Project Management

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I would appreciate advice from others working in healthcare project management. I am currently the sole PM for a growing post-acute healthcare organization with 3,000 employees across multiple state

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Alan Roberts Senior Project Manager| Rocky Mountain Care Layton, Ut, United States

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Imran Afzal Author| The Strategic PMO Cary, NC, United States
Alan, your response to Syed came in while I was posting my earlier reply, so I wanted to add one additional thought.

Based on your comments, it sounds like you've already started building several PMO foundations. The bigger challenge may not be creating the processes, but getting leadership to consistently reinforce and use them.

One lesson I've learned is that executives rarely invest in a PMO because of methodology, templates, or governance. They invest when they can clearly see a business problem that needs solving.

If I were in your position, I'd start tracking and making visible a few simple metrics:

• Number of active projects
• New project requests per month
• Average projects per PM (currently 8-10 for you)
• Resource conflicts and competing priorities
• Projects delayed due to lack of prioritization or decision-making

The goal isn't to justify a PMO. The goal is to make demand, capacity, and organizational friction visible. Once leadership can see the gap between incoming demand and available delivery capacity, the conversation often shifts from "Why do we need a PMO?" to "How do we continue scaling without one?"

One question I'd be curious about: when a new project request arrives today, who has the authority to say "not now" or "what should we stop doing to make room for this?" In my experience, that's often where the real bottleneck exists.
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Alan Roberts Senior Project Manager| Rocky Mountain Care Layton, Ut, United States
Jun 11, 2026 12:24 AM
Replying to Imran Afzal
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Alan, I've been in a similar situation, although it was for a healthcare tech company.

My advice would be to resist the temptation to build a full PMO all at once. When you're the only PM supporting a growing organization, every hour spent creating governance is an hour not spent delivering projects.

Instead, focus on building a few foundational capabilities:

  1. A simple intake process. This doesn't need to be sophisticated. Start with a standard project request form that captures the business problem, expected outcome, sponsor, timeline, and estimated effort. The goal isn't bureaucracy—it's creating visibility into demand and preventing work from arriving through hallway conversations, emails, and Teams messages.
  2. A single portfolio view. Create one place where leadership can see every active initiative, status, major risks, key dependencies, and project health. Even a simple spreadsheet can work initially. When executives can see all work in one place, prioritization discussions become much easier.
  3. A lightweight governance cadence. Consider a monthly or biweekly portfolio review with key leaders. Focus on project approvals, prioritization decisions, resource conflicts, and escalations. One of the biggest challenges for solo PMs is being forced to absorb organizational prioritization decisions that should be made by leadership.
  4. Standard templates and repeatable processes. Create a basic charter, status report, RAID log, and project closeout template. Every hour you spend creating a reusable asset today saves hours of effort across future projects.
Once those pieces are in place, start tracking demand versus capacity. If leadership can see that one PM is supporting 8-10 concurrent cross-functional initiatives while new requests continue to arrive, the conversation about additional PM resources becomes much easier because it's supported by data rather than opinion.

One lesson I learned is that PMOs are rarely built through a large upfront effort. They usually emerge incrementally as solutions to recurring organizational problems. Solve the highest-friction problem first, then build from there.

Out of curiosity, who currently prioritizes projects across the organization? That's often the first place I look when trying to establish a scalable project delivery model.

Does the organization have any tooling in place that you can leverage today? For example, Smartsheet, Microsoft Project, Jira, Monday.com, ServiceNow, or even SharePoint? Sometimes it's easier to build lightweight processes on top of existing tools than introduce something new.

How are new projects currently initiated? Is there a formal request process, or do most projects originate through leadership conversations and emails?

Do you have executive sponsorship for building PMO capabilities, or is this something you're trying to establish organically while managing active projects?

Are you primarily managing technology projects, operational initiatives, acquisitions, regulatory/compliance efforts, or a mix of everything? The answer can significantly influence how I'd approach building the foundation.

When leadership asks for status across all active initiatives, how do you currently provide that visibility?

Do you feel your biggest constraint is lack of process, lack of visibility, lack of prioritization, or simply lack of capacity?
Imran,
Thank you for the insights. Based on your comments, I believe I have been moving in the right direction and have spent much of the past year working through many of those same initiatives. The biggest challenge has been balancing the development of governance, intake, and prioritization processes while also managing a continually growing portfolio of active projects.
Fortunately, I have supportive partners within our IT department who recognize the need for a more structured approach. One of our primary areas of focus recently has been creating a process that ensures new and existing projects are reviewed, prioritized, and evaluated against the current workloads of the teams involved before additional work is approved.
I have also been piloting an intake and screening process where sponsors complete a preliminary questionnaire to determine whether a request warrants a formal project submission. If it meets the threshold, it moves into a more detailed project request process that can then drive the development of a charter, resource review, and prioritization discussion.
The challenge now is continuing to refine and institutionalize these processes while maintaining momentum on the projects already in flight. Your feedback reinforces that these are the right areas to focus on, and I appreciate you taking the time to share your perspective.
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