Ten-Week Promise, Unsigned Charter
Northvale Health Network (three hospitals, 40 clinics) approved a self-service check-in kiosk. The COO is the executive sponsor and has publicly promised go-live in 10 weeks to support a payer contract. A two-page charter exists but was never signed; it names "improve patient experience" as the goal and includes no metrics. Legal has not reviewed the consent and PHI screens. No clinical staff were consulted. IT says single sign-on with the legacy scheduling system is "unknown, maybe six weeks." A kiosk hardware contract is signed with a six-week lead time. The PM has started booking design meetings and two developers are already building screens. At the weekly review the COO asks for a green status.
1. The COO wants "green." What should the PM do this week about status and about the charter?
Read the worked answer
Do not report green, and do not let the charter stay unsigned.
Status. Green would assert that scope, schedule, and risk are understood. They are not: an unsigned charter, an unquantified six-week dependency, an unreviewed legal exposure, and hardware already on order. Report amber with explicit conditions: "On track for a 10-week pilot at one site only if Legal returns PHI/consent review by week 3 and SSO is confirmed feasible by week 2. Neither is confirmed today." Status is a forecast with reasons and asks, not a mood.
Charter. Get a signed version this week. It must include:
- Business case and measurable goal - e.g. "reduce average check-in time from 6 to 3 minutes at Site 1 by Q3," not "improve experience."
- Scope boundaries - which sites, which check-in functions, what is explicitly out (e.g. insurance verification).
- Success criteria, milestones, budget, key resources, constraints and top risks.
- Named decision-maker and escalation path.
The charter is what converts the COO's verbal promise into an agreed definition of done that the PM can be held to - and what protects the project when the promise meets reality.
2. Who are the missing stakeholders, and what engagement approach do you recommend for the most difficult ones?
Read the worked answer
Missing from the room: front-desk and registration staff, nursing/clinical leadership, Legal/Privacy Officer, IT security, a patient representative, and the payer's implementation contact.
Power/interest placement and actions
| Stakeholder | Power | Interest | Approach |
|---|---|---|---|
| COO (sponsor) | High | High | Manage closely - weekly 1:1, options not problems, signed charter |
| Legal/Privacy | High | Low | Keep satisfied - one clear ask with a deadline; make review easy, not optional |
| Front-desk staff | Low | High | Keep informed and involved - they can sink adoption; include in design sessions |
| Nursing leadership | Medium | High | Consult early - surface the fear that kiosks reduce staff or shift work |
| IT security/SSO team | High | Low–Med | Keep satisfied - schedule the feasibility spike, get a written estimate |
| Patients | Low | Medium | Monitor - small usability test with 5–8 real patients |
The difficult one is front-desk staff, who are low-power but high-interest and likely resistant because the change touches their daily work and job security. Classify them as resistant but influential on adoption, not as an afterthought: meet them in a working session, let them shape the screen flow, and give them a named role in the pilot. Adoption risk is rarely solved at the sponsor level.
3. The COO refuses to move the date. How should the PM handle an unrealistic commitment?
Read the worked answer
Treat the date as a fixed constraint and move something else - but only with the sponsor's explicit choice on record.
- Quantify the gap. Turn the unknowns into ranges: SSO "maybe six weeks" becomes a two-week spike that ends in a go/no-go; Legal review becomes a 3-week dependency with a start date. If the honest forecast is 14 weeks, say 14 weeks with the evidence, not 10 weeks with hope.
- Present options, not a refusal. Offer three packages: (a) 10 weeks, pilot scope only - one site, existing appointments, current consent flow, manual SSO; (b) 12 weeks, pilot plus one integration; (c) 14 weeks, original scope. Let the COO pick; record the decision and the accepted risk in the decision log.
- Protect what can still be protected. Start the six-week hardware order now, commission Legal immediately, and run the feasibility spike in parallel - parallelizing genuinely independent work is legitimate fast-tracking, provided the PM tracks that it raises rework risk.
- Re-baseline the plan if the scope or date changes, and tell stakeholders what changed and why.
What the PM must not do is absorb the gap silently and report green. That converts a sponsor's optimism into the PM's credibility problem in week 9.