By Shawna O’Neill, RN, MHA

In many organizations, implementation planning involves making work assignments and setting deadlines. While this is important, it usually isn’t enough to assure project success.

Projects are fraught with risks and obstacles. The project team can identify and assess the risks that could delay or derail a project. Determining the risks at the beginning of a project and identifying possible solutions will help to mitigate problems as implementation progresses. Risk management should identify and address:

• Knowledge and/or skill deficiencies
• Technical or platform barriers
• Non-supportive stakeholders
• Missed deadlines, “opts out,” or failure to take action
• Loss of critical people
• Unexpected changes that might affect the project (i.e., financial, volume)
• Competing organizational priorities
• Emerging organizational priorities

While proactive risk management is important for any significant project, it provides several benefits for projects involving physicians.

LEARNING EXPERIENCE

First, it is a learning experience for physicians. Many physicians view change as simple and have difficulties understanding why projects go awry. By engaging the project team in an analysis of risk, an appreciation of the complexity of the project becomes clearer. Furthermore, the project team (including physician members) understands what is expected of them to prevent problems.

The biggest risks are inadequate support and stakeholder resistance. These risks are addressed in part by a communication plan based on the stakeholder analysis. Since change is unsettling, communication needs to be clear, open, frequent and honest.

THREAT PERCEPTIONS

Acceptance of change is important to the success of any project. But different stakeholders have different assessments of the benefits and losses resulting from a change. When people perceive change as a threat, they resist adoption of the change. People are willing to implement changes if they see the change as a benefit to them. To promote change, leaders need to manage perceptions through clear communication. Honest communication builds trust and maximizes positive perceptions about the change.

IDENTIFICATION OF STAKEHOLDERS

To understand how to communicate with stakeholders, the project team should identify all stakeholders. A stakeholder is someone affected by the solution or someone needed to implement the solution. Stakeholder analysis should assess each stakeholder’s support of the project. A stakeholder either is:

• Strongly Supportive – someone who will make it happen – they will do what you ask enthusiastically and will help other stakeholders with their action items; they will try to help close the gap of resistance with other stakeholders
• Moderately Supportive – someone who will help it happen – they will competently do what is ask of them but nothing more
• Neutral – someone who will let it happen – they have not been convinced that the change is important enough for them to become involved
• Moderately Against – someone who passively complies – they will procrastinate unit you need to find someone to assist with the change
• Strongly Against – someone who does not want to participate in any action items – they will recruit others against your solutions

Some stakeholders may be less supportive than desired. This gap is operationally defined as probable resistance. Leaders need to develop communications plans to help resisters become more supportive of the plan. Support does not come by policy, but by dialogue.

Not every stakeholder needs to be strongly supportive, but when important stakeholders are less supportive than needed, leaders need to remedy the support problem or project success is at risk. When projects are at risk, obstruction or unsustainable short-term gains are likely.

BENEFIT FROM NEW PERSPECTIVES

By including physicians in stakeholder analysis, the project will benefit from new perspectives based on different relationships. Physicians have different relationships with other physicians than do nurses or administrators. They also have different relationships with patients. Physician participation can provide additional information that can improve stakeholder communication. Stakeholder analysis also can help physicians on the project team develop a better appreciation of how to communicate and persuade other members of the medical staff to support the proposed change.

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