Organizations often recognize the need for a Program Management Office (PMO) during periods of instability. In most cases, executives recognize the need for greater oversight as projects are already progressing through planning, design, procurement, construction, and activation.
The leadership challenge becomes finding a way to enhance oversight by implementing a PMO without disrupting the projects already in need of additional support.
This article is the third in an ongoing series examining lessons learned while supporting a large academic health system through a complex capital program transition. Read below to learn how organizations can establish a Program Management Office while major capital projects remain active, strengthening governance without disrupting project delivery.
Organizational restructuring at a large academic health system surfaced a familiar problem: leadership recognized the need for stronger portfolio-level oversight at exactly the moment when doing anything about it was hardest. Major capital projects were already moving through design, procurement, construction, and activation, and the department responsible for delivering them was itself in the middle of being redesigned: new leadership roles being defined, staffing decisions still open, reporting lines not yet settled.
That timing mattered. A permanent oversight structure needs a stable organization to sit inside of: clear roles, defined reporting relationships, and leadership in place to own it. None of that existed yet, and building it properly, the way any thoughtful organizational transformation should be built, was going to take time. Rushing it risked creating a structure that didn’t match the organization it was eventually going to serve.
But active projects didn’t have the luxury of waiting. Every month without portfolio-level visibility was a month where risks accumulated unnoticed and issues sat without a clear owner. The challenge wasn’t choosing between speed and rigor: it was finding a way to get governance benefits immediately, without either rushing the permanent redesign or disrupting the projects already underway.
Rather than wait for a permanent Program Management Office to be designed and staffed, the client stood up a deliberately temporary structure, an interim program office supported by Keel, built to deliver governance value on day one, not after a lengthy transformation process concluded.
The distinction mattered. A permanent PMO is built to match a settled org chart; this one was built to function before that org chart existed, which meant it had to be lightweight enough to stand up quickly and flexible enough to hand off cleanly once permanent leadership and structure were in place.
It wasn’t a scaled-down version of the eventual PMO. It was a different kind of structure entirely, purpose-built as a bridge.
Its mandate was narrow and immediate: give leadership visibility into the full portfolio, create a clear channel for stalled decisions to reach an executive who could resolve them, and connect the stage-gate reviews and governance committee already being established to the day-to-day project teams still delivering active work. The office was led by a senior finance executive on temporary assignment, a deliberate choice, since financial visibility across the portfolio was one of the most immediate gaps leadership needed closed.
Rather than taking on project management functions itself, the interim office operated as an integration layer: surfacing risk, coordinating across departments, and feeding accurate information to the governance bodies making portfolio-level decisions. Because it existed specifically to close the gap while permanent governance was being designed, it also created space for that permanent design work to happen properly, without the pressure of an ungoverned portfolio forcing shortcuts.
Early results showed the interim structure was already producing measurable value. Within the first ninety days, the office had established a unified portfolio dashboard, identified three active projects with unresolved escalation items that had been circulating for more than sixty days, and convened the organization’s first portfolio-level risk review.
These milestones gave leadership visibility into the capital portfolio it hadn’t previously had and created a structured process for surfacing and resolving organizational risk. Throughout the engagement, the interim office improved predictability and accountability without disrupting active project delivery.
This experience demonstrated that an interim governance structure can create substantial value during periods of organizational uncertainty: improving predictability and accountability without waiting for, or disrupting, the permanent structure being designed alongside it.
It also challenges a common assumption: that a PMO’s value is limited to project execution support. Built correctly, it can serve as a governance and integration layer, aligning leadership, project teams, and departments across a complex capital program well before a permanent structure is in place.
Capital programs don’t need to wait for an ideal organizational structure before establishing governance: a well-scoped interim structure can deliver most of the benefit immediately, and hand off cleanly once the permanent one is ready.
