Healthcare IT and PMO leaders are under more pressure than ever. Digital transformation, EHR optimizations, cloud migrations, cybersecurity work, and operational initiatives all compete for the same limited resources. And when priorities get murky and timelines slip, teams get burned out spending effort on projects that never seem to get done or generate real value.
To help healthcare leaders cut through the chaos, we sat down with Larry Green, Principal Advisory Consultant & Executive PMO Strategist at Optimum Healthcare IT, to answer the questions we hear most from PMO leaders across the country, and to break down what strong, modern PMOs are doing differently.
How can PMOs stop taking on everything and start prioritizing the right work?
A:
One of the biggest problems I see is PMOs trying to manage everything that comes their way. When you don’t have a structured intake process, the loudest or most persistent voices end up setting the agenda, rather than an approach that prioritizes value and strategy. That’s how you wind up with teams overloaded, trying to deliver hundreds of projects that aren’t tied to organizational goals.
What PMOs really need is a clear, consistent framework for evaluating work. Every request should be filtered through the same lens: Does it align with organizational strategy? What risk does it mitigate? What resources are required? And do we realistically have that capacity? When you introduce governance and a scoring model, it becomes much easier to say “yes” to the right projects and “not right now” to everything else. Strong PMOs also use multi‑layered governance, with smaller requests reviewed at the department level, and high‑impact initiatives escalated to executive governance. That structure makes it easier to say ‘no’ transparently, so teams understand why certain projects move forward and others wait. I’ve seen organizations cut their portfolios by 80% once they finally put that structure in place, and their teams were instantly more effective.
“Don’t just manage the work you’re handed — create the structure that ensures only the right work gets in the door.”
How do you get a true picture of resource capacity so you can staff projects realistically?
A:
Most project delays aren’t caused by poor execution; they’re caused by poor staffing decisions made before the project even begins. You can’t match people to work unless you genuinely understand who’s available, who’s overextended, and what skills you actually have on your team.
I always recommend starting with a skills inventory. Document what people are good at, their secondary skills, clinical expertise, system expertise — all of it. Once you have that, you can make smarter decisions about who supports which projects. It reduces burnout, improves delivery timelines, and prevents the last-minute scramble to “find someone” that happens far too often in healthcare. It’s equally important to engage subject matter experts early and use tiered resource planning. Not every project needs the same level of expertise, and matching resources to project complexity prevents overcommitting scarce clinical or IT talent.
“Don’t just track hours — track skills, capacity, and engagement.”
What if a PMO doesn’t have the tools or data to understand capacity today?
A:
If you don’t have a sophisticated system in place yet, start simple. Even a basic spreadsheet that lists people, skills, and rough allocation percentages is better than guessing. The goal is to create visibility; you can refine the tools later.
Ultimately, though, you’ll reach a point where manual tracking isn’t sustainable. That’s where tools like ServiceNow Strategic Portfolio Management (SPM) come in. Features like resource heat maps, scenario modeling, and real-time utilization give you the ability to see capacity clearly and make informed decisions before you commit to work. Without that kind of transparency, you and your team are flying blind.
What causes projects to stall, and how do you prevent that from happening?
A:
Projects stall when no one owns the outcome. It’s that simple. You can have great project managers and strong teams, but if there isn’t a clearly accountable leader, someone at the director level or above, the project may get stuck waiting for decisions that never come.
Every project needs one accountable person and one escalation path. If a project spans multiple departments, that escalation path usually includes a governance committee that can make cross-functional decisions quickly and when accountable leaders aren’t available, the escalation path should be explicit: re‑engage, adjust timelines, escalate further, or pause until support is secured. I tell PMOs all the time: If the accountable leader isn’t engaged or available, stop the project. Don’t let teams spend months working on something that’s drifting or not delivering value.
“Assign accountable leaders, establish governance, and empower the PMO — that’s how you prevent stalled projects.”
How much standardization should PMOs have around tools and processes? Where’s the line between helpful and rigid?
A:
Standardization is essential for consistency, but it doesn’t mean everything has to look exactly the same. The key is to standardize the foundation: charters, RACIs, intake forms, project plans, and status reporting. Once that baseline is consistent, teams can customize the details based on the type of work they’re doing.
The same philosophy applies to methodology. Use the right tool for the job. If you’re implementing an ERP or infrastructure upgrade, waterfall probably makes sense. If you’re rolling out digital tools or building software, agile or hybrid is usually the better fit. What matters most is that people can navigate the process without confusion or reinvention every time.
“The goal isn’t rigidity — it’s consistency. When everyone speaks the same project language, you reduce confusion and make prioritization easier.”
How can PMOs give executives the visibility they need to make smart decisions?
A:
Executives don’t just need data, they need context. They need to know what’s at risk, which decisions are pending, where bottlenecks exist, and how capacity is affected across the organization. Portfolio dashboards are essential for that. When leaders can see project health, risk status, timelines, and interdependencies at a glance, they’re able to step in early instead of reacting when it’s too late.
A strong PMO doesn’t just report what’s happening; it uses that information to steer the organization. If a project isn’t delivering the expected value or is consistently blocked, the PMO should be empowered to pause, reprioritize, or even sunset the work. Visibility isn’t just about transparency; it’s about making smarter decisions that protect capacity and improve outcomes. A simple decision framework helps leaders act on the data: slow projects that are at risk, stop those that no longer deliver value, and accelerate initiatives showing strong impact.
“Don’t just report on history — build a system where data, leadership, and governance work together in real time.”
Looking for More Free Healthcare PMO Advice?
If you’re curious about how to strengthen your healthcare PMO strategy or processes, or want to learn more about the tools available to streamline work and produce greater value, Larry Green, Principal Advisory Consultant & Executive PMO Strategist at Optimum Healthcare IT would be happy to walk you through some options.
Set up a complimentary advisory session with Larry to explore your PMO environment in more detail and discover best practices.
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