Hired to deploy software. The real problem was elsewhere.
A $1B+, three-year EMR program that wasn't delivering. A state AG audit open. The brief: deploy Microsoft Project Server in 9 months. I spent the first two weeks not deploying it.
What needs to happen for the next hospital to go live?
The methodology — three moves
Diagnostic first. Co-built peer team second. A delivery system third. This is the arc that turned the program around.
Listen before building
Two weeks with the PMO, IT directors, clinical leads, vendors, and the people doing the work. Same question to everyone: where does it get stuck, and who knows the answer when it does?
- The PMO already had three untrusted tracking systems — a fourth would add complexity, not visibility
- Work stalled at the same decision points: change orders, unowned dependencies, unscheduled clinical input
- Internal Agile sympathizers were quietly succeeding — with no permission and no one talking to them
Build the team from inside
No imported coaching consultancy. A ~10-person core design team drawn from the PMO, IT delivery, clinical informatics, and the internal Agile sympathizers — including two prior skeptics, for their judgment and their endorsement.
- Four weeks co-designing the operating model — specific to this org, not a template
- ~300 impacted staff, all managed by their existing leaders who owned execution
- Re-scoped the engagement with the CIO, COO, and General Counsel in one room
Leave a system, not a doc
Not a process document — a load-bearing system. Each piece is easy alone; together they kept producing outcomes after the consultant left.
- A delivery cadence with explicit decision rights
- A training program run by the (now-credited) internal sympathizers
- Project Server as a low-friction reporting layer — not the operating model
- A weekly 30-min steering touch replacing monthly governance theater
What changed measurably
By month 12 from re-scope.
The working model survived me leaving. Two more hospitals went live in the following 18 months — the system kept producing measurable outcomes after the consultant was gone.
Three things that generalize
The stated problem is rarely the real problem
The visible symptom is what gets scoped — but it's not the cause. A diagnostic reframing, done early with the sponsor's buy-in, changes the trajectory.
The peer team is already in your organization
The internal sympathizers were the highest-leverage resource. Building the model around their existing efforts produced native ownership that could carry it forward.
A delivery system is what survives the consultant
Cadence, training, tooling, comms, and leadership rituals together are load-bearing. Built properly, the consultant's departure is a non-event.
Have a stuck program at CIO scale?
I run 3-month bounded engagements with healthcare payer and provider CIOs whose programs have stopped delivering — diagnostic first, co-built peer team second, delivery system third. $35–50K/month with land-and-expand if the first cycle works. CMS-0057-F, V28 audit defense, post-M&A integration, or any other shape.