Using the “Pre-Mortem” Process for Success in Implementations

Insights 01
Jan 20, 2016

Using the “Pre-Mortem” Process for Success in Implementations

Written by Impact Advisors

Category: EHR

Anyone who has been in IT for some time has experienced a failure, outage, or error resulting in the need for a “post-mortem” review to ascertain the cause or events leading to the problem. If the process is followed through to conclusion, processes or alerts can be put in place to minimize the chance of the problem recurring. The concern with this approach is that the problem must have actually occurred to initiate the “post-mortem.”

During a large healthcare IT project, critical issues at the time of go-live can influence the success of change adoption at a minimum or cause patient harm at worst. For these reasons, proactively preventing the major issues is important.

Thorough testing, auditing, documentation and training certainly help mitigate problems and identify project risks, but our teams are only as good as the lens they are looking through. Using a process called the “pre-mortem” can shift that lens and give a fresh look at project risks and issues before they occur.

Gary Klein, cognitive psychologist, shared his process for a “pre-mortem” back in 2007 by using prospective hindsight to improve the predictions of future events. It sounds a bit supernatural; but rest assured, it’s not ESP or magic. It’s a simple trick of the brain, a shift in perspective of looking at the same project. Instead of identifying what might fail, the assumption presented is that the project did fail. Your team is then tasked with identifying why it failed. This is a small difference, but it is key in discovery of new or major risks. The difference is that team members are not pressured into minimizing or turning a blind eye to risks. They are not put in a situation of showing their weaknesses. Instead, they are valued problem solvers. Because the project has theoretically already failed, there is no pressure to push forward and ignore risks.

The exercise is simple and can be completed in an hour for even large projects. In order to facilitate a successful “pre-mortem,” you must:

  • Gather your subject matter experts or project leaders together.
  • Describe in detail that you are now at some future point in time where the project failed and explain the clear consequences of the failure. Be explicit and paint the bleak future.
  • Use blank paper and give each team member two minutes to document why the project failed. This can be done either anonymously or with names – use your judgment on team dynamics and trust.
  • With a quick tally and review, have a meaningful discussion of the largest risks or new risks presented by the team and set up task forces to follow-up and mitigate the risks.
  • Follow up, mitigate, document your new project risks and provide visibility through communication both to the project team as well as your operational customers.

The “pre-mortem” is a proactive look at failure that takes a minimal amount of resource time and could save you from project failures – why not add it to your project arsenal and give it a try in your next project?