By Margie Kennedy, PhD, RN, CPHIMS-CA, Prosci, PMP, P2P, ITIL, CNIO & Managing Partner, Clinical Informatics Practice, Gevity Consulting Inc. and Valerie Lukac, BSc, MPH, MBA, PMP, CPHIMS, CSSBB, Prosci, Associate Managing Partner, Health System Optimization Practice Lead, Gevity Consulting Inc.
The Executive Sponsor, sometimes called the project sponsor or senior responsible owner, is a critical role in both project management and change management, and is key to leading and enabling successful outcomes. Most of the literature about project and change management suggests that having a C-level sponsor is a key requirement for success. There are several reasons for this role prominence: the sponsor ensures that the project goals are aligned with overall company strategy, garners support (and overcomes resistance) from other senior executives, and provides ongoing direction as the initiative unfolds.
Prosci change management research and best practices consistently confirm that the key contributor to the success of a change initiative is an “identified active and visible executive sponsor”. Moreover, Prosci reports that executive sponsorship has been rated as number one on the list of success factors since the late 1990s and is prioritized over the next contributing factor by a 3:1 margin.
Top 5 Executive Sponsor Success Factors
- Share enterprise strategy
- Connect the dots between strategy and execution
- Set organizational priorities
- Establish the right mix of project portfolio investment
- Rally support from executive leadership peers
The executive sponsor has several specific obligations and responsibilities to lead the team to project success. He/she is the enabler to optimal delivery by acting as a champion to clinical, financial and other business leaders as well as the key to project team escalations and driver to manage change. The executive sponsor is also often responsible to the business for the ultimate success of the project.
In times of change, Prosci research refers to 3 key roles for the executive sponsors to ensure success of the initiative:
- Participate visibly throughout the project with a sustained presence
- Communicate support and promote change including the rationale and value proposition
- Build a coalition of sponsorship, mobilizing both stakeholders and leaders to legitimize the change initiative
Prosci3 also reports that the vast majority of executive sponsors report being willing or outright enthusiastic about serving in this pivotal role. At the same time however, executive sponsors may lack a full understanding of their role and its inherent responsibilities, and would benefit from coaching and support. Change management specialists and project leaders can support sponsors and act as enablers to guide them towards a better understanding of their role, as well as enable them to succeed by identifying supporting individuals and structures within the various organizations affected (see Figure 1). They can also enable the sponsor to communicate often and effectively about the initiative by identifying stakeholders, their leaders and leveraging existing communication mechanisms.
Figure 1 Percent of projects that met or exceeded objectives based on sponsor effectiveness. (Prosci, 2018)
Leading Through Dynamic Change
Healthcare is always in a state of change and evolution, and the progression of digital health has accelerated this phenomenon. The drivers of shifting population demographics, escalating morbidity burdens, evolving models of care, progressive digital innovation and disruptive technologies, and fiscal demands converge to foster dynamic environments balancing complex, interdependent change initiatives.
Executive sponsors must be diligently engaged in order to optimize outcomes in the challenging contemporary healthcare environment. Our current healthcare landscape presents three major threats to the success of the executive sponsors:
- Organizational consolidation fostering the creation of super-hospitals and multi-site healthcare delivery, meaning that staff / resources are operationally distributed
- The heightened complexity, pace of change in healthcare technology and processes as well as care delivery, resourcing, and patient mix/load create silos of projects with multiple sponsors intersecting or one sponsor managing a large portfolio of various initiatives simultaneously
- Change fatigue is significant and real within our health facilities. This is due to single versus multiple / parallel change implementations (regardless of whether it is digital health or not); the scope and impact of change; and patient care / provider schedules which are more compressed/intensive due to funding, resourcing, fatigue, etc.
Leadership models and accountability
Given the extent of competing demands and volume of change in the healthcare environment, it can be tempting for executive sponsors seeking to optimize sponsorship to consider delegation or dissemination of responsibility. Many executive sponsors would view this as building coalitions of sponsorship, however while there are obvious advantages to strengthening broad sponsorship, concurrent strategic and functional risks exist that may undermine effective executive sponsorship.
Delegated sponsorship distributes assigned activities within the executive sponsor scope to additional credible leaders across the organization or project network. This may enable departments or facilities to progress at their own pace, allowing champion organizations or those in high readiness to adopt the initiative and successfully forge ahead. However, this essentially dissipates accountability for the activities and may inadvertently create a laggard situation with some departments or facilities lacking a local champion to foster progress. Functional risks in delegation also include potential communication barriers, elevated coordination demands, information not being shared within hierarchical structures, and duality in the project timelines. It may also act as a barrier to fulfilling the wider goal if resources lack capacity or influence to act upon the delegated actions.
Dissemination of the executive sponsor role occurs by creating co-executive sponsors and adding senior clinical leads/others as executive sponsors. This approach expands the breadth of shared accountability and inclusive ownership for the successful project. Benefits include having resources that are influential both through the positional authority as well as domain expertise to advocate for change and contribute to the project momentum. However, risks emerge around diffuse accountability, conflicting or fragmented communications, and sluggish progress secondary to ineffective leadership coordination. While building sponsorship coalitions are highly desirable, the loss of clear executive sponsor identification and accountability is fraught with risk and negative consequences.
The nature of strong executive sponsorship demands that a single individual is accountable for the executive sponsor role. While sponsorship in general can be broad based and inclusive, delegation and dissemination of the executive sponsor role can equate with a “disappearing sponsor” who is present at launch events and then becomes essentially absent from any meaningful ongoing engagement. Executive sponsors must ensure that they remain actively and significantly engaged after the launch phase and avoid becoming mere figureheads4,.
Challenging situations can arise when executive sponsor inherits existing projects, for which they do not have full oversight or belief in the end goal. In that case, it is important to consider expanding sponsor leadership by building coalitions or realize that stepping away or declining the sponsor role may a more successful outcome for both the sponsor and the project. Inherently, to be a successful sponsor and advocate, one must believe and be aligned with the endeavor they are sponsoring.
Having an executive-level sponsor is recognized as being crucial for shepherding major projects toward success, particularly those that cut across functions. It is imperative that executive sponsors understand the strategic nature and sustained responsibilities of the role, obtain coaching and support where required from change management experts, and accept accountability for project success.
It is insufficient to rely on either delegation or dissemination as viable pathways to foster and sustain change, particularly in challenging environments and complex initiatives. The executive sponsor must be visibly present and engaged, voicing a clear and committed leadership message for sustained change, and guide the individuals affected to success.
 Ashkenas, R. (May 18, 2015) How to be an effective executive sponsor. Harvard Business Review. Available: https://hbr.org/2015/05/how-to-be-an-effective-executive-sponsor
 Prosci (2018) Best practices in change management – 2018 Edition.
 Prosci (2016) Research on the role of Executive Sponsors. Available: https://cdn2.hubspot.net/hubfs/367443/2.downloads/thought-leadership/Executive-Importance-and-Role-TL.pdf
 Ashkenas, R. (May 30, 2014) You can’t delegate change management. Harvard Business Review. Available: