By Laurence Smith, Greybeard Healthcare Co-Founder
May 2026
The US Air Corps is widely cited as the first organization to establish a specific unit with the name and function of a ‘project management office’ [1]. In 1939, responding to rising global tensions, Congress had authorized President Roosevelt’s administration to invest $300 million in the threefold expansion of the number of combat aircraft and associated weapon systems [2]. The purpose of the PMO was to coordinate this vital, complex programme to the required specifications and on an accelerated timeline.
As military readiness was a national priority for the United States ninety years ago, so has healthcare been identified today across the Gulf region. A paper presented at the UAE-based World Health Expo summarized the scale of the goal: “The healthcare sector is on the rise across the Gulf region, particularly in Saudi Arabia and the UAE, where plans to boost the industry to help diversify the economy away from oil and gas are continuing apace … across the entire MENA region, the healthcare market is forecast to grow from US$185.5 billion to US$243.6 billion (in a single year).” [3]
As these aspirations come to fruition, Greybeard Healthcare is honoured to have been invited to establish and run a number of PMOs for hospital groups across the Gulf region over the past four years. In this short article, we share four of the essentials we have observed during this period that ensure a PMO delivers results. They are: ambition, momentum, collaboration and data.
Ambition: “A clear vision of what a better future looks like”
As the US Air Corps case study demonstrates, PMOs are most valuable when the ambition is vast, the solutions are complex, and the urgency is mounting. Modest incremental changes to operating practices in a single hospital department can usually be accommodated through business-as-usual.
In addition, PMOs make the greatest impact when the hospital leadership has a clear vision of the destination. 23 years after the US Air Corps experience, a successor American president, John Fitzgerald Kennedy, raised his eyes even further skywards in setting a challenge to NASA’s scientists. Once again, he was not concerned with minor tweaks; and yet, despite the many unknowns, he was able to paint a picture of the future state as if it was right in front of him: “we shall send to the moon, 240,000 miles away from the control station in Houston, a giant rocket more than 300 feet tall, the length of this football field, made of new metal alloys, some of which have not yet been invented … and then return it safely to Earth.” [4]
In a hospital setting, PMOs can only be effective when the Board has an end-goal of comparable clarity. We have worked in situations where the unifying vision is technology innovation (to become a regional exemplar of A.I. and personalized genomics), consolidation (focusing on center-of-excellence capabilities and winding down services which are widely available elsewhere), cost efficiency (to ensure continuing commercial viability), new business models (treating patients in their homes and communities, rather than one vast bricks-and-mortar facility, wherever possible), and world class clinical outcome (embedding quality mindset and governance that goes far beyond regulatory requirements). The specifics of the vision can vary widely; what all these examples have in common is a lucid and precise articulation of what the Board is seeking to achieve.
Momentum: “Demonstrating impact from month one”
Even the most carefully established and well-resourced PMOs face obstacles which, left unaddressed, can prove terminal. Possibly the most pernicious is organizational scepticism and inertia. PMOs generally rely on goodwill and support from specialists throughout the wider hospital. If this is not forthcoming, for example because other tasks take precedence, the PMO can flounder, fail and fold.
For this reason, it is unwise for a PMO to hitch its entire credibility to a single distant milestone. Such an approach invites an inevitable sense of ennui and disenchantment when, after an initial surge of excitement, the months pass with nothing visible happening. Momentum is sacrificed and the symptoms of lost interest become visible: fewer people attend project meetings, functional leaders focus on their operational responsibilities, funding requests are rebuffed. Even President Kennedy, while securing the headlines with his commitment to land a man on the moon, also set out some shorter-term benefits from the undertaking – including transit satellites so that ships at sea could steer a safer course, and Tiros satellites to warn of hurricanes, storms, forest fires and icebergs.
A hospital PMO wins credibility for the long-term prize by showing that a return on investment is being generated from the beginning. Securing a ‘quick win’ by tackling an issue that, however modest, has languished unresolved for years, builds momentum towards later and more ambitious goals. Examples we have observed include speeding post-referral access to specialty services, revamping patient information, and adding functionality to patient apps. In each case, these achievements gave legitimacy for the PMO to accelerate its efforts to deliver other, higher-profile projects.
Collaboration: “Harnessing the knowledge and skills of the entire workforce”
In a typical hospital, 30% to 45% of the workforce is comprised of non-clinicians, including professionals in disciplines such as finance, human resources, information technology, marketing, administration and supply chain [5]. This presents the ever-present risk that silos can form and multiply, with the clinical and non-clinical sections of the workforce mistrusting (or actively undermining) one another. Of course, no hospital can operate to its fullest potential without expertise in all these fields; but, in a fragmented culture, the day-to-day practice sees teams undermine one another’s contribution.
Projects are an unparalleled opportunity to reset a culture in which suspicion and division have festered. By their nature, the vast majority of projects are multi-functional, and cannot be delivered without the participation of representatives from many departments and functions. In a recent PMO-led project to launch a hospital-at-home service, the project team was mobilized with representation from every specialist function identified in the preceding paragraph, who needed to work alongside physicians from primary care, specialty care, OR and quality.
In this example, as in many others, the project was launched on the basis that personal success was inextricably dependent upon team success. Regardless of the breadth and depth of their individual contribution, no individual would receive recognition (financial or otherwise) unless the entire team met its objectives. This single principle revolutionized the dynamics of project team meetings. Individual team members were no longer simply the representatives of their function; they also wore a ‘collective responsibility’ hat. Whenever an issue arose, the entire team would collaborate on its resolution, respecting the expertise that one another brought to bear in shaping a solution that would sustain. The finest Hollywood actor would have an empty trophy cabinet if numerous other professionals (from make-up artists to costume designers) fell short in their responsibilities.
Data: “Setting priorities based on evidence”
In any thriving hospital, there will be honorable differences of opinion among senior executives about critical issues and decisions to be taken. There is nothing inherently wrong with a range of views; on the contrary, it is generally a sign of an organization that is open-minded to fresh ideas and internal challenge.
As the fourth ‘essential’ of a strong PMO, I am highlighting its commitment to evidence-based decision-making. The PMO will lose its authority if it sides with one advocate in a live debate due, for example, to that person’s seniority or loudness of voice. Instead, the PMO should insist that priorities are set based on evidence. Sometimes, the PMO can help to assemble that evidence; on other occasions, it can conduct due diligence on the data to validate its authenticity, or act as the impartial arbiter of what it means. In all cases, it should use its independence from operational responsibility to ensure the evidence is obtained from the most irreproachable sources, is up-to-date, and is being faithfully represented. In most projects, there will be a multi-stage methodology; and in such cases, the first phase is often focused on evidence gathering, pulling together material from multiple sources – some may be publicly available, others may be from comparable hospital facilities and other operators willing to share data on a restricted basis for mutual benefit and in the public interest.
The pace of change in medicine is unrelenting. Every week, reports are circulated of clinical breakthroughs with wide-ranging repercussions. Practices which were taken for granted a decade ago can now be regarded as antiquated, and even dangerous. A PMO which observes John Adams adage that “Facts are stubborn things … our wishes, our inclinations, or the dictates of our passions cannot alter the state of facts and evidence” [6] is performing a valued service not just to the integrity of its own projects, but to the modernization of the wider hospital culture into one able to take rapid, informed decisions across its entire operation.
In closing
These ‘essentials’ have been selected because they have been observed across many types of transformation programs over many years. However, they are not exhaustive. Please return for future articles in this series, when other PMO essentials will be highlighted for discussion.
Notes.
- Giraudo, L., & Monaldi, E. (2015). PMO evolution: from the origin to the future. Paper presented at PMI® Global Congress 2015—EMEA, London, England. Newtown Square, PA: Project Management Institute (downloadable at: https://www.pmi.org/learning/library/pmo-evolution-9645#:~:text=Introduction,missile%20systems%20in%20the%201950s.)
- ‘Expansion of the Army Air Forces’: https://www.wingsofhonor.org/expansion-of-army-air-forces.html
- Olaf Jensen, ‘Healthcare in the Gulf goes from strength to strength’, 27 February 2023 (downloadable at: https://www.worldhealthexpo.com/insights/healthcare-trends/healthcare-in-the-gulf-goes-from-strength-to-strength)
- John F Kennedy, ‘We choose to go to the Moon’ (downloadable at: https://www.rice.edu/jfk-speech#:~:text=We%20choose%20to%20go%20to%20the%20moon%20in%20this%20decade,to%20postpone%2C%20and%20one%20which)
- https://www.oecd.org/en/publications/health-at-a-glance-2025_8f9e3f98-en/full-report/hospital-workers_b1673dc6.html
- John Adams, Argument in Defense of the British Soldiers in the Boston Massacre Trials, Dec. 4, 1770
