Inheriting a BCMA Program at 60% Spend and 30% Live
You have just been named CIO of a three-hospital system, inheriting an enterprise bar-code medication administration program. It is 22 months into an approved 30-month schedule and 60% through its $9M budget. Only 30% of inpatient units have gone live. Nursing satisfaction scores have dropped 14 points since the first go-live; the hardware refresh slipped, so some units use six-year-old scanners. Nursing leadership at two hospitals has formally withdrawn support pending a fix. The vendor says scope was fixed at contract and that workflow change requests are out of scope. Simultaneously the CMO wants a new sepsis screening alert built within 90 days to support a quality initiative tied to a payer contract.
1. What do you do in the first 30 days?
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Assess before announcing. The most damaging first move would be publishing a new go-live date to relieve pressure.
Weeks 1–2:
- Independent status review: schedule, actual spend against remaining scope, unit-by-unit readiness, and whether the business case benefits are still real.
- Go to the units and watch a medication pass. The 14-point nursing drop plus aging scanners suggests a workflow and ergonomics story rather than a training story - but do not assume it. Watch first.
- Pull the data that tests the story: scan rates by unit, workaround patterns, override rates, help-desk tickets, and turnover on live units.
- Read the contract and the last several steering committee minutes to understand how decisions have actually been made.
Weeks 3–4:
- Rebuild governance with an accountable executive sponsor, a nursing co-chair, pharmacy, and the vendor, plus a published decision log.
- Get the two withdrawn nursing leadership groups back to the table with something concrete - a hardware replacement plan, a named liaison, and a defined fix list - not a promise.
- Bring a re-baselined plan with options to the executive committee: full scope on an extended schedule, or reduced scope on the original schedule, with a recommendation.
Keep the CMO informed throughout but make no sepsis commitments until you have seen the delivery capacity data.
2. How do you handle the vendor's fixed-scope position and the budget gap?
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Start by reclassifying the disputed items rather than accepting the label. A configuration choice, a workflow the product was sold to support, and a defect are not scope changes. Produce an itemized, written list with contract citations and stop negotiating in the abstract.
- Check the contract for acceptance criteria, the change-control process, service levels, and remedies. If change control was never followed by either party, that is leverage in both directions.
- Escalate peer to peer. Vendor executives to system executives, not project managers, with a specific ask: hardware support through the remaining units and a joint review of the disputed change requests.
- Separate money from safety. If the remaining budget cannot fund the remaining 70% of units, the honest options are extending the schedule with operating funding or reducing scope - and any scope reduction must come from non-clinical features, never from scanning reliability, training, or support coverage.
- Bring legal and procurement in early as partners in the strategy, not as a threat issued late.
A documented re-baseline with explicit trade-offs is a stronger position than either capitulating or litigating, and it is the version the board can actually approve.
3. The CMO wants the sepsis work in 90 days. How do you decide between that and the BCMA program?
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Treat it as a portfolio decision made by a governance body against stated criteria, not a favor swap between executives.
Criteria: patient-safety and payer/regulatory exposure, dependency on the unstable program, whether the same delivery team is required, and whether the change adds load to clinicians already absorbing a rollout.
Applying them:
- A sepsis screen is largely rules configuration plus order-set content and does not depend on BCMA finishing, so it can run on a small separate team if one exists.
- But it lands on nurses in the middle of a rollout they are already unhappy with, and a screen that fires on nearly everyone will be dismissed within a week - design for specificity before sensitivity.
- The payer contract makes the sepsis work genuinely time-bound in a way the BCMA schedule is not.
Recommendation: run a scoped sepsis build with a dedicated owner and a 90-day deliverable (screen, order set, and a measure), while freezing BCMA scope changes for the same 90 days to protect the stabilization work. Write the trade-off down and take it to the executive committee, naming both risks: the payer exposure if sepsis slips, and the nursing relationship if BCMA gets destabilized further.