The Challenge
A large regional health centre had accumulated more than 600 active initiatives across its departments. Every project had a sponsor who believed it was critical. Resources were stretched across all of them, yet meaningful progress was rare. Teams were overwhelmed, accountability was unclear, and there was no reliable way for leadership to know where time, money, and effort were actually going.
The sheer volume of competing priorities had created a culture of initiative fatigue. People were working hard but achieving little. The organization needed to stop doing many things poorly and start doing the right things well.
The Approach
A structured prioritization process was designed to bring order and strategic alignment to the portfolio:
- Leadership workshops identified vital few strategic objectives and translated them into a hospital-wide report card with clear big-dot metrics
- The report card was cascaded to every department, where teams used the Balanced Scorecard approach to create aligned performance scorecards
- Physicians participated in dedicated sessions to identify priorities across primary care, medicine, surgery, mental health, and emergency services
- Weighted prioritization filters enabled all projects to be scored and integrated into a single rationalized portfolio
- A visual strategy room was established for initiatives exceeding four weeks, while frontline teams managed shorter projects through huddle boards
- Senior leaders reviewed progress quarterly and managers monitored departmental performance through daily and weekly scorecard huddles
The Outcome
The active project portfolio was reduced from more than 600 initiatives to 45 high-value, strategically aligned projects. Clarity was restored, resource allocation improved, and leaders regained confidence in the organization's ability to execute.
Visual performance management became standard practice across clinical and non-clinical programs, and the culture shifted from reactive busyness to disciplined, intentional execution.