects national economies as well as millions of people. The role of the executive project sponsor is merely one of the decisive factors in the success of these projects, but it is still much neglected in project management literature. This paper investigates attributes required by executive sponsors of megaprojects. The paper reports on the perceptions of 26 executives who played key roles in six recently completed megaprojects. The findings include essential attributes that an executive sponsor should have in order to improve the probability of a megaproject's success. The single most significant attribute is seniority and power.

Aims and Objectives: To develop an understanding of the implementation of the Community-Criteria for Screening and Triaging to Appropriate aLternative care (C-CriSTAL) initiative in primary healthcare setting in South Western Sydney (SWS). Background: C-CriSTAL is a prognostic assessment tool that identifies elderly patients at the end-of-life (EOL), quantifies the risk of imminent death and facilitates discussion on care preferences. A General Practice co-designed initiative C-CriSTAL was developed which included an advance care planning implementation package (ACPIP) with the components of early detection, identification of EOL care needs and communication with the patient in primary healthcare setting. Design: Qualitative study. Methods: Semi-structured interviews were conducted with purposive sample of Executive Sponsor and members of the Clinical Reference Group including representatives from a Local Health District, C-CriSTAL Project Team, a Primary Health Network, Consumer, General Practitioners. The Interviews were recorded, transcribed verbatim and analysed qualitatively by means of a thematic analysis. Results: A total of 12 interviews were conducted. Thematic analysis resulted in identification of three salient themes: 1) Success elements; 2) Facilitators; and 3) Future Enablers. These salient themes capture facilitators and barriers to the program’s implementation and ability to become part of routine practice. Conclusions: The C-CriSTAL initiative in SWS was well accepted and perceived as valuable and beneficial for patient’s health care. The tool enhanced clinician’s confidence in initiating earlier EOL discussions and empowered patients to express EOL wishes in a comfortable environment then subsequently documented in the form of an advance care directive (ACD). However, challenges to sustain the program as a whole in the longer term were evident due to issues of time, funding, education/training for staff. Relevance to Clinical Practice: This study provides insight into the practical considerations as well as barriers and facilitators to the implementation of C-CriSTAL package in primary healthcare setting.

Healthcare organizations must continue to improve services to meet the rising demand and patient expectations. For this to occur, the health workforce needs to have knowledge and skills to design, implement, and evaluate service improvement interventions. Studies have shown that effective training in health service improvement and redesign combines didactic education with experiential project-based learning and on-the-ground coaching. Project-based learning requires organizational support and oversight, generally through executive sponsorship. A mixed-methods approach, comprising online surveys and semi-structured interviews, was used to explore the experiences of expert coaches and executive sponsors as key facilitators of workplace-based projects undertaken during an Australian postgraduate healthcare redesign course. Fifteen (54%) expert coaches and 37 (20%) executive sponsors completed the online survey. Ten expert coaches and six executive sponsors participated in interviews. The survey data revealed overall positive experiences for coaches and mixed experiences for sponsors. Interview participants expressed a sense of fulfillment that came from working with project teams to deliver a successful project and educational outcomes. However, concerns were raised about adequate resourcing, organizational recognition, competing priorities, and the skills required to effectively coach and sponsor. Expert coaches and executive sponsors sometimes felt under-valued and may benefit from cohort-tailored and evidence-based professional development.

ObjectiveTo explore the most important public health information system database integration project success factors to include: technological, organizational, project-specific, or external.MethodsThis study involved a cross-case design. Cases were identified through literal replication logic and screened through a survey and review of available literature. Study participants were interviewed through hour-long sessions steered by a semi-structured guide. Survey responses, interview transcripts and available documents were coded and analyzed deductively, and matrices were developed to illustrate relationships.ResultsLeadership among the project’s participants is the most important integration project success factor. This leadership factor manifests in the following ways. Executive sponsors champion the initiative. Informaticians facilitate communication and system requirement collection. Program directors contribute substantive energy to the project and remove obstacles. Some other factors also contribute to project success. For example, strong Financial Management and Support promotes project initiation. Technological aspects impact the final product’s quality. Utilizing formal project management techniques, particularly the Agile software development methodology, contributes to successful project resolution by ensuring daily operational effectiveness.DiscussionThe principal finding illustrates important contributions by project leaders, transcending those of the executive sponsor. Other participants, notably informaticians and program directors, substantially contribute to the project’s success. Additionally, the Agile software development methodology is emerging as a successful approach to project management for these and related projects.ConclusionInvesting in the leadership and project management skills of database integration project participants could improve the success of future projects. State health department staff considering these projects should carefully select project participants and train them accordingly.

Introduction: The administration of “to-go” medications in the Kelowna General Hospital Emergency Department was identified as an issue. Frequently, multiple administrations of “to-go” medication pre-packs were administered to individual patients on a frequent basis. In addition, the variability in “to-go” medication was substantial between providers. Recognizing the patient issues (addiction, dependency and diversion) and system issues (costs, risk) a team-based quality improvement initiative was instituted, utilizing a variety of quality improvement techniques. The aim was to reduce the number of “to-go” medications by half, within a year. Methods: The project began January 2015, and is ongoing. Multiple stakeholders were engaged within the emergency department; these included leaders of the physician, nursing and pharmacy teams, including an executive sponsor. Using change theory, and traditional Plan-Do-Study-Act (PDSA) cycles, an iterative methodology was proposed. The outcome measure proposed was number of “to-go” medications administered; secondary measures included number of opioid “to-go” and benzodiazepine “to-go“prescriptions. Balancing measures were the number of narcotic prescriptions written. Physician prescribing practice and nursing practice were reviewed at meetings and huddles. Individualized reports were provided to physicians for self-review. Data was collated at baseline then reviewed quarterly at meetings and huddles. Run charts were utilized along with raw data and individualized reports. Results: At baseline (January 2015), the number of “to-go” medications was 708. Over the next year, this value reduced to 459, showing a 35% reduction in “to-go”. Two years later (June 2017), this had reduced to 142, resulting in an overall reduction of 80% “to-go” medications. Secondary measures are currently under analysis. Further, no increase in prescribing of narcotics was seen during this time period. Conclusion: The administration of “to-go” medications from the emergency department has significant individual and societal impact. Frequently, these medications are diverted; meaning, sold for profit on the black market. Further, opioid prescribing is under increased scrutiny as the linkage between opioid prescriptions and addiction / dependency becomes more evident. This quality improvement initiative was successful for a number of reasons. First, we had strong engagement from the full emergency department clinical teams. The issue was first identified collaboratively, and teamwork and participation was strong from the outset. Second, we used individual and aggregate data to provide feedback on a regular basis. Third, we had strong support from our executive sponsor(s) who were able to support the efforts and champion and present the results locally, and now, throughout the Health Region.

Using the Heart Foundation Heart Failure Toolkit to Design a Model of Care for Patients Admitted with Heart Failure

Introduction: New Zealand’s population is growing, ageing and living longer with ensuing increases in chronic disease. At the same time, the healthcare system is under increasing financial and workforce pressure due to the pattern of demand. Sustainable intervention and new models of care are needed to meet and manage this demand and improve efficiency and effectiveness. This project is a government funded, year-long demonstration of a new model of integrated and patient-centred care that is delivered in primary care settings which supports and empowers patients with chronic disease to successfully manage their conditions.Project description: An integrated model based on care planning where health goals are set in partnership with patient and clinician is being demonstrated in two general practices with different geographical locations, patient populations and business models. A shared information technology platform and access to multidisciplinary input is designed to enable coordinated management while flexible funding allows individualised interventions and more effective and patient-centred care. Emphasis has been placed on the change management processes and business modelling required to sustainably implement the model with transferrable lessons captured to inform the roll out of future initiatives.Key findings: The shift from a traditional business model to an integrated and patient-centred care model requires considerable change support. It has been more successful with active and visible ‘executive’ sponsorship from within the practice, along with a dedicated change management coach. The model works best when implemented as a whole practice approach. It requires clear and effective internal communication and on-going training for all roles.Quality care planning that incorporates psycho-social needs alongside the traditional medical focus and coordination of appropriate services is contributing to valuable patient outcomes. These include better engagement and patient experience, medication adherence, preliminary reductions HbA1c levels and continuity of care, among other benefits.Highlights: Improved patient outcomes and stories are evident, for example; HbA1c reductions through ascertaining barriers to healthy eating (e.g. lack of an oven at home), or phobia of needles causing the patient to not want to take insulin.The pace of change that can be achieved when you have an executive sponsor who can commit resources and get the practice team involved, on-board and engaged has been a highlight.Conclusion: The approach is demonstrating improved patient outcomes. Implementation of a model of this scope requires investment in change management as well as consideration of the financial and time impacts on privately owned general practices; and has been specifically implemented in order to achieve sustainability and transferability.

This study is conducted in companies of Lilama. The results of this study are top management support refers to the executive sponsor (1) invest sufficient time, effort and resources to the project; (2) have a realistic understanding of the capabilities and limitation of the systems; (3) legitimize new goal and objective and ask questions before the project implemented ; (4) establish and approve new organizational structures, roles, policies and responsibilities; (5) monitor project process constantly; and (6) in times of conflict, managers should mediate between parties. The importance of the top management support is agreed by all researchers. The IT literature has clearly documented that for IT projects to succeed top management support is critical. It is said that top managers’ understanding of the systems and IT is highly related to the quality of the top management support factors. The success of a project completely hinges on the strong, sustained commitment of top management. It is the first condition of any success ERP project. No support from the top managers, everything is hard to do.

BackgroundIn the growing field of implementation science, sustainability is a critical component of the implementation process of moving evidence-based treatments to regular practice. This paper is intended to extend our understanding of factors that influence the sustainability of HIV services in correctional settings following an organization-level intervention designed to implement improvements in preventing, detecting, or treating HIV for persons under correctional supervision.MethodsUsing semi-structured interviews to elicit perceptions from the principal researcher and executive sponsor at each of nine participating sites, this study explores the variations in the sustainability of HIV services in these criminal justice settings following the experimental implementation intervention.ResultsIn six of the nine sites, changes in HIV services implemented as a result of the organizational intervention were sustained six to nine months following the end of project implementation. Organizational endorsement at multiple levels is likely the principal factor that facilitates sustainability.ConclusionsThe factors that result in the sustainability of changes to health services in correctional organizations include elements internal and external to the organization. Implementation strategies, such as the change team model strategy used in this study, are also sustainable and can be used to identify other changes that could be made, or improve other aspects of service delivery.

Purpose – To highlight that one of the main causes of transformation failure relates to project governance, which is the primary responsibility of an Executive Sponsor. Design/methodology/approach – The methodology was based on a combination of literature review and experience. Findings – All too often, once a transformation project is underway, the Executive Sponsor passes the reins to the project manager and takes a back seat, with their involvement confined to Steering Group meetings or when problems are brought to their attention. This can be a very costly mistake, as weak governance is a common contributor to transformation project failure. Achieving good governance requires the Executive Sponsor, like the Project Manager, to have the right combination of “art” and “science” skills, though their roles as well as the relative balance of art and science involved in these will differ. Originality/value – The briefing saves busy executives and researchers hours of reading time by selecting only the very best, most pertinent information and presenting it in a condensed and easy-to-digest format.

The role of the executive sponsor in achieving project success is important, yet rarely addressed. Recent research identifies behaviors that constitute the role of the executive project sponsor and evaluates how such behavior affects project success during different project stages. This study answers two research questions: (1) Does the relative importance of executive sponsor behavior vary significantly at different project stages? And (2) Does the relative importance of project success dimensions vary significantly within and across the different stages of completion? Results provide knowledge that will help executive sponsors decide how to invest their limited time and resources.

Background:Organizations that value their employees and appreciate their contributions strive to create a supportive work environment. Leaders can demonstrate care and support for staff by offering a stress-management program. However, program implementation can be challenging. Leadership endorsement, funding, program development, and assimilation within the organizational culture are important elements. Demonstrating value is critical to success, and even the most effective programs may not provide leaders with the results they anticipated. What gets in the way?Methods:This presentation provides a retrospective review of situations within Mayo Clinic that propelled its trainers to navigate the waters of uncertainty and rise above adversity. From a leadership perspective, a successful program requires ongoing intentional focus and promotion, not an easy task when resources are at a premium and organizational priorities are constantly vying for attention. When the trainers faced the prospect of program demise due to the loss of an executive sponsor and three of the four original trainers, the remaining members were at a crossroads. Rather than surrender to the lack of a well-defined champion, trainers decided to continue the legacy of sharing the gift of the Transforming Stress program with colleagues. Through the application of HeartMath coherence-building and -sustaining techniques, the remaining trainers listened to their own heart wisdom and found that each trainer possessed a unique skill set to contribute to the group. The information received during several group Heart Lock-In's guided the training team to collaboratively explore new ways of thinking.Results:A fluid marketing plan includes methods of informing employees about the program, focusing on evidence-based benefits and motivating them to participate. At Mayo Clinic, it is crucial for training programs to create incentives and opportunities for employees to attend stress-management workshops. Trainers rearranged their training schedules, offered evening classes, developed a web and email presence, and created a variety of marketing tools that were highly effective. Individual class registration improved and entire departments (intact teams) were requesting workshops. Similarly, the weeks and months immediately after the workshop, during which the employee is introduced to new techniques and tools, are critical. Answering their questions in real time via email or in person and keeping them engaged in the application of these emotional refocusing techniques were highly valued by individuals and groups alike. These efforts contributed significantly to the ongoing success and evolution of our program.Conclusion:By the end of the presentation, attendees learned how to identify potential challenges associated with program maintenance and expansion; describe coherence-building strategies for trainers, individuals, and teams; and conceptualize internal marketing approaches and practical applications to grow and sustain a resilient program within an organization. As part of a robust employee benefits package, the perception of a caring work environment may lead to reduced staff turnover, feelings of joy and fulfillment among staff, and increased organizational loyalty, as well as serve as a competitive recruitment tool.

Introduction/Background Rapid changes are imminent in healthcare because of the Affordable Care Act. Healthcare organizations will be rewarded for achieving specific targets for the delivery of healthcare services. Therefore, it is imperative for healthcare organizations to be poised to respond in order to remain financially viable-“no money no mission.” Evidence based research documents the critical role healthcare leaders will play in achieving the Pay for Performance (value based purchasing), HCAHPS and other standards. The evidence further documents that leadership rounding is a ‘best practice’ that positively impacts patient satisfaction scores and employee engagement…as go the leaders go the organizations! Research also links the impact of employee engagement with higher patient satisfaction scores, higher quality of care and increased revenue. Methods The Western Pennsylvania Hospital (WPH), part of the Allegheny Health Network, implemented a leadership rounding initiative in January 2013. With Duke Rupert, President/CEO as the executive sponsor, all WPH leaders were expected to attend the training sessions and then participate in leadership rounding. His goals were to implement “best practices,” continue to strengthen the Values-based culture, improve communication, achieve superior clinical outcomes, provide exquisite customer service and achieve the HCAHPS and other standards. To plan and implement innovative and interactive education for the leadership rounding initiative, the Corporate Organizational Development/Talent Management (OD/TM) Team partnered with the STAR Center Team. All WPH leaders including the C-Suite attended a four hour educational session, replete with didactic content, videos and ‘hands on" practice where leaders were filmed with a follow-up debrief of their own scenarios. The debrief enabled the leaders to identify their own opportunities for improvement. Results: Conclusion The four Kirkpatrick levels of evaluation are being implemented in this project. Level I-satisfaction feedback indicated that leaders were receptive to the information and believed the education was valuable. The leaders (n = 62) were asked to complete course evaluations to measure how satisfied/dissatisfied they were with their training. Five items asked about the simulations and the leaders rated how much they agreed/disagreed with the items using seven-point Likert scales where one represented “strongly disagree” and seven represented “strongly agree.” Each of these items had measures of central tendency at or very close to seven, indicating very high levels of satisfaction. See Table 1.The scenario debriefs indicated that Level II - learning did occur. Level III evaluation - behavior change on the job and Level IV - impact will measure the Results of the following process: leaders were assigned to round in various departments, equipped with scripted messages for both patients and staff. Specific questions and logs were developed in order to obtain information and report feedback. Because the data gathering has just begun, it is premature to provide statistical proof of behavior change and/or impact. Monitoring will continue, Results reviewed and changes/enhancements made in order to improve the outcomes. All 21st century healthcare organizations have similar challenges in clinical quality, customer service and process improvement. This innovative educational methodology to prepare leaders for those challenges can be easily replicated at other institutions. Disclosures None.

This paper discusses the dilemma that upper management has during the cycle of purchase for technology base products. The executive must sort through the executive sponsor’s rationale and attempt to rely upon their unstructured personal assessment. The authors present a methodology that is based upon a plan of reasoning and assessment called “process innovation.” They maintain that the executive decision makers will rely upon this new methodology to improve their judgment by diffusing the overall purchase process with sound reasoning that leads to good judgment.